So trivial, yet it really ticks you off.

Discussion in 'The Observation Bar' started by GHT, Mar 21, 2015.

  1. LizzieMaine

    LizzieMaine Bartender

    I have severe vision problems. I have had to make choices on treatment based not on what is best for my long-term ability to see-- and therefore to continue working in my field as a productive member of society -- but on the basis of what treatment I can afford to pay for.

    I do not have freedom of choice.
     
  2. ChiTownScion

    ChiTownScion One Too Many

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    A "like" only because I agree.. but the reality of the comment makes me both sad and angry.
     
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  3. GHT

    GHT I'll Lock Up

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    Had Lizzie been a UK citizen, her GP, that's our terminology for a general doctor, or General Practitioner, would have referred her to an ophthalmologist for a consultation and, if needs be, corrective eye surgery. The NHS serves everyone the same, she would get the best surgeon in her area, and at the end of her treatment she wouldn't pick up the tab. it might be that she would require continued ongoing treatment, so be it, that's how our system works.

    But as Fading Fast pointed out, being free to all means that it's subject to abuse. The downside is that some time waster has called an ambulance. The time that that ambulance crew have spent dealing with such trivial non emergencies robs those in dire need of that ambulance. I'll give you just one example that had my wife spitting blood and feathers. She responded to a call where a guy claimed that he had put a garden fork through his foot, all he had was a deeply embedded rose thorn in his thumb. When the crew challenged him about the garden fork he denied it. What the guy didn't know was that all calls are recorded and in his case he was invoiced for the call out.

    But the kind of abuse to the system that really costs our health service a good deal of money are the time wasters. 20% of hospital appointments are never kept, people just don't turn up, no call, no apology, yet if those same people need emergency care, they expect their hospital to serve on demand when they turn up. Such is the nature of social health care.
     
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  4. tonyb

    tonyb Vendor

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    I checked into a local hospital early in the morning of January 31 of this year. The first person I dealt with there laid out the estimated out-of-pocket costs for my visit and fairly forcefully suggested I make that payment right there and then. I gave her half and told her that in my experience the estimates are never accurate (they tilt in the hospital’s favor) and that I would wait for the dust to settle before settling up.

    A couple hours later I was sedated and spent about an hour having a device implanted.

    I was held in the hospital overnight and released the next morning.

    A few weeks later I received in the mail an “explanation of benefits” from my health insurer — you know, one of those “THIS IS NOT A BILL” missives, according to which the provider (the hospital) billed $190,275.18. But after “discounts and payments” of $189,728.17 I was left with a remaining obligation of $547.01. Oh, and $3.55 for my piece of what radiology imaging tacked on to the bill.

    And then a couple weeks after that I get the actual bill for about a hundred bucks less.

    The most fitting word for all this is “absurdity.”

    I don’t know how much the hospital discounted its services to the insurance company, but I’m confident it was all but a small fraction of that 190 grand and change. My out-of-pocket was relatively modest in part because with this hospitalization I have paid my entire $5,000 obligation for this “benefit year,” which runs from July 1, 2018 through June 30, 2019.

    I can more than imagine what people without health insurance go through, as I am personally familiar with folks who have been ruined financially by health crises. It embarrasses me for all of us that we allow this to continue.
     
    Last edited: Mar 25, 2019
  5. ChrisB

    ChrisB A-List Customer

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    Health care has become a racket.
     
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  6. LizzieMaine

    LizzieMaine Bartender

    The word "kleptocracy" comes to mind.
     
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  7. tonyb

    tonyb Vendor

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    The implanted device to which I alluded above is sometimes characterized as an “insurance policy” by those in the field. Chances aren’t all that high that I will ever need what it does, but if I do, it could well save my life.

    Now, if I were uninsured, and was faced with either paying 190K (hah!) or taking my chances, I might opt for the latter. At the very least, the thought would surely cross my mind.

    Yes, the providers would likely discount their services, but a half or a third or even a quarter of that amount is as much or more than many of our hardworking (if not truly gainfully) employed fellows see in a full year.

    I may value my own life more than any other person’s, but there’s no morally justifiable reason the rest of us should.
     
    Last edited: Mar 25, 2019
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  8. LizzieMaine

    LizzieMaine Bartender

    The worst part of it for me is I do have insurance -- I pay about $500 a month for it thru work -- but every year the plan covers less and charges more, both for employee contributions and in the deductible. I had eye surgery last year to head off retinal separation, but the insurance refused to cover it, leaving me on the hook for the whole thing. I did get a "discount for using an in-system provider" for which I should be, I suppose, on my knees before the Holy Blue Cross. But even with that discount, it meant skipping other bills over the winter. So when I went back in February for a six month follow up I had to tell them straight up I couldn't afford any additional surgeries in the immediate future, and we'll just have to wait and see. So to speak, because my vision is even worse now. I see double much of the time, which makes it inconvenient when I'm trying to align the projector at work.

    On the positive side, I guess, I finished paying off my 2015 appendectomy last fall, and just this month finished paying off my 2016 kidney stone. Meanwhile, the insurance company stockholders are doing just fine.
     
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  9. tonyb

    tonyb Vendor

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    ^^^^^
    Like most of us with “employer-provided” health insurance, we see a big chunk of my wife’s pay deducted for our contribution to the plan. And that’s before any co-pays and whatever else we shell out above and beyond that. (Another 5 G’s for me this “benefit year.”)

    The system works well enough for me and for now. We are not yet reduced to eating the family pets. But that could change in an instant.

    The stress of coping with life-threatening conditions isn’t made any lighter by financial ruin. Friends, a married couple a few years younger than me, barely squeak by on a month-to-month basis. They once had a modest house and a not-elderly car and all the other standard trappings of lower middle-class life. She then got cancer. Twice. He contracted a virus that destroyed a heart valve. He sports an artificial valve now, but he had a couple of strokes while all that was happening. He now works for minimum wage, while she collects a pension, thanks to her 35-year employment in a union shop. She also picks up a few bucks doing mostly domestic work.

    These are decent people. They’re honest, they do (and have done) work of real value, they play by the rules. And here they are, approaching retirement age, and they can’t plan for anything more distant than getting through the current month.

    And it’s all on account of their being so irresponsible as to fall ill.
     
    Last edited: Mar 25, 2019
  10. sheeplady

    sheeplady I'll Lock Up Bartender

    In the current for-profit system, there seems to be little concern for fraud. Oh, I am sure that if a member tried to defraud an insurance company, they'd get slammed. But providers get a pass and in some cases appear to be in kahoots.

    I've been the personal "victim" (not sure that is the correct word) of providers charging me for procedures I've never gotten, appointments I never attended (or made), and products never received at least 3 or 4 times.

    I tried to report blatant fraud by a provider (they charged for an appointment I never attended and services never rendered, to the tune of over $350). I was told by the insurance company that the provider could then bill ME directly for the fraudulent claim... if I reported it as fraud to my insurance company and they denied it as fraud, the provider would charge ME for the fraud appointment.

    Yup. I was discouraged from reporting insurance fraud to my insurance company. And the sad thing is, I know from personal experience what they say is right.

    I spent a whole year of daily phone calls to clear $280 of fraudulent double billing after my insurance company determined it was fraud and the provider came back and billed me...

    It makes me so very happy to think of the thousands of dollars I pay in fraudulent claims everytime I get the $363 removed from my paycheck for my insurance.

    And I only go to the doctor 5 times a year: twice to the dentist, once to my PCP, once to my oncologist, and once to my GYN.
     
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  11. tonyb

    tonyb Vendor

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    Much as the lovely missus and I shell out for health insurance and copays and all that, I’m still confident that on balance we cost the system more than we pay into it — not year-to-year, maybe, but certainly over every four or five years.

    But then, I’ve paid into many a system of which I have NEVER made direct use. I don’t have kids, but I’ve been financing schools for 50 years or so. I’ve paid for social programs I’ve never used and likely never will. Et cetera, et cetera. That’s how a healthy society works, or ought to. I want the neighbor kids to get good educations, no matter how unsophisticated in that regard their parents might be. I want food in their bellies and clothes on their backs. I view that as ultimately being in my own best interest.
     
    Last edited: Mar 27, 2019
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  12. Woodtroll

    Woodtroll Practically Family

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    That's a great point of view, well explained. I think it is in everyone's best interest for those who are unable to take care of themselves to be tended to at least to a basic needs level (especially the elderly, children, and disabled). Those who are able to take care of themselves, however, are another matter and are one of my pet peeves. Call them entitled, lazy, leeches, or whatever you want - I don't see how we can continue to add folks to the rolls who won't or can't contribute, while the percentage of those who do contribute to "the system", "the establishment", or whatever you want to call it grows smaller every year. When we make it more profitable to NOT work, we help no one.

    There are certainly no easy answers here.
     
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  13. Zombie_61

    Zombie_61 I'll Lock Up

    That's because in our current for-profit system they already have their falsely over-inflated costs built-in, so they don't need fraud to make sure everyone gets paid off.

    In 1988 it became necessary for me to take an ambulance ride. A month later a representative from the ambulance company called to inform me I owed them $1,200 for the privilege. I verified the cost was covered by our insurance and told her so, but the rep insisted that wasn't the case and that payment was my responsibility. We received weekly calls about this for a couple of months, then the calls suddenly stopped. A month later the Los Angeles Times ran an article that stated the ambulance company had been shut down and were under Federal investigation for fraud. Including, of course, double billing. o_O
     
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  14. sheeplady

    sheeplady I'll Lock Up Bartender

    I have no problems paying more into the system than I get out. For healthcare, I'd prefer if I could do that, getting your money's worth out of the healthcare system is like winning the bad luck lottery. (I should know as a stage III cancer survivor.)

    But the truth is, the system is crooked. I thank God I had decent insurance when I went through treatment; we didn't even bother opening up some of our Explanation of Benefits at the time we were so stressed. The idea that fraud could happen like I've experienced on different insurance was... laughable. Honestly the insurance was that good... we had the best plan the company offered nationally. (It was so good we thought it might have been "Cadillac insurance," but it wasn't.)

    I've been on two different insurances since. I pay a premium (about $2,000 a year) to have the "best" plan as far as benefits from my employer. And it's only half as good as my insurance was two insurance companies ago. Not because of the companies, but because my employer doesn't have the economic clout or connections to get a plan as nice as the much larger and prestigious employer did.
     
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  15. tonyb

    tonyb Vendor

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    Yeah, I know, I know: People gotta be incentivized to get off their asses and do something of real value to the rest of us. And part of what incentivizes people is employment that pays well enough to cover one’s bills and still be left with a couple nickels to rub together.

    I don’t know it is so, as you assert, that fewer people, as a percentage or in absolute numbers, are contributing with each passing year. And many receiving benefits, such as those buying-in to Medicaid or receiving partial subsidies for private health insurance purchased on the state exchanges, are working (and paying taxes), so they are both “makers” and “takers.” (As are the overwhelming majority of us, in one way or another.)

    What I do know is true, though, is that the proportion of the wealth being created is being concentrated in fewer hands.

    Leeches? Yeah, we got ’em — poor ones, rich ones, some in-between ones.
     
    Last edited: Mar 28, 2019
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  16. tonyb

    tonyb Vendor

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    I don’t know the best way to address this sad state of affairs. But I strongly suspect that the people best positioned to address it have no real desire to do so.

    I had a major surgery a dozen years and some months ago. The percentage chances of my not surviving it were in the single digits provided a complicating condition wasn’t present, and in the teens if it were. Determining whether it was there or not wouldn’t be certain until I got cracked open.

    I found the best way to cope, in the lead-up and immediate aftermath, was to disregard almost all the correspondence relating to it — from the hospital, the physicians and surgeons, the anesthesiologists, the insurance company. Seemed like even the people in the hospital gift shop were expecting to get something out of me.

    It turned out to be costly, but we had relatively good insurance so it wasn’t so costly as to ruin our finances. We maxed our annual out-of-pocket, and we were grateful that there was a lid on what we would have to pay.
     
    Last edited: Mar 28, 2019
  17. GHT

    GHT I'll Lock Up

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    My wife and I have enjoyed many a visit to Uncle Sam's shores, but we have always agreed that it's not a country that you would want to be poor in. I have been following these comments on insurance health care and in honesty, I find it painful to read.

    You can call it political manipulation if you like, but having no worries of a medical bill certainly helps you sleep at night. For those interested this is what it costs to have a National Health Service:
    An employee is deducted 12% of their wage for every penny above the first £162 (per week) of their pay. On top of this, employers contribute 13.8%. The median wage is £27,195. That's somewhat lower because part time workers are included, but working on that figure the cost would be.
    Employee £27,195 less £8,424 (that's the annual figure of the first £162 per week.) 12% of £20,771 = £2492 per annum.
    Employer £27,195 13.8% = £3,753. Total cost £6245. (employee & employer costs combined.)
    At the current rate of exchange that's $8300 US or $160 per week for full, complete, medical cover.

    There are a few variations and there are exemptions, the main ones being, those in full time education, the elderly and those out of work. If any of those categories have unearned income though, they will become liable to pay. The reason for that is to stop the wealthy from transferring funds to family members.

    Remember that the above figures do not include income tax.
     
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  18. tonyb

    tonyb Vendor

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    Costly as your system is, it’s still less costly than ours, by quite a margin.

    As I noted in a couple-three posts back, our system works pretty well for me, and for now. And, as I noted, that could change in a heartbeat, or want thereof. So even with “good” insurance, which gets me access to pretty much every appropriate therapy available, I worry for what I’ll be dealing with a year from now, or five years or 10 (should I be so fortunate), as my circumstances change.

    I got a taste of that a few months ago, when funding for a diagnostic procedure ordered by one of my specialists was denied by the insurance company, which determined it wasn’t medically necessary. This specialist grumbled to me about how much of her workday is spent arguing with the physicians in the employ of the insurance companies, who, from her perspective, plainly know which side their bread is buttered on.

    Rationed care? You bet it is. Always has been, always will be, no matter how else it might be characterized. It’s a world of finite resources.
     
    Last edited: Mar 28, 2019
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  19. 3fingers

    3fingers One Too Many

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    I'm sure somebody in this nearly 500 page tome has mentioned it already, but I'm here to vent my spleen on internet comment sections. It matters not what site you go to or what position they take, many comments both in support and opposition of any article take the affliction of moronism to new heights.
    It saddens me that the ability to discuss or debate in a reasonable manner has been completely lost, but even worse the stupidity shown by far too many people on both sides of any argument has caused me to completely swear off of even reading what they have to say.
     
  20. Woodtroll

    Woodtroll Practically Family

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    Upon revisiting this thread and reading through the replies, I realized that in part what I said wasn't exactly what I intended to say (but that's nothing new for me, unfortunately). I do not consider those who can't contribute due to age, infirmity, unemployment, or other involuntary reasons to be leeches or lazy; they are who the support system is supposed to be intended for in the first place.

    Those who choose not to work are not who the system should support, and I feel their burden will eventually lead to its failure. They should reap the consequences of their lack of work ethic, not all of us. And yes, there certainly are leeches at every stage of the health care system - my experiences certainly support that notion and I would never argue otherwise.
     
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