Replacing the Affordable Care Act

There are millions of perfectly healthy people that encounter an unexpected serious illness which is why there's insurance. By analogy I've never been involved in a traffic accident but I'd be an idiot to not have auto insurance "just in case" I do have an accident. The very purpose of "insurance" is to mitigate against a potentially devastating financial situation that can occur in the future.

Of course for many households just going to the doctor for a routine check-up is a catastrophic financial situation because they don't have the income necessary to pay for even a routine visit to the doctor.

 

Actually, my proposal is to let doctors from insurance co ops and compete with traditional insurance companies, the most important component is to have price communication between the consumer and the provider. Does anyone using insurance know what the charges are or do they just pay the out of pocket?

 

The anti-government dupes that parrot their nihilistic ideological dogma? Indeed.

If they fancy themselves happier in their imaginary Aynrandistan, they can self-deport.

We have figured out how to "do it for ourselves" via a government of, by, and for the People, the alienated notwithstanding.

Pragmatists invite examples of superior approaches, and the kvetchers offer nothing.

Americans who understand that they might find themselves in need of such assistance have the solace of not having to depend upon the capricious whims of strangers.

 

Medicare, Medicaid, private insurance all determine the real cost of healthcare. Its called a fee schedule. I cannot speak for hospitals regarding negotiating those fees but I do know that all private practices have no negotiating power because they fear if they do, they will lose the population in their area that has that insurance coverage.

 

If you have private insurance and you wanted a copy of the schedule, they would not give it to you. You should have a right to a copy of it and everyone should demand that they should legally provide it. The reason why they won't give you a copy of the fee schedule is because the public would be very angry when they discover what is really paid to providers of healthcare while the consumer is stuck with high premiums and high deductibles.

 

pricing transparency will bring down costs.

 

As will single payer which keeps providers prices down where they belong.

 

Bring cost down, they are already low.

For example, I had lab work in 2012 total billed charges were $1,231.35, United Healthcare per their fee schedule allowed $89.37. The lab per contract had to write off the difference. I was billed $89.37 because this was applied to my deductible.

I can certainly provide you with many examples if you want.

 

perhaps I was talking about the cost of insurance!

seek first to understand then to be understood!

 

Research and development costs are taken off their taxes already. They get a deduction.

 

Not a 100% deduction, and they still require Cash Capital from profits to fund new Research & Development.

 

Written by the republicans.
Lets not forget that.

 

I've underlined what is key and that is something we really don't have.

Back in 2009 an investigative reporter took the time to compare the costs of services for two hospitals just a couple of miles apart. This is not information that is readily available to consumers because the hospitals don't publish a listing of fees for common medical treatments and procedures. What the reporter found was that one of the hospitals was charging up to twice as much for the same treatments and procedures but no one knew that. Even if the "consumer" wants to be informed that information is not readily available for cost comparison on the internet. We can compare the prices for virtually anything except medical services.

So why not a law requiring medical service providers to publish this information on their website? Not everyone chooses to be an informed consumer but at least those that do want to be informed could be informed but they can't do that today.

Of course the insurance companies help in this regard because they do negotiate with the medical providers in establishing their "preferred provider" list. We're not doing the cost comparisons but the insurance companies are to keep their costs down.

One problem many also ignore is that when a person actually needs the medical services it's often too late to do the investigation. If you break a leg are you really going to take the time to check out the prices for the medical services before you decide where to go to have it taken care of? Typically you go to the closest emergency hospital and pay whatever they demand to treat the broken leg. It's not like having to replace a tire on your car.

 

You can do all the price comparison you want but it only benefits the person with no insurance. Anyone that has insurance, the price for those charges means nothing since it is the person's insurance that determines the real cost of each code that is billed. There really is no difference in the fee schedule if you chose to go to one facility over another provided they both are in your network.

 

Contact your State legislators. While you're at it, ask them to eliminate the anti-trust law shields for hospitals.

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So, you're saying it's okay if hospitals price gouge their patients?

 

If both are in my insurance network of preferred providers then they charge the same rates for services. That's a negotiated fee schedule with the insurance provider. Of course the person is NOT required to use a network provider.

During my career I always had employer provided group health insurance that was an 80/20 plan (with preferred providers). Obviously my 20% went up if I used an out-of-network provider that charged more than someone in the preferred provider network that had their fees negotiated with the insurance provider. Do the math. 20% of $100 is less than 20% of $200 and often the insurance provider would only pay the $80 regardless of the actual charges (if I recall correctly) so it does matter.

BTW - I also learned that if I paid cash my health clinic reduced the charges by 20% and then I could submit the bill to the insurance company for re-imbursement and save money. Most clinics won't tell you this unless you actually ask about it.

In any case we can't compare anyway and that is something that can be corrected without any costs to the medical providers because they already know what they're charging.

 

Medical providers can charge whatever they want but if they all rely on being contracted with the insurance companies that will provide them patients, it is the insurance companies that determine the real charge. What I am trying to clarify is that people should stop going after the medical providers for transparency on pricing, they should demand and have a legal right to a copy of the fee schedule of who they are insured with

This way a person can know exactly what their portion of the bill will be before they decide to agree to obtain those medical services.

 

I believe you can request the specific fee schedule information on medical services you might need from the insurance companies but it's all pretty much covered by the insurance contract that the insured is provided with upon enrollment.

 

It is called the research credit. Besides, the cost of research is never fully vested in the price of the medicine or service to begin with anyways.

Part of the FICA taxes is Medicare, which is specifically designed for elderly and those who are totally and permanently disabled and who have enough credits to qualify for Medicare. However, what Germany does have that the US really does not have, is a populous that is intertwined with eating healthy and staying healthy. We want convenience and will not care how much it costs to our bodies for that convenience. But thankfully, the fast food industry is starting to produce healthier products, but we are not there yet.

 

We on the Right support keeping what remains of the best healthcare system on earth. What does that mean? It means what health care was like before you socialists rammed this Obamacare crap down our throats with one lie after another. You get sick, you go to your doctor, you get your treatment, and you pay your bill. What a concept! But a bunch of welfare slackers would prefer that everybody else pay their bills for them and that goes for everything else besides healthcare too.

You like socialism? Look at Venezuela today, you (*)(*)(*)(*)ing morons!

 

You are obviously an ideologue, and all the advanced nations that have managed to achieve quality health care for all citizens at far lower cost that the US are anathema to your dogma.

Americans will not stand for a return to the plight you prescribe - tens of millions uninsured, their medical costs dumped on the taxpayer, and constantly soaring costs (that still need to be brought under control because nationalized RomneyCare does not address inadequacies such as allowing negotiation of prescription cost under Medicare.)

As a realist, I understand what is, demonstrably,the most successful paradigm, and the popularity of Medicare underscores the sensibility of incrementally lowering the eligibility age to incorporate the lower-cost demographics into the risk pool.

 

You say that I'M the ideologue? Are you kidding? When I read your post all I see is this insane idea that for no reason that was ever mentioned in the Constitution the American public is supposed to pay for healthcare expenses for everybody who won't or doesn't pay for their own. What's next? How about mandatory public payment of veterinary bills for people's pets. Why not, it's the same principle.

The central evil in all of this socialism is that when you scrape away all the window dressing it boils down to this one simple thing. Making somebody else pay for what you want, period. The only difference between socialism and robbery is that robbers use guns, but socialists use liberal politicians who trade welfare for votes.

So socialism and medicare and all this other something for nothing insanity is popular? Does it take a genius to figure that out? When you get people to understand that all they have to do is sit on their ass and poor mouth and cry then there is always some socialist politician who says, not to worry, I'll give it to you for free, but you have to vote for me!

But answer one question and I'll just go away. Will you admit that Obamacare was rammed down the throats of the American public with a pack of lies or will you not? Once we establish that fact then everything else about socialized medicine is easy to understand.

 

Here is how Obamacare worked for me so far.

- Monthly premiums (2) increased from $450 to premiums of $800 a month
- Numbness in my leg, possible blockage, went to doctor,
- Did venous test - Billed $195.00
- Doctor ordered CT scan *** Insurance company denied payment for test,

But hey, I'm 55 years old, I got maternity care!

 

My monthly premiums have jumped only 6% per annum. My copay was $25 in 2014, $30 in 2015, and now $35 in 2016. I probably have more medical issues than you can think of or imagine with out of pocket expenses for mail order drugs, medical supplies, and copays for all the quarterly lab tests for a couple of thousand dollars. These past three years have been better than in the mid 1990's where my insurance rates were going up in double digits, far less plan allowance for those quarterly tests, and my out of pocket expenses being about $1300 more in the mid 1990's. But hey, I used to work for a very large employer and was able to retain that insurance when I left and now work for a midsize employer.

 

Three years before Obamacare:

- Monthly premiums $420,
- Numbness in leg, unable to walk, possible blockage,
- went to doctor,
- Did venous test - Billed (so little I can't remember)
- Doctor ordered CT scan
- Found 80% blockage to legs,
- Dr ordered heart catheterization,
- Surgury, two stents put in,
- Able to walk, able to run

Cost so minor that it was a non-event.
Insurance premium stayed around the same, also a nonevent

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All I can do is say what I am experiencing. I"m paying a lot more money and getting less. Obamacare is not working for me. But there you gloat while my life can be on the line.