Health Care - we gotta fix this shit...

[boedicca]

You again? heh

Is this a memory lapse, or willful ignorance. It's getting hard to tell

Neither. Just plain old vanilla sheer boredom. Toodles!

 

[Flopper]

You misread. I might have mentioned supplemental plans, but the point of the article is that the top five insurance companies are getting 60% of the revenue from the plans they serve up to Medicare and Medicaid. Read it again, perhaps without an incorrect assumption guiding you. The government sub-contracts Medicare and Medicaid to private for-profit insurance companies. This is an established fact.

I wouldn't make such a fuss about this, but a lot of people think that Medicare for All will take private insurance out of the equation, when the fact of the matter is it won't. They are deeply embedded in Medicare and Medicaid. Medicare for all will just force us to buy their insurance, whether we want to or not - much like ACA.

Single-payer wouldn't be an end-run around insurance companies, it would be a funnel forcing us to support them.

Whereas I understand that Medicare/Caid are using ins. company infrastructure to deliver care to patients, said patients are only paying for their supplemental coverage that isn't covered under their Medicare plan...which costs little or nothing. Are you saying that insurers are taking Fed money, and pocketing the bulk of that money as profits?

Exactly. Do you really think an insurance company is going to give you a low or no premium Medicare Advantage plan out of the goodness of their hearts? Nope, the government gives them upwards towards or a little more than $10000.00 per person per year just to handle your health insurance. The higher the star rating of a plan the more money they get.

According to the law Medadvantage plans are paid by Medicare to insure members. The amount the plan receives is determined by the number of members and is suppose to be no more than Medicare would pay to provide healthcare if they were Medicare beneficiaries. The insurance companies must cover the same things that Medicare covers. However, the insurance companies are given great latitude as how they will cover them, through private networks, through their own healthcare facilities, etc. The insurance company also become the one to determine whether a procedure is medically necessary, not Medicare.

The way the companies make their money is by offering incentives that will attack younger healthier retirees such as gym membership, discounts on sporting goods, discounts on travel, and most important low or zero premiums. Insurance companies know that healthy people don't pay a lot attention to their share of medical cost. As the members grow older they see their costs rising sharply and they are not able to take advantage of the perks the plans often. The insurance companies often scrutinize the need for procedures, pressure hospitals for early release, and deny coverage for various reason. If a member becomes dissatisfied and wants to go back to regular medicare with a supplement, they find they will probably be subject to medical underwriting which makes it impossible for most people, so they're stuck in the Medadvantage world.

your last sentence is incorrect. you can change plans or go back to basic medicare until March 30 or each year regardless of which plan you sign up for the previous year, and there is no penalty or limitation on doing so.

Yes, if you are dissatisfied with your MedAdvantage Plan, you have until the end of March to change to a different Medicare Advantage plan or go back to original medicare.

However, if you sign up for a MedAdvantage Plan when you become eligible for Medicare then a few years latter you decide you want to get out of MedAdvantage and go to original medicare with a supplement, you may find it very difficult. The reason is supplement plans have some pretty strict rules. If you don't meet certain guaranteed issue rights, then you are subject to Medical Underwriting which often means, you will not be accepted or only at a much higher premium.

MedAdvanatage and original medicare with a supplement are two very different types of medical coverage. You can always joint or leave a MedAdvantage plan during yearly open enrollment. Supplement plans have only one open enrollment and that's during the 6 months after you become eligible for Medicare. After that time, getting a supplement can be difficult.

People that choose Medicare Advantage are usually in it for the rest of their life. That's why people should consider carefully which is the best path. They both have advantages and disadvantages.

 

[Flopper]

All insurance has deductibles and coinsurance. The difference with Medicare, is that the admin. fees are a fraction of those in the private insurance sector.

Hell, it ought to be. If we move to "Medicare for All" the insurance companies will no longer have to appeal to customers to make a profit, they'll just have to lobby government, an
d they're pretty good at that. That should represent a significant savings. Should. But whadya bet they pocket most of it as windfall? Why not, they'll have a captive customer base.

More than likely the government would make a bigger push than they already do to encourage Medicare Advantage plans and let the insurance companies basically take it over.

And I for one am very happy with my Medicare Advantage plan!
My advantage plan does MORE for me than plain Medicare and that's why 36% of the 60 million are
using MA plans. For example plain Medicare subtracts $134/mo from peoples' SS. My MA pays SS that
deduction. My MA calls me every month to make sure I've seen my doctor. They also provide me $50/mo in OTC supplies, toothpaste, etc. And the best part is these MAs pay Federal taxes on their profits!

So really ignorant people about Medicare have no idea how it works why the MAs were the best thing to come from the Medicare Modernization Act of 2003!

Medicaid, Medicare reflect 59% of revenue for 5 largest commercial insurers

Don't be fooled. Medicare for All doesn't deny insurance companies their profits. It guarantees them. Medicare is insurance that government buys for us, with tax dollars, from private vendors - generally the same bastards who have been screwing us all in the traditional insurance market. The only difference is that we don't have any say in it. The government sits down with insurance industry lobbyists and decides what kind of health care we'll get. Pretty much the same as ACA, albeit with even less input from consumers.

Medicare for all mean original Medicare, not MedAdvantage plans. 2/3 of the people on Medicare opt for original Medicare and 70% purchase a supplement. I have original Medicare plus a supplement. To me this is the way healthcare should be in this country. I can go to essentially any doctor and any hospital in the country. I pay nothing. I don't get any medical bills. I don't worry about copays, co-insurance, deductibles, or referrals. I don't have to ask permission from anyone to go to a doctor. I never have to change doctors because the insurance company's network changes. The only question I need to ask a healthcare provider is do you take Medicare. If the answer is yes, which it in over 97% of the healthcare facilities in the US, then I get the care my doctor thinks I need, not what an insurance company believes is needed or what the plan covers. When you have a serious healthcare problem, the last thing you need is a battle with your insurance company to get the care your doctor says you need when you needed.

The cost of original Medicare with a supplement is not cheap but to me it's worth the extra cost.

that's your decision and that's just fine. I have been on medicare advantage since I was eligible and was totally satisfied with the coverage, the doctors, the hospitals and the 0 or very small premiums. But to each his own, there is no right and wrong about this, its a choice.

I had an MedAdvantage Plan for 9 years and was quite satisfied, free gym membership, free vision care, and some dental benefits, plus out of network coverage. Then one day I got a letter saying the plan would no longer include any of the doctors, hospitals, or other medical providers my wife and I used in my area. The only MedAdvantage alternatives were a half dozen HMOs with high co-insurance and yearly maximums, with no coverage out of the immediate area and no foreign coverage. Lucky for us, the exiting of our MedAdvatage company provided a window to enter original medicare with a supplement. Since we made the change a few years ago, we have not paid a single medical bill. In fact we don't even receive bills anymore. It's great for us, however people with fewer medical bills would probably find a MedAdvantage plan more appealing because the premiums are lower. However, when you start receiving a stack of medical bills each month or you start traveling extensively, the MedAdvantage plan is not so good . Like you said there is no right or wrong plan.

 

[Flopper]

No thank you.

The first biggest problem we have is government interference in the health care markets. It's not a coinkydink that health care inflation has sky rocketed as government's share has increased.

The second biggest problem is that consumers are shielded from prices due to routine and maintenance care being co-mingled with catastrophic insurance. Routine and maintenance care end up being overpriced prepaid services masking as insurance. I'm convinced that without the insurance overhead and cost plus distorted incentives for the insurance middleman - supplier duopology, that what we currently pay as co-pays would be what routine appointments and prescriptions would cost without insurance.

So - we should break up the insurance bundles. Consumers should be free to choose catastrophic care only and to self-fund routine care or subscribe to a concierge service...or other models as the market is free to experiment.

One size fits all is one size fits none.

I don't get it. They've finally figured out that employer provided health care is a bad idea. It's made us virtual slaves to our employers, dependent on them for our very health. And the only fix they can come up with is to shift the dependency to government.

I've often said the the underlying ideology of Progressivism turns people into slaves. It's actually incredibly reactionary (hence the deceptive branding) as most people throughout history have lived as serfs, slaves or chattel.

Look on the bright side. If conservatives of those eras had their way, most people would still live as serfs, slaves and chattel. Thank progressives.

Don't know much about history, do you bub?

The term conservative under authoritarian regimes is misnomer.

Conservatives are always dragged into the future, kicking and screaming. Then and now.

That seems to be the nature of conservatives, return to the good old days or maintain the status quo.

 

[boedicca]

I don't get it. They've finally figured out that employer provided health care is a bad idea. It's made us virtual slaves to our employers, dependent on them for our very health. And the only fix they can come up with is to shift the dependency to government.

I've often said the the underlying ideology of Progressivism turns people into slaves. It's actually incredibly reactionary (hence the deceptive branding) as most people throughout history have lived as serfs, slaves or chattel.

Look on the bright side. If conservatives of those eras had their way, most people would still live as serfs, slaves and chattel. Thank progressives.

Don't know much about history, do you bub?

The term conservative under authoritarian regimes is misnomer.

Conservatives are always dragged into the future, kicking and screaming. Then and now.

That seems to be the nature of conservatives, return to the good old days or maintain the status quo.

The most reactionary people on the planet are the Progs that want to return us all to the state of serfs, slaves and chattel owned by the elites.

 

[SmokeALib]

I don't get it. They've finally figured out that employer provided health care is a bad idea. It's made us virtual slaves to our employers, dependent on them for our very health. And the only fix they can come up with is to shift the dependency to government.

I've often said the the underlying ideology of Progressivism turns people into slaves. It's actually incredibly reactionary (hence the deceptive branding) as most people throughout history have lived as serfs, slaves or chattel.

Look on the bright side. If conservatives of those eras had their way, most people would still live as serfs, slaves and chattel. Thank progressives.

Don't know much about history, do you bub?

The term conservative under authoritarian regimes is misnomer.

Conservatives are always dragged into the future, kicking and screaming. Then and now.

That seems to be the nature of conservatives, return to the good old days or maintain the status quo.

Rediculous statement. Just when I decide to give you clowns the benefit of the doubt, you blow it out of the water.

 

[w1nter1sc0ming]

Conservatives conserve. Ted Nugent for example plants 2 trees for every 1 he cuts down. Liberals burn California for land. They’ve clear cut Corrupticut to install tolls they haven’t even approved yet, though they’ve spent 15 mil on 4 studies to a company that has a track record of corruption.
What do the liberal pushers of ‘global warming’ drive/fly/live in? The hypocrisy is blinding. It’s nothing but a money maker. They come up with convoluted theories & fake info to support their bs, & have dumbed down most of the people into being easily brainwashed. Go libs. [emoji849]

 

[PredFan]

I'm a conservative.
But even I realize that our health Care system is screwed.
Pharmacutical companies are gouging us out of our retirement savings.
Insurance companies are gouging us out of our 401k's.
Doctors and hospitals are performing unneeded procedures and prescribing unneeded drugs for profit.
I'm all about profit - but not profit over deceit.
And not profit over the well-being of American citizens.
I always thought the federal government was fundamental for our national defense, and national defense only.
Not any more.
Get rid of Medicare and Medicaid. Both systems are abused and bankrupt.
Have a single payer system. Tack on 5% on our paychecks and have the government have oversight.
Everybody has health care.
I hate to say it, but that's what it's come down to.

Our healthcare system is not broken, it is not screwed, it is in fact the best in the world.

It's our healthcare insurance system that is broken.

 

[PredFan]

I am too a Conservative and agree. Everyone needs quality health CARE, not just a once over & given some drug that has more side effects than it treats just so everyone in the loop gets rich. Dr's don't treat the problems, they treat the symptoms and that's not healthcare.

One of the things I do have a problem with having government regulated healthcare is I don't want them telling me what can be treated or not....although Dr's & Insurance already do that to some degree. I am thinking of the case of the little boy in England that they refused care because of his condition that even a US Dr said he'd do it, but they wouldn't let the boy come for treatment and soon died.

And therein lies the problem. You can't get the best of universal care, without the worst of it.

 

[Howard Roark]

Conservatives conserve. Ted Nugent for example plants 2 trees for every 1 he cuts down. Liberals burn California for land. They’ve clear cut Corrupticut to install tolls they haven’t even approved yet, though they’ve spent 15 mil on 4 studies to a company that has a track record of corruption.
What do the liberal pushers of ‘global warming’ drive/fly/live in? The hypocrisy is blinding. It’s nothing but a money maker. They come up with convoluted theories & fake info to support their bs, & have dumbed down most of the people into being easily brainwashed. Go libs. [emoji849]

LMAO

"Clean Coal"

LMAO

 

[Flopper]

I am too a Conservative and agree. Everyone needs quality health CARE, not just a once over & given some drug that has more side effects than it treats just so everyone in the loop gets rich. Dr's don't treat the problems, they treat the symptoms and that's not healthcare.

One of the things I do have a problem with having government regulated healthcare is I don't want them telling me what can be treated or not....although Dr's & Insurance already do that to some degree. I am thinking of the case of the little boy in England that they refused care because of his condition that even a US Dr said he'd do it, but they wouldn't let the boy come for treatment and soon died.

Someone has to regulate healthcare spending, that is what medical procedures will be covered. It can't be doctors and hospitals which leaves either the insurance companies or the government. If insurance companies are allowed to make that decision, they will cover only what maximizes profits. That leaves government.

For the last two decades Medicare, that is CMS has made the major decisions as to what will be covered by Medicare. Medicaid picks up basically what Medicare covers. Insurance companies are compelled by federal and state laws to cover procedures that Medicare covers.

That's not to say that insurance coverage will be exactly the same as Medicare. Insurance companies add perks to their coverage which may include holistic medicine, nurse call lines, dental care, vision care, gym membership etc. Also state laws can force insurance companies to consider procedure that have not yet been covered by Medicare.

Various provides of medical coverage do have great latitude in determining how cost will be shared between the company or agency, the medical provider, and the customer.

Basically, I don't think we need to worry about government restricting medical procedures. They have been doing it for decades.

 

[dblack]

Someone has to regulate healthcare spending, that is what medical procedures will be covered.

Why? Why can't you regulate your healthcare spending and I regulate mine? Why the presumption of centralized, authoritarian control of every. god. damned. thing?

 

[Howard Roark]

Someone has to regulate healthcare spending, that is what medical procedures will be covered.

Why? Why can't you regulate your healthcare spending and I regulate mine? Why the presumption of centralized, authoritarian control of every. god. damned. thing?

LMAO. Regulate your spending? When your meds cost $2000/month, do you opt to avoid food?

 

[dblack]

Regulate your spending? When your meds cost $2000/month, do you opt to avoid food?

Why? Did you want government regulating our food spending next?

 

[Howard Roark]

Regulate your spending? When your meds cost $2000/month, do you opt to avoid food?

Why? Did you want government regulating our food spending next?

Perhaps you didn't understand the question?

Meds or food. What do you choose?

 

[Howard Roark]

Pfizer announced that they're jacking up prices on a list of meds soon. This little lie has been discussed in this thread. The Ins. companies never pass the discounts along.

Pfizer said it expects list prices “to be offset by higher rebates and discounts paid to Insurance Companies and Pharmacy Benefit Managers” and said the net effect on the company’s revenue growth in the U.S. in 2019 is expected to be zero.

Why increase prices to consumers, if the revenue growth will be zero?

 

[dblack]

Regulate your spending? When your meds cost $2000/month, do you opt to avoid food?

Why? Did you want government regulating our food spending next?

Perhaps you didn't understand the question?

Meds or food. What do you choose?

Purple. What's your fucking point?

 

[Howard Roark]

Regulate your spending? When your meds cost $2000/month, do you opt to avoid food?

Why? Did you want government regulating our food spending next?

Perhaps you didn't understand the question?

Meds or food. What do you choose?

Purple. What's your fucking point?

It seems that this discussion is a tad above your pay grade.

 

[dblack]

Regulate your spending? When your meds cost $2000/month, do you opt to avoid food?

Why? Did you want government regulating our food spending next?

Perhaps you didn't understand the question?

Meds or food. What do you choose?

Purple. What's your fucking point?

It seems that this discussion is a tad above your pay grade.

So, no point. Just distraction. Thanks.

 

[Howard Roark]

Regulate your spending? When your meds cost $2000/month, do you opt to avoid food?

Why? Did you want government regulating our food spending next?

Perhaps you didn't understand the question?

Meds or food. What do you choose?

Purple. What's your fucking point?

It seems that this discussion is a tad above your pay grade.

So, no point. Just distraction. Thanks.

Yea...go with that. At least you didn't opt for a color this time. Maybe the next door neighbor's kid can explain this segment to you?