What's going on with health care? (Phoenix: sale, dermatology, health insurance)
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I just called Mayo and they do take Medicare patients, but they do not accept the Medicare payment as payment in full. Since you have BC/BS as a secondary insurer, they would bill them for the amount Medicare did not pay. You would be responsible for the portion left after both of your insurers had paid their amount.
If you want to go to Mayo, it will cost more, but you definitely can use your Medicare there. My mother was in Mayo after spending months trying to get a diagnosis from her primary physician and his specialists.
After one day at Mayo she was diagnosed with terminal lung cancer, which had gone undiagnosed by the other doctors she had been seeing for months. I think Mayo is worth the extra $$$.
With Medicare low balling physicians and hospitals, more people are having a difficult time finding doctors to treat them. It is a shame that sick people are turned down by physicians who cannot afford to treat Medicare patients and pay their overhead.
altus2006
As many of you might know, I'm a physician so I might be able to shed some light on this topic. I'm a Cardiologist. Among the patients I see, half are only on Medicare and don't have secondary insurance. If I don't get paid enough through Medicare alone so be it. I still make a comfortable living and I didn't get into medicine to treat only a certain segment of the population.
The Mayo Clinic on the other hand does cater to a select percentage of the population. They do require secondary insurance because they want to be paid more for their services.If they aren't reimbursed enough by Medicare, they want a secondary insurance to cover the remainder. President Obama has used the Cleveland Clinic and the Mayo Clinic as examples because they bill Medicare less than other hospitals like UCLA Med Center etc. However, the reason they bill Medicare less is because many of their patients have secondary insurance or are private cash paying wealthy patients. Many county hospitals like Maricopa County do not have that luxury like the Mayo Clinic of turning away patietns who lack a certain type of insurance or can't afford to pay. Mayo doesn't accept Medicaid but Maricopa does. Maricopa doesn't turn away illegals while Mayo does.
My girlfriend makes a 6-figure income and has great insurance provided by her employer. However, she had cancer about 4 years ago - all taken care of now. She just lost her job; along with that, she loses her group health coverage once cobra runs out. With a pre-existing condition, there is no way any private insurance company will give her coverage - right at the time (age 55) that she needs it. The current system is fundamentally flawed in that people are denied coverage right at the time they actually need it.
You can paint all kinds of doom and gloom pictures, but - the simple fact is, countries such as France have better 'outcomes' than the US, for far less expenditure.
It is utter nonsense to suggest that a public insurance option will put private insurance companies out of business. In the UK, many people opt for private insurance, but the NHS is there as a safety-net.
People freak out at the thought of the 'Government' making decisions about their health, yet the Insurance Companies have a terrible track-record of making very, very bad decisions and we seem ok with that.
Has anyone noticed that private education (Stanford, Yale, Harvard, etc) still seems to be surviving despite the existence of a public education option (UC Berkeley, ASU, etc) ...
Bring on a public health option. Life as we know it will continue, I assure you ...
Private Insurance is difficult to deal with but compared to the government they are better. I worked in the VA hospital for years and if you think your private insurance plan is bad about denying coverage, you haven't see the government in action. At the VA, they limit patients to 1-2 types drugs. Drugs that are no longer used are still being used at the VA. In addition, many wards in the VA have 4 patients and one bathroom to a room. Getting tests approved. The first year working at the VA was so stressful but not for the reason you think. The patients were great and extremely hospitable and grateful. The problem was getting the govt to approve tests and procedures that private insurance would do automatically. You had to learn the VA system and how to practice within that system because it was so limited. I'm in the private world now and it's so much easier than what I had to deal with at the VA.
Also, Medicaid or ACCHS provides horrible coverage. Many doctors won't even accept ACCHS because like the VA, they don't approve of many tests that private insurance covers without question.
You mentioned the UK, a family of 4 pays 27% in income tax. In the United States, that same family pays 11.9%. They pay more than double the amount of income tax we pay not to mention higher taxes overall. In France, a family of 4 pays 41.7% in income tax. Sweden pays 42.4% in income taxes. Unless you are willing to pay 60% in taxes don't expect to have the same quality of care as those countries. The money has to come from somewhere so if you are paying less taxes yet want govt healthcare, the only solution is to ration care. Obviously, they are paying for that socialized health care in higher taxes. It's not free like you would like to think. Also, those private plans in the UK are expensive are only enjoyed by the top 5% of earners there.
Lastly, the issue isn't whether private insurance will exist. It will exist although many will be closed. The issue is that quality of care will go down and rationing will exist. Let me explain. When private insurance is forced to lower its premiums to compete with the govt, do you think they will still provide the same services they are now? What do companies typically do in this country when they are forced to bear higher costs? Do they absorb those costs and charge the same prices or do they shift the costs onto the consumer? I think we know the answer to that. In order to save costs, private insurance companies will limit the number of specialist visits, will limit the types of drugs you can use, will make it more difficult to get surgeries approved.
I'm not opposed to a Co-op to keep insurance companies honest but I don't favor a govt takeover of healthcare. Furthermore, why hasn't there been any mention of tort reform in this legislation. I don't believe in placing caps on punitive damages but we should make it more dificult for lawyers to file frivolous lawsuits. 3/4 of all suits against physicians that go to trial favor the physician proving that most lawsuits are bogus. Unfortunately there are many more lawsuits that doctors don't fight because its cheaper to settle out of court than go to court. The data that lawyers provide saying that malpractice only accounts for 1-4% of healthcare costs is misleading because it doesn't account for defensive medicine costs or what we physicians like to call "Cover Your A$$ Medicine" or CYA. Case in point, if a little kid hits her head while playing on the playground and has a cut requiring stitches, many ER docs will order a head CT to rule out an intracranial bleed due the risk of the girl suffering from an epidural hematoma and dying. The risk assessment shows a very low probability that the girl would have an epidural hematoma. However, if the girl dies, the patient's family will sue. The ER and Hospital will be sued and they will settle out of court paying the girl's family 1-2 million. So guess what happens, everyone gets an expensive head CT now. According to a Price Waters House Coopers survey 200 billion dollars in health care costs each are attributed to CYA medicine. Due to Sen John Edwards lawsuits, doctors are performing 4 times the rate of C sections that were done in 1970 to prevent risk of Cerebral Palsy (which Edwards accused of OBGYNs of causing because of failure to perform C-section). Interestingly, the incidence of Cerebral Palsy has not decreased in this country despite 4 times the number of c-sections preformed.
Last edited by azriverfan.; 08-21-2009 at 05:53 AM..
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"Ritchie, I'm pretty new to this, what is "rep-ed"? Also, how doe's a person post without posting their name? Sorry if these are dumb questions.
Darrell"
Up at the top right of every post there is a scale. You can "rep" (add to someone's reputation) someone and you can choose to leave a comment. However, unless you specifically type your name, it is completely anonymous.
I don't mind someone leaving a private message disagreeing or even name-calling. But to say "you're an idiot" and not have the guts to say who you even are--well, I don't think highly of that.
Besides, name-calling is a logical fallacy that one uses when he or she has no real arguement, so I take it as a compliment. I just wish the person had the guts to leave their name.
I appreciate your thoughtful response. I especially appreciate, and agree with, your issues with the costs (and hidden costs) of defensive medicine brought on by lawsuits.
My mom is 80 and lives in the UK; she never made much over minimum wage while she was working, and has never had to even think about the cost of medical coverage, and has received good care. Sure, she can't see a doctor 'tomorrow' - but then again, I called my doctor for my annual physical in January and was given a date - no kidding - in May.
Specifically ...
Quote:
Originally Posted by azriverfan.
...
You mentioned the UK, a family of 4 pays 27% in income tax. In the United States, that same family pays 11.9%. They pay more than double the amount of income tax we pay not to mention higher taxes overall. ... Unless you are willing to pay 60% in taxes don't expect to have the same quality of care as those countries. The money has to come from somewhere so if you are paying less taxes yet want govt healthcare, the only solution is to ration care. Obviously, they are paying for that socialized health care in higher taxes. It's not free like you would like to think.
Your figures take the worst case (family vs. single) from the report (for singles, it's almost the same tax in both countries - 4% difference). But more importantly, in the US, your healthcare premiums are not included in the 'tax' figures, nor are private retirement plan costs. I'm plugging $15,000 p/a into my 401K here, and I pay several more thousands for my group medical coverage (plus, I'm anticipating another $10-15,000 anually in premiums if I were to try to retire at 55) - since healthcare and retirement are covered in UK, it's not an apples-to-apples comparison. Compare US income tax+healthcare premiums+retirement plan costs to a UK tax, and the comparison will be more interesting.
But perhaps even more vital is the concept of 'no coverage'. In my case, I'm reasonably healthy so will probably - if my luck continues to hold - be able to get coverage at, say 55 in the private arena, but my girlfriend cannot - at any price. And any recurrence of her cancer will literally bankrupt her. So - what's the point of 'only paying 11%' tax if, when you reach 55, you can't retire. I've worked hard all my life, and gladly paid taxes, and saved lots of money for the future; but NO AMOUNT of personal savings can insulate you from a catastrophic illness - and THAT is what I'm now realizing as I get to my 50's and want to consider retirement.
Quote:
Originally Posted by azriverfan.
Also, those private plans in the UK are expensive are only enjoyed by the top 5% of earners there.
That was my understanding/perception when I left UK about 25 years ago; it is not the case today. My brother lives there and is in a very mediocre job, and has BUPA provided by his employer. It is not an expensive option for him. This is an area worth a lot more investigation as it gets to the heart of what the scare-mongers are suggesting in the US. Now, MOST people over there simply don't see the point of it, and thus don't pay for it; but it is there and is not terribly expensive.
Quote:
Originally Posted by azriverfan.
Lastly, the issue isn't whether private insurance will exist. It will exist although many will be closed. The issue is that quality of care will go down and rationing will exist. Let me explain. When private insurance is forced to lower its premiums to compete with the govt, do you think they will still provide the same services they are now? What do companies typically do in this country when they are forced to bear higher costs? Do they absorb those costs and charge the same prices or do they shift the costs onto the consumer? I think we know the answer to that. In order to save costs, private insurance companies will limit the number of specialist visits, will limit the types of drugs you can use, will make it more difficult to get surgeries approved.
After many years in various high-tech fields, I find myself now working in the technology area of medicine. I have never seen such a mess. Every insurance company has its own 'standard', 'format', 'process'. Every doctor has to conform to each and every different standard if they want to work with 'insurance company x'. Each state has its own reporting standards, licensing standards, etc. There is an entire cottage-industry dedicated to massaging and dressing up 'claims data' beteen doctors' offices and insurance companies. The statistics on 'administrative overhead' in the US are staggering.
Quote:
Originally Posted by azriverfan.
Furthermore, why hasn't there been any mention of tort reform in this legislation. I don't believe in placing caps on punitive damages but we should make it more dificult for lawyers to file frivolous lawsuits. 3/4 of all suits against physicians that go to trial favor the physician proving that most lawsuits are bogus. Unfortunately there are many more lawsuits that doctors don't fight because its cheaper to settle out of court than go to court. The data that lawyers provide saying that malpractice only accounts for 1-4% of healthcare costs is misleading because it doesn't account for defensive medicine costs or what we physicians like to call "Cover Your A$$ Medicine" or CYA. Case in point, if a little kid hits her head while playing on the playground and has a cut requiring stitches, many ER docs will order a head CT to rule out an intracranial bleed due the risk of the girl suffering from an epidural hematoma and dying. The risk assessment shows a very low probability that the girl would have an epidural hematoma. However, if the girl dies, the patient's family will sue. The ER and Hospital will be sued and they will settle out of court paying the girl's family 1-2 million. So guess what happens, everyone gets an expensive head CT now. According to a Price Waters House Coopers survey 200 billion dollars in health care costs each are attributed to CYA medicine. Due to Sen John Edwards lawsuits, doctors are performing 4 times the rate of C sections that were done in 1970 to prevent risk of Cerebral Palsy (which Edwards accused of OBGYNs of causing because of failure to perform C-section). Interestingly, the incidence of Cerebral Palsy has not decreased in this country despite 4 times the number of c-sections preformed.
I couldn't agree with you more!
If we addressed the 'un-necessary' (defensive) procedures, frivolus lawsuits, and enforced various cross-company standards and cross-state standards, as well as eliminating some 'high-profit' but not very necessary capital investments (too many CT scanners, not enough basic clinics), we may be able to provide the same care at a much lower cost.
The final piece of the puzzle is the true cost of the great numbers of uninsured citizens. Bush made the ridiculous and insulting statement that 'all Americans have access to healthcare- they can visit an Emergency Room'. Well, if you don't offer any preventive care (checkups, minor 'repair') to the poor, then they eventually get sick and DO go to the emergency room, costing the government thousands. A case in point - my g/f's sister did not have insurance; she did not get checkups; by the time she went to the doctor (because of pain), her cancer was stage 3 and was very expensive to treat (and she died in 3 years, after much expensive treatment ultimately paid by the government because she had no money). My g/f, on the other had, who has insurance, has regular checkups and her cancer was caught at a 'pre-stage-1' level, and was taken care of by relatively minor (and inexpensive) surgery. So in my view, it is actually COST EFFECTIVE to give free healthcare to everyone as long as it includes preventive care.
A final comment on taxes - the last govt. just spent about a trillion dollars fighting a war we didn't need; THAT has to be paid for somehow. I'd rather pay my taxes and see the money go to healthcare than to a war that was unnecessary.
First of all, Ritchie, I have no idea who "rep-ed" you, But I can assure you it wasn't me. I have never worried about calling someone an idiot to their face, let alone on something like this. Personally, while I think you are wrong on a couple issues, i feel you are far from an idiot.
That said, We again called Mayo, and found this: Their Internists are not seeing any new Medicare patients. The Internist being the Doctor you have to see before seeing a specialist. That means, basically, that the patient can not go in, see the internist and have their schedule set up so they go from one specialist to the next to get their medical needs met. However they can go to their own Internist and be referred to a specialist at Mayo. The process just takes longer.
What I posted earlier was what we were told when we first called Mayo.
Incidentally, I am considered a new patient, even though I have been a patient of Mayo, and spent 69 days in their facility in the last 3 years. The reason I wanted into Mayo so badly, and was so concerned, was that the majority of my problems are the result of a medical "accident" at a hospital here that almost killed me. You might say I'm "gun-shy" now, and want to go somewhere that I already trust
"First of all, Ritchie, I have no idea who "rep-ed" you, But I can assure you it wasn't me."
I never thought it was you. Sorry if I caused confussion. I have an idea of who it was, but since the person didn't leave their name, I will never know for sure.
"while I think you are wrong on a couple issues, i feel you are far from an idiot."
I appreciate that. I think we can strongly disagree on issues, and still walk away with a respect for each other and each other's opinions. While there are some trolls I might think are idiots (or perhaps troublemakers), I don't think any regular posters on this board are idiots.
Why is this on the Arizona board? No offense. I fully hope for a seasoned debate, but this is a national bill and should be on the national boards.
I agree but have you been to the political forum? It's a mess! This is the first rationale and civil discussion I've seen on health care from both sides and I've been impressed with what I've read. Plus, i want to know how my fellow Arizonans feel about this issue.
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