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Old 09-13-2008, 09:45 AM
 
Location: Houston, TX
2,373 posts, read 5,238,041 times
Reputation: 6211

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Quote:
Originally Posted by TristansMommy View Post
This is a heated and hot topic and has been in the past

I would like to hear your experience with the health care system. . all positive and negatives. What sacrafices have you made in order to afford health care for you and your family (if you purchase for yourself).

If you have health care through your employer do you feel it's adequate and what is your contribution? What kind of plan do you have.. deductables, lifetime caps etc.

If you purchase insurance for yourself what state are you in, what challenges have you faced in purchasing the insurance (denial, etc) and if you were able to purchase at a pretty "cheap" price what does that plan come with (what is the lifetime/yearly max, out of pocket etc) What percentage of your income goes to your monthly health insurance premiums.

If you are for or against a universal health plan , elaborate why. Do you think the current healthcare system is just fine or is it broken and why?
I have health care through my employer. I get medical, prescription, vision, dental, life insurance (for me and my spouse) and of course short and long term disability. For all those I pay $149.71 a month.

Now for the coverage. I and my husband are both covered with the following.

Medical:

Deductible: individual $400/Family$800
Max out of pocket (yearly): I-$2000/ F-$4000
Lifetime Max: $5,000,000 per covered person

Hospital Services: I pay 10% after deductible is met.

Physician Services:
Injections: 10% of cost. Allergy shots are covered at 100%
Nutrition counseling: $25 copay. Specialist $40 copay
Office visits: $25 copay. Specialist $40 copay
Preventive Care: $25 copay - mammograms covered at 100%
Professional fees for surgery: 10% after deductible is met.
Second surgical opinion: $25 copay

Pharmacy: Retail purchase (1-31 day supply)
Tier 1 = $10 copay
Tier 2 = $25 copay
Tier 3 = $40 copay

Pharmacy: Home Delivery (up to 90 day supply)
Tier 1 = $25 copay
Tier 2 = $63 copay
Tier 3 = $100 copay

Dental:
6 month office check ups: I pay $0
cavity filling: I pay 30%
root canals: I pay 50%

Vision:
$25 copay for eye exam
Up to $150 for frames
Lenses are 100% covered
Up to $125 for contacts

I have a lot more coverage in the medical and dental field, but since most of it doesn't apply nor will it ever apply I don't pay much attention to it.

To save time I just gave the information of my in-network stuff.

Personally I have more problems with doctors and hospitals than I ever have with my insurance. (sticking drugs in my hands, doing things that don't work over and over again, just transferring me from place to place, wrong billing, etc etc.)

The times I didn't have medical insurance I went to discount clinics (ie Planned Parenthood for my birth control).
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Old 09-13-2008, 03:05 PM
 
Location: God's Country, Maine
2,052 posts, read 3,973,738 times
Reputation: 1295
Quote:
Originally Posted by molochai2580 View Post
I have health care through my employer. I get medical, prescription, vision, dental, life insurance (for me and my spouse) and of course short and long term disability. For all those I pay $149.71 a month.

Now for the coverage. I and my husband are both covered with the following.

Medical:

Deductible: individual $400/Family$800
Max out of pocket (yearly): I-$2000/ F-$4000
Lifetime Max: $5,000,000 per covered person

Hospital Services: I pay 10% after deductible is met.

Physician Services:
Injections: 10% of cost. Allergy shots are covered at 100%
Nutrition counseling: $25 copay. Specialist $40 copay
Office visits: $25 copay. Specialist $40 copay
Preventive Care: $25 copay - mammograms covered at 100%
Professional fees for surgery: 10% after deductible is met.
Second surgical opinion: $25 copay

Pharmacy: Retail purchase (1-31 day supply)
Tier 1 = $10 copay
Tier 2 = $25 copay
Tier 3 = $40 copay

Pharmacy: Home Delivery (up to 90 day supply)
Tier 1 = $25 copay
Tier 2 = $63 copay
Tier 3 = $100 copay

Dental:
6 month office check ups: I pay $0
cavity filling: I pay 30%
root canals: I pay 50%

Vision:
$25 copay for eye exam
Up to $150 for frames
Lenses are 100% covered
Up to $125 for contacts

I have a lot more coverage in the medical and dental field, but since most of it doesn't apply nor will it ever apply I don't pay much attention to it.

To save time I just gave the information of my in-network stuff.

Personally I have more problems with doctors and hospitals than I ever have with my insurance. (sticking drugs in my hands, doing things that don't work over and over again, just transferring me from place to place, wrong billing, etc etc.)

The times I didn't have medical insurance I went to discount clinics (ie Planned Parenthood for my birth control).
All I can say is, WOW! Any clue what that is costing your employer?

Up here, the Legislature ran all the insurers out by requiring coverage with no community rating. A similar policy here will run you $2,000/mo.
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Old 09-13-2008, 09:01 PM
 
5,160 posts, read 6,610,508 times
Reputation: 3520
2 things that haven't been addressed in this debate: Cost and exclusions.

What percentage of your income will you be required to spend via taxes? No matter how you pay it via taxes or premiums you still will have the same dollar amount being spent in the country to procure the care. Will middle class working people really see difference in the money spent towards health care? Will they want to work harder and longer to support those who won't or can't work?

If you don't cut out some of the spending, taxes for the insurance will soon approach what would pay in premiums anyway. What should be cut? Do we stop treatments at a certain age? Do we exclude diagnoses instead? If we insist on having effective treatments, do we stop paying for palliative care?
Should we keep premature infants alive? Alzheimer's patients? Low cure rate cancer patients?

People mistakenly believe that if the government handles it, everything will be covered, the sky is the limit budget wise. It won't be. I'm in healthcare, and every year there are fights over declining goverment reimbursal rates, and what they will cover. That is no different than the "evil" HMO not paying for care.

Lots of questions, needing lots of answers before many are ready to sign on the bottom line.
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Old 09-13-2008, 09:13 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,111,845 times
Reputation: 908
Quote:
Originally Posted by fopt65 View Post
2 things that haven't been addressed in this debate: Cost and exclusions.

What percentage of your income will you be required to spend via taxes? No matter how you pay it via taxes or premiums you still will have the same dollar amount being spent in the country to procure the care. Will middle class working people really see difference in the money spent towards health care? Will they want to work harder and longer to support those who won't or can't work?

If you don't cut out some of the spending, taxes for the insurance will soon approach what would pay in premiums anyway. What should be cut? Do we stop treatments at a certain age? Do we exclude diagnoses instead? If we insist on having effective treatments, do we stop paying for palliative care?
Should we keep premature infants alive? Alzheimer's patients? Low cure rate cancer patients?

People mistakenly believe that if the government handles it, everything will be covered, the sky is the limit budget wise. It won't be. I'm in healthcare, and every year there are fights over declining goverment reimbursal rates, and what they will cover. That is no different than the "evil" HMO not paying for care.

Lots of questions, needing lots of answers before many are ready to sign on the bottom line.
I can agree with a lot of your post, in the sense that we haven't talked about dollars and cents here.

But.. from a purely logical viewpoint and not a factual viewpoint this is what I see.

First.. the working classes of people are currently paying into FICA or Medicaid for those that do not work or do not make sufficient incomes to sustain. So, we are paying into something and we are not getting in return. Now, obviously to sustain a larger scale program on a national level what we pay into it would be greater than what we are paying into FICA.. however perhaps FICA is not funded sufficiently enough because it's not a higher amount we're paying in.. and the reason for that is that we are not directly benefiting from it so it's hard to justify higher payments.

Second. . a UHI system would not be working for a "profit" so to speak.. it doesn't want to loose money of course, but profit to pay out to shareholders CEO's fat salaries, etc. would be trimmed. In addition so too could the administrative costs by havinga one payer system (this on the side of the Dr's AND the UHI). There's also the amount of money that goes into insurance companies lobbying in congress as a special interest. All of which we pay for in our premiums.

Third - if all Americans are insured (with the acception of the illegal immigrant populations) than there would be no such thing as an unpaid ER bill or procedural bill from lack of insurance or money to pay for it. That cost will no longer have to be passed on to the consumers that can actually pay with increase prices for the rest of us. I did link to a study quite some time ago in a thread about what the uninsured costs us .. but I don't know where that link is at the moment.

Of course a UHI is a hypothetical... and of course a serious look at the numbers would have to be done.. and done looking at several types of models including one with private along with UHi runing side by side.

I don't doubt it will have it's problems and how to address issues you've mentioned.. and all that already exists with private insurance. No system will be perfect.. because perfection is impossible. However, I do believe there is a much better solution out there than the system we currently have in the U.S I found the posts about the German system very encouraging.
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Old 09-13-2008, 09:24 PM
 
5,160 posts, read 6,610,508 times
Reputation: 3520
Quote:
Originally Posted by TristansMommy View Post
I can agree with a lot of your post, in the sense that we haven't talked about dollars and cents here.

But.. from a purely logical viewpoint and not a factual viewpoint this is what I see.

First.. the working classes of people are currently paying into FICA or Medicaid for those that do not work or do not make sufficient incomes to sustain. So, we are paying into something and we are not getting in return. Now, obviously to sustain a larger scale program on a national level what we pay into it would be greater than what we are paying into FICA.. however perhaps FICA is not funded sufficiently enough because it's not a higher amount we're paying in.. and the reason for that is that we are not directly benefiting from it so it's hard to justify higher payments.

Second. . a UHI system would not be working for a "profit" so to speak.. it doesn't want to loose money of course, but profit to pay out to shareholders CEO's fat salaries, etc. would be trimmed. In addition so too could the administrative costs by havinga one payer system (this on the side of the Dr's AND the UHI). There's also the amount of money that goes into insurance companies lobbying in congress as a special interest. All of which we pay for in our premiums.

Third - if all Americans are insured (with the acception of the illegal immigrant populations) than there would be no such thing as an unpaid ER bill or procedural bill from lack of insurance or money to pay for it. That cost will no longer have to be passed on to the consumers that can actually pay with increase prices for the rest of us. I did link to a study quite some time ago in a thread about what the uninsured costs us .. but I don't know where that link is at the moment.

Of course a UHI is a hypothetical... and of course a serious look at the numbers would have to be done.. and done looking at several types of models including one with private along with UHi runing side by side.

I don't doubt it will have it's problems and how to address issues you've mentioned.. and all that already exists with private insurance. No system will be perfect.. because perfection is impossible. However, I do believe there is a much better solution out there than the system we currently have in the U.S I found the posts about the German system very encouraging.
You are mistakenly believing the Doctors and UHI will be on the same page,they won't and can't. The goverment will be the new gate keeper, not the insurance company.
Health care costs will continue to exponentially increase as the population increases. It becomes a viscious cycle: we need more workers to pay into the system to raise revenue, but more people equals more expense. The system is doomed to lose unless you raise taxes so high that you start to lose support for the system.

Bottom line, services will have to be cut. Politicians won't have the guts to do this (imagine a platform based on euthenasia), and we'll play the shell game. Unaffordable premiums will just morph into astronomical, unaffordabe taxes.
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Old 09-14-2008, 09:21 AM
 
Location: Houston, TX
2,373 posts, read 5,238,041 times
Reputation: 6211
Quote:
Originally Posted by dmyankee View Post
All I can say is, WOW! Any clue what that is costing your employer?

Up here, the Legislature ran all the insurers out by requiring coverage with no community rating. A similar policy here will run you $2,000/mo.
My employer pays aprox $700/month for this policy.
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Old 09-14-2008, 09:46 AM
 
Location: Foot of the Rockies
84,960 posts, read 98,795,031 times
Reputation: 31371
Quote:
Originally Posted by rubytue View Post
Something to thing about, I just took the 6.5% tax mentioned for Germany. It worked out to about $15 more per month than I pay now for my health insurance. Although that does not include the fact that my health insurance is deducted pre-tax. Personally, I would be more than happy to pay $180/year extra, and thats far less than I currently pay into the medicare system (FICA) and I don't even use that!

I don't really buy the argument of not wanting to pay for other people's health issues. First, you are when you pay into FICA, which is covering some of the most expensive to treat people. Second, you are when you buy health insurance (its pooled risk) your money goes to fund everyone in your pool. Third, you are when you and/or your insurance pays the bills b/c you are covering other people that the doctor/hospital/etc wrote off.

Example - I had a $4500 test run (YIKES!!) My insurance refused to pay b/c my doctor didn't send it to the correct lab. I freaked. My doctor's office said no worries b/c that lab writes off those that don't pay. Think about the ramifications here. Those that pay that $4500 bill are essentially covering the costs of their own tests and some portion of those tests the lab wrote off.
My blue statement is the one I want to comment on first. Yes, UHI is likely to be as expensive as current health insurance is. That is what a lot of UHI supporters don't seem to understand. Health financing is complex. I work in a dr's office and I don't understand all of it, and the docs don't either. UHI has many benefits, but I don't think it will be cheaper, particularly if there are no co-pays, etc.

The lab experience is another thing. All these different insurances have contracts with different labs. It is really a pain, not to mention a waste of employee time (which is money) to keep up with all of this. I think a benefit of UHI would be an end to that stuff. That is one way UHI may make costs go down a little.
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Old 09-15-2008, 06:21 PM
 
Location: Sometimes Maryland, sometimes NoVA. Depends on the day of the week
1,501 posts, read 10,538,751 times
Reputation: 1091
Quote:
Originally Posted by Katiana View Post
My blue statement is the one I want to comment on first. Yes, UHI is likely to be as expensive as current health insurance is. That is what a lot of UHI supporters don't seem to understand.
I'm a bit confused. My entire point was the UHC will not add much, if anything, to our bill. I would say that its UHC opponents that never talk about or recognize this point, not UHC supporters. I'm not sure if thats a typo in your post, or I wasn't as clear as I meant to be, but I wanted to clarify.
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Old 09-15-2008, 07:38 PM
 
Location: Foot of the Rockies
84,960 posts, read 98,795,031 times
Reputation: 31371
Thanks for the clarification. I have heard and read much information where UHI proponents talk about how much cheaper UHI will be. I personally think it will cost as much if not more than pvt insurance. I'm not necessarily opposed to UHI.
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Old 09-16-2008, 02:07 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,111,845 times
Reputation: 908
Quote:
Originally Posted by Katiana View Post
Thanks for the clarification. I have heard and read much information where UHI proponents talk about how much cheaper UHI will be. I personally think it will cost as much if not more than pvt insurance. I'm not necessarily opposed to UHI.

What a UHI will do is keep costs from rising drastically.

First.. risk pool will be wide spread and THAT could drive down your premiums anyone.

In addition, with acceptions of non legal residents, there will be no such thing as an uninsured American. Hospital bills will not go unpaid and we will not have medical care via bankruptcy.. which passes the cost on to the rest of us.

There would also be trimmed costs in adminstrative with a more mainstreamed system. Doctors will not have to do 6 million (ok exageration - but yo uget the point) differnet billing codes and amounts for different plans.

There would be an elimination of "profit" and high CEO salaries to pay (yes, I am aware there will be salaries to pay.. but you get my point). We would also have removed from our premiums, the margin needed for the insurance companies to lobby in Washington.

Will it be perfect.. no. Will it be much cheaper.. well depends onhow you look at it.. and what your financial situation is. I think it would be more affordable and keep it within affordable lines in the future.
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