SpeedoGuy
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I can't believe there isn't a healthcare thread
- Thread starter Notaguru2
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Great article:
Like Your Health Insurance? Maybe You Shouldn't
until you have a serious illness, the kind where your plan's limits and exclusions may kick in, how do you know if your health coverage is any good?
Like Your Health Insurance? Maybe You Shouldn't
until you have a serious illness, the kind where your plan's limits and exclusions may kick in, how do you know if your health coverage is any good?
Christ, I'm a damn human spellchecker, but you're going pretty damn far into Grammar Nazi-land. However, if you want to get technical, prior to starting this thread, he couldn't believe (figuratively, mind you) that at that time there was no health care thread. So, as he was writing and titling the thread, a health care thread still did not exist. He stated the problem and then remedied it by making the initial post.
Like another poster I am in some ways disappointed that this discussion has not been far more broad in scope and to see the low number of participants.
My family was in the medical business. My late stepfather was a physician and surgeon in the greater Los Angeles area. Because of this, I have watched a steady and incredible decline in health care and I have also seen insurance carries begin to slowly dictate to MD's what health care is based on what they the insurance carriers will pay for.
MD's working for HMO's are dictated to by the accountants in a different way. What happens there is that MD's who save the parent company money are promoted and given merit raises in pay while those promoting the best of care are either held back or they are released from their contracts. I knew an MD who started with an HMO and was released after two years. He framed the letter and posted it in his private practice waiting room years later. The letter was extremely vague and gave the reasons for termination as being high costs of treating his patients and their diagnoses. That was years ago and it has only gotten worse.
To get out of paying for things insurance carriers and HMO providers simply classify anything they do not want to pay for as "experimental". They then make up statistics to back up their positions.
Here are some of the things that are currently classified as "experimental" by most but not all insurance carriers.
1. Erectile dysfunction treatment. They will often pay for diagnosis simply because it gives them clues to other things such as probability for heart disease, blood sugar abnormalities, and endocrine disorders. This allows them to begin the process of moving the patient into a higher risk category. After gaining the information, treatment for the condiditon however is denied because according to most the medications are classified as "experimental". These experimental medications include all the oral medications for ED, the trans-urethral pellets, and the injectables. What is really bizarre is that some of these people will not pay for medications, but some will pay for intracavernosal implants and the related surgery which would in most cases buy 15 years of the other medications in cost.
2. Most carriers will quickly pay for hormone replacement therapy in a female, but if a male comes back with female hormone patterns he better get ready to be fitted for a bra, because about 50% of all carriers will deny payment for threatment without an incredible fight for a male needing the same thing. The use the false logic that replacement can cause cancer in a male, where replacement in a female and the increased risks for cancer are overlooked.
What is really a crock is that 90% of the medical community has not followed the studies out of Europe. There are studies that took place about a decade ago that showed that prostatic enlargement was NOT a result of DHT, but was a result of a hormone balance. Move the male hormone patterns out of this certain range and the prostatic enlargement stopped. Those studies have been going for years. It's cheaper to do nothing about anything and hope the patient dies first.
3. In my Mother's case because of her age diagnostic tests were repeatedly denied. She was rushed to Eisenhower Medical Center in Rancho Mirage, California with a heart attack in 2001. This was at age 80. Common tests done after a cardiac incident would have uncovered the fact that the heart attack was mild, but, that she also had an abdominal aortic aneurysm that was about to blow. The HMO to save themselves money denied all cardiac care and denied my Mother CCU. Instead of CCU she was transferred directly from ICU to a convalescent home. At the convalescent home she was not even attached to a cardiac monitor. She was discharged and died at home 1 week later when the aneurysm blew. I contacted a specialist Attorney. That Attorney on meeting showed me on paper that he currently had litigation in the amount of 52 cases filed against this same HMO for doing exactly the same thing.
What shocked me was that one of the cases he had was from the family of a 27 year old male who in Southern California had been exposed to "Necrotizing Staph" which he had somehow contracted it was felt at a San Diego area gym.
He died because the HMO under which he was covered simply refused to pay for the testing which would have quickly identified the causative agent. This of course spreads very quickly, and they saved a ton of money by simply allowing the patient to die.
Guys, these kinds of things have the potential inside the U.S. to get any one of you and until it happens to you or someone to whom you are close it is easy to listen to those individuals who say that everything is just great as it is.
This time is one where you may have the power to decide the future of yourself and your loved ones.
My family was in the medical business. My late stepfather was a physician and surgeon in the greater Los Angeles area. Because of this, I have watched a steady and incredible decline in health care and I have also seen insurance carries begin to slowly dictate to MD's what health care is based on what they the insurance carriers will pay for.
MD's working for HMO's are dictated to by the accountants in a different way. What happens there is that MD's who save the parent company money are promoted and given merit raises in pay while those promoting the best of care are either held back or they are released from their contracts. I knew an MD who started with an HMO and was released after two years. He framed the letter and posted it in his private practice waiting room years later. The letter was extremely vague and gave the reasons for termination as being high costs of treating his patients and their diagnoses. That was years ago and it has only gotten worse.
To get out of paying for things insurance carriers and HMO providers simply classify anything they do not want to pay for as "experimental". They then make up statistics to back up their positions.
Here are some of the things that are currently classified as "experimental" by most but not all insurance carriers.
1. Erectile dysfunction treatment. They will often pay for diagnosis simply because it gives them clues to other things such as probability for heart disease, blood sugar abnormalities, and endocrine disorders. This allows them to begin the process of moving the patient into a higher risk category. After gaining the information, treatment for the condiditon however is denied because according to most the medications are classified as "experimental". These experimental medications include all the oral medications for ED, the trans-urethral pellets, and the injectables. What is really bizarre is that some of these people will not pay for medications, but some will pay for intracavernosal implants and the related surgery which would in most cases buy 15 years of the other medications in cost.
2. Most carriers will quickly pay for hormone replacement therapy in a female, but if a male comes back with female hormone patterns he better get ready to be fitted for a bra, because about 50% of all carriers will deny payment for threatment without an incredible fight for a male needing the same thing. The use the false logic that replacement can cause cancer in a male, where replacement in a female and the increased risks for cancer are overlooked.
What is really a crock is that 90% of the medical community has not followed the studies out of Europe. There are studies that took place about a decade ago that showed that prostatic enlargement was NOT a result of DHT, but was a result of a hormone balance. Move the male hormone patterns out of this certain range and the prostatic enlargement stopped. Those studies have been going for years. It's cheaper to do nothing about anything and hope the patient dies first.
3. In my Mother's case because of her age diagnostic tests were repeatedly denied. She was rushed to Eisenhower Medical Center in Rancho Mirage, California with a heart attack in 2001. This was at age 80. Common tests done after a cardiac incident would have uncovered the fact that the heart attack was mild, but, that she also had an abdominal aortic aneurysm that was about to blow. The HMO to save themselves money denied all cardiac care and denied my Mother CCU. Instead of CCU she was transferred directly from ICU to a convalescent home. At the convalescent home she was not even attached to a cardiac monitor. She was discharged and died at home 1 week later when the aneurysm blew. I contacted a specialist Attorney. That Attorney on meeting showed me on paper that he currently had litigation in the amount of 52 cases filed against this same HMO for doing exactly the same thing.
What shocked me was that one of the cases he had was from the family of a 27 year old male who in Southern California had been exposed to "Necrotizing Staph" which he had somehow contracted it was felt at a San Diego area gym.
He died because the HMO under which he was covered simply refused to pay for the testing which would have quickly identified the causative agent. This of course spreads very quickly, and they saved a ton of money by simply allowing the patient to die.
Guys, these kinds of things have the potential inside the U.S. to get any one of you and until it happens to you or someone to whom you are close it is easy to listen to those individuals who say that everything is just great as it is.
This time is one where you may have the power to decide the future of yourself and your loved ones.
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I was cared for in a gov't hospital (indian healthcare) most of my life. Many medicines were not covered, for example, if you need an antidepressant and Prozac doesnt work for you, oh well. You arent getting it. If you need your teeth filled and you are over 18 years old, you arent getting that either, they pull teeth only when you visit the indian hospital for any dentistry over the age of 18.
I am on about 11 medications daily and i pay well over $600 a month for private insurance and prescriptions. There is no way i want the government to pay for them. Many of them are expensive alternatives to cheaper versions that didnt work for me. I'd rather have what i pay for than to rely on anyone else to pay for them.
It's no one elses responsibility to pay for my medical issues. Mine are very expensive and unusual and they cost a lot if you dont have private insurance. People like me will make health care outrageously expensive for the rest of you when it averages out OR we will end up falling through the cracks because we cost to much money.
I had an issue that needed addressed by a specialist when i was 17 years old, it took over a DOZEN emergency room visits to have a doctor look back in my chart and refer me to a specialist. Which took ages to get into because it had to be contracted out through the indian hospital.
I also grew up with no pediatrician. You dont get one, you just show up to be seen if you have a cold or something and wait about 12 hours in the waiting room. It sucked, i dont want this at all. I pay good money to avoid it.
I also got a different Obstetrician every visit during my pregnancy, you dont get to pick one. You get who is working that day and who is on call when you give birth. You guys are on another planet if you assume anything ran by the government is FAST, FREE, CHEAP and EFFICIENT in any way.
Last but not least, your health problems are not my responsibility to pay for....i'll spare you mine in the process.
Oh and i chose not to have my baby there, not because they cant be trusted, but because they dont give you epidurals during labor. It costs the hospital too much and there arent enough anesthesiologists to be available outside of legitimate surgeries to offer them to laboring women.
I am on about 11 medications daily and i pay well over $600 a month for private insurance and prescriptions. There is no way i want the government to pay for them. Many of them are expensive alternatives to cheaper versions that didnt work for me. I'd rather have what i pay for than to rely on anyone else to pay for them.
It's no one elses responsibility to pay for my medical issues. Mine are very expensive and unusual and they cost a lot if you dont have private insurance. People like me will make health care outrageously expensive for the rest of you when it averages out OR we will end up falling through the cracks because we cost to much money.
I had an issue that needed addressed by a specialist when i was 17 years old, it took over a DOZEN emergency room visits to have a doctor look back in my chart and refer me to a specialist. Which took ages to get into because it had to be contracted out through the indian hospital.
I also grew up with no pediatrician. You dont get one, you just show up to be seen if you have a cold or something and wait about 12 hours in the waiting room. It sucked, i dont want this at all. I pay good money to avoid it.
I also got a different Obstetrician every visit during my pregnancy, you dont get to pick one. You get who is working that day and who is on call when you give birth. You guys are on another planet if you assume anything ran by the government is FAST, FREE, CHEAP and EFFICIENT in any way.
Last but not least, your health problems are not my responsibility to pay for....i'll spare you mine in the process.
Oh and i chose not to have my baby there, not because they cant be trusted, but because they dont give you epidurals during labor. It costs the hospital too much and there arent enough anesthesiologists to be available outside of legitimate surgeries to offer them to laboring women.
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So what would you do if you could NOT afford 600 dollars a month yet made too much money to qualify for public assistance with your healthcare?
Glad that's cleared up because grammar nazi-land was beginning to get a bit too comfortalbe. But i guess you need to get out of thread nazi-land.
D_Tintagel_Demondong
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The death panels will gitcha! :deal:
These quick and efficient panels will cull the elderly and gimpy to compensate for the existing medicaid debt.
Proof.
These quick and efficient panels will cull the elderly and gimpy to compensate for the existing medicaid debt.
Proof.
D_Fiona_Farvel
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Or, more importantly, if not to her tastes, she and her family can fully and without issue retain their own coverage.
Ahh, the beauty of 'opt-in' (choice). :wink:
Eta:
There will always be some people that prefer to deal and struggle with healthcare and pharmaceuticals as the system is today. They can't imagine an alternative, or, a positive one, so the inadequate one in place is preferable.
This is absolutely their choice, however, it does not alter the fact that the healthcare, or "disease management system", to quote someone, is in need of a complete overhaul. With Obama's proposal being a first step in that process.
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I'm not an American, although many of my relatives are. I sincerely hope you all get a better, fairer healthcare system. I can't for the life of me understand why the wealthiest nation on the planet cannot organize a public health system that works.
I was talking to a friend here in Turkey who is moving to Canada. He asked about healthcare and the cost of drugs. He is on five different heart medications. His total bill for the month is 50 dollars and these are all name brand (Lilly, phizer etc) pills. The national health care isn't paying for them either. He pays cash over the counter to the druggist. Americans are getting taken to the cleaners by the drug companies. A US firm researches, develops, tests and markets drugs and sells them ten times cheaper to people in Asia than they do to Americans? Whats up with that??
My friend will get insurance in Canada once he establishes residency, in spite of his pre-existing condition. Canada can insure foreign residents with pre-existing conditions, but our Indy who has worked and paid taxes and premiums his whole life is worried about going broke because of his medical issues? WTF?
I hate this "we can't" attitude. What happened to "Yes we can"?
I was talking to a friend here in Turkey who is moving to Canada. He asked about healthcare and the cost of drugs. He is on five different heart medications. His total bill for the month is 50 dollars and these are all name brand (Lilly, phizer etc) pills. The national health care isn't paying for them either. He pays cash over the counter to the druggist. Americans are getting taken to the cleaners by the drug companies. A US firm researches, develops, tests and markets drugs and sells them ten times cheaper to people in Asia than they do to Americans? Whats up with that??
My friend will get insurance in Canada once he establishes residency, in spite of his pre-existing condition. Canada can insure foreign residents with pre-existing conditions, but our Indy who has worked and paid taxes and premiums his whole life is worried about going broke because of his medical issues? WTF?
I hate this "we can't" attitude. What happened to "Yes we can"?
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I guess all of that was pointless. I've managed to afford what i've needed to me entire adult life. I've had to budget for it, make payments to the doctors offices or hold out on getting a prescription if i can avoid it. Its just the way life is. I'd rather do that than to be under a government ran healthcare. I've explained why i would rather avoid it and keep doing what i have been.
Whether i made 7$ an hour or what we make now. We've done it.
I guess whatever i write about my experience with gov't healthcare and their lack of funds to make things proper doesnt give a shit. There is no arguing with you IndustrialSize. It's always the same, your way or the highway.
People do what they have to, they prioritize things in order of importance. People will spend that much on a car payment each month on a car they cant afford and then expect ME to pay higher and higher taxes to cover their costs of healthcare.
You forget we have healthcare for poverished children and the elderly. Its not like we arent helping those who make virtually no money to live on. Most of us in America just manage our money very poorly and many are looking for a bailout for their own horrible financial decisions. Its not my problem.
Whether i made 7$ an hour or what we make now. We've done it.
I guess whatever i write about my experience with gov't healthcare and their lack of funds to make things proper doesnt give a shit. There is no arguing with you IndustrialSize. It's always the same, your way or the highway.
People do what they have to, they prioritize things in order of importance. People will spend that much on a car payment each month on a car they cant afford and then expect ME to pay higher and higher taxes to cover their costs of healthcare.
You forget we have healthcare for poverished children and the elderly. Its not like we arent helping those who make virtually no money to live on. Most of us in America just manage our money very poorly and many are looking for a bailout for their own horrible financial decisions. Its not my problem.
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Once again, you dont read anything. You take none of my experience into account. I've been without money, i've been on government healthcare for about 20 years of my life, it wasnt fun. It sucks and everyone else will find that out when they get their way with the health care.
I also found a way to pay for what is important in my life. Today's poor people have cell phones and fake nails.
I live in a very poverished state and much of my family duped the government to not have to pay their way. Call me burned out but i really don't care anymore.
$600 a month isnt a big deal when its your life. You work out payment plans with the doctors and hospitals like the rest of us.
Let me ask you again- What has the government ever done that wasnt costly, inefficient and a waste? Do you think this will be ANY different?
Also, anytime someone else is footing your bill, you run it up faster and with less concern. So go ahead and burden the health care system with snotty noses in the emergency room being seen instead of real priorities. People who dont have to pay for their bills are more likely to go in for insignificant things. And this makes the wait longer and our physicians and nurses more frustrated, and us more frustrated.
Im not some bleeding heart waiting for a government ran utopia, i actually think this out and use common sense.
Ask our veterans, especially the ones with real health problems (especially the elder veterans) how the VA hospitals are treating them and their real medical concerns.
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I respect your right to deny yourself care and your rights to hasten your own demise.
I am saddened however at what appears to be an ability to recognize that the plight of many other adults is dissimilar if not completely different than your own.
If you are a transplant patient and your required drugs to prevent organ rejection would cost you $3,500 per months, could you afford that? Many private carriers have reduced drug benefits on fixed cost drugs. It is not like Cyclosporine and all of it's various derivitives have radically increased in price, it is that the companies in question have in the name of increased proftits reduced their benefits.
Failure to stick to a prescribed regimen of anti-rejection therapy kills the transplanted organ, and in so doing kills the patient.
I too recognize the problems in some managed health care plans. The idea of this one is to take the plans and make them better for all United States Citizens. My experience with private medical insurance carriers has been dismal. Denial of payment and excuses as to why payment was denied again and again. We just finished paying off $5,000 in debt caused by denial of wound care affter a common (non-necrotizing) staff infection because the company repeatedly simply denied all costs and with every letter the reasons for denial changed. The reason for denial on a plan that was paid into by a combination of payroll deduction and employer contribution is worthless. I myself have repeatedly had denials of payment for lab tests, and, I have also had repeated denials of payment for the office calls when the lab tests requested by the MD's were denied.
I have also had the displeasure of seeing some very poorly administrated "government run" programs that were as bad as some of the commercial insurance plans available. There is no doubt that not all plans are good, and this means governmental and State run as well.
There is also no doubt that the entire system here is broken, and that the breakage is on all levels. We in the United States are in some cases paying 500% more for the same drugs that companies send to other markets. One of my largest complaints with regards to the current plan as proposed is that it does not address this issue.
This country never seems to learn. We deregulate the energy industry and all of a sudden the costs of energy go through the roof. We deregulate the pharmaceutical industry and the same happens in our market for these products to American Citizens. We deregulate the petroleum industry and the same thing happens.
In each of these cases, the selling points proposed by the industries seeking deregulation to the United States Senate and Congress were that competition between competing companies would save money for the consumer and drive down prices.
In my own life, as a teen with a Stepfather as an MD, I needed some medication for an upper respiratory infection. This illness took place on a trip to Nogales, Arizona. We were told by relatives to go into Nogales, Mexico to get the medication. My Stepfather was shocked when he had expected to pay about $30 in 1969 dollars for that medication. The total cost was about $3.25 as I remember.
It is also your right to feel that it is an honor to pay $600 per month for your medications out of pocket. If you were in Mexico or Canada those same medications would probably be costing you about 1/2 that amount or less.
Most of us are facing great problems, that you don't seem to recognize.
About 20 years ago my then 52-year-old Uncle was diagnosed with prostate cancer. His treatment and follow up by the time it was all over cost over $150,000.00. Had they subscribed to your viewpoint, they would have had the honor of selling everything they owned to pay those kind of medical bills. As it was, portions not covered by the insurance exceeded $30,000.00.. Maybe you have the financial resources to afford a situation like this, but most of the rest of us fall into the most financially abused group of people in history in this country and these are referred to as "the middle class". By the way, that Uncle was at last check still alive and well after his treatment.
I had an acquaintance who after seven bouts with Non-Hodgkins Lymphoma (not hiv related) found himself in The City of Hope Medical Center in Duarte, California. Cost of that treatment over a period of several years was nearly $500.000.00. He is still alive and well and he beat Non Hodgkins Lymphoma.
The disease process from diagnosis to full recovery in this man lasted over 5 years. I guess it would have been much cheaper and his honor to have just died.
His private insurance carrier by the way started denial of all care when the bill reached about $100,000,00. He beat the cancer and is still alive because of government programs that stepped in when the private carrier was given the option to deny care.
I am saddened because you refer to things which would tend to indicate that part of your heritage is Native American. Your negative experiences and your situation is one of the things that so many are in fact fighting to change and resolve. Your medical care and denials of care based on what you have stated by your words, are felt to be based on your heritage. Again, that is what those of us fighting for meaningful improvements are fighting to change. Quite frankly the reason that medical care has problems is that most people serving in public life (a nice way of saying Senators and Congressmen) are not under the same health care as we are.
If we can get a single pay system as already exists in many other countries, they would be.
How bad do you think medical care is going to be if the guy sitting next to you in the waiting room to see the doctor is a Senator or Congressman. (By the way? Is Congresswoman or Congressperson politically correct?)
I can only see two exemptions in all honesty to this system.
Exemption #1
Active military and those serving in foreign countries, and this is because of locations and the types of wounds received in battle, and #2 the President of the United States. Those should be the ONLY two exceptions to the rules.
Now, applying this to the Obama family. President Obama would be covered under the plan designed for him, Michelle and the kids would get the same plan that the rest of us have.
We have just successfully fixed the system if the politicians are in the same pool.
SpeedoGuy
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Its because of the ingrained for-profit motive that underlies so much of our mindset.
Yes We Can afford a McMansion.
Yes We Can afford a BMW and a Lexus.
Yes We Can afford a wide screen television and premium cable TV service.
We Can't afford to help subsidize our fellow citizens' basic healthcare.
This might help some people if you know someone who needs some help.
HRSA - Find a Health Center - Search Page
Cheers
HRSA - Find a Health Center - Search Page
Cheers
name one thing the government has done right. have you ever dealt with any branch of the government?
have you ever had to deal with their totally insane way of thinking?
just think of all the stupid things they have done,said and wasted money on and then decide if you really want to put your life in their hands.
you'll be dead before you can even get the paper work filled out.
have you ever had to deal with their totally insane way of thinking?
just think of all the stupid things they have done,said and wasted money on and then decide if you really want to put your life in their hands.
you'll be dead before you can even get the paper work filled out.
SpeedoGuy
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No matter what anyone replies, its already clear you're going to ridicule it, disparage it, or change the terms of the question.
Questions like this convey such a mindset of absolute certainty that it robs you of credibility.
Never done anything right?
Can you really back that up or are you just expressing frustration?
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