View Full Version : Medicare for All
FromMyColdDeadHand
03-05-19, 18:27
Isn't this a misnomer? We all pay into Medicare for decades before we start to draw benefits. Medicare also has some private insurance built into it, correct?
Isn't what they are really touting is 'Medicaid for All'? It comes out of general taxes and the govt pays for everything. They are going to get rid of all private insurance, so no co-insurance.
It's just single payer, Gov't controlled death panels...oops...I mean healthcare. Medicare for all is just the spin.
Medicare for all= Quality healthcare for none.
I am qualified for Medicare and received it for me at age 65. Without paying for all of the optional parts it is pretty much all but worthless. Basic Medicare is hospital insurance. Problem is if your stay isn't longer than 3 days it pays nothing. If you opt for all of the parts your cost will eat up most of your SS income. The sad truth is.... even with Medicare the health care system will bankrupt you with the government's consent! Medicare for all won't solve anything unless you have NO assets. People with no assets don't pay taxes.
BoringGuy45
03-05-19, 22:32
Considering the incredible amount that an individual pays for shitty coverage with extremely high deductibles, single payer coverage isn't, in and of itself, a bad idea...Ideally. However, it can't exist in this current system, because of the corruption of insurance companies, pharmaceutical companies, and healthcare providers. They already have a monopoly on the entire healthcare system, so they charge pretty much whatever they want. So the answer seems to be, why not just have the government pay for it as a public service? But all that would happen is that prices would get cranked up even more; it would eventually bankrupt the country. Something needs to be done about these companies who are playing with people's lives for profit before we can talk about reforming anything else.
Medicare for all= Quality healthcare for none.
Yep, it will be like the DMV of health care.
Medicare for All has almost nothing to do with Medicare. The biggest thing they have in common is that M4A would replace Medicare.
It works like this. M4A would replace all existing insurance and copayments. The government would set the price that it is willing to pay for services, devices and medications. Medical care would be provided by private providers except the Veteran's Administration and the Indian Health Service, which wouldn't change under most (all?) proposals.
So the government would get control of health care spending and ratchet it down to level that the US hasn't seen in decades. A typical estimate is a 40% reduction in health care spending.
The problems are:
1) Availability. We don't have the doctors or facilities to treat everyone if everyone could suddenly afford to go.
2) Cost. While the cost would fall we would sever the link between people who receive care and people who pay for it. Most proposals call for a mix of payroll, income and capital gains taxes to pay for care. This would replace your existing premiums and co-pays. In practice, the people that would be harmed by this are those poor enough for Medicaid and people making more than median income, who may pay more in taxes than their previous plans cost.
3) Additional Services. If you want to skip the line you'd have to pay cash for service. I'm told it is common in Canada where an MRI might take months unless you pay $400 CDN to see a private provider.
4) Freeloaders. Plenty of people would quit working if they didn't need to pay for health care.
Advantages:
1) Stability. There are no unexpected bills.
2) Decoupling from Employment. Forming a business would be much easier if you didn't have to worry about providing benefits. Especially a small business.
3) Cost. For about half of Americans this would immediately put more money in their pockets.
4) Administrative Costs. Your typical doctors office would pull in almost as much revenue but pay much less for office staff.
My take? I think we should look at a dual payer system that looks more like Medicare proper. Everyone gets a basic level of insurance, the poor get a (crappy) layer on top of that and you can buy your own insurance to get better care. That controls costs well in Australia.
I have a relative in Sweden. He had a bone spur in the heel of his foot. He was given pain meds for 14 months and then was able to have the surgery to remove it. Long waits are the norm with government provided healthcare. In the US, the surgery could have taken place in less than 30 days.
Are the long waits because of rationing? And who decides who gets what? And when you're really old, do you get thrown under the bus?
Averageman
03-06-19, 01:49
So when Grandma's operation is too expensive for Medicare to pay for, or four year old little Kimmy has to wait six months before she can start her treatments for her cancer, we've got a whole new reason for Civil War II.
I waiting for someone to tell me "If you like your Doctor you can keep him." Or "If you like your insurance, you can keep it."
Socialists want control, they want control of your life and your money.
FromMyColdDeadHand
03-06-19, 05:59
Thanks GH41 and SethB (and others).
GH41, I kind of knew that there was still cash out of pocket. I really think that may be achillies heal of this. When people find out that 'free' ain't free.
SethB- on the cost savings to docs offsetting lower payments for services- I think that is an idea, but probably won't happen. Sure coding fees for insurance companies is a pain, but that is clerical wages. Doc fees, drugs and tests are where the money is at. I hope you are right, I just think that is a wish, not a reality.
Wait till all those upper middle class progressives see what their tax rates have to do to cover this....
So really, what the left really wants is Medicaid for all. You don't have co-pays or co-insurance with that- and it pays for ibuprofen and everything.
I know people hate insurance companies, but a big one here in CO is going to go under because of Obama care and the mistakes they made in pricing and plans that they offered- and by that I mean too cheap and too many benefits (plus people joining and only paying for a few months till they get services and then 'dropping' out).
The only way any entity can keep medical costs down is to ration care. That’s already being done on a fairly broad scale in the US by all of the insurance companies, and certainly by Medicare/Medicaid and the VA, but in a single payer system...yeah...death panels or something equivalent are inevitable. Health care rationing is the only way to keep costs down while maintaining quality.
If/when “Medicare for All” becomes reality, be aware that in your declining years your “doctor” is going to actually be a nurse. There won’t be enough doctors.
Socialists want control, they want control of your life and your money.
Health costs in the US are at 18% of GDP. You’d better believe that the government wants control of that vast segment of the US economy. And you’d better believe that, eventually, they’re going to get it. The wheels for that are already in motion.
My nephew works for a large regional hospital. He said 60% of the people who walked through ER door last year were uninsured. Guess what that does to the cost of healthcare?? My first wife was a scrub nurse for a neurosurgeon. The cost of her GL policy was 6 figures per year and that was 35 years ago! You don't have to look far to find the reason why healthcare is expensive. Medicare for all might work if combined with tort reform.
The_War_Wagon
03-06-19, 07:54
I just wanna die in the age of socialized medicine - to see who resurrects me first. The Obamessiah... of the TRUE Messiah. :rolleyes:
MY money's on the latter...
Just the fact that gov't will, without smoke and mirrors, be providing free abortions, payed for by me and people who think like me, is more than enough for me to be totally against it.
My nephew works for a large regional hospital. He said 60% of the people who walked through ER door last year were uninsured. Guess what that does to the cost of healthcare?? My first wife was a scrub nurse for a neurosurgeon. The cost of her GL policy was 6 figures per year and that was 35 years ago! You don't have to look far to find the reason why healthcare is expensive. Medicare for all might work if combined with tort reform.
I am quoting you but also addressing this to most of the posts here.
I am an executive in a hospital based health plan that administrates Medicare, Medicaid, Tricare, and the ACA. I know about hospital costs and health insurance.
This that think that Medicare for All (M4A) is a good idea have never dad to use Medicare. As an insurance it is not good at all. If you do not have a Medicare supplement insurance when you turn 65 you are screwed.
GH41, for your part. That part about 60% of the people that walk into the ER are uninsured is crap. A lot of them do have insurance but don't want to have to pay the huge deductible for their cheap plans. The ACA took care of everyone having insurance. Now they are supposed to. Oh wait, M4A will take care of that....... NOPE, you still have to register for it..... and fay a fine if you are late.... and it can be terminated if you don't pay. So you will still not have insurance like a bunch of people that don't today.
You also have to understand that the ER is the most expensive form of visit a person can have. This is because of the stupid EMTALA Law (Emergency Medical Treatment And Labor Act) that requires treatment at the ER for all IF they take Medicare and Medicaid. So will all f the illegals get this new M4A? Because they use the ER are their person clinic, this is a fact as I have seen the reports from our ER visits. As for Tort reform, we have this in Texas, not much of a help. And we also DID NOT Expand Medicaid because we did not wan to pay for it.
M4A is simply Socialized medicine and Hmac is correct, it is a lot of money and the Dems that want to control it. Even if there is M4A there is still going to be insurance. If you want real healthcare you will have to have it. So you will be paying for both.
There is not advantages for M4A except for those that already have really crappy insurance. Someone mentioned Small Businesses, it will not help them at all. They will not have to pay for insurance directly but the tax increase will put many out of business. The same will go for the economy, it will take a huge hit as a great deal of this countries disposable income will now go to taxes to pay for this program. This will mean less money being spent and that is not a good thing for the overall economy.
There is a reason that healthcare cost so much in the US. It is because someone has to pay for all of the R&D for the rest of the world. In the past 30 years the US has been credits for vast majority of the medical and pharmaceutical advances. ( You can simply Google this because I am not going to post a huge Bibliography) The rest of the world reaps the benefits of this and they don't have the ability to conduct this type of research as the bases behind socialized medicine are counter intuitive to this process. Also the cost is so high because of the socialized programs that we currently have. The ACA has increased the risk and cost to providers that take that insurance. They can get paid for a claim and then 90 days later have to pay that money back as the patients insurance retroactively lapsed. Great system........ The Risk Adjustment for the ACA and Medicare is also killing the insurance companies that administer it.
The people that want to see M4A in place need to ONLY go tto the VA for one year. They will see what a true government based and run health system looks like with no penalties, oversight, or motivation.
It boils down to one thing, IF YOU WANT HEALTHCARE PAY FOR IT. IT IS NOT A RIGHT, IT IS A SERVICE. IF YOU WANT IT, GET A JOB AND PAY FOR IT.
RobertTheTexan
03-06-19, 10:30
The people that want to see M4A in place need to ONLY go to the VA for one year. They will see what a true government based and run health system looks like with no penalties, oversight, or motivation.
It boils down to one thing, IF YOU WANT HEALTHCARE PAY FOR IT. IT IS NOT A RIGHT, IT IS A SERVICE. IF YOU WANT IT, GET A JOB AND PAY FOR IT.
you hit a lot of nails right on the head doc. These two comments stood out to me. Ne’er truer words spoken. I have to go to the VA at least monthly. We have a large regional VA medical center here in CENTEX and I swear 99% of the service/support related staff act as though they are doing you a favor by doing their flipping job. Half the doctors we have - if not more are from another country and you may think, “an educated doc is an educated doc” but those of you who served know the military, especially the Army and I imagine the Marine Corp is a different [I]world
And I mean different WORLD. These foreign doctors don’t have a clue about the culture of the military. I distinctly recall seeing a doc from India for a C&P right after I ETS’d. He had me do shit that was downright painful. Being fresh out of the Army after 15 yrs I didn’t know that I should not force my range of motion beyond pain. The DAV later schooled me on this, but st the time I swear this clowns goal was to see me receive zero compensation for documented injuries - nothing for the shoulders I’ve had 4 surgeries on and the knees that have had more orthoscopes poked in than I can remember. I know this isn’t health plan related, but it is in terms of principle of treatment philosophy, and it shows just how F’d up the VA is. I have not seen any improvements over the years. Sure I’ve ran into good docs. Docs that cared for and about the veteran, but they do not hold the majority. Most of those particular docs were prior service as well. They got it and understood the culture of the military
Sent from my iPhone using Tapatal
Doc Safari
03-06-19, 10:40
So when Grandma's operation is too expensive for Medicare to pay for, or four year old little Kimmy has to wait six months before she can start her treatments for her cancer, we've got a whole new reason for Civil War II.
I waiting for someone to tell me "If you like your Doctor you can keep him." Or "If you like your insurance, you can keep it."
Socialists want control, they want control of your life and your money.
And the best way to do it is to control your health care.
Plus, they will be offing the elderly, handicapped, mentally disturbed, and any other group they find undesirable. That'll cut down on the waiting times.
I am quoting you but also addressing this to most of the posts here.
I am an executive in a hospital based health plan that administrates Medicare, Medicaid, Tricare, and the ACA. I know about hospital costs and health insurance.
This that think that Medicare for All (M4A) is a good idea have never dad to use Medicare. As an insurance it is not good at all. If you do not have a Medicare supplement insurance when you turn 65 you are screwed.
GH41, for your part. That part about 60% of the people that walk into the ER are uninsured is crap. A lot of them do have insurance but don't want to have to pay the huge deductible for their cheap plans. The ACA took care of everyone having insurance. Now they are supposed to. Oh wait, M4A will take care of that....... NOPE, you still have to register for it..... and fay a fine if you are late.... and it can be terminated if you don't pay. So you will still not have insurance like a bunch of people that don't today.
You also have to understand that the ER is the most expensive form of visit a person can have. This is because of the stupid EMTALA Law (Emergency Medical Treatment And Labor Act) that requires treatment at the ER for all IF they take Medicare and Medicaid. So will all f the illegals get this new M4A? Because they use the ER are their person clinic, this is a fact as I have seen the reports from our ER visits. As for Tort reform, we have this in Texas, not much of a help. And we also DID NOT Expand Medicaid because we did not wan to pay for it.
M4A is simply Socialized medicine and Hmac is correct, it is a lot of money and the Dems that want to control it. Even if there is M4A there is still going to be insurance. If you want real healthcare you will have to have it. So you will be paying for both.
There is not advantages for M4A except for those that already have really crappy insurance. Someone mentioned Small Businesses, it will not help them at all. They will not have to pay for insurance directly but the tax increase will put many out of business. The same will go for the economy, it will take a huge hit as a great deal of this countries disposable income will now go to taxes to pay for this program. This will mean less money being spent and that is not a good thing for the overall economy.
There is a reason that healthcare cost so much in the US. It is because someone has to pay for all of the R&D for the rest of the world. In the past 30 years the US has been credits for vast majority of the medical and pharmaceutical advances. ( You can simply Google this because I am not going to post a huge Bibliography) The rest of the world reaps the benefits of this and they don't have the ability to conduct this type of research as the bases behind socialized medicine are counter intuitive to this process. Also the cost is so high because of the socialized programs that we currently have. The ACA has increased the risk and cost to providers that take that insurance. They can get paid for a claim and then 90 days later have to pay that money back as the patients insurance retroactively lapsed. Great system........ The Risk Adjustment for the ACA and Medicare is also killing the insurance companies that administer it.
The people that want to see M4A in place need to ONLY go tto the VA for one year. They will see what a true government based and run health system looks like with no penalties, oversight, or motivation.
It boils down to one thing, IF YOU WANT HEALTHCARE PAY FOR IT. IT IS NOT A RIGHT, IT IS A SERVICE. IF YOU WANT IT, GET A JOB AND PAY FOR IT.
.
Yup. All of the above.
http://ssequine.net/likebutton.png
..
.
Yup. All of the above.
http://ssequine.net/likebutton.png
..
Thanks.
But you like button doesn't work........ :jester:
A big part of the reason for the US high health care cost is the advance of technology. The US absolutely leads the world in broadly implementing cutting edge technology, but that shit costs money, lots of it, and the cost is increasingly increasing. As an example that I've been dealing with over the last 12 months, the da Vinci Xi surgical robot provides some significant advances in Surgery. That robot is just now entering an explosive growth phase across the country/around the world. That robot costs $2.5 million. Likewise, the complexity of the many other surgical tools that I use every day is increasing exponentially (as is the cost). Imaging technology (CT scans, MRI, PET etc) a vital part of medical practice, is rapidly increasing in accuracy and sophistication and allowing me to see things and do things that I couldn't have even dreamed of when I was a resident 35 years ago. How do we decrease the cost of medicine without limiting, or preventing, access to all of that increasingly sophisticated (and expensive) technology? Should we just skip it? "Mr. Smith...the technology exists to do your operation with more precision, fewer complications, less pain, but...sorry...it's just too expensive. We'll just have to do it the old way because it's cheaper". Or should we limit access, like they do in Canada? "I'm sorry Mr. Smith...you need a 3-Tesla MRI scan with rectal coils to stage your rectal cancer. It's a very expensive machine and there are only two in this state. You'll have to drive 4 hours to get the test, and it looks like we can get you in in 3 months...".
Welcome to Medicare for All.
A big part of the reason for the US high health care cost is the advance of technology. The US absolutely leads the world in broadly implementing cutting edge technology, but that shit costs money, lots of it, and the cost is increasingly increasing. As an example that I've been dealing with over the last 12 months, the da Vinci Xi surgical robot provides some significant advances in Surgery. That robot is just now entering an explosive growth phase across the country/around the world. That robot costs $2.5 million. Likewise, the complexity of the many other surgical tools that I use every day is increasing exponentially (as is the cost). Imaging technology (CT scans, MRI, PET etc) a vital part of medical practice, is rapidly increasing in accuracy and sophistication and allowing me to see things and do things that I couldn't have even dreamed of when I was a resident 35 years ago. How do we decrease the cost of medicine without limiting, or preventing, access to all of that increasingly sophisticated (and expensive) technology? Should we just skip it? "Mr. Smith...the technology exists to do your operation with more precision, fewer complications, less pain, but...sorry...it's just too expensive. We'll just have to do it the old way because it's cheaper". Or should we limit access, like they do in Canada? "I'm sorry Mr. Smith...you need a 3-Tesla MRI scan with rectal coils to stage your rectal cancer. It's a very expensive machine and there are only two in this state. You'll have to drive 4 hours to get the test, and it looks like we can get you in in 3 months...".
Welcome to Medicare for All.
And to the VA..........
I agree 100% with that post. Medicine is a resource and there will always be competition for resources. In the M4A system it will back up the system...... and everyone will pay for it.....and not just in $$$$$ but also in lives.
just a scout
03-06-19, 11:59
Medicare for all might work if combined with tort reform.
The Socialist asshats pushing M4A are also fighting tort reform tooth and nail.
Sent from my iPhone using Tapatalk Pro
Averageman
03-06-19, 12:33
Just a couple of points here, I'm by no means a medical or an insurance expert, just an old guy who's observed a lot of malarkey.
If huge Insurance Companies were going to be ruined by Medicaid for All, don't you think there would be Legions of Lobbyists descending on every State Capital and that Washington DC would look like Omaha Beach with Lobbyists swarming the place with Lawyers Guns and Money?
Big Pharma has a stake in this too and will be effected as it gets a squeeze, so why isn't Big Pharma doing the Lobbyists thing also? I mean their profits come in part from what Americans are willing to pay for pharmaceuticals versus the rest of the World which in many cases is quite a bit less, so why aren't they up in arms?
Someone is going to pay more and my best guess would be taxpayers. No one else is taking a pay cut or giving up their golden parachute.
Just a couple of points here, I'm by no means a medical or an insurance expert, just an old guy who's observed a lot of malarkey.
If huge Insurance Companies were going to be ruined by Medicaid for All, don't you think there would be Legions of Lobbyists descending on every State Capital and that Washington DC would look like Omaha Beach with Lobbyists swarming the place with Lawyers Guns and Money?
Big Pharma has a stake in this too and will be effected as it gets a squeeze, so why isn't Big Pharma doing the Lobbyists thing also? I mean their profits come in part from what Americans are willing to pay for pharmaceuticals versus the rest of the World which in many cases is quite a bit less, so why aren't they up in arms?
Someone is going to pay more and my best guess would be taxpayers. No one else is taking a pay cut or giving up their golden parachute.
Because someone will have to administer it...... The Insurance companies will have to do it just like they do for Medicare and Medicaid. You are correct.... the Tax payers will be the ones that suffer....... Notice I said taxpayers and not people. If you pay in you are going to get screwed in this deal....BIG TIME
Just a couple of points here, I'm by no means a medical or an insurance expert, just an old guy who's observed a lot of malarkey.
If huge Insurance Companies were going to be ruined by Medicaid for All, don't you think there would be Legions of Lobbyists descending on every State Capital and that Washington DC would look like Omaha Beach with Lobbyists swarming the place with Lawyers Guns and Money?
Big Pharma has a stake in this too and will be effected as it gets a squeeze, so why isn't Big Pharma doing the Lobbyists thing also? I mean their profits come in part from what Americans are willing to pay for pharmaceuticals versus the rest of the World which in many cases is quite a bit less, so why aren't they up in arms?
Why do you think that they aren't?
Does everyone recognize that Medicare for all is not the equivalent of a completely government run healthcare system, which would be more like VA medical care for all? I’m not in favor of Medicare for all or any government run healthcare system. But it’s important to understand that Medicare is health insurance. Patients go to private, non-government physicians and use their Medicare as one would use any other commercial insurance. Long wait times, poor quality of care, etc would be the result of a healthcare system. Again, I’m not in favor of Medicare for all.
The_War_Wagon
03-06-19, 13:40
There is a reason that healthcare cost so much in the US.
Lawyers? :rolleyes:
Lawyers? :rolleyes:
I don't think so. I suspect that lawyers and the tort system are relatively small components.
sundance435
03-06-19, 16:01
Does everyone recognize that Medicare for all is not the equivalent of a completely government run healthcare system, which would be more like VA medical care for all? I’m not in favor of Medicare for all or any government run healthcare system. But it’s important to understand that Medicare is health insurance. Patients go to private, non-government physicians and use their Medicare as one would use any other commercial insurance. Long wait times, poor quality of care, etc would be the result of a healthcare system. Again, I’m not in favor of Medicare for all.
No, I don't think they do. Few buzzwords strike up abortion-level sentiments as "M4A". Medicare and Medicaid DO control supplier-side costs - if you want to sign up for government-run health insurance, go for it. I think that can only drive positive competition among private health plans. I think that Obamacare was the least bad choice between cosmetic tweaks of the existing system and doing nothing. It went as far as you can without single-payer or M4A and now 7 years on, things are relatively normal. What I struggle with is the huge Constitutional overreach of the expansion of the commerce clause to hold the penalty as Constitutional and the nonsensical interpretation of what is a penalty vs. a tax.
RE: Other countries. As I understand it, private insurance is still alive and well in the U.K. and Canada more so as supplementary insurance, which helps with "skipping the queue" on stuff the state doesn't deem a priority (plus, if it really is only $400 Canadian cash for an MRI, there have been times I would gladly pay that rather than deal with my insurance company on the backend). I've never heard of an infant cancer patient being denied care on a timely basis (at least not systematically), but I have read reports of what we in the U.S. would consider unreasonable wait times for "borderline" cases. What I mean is, cases where the medical condition actually impacts a person's life/productivity being untreated for seemingly long periods, which I doubt factors into the value proposition, if any, from the state's perspective. Even if someone didn't receive timely care for a serious issue in Canada/the U.K., etc., that still happens here - it's a straw-man argument to use it against other healthcare systems.
The Republicans trying to repeal Obamacare with no viable alternative was the biggest political clown-fest of the last 4 years. I don't have an alternative and I don't support single-payer as it's being used now, but repealing Obamacare without a feasible alternative that seeks to tackle some of the structural problems in our healthcare system is highly irresponsible. Obamacare should be studied for the effects, positive and negative, it had on those structural problems.
The_War_Wagon
03-06-19, 16:13
The Republicans trying to repeal Obamacare with no viable alternative
I reject the notion, that ANY "alternative" was necessary - especially a gummint one.
INTERSTATE health insurance policy sales (REAL competition), is the MOST feasible solution, that truly lowers cost - AND - keeps the gummint OUT of health CARE. Der Kommissar ObamassarKare is - and remains - a complete failure.
No, I don't think they do. Few buzzwords strike up abortion-level sentiments as "M4A". Medicare and Medicaid DO control supplier-side costs - if you want to sign up for government-run health insurance, go for it. I think that can only drive positive competition among private health plans. I think that Obamacare was the least bad choice between cosmetic tweaks of the existing system and doing nothing. It went as far as you can without single-payer or M4A and now 7 years on, things are relatively normal. What I struggle with is the huge Constitutional overreach of the expansion of the commerce clause to hold the penalty as Constitutional and the nonsensical interpretation of what is a penalty vs. a tax.
RE: Other countries. As I understand it, private insurance is still alive and well in the U.K. and Canada more so as supplementary insurance, which helps with "skipping the queue" on stuff the state doesn't deem a priority (plus, if it really is only $400 Canadian cash for an MRI, there have been times I would gladly pay that rather than deal with my insurance company on the backend). I've never heard of an infant cancer patient being denied care on a timely basis (at least not systematically), but I have read reports of what we in the U.S. would consider unreasonable wait times for "borderline" cases. What I mean is, cases where the medical condition actually impacts a person's life/productivity being untreated for seemingly long periods, which I doubt factors into the value proposition, if any, from the state's perspective. Even if someone didn't receive timely care for a serious issue in Canada/the U.K., etc., that still happens here - it's a straw-man argument to use it against other healthcare systems.
The Republicans trying to repeal Obamacare with no viable alternative was the biggest political clown-fest of the last 4 years. I don't have an alternative and I don't support single-payer as it's being used now, but repealing Obamacare without a feasible alternative that seeks to tackle some of the structural problems in our healthcare system is highly irresponsible. Obamacare should be studied for the effects, positive and negative, it had on those structural problems.
So after reading your post I can tell you really don't know anything about the current condition of the ACA. Many carriers are switching completely to Off Exchange products. That means they don't have to deal with the government other than getting their plans approved. No subsidies, no crazy 90 day retroactive terminations, no mid month rate changes, no file errors for membership, and they don't have to deal with the Risk Ajustment. The ACA is a trainwreck full of lepers.
Yes it happens here all of the time. Look at the VA.... And with other questionable insurance.... I am speaking of Medicare and Medicaid....... the wait times are high because it is often hard to contract with many specialist providers because they don't want to deal with that CMS rules.
Yes private insurance is alive and well in many of those countries and will continue to be for the rich. Nothing like having to pay for 2 insurance policies and you will never use one.
There is an alternative to Obama care already in place. It is called get a job and pay for your insurance. Why should the entire US population pay for those that made bad life decisions?
FromMyColdDeadHand
03-06-19, 18:08
The only way any entity can keep medical costs down is to ration care. That’s already being done on a fairly broad scale in the US by all of the insurance companies, and certainly by Medicare/Medicaid and the VA, but in a single payer system...yeah...death panels or something equivalent are inevitable. Health care rationing is the only way to keep costs down while maintaining quality.
If/when “Medicare for All” becomes reality, be aware that in your declining years your “doctor” is going to actually be a nurse. There won’t be enough doctors.
Not saying that insurance companies have cost containment protocols, but I think describing it as rationing at a 'fairly broad scale' is to put it, a fairly broad statement.
I don't think so. I suspect that lawyers and the tort system are relatively small components.
Definitely in direct costs, but the impact on how medicine is practiced is hard to discern. There isn't enough money to fix the system, but it isn't inconsequential.
FlyingHunter
03-06-19, 18:29
The "Medicare for all" concept is very similar to "gun control for all".
Neither has anything much to do with care or guns...it's all about control.
Not saying that insurance companies have cost containment protocols, but I think describing it as rationing at a 'fairly broad scale' is to put it, a fairly broad statement.
Definitely in direct costs, but the impact on how medicine is practiced is hard to discern. There isn't enough money to fix the system, but it isn't inconsequential.
"Cost containment protocols" :D. What a bullshit euphemism. It's rationing. Insurance companies deny care to patients in need Every. Single. Day. And I deal with it directly Every. Single. Day.
As to the tort system... the indirect costs, Defensive Medicine, play a role, but a relatively minor one.
I think it's pretty clear that nobody is going to get all the healthcare he wants. Except maybe the fairly rich folks. It seems to me the question is how much govt we want involved in what healthcare we can afford.
FromMyColdDeadHand
03-06-19, 23:32
"Cost containment protocols" :D. What a bullshit euphemism. It's rationing. Insurance companies deny care to patients in need Every. Single. Day. And I deal with it directly Every. Single. Day.
As to the tort system... the indirect costs, Defensive Medicine, play a role, but a relatively minor one.
Wife is a doc, and a specialist. The only thing she ever says is an issue is transporting patients to a different facility for non-medical reasons is what isn’t paid for.
Is it specific surgeries or techniques that you won’t get reimbursed for?
never mind - From My, post was not directed at you. :D
Wife is a doc, and a specialist. The only thing she ever says is an issue is transporting patients to a different facility for non-medical reasons is what isn’t paid for.
Is it specific surgeries or techniques that you won’t get reimbursed for?
Yes. Various operations, particularly the advanced MIS operations and revisions that I do, routinely require pre-authorization and are routinely denied. That in turn leads to time-consuming wrestling with appeals to the insurance company while the patient is in limbo, and often suffering to some degree. At least a couple of times a week, I have to take time out of my day to talk on the phone with some Family Practitioner insurance company medical director that hasn't practiced medicine in years since he/she took that 9-5 desk job and review for him/her the current literature (because I actually read the current literature) that supports an obvious assertion as to why that particular patient needs that particular operation.
Furthermore, they aren't stopping at denying pre-authorization for surgical procedures. A couple of days ago, I got this email, cut and pasted here, from our Radiology director.
All:
New Prior Authorization guidelines took affect January 1, 2019.
The stricter guidelines and increased denial rates requires us to modify our practices.
High Tech imaging orders (CT, MRI, PET and some injections/procedures with the radiologist) will follow the process below.
The Prior Authorization department needs a minimum of 5-7 days before radiology can schedule outpatient exams.
Prior Auth. can no longer be completed retrospectively. As a result we can’t initiate exams without a completed Prior Authorization.
Ordering an outpatient exam as “ASAP” or “STAT” does not exempt it from the routine Prior Authorization process and the standard wait time. These orders will go in the queue with all the other outpatient orders.
Patients with true emergencies need to be referred to the ED for same day care.
In some rare cases the Prior Authorization team may be able to expedite the process. The provider/nurse should call Prior Auth. at 4132 or 2627 to get this process started.
Thank you for your understanding and patience.
So...you come into my office with significant lower abdominal pain increasing over three days. I suspect diverticulitis but need a CT scan to confirm that diagnosis and determine whether or not it has perforated and an abscess has formed that needs to drained (which, by the way, will require another pre-authorization). Or, whether or not I need to take you to the operating room within the next few hours. Sorry...you'll have to wait 5-7 days for pre-authorization from your insurance company (not including the weekend) OR I can send you over to the ER. You'll sit over there for awhile in the waiting room. They'll evaluate you, repeat the labs I already drew in the office, then order the CT scan, and then call me for an ER consult. They'll charge you a bunch of money for the ER visit, you'll have to cough up another co-pay, AND you'll have to cover that rather breathtaking component of your insurance deductible. And by the way, I'll have to charge you for an ER consultation in addition to the office visit I just charged you for earlier that day while you were in my office. Think about what that costs...not just the extra ER visit but the fact that we actually have a "Pre-Authorization Department". Several people, all getting a salary and benefits, whose sole job it is to help a patient wade through and stand in line while the health care rationing process plays itself out.
Additionally, what if it's not a "true emergency" that warrants a trip to the ER? What if you're just in pain, but your labs and vitals are stable? Not life-threatening, just painful? I don't know exactly what's going on in your body...how do I treat you? Do I give you pain medication to try to keep you comfortable while we wait for the CT scan to be approved? No, I can't do that....we have an "opioid crisis" here in the US, so I can't give you pain medication. So....sorry. Good luck with all that...I'll see you back in 5-7 days (not including weekends) after we have the CT scan. If, or when, you get worse and it becomes a true emergency, then you can hit the ER and we can begin the process that I tried to start 5-7 days ago.
This is just a rather routine example of the "cost containment protocols":rolleyes: that insurance companies are increasingly implementing. It's not just a nuisance, it's time-consuming, prevents me from providing good patient care, and detracts from my ability to be productive. The solution? I don't have time to wade through the pre-authorization process so we just hire a bunch of people to do all that nuisance work. Yes, it's expensive but it actually saves us money if it keeps the doctors productive and providing patient care. But seriously...think about the cost of hiring all those administrative people. Who do you think, in the end, is paying for that?
...
never mind - From My, post was not directed at you. :D
And no, I will not be affected at all. There will always have to be someone to administer any program. My concern is the quality of that program. I can see the difference between the different kines of businesses that we administer. We even run an indigent care charity program that cost the people that qualify absolutely nothing...... it is coverage but they really do get what that pay for.
Averageman
03-07-19, 08:16
Follow the money, if there isn't money involved, follow the political power involved.
"They" are giving pregnancy tests to ten year old's who illegally crossed the border. Think about that for a hot minute, think about who the small percentage of positive tests might give an advantage to, think about why a ten year old gets pregnant?
We're screwed.
Yes. Various operations, particularly the advanced MIS operations and revisions that I do, routinely require pre-authorization and are routinely denied. That in turn leads to time-consuming wrestling with appeals to the insurance company while the patient is in limbo, and often suffering to some degree. At least a couple of times a week, I have to take time out of my day to talk on the phone with some Family Practitioner insurance company medical director that hasn't practiced medicine in years since he/she took that 9-5 desk job and review for him/her the current literature (because I actually read the current literature) that supports an obvious assertion as to why that particular patient needs that particular operation.
Furthermore, they aren't stopping at denying pre-authorization for surgical procedures. A couple of days ago, I got this email, cut and pasted here, from our Radiology director.
So...you come into my office with significant lower abdominal pain increasing over three days. I suspect diverticulitis but need a CT scan to confirm that diagnosis and determine whether or not it has perforated and an abscess has formed that needs to drained (which, by the way, will require another pre-authorization). Or, whether or not I need to take you to the operating room within the next few hours. Sorry...you'll have to wait 5-7 days for pre-authorization from your insurance company (not including the weekend) OR I can send you over to the ER. You'll sit over there for awhile in the waiting room. They'll evaluate you, repeat the labs I already drew in the office, then order the CT scan, and then call me for an ER consult. They'll charge you a bunch of money for the ER visit, you'll have to cough up another co-pay, AND you'll have to cover that rather breathtaking component of your insurance deductible. And by the way, I'll have to charge you for an ER consultation in addition to the office visit I just charged you for earlier that day while you were in my office. Think about what that costs...not just the extra ER visit but the fact that we actually have a "Pre-Authorization Department". Several people, all getting a salary and benefits, whose sole job it is to help a patient wade through and stand in line while the health care rationing process plays itself out.
Additionally, what if it's not a "true emergency" that warrants a trip to the ER? What if you're just in pain, but your labs and vitals are stable? Not life-threatening, just painful? I don't know exactly what's going on in your body...how do I treat you? Do I give you pain medication to try to keep you comfortable while we wait for the CT scan to be approved? No, I can't do that....we have an "opioid crisis" here in the US, so I can't give you pain medication. So....sorry. Good luck with all that...I'll see you back in 5-7 days (not including weekends) after we have the CT scan. If, or when, you get worse and it becomes a true emergency, then you can hit the ER and we can begin the process that I tried to start 5-7 days ago.
This is just a rather routine example of the "cost containment protocols":rolleyes: that insurance companies are increasingly implementing. It's not just a nuisance, it's time-consuming, prevents me from providing good patient care, and detracts from my ability to be productive. The solution? I don't have time to wade through the pre-authorization process so we just hire a bunch of people to do all that nuisance work. Yes, it's expensive but it actually saves us money if it keeps the doctors productive and providing patient care. But seriously...think about the cost of hiring all those administrative people. Who do you think, in the end, is paying for that?
...
The wait and see approach must be common. Wife crashed her bike and broke her wrist. It was bad enough to require plates/screws. Her Sawbones did put it in a light cast and gave her some pain meds but it took 7 days for our insurance company to approve the surgery. We paid our deductible up front and 6 months later we are still getting bills for stuff the insurance didn't cover. We are 5K out of pocket so far. We are lucky in that her policy is 100% paid for by her employer and her deductible is only $2,500.
sundance435
03-07-19, 09:00
There is an alternative to Obama care already in place. It is called get a job and pay for your insurance. Why should the entire US population pay for those that made bad life decisions?
What a ridiculously absurd statement. Right, the only people who can't afford health insurance are those without jobs and/or made bad life decisions. I'm sure you go to church every Sunday, too.
Also, I never said ACA was THE solution. In fact, I said it was the least bad solution between doing nothing and single-payer. Let's just shit-can it, though, because Obama, and let insurance premiums and healthcare spending spiral upward to infinity. Cross-state policies? Sure, that's a minor fix, but not the panacea some claim it to be.
Those who are for MFA would rather have the illusion of medical coverage rather than the reality of very little or nothing.
Adrenaline_6
03-07-19, 09:39
Let's just shit-can it, though, because Obama, and let insurance premiums and healthcare spending spiral upward to infinity.
Let insurance premiums skyrocket? What rock have you been under dude?
Let insurance premiums skyrocket? What rock have you been under dude?
Going to get worse unless we do something.
The study confirmed that the U.S. has substantially higher spending, worse population health outcomes, and worse access to care than other wealthy countries. For example, in 2016, the U.S. spent 17.8 percent of its gross domestic product on health care, while other countries ranged from 9.6 percent (Australia) to 12.4 percent (Switzerland). Life expectancy in the U.S. was the lowest of all 11 countries in the study, at 78.8 years; the range for other countries was 80.7 to 83.9 years. The proportion of the U.S. population with health insurance was 90 percent, lower than all the other countries, which ranged from 99 to 100 percent coverage.
But commonly held beliefs for these differences appear at odds with the evidence, the study found.
Belief: The U.S. uses more health care services than peer countries, thus leading to higher costs.
Evidence: The U.S. has lower rates of physician visits and days spent in the hospital than other nations.
Belief: The U.S. has too many specialists and not enough primary care physicians.
Evidence: The primary care versus specialist mix in the U.S. is roughly the same as that of the average of other countries.
Belief: The U.S. provides too much inpatient hospital care.
Evidence: Only 19 percent of total health care spending in the U.S. is spent on inpatient services — among the lowest proportion of similar countries.
Belief: The U.S. spends too little on social services and this may contribute to higher health care costs among certain populations.
Evidence: The U.S. does spend a bit less on social services than other countries, but it is not an outlier.
Belief: The quality of health care is much lower in the U.S. than in other countries.
Evidence: Overall, quality of care in the U.S. isn’t markedly different from that of other countries, and in fact excels in many areas. For example, the U.S. appears to have the best outcomes for those who have heart attacks or strokes, but is below average for avoidable hospitalizations for patients with diabetes and asthma.
What does explain higher spending in the U.S. is administrative complexity and high prices across a wide range of health care services. For example, the findings showed that:
• Administrative costs of care — activities related to planning, regulating, and managing health systems and services — accounted for 8 percent of total health care costs, compared with a range of 1 to 3 percent for other countries.
• Per capita spending for pharmaceuticals was $1,443 in the U.S., compared with a range of $466 to $939 in other nations. For several commonly used brand-name pharmaceuticals, the U.S. had substantially higher prices than other countries, often double the next-highest price.
• The average salary for a general practice physician in the U.S. was $218,173, while in other countries the salary range was $86,607 to $154,126.
https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more-for-health-care-with-worse-population-health-outcomes/
Lets visit this one for a moment: • The average salary for a general practice physician in the U.S. was $218,173, while in other countries the salary range was $86,607 to $154,126.
I think this is pretty much misleading. In my community we have essentially two places for care, one a non-profit, medicare/medicaid focused clinic, the other a doctor owned clinic. So my doctor gets a salary and a cut of the profits. Not sure how widespread this practice is.
I also find it curious that we accept statements such as 'And by the way, I'll have to charge you for an ER consultation in addition to the office visit I just charged you for earlier that day while you were in my office.' without challenge. Why? Is it a law?
Nobody, wants physicians to be underpaid for their dedication and knowledge, but from my perspective things could be made better for all with a little less profit motive on the part of hospitals and clinics.
Adrenaline_6
03-07-19, 13:11
Going to get worse unless we do something.
Understood, but I have a hard time swallowing the fact that a government run system will be more efficient, cheaper, and a better overall consumer experience. Name one instance in the US that this is the case...at the federal or state level.
Dr. Bullseye
03-07-19, 13:52
The goal of Socialism is Communism. Great example here.
sundance435
03-07-19, 14:37
Let insurance premiums skyrocket? What rock have you been under dude?
For non-ACA plans, premium increases are down to below pre-ACA levels. The exchange is a disaster because of insurance companies leaving the market after subsequent repeal of certain ACA provisions. Again, neither the ACA or the status quo ante tackled the structural problems of our insurance/healthcare system, but ACA at least attempted to - generally by applying Medicare-like oversight.
Going to get worse unless we do something.
Exactly. I'm no fan of the ACA, but to ignore it completely and go back to the status quo is at least just as irresponsible. If anything, the ACA tried to tackle, in both banal and novel ways, some of the structural problems that others have alluded to - terrible patient outcomes, exorbitant costs, unnecessary care, etc., short of going full-on single-payer.
Understood, but I have a hard time swallowing the fact that a government run system will be more efficient, cheaper, and a better overall consumer experience. Name one instance in the US that this is the case...at the federal or state level.
You're right, government control should never be considered the best option. However, Government or not, in the real world, you can have 2 of those 3, but not all 3. We currently don't even have 1 of the 3 with ACA-lite and were arguably worse off prior to the ACA, so what's your solution beyond repealing the ACA (because that ain't gonna do it)?
Adrenaline_6
03-07-19, 14:48
For non-ACA plans, premium increases are down to below pre-ACA levels. The exchange is a disaster because of insurance companies leaving the market after subsequent repeal of certain ACA provisions. Again, neither the ACA or the status quo ante tackled the structural problems of our insurance/healthcare system, but ACA at least attempted to - generally by applying Medicare-like oversight.
They were already leaving before the repeal because it was designed to fail to begin with and the providers saw it wasn't in their best interest to continue.
You're right, government control should never be considered the best option. However, Government or not, in the real world, you can have 2 of those 3, but not all 3. We currently don't even have 1 of the 3 with ACA-lite and were arguably worse off prior to the ACA, so what's your solution beyond repealing the ACA (because that ain't gonna do it)?
I don't have a solution because I am in no way an expert and know all the facts to come up with one, but to acknowledge the fact that the government is a poor choice but we should do something and that is at least something is a mirror image of the gun control nut saying we should pass more gun control laws because we should at least do something to stop gun violence.
...In retrospect, it is actually worse, because the gun control nut doesn't acknowledge the fact that gun laws will solve nothing.
sundance435
03-07-19, 15:25
I don't have a solution because I am in no way an expert and know all the facts to come up with one, but to acknowledge the fact that the government is a poor choice but we should do something and that is at least something is a mirror image of the gun control nut saying we should pass more gun control laws because we should at least do something to stop gun violence.
...In retrospect, it is actually worse, because the gun control nut doesn't acknowledge the fact that gun laws will solve nothing.
I get that that might be a tempting analogy, but if you don't see a difference between government "doing something" about the health insurance industry vs. gun control, then we'll agree to disagree. One (2A) is a fundamental right enshrined in the Constitution, the other is purely a creation of a semi-free market and driven by profit, despite being fundamentally important to another inalienable right. I have no doubt that it was government involvement in the first place that created the healthcare mess pre-ACA (see ERISA, HMO Act, etc.), but we don't live in a vacuum and here we are. At this point, I think it's fair to say that the government will never not be involved in healthcare. So, either it unscrews the system it helped create and allowed to fester, or we end up with single-payer. ACA, warts and all, at least contained some provisions to address fundamental flaws - maybe it's a distinction without a difference, but I don't really see how the status quo was viable, either.
What a ridiculously absurd statement. Right, the only people who can't afford health insurance are those without jobs and/or made bad life decisions. I'm sure you go to church every Sunday, too.
Also, I never said ACA was THE solution. In fact, I said it was the least bad solution between doing nothing and single-payer. Let's just shit-can it, though, because Obama, and let insurance premiums and healthcare spending spiral upward to infinity. Cross-state policies? Sure, that's a minor fix, but not the panacea some claim it to be.
Show me a real example where a person did not make a poor life choice and is in a situation where they can't afford insurance........ I will wait. Life choices will come back in get you. And WTF does going to church have to do with anything?
And the Do Nothing would have been better then the ACA. Here is the real story that you never hear..... YES, more people have insurance (uninsured dropped 19% See link for citation) That means nothing in reality. Do these people now have access to healthcare...... NOPE, even less people have access now. Now people have super high Co Pays and Deductibles that they can never afford to meet. So in REALITY more people have less access to health care. SO doing NOTHING would have been better.
https://www.inlander.com/Bloglander/archives/2018/01/31/study-washingtons-uninsured-rate-dropped-to-record-lows-under-aca-but-could-go-up-again
Adrenaline_6
03-07-19, 17:56
I get that that might be a tempting analogy, but if you don't see a difference between government "doing something" about the health insurance industry vs. gun control, then we'll agree to disagree. One (2A) is a fundamental right enshrined in the Constitution, the other is purely a creation of a semi-free market and driven by profit, despite being fundamentally important to another inalienable right
I thnk you missed the point. I was not making a rights vs. needs comparison. It was only about "doing something just to do something" is never a good idea. This is exactly the same in both cases. Knowing that something won't work and doing it anyway just to say you tried something and it made you or other people temporarily feel better because of it, is not only a waste of time and resources, it is outright ignorant and illogical.
You know who did the same exact thing, lynch mobs.
sundance435
03-08-19, 10:06
Show me a real example where a person did not make a poor life choice and is in a situation where they can't afford insurance........ I will wait. Life choices will come back in get you. And WTF does going to church have to do with anything?
If they aren't on a group plan: juvenile diabetics, juvenile cancer patients, anyone with a chronic condition that has nothing to do with life choices, etc., then it's fair to say they might have a problem affording insurance on their own.
If they aren't on a group plan: juvenile diabetics, juvenile cancer patients, anyone with a chronic condition that has nothing to do with life choices, etc., then it's fair to say they might have a problem affording insurance on their own.
All of which are covered if they have a policy before the diagnosis....... even before the ACA. Having you child diagnosed with juvenile diabetics of cancer an THEN trying to get coverage was is like to buy a parachute AFTER you jump out of a plan. The sob stories about a carrier dropping people after they get a diagnosis is mostly crap. Most of the time it has to due with them not paying their premium on time or not filling the proper documents to the carrier when asked for them.
Here is a situation I want you to do. Call Geico, or any insurance company, and tell them that you to want to insure your car. Also tell them that you wrecked it last week and need to know how to file a claim. Or home insurance.... tell them your house burnt down last week. Or renters insurance and tell them that your apartment was broken into last week and everything was stolen...... Or that you want to buy Life insurance for you spouse that died last week........Or get some short and long term disability insurance and tell them that you broke both of your legs and arms last week........see what happens........ Let me know what they say.........
Poor choices..... get insurance and don't let it lapse. Have it BEFORE something happens and you become one of those people that complain that they can't get coverage because they waited until something bad happened...... Again, THAT IS A POOR LIFE CHOICE.
Well, sure, you can look back at anything and say poor life choice - folks make them everyday.
Do you by any chance have kids?
Well, sure, you can look back at anything and say poor life choice - folks make them everyday.
Do you by any chance have kids?
Four of them and before I had them I ensured that all of their needs were provided for BEFORE I had them. I also waited longer to have them then most and did not have them until I was properly prepared, all of the important bases covered..... married, good job, savings, benefits, GOOD INSURANCE, and living in an area that has a great school system.
Have I made mistakes, sure I have, but I take responsibility for them and then I fix them. I don't whine about them and blame others for them.
Let's talk about the average American. Say a single mother with a couple of young kids. She lives down south where 40-50K per year is a good salary for a women. When she lost her husband the settlement allowed her to pay off the house and put away some money for the kids education. She pays $150 a week for child care while she works. How does she budget an $1,100 per month insurance premium with an $8,000 per year deductible? She would spend $21,000 for insurance a year before she has any insurance coverage and $7,800 for child care so she can work. How does she do it? She doesn't! Is she somehow negligent for not being a doctor, lawyer or Indian Chief? If everyone was a successful doctor, lawyer or Indian Chief the job wouldn't pay very well. Most doctors, lawyers and Indian Chiefs won't admit that to some degree they are lucky to be successful. They look down at the hard working people that weren't so lucky. There are plenty of hard working people out there that cannot afford GOOD INSURANCE like the Doc can. The system is ****ed up. The average American cannot afford health insurance.
Let's talk about the average American. Say a single mother with a couple of young kids. She lives down south where 40-50K per year is a good salary for a women. When she lost her husband the settlement allowed her to pay off the house and put away some money for the kids education. She pays $150 a week for child care while she works. How does she budget an $1,100 per month insurance premium with an $8,000 per year deductible? She would spend $21,000 for insurance a year before she has any insurance coverage and $7,800 for child care so she can work. How does she do it? She doesn't! Is she somehow negligent for not being a doctor, lawyer or Indian Chief? If everyone was a successful doctor, lawyer or Indian Chief the job wouldn't pay very well. Most doctors, lawyers and Indian Chiefs won't admit that to some degree they are lucky to be successful. They look down at the hard working people that weren't so lucky. There are plenty of hard working people out there that cannot afford GOOD INSURANCE like the Doc can. The system is ****ed up. The average American cannot afford health insurance.
You have got to be kidding........ such a sad sorry.
So what is your hypothetical woman doing to improve her life situation? $40-50 k sucks. She needs to improve her situation....... how about an education..... she can go to school and get her degree ...... while working and taking care of her kids and so forth. It sucks for a bit but it can be done. Sleep less and stay up to do homework. Get a degree in something that is useful to society and you will get paid.
Here is how the story plays out. This woman gets enrolled in college to become an ADN. She does all of her online classes at night after the kids go to bed. She Diego to bed before midnight during the week for the 2 years she is getting Associate Degree in Nursing. But she is thinking about her kids and does it. She graduates and passes her boards. There is suck a shortage of RNs that it only takes her 1 week to get a job and she is now making $60k (median income for the US). Wow.... she is .ow making $10k more in just 2 years.....
But wait.... the suck is not over. She does not quite. She stays at it and gets her BSN and now has a 4 year degree after 18 more months. And now she is making $70k ( median income for the US). She now make $20k more..... oh, and she now has good health insurance because most medical systems have good coverage.
But wait. She is a motivated person and after 2 years of working as an RN she goes back to school and gets her Masters as a Nurse Practitioner while working as an RN making $70k a year. After her 36 month program she is an NP and making something like $110k a year. It was hard work and she lost a lot of sleep but she doubled her salary and now has a career and good health insurance....... good for her.
That is what I call a life choice.
You have got to be kidding........ such a sad sorry.
So what is your hypothetical woman doing to improve her life situation? $40-50 k sucks. She needs to improve her situation....... how about an education..... she can go to school and get her degree ...... while working and taking care of her kids and so forth. It sucks for a bit but it can be done. Sleep less and stay up to do homework. Get a degree in something that is useful to society and you will get paid.
Here is how the story plays out. This woman gets enrolled in college to become an ADN. She does all of her online classes at night after the kids go to bed. She Diego to bed before midnight during the week for the 2 years she is getting Associate Degree in Nursing. But she is thinking about her kids and does it. She graduates and passes her boards. There is suck a shortage of RNs that it only takes her 1 week to get a job and she is now making $60k (median income for the US). Wow.... she is .ow making $10k more in just 2 years.....
But wait.... the suck is not over. She does not quite. She stays at it and gets her BSN and now has a 4 year degree after 18 more months. And now she is making $70k ( median income for the US). She now make $20k more..... oh, and she now has good health insurance because most medical systems have good coverage.
But wait. She is a motivated person and after 2 years of working as an RN she goes back to school and gets her Masters as a Nurse Practitioner while working as an RN making $70k a year. After her 36 month program she is an NP and making something like $110k a year. It was hard work and she lost a lot of sleep but she doubled her salary and now has a career and good health insurance....... good for her.
That is what I call a life choice.
There are a couple of things wrong with the scenario - first of all, more than one kid for $150.00 a week child care is a fantasy. Much less when you start bumping up to working full time and going to school fulltime. Ever tried to find second shift daycare? Paid for it?
Second, $50,000.00 a year/$25.00 and hour is a pretty good wage across most of the mid-west, and I'm assuming southern states.
Additionally, most ADN programs, in my area all of them, are geared for the full-time student. They won't juggle clinicals, you get in the program and you go.
And finally, ADN, bridge to BSN, and then RNP, how much education debt does she have?
So how much of that did you have to do?
I don't know anything much about you, but let me hazard a guess, you were career military, and now on a second career, correct?
There are a couple of things wrong with the scenario - first of all, more than one kid for $150.00 a week child care is a fantasy.
Second, $50,000.00 a year/$25.00 and hour is a pretty good wage across most of the mid-west, and I'm assuming southern states.
Additionally, most ADN programs, in my area all of them, are geared for the full-time student. They won't juggle clinicals, you get in the program and you go.
So how much of that did you have to do?
I don't know anything much about you, but let me hazard a guess, you were career military, correct?
I am a realist and know that $150 a week is as realistic as a logical Liberal..... not going to happen.
You are correct, that is a full time program and you can do all of that while working and with children. My wife did while I was deploying all of the time. Clinicals can be done while working full time.
It all has to do a person's level of motivation. I have 4 kids, work full time and my wife and I are still full time students. Why, we want more.
There are a couple of things wrong with the scenario - first of all, more than one kid for $150.00 a week child care is a fantasy. Much less when you start bumping up to working full time and going to school fulltime. Ever tried to find second shift daycare? Paid for it?
Second, $50,000.00 a year/$25.00 and hour is a pretty good wage across most of the mid-west, and I'm assuming southern states.
Additionally, most ADN programs, in my area all of them, are geared for the full-time student. They won't juggle clinicals, you get in the program and you go.
And finally, ADN, bridge to BSN, and then RNP, how much education debt does she have?
So how much of that did you have to do?
I don't know anything much about you, but let me hazard a guess, you were career military, and now on a second career, correct?
Maybe an easier to achieve path to success for the woman in my scenario would be learning to suck the chrome off of a trailer hitch ball. It would probably take a lot less time and effort than a nursing degree and land just as many doctors with secure futures than a nursing career. Should a girl doing what she has to do be looked down upon for doing it? Some people would think so.
I am a realist and know that $150 a week is as realistic as a logical Liberal..... not going to happen.
You are correct, that is a full time program and you can do all of that while working and with children. My wife did while I was deploying all of the time. Clinicals can be done while working full time.
It all has to do a person's level of motivation. I have 4 kids, work full time and my wife and I are still full time students. Why, we want more.
My experience was different, I got a part time job on top of working full time, going to college and doing the Army Reserve thing, while my first wife wife got her RN.
Around here getting into the program was/is competitive, you start with a class and if you don't progress through with the class, you get dropped from the program. It is a straight through two year shot.
Sure, if you had a job that was flexible enough to shift your hours around you could do it, but not many like that - especially for a single parent family.
The fact is that medical insurance, which is what were talking about doesn't need to be so expensive.
If you make 50,000 a year and are paying 1,200 a month for family health insurance, that is 14,400 nearly 29% of your pay.
Heck, I bet you were one of those guys bitching about having to pay copays for your dependents under TriCare.
Maybe an easier to achieve path to success for the woman in my scenario would be learning to suck the chrome off of a trailer hitch ball. It would probably take a lot less time and effort than a nursing degree and land just as many doctors with secure futures than a nursing career. Should a girl doing what she has to do be looked down upon for doing it? Some people would think so.
I hang with a lot of very conservative, fairly wealthy folks. One of them was a state representative. One day we were talking about how many kids in our school district are on free or reduced lunch because of what their parents make. Her response 'they need to get better jobs.' She was sincere, she thought it was just that easy. Not a clue.
My experience was different, I got a part time job on top of working full time, going to college and doing the Army Reserve thing, while my first wife wife got her RN.
Around here getting into the program was/is competitive, you start with a class and if you don't progress through with the class, you get dropped from the program. It is a straight through two year shot.
Sure, if you had a job that was flexible enough to shift your hours around you could do it, but not many like that - especially for a single parent family.
The fact is that medical insurance, which is what were talking about doesn't need to be so expensive.
If you make 50,000 a year and are paying 1,200 a month for family health insurance, that is 14,400 nearly 29% of your pay.
Heck, I bet you were one of those guys bitching about having to pay copays for your dependents under TriCare.
I guess there are different programs in different areas. But my point is simply that it can be done. It just takes a lot of hard work.
As for the cost of medical insurance, it is what it is. If you don't want to pay it don't . Just don't complain about it all of the time. I am not of huge fan of paying taxes. But guess what, I do. And I don't bitch about it all of the time.
FYI, TriCare Prime for Active Duty don't have CoPays, even for dependents. They only thing that AD pays for is Pharmacy and only if they get it outside of a MTF. I am not on TriCare Select for Retired. I have a 20% copay for everything now. I could be on Prime and not have that 20% but I want to bigger network so I pay more.
I hang with a lot of very conservative, fairly wealthy folks. One of them was a state representative. One day we were talking about how many kids in our school district are on free or reduced lunch because of what their parents make. Her response 'they need to get better jobs.' She was sincere, she thought it was just that easy. Not a clue.
I really don't get this mentality. If you want more work hard and get it. Or are you saying t that some people are just too stupid to do this? It can really only be one of two ways:
1. All people are capable of advancing and those that don't are lazy.
2. Not all people are capable of advancing because some are too stupid.
I guess that there could be a #3. Some people blame everyone else to cover up the fact that they are inferior to those that are successful to try and make themselves feel better. But the reality is that is just a variation of #2.
The reality is that in the US there are so many possibilities that a person is only limited to their own imagination and drive.
morbidbattlecry
03-10-19, 11:30
I really don't get this mentality. If you want more work hard and get it. Or are you saying t that some people are just too stupid to do this? It can really only be one of two ways:
1. All people are capable of advancing and those that don't are lazy.
2. Not all people are capable of advancing because some are too stupid.
I guess that there could be a #3. Some people blame everyone else to cover up the fact that they are inferior to those that are successful to try and make themselves feel better. But the reality is that is just a variation of #2.
The reality is that in the US there are so many possibilities that a person is only limited to their own imagination and drive.
I know plenty of people who work hard and can barely if not at all get buy. The world isn't as black and white as you think it is.
morbidbattlecry
03-10-19, 11:36
Medicare sucks a big one first of all, my mother was on it for a long time while disabled. Secondly the Medicare for all idea doesn't fix the real problem which is the medical system is geared not towards the patient but towards making as much money as it can. We as Americans pay more and receive less quality healthcare then the rest of 1st world countries. What we pay for a procedure and what the real cost is has is so out of wack it's unreal.
I really don't get this mentality. If you want more work hard and get it. Or are you saying t that some people are just too stupid to do this? It can really only be one of two ways:
1. All people are capable of advancing and those that don't are lazy. You certainly see things in black and white don't you?
2. Not all people are capable of advancing because some are too stupid. And God said the stupid are to be taken advantage of, right?
I guess that there could be a #3. Some people blame everyone else to cover up the fact that they are inferior to those that are successful to try and make themselves feel better. But the reality is that is just a variation of #2.
The reality is that in the US there are so many possibilities that a person is only limited to their own imagination and drive.
At this point you are just spouting the 'anyone can be President' dogma.
I have a 20% copay for everything now. I could be on Prime and not have that 20% but I want to bigger network so I pay more.
And, let me guess, work furnishes your insurance.
I know plenty of people who work hard and can barely if not at all get buy. The world isn't as black and white as you think it is.
Ok, then what are they doing to improve their situation? Besides playing Lotto.....
At this point you are just spouting the 'anyone can be President' dogma.
Point is missed. There is a grey area but it is what YOU do to get out of it that makes you what you are. I did not say that people need to be taken advantage of. My point is the exact opposite. If a person is not smart enough to help themselves then they need to be helped. Throwing money at an issue never helps. There need stk be a plan put into place to help those that are not able to or smart enough to assist themselves. As for the lazy, they need to be put into a different category and let to rot with all of the other garbage.
And, let me guess, work furnishes your insurance.
Nope. I am on TriCare because I retired after 24 years in the Army busting my ass doing very challenging things. Hard work pays off.
See the system works.
My wife and I are on Tricare Prime now, because it works for us. I get irritated about the cost until I talk to my employees and peers who did not retire from the military.
We both qualify for free health care, Indian Health Service for her and the VA for me but I would rather pay for Tricare and the excellent IHS facility she can use is on the far side of the state (2 of my adult sons drive down for dental and routine medical).
When I think of Medicare for all, I think about my worst interactions with the VA and the time I waited 4 months for a MRI my VA doc insisted I need, the rare but well entrenched quacks working for the military health care system, then contemplate how much worse it would be if those same folks ran Healthcare for everyone, because they will be.
IME with 5-6 older relatives, Medicare works great. All had the supplemental insurance, all had the same doctors, hospitals they had prior to Medicare, and none ever paid a bill, it was covered 100%. Can't get much better than that.
Problem is, system is not self-sufficient. It is deficit spending and opening it up to more folks will only make the deficit bigger,. there is no way they will raise taxes enough to cover the costs.
I really don't get this mentality. If you want more work hard and get it. Or are you saying t that some people are just too stupid to do this? It can really only be one of two ways:
1. All people are capable of advancing and those that don't are lazy.
2. Not all people are capable of advancing because some are too stupid.
I guess that there could be a #3. Some people blame everyone else to cover up the fact that they are inferior to those that are successful to try and make themselves feel better. But the reality is that is just a variation of #2.
The reality is that in the US there are so many possibilities that a person is only limited to their own imagination and drive.
and when the lefties decide to destroy you because are a Christian ?
sadly this is happening now more and more
also now you can work hard be the best but sorry you are a white male ! this or that person gets the job before you because of the skin color or sex !
the day of a life long job is almost gone !
you were lucky for sure to be in the military and have that gov job in a sense but not everyone can do that ? health does hold some back etc..
then having gov healthcare of some kind because of that again i
and someone had to pay for all those soldiers to get what they did ! and some of those folks are now hosed for various reasons !
who would pay if every single person in the US was in for 25 years ? it could not exist or happen unless people took chances and did things and sometimes those things do get pulled down for various reasons
I do agree your points can be valid but have to also say that it is not just those two !
think of the coal mine worker that worked until he was 50 and now his company is gone pension is gone everything is gone ? and on top the whole town he lived in is dead now because of that ? often because some lefty rich democrat decided it was to dirty ? or the company moved the jobs to another country in some manufacture cases etc...
was that him being stupid or lazy ?
IME with 5-6 older relatives, Medicare works great. All had the supplemental insurance, all had the same doctors, hospitals they had prior to Medicare, and none ever paid a bill, it was covered 100%. Can't get much better than that.
Problem is, system is not self-sufficient. It is deficit spending and opening it up to more folks will only make the deficit bigger,. there is no way they will raise taxes enough to cover the costs.
This is spot on.
IME with 5-6 older relatives, Medicare works great. All had the supplemental insurance, all had the same doctors, hospitals they had prior to Medicare, and none ever paid a bill, it was covered 100%. Can't get much better than that.
Problem is, system is not self-sufficient. It is deficit spending and opening it up to more folks will only make the deficit bigger,. there is no way they will raise taxes enough to cover the costs.
That, on top of the problem that the US Government itself is not sufficient, and is all about deficit spending. That problem, along with the programs that it funds (like Medicare) won't manifest until the bill comes due...as it always does. Like Greece, for example.
What we pay for a procedure and what the real cost is has is so out of wack it's unreal.
What you are paying for is that you can have that procedure tomorrow right there in your home town, instead of 6 months from now and 350 miles away, which is what you'd get in the rest of those 1st world countries you reference. And your procedure will be top quality with the best-trained surgeons, and the latest, most advanced technology on the planet. I understand why you might think the cost is out of whack. What, in the list above, are you willing to give up?
http://ssequine.net/triangle.png
Nope. I am on TriCare because I retired after 24 years in the Army busting my ass doing very challenging things. Hard work pays off.
See the system works.
Sorry, I misread this, and got the impression you were saying you din't have TriCare due to mentioning both Select and Prime in the same sentence: I am not on TriCare Select for Retired. I have a 20% copay for everything now. I could be on Prime and not have that 20% but I want to bigger network so I pay more.
I'm also on TriCAre, but unlike you (apparently) I didn't do all my time active duty, so I had to wait until 60 to draw.
I'm grateful for the government assistance with my insurance, it allowed both my wife and myself to retire early and not have to worry about insurance.
Unlike an active component retiree, I had to pay health insurance premiums, along with co-pays, for most of my adult life, plus chunking away 1/4ish of my pay for retirement, again something I've often found the active component retiree often doesn't get.
Empathy doesn't mean sympathy, it simply means trying to look at things from the other person's perspective. Generally if both sides look at things with an empathetic mind, they can find middle ground to work from. Spotting the dogmatic response doesn't generally get you there.
Unlike an active component retiree, I had to pay health insurance premiums, along with co-pays, for most of my adult life, plus chunking away 1/4ish of my pay for retirement, again something I've often found the active component retiree often doesn't get.
Active component service members generally retire and step directly into a job, because $1500 - 3K a month ain't exactly living high on the hog.
I retired from the military 10 years ago and plan to work another 10 before I retire at 60. I am contibuting 19% into my 401K now, pay (very small) premiums and (very small),co-pays for Tricare, (doesn't include vision or dental, by the way).
Andy
Active component service members generally retire and step directly into a job, because $1500 - 3K a month ain't exactly living high on the hog.
I retired from the military 10 years ago and plan to work another 10 before I retire at 60. I am contibuting 19% into my 401K now, pay (very small) premiums and (very small),co-pays for Tricare, (doesn't include vision or dental, by the way).
Andy
Yep, I went with Aetna for both on the FEDVIP program.
Every time I hear the phrase...”free medical” or free lunch or free company car and so forth, I just shake my head. Nothing is free except the air you breath and possibly the water you drink (I am sure you have been charged for it as well). Some one or something has to pay for that free benefit. The Socialist dream is free stuff for everyone yet it still has to be paid for. More people are being added to medical dependency than are people whom have to pay into the system. This “free” health care system isn’t sustainable.
At this point you are just spouting the 'anyone can be President' dogma.
Yep. That's what they believe but they refuses to recon the fact that everyone can't be. Only one can be at a time. In his view all are failures except the one that made it. On my birth certificate it list my father's occupation as professional baseball player. He was but never got called up from the farm league. He was obviously a failure for not trying hard enough to make the big leagues. These people's logic is warped. They made it and refuse to admit any part of their success was due to being in the right place at the right time.
I worked my ass off to take every possible advantage of every opportunity that was presented to me. I went to school with many people who had less opportunity, worked even harder than me, and ended up in the same place as me. It's been a common thread throughout my professional career.
I think folks sometimes forget that we all don't have the same drive, aptitude or temperament.
I also find it curious that we accept statements such as 'And by the way, I'll have to charge you for an ER consultation in addition to the office visit I just charged you for earlier that day while you were in my office.' without challenge. Why? Is it a law?
Strange question. It's because I can't afford to work for free.
I think folks sometimes forget that we all don't have the same drive, aptitude or temperament.
Exactly. If it was a total lack of opportunity, I can see that. But apparently I should also help pay for their lack of drive, aptitude, and temperament. I was just listening to Elizabeth Warren providing that same explanation, after clarifying that she isn't a socialist.
Strange question. It's because I can't afford to work for free.
Or want to work for free........
Sorry, I misread this, and got the impression you were saying you din't have TriCare due to mentioning both Select and Prime in the same sentence: I am not on TriCare Select for Retired. I have a 20% copay for everything now. I could be on Prime and not have that 20% but I want to bigger network so I pay more.
I'm also on TriCAre, but unlike you (apparently) I didn't do all my time active duty, so I had to wait until 60 to draw.
I'm grateful for the government assistance with my insurance, it allowed both my wife and myself to retire early and not have to worry about insurance.
Unlike an active component retiree, I had to pay health insurance premiums, along with co-pays, for most of my adult life, plus chunking away 1/4ish of my pay for retirement, again something I've often found the active component retiree often doesn't get.
Empathy doesn't mean sympathy, it simply means trying to look at things from the other person's perspective. Generally if both sides look at things with an empathetic mind, they can find middle ground to work from. Spotting the dogmatic response doesn't generally get you there.
It must have been a typo, I am NOW on TriCare Select for retires. I agree with the Empathy part. I can empathize with those people because I was there at one time. I did not like it... So I changed my situation. What I can't condone are those that don't try.
Yep. That's what they believe but they refuses to recon the fact that everyone can't be. Only one can be at a time. In his view all are failures except the one that made it. On my birth certificate it list my father's occupation as professional baseball player. He was but never got called up from the farm league. He was obviously a failure for not trying hard enough to make the big leagues. These people's logic is warped. They made it and refuse to admit any part of their success was due to being in the right place at the right time.
So you are saying that everyone is a winner? What?
Not everyone can be the winner. Your father never made it to the pros...... But he did make it to the farm league, correct? If so that means he tried and did make it farther than 90% of the people out there. That is an accomplishment.
Being in the right place at the right time is CRAP The people that are in the right place at the right time put themselves there for the reason that they WANT to make it.
Most of the "reasons" that other people make it are excuses that people that didn't make it tell others to make themselves feel better. "I would have gotten an A in that class but the teacher didn't like me", "I could have been the starting quarterback but it is all political"..... Right, keep telling yourself that.
Adrenaline_6
03-11-19, 09:57
So you are saying that everyone is a winner? What?
Not everyone can be the winner. Your father never made it to the pros...... But he did make it to the farm league, correct? If so that means he tried and did make it farther than 90% of the people out there. That is an accomplishment.
Being in the right place at the right time is CRAP The people that are in the right place at the right time put themselves there for the reason that they WANT to make it.
Most of the "reasons" that other people make it are excuses that people that didn't make it tell others to make themselves feel better. "I would have gotten an A in that class but the teacher didn't like me", "I could have been the starting quarterback but it is all political"..... Right, keep telling yourself that.
Yup. It's like Bruce Lee quote of you will never see the winner of a fight say it was a dirty fight.
I don't know where he got it from, but my Dad always said, you need to be good (skill/talent) to be lucky. for the most part barring something like the lottery, he was right.
Strange question. It's because I can't afford to work for free.
My apologies, I'm backing out of this thread.
Or want to work for free........
I'm backing out of this thread.
So now your saying I'm a loser for working as a volunteer? Got it.
In HMAC's example, the patient shouldn't have been billed for the office call IF they HAD to send them to the ER for treatment.
Likewise, if you take what was billed for the office call, and divide it among the time spent in the office and on the OR consult, since the two are interconnected, it isn't working for free, it's just not making as much.
WOW..... Projecting much? I never said that. Charity is a great thing. Everyone should be charitable in some way. I have no issue with that at all. I give time and money to many charities.
There is a huge difference between charity and having people EXPECT free sh!t. When people EXPECT Charity they need to be cut off immediately.
Charity should be given. Not forced or EXPECTED.
Thant was my point
WOW..... Projecting much? I never said that. Charity is a great thing. Everyone should be charitable in some way. I have no issue with that at all. I give time and money to many charities.
There is a huge difference between charity and having people EXPECT free sh!t. When people EXPECT Charity they need to be cut off immediately.
Charity should be given. Not forced or EXPECTED.
Thant was my point
I guess I deleted too late. Shouldn't have taken the break to work with the dogs.
I guess I deleted too late. Shouldn't have taken the break to work with the dogs.
No Problem.
In HMAC's example, the patient shouldn't have been billed for the office call IF they HAD to send them to the ER for treatment.
Likewise, if you take what was billed for the office call, and divide it among the time spent in the office and on the OR consult, since the two are interconnected, it isn't working for free, it's just not making as much.In this case, the insurance company's rules require that such a patient has to go to the ER...the needed CT scan can't be obtained in a timely fashion demanded by good medical care unless he goes to the ER. In doing so, I then have to put my clinic on hold, make my other patients wait, while I trudge over to the ER to duplicate much of the work and record that I had already done. The extra work is probably more than double given the inefficiencies of most ER's (ours is very efficient but not as efficient as my outpatient clinic because of different rules and regulations, also not of my doing nor the hospital's) is not my fault and certainly not my choice - it's the insurance company's. But it has to be done and I should be paid for it.
Someone around here mentioned administrative and regulatory inefficiencies as adding a lot of work and a lot of cost to the system. Yep.
FromMyColdDeadHand
03-11-19, 16:11
My apologies, I'm backing out of this thread.
I'm backing out of this thread.
Three steps towards the door....... ;)
While there are plenty of economic, political and fairness reasons that 'universal healthcare' is not as simple or good as it seems, I wanted to focus in the literal term "Medicare for all". It seems that is the shorthand that they want to use to get around terms like "socialized medicine" and 'universal healthcare".
As I pointed out, you pay into Medicare for decade before getting benefits, so that seems to be a big difference. I also knew that there different parts of Medicare and even insurance. So I asked my MIL about her and her sisters medicare.
My MIL is healthy as a horse. He sister is in the start of dementia and is in a controlled care facility. Really different use patterns.
MIL pays about $7k out of pocket for co-insurance and pays a bit of a premium due to income. She showed me her 2019 benefits and costs statement. That means medicare and the insurance cover almost all her costs with little or no deductible. I;'m not sure on the sisters co-inusrance, but I assume it similar since it covers all her care. What it doesn't cover is all her drug costs and she is in the 'donut hole' on those where she has bog out of pocket payments as coverage stops and before it starts again. I don't know the exact dollars there.
But what you can see is- with all the parts and insurances you need to add to be truly 'covered'- it is pretty complex and definitely not simple. Also, Medicare isn't 'free coverage' and there are still private insurances. So the idea that young people may have- and how the commies are selling it- are wrong. You can still get into financial problems even with 'medicare' coverage.
And lastly, that doesn't even address the fact that Medicare pays about $0.20 on the $1.00 for reimbursement. Now we know the list price are BS, but Medicare pays less than regular insurance, so if you went with all medicare payments, there would be less dollars for care- and something has to give.
My main point is that "Medicare for All' isn't a solution to the real problems and it is an implied lie that it would address all the cost, price and access issues. It won't.
Averageman
03-11-19, 16:45
I was watching something on YouTube (Agree, not the best source for the truth.) but, it mentioned that Doctors now have less time for seeing a Patient due to the billing and payments for Medicare are less than conventional insurance billing, is this true?
If that is a fact (I do not know that it is.) how does this effect the care and decision making process?
I was watching something on YouTube (Agree, not the best source for the truth.) but, it mentioned that Doctors now have less time for seeing a Patient due to the billing and payments for Medicare are less than conventional insurance billing, is this true?
If that is a fact (I do not know that it is.) how does this effect the care and decision making process?
It is a fact, but it’s actually a conflation of two different problems. Problem 1...Medicare reimburses about $.20 on the dollar. Increasingly, small practices and large systems are finding that accepting Medicare patients isn’t financially viable because they end up without sufficient doctors to care for their entire patient load. They have to decide to make room for the patients that have insurance that reimburses more. The Mayo Clinic (all locations), for example, is no longer accepting new Medicare patients for that reason. They can’t afford it. They lose money on every patient. Problem 2...the regulatory and documentation burden for doctors these days has become ridiculous. Primary care doctors spend abut two hours on the computer documenting patient care for every hour that they spend actually providing patient care. As you might imagine, that’s kind of a bummer for someone who became a doctor because they grew up watching Marcus Welby, and is the main reason for unprecedented rates of physician burnout, in turn the reason there is a critical shortage of Family Practitioners, and in turn the reason that your new doctor is probably actually a nurse. Patient care and decision-making...? It probably happens some places but I don’t see those issues affecting patient care and decision-making. The biggest problem caused by these two issues is the rapidly decreasing number of primary care doctors, and the fact that they see fewer patients in a day.
Averageman
03-11-19, 20:33
Makes sense to me.
sundance435
03-12-19, 10:16
It is a fact, but it’s actually a conflation of two different problems. Problem 1...Medicare reimburses about $.20 on the dollar. Increasingly, small practices and large systems are finding that accepting Medicare patients isn’t financially viable because they end up without sufficient doctors to care for their entire patient load. They have to decide to make room for the patients that have insurance that reimburses more. The Mayo Clinic (all locations), for example, is no longer accepting new Medicare patients for that reason. They can’t afford it. They lose money on every patient. Problem 2...the regulatory and documentation burden for doctors these days has become ridiculous. Primary care doctors spend abut two hours on the computer documenting patient care for every hour that they spend actually providing patient care. As you might imagine, that’s kind of a bummer for someone who became a doctor because they grew up watching Marcus Welby, and is the main reason for unprecedented rates of physician burnout, in turn the reason there is a critical shortage of Family Practitioners, and in turn the reason that your new doctor is probably actually a nurse. Patient care and decision-making...? It probably happens some places but I don’t see those issues affecting patient care and decision-making. The biggest problem caused by these two issues is the rapidly decreasing number of primary care doctors, and the fact that they see fewer patients in a day.
Serious question - I thought Medicare reimbursement was closer to 60% of established rates? Not necessarily 60% of what private insurance will pay, which is usually a negotiated rate, anyway. On the other side, hospitals/specialists/physician group facilities don't accept Medicare because they're not making any money on it, but because they're not making as much as they could through a private insurer.
I have heard that Medicare regulatory compliance is a nightmare and independent studies have shown that it adds a not-insignificant amount of cost to a healthcare operation. It's probably far simpler to deal with private insurers because the burden is ultimately on the patient, which is not how it should be. There's a lack of accountability from anyone but the patient (and Medicare), at this point.
Averageman
03-12-19, 11:02
I had a very good British friend who woke up one morning and pissed blood, so he goes to the Doctor.
The Doc sent him to a Specialist, the Specialist set him up for further diagnostic evaluations and then they determined he had cancer. When his turn for an operation came up, the Surgeon didn't show because of a snow storm, so they put him back in the system for another appointment.
So, if any of all of this is beginning to sound like the DMV or the VA, perhaps it is because it's another inefficient government run system.
BTW, the poor guy got his appointment and then died on the table.
I think about him everytime someone mentions the need for our government to run our healthcare system.
On the other side, hospitals/specialists/physician group facilities don't accept Medicare because they're not making any money on it, but because they're not making as much as they could through a private insurer.
I have heard that Medicare regulatory compliance is a nightmare and independent studies have shown that it adds a not-insignificant amount of cost to a healthcare operation. It's probably far simpler to deal with private insurers because the burden is ultimately on the patient, which is not how it should be. There's a lack of accountability from anyone but the patient (and Medicare), at this point.
Yes. When you have limited provider resources, you have to make a decision as to whom you are going to treat relative to how much their payor is going to reimburse. With Medicare, it's all-or-none. You can't pick and choose your Medicare patients. If you accept Medicare, you have to see them all.
As to remibursement, it varies widely from region to region. Around here, it's 20% when you take denials into account. With Medicare, there's no pre-authorization possible. You do an operation, for example, then have to hope that Medicare won't deny it after the fact. Which is not uncommon.
And yes, Medicare comes with a HUGE regulatory burden, as you would expect from a government with a history of truly profound bureacracy.
I have not had to deal with it from the provider standpoint as hmac has, but I have dealt with it from a leadership in the hospital perspective. It is a pain in the ass, no doubt. It all has a trickle-down effect as well with funding being controlled or pooled based on patient outcomes. So it's not just about the funding upfront, there is control throughout process.
Every veteran has dealt with socialized medicine with the VA or with military medicine. It's all about rationing resource and cost mitigation. We have seen what that does.
FromMyColdDeadHand
03-12-19, 17:37
I had a very good British friend who woke up one morning and pissed blood, so he goes to the Doctor.
The Doc sent him to a Specialist, the Specialist set him up for further diagnostic evaluations and then they determined he had cancer. When his turn for an operation came up, the Surgeon didn't show because of a snow storm, so they put him back in the system for another appointment.
So, if any of all of this is beginning to sound like the DMV or the VA, perhaps it is because it's another inefficient government run system.
BTW, the poor guy got his appointment and then died on the table.
I think about him everytime someone mentions the need for our government to run our healthcare system.
I have two workmates that had parents in Britian, had. Both died from flu/colds that got out of hand, with delay of care being a primary cause they didn't make it. Old people die of a lot of routine stuff, but routinely, they die of routine stuff in socialized care.
Serious question - I thought Medicare reimbursement was closer to 60% of established rates? Not necessarily 60% of what private insurance will pay, which is usually a negotiated rate, anyway. On the other side, hospitals/specialists/physician group facilities don't accept Medicare because they're not making any money on it, but because they're not making as much as they could through a private insurer.
I have heard that Medicare regulatory compliance is a nightmare and independent studies have shown that it adds a not-insignificant amount of cost to a healthcare operation. It's probably far simpler to deal with private insurers because the burden is ultimately on the patient, which is not how it should be. There's a lack of accountability from anyone but the patient (and Medicare), at this point.
I had three bills for short hospitalizations/ED triggered events from my MIL's sister. All three were within a few percent of 20% reimbursement rate.
So the issue is that if your provider doesn't have a 'deal' with the hospital system that you visit for something- they get charged the full boat rate. That is why they want you at an in system facility where even if it isn't 'theirs', they might pay 50% rather than the suckers 100%.
So the issue is that if your provider doesn't have a 'deal' with the hospital system that you visit for something- they get charged the full boat rate. That is why they want you at an in system facility where even if it isn't 'theirs', they might pay 50% rather than the suckers 100%.
I don't follow this at all. Hospitals can't make "deals" with providers. It's a blatant violation of Stark Laws.
I don't follow this at all. Hospitals can't make "deals" with providers. It's a blatant violation of Stark Laws.
Okay, I said I was bowing out, but I've been following. I submit the following as an example:
I was at the dentist being scheduled for a root canal and cap - apparently a 30 year-old root canal can go bad if the cap isn't sealed or something, I trust my dentist and I was having problems, so there you go. The last stop was the part when they make sure you know what you are going to pay. I saw the chart and the following discussion ensued:
Me: Wow, so this would cost almost 2,000 bucks if I didn't have insurance?
Nice, about to be confused, office lady: Yes it would, but when you consider the write off we give the insurance company, and what they cover, your cost will be $400.00
Me: So, you charge more for a root canal and cap if folks don't have insurance.
Nice office lady: No, everyone pays the same, we just give the insurance company a write off.
Me: Let me make sure I understand, at the end of the day with the 1200.000 the insurance is paying, and my 400.00 co-pay you are getting a total of 1600.00 for doing my root canal.
Nice office lady, who doesn't like where this is going: Yes, but that's with the write off.
Me: But if I didn't have insurance, I'd be paying you a total of 2000.00, correct.
Nice office lady, trying to salvage it, but failing: Well. yes, but most of our patients have insurance.
Me: I know you aren't the one who sets prices, or decides how things are run, so I don't mean to upset you, I just think there are a lot of unfair practices in medical billing. (or something like that - I apologized for any discomfort - the total write off was a couple hundred for the root canal and almost one fifty for the cap IIRC, nimbers in example are approximate, this was a couple years ago)
I think that's what FromMyColdDeadHand meant by the 'deal' and the 'suckers.'
Now, I'm going back in my hole.
FromMyColdDeadHand
03-12-19, 21:55
I don't follow this at all. Hospitals can't make "deals" with providers. It's a blatant violation of Stark Laws.
Sorry, between insurance and providers. If the insurance doesn't have a deal with the provider, the insurance company gets a bill for full boat price. Not sure if the insurance didn't set up their plan right and people are going out of system and the penalties don't line up with the costs.
I assume you provide services for a number of hospitals. I assume you have a contract? That isn't what I was referring to.
26INF ins't off, but that is between an individual and the provider. Mine was about insurance company and out of system providers.
Okay, I said I was bowing out, but I've been following. I submit the following as an example:
I was at the dentist being scheduled for a root canal and cap - apparently a 30 year-old root canal can go bad if the cap isn't sealed or something, I trust my dentist and I was having problems, so there you go. The last stop was the part when they make sure you know what you are going to pay. I saw the chart and the following discussion ensued:
Me: Wow, so this would cost almost 2,000 bucks if I didn't have insurance?
Nice, about to be confused, office lady: Yes it would, but when you consider the write off we give the insurance company, and what they cover, your cost will be $400.00
Me: So, you charge more for a root canal and cap if folks don't have insurance.
Nice office lady: No, everyone pays the same, we just give the insurance company a write off.
Me: Let me make sure I understand, at the end of the day with the 1200.000 the insurance is paying, and my 400.00 co-pay you are getting a total of 1600.00 for doing my root canal.
Nice office lady, who doesn't like where this is going: Yes, but that's with the write off.
Me: But if I didn't have insurance, I'd be paying you a total of 2000.00, correct.
Nice office lady, trying to salvage it, but failing: Well. yes, but most of our patients have insurance.
Me: I know you aren't the one who sets prices, or decides how things are run, so I don't mean to upset you, I just think there are a lot of unfair practices in medical billing. (or something like that - I apologized for any discomfort - the total write off was a couple hundred for the root canal and almost one fifty for the cap IIRC, nimbers in example are approximate, this was a couple years ago)
I think that's what FromMyColdDeadHand meant by the 'deal' and the 'suckers.'
Now, I'm going back in my hole.
That is the contracted rate they get from the insurance companies. Think of it as a volume discount. The insurance company sends 20 people to provider X and they offer a 20% discount to the insurance company. The insurance company saves money by promising more volume. By doing this the insurance company saves money on claims and therefore can charge lower rates to the members that buy their insurance. It is a win win for everyone.
That is the contracted rate they get from the insurance companies. Think of it as a volume discount. The insurance company sends 20 people to provider X and they offer a 20% discount to the insurance company. The insurance company saves money by promising more volume. By doing this the insurance company saves money on claims and therefore can charge lower rates to the members that buy their insurance. It is a win win for everyone.
Since you replied to me, I'll reply back.
I get how it works, I think it is bullshit.
So, I get in a wreck, go to the body shop and get an estimate, I'll bet it works out that if I pay cash, instead of making them go through the claims submission deal, and waiting for payment, my price out the door is going to be a bit cheaper.
Why shouldn't medicine work that way? It used to.
And, you miss the point, since most American have insurance, medical practices are predominantly geared toward accepting insurance, therefore they can make their nut with what the insurance company pays.
According to the census bureau, over 90% of Americans have insurance, so the minority of folks who are having to pay cash really wouldn't impact the bottom line if they were charged at the insured rate.
If you reply and I don't respond, it is because I'm trying to stay out of this thread, which has worked well so far. :rolleyes:
Okay, I said I was bowing out, but I've been following. I submit the following as an example:
I was at the dentist being scheduled for a root canal and cap - apparently a 30 year-old root canal can go bad if the cap isn't sealed or something, I trust my dentist and I was having problems, so there you go. The last stop was the part when they make sure you know what you are going to pay. I saw the chart and the following discussion ensued:
Me: Wow, so this would cost almost 2,000 bucks if I didn't have insurance?
Nice, about to be confused, office lady: Yes it would, but when you consider the write off we give the insurance company, and what they cover, your cost will be $400.00
Me: So, you charge more for a root canal and cap if folks don't have insurance.
Nice office lady: No, everyone pays the same, we just give the insurance company a write off.
Me: Let me make sure I understand, at the end of the day with the 1200.000 the insurance is paying, and my 400.00 co-pay you are getting a total of 1600.00 for doing my root canal.
Nice office lady, who doesn't like where this is going: Yes, but that's with the write off.
Me: But if I didn't have insurance, I'd be paying you a total of 2000.00, correct.
Nice office lady, trying to salvage it, but failing: Well. yes, but most of our patients have insurance.
Me: I know you aren't the one who sets prices, or decides how things are run, so I don't mean to upset you, I just think there are a lot of unfair practices in medical billing. (or something like that - I apologized for any discomfort - the total write off was a couple hundred for the root canal and almost one fifty for the cap IIRC, nimbers in example are approximate, this was a couple years ago)
I think that's what FromMyColdDeadHand meant by the 'deal' and the 'suckers.'
Now, I'm going back in my hole.
Dentists?
Nah...:rolleyes:
sundance435
03-13-19, 08:56
That is the contracted rate they get from the insurance companies. Think of it as a volume discount. The insurance company sends 20 people to provider X and they offer a 20% discount to the insurance company. The insurance company saves money by promising more volume. By doing this the insurance company saves money on claims and therefore can charge lower rates to the members that buy their insurance. It is a win win for everyone.
Right, but if the non-insurance price is inflated/artificial to begin with, there's no real savings. I'm thinking $90/aspirin here.
Since you replied to me, I'll reply back.
I get how it works, I think it is bullshit.
So, I get in a wreck, go to the body shop and get an estimate, I'll bet it works out that if I pay cash, instead of making them go through the claims submission deal, and waiting for payment, my price out the door is going to be a bit cheaper.
Why shouldn't medicine work that way? It used to.
And, you miss the point, since most American have insurance, medical practices are predominantly geared toward accepting insurance, therefore they can make their nut with what the insurance company pays.
According to the census bureau, over 90% of Americans have insurance, so the minority of folks who are having to pay cash really wouldn't impact the bottom line if they were charged at the insured rate.
If you reply and I don't respond, it is because I'm trying to stay out of this thread, which has worked well so far. :rolleyes:
The provider automatically inflates prices to give a "discount" to the ins. co., right? If that isn't a flawed/paradoxical system, I don't know what is. If the provider can make money on a $1600 procedure for insured patients, then they artificially set the price at $2000 for those without.
Sorry, between insurance and providers. If the insurance doesn't have a deal with the provider, the insurance company gets a bill for full boat price. Not sure if the insurance didn't set up their plan right and people are going out of system and the penalties don't line up with the costs.
I assume you provide services for a number of hospitals. I assume you have a contract? That isn't what I was referring to.
26INF ins't off, but that is between an individual and the provider. Mine was about insurance company and out of system providers.
That isn't the way it works at all. And 26INF is trying to compare a private dental office and dental insurance to medical care and reimbursement under medical insurance. It's not even apples and oranges. It's apples and tennis balls.
And no, private practice physicians don't have contracts with hospitals except in a very special circumstance called Provider Service Agreement, which is a hybrid between private practice and employed physician model. Private practice physicians have no financial relationship or contract with the hospitals at all. Hospital-employed physicians are simply employees and don't submit any bills at all. Their employer (the hospital) submits the bills for the work that they do.
Hospitals and private practice physicians (as opposed to physicians that are hospital employees) each negotiate reimbursement rates with insurance companies, and separately. They have to submit the same bill and charges for all insurance companies whether they have a negotiated rate or not. The insurance company parses the bill and pays the negotiate discounted rate according to the contract. If the patient's insurance company is one with whom the physician doesn't have a negotiated rate then that insurance company just denies the whole bill and that bill is now the responsibility of the patient. IOW, if the insurance company doesn't have a deal with the provider (or the hospital) the provider (or hospital) can submit a bill for the "full boat price" but the insurance company is going to just smile sadly and put that bill through the shredder and the next bill that goes out goes to the patient. Obviously therefore, it behooves the doctors' office to ascertain on the front end whether the patient that checks in at the front desk has insurance that that office can accept, otherwise they risk non-reimbursement. Likewise, a smart patient will get their care from a doctor's office that accepts the medical insurance that they have. Otherwise they risk getting stuck with a big bill. That's never a surprise. The first thing that the receptionist does when you check in is look at your insurance, and they'll disclose on the front end what your financial responsibility is based on your insurance.
In some cases, there is "tiering"....different negotiated reimbursement rates. Some hospitals can get better rates from a given insurance company than others and they may be in a higher "tier". In that case, the hospital and the doctor (they may each be in different tiers) submit the bill for their usual published fee schedule, the insurance company parses the bill and reimburses according to the tier that the doctor/hospital is in. In that case, the balance of the bill is the patient's responsibility. We talk about providing free medical care...I write off over $100,000 a year in unpaid medical bills, often from patients in that category. More often, when the patient is informed on the front end (as they always are) of what their financial responsibility is, they elect to find a provider that is "in network" or in a higher tier. It's a problem. A couple of years ago, our group got moved into a lower tier with one of our insurance companies. Many of our patients, some that had been with us for decades, suddenly found that they couldn't afford the higher co-pay, or the new 80/20 rate that they would have to pay and after all that time and that longstanding relationship, they had to now find a different doctor. In other cases, the contract rate that the insurance company offers is so low that the medical practice or the hospital just decides to stop accepting that insurance. In that case, those patients with that insurance that go to that doctor or hospital anyway have to pay the whole bill themselves. They'll be warned beforehand, however.
Stop getting sick and getting old.
Problem solved :)
Since you replied to me, I'll reply back.
I get how it works, I think it is bullshit.
So, I get in a wreck, go to the body shop and get an estimate, I'll bet it works out that if I pay cash, instead of making them go through the claims submission deal, and waiting for payment, my price out the door is going to be a bit cheaper.
Why shouldn't medicine work that way? It used to.
And, you miss the point, since most American have insurance, medical practices are predominantly geared toward accepting insurance, therefore they can make their nut with what the insurance company pays.
According to the census bureau, over 90% of Americans have insurance, so the minority of folks who are having to pay cash really wouldn't impact the bottom line if they were charged at the insured rate.
If you reply and I don't respond, it is because I'm trying to stay out of this thread, which has worked well so far. :rolleyes:
You aren't alone. It's a common sentiment, even among physicians. I think it's bullshit too. Don't mistake my arguing with you as meaning that I support the current system.
Most doctors are terrible businesspeople. They didn't go into Medicine and invest 13-15 years in college/medical school/residency/Fellowship to have to deal with this insurance company bullshit (and NO part of that education addresses any of the business aspects of Medicine). Most doctors don't deal with it...they just hire people to deal with it for them because they don't have the time to take care of sick people and manage the ever-increasing load of bullshit that goes along with being a doctor these days. Doctors are generally just as frustrated as you by the system as it exists, probably more so. We think it's bullshit too. If you find them arguing with you, it's going to be because your arguments, based on a very incomplete understanding of the "system" and it's complexities, are often way off the mark like MyColdDeadHand's. I don't begrudge you your frustration. I have my own frustrations, but mine are based on a much more accurate understanding of the complexities of the situation, so my arguments have to start with correcting your misimpressions. We want the same thing in the end, but I know that it's not as simple as you think it is. It's like taking out a gallbladder. What's the big deal? You just cut the patient open and cut the thing out. You and I each have a different understanding of what that entails.
Since you replied to me, I'll reply back.
I get how it works, I think it is bullshit.
So, I get in a wreck, go to the body shop and get an estimate, I'll bet it works out that if I pay cash, instead of making them go through the claims submission deal, and waiting for payment, my price out the door is going to be a bit cheaper.
Why shouldn't medicine work that way? It used to.
And, you miss the point, since most American have insurance, medical practices are predominantly geared toward accepting insurance, therefore they can make their nut with what the insurance company pays.
According to the census bureau, over 90% of Americans have insurance, so the minority of folks who are having to pay cash really wouldn't impact the bottom line if they were charged at the insured rate.
If you reply and I don't respond, it is because I'm trying to stay out of this thread, which has worked well so far. :rolleyes:
Let us assume it is true that 90% of Americans have insurance. Of that 90% what percentage can afford the out of pocket expenses their policy doesn't cover. Being insured doesn't mean they are adequately insured. I did the math earlier. There are families who are insured but only after paying 20K+ (premiums and deductible) per year do they have any real coverage.
So, I get in a wreck, go to the body shop and get an estimate, I'll bet it works out that if I pay cash, instead of making them go through the claims submission deal, and waiting for payment, my price out the door is going to be a bit cheaper.
Why shouldn't medicine work that way? It used to.
Well, maybe it used to, but I can't remember a time since I've been in practice that that's been true. And cash payment doesn't apply to Medicare. A Medicare patient doesn't have the option of paying cash for medical care under any circumstance except if and when the doctor has opted out of Medicare participation. For those patients, it's Medicare or nothing.
Non-Medicare patients pay cash for medical care all the time. It's not common, but it happens. They generally get a discounted rate, not because of the claims submission hassle, nor for the waiting for payment. The discounted rate that they get is typically the same as the discounted rate the insurance company would get according to the agreement the hospital executed with them. As to waiting for payment....typical delay in payment from insurance would be 60 days minimum, often as much as 90 days. That assumes that they don't just deny the payment altogether, in which case it can go far, far longer as the appeals process plays itself out. That's usually still shorter than the payment plan that hospitals give non-Medicare patients that want to pay cash for their operation, which may well extend into a year or more, with no interest fees possible.
Cash "settlement" still occurs. According to our business folks, it still happens, and it's not a small percentage, either. If you are an international patient they require you to sign a waiver saying you will front for all the costs, sometimes international patients can get their respective insurers or whoever to pay for it on the back end, some will pay for it upfront. What is interesting is if patients want to pay out-of-pocket for our procedures, even international patients, it is cheaper than the cost of the procedure with insurance.
I don't know if hmac even touched on the provider peer-to-peer which adds more administrative time and decreases the amount of time a provider can spend with a patient. We hired a mid-level to do peer-to-peer calls and that takes half of her day, everyday.
I don't know if hmac even touched on the provider peer-to-peer which adds more administrative time and decreases the amount of time a provider can spend with a patient. We hired a mid-level to do peer-to-peer calls and that takes half of her day, everyday.
Peer-to-peer is a joke. It's basically a conversation with the insurance company's Medical Director wherein I have to justify to him/her why a given operation or treatment that they have denied is justified. We have not had a high success rate letting that conversation take place between the Medical Director and an APRN. Those Medical Directors are generally a primary care doctor (not surgeon) who has been long out of active practice and may or may not even have an active medical license. They have not seen or examined this patient and usually have no clue about the nature of the operation that that patient needs. They exist to bring the "credibility" of an MD to the insurance company's denials, which was usually issued initially by a non-medical reviewer basing the denial off a list of criteria in a book on their desk. These Medical Directors typically don't read ANY current medical literature, let alone surgical literature so my discussion with them is a general review of the anatomy, physiology, and current literature that supports the proposed operation. They tend to be frustrating, time-consuming phone conversations that often end up with an arbitrary denial despite the evidence. I actually get very few denials these days, ever since I started opening the conversation by saying "Doctor, this conversation is being recorded to make sure there are no misunderstandings if we end up taking the case to the State Insurance Commissioner's office...".
Peer-to-peer is a joke. It's basically a conversation with the insurance company's Medical Director wherein I have to justify to him/her why a given operation or treatment that they have denied is justified. We have not had a high success rate letting that conversation take place between the Medical Director and an APRN. Those Medical Directors are generally a primary care doctor (not surgeon) who has been long out of active practice and may or may not even have an active medical license. They have not seen or examined this patient and usually have no clue about the nature of the operation that that patient needs. They exist to bring the "credibility" of an MD to the insurance company's denials, which was usually issued initially by a non-medical reviewer basing the denial off a list of criteria in a book on their desk. These Medical Directors typically don't read ANY current medical literature, let alone surgical literature so my discussion with them is a general review of the anatomy, physiology, and current literature that supports the proposed operation. They tend to be frustrating, time-consuming phone conversations that often end up with an arbitrary denial despite the evidence. I actually get very few denials these days, ever since I started opening the conversation by saying "Doctor, this conversation is being recorded to make sure there are no misunderstandings if we end up taking the case to the State Insurance Commissioner's office...".
Yep. And as a surgical Subspecialist I am frequently talking to a family medicine “peer” doing the peer to peer, who tells me in short order that he has no idea what I’m talking about and needs to refer this to someone in my specialty.
Business_Casual
03-14-19, 18:27
Just FYI, this is the door that opens your front door. Literally. If the State pays for your healthcare and you have kids, the State will take the right to enter your home under the guise of monitoring the health of the children. I lived in a country with socialized healthcare and we had a little red, I kid you not, book that we had to keep on our kid and the social worker would visit your home and check it.
Just FYI, this is the door that opens your front door. Literally. If the State pays for your healthcare and you have kids, the State will take the right to enter your home under the guise of monitoring the health of the children. I lived in a country with socialized healthcare and we had a little red, I kid you not, book that we had to keep on our kid and the social worker would visit your home and check it."A government big enough to give you everything you want is a government big enough to take from you everything you have." -Gerald R. Ford
Sent from my SM-G973F using Tapatalk
Just FYI, this is the door that opens your front door. Literally. If the State pays for your healthcare and you have kids, the State will take the right to enter your home under the guise of monitoring the health of the children. I lived in a country with socialized healthcare and we had a little red, I kid you not, book that we had to keep on our kid and the social worker would visit your home and check it.
What country? What was in the book that they were checking?
Yep. And as a surgical Subspecialist I am frequently talking to a family medicine “peer” doing the peer to peer, who tells me in short order that he has no idea what I’m talking about and needs to refer this to someone in my specialty.
We're one of 3 places in the country that does what we do. NONE of the docs on the other end of the line for the peer-to-peer understand a single thing we do. Then the amount of documentation and background me and my colleagues have to provide to my docs and our hospitals insurance people is voluminous and the huge time suck.
Powered by vBulletin® Version 4.2.5 Copyright © 2024 vBulletin Solutions, Inc. All rights reserved.