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I just listened to this very tremendous podcast today on Pitchfork Economics, where he interviewed a man named T.R. Reid, who traveled around the world learning about different healthcare systems and what they do differently and how we could use some of their ideas. He identified four main types of payment systems:
A. State owned hospitals and clinics with docs working for the govt and the govt paying for the services. This is what we have with the VA.
B. Private hospitals and clinics with govt paying the bills. We have this with Medicare.
C. Private hospitals and clinics and private insurance. That’s what full time working Americans have but keep in mind that 20% of Americans work in retail and the food industry. Not much in the way of benefits there. If you make $11/hour or less, and have no health insurance, you’re sunk if you or your kid gets sick.
D. Nothing. If you have money in a developing country you can buy a policy but otherwise you’re SOL. Think Afghanistan. And us.
Not so surprising that the Medicare type system had the most customer satisfaction. And with that I’m curious. Any folks on here retired and on Medicare? How does that compare with your company insurance from the last ten years or so? Seems like ten yrs ago is when I really began to feel the pain and when I realized how much of my teacher’s paycheck was being taken.
He also said a very surprising thing...we are the only country in the world that limits which docs you can see. I was surprised because one of the main arguments against medicare for all is that you couldn’t keep your doctor. We’re being lied to folks and the insurance companies have a huge stranglehold on our country and the people. I think we need to start with campaign finance reform to loosen some of the power the companies have on the govt and I think it’s sad that the insurance companies have more clout than the most powerful govt on the planet.
If you listen to the podcast and you’re interested, there is a part 2 and it’s about Bernie’s Medicare for All so it should be interesting; I haven’t heard it yet. There is also one about pharma that will blow your socks off.
Here in Australia, legal citizens and permanent residents are provided with a Medicare card (our Medicare is completely different from yours - not comparable at all). Your Medicare card gets swiped when you see a doctor or attend a hospital. No Medicare card, no free/subsidised treatment - you pay the full whack.
Surely the US could easily have a similar system?
Hospitals in the USA are required by law to provide services to anyone presenting at a emergency room without regard to citizenship, financial status or level of insurance. In 1986 Congress made this deal with the devil (the insurance companies/hospitals) in exchange for exempting them from federal antitrust laws. That is why it’s legal for hospitals to conspire to fix prices, limit competition, and charge vastly different fees for the same procedures. The health insurance industry wasn’t about to be left out, so their lobbyists wrote the ACA so the law would “insure” their profitability into the foreseeable future.
Hospitals in the USA are required by law to provide services to anyone presenting at a emergency room without regard to citizenship, financial status or level of insurance. In 1986 Congress made this deal with the devil (the insurance companies/hospitals) in exchange for exempting them from federal antitrust laws. That is why it’s legal for hospitals to conspire to fix prices, limit competition, and charge vastly different fees for the same procedures. The health insurance industry wasn’t about to be left out, so their lobbyists wrote the ACA so the law would “insure” their profitability into the foreseeable future.
However they are not required to automatically forgive a debt, or simply not charge the patient. They can still charge the patient, and still send collectors after them, and still take them to court for refusal to pay the bill.
Not so surprising that the Medicare type system had the most customer satisfaction. And with that I’m curious. Any folks on here retired and on Medicare? How does that compare with your company insurance from the last ten years or so? Seems like ten yrs ago is when I really began to feel the pain and when I realized how much of my teacher’s paycheck was being taken.
I started on Medicare 1/1/18. I'm probably atypical- no ongoing health issues and only one prescription, which deals with a symptom of menopause. That's under patent so no breaks with the prescription drug program, GoodRx, anything. It is what it is. I can say I'm very happy with how Medicare and the supplement covered all of DH's health issues before he died- our out-of-pockets were mostly for prescriptions and they were manageable.
The biggest problem I've encountered is coding. Yeah, coding. I'm dropping my doc even though she's great because her staff doesn't know how to code things so Medicare will pay them. "Pap smear plus breast exam" was denied because it was too early for another Pap smear. I requested that the re-code the procedures separately so that the breast exam was covered. They never did. Bloodwork was coded as "routine" even though my fasting glucose runs over 100, my a1C is in the high end of normal and my total cholesterol is over 200 so the components really need to be looked at. Medicare denied $800 worth of these tests as "not medically necessary" and I was let off the hook only because they forgot to have me sign an Advance Beneficiary Notice. Now I order tests on-line through Requestatest.com and pay out of pocket. No BS and I get what I want for under $100.
I've read/heard that hospitals and practitioners barely break even on Medicare and lose money on Medicaid patients, so reimbursing all providers at the Medicare level could cause significant disruptions.
Hospitals in the USA are required by law to provide services to anyone presenting at a emergency room without regard to citizenship, financial status or level of insurance.
The law requires them to stabilize and treat emergencies not provide standard healthcare.
However they are not required to automatically forgive a debt, or simply not charge the patient. They can still charge the patient, and still send collectors after them, and still take them to court for refusal to pay the bill.
Or, they can avoid all that and do what they are doing now, shift the cost of indigent care onto the accounts of the patients who can pay their bills. This flim-flam is perfectly legal under the EMTALA act and hospitals get away with it every day.
I've read/heard that hospitals and practitioners barely break even on Medicare and lose money on Medicaid patients, so reimbursing all providers at the Medicare level could cause significant disruptions.
One of the reasons I’ve heard for that is because the only people who can get Medicare are over 65, which of course is the population most likely to seek medical care, and the most expensive medical care at that. When more young and healthy people are paying in, prices will drop. I’m pretty sure that’s not exactly what you’re saying but I wanted to make that point.
We were on the exchange last year and we qualified for a partial subsidy. This year, our household income has gone up about $20K (mostly because my adult son is working full-time this year) and we no longer qualify. With two adults and two "children" (one is grown but still able to be on our plan), it would have been $1,400 for the bare-bones plan for this year.
Last year, my daughter needed some cardiac imaging done, like she does every year. The deductible on our plan ($6,500) was just a bit more than the cost of that imaging, so they covered exactly $0. Because she's under 18 and gets her imaging done at a children's hospital, they have lots of grants in place and we only had to pay 1/3 of that.
We decided to drop the exchange insurance now that we don't qualify for any subsidy. Yes, we would be covered in the case of something catastrophic, but we really can't afford $1,400/month for no other coverage. We do belong to a direct primary care practice, which costs $200/month and allows us to access our primary care physician basically an unlimited number of times. We also get discounts on things like xrays (son needed one on his foot and it was $25), physical therapy, etc. I'm looking into the healthshare ministries and also a short-term plan, but my daughter's cardiac history seems to be a disqualifying condition. It's possible that I could get her on our CHIP program and simply pay the whole fee... that might be what we need to do for her.
It's frustrating and infuriating that in the USA, families are all but forced to go without coverage because the insurance and healthcare industries are completely out of control.
We were on the exchange last year and we qualified for a partial subsidy. This year, our household income has gone up about $20K (mostly because my adult son is working full-time this year) and we no longer qualify. With two adults and two "children" (one is grown but still able to be on our plan), it would have been $1,400 for the bare-bones plan for this year.
Last year, my daughter needed some cardiac imaging done, like she does every year. The deductible on our plan ($6,500) was just a bit more than the cost of that imaging, so they covered exactly $0. Because she's under 18 and gets her imaging done at a children's hospital, they have lots of grants in place and we only had to pay 1/3 of that.
We decided to drop the exchange insurance now that we don't qualify for any subsidy. Yes, we would be covered in the case of something catastrophic, but we really can't afford $1,400/month for no other coverage. We do belong to a direct primary care practice, which costs $200/month and allows us to access our primary care physician basically an unlimited number of times. We also get discounts on things like xrays (son needed one on his foot and it was $25), physical therapy, etc. I'm looking into the healthshare ministries and also a short-term plan, but my daughter's cardiac history seems to be a disqualifying condition. It's possible that I could get her on our CHIP program and simply pay the whole fee... that might be what we need to do for her.
It's frustrating and infuriating that in the USA, families are all but forced to go without coverage because the insurance and healthcare industries are completely out of control.
Would you qualify for a subsidy if your adult son got his own insurance and his income was not included in the household?
An alternative that may work for some people is to enroll in a state college degree program. Healthcare is available and the premiums are much cheaper than market rate. Combined tuition and insurance premium can be a lot cheaper than ACA depending on the state and school. Many states offer free tuition to senior students.
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