Is it time for Universal Healthcare....and can it be done?

[MaryAnne11]

Why are you paying that much money if you are on Medicare? Have you checked Medicare Advantage plans?

MaryAnne11 do you know the difference between Medicare and Medicare Advantage Plans because it doesn't seem like you do.

A) Medicare traditional Fee for service means as a Medicare beneficiary you pay the 20% that Medicare won't like for a doctor office visit.
B) Medicare Advantage (MA) Plans are where the MA signs a contract to pay all health care expenses for a Medicare beneficiary if Medicare agrees to pay the MA $800/month.

There are over 607 MA plans and most are for profit health insurance companies that contract with Medicare. Again I KNOW what I'm talking about.

For more details: https://www.medicare.gov/Pubs/pdf/11474.pdf

I learned all that long ago. I certainly do not need anyone to explain to me.

But where in the world do you live that you pay $800 a month for Medicare Advantage?

You do pay for regular Medicare.

 

[MaryAnne11]

Why are you paying that much money if you are on Medicare? Have you checked Medicare Advantage plans?

His figures are a tad off but I believe he's talking about the premium for Part B. The higher amounts are what higher income people pay.

I can see that for regular Medicare but his post said for Medicare Advantage.

 

[Rigby5]

What you are illustrating is the COSTS of practicing medicine paid for by others and not YOU!
A) If you had to pay out of your pocket office visits would you be going to the doctor for a splinter in your finger?
B) Would you be doing dumb ass stunts such as these or let your kids do them?
View attachment 208457
C) Why do you think insurance companies pay hospitals $3,000 for a CAT scan that costs less than $100 to perform? CHECK OUT EMTALA!
D) Why do you think doctors agree nearly $800 billion a year in wasted medical tests, etc... all because they fear being sued.

These idiotic stunts, idiotic attitude..."hey I've got insurance..." all contribute to what you complained about!

Insurance companies don't pay hospitals $3,000 for CT scan, shit after it's discounted down they are lucky to get $800. I had an MRI a few weeks back, retail $3500, allowed amount $336.00, my copay $40.00

OK... check out this then: for a hospital in Texas and what they charged Medicare...
CT Scan for 4,456 patients -- average charge: $4,819 -- Average cost: $52

All information in this report is taken from the Medicare Outpatient Prospective Payment System (OPPS) Limited Data Set which is updated annually by CMS based on the calendar year. The file includes billing data for 100% of all Medicare fee-for-service claims for hospital outpatient services during the twelve months ending December 31. The report is based on the most recent period available and is consistent with CMS cell size suppression policy.

Services are defined based on the revenue code for a line item. Averages are based on units of service (i.e. the number of units of items or services delivered).

• Number Patient Claims - the total number of claims for the service.
• Units of Service - the number of units of the items or services delivered. (One claim may have multiple units of service for an item or service.)
• Average Charge - the total charges (covered and non-covered) for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
• Average Cost - Charges adjusted to cost using the hospital's specific cost center cost-to-charge ratio. This calculation is done by CMS and included with OPPS claims data. (Details of the calculation are not provided by CMS.)
• Average Payment - The computed OPPS payment for a line item based on the payment APC. The "payment APC" refers to total payment, including deductible, coinsurance, and program payment.
• Service Mix Index (SMI) - Each APC has a relative weight assigned by CMS. The Service Mix Index is the average relative weight of the procedures billed for a service (e.g. the average relative weight of all surgical procedures performed).

the hospitals play that game for tax purposes, they create huge charges and then accept much less from insurance or medicare and claim the rest as a business loss for tax purposes. Its a game and they have been doing it for years.

a few years ago my wife had a brain aneurysm (from which she recovered completely after amazing surgery). he hospital bill was over 250K plus 60K for the brain surgeon and his team. Insurance (medicare advantage) paid 80K total and the hospital and doctor never asked us for more than our deductible of 2K. I am quite sure that their tax returns will show losses on this patient of 190K or more.

Same procedure is used by the drug companies. that is what needs to be fixed, not create some huge inefficient government agency that would ruin the best medical system in the history of the world.

Huge government agencies are the most efficient at things like administering health care because they have the most negotiating clout.
Works in every country in the world.
Medicare and VA show less than a 10% administration overhead, while private insurance companies are more like 40%.

We do not have the best health care in the world.
Actually we are rated 37, about the lowest of all the developed nations.

World Health Organization's Ranking of the World's Health Systems

Once again your lack of really understanding how the world works is appalling!
A) Medicare doesn't process ONE SINGLE CLAIM! For profit insurance companies contract with Medicare and pay all the claims.
B) The average insurance company nets AFTER paying claims 20%! NOT 40%
C) STATE laws require these insurance companies to have reserves that are paid from "PROFITS" or they can't sell insurance. As a result idiots like Obama in Obamacare
said insurance companies must pay out 85% of all premiums. This left NOTHING for profits after 15% deducted for administration. HENCE the reason companies dropped ACA!
D) There are NO countries in the world where govt. run health care are "efficient". Canadians come to the USA for health care! FACT!
The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.Aug 3, 2016
https://www.usnews.com/news/best-co...dians-increasingly-come-to-us-for-health-care

E) Ultimately any more facts I share with you is useless as you have absolutely NO common sense! Zero.

Not one of your inane comments had any substantiation. YOU are guessing and are wrong on all counts.

FACTS prove how totally and truly ignorant you are as to how the REAL world works. Please read for once FACTS ...not fiction!

Not at all true.

A) I am on Medicare now, and there is absolutely no private insurance company involved.
I fill out Medicare forms myself.
And it would no matter if they did subcontract as long as they get the charges down as low as they do.

B) You are forgetting that insurance companies charge you 30 years or so ahead of when they actually normally start making payments back out, on average. So you either have to include the profit they make borrowing your money, or include the interest they should be paying on the loan we are forced to give them. Statisticians estimate it is actually over 40% they are making off our misery.

C) Not making as much profit from ACA only means insurance companies are greedy. There is more than enough profit under ACA. But mandating insurance is inherently illegal and should be stopped.

D) Every country in the world runs more efficient health care than the US, which is why most people leave the US for health care.
The ONLY ones that come to the US for health care are the very top wealthy, because there is no waiting here for the wealthy, and we do have the very best, highest paid, specialists. If you want a pacemaker, you go to France. If you want plastic surgery, you go to Thailand. Cancer goes to Mexico. Canada is good for most things. Medical tourism out is far higher than it is into the US, by about a factor of 100 or so.

{...
Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in other countries. For example, in the United States, a liver transplant that may cost $300,000 USD, would generally cost about $91,000 USD in Taiwan.[8]
...
In First World countries such as the United States, medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
...}

Medical tourism - Wikipedia

Face it, medical care in the US really, really sucks.

 

[MaryAnne11]

When we stop the insanity of looking at Doctors like they were Gods and quit allowing ourselves to be treated as cash flow this stupidity will stop.

Last trip I took to the Doctor I asked flat out what my cost would be. When he couldn’t answer I told him, I’ll pay you $200 period and in cash. Period

Took care of it.

 

[Rigby5]

I'm also not responsible for paying for your damn cable tv, water and garbage, electric bill, rent, or your damn car payment. Moochers need to get up off their ass and pay their own bills.

You don't pay anyone else's cable, water, garbage, electric, rent or car payment.
Only when there are dependent children are there any minor subsidies available, like Section 8 rent help, which only pays about 30% at most.
Almost all the Human Services federal money goes to disabled vets.

Government abolished welfare??? Oh wait they didn't

You obviously don't know anything about welfare.
If you are a male and not disabled, you just will not qualify.
Women with dependent children are the only ones who can get it, unless you are disabled.

 

[MaryAnne11]

I pay $5. You cost yourself $195. i had a complete physical, blood tests.

Then an MRI forr bone density. No charge to me.Went online,read the chart myself even though the Nurse called me to inform me of the results.

Amazing how health care has changed.

 

[MaryAnne11]

I'm also not responsible for paying for your damn cable tv, water and garbage, electric bill, rent, or your damn car payment. Moochers need to get up off their ass and pay their own bills.

You don't pay anyone else's cable, water, garbage, electric, rent or car payment.
Only when there are dependent children are there any minor subsidies available, like Section 8 rent help, which only pays about 30% at most.
Almost all the Human Services federal money goes to disabled vets.

Government abolished welfare??? Oh wait they didn't

You obviously don't know anything about welfare.
If you are a male and not disabled, you just will not qualify.
Women with dependent children are the only ones who can get it, unless you are disabled.

If you are disabled you get disability.

 

[MaryAnne11]

Insurance companies don't pay hospitals $3,000 for CT scan, shit after it's discounted down they are lucky to get $800. I had an MRI a few weeks back, retail $3500, allowed amount $336.00, my copay $40.00

OK... check out this then: for a hospital in Texas and what they charged Medicare...
CT Scan for 4,456 patients -- average charge: $4,819 -- Average cost: $52

All information in this report is taken from the Medicare Outpatient Prospective Payment System (OPPS) Limited Data Set which is updated annually by CMS based on the calendar year. The file includes billing data for 100% of all Medicare fee-for-service claims for hospital outpatient services during the twelve months ending December 31. The report is based on the most recent period available and is consistent with CMS cell size suppression policy.

Services are defined based on the revenue code for a line item. Averages are based on units of service (i.e. the number of units of items or services delivered).

• Number Patient Claims - the total number of claims for the service.
• Units of Service - the number of units of the items or services delivered. (One claim may have multiple units of service for an item or service.)
• Average Charge - the total charges (covered and non-covered) for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
• Average Cost - Charges adjusted to cost using the hospital's specific cost center cost-to-charge ratio. This calculation is done by CMS and included with OPPS claims data. (Details of the calculation are not provided by CMS.)
• Average Payment - The computed OPPS payment for a line item based on the payment APC. The "payment APC" refers to total payment, including deductible, coinsurance, and program payment.
• Service Mix Index (SMI) - Each APC has a relative weight assigned by CMS. The Service Mix Index is the average relative weight of the procedures billed for a service (e.g. the average relative weight of all surgical procedures performed).

the hospitals play that game for tax purposes, they create huge charges and then accept much less from insurance or medicare and claim the rest as a business loss for tax purposes. Its a game and they have been doing it for years.

a few years ago my wife had a brain aneurysm (from which she recovered completely after amazing surgery). he hospital bill was over 250K plus 60K for the brain surgeon and his team. Insurance (medicare advantage) paid 80K total and the hospital and doctor never asked us for more than our deductible of 2K. I am quite sure that their tax returns will show losses on this patient of 190K or more.

Same procedure is used by the drug companies. that is what needs to be fixed, not create some huge inefficient government agency that would ruin the best medical system in the history of the world.

Huge government agencies are the most efficient at things like administering health care because they have the most negotiating clout.
Works in every country in the world.
Medicare and VA show less than a 10% administration overhead, while private insurance companies are more like 40%.

We do not have the best health care in the world.
Actually we are rated 37, about the lowest of all the developed nations.

World Health Organization's Ranking of the World's Health Systems

Once again your lack of really understanding how the world works is appalling!
A) Medicare doesn't process ONE SINGLE CLAIM! For profit insurance companies contract with Medicare and pay all the claims.
B) The average insurance company nets AFTER paying claims 20%! NOT 40%
C) STATE laws require these insurance companies to have reserves that are paid from "PROFITS" or they can't sell insurance. As a result idiots like Obama in Obamacare
said insurance companies must pay out 85% of all premiums. This left NOTHING for profits after 15% deducted for administration. HENCE the reason companies dropped ACA!
D) There are NO countries in the world where govt. run health care are "efficient". Canadians come to the USA for health care! FACT!
The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.Aug 3, 2016
https://www.usnews.com/news/best-co...dians-increasingly-come-to-us-for-health-care

E) Ultimately any more facts I share with you is useless as you have absolutely NO common sense! Zero.

Not one of your inane comments had any substantiation. YOU are guessing and are wrong on all counts.

FACTS prove how totally and truly ignorant you are as to how the REAL world works. Please read for once FACTS ...not fiction!

Not at all true.

A) I am on Medicare now, and there is absolutely no private insurance company involved.
I fill out Medicare forms myself.
And it would no matter if they did subcontract as long as they get the charges down as low as they do.

B) You are forgetting that insurance companies charge you 30 years or so ahead of when they actually normally start making payments back out, on average. So you either have to include the profit they make borrowing your money, or include the interest they should be paying on the loan we are forced to give them. Statisticians estimate it is actually over 40% they are making off our misery.

C) Not making as much profit from ACA only means insurance companies are greedy. There is more than enough profit under ACA. But mandating insurance is inherently illegal and should be stopped.

D) Every country in the world runs more efficient health care than the US, which is why most people leave the US for health care.
The ONLY ones that come to the US for health care are the very top wealthy, because there is no waiting here for the wealthy, and we do have the very best, highest paid, specialists. If you want a pacemaker, you go to France. If you want plastic surgery, you go to Thailand. Cancer goes to Mexico. Canada is good for most things. Medical tourism out is far higher than it is into the US, by about a factor of 100 or so.

{...
Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in other countries. For example, in the United States, a liver transplant that may cost $300,000 USD, would generally cost about $91,000 USD in Taiwan.[8]
...
In First World countries such as the United States, medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
...}

Medical tourism - Wikipedia

Face it, medical care in the US really, really sucks.

My Insurance company notified me after 3 years they had adjusted and every year since we have had added benefits. Vision, Dental, even Hearing Aids.

 

[MaryAnne11]

Insurance companies don't pay hospitals $3,000 for CT scan, shit after it's discounted down they are lucky to get $800. I had an MRI a few weeks back, retail $3500, allowed amount $336.00, my copay $40.00

OK... check out this then: for a hospital in Texas and what they charged Medicare...
CT Scan for 4,456 patients -- average charge: $4,819 -- Average cost: $52

All information in this report is taken from the Medicare Outpatient Prospective Payment System (OPPS) Limited Data Set which is updated annually by CMS based on the calendar year. The file includes billing data for 100% of all Medicare fee-for-service claims for hospital outpatient services during the twelve months ending December 31. The report is based on the most recent period available and is consistent with CMS cell size suppression policy.

Services are defined based on the revenue code for a line item. Averages are based on units of service (i.e. the number of units of items or services delivered).

• Number Patient Claims - the total number of claims for the service.
• Units of Service - the number of units of the items or services delivered. (One claim may have multiple units of service for an item or service.)
• Average Charge - the total charges (covered and non-covered) for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
• Average Cost - Charges adjusted to cost using the hospital's specific cost center cost-to-charge ratio. This calculation is done by CMS and included with OPPS claims data. (Details of the calculation are not provided by CMS.)
• Average Payment - The computed OPPS payment for a line item based on the payment APC. The "payment APC" refers to total payment, including deductible, coinsurance, and program payment.
• Service Mix Index (SMI) - Each APC has a relative weight assigned by CMS. The Service Mix Index is the average relative weight of the procedures billed for a service (e.g. the average relative weight of all surgical procedures performed).

the hospitals play that game for tax purposes, they create huge charges and then accept much less from insurance or medicare and claim the rest as a business loss for tax purposes. Its a game and they have been doing it for years.

a few years ago my wife had a brain aneurysm (from which she recovered completely after amazing surgery). he hospital bill was over 250K plus 60K for the brain surgeon and his team. Insurance (medicare advantage) paid 80K total and the hospital and doctor never asked us for more than our deductible of 2K. I am quite sure that their tax returns will show losses on this patient of 190K or more.

Same procedure is used by the drug companies. that is what needs to be fixed, not create some huge inefficient government agency that would ruin the best medical system in the history of the world.

Huge government agencies are the most efficient at things like administering health care because they have the most negotiating clout.
Works in every country in the world.
Medicare and VA show less than a 10% administration overhead, while private insurance companies are more like 40%.

We do not have the best health care in the world.
Actually we are rated 37, about the lowest of all the developed nations.

World Health Organization's Ranking of the World's Health Systems

Once again your lack of really understanding how the world works is appalling!
A) Medicare doesn't process ONE SINGLE CLAIM! For profit insurance companies contract with Medicare and pay all the claims.
B) The average insurance company nets AFTER paying claims 20%! NOT 40%
C) STATE laws require these insurance companies to have reserves that are paid from "PROFITS" or they can't sell insurance. As a result idiots like Obama in Obamacare
said insurance companies must pay out 85% of all premiums. This left NOTHING for profits after 15% deducted for administration. HENCE the reason companies dropped ACA!
D) There are NO countries in the world where govt. run health care are "efficient". Canadians come to the USA for health care! FACT!
The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.Aug 3, 2016
https://www.usnews.com/news/best-co...dians-increasingly-come-to-us-for-health-care

E) Ultimately any more facts I share with you is useless as you have absolutely NO common sense! Zero.

Not one of your inane comments had any substantiation. YOU are guessing and are wrong on all counts.

FACTS prove how totally and truly ignorant you are as to how the REAL world works. Please read for once FACTS ...not fiction!

Not at all true.

A) I am on Medicare now, and there is absolutely no private insurance company involved.
I fill out Medicare forms myself.
And it would no matter if they did subcontract as long as they get the charges down as low as they do.

B) You are forgetting that insurance companies charge you 30 years or so ahead of when they actually normally start making payments back out, on average. So you either have to include the profit they make borrowing your money, or include the interest they should be paying on the loan we are forced to give them. Statisticians estimate it is actually over 40% they are making off our misery.

C) Not making as much profit from ACA only means insurance companies are greedy. There is more than enough profit under ACA. But mandating insurance is inherently illegal and should be stopped.

D) Every country in the world runs more efficient health care than the US, which is why most people leave the US for health care.
The ONLY ones that come to the US for health care are the very top wealthy, because there is no waiting here for the wealthy, and we do have the very best, highest paid, specialists. If you want a pacemaker, you go to France. If you want plastic surgery, you go to Thailand. Cancer goes to Mexico. Canada is good for most things. Medical tourism out is far higher than it is into the US, by about a factor of 100 or so.

{...
Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in other countries. For example, in the United States, a liver transplant that may cost $300,000 USD, would generally cost about $91,000 USD in Taiwan.[8]
...
In First World countries such as the United States, medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
...}

Medical tourism - Wikipedia

Face it, medical care in the US really, really sucks.

Medicare advantage is a supplimentary plan the helps pay the 20% that

Medicare does not cover. In many cases there is no zero monthly payment.payment. Check the back of your Medicare book. The plans are all there. Your state and your County.

 

[MaryAnne11]

Monthly Costs for Medicare.

Part B costs for those with higher incomes - Medicare Interactive

 

[mikegriffith1]

"We're the only industrialized without universal health care," blah, blah, blah, blah. And have you ever used some of those health care systems? I have. I lived in Greece and England while I was in the military. The national health care system in Greece was so bad that we were advised not to use it, and the military arranged contracts with private hospitals. As for England's national health care system, go ask my oldest son about how pitiful it is. Go ask British folks about how long they have to wait for any procedure that is deemed non-essential. Why do you think private hospitals in the UK are thriving even though they're pay-for-service?

 

[Redfish]

and just maybe we would get doctor's who are in it to actually help patients instead of the money.

^^^ another stupid ass socialist who lives in fantasy land. Why do shit for brains liberals always assume the people they are trying to screw over are 'rich' and can afford it?

That is backwards.
Public health care would save everyone lots of money, because you then don't have the layers skimming off profits, like insurance companies, health care conglomerates, etc.
The rest of the world has better health care at less than half the cost, by hiring the doctors directly, or using single payer negotiating clout to get the best prices and quality.
Private health insurance makes no sense at all, since once you prepay, you have ZERO negotiating power over quality or price.
And by making health insurance benefits tax exempt, the poor actually help subsidize the health care of the wealthy.

more leftist BS. the rest of the world does NOT have better healthcare than we do. Ask any Canadian or Brit if they like their national health service. It is akin to our VA, is sucks and people are waiting months for routine procedures. The insurance companies have plenty of leverage on pricing, compare the listed price for any procedure with what your hospital accepts from your insurance company. Sure, its far from perfect, but what isn't.?

 

[JBond]

We need to get the health care lobby out of government, keeping their monopoly pricing alive.

We need to get government out of health care. They are the ones that fucked this up.

 

[debbiedowner]

and just maybe we would get doctor's who are in it to actually help patients instead of the money.

^^^ another stupid ass socialist who lives in fantasy land. Why do shit for brains liberals always assume the people they are trying to screw over are 'rich' and can afford it?

Not a lib or a socialist, but it is you that lives in fantasy land. Get rid of Medicaid, Medicare, VA and tricare and you have more than enough to insure everyone in the U.S. But I don't advocate Medicare for All just a form, let everyone 55 or above receive Medicare, lower the insurance rates on individual plans to what they were 20 years ago, medically underwrite all policy's and anyone who is declined buys into Medicare and a higher rate than anyone that is currently on it until they reach 55.

 

[debbiedowner]

What you are illustrating is the COSTS of practicing medicine paid for by others and not YOU!
A) If you had to pay out of your pocket office visits would you be going to the doctor for a splinter in your finger?
B) Would you be doing dumb ass stunts such as these or let your kids do them?
View attachment 208457
C) Why do you think insurance companies pay hospitals $3,000 for a CAT scan that costs less than $100 to perform? CHECK OUT EMTALA!
D) Why do you think doctors agree nearly $800 billion a year in wasted medical tests, etc... all because they fear being sued.

These idiotic stunts, idiotic attitude..."hey I've got insurance..." all contribute to what you complained about!

Insurance companies don't pay hospitals $3,000 for CT scan, shit after it's discounted down they are lucky to get $800. I had an MRI a few weeks back, retail $3500, allowed amount $336.00, my copay $40.00

OK... check out this then: for a hospital in Texas and what they charged Medicare...
CT Scan for 4,456 patients -- average charge: $4,819 -- Average cost: $52

All information in this report is taken from the Medicare Outpatient Prospective Payment System (OPPS) Limited Data Set which is updated annually by CMS based on the calendar year. The file includes billing data for 100% of all Medicare fee-for-service claims for hospital outpatient services during the twelve months ending December 31. The report is based on the most recent period available and is consistent with CMS cell size suppression policy.

Services are defined based on the revenue code for a line item. Averages are based on units of service (i.e. the number of units of items or services delivered).

• Number Patient Claims - the total number of claims for the service.
• Units of Service - the number of units of the items or services delivered. (One claim may have multiple units of service for an item or service.)
• Average Charge - the total charges (covered and non-covered) for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
• Average Cost - Charges adjusted to cost using the hospital's specific cost center cost-to-charge ratio. This calculation is done by CMS and included with OPPS claims data. (Details of the calculation are not provided by CMS.)
• Average Payment - The computed OPPS payment for a line item based on the payment APC. The "payment APC" refers to total payment, including deductible, coinsurance, and program payment.
• Service Mix Index (SMI) - Each APC has a relative weight assigned by CMS. The Service Mix Index is the average relative weight of the procedures billed for a service (e.g. the average relative weight of all surgical procedures performed).

the hospitals play that game for tax purposes, they create huge charges and then accept much less from insurance or medicare and claim the rest as a business loss for tax purposes. Its a game and they have been doing it for years.

a few years ago my wife had a brain aneurysm (from which she recovered completely after amazing surgery). he hospital bill was over 250K plus 60K for the brain surgeon and his team. Insurance (medicare advantage) paid 80K total and the hospital and doctor never asked us for more than our deductible of 2K. I am quite sure that their tax returns will show losses on this patient of 190K or more.

Same procedure is used by the drug companies. that is what needs to be fixed, not create some huge inefficient government agency that would ruin the best medical system in the history of the world.

Huge government agencies are the most efficient at things like administering health care because they have the most negotiating clout.
Works in every country in the world.
Medicare and VA show less than a 10% administration overhead, while private insurance companies are more like 40%.

We do not have the best health care in the world.
Actually we are rated 37, about the lowest of all the developed nations.

World Health Organization's Ranking of the World's Health Systems

Once again your lack of really understanding how the world works is appalling!
A) Medicare doesn't process ONE SINGLE CLAIM! For profit insurance companies contract with Medicare and pay all the claims.
B) The average insurance company nets AFTER paying claims 20%! NOT 40%
C) STATE laws require these insurance companies to have reserves that are paid from "PROFITS" or they can't sell insurance. As a result idiots like Obama in Obamacare
said insurance companies must pay out 85% of all premiums. This left NOTHING for profits after 15% deducted for administration. HENCE the reason companies dropped ACA!
D) There are NO countries in the world where govt. run health care are "efficient". Canadians come to the USA for health care! FACT!
The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.Aug 3, 2016
https://www.usnews.com/news/best-co...dians-increasingly-come-to-us-for-health-care

E) Ultimately any more facts I share with you is useless as you have absolutely NO common sense! Zero.

Not one of your inane comments had any substantiation. YOU are guessing and are wrong on all counts.

FACTS prove how totally and truly ignorant you are as to how the REAL world works. Please read for once FACTS ...not fiction!

OK... check out this then: for a hospital in Texas and what they charged Medicare...
CT Scan for 4,456 patients -- average charge: $4,819 -- Average cost: $52

All information in this report is taken from the Medicare Outpatient Prospective Payment System (OPPS) Limited Data Set which is updated annually by CMS based on the calendar year. The file includes billing data for 100% of all Medicare fee-for-service claims for hospital outpatient services during the twelve months ending December 31. The report is based on the most recent period available and is consistent with CMS cell size suppression policy.

Services are defined based on the revenue code for a line item. Averages are based on units of service (i.e. the number of units of items or services delivered).

• Number Patient Claims - the total number of claims for the service.
• Units of Service - the number of units of the items or services delivered. (One claim may have multiple units of service for an item or service.)
• Average Charge - the total charges (covered and non-covered) for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
• Average Cost - Charges adjusted to cost using the hospital's specific cost center cost-to-charge ratio. This calculation is done by CMS and included with OPPS claims data. (Details of the calculation are not provided by CMS.)
• Average Payment - The computed OPPS payment for a line item based on the payment APC. The "payment APC" refers to total payment, including deductible, coinsurance, and program payment.
• Service Mix Index (SMI) - Each APC has a relative weight assigned by CMS. The Service Mix Index is the average relative weight of the procedures billed for a service (e.g. the average relative weight of all surgical procedures performed).

the hospitals play that game for tax purposes, they create huge charges and then accept much less from insurance or medicare and claim the rest as a business loss for tax purposes. Its a game and they have been doing it for years.

a few years ago my wife had a brain aneurysm (from which she recovered completely after amazing surgery). he hospital bill was over 250K plus 60K for the brain surgeon and his team. Insurance (medicare advantage) paid 80K total and the hospital and doctor never asked us for more than our deductible of 2K. I am quite sure that their tax returns will show losses on this patient of 190K or more.

Same procedure is used by the drug companies. that is what needs to be fixed, not create some huge inefficient government agency that would ruin the best medical system in the history of the world.

Huge government agencies are the most efficient at things like administering health care because they have the most negotiating clout.
Works in every country in the world.
Medicare and VA show less than a 10% administration overhead, while private insurance companies are more like 40%.

We do not have the best health care in the world.
Actually we are rated 37, about the lowest of all the developed nations.

World Health Organization's Ranking of the World's Health Systems

Once again your lack of really understanding how the world works is appalling!
A) Medicare doesn't process ONE SINGLE CLAIM! For profit insurance companies contract with Medicare and pay all the claims.
B) The average insurance company nets AFTER paying claims 20%! NOT 40%
C) STATE laws require these insurance companies to have reserves that are paid from "PROFITS" or they can't sell insurance. As a result idiots like Obama in Obamacare
said insurance companies must pay out 85% of all premiums. This left NOTHING for profits after 15% deducted for administration. HENCE the reason companies dropped ACA!
D) There are NO countries in the world where govt. run health care are "efficient". Canadians come to the USA for health care! FACT!
The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.Aug 3, 2016
https://www.usnews.com/news/best-co...dians-increasingly-come-to-us-for-health-care

E) Ultimately any more facts I share with you is useless as you have absolutely NO common sense! Zero.

Not one of your inane comments had any substantiation. YOU are guessing and are wrong on all counts.

FACTS prove how totally and truly ignorant you are as to how the REAL world works. Please read for once FACTS ...not fiction!

Not at all true.

A) I am on Medicare now, and there is absolutely no private insurance company involved.
I fill out Medicare forms myself.
And it would no matter if they did subcontract as long as they get the charges down as low as they do.

B) You are forgetting that insurance companies charge you 30 years or so ahead of when they actually normally start making payments back out, on average. So you either have to include the profit they make borrowing your money, or include the interest they should be paying on the loan we are forced to give them. Statisticians estimate it is actually over 40% they are making off our misery.

C) Not making as much profit from ACA only means insurance companies are greedy. There is more than enough profit under ACA. But mandating insurance is inherently illegal and should be stopped.

D) Every country in the world runs more efficient health care than the US, which is why most people leave the US for health care.
The ONLY ones that come to the US for health care are the very top wealthy, because there is no waiting here for the wealthy, and we do have the very best, highest paid, specialists. If you want a pacemaker, you go to France. If you want plastic surgery, you go to Thailand. Cancer goes to Mexico. Canada is good for most things. Medical tourism out is far higher than it is into the US, by about a factor of 100 or so.

{...
Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in other countries. For example, in the United States, a liver transplant that may cost $300,000 USD, would generally cost about $91,000 USD in Taiwan.[8]
...
In First World countries such as the United States, medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
...}

Medical tourism - Wikipedia

Face it, medical care in the US really, really sucks.

Medicare advantage is a supplimentary plan the helps pay the 20% that

Medicare does not cover. In many cases there is no zero monthly payment.payment. Check the back of your Medicare book. The plans are all there. Your state and your County.

No, Medicare Advantage is not a supplement, it replaces your Medicare except for hospice and you still pay your part B premium. Many counties in the U.S. do charge a hefty premium on MAPD but I never have heard of $800 and never seen in. There is an online file somewhere that shows each county in the U.S. that offers MAPD, MA and PDP's and it show's you the premium's. It all depends in which state and country you live. Most Regional PPO's have the same premium within a state.

 

[healthmyths]

Insurance companies don't pay hospitals $3,000 for CT scan, shit after it's discounted down they are lucky to get $800. I had an MRI a few weeks back, retail $3500, allowed amount $336.00, my copay $40.00

OK... check out this then: for a hospital in Texas and what they charged Medicare...
CT Scan for 4,456 patients -- average charge: $4,819 -- Average cost: $52

All information in this report is taken from the Medicare Outpatient Prospective Payment System (OPPS) Limited Data Set which is updated annually by CMS based on the calendar year. The file includes billing data for 100% of all Medicare fee-for-service claims for hospital outpatient services during the twelve months ending December 31. The report is based on the most recent period available and is consistent with CMS cell size suppression policy.

Services are defined based on the revenue code for a line item. Averages are based on units of service (i.e. the number of units of items or services delivered).

• Number Patient Claims - the total number of claims for the service.
• Units of Service - the number of units of the items or services delivered. (One claim may have multiple units of service for an item or service.)
• Average Charge - the total charges (covered and non-covered) for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
• Average Cost - Charges adjusted to cost using the hospital's specific cost center cost-to-charge ratio. This calculation is done by CMS and included with OPPS claims data. (Details of the calculation are not provided by CMS.)
• Average Payment - The computed OPPS payment for a line item based on the payment APC. The "payment APC" refers to total payment, including deductible, coinsurance, and program payment.
• Service Mix Index (SMI) - Each APC has a relative weight assigned by CMS. The Service Mix Index is the average relative weight of the procedures billed for a service (e.g. the average relative weight of all surgical procedures performed).

the hospitals play that game for tax purposes, they create huge charges and then accept much less from insurance or medicare and claim the rest as a business loss for tax purposes. Its a game and they have been doing it for years.

a few years ago my wife had a brain aneurysm (from which she recovered completely after amazing surgery). he hospital bill was over 250K plus 60K for the brain surgeon and his team. Insurance (medicare advantage) paid 80K total and the hospital and doctor never asked us for more than our deductible of 2K. I am quite sure that their tax returns will show losses on this patient of 190K or more.

Same procedure is used by the drug companies. that is what needs to be fixed, not create some huge inefficient government agency that would ruin the best medical system in the history of the world.

Huge government agencies are the most efficient at things like administering health care because they have the most negotiating clout.
Works in every country in the world.
Medicare and VA show less than a 10% administration overhead, while private insurance companies are more like 40%.

We do not have the best health care in the world.
Actually we are rated 37, about the lowest of all the developed nations.

World Health Organization's Ranking of the World's Health Systems

Once again your lack of really understanding how the world works is appalling!
A) Medicare doesn't process ONE SINGLE CLAIM! For profit insurance companies contract with Medicare and pay all the claims.
B) The average insurance company nets AFTER paying claims 20%! NOT 40%
C) STATE laws require these insurance companies to have reserves that are paid from "PROFITS" or they can't sell insurance. As a result idiots like Obama in Obamacare
said insurance companies must pay out 85% of all premiums. This left NOTHING for profits after 15% deducted for administration. HENCE the reason companies dropped ACA!
D) There are NO countries in the world where govt. run health care are "efficient". Canadians come to the USA for health care! FACT!
The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.Aug 3, 2016
https://www.usnews.com/news/best-co...dians-increasingly-come-to-us-for-health-care

E) Ultimately any more facts I share with you is useless as you have absolutely NO common sense! Zero.

Not one of your inane comments had any substantiation. YOU are guessing and are wrong on all counts.

FACTS prove how totally and truly ignorant you are as to how the REAL world works. Please read for once FACTS ...not fiction!

Not at all true.

A) I am on Medicare now, and there is absolutely no private insurance company involved.
I fill out Medicare forms myself.
And it would no matter if they did subcontract as long as they get the charges down as low as they do.

B) You are forgetting that insurance companies charge you 30 years or so ahead of when they actually normally start making payments back out, on average. So you either have to include the profit they make borrowing your money, or include the interest they should be paying on the loan we are forced to give them. Statisticians estimate it is actually over 40% they are making off our misery.

C) Not making as much profit from ACA only means insurance companies are greedy. There is more than enough profit under ACA. But mandating insurance is inherently illegal and should be stopped.

D) Every country in the world runs more efficient health care than the US, which is why most people leave the US for health care.
The ONLY ones that come to the US for health care are the very top wealthy, because there is no waiting here for the wealthy, and we do have the very best, highest paid, specialists. If you want a pacemaker, you go to France. If you want plastic surgery, you go to Thailand. Cancer goes to Mexico. Canada is good for most things. Medical tourism out is far higher than it is into the US, by about a factor of 100 or so.

{...
Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in other countries. For example, in the United States, a liver transplant that may cost $300,000 USD, would generally cost about $91,000 USD in Taiwan.[8]
...
In First World countries such as the United States, medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
...}

Medical tourism - Wikipedia

Face it, medical care in the US really, really sucks.

You wrote:
A) I am on Medicare now, and there is absolutely no private insurance company involved.
I fill out Medicare forms myself.
And it would no matter if they did subcontract as long as they get the charges down as low as they do.

Here is a web site from CMS the federal agency that handles Medicare!
MAC Website List - Centers for Medicare & Medicaid Services
Click on your state... for example I'm in Texas...
Part A and B - Novitas Solutions, Inc - Jurisdiction H

DME - CGS Administrators, LLC - Jurisdiction C

Home Health & Hospice - Palmetto GBA, LLC - Jurisdiction M

Do you understand what that means? Click on Novitas Solutions, Inc. you will go to a web site managed by Novitas WHICH all hospitals and Part B providers
send their claims to be processed. Medicare contracts with them to do so. Medicare doesn't pay a single claim. The Medicare Administrative Contractor which
handles all the claims for Texas hospitals and providers pays the claims out of the fees they charge Medicare. But Medicare doesn't process a single claim.
And as such Novitas has thousands of people working for them that process these claims and when all the expenses are deducted, Novitas make a slight profit.
Novitas is owned by GuideWell Source
Guidewell Source also owns First Coast Service Options which handles Fl... and from Guidewellsource.com
First Coast and Novitas provide administrative and claims processing services for state and federal health care programs such as Medicare and Medicaid. First Coast and Novitas contract with CMS to provide quality Medicare administrative services throughout the United States to more than eleven million beneficiaries and the five hundred thousand health care providers who care for them.

But once again your truly lack of health care finances is showing!
Novitas, etc. of which there are seven Medicare Administrative Contractors that pay all the claims EXCEPT for the 607 Medicare Advantage plans are all operated by mostly for
profit companies. Again... if you knew anything about health care financing you'd be aware of this as I am intimately aware!

And you admitted it..."because there is no waiting here for the wealthy," So there is waiting in these countries that have socialized medicine is what you are saying?
Do you understand the implications of your comment?? You admit the USA has faster, better services than those countries with socialized medicine!

 

[basquebromance]

"In another attempt to undermine health care, the Trump Administration is putting power back into the hands of insurance companies by making it easier for them to sell junk insurance -- plans that skirt patient protections for pre-existing conditions and maternity care." - Senator Patty Murray

 

[dblack]

Welcome to government health care. Dr Trump will see you now. Bend over and say "ahhh".

 

[healthmyths]

"In another attempt to undermine health care, the Trump Administration is putting power back into the hands of insurance companies by making it easier for them to sell junk insurance -- plans that skirt patient protections for pre-existing conditions and maternity care." - Senator Patty Murray

How many people TRULY were unable to get health insurance BEFORE ACA because of "pre-existing conditions"?
Now don't use the gigantic lie Obama stated:Up to half of all Americans have a pre-existing condition." — Barack Obama on Thursday, September 26th, 2013 in a speech about ACA.

I'm waiting for you to do a little research as I know the answer but YOU need to do some scholarly work and see how your BIASED MSM has NOT shared the Truth that Obama LIED
about i.e. half of all Americans!

 

[BluesLegend]

I'm also not responsible for paying for your damn cable tv, water and garbage, electric bill, rent, or your damn car payment. Moochers need to get up off their ass and pay their own bills.

You don't pay anyone else's cable, water, garbage, electric, rent or car payment.
Only when there are dependent children are there any minor subsidies available, like Section 8 rent help, which only pays about 30% at most.
Almost all the Human Services federal money goes to disabled vets.

Government abolished welfare??? Oh wait they didn't

You obviously don't know anything about welfare.
If you are a male and not disabled, you just will not qualify.
Women with dependent children are the only ones who can get it, unless you are disabled.

I pay 10 times as much in taxes as the average middle class family, what do you mooching Dem's do with all my money?