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Old 11-14-2016, 01:04 PM
 
18,740 posts, read 8,361,835 times
Reputation: 4118

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Quote:
Originally Posted by workingclasshero View Post
very true.

the point that I was ''trying'' to make is that insurance is not care (maybe, I am trying to make the point, in a poor manner)

IF I need care I go to DR. Hoonose , he provides the service I need or want

he EXPECTS to get paid, for the service he gave me...... I expect good service, and will pay for that good service... out of my pocket, through payments...or my insurance

but for the last 75 years, health insurance has been getting larger and larger, now everyone EXPECTS it to cover even a runny nose

not even 35 years ago..the standard was health insurance was generally called hospitalization... when you went to the DR for a annual physical, or a required immunization for school..you paid the bill out of pocket...usually is a small bill (less than 150) ........and even today, why would anyone with fiscal smarts pay 4000-16000 per year for insurance, when they go to the doctor only once a year for a physical which will cost less than 200 dollars(hmm pay 16k or pay 200...the choice for the healthy 20 somethings is pretty easy) ....but a lot has changed in the last 35 years... people and unions now expect insurance to PAY FOR EVERYTHING...even a runny nose, where DR. Hoonose will say take this Musinex , ot works great and will clear you runny nose and congestion.......really why must insurance cover a $60 office visit???
Most people don't go to the doc for a simple runny nose. Serious and choking nasal drainage for a month and maybe. Accompanied by a high fever and headache maybe. Co-pays and deductibles take care of most nonsense and abuse. That being said, these sorts of simple medical encounters are cheap, quick and easy, and they are not the main drivers of our high HC costs.

An 80 y/o with 10 chronic diseases and conditions, and on a dozen meds, might well benefit from insurance that provides for office visits and medical maintenance on a regular basis. Maybe monthly if not stable or every 3 months if stable. This is Medicare. And it does cover just about everything. In my long experience abuse is low.

 
Old 11-14-2016, 01:14 PM
 
1,290 posts, read 584,999 times
Reputation: 761
Here's some background of Health Insurance before ObamaCare.

Quote:
A lot of people only found out that the pre-Obamacare individual health insurance market was different when they got laid off from work and lost their group coverage. Not only did they almost always experience sticker shock (no employer subsidy meant they had to pay the entire premium themselves), many of them found out they couldn’t buy coverage at any price because of a pre-existing condition.

Insurance companies maintained a very long list of conditions that could trigger a coverage denial letter. Not only that, but they also had scores if not hundreds or thousands of underwriters who did nothing more than make decisions about applicants’ suitability for coverage. If underwriters felt applicants might be a bad risk – in other words, might need medical care – the insurer could and often did send them rejection letters.

A Congressional investigation into this practice during the health care reform debate uncovered more than 400 medical diagnoses or conditions that insurers used to justify a coverage denial.

The Congressional investigation was limited to four insurers (Aetna, Humana, UnitedHealthcare and WellPoint/Anthem) and covered only a three-year period: 2007-2009. It found that just those four companies had denied coverage to 651,000 people – one of every seven who applied – because of pre-existing conditions. It also found the rate of denials was increasing at the companies every year.
The investigators wrote this in a memo about their findings:

A year-by-year analysis shows a significant increase in the number of coverage denials each year. The insurance companies denied coverage to 172,400 people in 2007 and 221,400 people in 2008. By 2009, the number of individuals denied coverage rose to 257,100. Between 2007 and 2009, the number of people denied coverage for pre-existing conditions increased 49 percent. During the same period, applications for insurance coverage at the four companies increased by only 16 percent.

Generally, the states with the highest rates of denial were in the South and Midwest where the overall health status of residents has consistently been worse than in other parts of the country. The incidence of cancer, heart disease and diabetes is higher in those states, a big reason insurers had no problem blackballing them in the years before the Affordable Care Act.

Ironically, almost all of those states are controlled by Republican governors and state legislators who never miss an opportunity to diss Obamacare and call for its repeal. If GOP lawmakers were able to repeal the law, their constituents, the people who voted them into office, would be among the biggest losers.
Source: https://www.healthinsurance.org/blog...d-to-millions/
 
Old 11-14-2016, 01:29 PM
 
Location: Houston
26,979 posts, read 15,805,408 times
Reputation: 11259
Quote:
Originally Posted by Katarina Witt View Post
How? How, how, how, how?
It appears Trump is ready to go full blown Keynesian. He will pay for it the same way Bush paid for his prescription drug benefit.

Another step down the road to socialized medicine.

We got a RINO for president.
 
Old 11-14-2016, 01:32 PM
 
9,732 posts, read 9,690,149 times
Reputation: 6407
Quote:
Originally Posted by mohawkx View Post
When Trump and the republican congress kill Obamacare probably the first week of his presidency, they'll have a few quandries to navigate.
1. What happens to the 22 million people who only have health insurance through the ACA.
2. What about people with preexisting conditions who the insurers don't want to insure.

Kicking 22 million people off of health care is going to really set the stage for Trump's downfall. These people are his constituents. Middle and lower class working stiffs who are just scraping by and without the ACA subsidies, couldn't afford insurance.

The pre existing condition has an easy bailout for Trump and republicans. Once the unfettered free market returns to health insurance, the repubs will declare the preexisting condition coverage is mandatory for insurance providers. But since required health insurance will no longer be a mandate, the requirement to keep it affordable with subsidies will go out the window. This will allow insurers to offer insurance for preexisting conditions with an insurance pool separate from the main pool just for people with preexisting conditions. The cost will be astronomical as the only participants will be those with some preexisting condition. Remember, pregnancy is considered a preexisting condition. Also, if you're in a normal insurance pool and you get sick like diabetes, the insurance co. can send you a notice bumping you to the preexisting pool from the regular pool where your rates will go up 4-6 times what they were.
Trump can stand up and give a speech as to how he saved the preexisting condition clause from the ACA by saying that his version requires all insurers to provide coverage for those with preexisting conditions but in reality, no one will be required to purchase it and no one will, because it won't be affordable.

Cheaper rates for me and the rest of the taxpayers "trumps" 22 million who get dumped and have to find another policy they can afford.
 
Old 11-14-2016, 01:52 PM
 
Location: Foot of the Rockies
90,316 posts, read 120,288,414 times
Reputation: 35920
Quote:
Originally Posted by workingclasshero View Post
very true.

the point that I was ''trying'' to make is that insurance is not care (maybe, I am trying to make the point, in a poor manner)

IF I need care I go to DR. Hoonose , he provides the service I need or want

he EXPECTS to get paid, for the service he gave me...... I expect good service, and will pay for that good service... out of my pocket, through payments...or my insurance

but for the last 75 years, health insurance has been getting larger and larger, now everyone EXPECTS it to cover even a runny nose

not even 35 years ago..the standard was health insurance was generally called hospitalization... when you went to the DR for a annual physical, or a required immunization for school..you paid the bill out of pocket...usually is a small bill (less than 150) ........and even today, why would anyone with fiscal smarts pay 4000-16000 per year for insurance, when they go to the doctor only once a year for a physical which will cost less than 200 dollars(hmm pay 16k or pay 200...the choice for the healthy 20 somethings is pretty easy) ....but a lot has changed in the last 35 years... people and unions now expect insurance to PAY FOR EVERYTHING...even a runny nose, where DR. Hoonose will say take this Musinex , ot works great and will clear you runny nose and congestion.......really why must insurance cover a $60 office visit???
No. 35 years ago, 1981, everything was going HMO. I had two children, one 32 years ago and one 29 years ago. With the first, the OB care including post-partum and all the hospital care except the TV rental was covered. My husband was working for a mining company and the insurance was negotiated for the miners by the United Mine Workers; the computer guys got the same insurance. With the second, DH was working for a small start up and we had to pay more in deductibles and co-pays, but the OB care was covered and the hospital (same one) quit charging for TV rental! What you're talking about was more like 45 years ago. "Major medical" has been around a long time.

And Hoonose is right. People don't go to the doctor for "every runny nose". What "waste, fraud and abuse" there is doesn't come from the patients, or the hardworking PCPs.
 
Old 11-14-2016, 01:55 PM
 
16,376 posts, read 22,383,529 times
Reputation: 14396
Quote:
Originally Posted by mohawkx View Post
No they won't. He never said he'd cover them. He'll force the insurance companies to offer policies for the Preexistings. People with preexisting conditions will be offered an opportunity to buy insurance on the open market. The cost for most will be prohibitive because they will be in a separate pool out side the normal insurance pool.
Since the mandate is gone. Insurers will never lump the high risk patents in with the healthy because then the premiums will be too high for anybody to afford and very few will purchase it.
Only way it can work is to have a high risk pool with unaffordable premiums and a normal pool with reasonably affordable premiums.
Most people will eventially move from the normal pool to the high-risk pool. Even if you are perfectly healthy one day, something minor such as a benign breast lump or an enlarged prostate or a funny looking mole(that wasn't skin cancer after it was checked) could put someone in the pre-existing category, even if they didn't have cancer and surgery/prescription wasn't necessary for their situation.

Even someone with migraines can be considered high-risk and fall into the pre-existing category, even if they have nothing else wrong. Get bronchitis one winter could put someonel= into the pre-existing category(true story, a family member of mine had bronchitis and it was deemed preexisting even though just a simple doctors visit and prescription for antibiotic occurred).

This is the scary part - you could decide to open your own business and be healthy and buy insurance in the open(individual market) and the next year you might fall into the pre-existing condition category for some minor illness that you had (such as got your appendix removed) even though you are 100% healthy again. Once into pre-existing category, you might be uninsurabe for the rest of your life.

Do you have red hair and freckles and had 3 sunburns in your life? This might put you at risk for skin cancer and could be a pre-existing condition.
 
Old 11-14-2016, 01:57 PM
 
1,290 posts, read 584,999 times
Reputation: 761
Quote:
Originally Posted by kevinm View Post
Cheaper rates for me and the rest of the taxpayers "trumps" 22 million who get dumped and have to find another policy they can afford.
Yeah me, myself and I.
Great way to run a country.
It's almost like we have an entire party built on selfishness.
 
Old 11-14-2016, 02:50 PM
 
Location: Foot of the Rockies
90,316 posts, read 120,288,414 times
Reputation: 35920
OK, have read through the whole thread now. Don't everyone groan at once.

Quote:
Originally Posted by Hoonose View Post
In my medical office we excluded my wife from our medical plan. With her disease she would have DOUBLED the premiums of all our 40 or so employees! Her medical bills are up to $170K so far this year. About every 4 years new and expensive medical technologies save her.
When my husband worked for the start up, some insurance person tried to convince the owner to take his son, a diabetic, off the policy to make it cheaper. Sonny was in college, could have gotten insurance from the University. The owner made a decision as a father to keep his son on the work policy, which was a better policy than the university one. I couldn't disagree with him. Sonny graduated in due time and b/c this was before the ACA, he had to get his own insurance.
 
Old 11-14-2016, 02:54 PM
 
Location: Foot of the Rockies
90,316 posts, read 120,288,414 times
Reputation: 35920
Quote:
Originally Posted by workingclasshero View Post
well then...how about we start with the fact that INSURANCE is not CARE

INSURANCE (risk management) is a way to have someone else (or some entity) PAY for your bill

your CARE on the other hand is provided by a Doctor, Nurse, Specialist, Hospital, and/or Clinic


INSURANCE has never been health CARE


do you call your auto insurance company every time you need tires, and engine overhaul, or even a simple oil change??? nope

do you call your homeowners insurance when you want to repaint your daughters room purple, or if you want new windows, or need a new hotwater heater???...nope



insurance has NEVER been about care... its about who is going to pay the bill, """"IF""" something CATASTROPHIC happens......not just if you are visiting the dr for the sniffles


that is why insurance is so expensive...fraud/ waste/ abuse from the users
Quote:
Originally Posted by NxtGen View Post
Should you be able to go get car insurance with a broken car and then turn around and have them pay for it? Do you know what insurance is?
Quote:
Originally Posted by middle-aged mom View Post
Most states , if any, do not require a physical inspection of the auto as a condition of insurance.

Auto insurance does not cover the risk of routine maintenance, repair and replacement of worn out parts.

Appropriate liability, comprehensive and collision insurance will however, cover an accident, auto and property damage caused by a lack of routine maintenance, repair and when necessary replacement of worn out parts.

The payout on a totaled claim is the same if the care was properly or poorly maintained.
"Waste, fraud and abuse" is another one of these trite sayings that really has no meaning. We've all read horror stories. In point of fact, most WFA is committed by a few providers. It's rarely committed by patients.

Comparisons with auto insurance are apples to oranges. You can total a car. You can't total your body and replace it.

Last edited by Katarina Witt; 11-14-2016 at 03:07 PM..
 
Old 11-14-2016, 03:12 PM
 
Location: Foot of the Rockies
90,316 posts, read 120,288,414 times
Reputation: 35920
Quote:
Originally Posted by jojajn View Post
We are using tremendous resources to treat conditions with no hope just to delay inevitable deaths.
Quote:
Originally Posted by Hoonose View Post
End of life care remains a big nut to crack. We have living wills and hospice. And those along with a primary care doc weed out most of the really stupid spending. Most elderly do not want all stops pulled if they are going to be veggies the last few days of their lives. When the primary doc is not involved at the terminal stage of patients care, much more gets spent medically, and many times not in coherence with the living will.
Quote:
Originally Posted by middle-aged mom View Post
In my limited experience, it's the family who often advocate for the so called, beyond reasonable, end of life care for relatives nearing the end stage. They typically are not paying for that care which likely contributes to emotional reactions.

I agree it's often the Primary Care doc who is the voice of reason, especially when the doc and patient have a history.
Quote:
Originally Posted by usayit View Post
I agree with this. I personally support provisions for assisted end of life is a reasonable option. It would solve a few problems associated with the high cost to both the system and family of terminal ill situations.

I also would like the option to choose how /when I die in such situations.
Quote:
Originally Posted by Hoonose View Post
From my long and extensive experience the best set up is with a primary doc who knows the patient and family long term. Then the three of us have ongoing end of life decisions as patients get old. I have found it very uncommon for families to get way out of sensible line when these conditions are met. But I have seen it at times when they are not.

Like an air transport AZ to Boston so that essentially their own doctor agrees to pronounce the patient dead!
I have to cast my lot with Hoonose on this. I too have some experience in this area, having been a visiting nurse for many years. I also have experience with my own family. It's quite cruel to talk about families that way M-A-M; there's never a good time for a loved one to die, even if it's a "good death". (I've also worked some for hospice.) I've known people who had to make the decision to turn off the life support. It's wrenching. No one wants to see their loved one suffer, but they don't want to kill them either. Assisted suicide is not going to be a panacea, usayit. For one thing, the patient has to be mentally competent, which excludes most Alzheimer's patients and many stroke patients.

This meme that we spend more money on the last (insert time span here) than all the years before just means people are sicker at the end of their lives.

Last edited by Katarina Witt; 11-14-2016 at 04:41 PM..
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