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The myths of high cost healthcare

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Old 01-22-2013, 09:45 AM
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The myths of high cost healthcare

All healthcare providers in order to stay in business must contact with all of the health insurance companies. These contracts contain fee schedules of what they will pay for as allowable charges. It is the insurance companies that have complete control of healthcare costs and not the providers of service.

In 2011 U.S. healthcare spending growth stayed at slowest rate in 52 years and the reason why is because they control healthcare spending while providers of service must write off thousands of dollars because they were n't allowed by the contracted insurance.

Healthcare insurance companies do not absorb the cost of people without insurance. The State programs take care of that. Hospitals must accept the allowable fees from contracted insurance companies so the costs of the uninsured does not effect the health insurance companies.

The health insurance companies got hit when all the corporations of America paid lobbyist to change the laws so they could expand the oversea markets as this caused a lost of a large group of healthy people that paid premiums that now no longer have a job.

This is where Obamacare comes in to replace that lost revenue that are now mandated to buy coverage. The health insurance companies are raising premiums purely out of greed and to fund their expanding overseas market. They all paid lobbyist and paid contributions to Senators to get laws passed so their profit margin got raised.

They now got waivers so they can keep their preexisting clause in tact and can cap benefits on individuals so nothing was lost to them. Obamacare has been reduced to only effect the tax payers and not the health insurance industry.

Everyone can agree their premiums have gone up and are now facing more out of pocket costs but we are getting nothing in return. When you CEO's of health insurance companys making 49 million a year such as United Healthcare and they paid lobbists in 2009 for 110,000 and paid contributions to Senators in 2010 for 458,000, they are absorbing administration costs in oversea markets, what is left to pay on claims is minimal.

All of these statistics on healthcare costs is totaled by the charges submitted to insurance companies when the real report should be on the allowables that the insurance company will actually approve. If we had that report we would see who is the most corrupt of all and that is the insurance companies.

They are draining society of all the money spent on premiums and have reduced fee schedules so providers of healthcare are feeling the pinch while leaving the masses to not only pay in portions of their premiums but also pay for their medical services due to high deductibles.

My employer paid $10,000 for my husband and myself for health benefits. My healthcare bill in charges submitted for 2011 was $6822.25 but the insurance company only allowed $3499.54. Out of that they paid only $374.74 for the year 2011. I am responsible for the balance. The insurance company profited just on us alone for 2011 $9793.46

So you tell me who is actually getting screwed here
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Old 01-22-2013, 03:47 PM
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Sounds like you have lousy insurance.

I (and my company) pay roughly the same. And my insurance picks up the tab for 90% of my cost for anything major and about 50% for anything minor.

Insurance companies are required to average 80% payout to premium rates under Obama-care (and have been required by many states to do this for years). In other words 80% of all the money they collect must be spent on health care cost.
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Old 01-24-2013, 05:07 PM
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US insurance companies cannot expand into foreign markets because every other first world country has single payer government funded health care and there is no need for US style insurance outside of the US. To suggest that US health insurance companies are increasing premiums to US customers to fund lower premiums for people outside the US, is ludicrous.
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Old 01-24-2013, 06:01 PM
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This is in CANADA??

You really do have terrible insurance.

My insurance pays most of our bills with low or no co-pays.

As mentioned, your insurance company must pay $.80 of every dollar to patient care. If they don't, they must refund it. You might want to look into that.
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Old 01-24-2013, 09:02 PM
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Quote: Originally Posted by luddly.neddite View Post
This is in CANADA??

You really do have terrible insurance.

My insurance pays most of our bills with low or no co-pays.

As mentioned, your insurance company must pay $.80 of every dollar to patient care. If they don't, they must refund it. You might want to look into that.
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Old 01-24-2013, 09:25 PM
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Quote: Originally Posted by luddly.neddite View Post
This is in CANADA??

You really do have terrible insurance.
Can't be Canada. We only pay about $2000 for our insurance and we have no co-pays at all other than $5 for a prescription. Co-pays on doctors visits or hospital stays are illegal here.
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Old 01-30-2013, 12:19 AM
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Quote: Originally Posted by Luddly Neddite View Post
This is in CANADA??

You really do have terrible insurance.

My insurance pays most of our bills with low or no co-pays.

As mentioned, your insurance company must pay $.80 of every dollar to patient care. If they don't, they must refund it. You might want to look into that.
That 80% is for the entire pool of all customers. Just because you only received a $200 benefit from you insurance in a given year doesn't mean that the insurance company profited the remainder of your premiums. Good Lord, some of you just make me say WTF? Insurance is exactly that, insurance. You have it in case you are the one to get sick. Then all the people who don't get sick pay your bill. It's not direct, but that is the bottom line. When my wife was battling leukemia, the cost was over $1 million. The money to pay for that came from premiums paid by policy holders who didn't use much of their insurance that year. This is how any insurance works. It really is quite simple.
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Old 01-30-2013, 12:21 AM
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Quote: Originally Posted by Dragonlady View Post
Quote: Originally Posted by luddly.neddite View Post
This is in CANADA??

You really do have terrible insurance.
Can't be Canada. We only pay about $2000 for our insurance and we have no co-pays at all other than $5 for a prescription. Co-pays on doctors visits or hospital stays are illegal here.
Nice, someone from Canada. Tell us Dragonlady, how do you like your healthcare system. Be completely honest, and give us the the good and bad. It would be nice to get an honest assessment from someone who actually lives there. My parents have a number of friends there who love the system, but that is them. I'd like to hear your view.
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Old 01-30-2013, 01:43 AM
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I love the Canadian Health Care System, at least the Ontario version of it, Ontario Health Insurance Program (OHIP for short). Each province has it's own independent system funded under the federal Canada Health Act. I've never had any experience with out of province medical care so I can only speak about what I know.

OHIP doesn't cover prescriptions or dental, or vision care, and some other services (except for the elderly and the poor), so in Canada we have private supplemental insurance, usually through our employers, which covers those things that OHIP does not. We pay $2,200 a year for a family plan through my husband's employer. His employer pays nothing, but makes the cheaper group insurance available to his employees. My employer paid for my insurance, but the additional family plan costs, we paid by way of payroll deduction. Our share of OHIP Premiums for our family is $300 each for a total of $600. Our total health insurance premiums for all-inclusive, low co-pay, cadillac insurance coverage is $2,800.00 per year. We have to pay 15% of our dentist billls, and $5 for a prescription. My husband's blood pressure medication costs $200 per month, which is about equal to our monthly premium. The insurance pays for itself.

If I get sick, I call my family doctor for an appointment. Go to his office for a consultation and preliminary testing, if necessary. The doctor isn't required to obtain pre-approvals for any standard treatment or tests he deems necessary. My doctor's office has a nurse to draw blood and obtain samples, which means quicker results. For X-rays, mammograms, or other diagnostics involving specialized equipment, I usually go to a private testing lab, or these can be done at the hospital. There are no co-pays for any of these, nor do I have to complete any paperwork at the doctor's office for my treatment. My doctor bills OHIP directly, as do all private labs and hospitals. Co-pays for doctors, labs, and hospital treatments are illegal in Canada.

Doctors and hospitals give very patient focussed care. Every resident of Ontario has an OHIP card, even foreign students in Canada studying. Many American students retain their OHIP cards long after they've finished school and sneak back across the border for treatment. You provide you OHIP card or number upon admission, and your supplemental insurance information, if you have it and get wheeled off for treatment. No one ever has to cut corners on testing because they can't afford the cost, and no one ever asks you about money, once you leave the admissions desk.

Waiting lists exist for certain treatments and services, but a triage system exists for all treatments. Those in urgent need of care, bypass all waiting lists and are admitted immediately. Americans are quick to say that no one should have to suffer while on a waiting list, and for the most part they don't. If you want hip replacement surgery, or any other osteopathic surgery, you will have a long wait - up to 6 months, because there is a serious shortage of osteopathic surgeons in Canada. That's the longest waiting list we have right now.

As for how triage functions: The current target waiting time for a cancer patient to seen by an oncologist is 14 days. The target waiting time between the first visit with the oncologist and the first chemo treatment is 28 days. Ontario is currently meeting and exceeding those target times, but there is always that delay between when your doctor sees you, and when you first see the specialist, except if you really are very sick.

My friend went to the Emergency room on December 28th, thinking she had developed pneumonia after having a cold/flu over Christmas. They checked her blood levels and admitted her immediately with a particularly nasty form of leukemia. They told her had she gone home to bed instead of coming to emergency, she would have likely died in the night. They stabilized her condition and put her through daily rounds of testing and preparation, and on January 2nd, five days after she walked into Emergency, she received her first round of chemo.

Yesterday, she was discharged from hospital for the first time. She spent and entire month there. She survived the chemo, her blood levels are where they should be, and we now have to wait and see if she goes into remission. Home care had already been arranged for her when she left the hospital. She will be having follow up treatments and tests on an out-patient basis from now on.

What did all of this cost? We have no idea. Neither my friend nor her husband will never see a bill for this. There are no financial caps on her treatment. All they have to to worry about is getting her better.

Now, I hasten to add, to this story, the hospital my friend walked into was the Sunnybrook Health Sciences Centre, a world-renowned research and teaching hospital, which has been conducting ground breaking research for generations, which happens to be 15 minutes from their house. She went there on purpose, because it's one of the finest hospitals in the world and whatever was wrong with her, she would get the best treatment there.

I have grown up all of my life with OHIP. I broke my ankle toboganning as a child. I had my tonsils out, my appendix, and my gall bladder all before I was 25. I've given birth to three children, and a few years ago, I fell off my bicycle and broke my foot. I have never seen a bill from a doctor or hospital. If I get sick, I get treated. I don't worry about the cost, I worry about getting well.

My doctor doesn't worry whether he will get paid, so he is able to focus on the health of his patients. Our whole system, is centred around making patients well, not around making sure that doctors get paid.

Last edited by Dragonlady; 01-30-2013 at 01:53 AM.
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Old 02-06-2013, 04:54 PM
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Quote: Originally Posted by dblack View Post
Quote: Originally Posted by luddly.neddite View Post
This is in CANADA??

You really do have terrible insurance.

My insurance pays most of our bills with low or no co-pays.

As mentioned, your insurance company must pay $.80 of every dollar to patient care. If they don't, they must refund it. You might want to look into that.
Luddly loves insurance companies. And they love him.
It's cons that appear to love insurance companies ... they're against single payer.
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Old 02-06-2013, 05:54 PM
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Quote: Originally Posted by Political Junky View Post
Quote: Originally Posted by dblack View Post
Quote: Originally Posted by luddly.neddite View Post
This is in CANADA??

You really do have terrible insurance.

My insurance pays most of our bills with low or no co-pays.

As mentioned, your insurance company must pay $.80 of every dollar to patient care. If they don't, they must refund it. You might want to look into that.
Luddly loves insurance companies. And they love him.
It's cons that appear to love insurance companies ... they're against single payer.
Though I'm sure they would have, given the opportunity, the 'cons' didn't sell us out to the insurance industry. The President, the Democrats in Congress, and the Court did. They joined forces to usher in the worst corporate abuse of government influence in the history of the nation.
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Old 02-12-2013, 01:57 PM
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Quote: Originally Posted by Dragonlady View Post
I love the Canadian Health Care System, at least the Ontario version of it, Ontario Health Insurance Program (OHIP for short). Each province has it's own independent system funded under the federal Canada Health Act. I've never had any experience with out of province medical care so I can only speak about what I know.

OHIP doesn't cover prescriptions or dental, or vision care, and some other services (except for the elderly and the poor), so in Canada we have private supplemental insurance, usually through our employers, which covers those things that OHIP does not. We pay $2,200 a year for a family plan through my husband's employer. His employer pays nothing, but makes the cheaper group insurance available to his employees. My employer paid for my insurance, but the additional family plan costs, we paid by way of payroll deduction. Our share of OHIP Premiums for our family is $300 each for a total of $600. Our total health insurance premiums for all-inclusive, low co-pay, cadillac insurance coverage is $2,800.00 per year. We have to pay 15% of our dentist billls, and $5 for a prescription. My husband's blood pressure medication costs $200 per month, which is about equal to our monthly premium. The insurance pays for itself.

If I get sick, I call my family doctor for an appointment. Go to his office for a consultation and preliminary testing, if necessary. The doctor isn't required to obtain pre-approvals for any standard treatment or tests he deems necessary. My doctor's office has a nurse to draw blood and obtain samples, which means quicker results. For X-rays, mammograms, or other diagnostics involving specialized equipment, I usually go to a private testing lab, or these can be done at the hospital. There are no co-pays for any of these, nor do I have to complete any paperwork at the doctor's office for my treatment. My doctor bills OHIP directly, as do all private labs and hospitals. Co-pays for doctors, labs, and hospital treatments are illegal in Canada.

Doctors and hospitals give very patient focussed care. Every resident of Ontario has an OHIP card, even foreign students in Canada studying. Many American students retain their OHIP cards long after they've finished school and sneak back across the border for treatment. You provide you OHIP card or number upon admission, and your supplemental insurance information, if you have it and get wheeled off for treatment. No one ever has to cut corners on testing because they can't afford the cost, and no one ever asks you about money, once you leave the admissions desk.

Waiting lists exist for certain treatments and services, but a triage system exists for all treatments. Those in urgent need of care, bypass all waiting lists and are admitted immediately. Americans are quick to say that no one should have to suffer while on a waiting list, and for the most part they don't. If you want hip replacement surgery, or any other osteopathic surgery, you will have a long wait - up to 6 months, because there is a serious shortage of osteopathic surgeons in Canada. That's the longest waiting list we have right now.

As for how triage functions: The current target waiting time for a cancer patient to seen by an oncologist is 14 days. The target waiting time between the first visit with the oncologist and the first chemo treatment is 28 days. Ontario is currently meeting and exceeding those target times, but there is always that delay between when your doctor sees you, and when you first see the specialist, except if you really are very sick.

My friend went to the Emergency room on December 28th, thinking she had developed pneumonia after having a cold/flu over Christmas. They checked her blood levels and admitted her immediately with a particularly nasty form of leukemia. They told her had she gone home to bed instead of coming to emergency, she would have likely died in the night. They stabilized her condition and put her through daily rounds of testing and preparation, and on January 2nd, five days after she walked into Emergency, she received her first round of chemo.

Yesterday, she was discharged from hospital for the first time. She spent and entire month there. She survived the chemo, her blood levels are where they should be, and we now have to wait and see if she goes into remission. Home care had already been arranged for her when she left the hospital. She will be having follow up treatments and tests on an out-patient basis from now on.

What did all of this cost? We have no idea. Neither my friend nor her husband will never see a bill for this. There are no financial caps on her treatment. All they have to to worry about is getting her better.

Now, I hasten to add, to this story, the hospital my friend walked into was the Sunnybrook Health Sciences Centre, a world-renowned research and teaching hospital, which has been conducting ground breaking research for generations, which happens to be 15 minutes from their house. She went there on purpose, because it's one of the finest hospitals in the world and whatever was wrong with her, she would get the best treatment there.

I have grown up all of my life with OHIP. I broke my ankle toboganning as a child. I had my tonsils out, my appendix, and my gall bladder all before I was 25. I've given birth to three children, and a few years ago, I fell off my bicycle and broke my foot. I have never seen a bill from a doctor or hospital. If I get sick, I get treated. I don't worry about the cost, I worry about getting well.

My doctor doesn't worry whether he will get paid, so he is able to focus on the health of his patients. Our whole system, is centred around making patients well, not around making sure that doctors get paid.
Sounds terrible. A true nightmare. I can see why we would never want anything remotely like that here...


*that's sarcasm for those dyed in the wool republicans out there...
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Old 02-13-2013, 07:35 PM
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Quote: Originally Posted by auditor0007 View Post
Quote: Originally Posted by Luddly Neddite View Post
This is in CANADA??

You really do have terrible insurance.

My insurance pays most of our bills with low or no co-pays.

As mentioned, your insurance company must pay $.80 of every dollar to patient care. If they don't, they must refund it. You might want to look into that.
That 80% is for the entire pool of all customers. Just because you only received a $200 benefit from you insurance in a given year doesn't mean that the insurance company profited the remainder of your premiums. Good Lord, some of you just make me say WTF? Insurance is exactly that, insurance. You have it in case you are the one to get sick. Then all the people who don't get sick pay your bill. It's not direct, but that is the bottom line. When my wife was battling leukemia, the cost was over $1 million. The money to pay for that came from premiums paid by policy holders who didn't use much of their insurance that year. This is how any insurance works. It really is quite simple.
All of what you say is true. Nonetheless, ACA does require insurance companies to pay $.80 of every dollar in premiums paid to patient care. Insurance companies can no longer set arbitrary treatment costs and they must, by law, any difference.

Under ACA, insurance and parma companies can't set the rules.
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Old 02-13-2013, 07:50 PM
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Quote: Originally Posted by Luddly Neddite View Post

Under ACA, insurance and parma companies can't set the rules.
That's a pretty hilarious assertion.
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Old 02-14-2013, 07:50 AM
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Quote: Originally Posted by Luddly Neddite View Post
Quote: Originally Posted by auditor0007 View Post
Quote: Originally Posted by Luddly Neddite View Post
This is in CANADA??

You really do have terrible insurance.

My insurance pays most of our bills with low or no co-pays.

As mentioned, your insurance company must pay $.80 of every dollar to patient care. If they don't, they must refund it. You might want to look into that.
That 80% is for the entire pool of all customers. Just because you only received a $200 benefit from you insurance in a given year doesn't mean that the insurance company profited the remainder of your premiums. Good Lord, some of you just make me say WTF? Insurance is exactly that, insurance. You have it in case you are the one to get sick. Then all the people who don't get sick pay your bill. It's not direct, but that is the bottom line. When my wife was battling leukemia, the cost was over $1 million. The money to pay for that came from premiums paid by policy holders who didn't use much of their insurance that year. This is how any insurance works. It really is quite simple.
All of what you say is true. Nonetheless, ACA does require insurance companies to pay $.80 of every dollar in premiums paid to patient care. Insurance companies can no longer set arbitrary treatment costs and they must, by law, any difference.

Under ACA, insurance and parma companies can't set the rules.
NYS has had that rule for a long time. The problem with it is this.

When insurers know they have a captured market, the insentive is actually there to pay out more.

If a pill cost 1$ they can only make 20 cents on that pill. But if they jack up the price to $10, they can make 2 dollars.

As I've said many times, the problem with the system is not fixable without control. The rest of the world does it much cheaper because they control the whole system.

Right now, many doctors need a team of people for billing. Get rid of the whole system and go to single payer, they now need one, maybe even none. Big savings when you consider that this is the case for virtually all doctors, hospitals, nursing homes, clinics.... anyone who bills services for the health care industry.

And that is just one example among many.
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