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Post by 950nancy on Nov 10, 2016 18:35:40 GMT
I'm no economist, but I just don't see how the current situation can be financially sustainable. The average family cannot afford the premiums that have come into effect since Obamacare. Yes, some people now are covered who once were not, but so many more people have lost the coverage they had. My husband just had a meeting with our kids' health insurance company. The representative thought that when Obamacare was repealed, more companies would provide more competition. Costs should go down. That is great if you don't have any pre existing conditions. I hope that those people will have some affordable coverage also. All of us are one emergency away from that.
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Post by Darcy Collins on Nov 10, 2016 18:36:07 GMT
I'll throw out a nice ugly statistic for you 50% of that $3.3 trillion is spent on 5% of the population with 1/3 of that in their last year of life. It's one of the big reason this is hugely difficult politically. Even if various studies show that increasing spending in that year of life is correlated with DECREASING quality of life metrics - very, very few politicians want to stand up and say - well what we need is more palliative care and hospice. People often talk about how we're different than other countries. Well we need to acknowledge that we're ALREADY spending more GOVERNMENT money than the vast majority of other countries on health care. Culturally this country is hell bent on our doctor's preventing dying. I'm not saying there aren't things that can be done to help the problem - but until we tackle that big ugly reality - we won't see appreciable movement on controlling our spending. And it's a political hand grenade.
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Post by Darcy Collins on Nov 10, 2016 18:44:27 GMT
Here's the deal though.....Yes, uninsurable people got insurance - by those I mean people with pre-existing conditions and lots of health care needs. That drives up costs. HOWEVER, if EVERYONE gets insurance, the pool of insured is larger and the percentage of high risk people becomes lower, leading to lower costs for the insurance company. IF everyone in the US was buying insurance, whether or not they had health problems, all of those who are extremely healthy would be putting money in the pot for everyone and not using it. Those who need it would also be putting money in but taking out lots. There should be a net benefit for everyone and premiums should go down. That didn't happen....why? For example,let's say we have 100 people. 5 have severe health problems and couldn't be insured before, 40 were healthy and couldn't be bothered to be insured or worry about it. So 55 people are insured. They pay, (just a nice number) $100 per year for a total of $5500. Those 5 unhealthy people use $500 per year each, for a total of $2500 but they aren't insured and can't afford to pay so the system picks it up, the other 50 use a total of $2500 and insurance makes a profit of $3000. So then ACA starts and all 100 people buy insurance at $100 per year. $10,000 coming in. The 5 unhealthy use $2500, the existing use $2500 and the healthy actually go to the doctor here and there but don't need much so they use $1000. The insurance company makes $4000. They could reduce premiums. Why didn't that happen? There's two reasons. The very biggest is it wasn't $100 a year. I know you're just using round numbers but it's an important point. I had looked at someone advocating the universal part of the health care plan be catastrophic. So young, healthy people would be paying a relatively small amount and it would at least help deal with medical bankruptcies etc. I think that might have worked better - but instead requiring plans with "better" coverage meant more expense. Suddenly someone who's typical annual health care needs are less than $500 a year is expected to spend more than that in a month. They're not willing to pay $6000 for the possibility that they might be hit by a truck tomorrow or be diagnosed with cancer. When you then layer on the fact that NONE of this addressed the actual COST of health CARE - and it just doesn't work.
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Deleted
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Post by Deleted on Nov 10, 2016 18:45:01 GMT
And someone needs to blame DHHS Sebelius for defining what the "essential health benefits" were. We are still on a grandfathered plan and ours for 2017 went up 12% (a mirror ACA plan which includes more of the required minimum essentials) would be a 58% increase just this year alone! I argued back in 2010 when they defined these that alone would cause rates to skyrocket for everyone and I think it is leading to a larger claims cost... Many plans didn't offer the full range that PPACA now required. Now honestly I don't remember what was required to be covered....but it to me at the time was too large a jump all at once.
I firmly believe insurance should be for catastrophic large events and not for every hangnail, sniffle, etc. Those services should be more doable out of pocket. (more like car or homeowners insurance). Have lower rates and allow that extra $ to go to paying the medical bills. (much like high deductible plans with lower premiums with the difference in premiums going to an HSA....) Give grants/gov't money for low cost clinics --- I remember as a kid our county had a low cost clinic we went to for small things. We only went to the real dr's office when we were really sick...not for physicals, well visits or immunizations.
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Deleted
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Post by Deleted on Nov 10, 2016 18:57:29 GMT
Here's the deal though.....Yes, uninsurable people got insurance - by those I mean people with pre-existing conditions and lots of health care needs. That drives up costs. HOWEVER, if EVERYONE gets insurance, the pool of insured is larger and the percentage of high risk people becomes lower, leading to lower costs for the insurance company. IF everyone in the US was buying insurance, whether or not they had health problems, all of those who are extremely healthy would be putting money in the pot for everyone and not using it. Those who need it would also be putting money in but taking out lots. There should be a net benefit for everyone and premiums should go down. That didn't happen....why? For example,let's say we have 100 people. 5 have severe health problems and couldn't be insured before, 40 were healthy and couldn't be bothered to be insured or worry about it. So 55 people are insured. They pay, (just a nice number) $100 per year for a total of $5500. Those 5 unhealthy people use $500 per year each, for a total of $2500 but they aren't insured and can't afford to pay so the system picks it up, the other 50 use a total of $2500 and insurance makes a profit of $3000. So then ACA starts and all 100 people buy insurance at $100 per year. $10,000 coming in. The 5 unhealthy use $2500, the existing use $2500 and the healthy actually go to the doctor here and there but don't need much so they use $1000. The insurance company makes $4000. They could reduce premiums. Why didn't that happen? One problems is that ACA also allows kids to stay on parent plans until 26 ---> that takes a large group of healthy young adults out of the 100 that had to buy their own insurance. It used to be age 18/21 (and prove you were still in school). Now it leaves them on the family plan that costs the same regardless of # of dependents so at that point anyone over 1 kid is essentially not paying any extra into the system. This was counterintuitive to what they were trying to do -- get more younger healthy people to buy their own insurance.
And the unhealthy aren't just using 5x their premium -- think of someone with $100K in claims in one year (or 1000x what they pay in) -- that means it takes 1000 healthy people to pay those claims out assuming there is no profit AND none of the 1000 healthy make any claims. Yes, that is extreme, but it happens especially with no annual or lifetime caps anymore. The lifetime caps also helped keep the overall insurance premiums down for everyone. A family through our employer pays $15600 a year in premiums-- one hospital stay for one family member can be much more than that! So I think you are underestimating the actual claims that will be made by the unhealthy.
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scrappinghappy
Pearl Clutcher
“I’m late, I’m late for a very important date. No time to say “Hello.” Goodbye. I’m late...."
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Jun 26, 2014 19:30:06 GMT
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Post by scrappinghappy on Nov 10, 2016 19:05:52 GMT
I think an ideal middle ground, after tort reform and drug pricing caps are put in place, is for a single payer system where everyone pays the same tax to fund it, like we have a medicare deduction on our salaries. This entitles everyone to the same basic care, just as it does in the UK, Canada and Australia. (Hope I got that right). Then the wealthy can have Cadillac insurance which pays for treatment out of the system whatever that may be. Not lesser quality service per se but faster maybe.
So for a non life threatening MRI for example, like one I asked for last week to diagnose a torn rotator cuff, under the single payer system, I might have to wait 3 months or more for and using Cadillac insurance I could have done today if not sooner. Same for the surgery, if required, to fix it.
ETA: Basic healthcare would have to change over from dr's offices to clinics or hospital Er's would be swamped.
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Deleted
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Post by Deleted on Nov 10, 2016 20:16:06 GMT
One of the reasons that so many countries can offer universal healthcare is that they cap the cost of prescriptions from pharmaceutical companies. If they had to pay for the price of research and development for those drugs (like we do), that would greatly lower drug costs in the US. Pharma is making a lot of money, insurance companies are not really all that profitable.The way we set up insurance pools here, mostly through people's jobs, is another issue. Small businesses are unable to form pools, where big companies are able to negotiate better premiums for their employees. I don't see that changing, but it makes the problem even more complex. The ACA has shifted the problem, but certainly didn't cause it.
I'm glad I live in Massachusetts. I don't have to worry about losing insurance due to pre-existing conditions. That would bankrupt my family. Our republican governor, Mitt Romney, worked very hard to put that into place.
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Post by refugeepea on Nov 10, 2016 20:26:48 GMT
I don't know. It's helpful for some and not for others. Obamacare doesn't cover my kids pre-existing conditions.
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pridemom
Pearl Clutcher
Posts: 2,843
Jul 12, 2014 21:58:10 GMT
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Post by pridemom on Nov 10, 2016 20:32:25 GMT
So I see that once again, private businesses should give away money because they choose to pay their CEOs large salaries. It is not their obligation to make sure you have what you feel you need. Insurance companies are a gambling business. I don't expect them to give away money, but they are a service industry and they make deals with providers to help reduce their expenses. I am fortunate that my employer provides my health insurance as a benefit. Insurance company profits rely on those who don't have need to use the service they buy. It's unlikely my family will collect on the premiums paid for life insurance on my spouse and myself, but other people will. I still pay the premium. My health insurance premium is paid and my employer pays a rate based on use. That's a cost of business. If big pharma didn't charge such ridiculous prices for medications, healthcare costs would be lower. If hospitals weren't so heavy on administrative staff, costs would go down. There are ways to cut cost without cutting care. Of course, without the expensive medication I take, I would be unable to work and have to take SSDI. Then Medicare (once the 2year wait was up) and the tax payers could pay for my expensive drugs! I'd rather work.
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Post by ahiller on Nov 10, 2016 20:58:37 GMT
I have said from the beginning that insurance companies saw their chance and jumped on it and have continued to raise rates because they can blame it on Obamacare. So many people who believe in trickle down economics put way too much faith in large corporations to do the right thing, imo. And those who blame it all on greedy insurance companies are clueless about basic economics Who said I was blaming it all on greedy insurance companies? I simply said I think insurance companies saw a chance to raise rates and did so knowing they could shift the blame elsewhere. I think there are plenty of faults with Obamacare and if Republicans can come up with a solution that doesn't screw people with pre-existing conditions, poor people and women, then good for them. I'm all for it. You really are a peach.
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johnnysmom
Drama Llama
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Jun 25, 2014 21:16:33 GMT
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Post by johnnysmom on Nov 10, 2016 21:55:04 GMT
I firmly believe insurance should be for catastrophic large events and not for every hangnail, sniffle, etc. Those services should be more doable out of pocket. I think this is important. If everyone had to pay a portion of their bill they would make more responsible medical decisions. We sent a kid home today with a fever of just over 100, not even 101. When mom finally got around to picking him up she said she was taking him right to the ER. Really? The kid needed some tylenol, gatorade and a blanket, nothing that justified hundreds of dollars of care.
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Post by Scrapper100 on Nov 10, 2016 21:59:36 GMT
They need to come up with something else before they take this away. I would like to see it go back to what it was before and then have government programs just for those that can't pay or for those with prexisting conditions. No reason to change everything. Also most states had programs for low income people. However 2017 is the year it's supposed to implode so we will see. I don't envy trump for inheriting this mess it would have been karma if Hillary had to fix it.
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Post by papercrafteradvocate on Nov 10, 2016 22:17:05 GMT
And those who blame it all on greedy insurance companies are clueless about basic economics Who said I was blaming it all on greedy insurance companies? I simply said I think insurance companies saw a chance to raise rates and did so knowing they could shift the blame elsewhere. I think there are plenty of faults with Obamacare and if Republicans can come up with a solution that doesn't screw people with pre-existing conditions, poor people and women, then good for them. I'm all for it. You really are a peach. You aren't clueless ahiller what you said is absolutely true---and it totally went over her head --because she didn't respond to what you actually wrote--instead she responded to what she thought she "heard". It's funny too that she's been leading the lynch mob on several other threads on the name calling, when she dishes it out better than she gets with calling people names or trying to render their thoughts to being stupid.
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Post by lisae on Nov 10, 2016 23:05:36 GMT
Coincidentally, I've been shopping for my 2017 coverage today. There is now only one ACA carrier in NC. There weren't many to begin with and the others left because they were losing so much money. Thus, more insurance companies competing isn't the answer.
Anyway, my plan is now $873 per month without a tax credit. It has copays for most things.
The cheapest plan is $625 per month without a tax credit with a $7,150 deductible. It pays for NOTHING, not even prescriptions (except I assume mandatory covered services like physicals and mammograms) until you meet the deductible. So if I took the cheapest plan, I'd have to spend $14,650 out of pocket before I got any benefit at all from this coverage.
My challenge is: How do I decide what health plan to choose for 2017 when I don't know what Congress and the new President will do? If they defund the ACA removing all tax credits, am I stuck with these high prices for the entire year?
I have a screening colonoscopy scheduled later this month just because I'm old enough for that now. I scheduled it weeks ago so that if something showed up, I could make my health plan decisions for 2017 based on that. I'm glad I scheduled it. It is one of the mandatory covered services. If I'd left it to next year and the repeal the ACA, I might have had to pay it out of pocket.
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Post by terri on Nov 10, 2016 23:23:44 GMT
I am so frightened by this. I have an incredibly rare medical condition and because of its rarity, all treatments are considered experimental. If insurance companies go back to the pre-ACA policies, I am on borrowed time.
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Post by Tamhugh on Nov 10, 2016 23:35:13 GMT
I'll throw out a nice ugly statistic for you 50% of that $3.3 trillion is spent on 5% of the population with 1/3 of that in their last year of life. It's one of the big reason this is hugely difficult politically. Even if various studies show that increasing spending in that year of life is correlated with DECREASING quality of life metrics - very, very few politicians want to stand up and say - well what we need is more palliative care and hospice. People often talk about how we're different than other countries. Well we need to acknowledge that we're ALREADY spending more GOVERNMENT money than the vast majority of other countries on health care. Culturally this country is hell bent on our doctor's preventing dying. I'm not saying there aren't things that can be done to help the problem - but until we tackle that big ugly reality - we won't see appreciable movement on controlling our spending. And it's a political hand grenade. I would really like to learn more about how other countries/cultures handle this issue. When my dad was at the end of his life last year, there were some rough patches in making the decisions on palliative care and hospice. And when everyone came together on it, it was such a relief and a blessing. Once the decision was made, the resources were fabulous. But there was nothing to really help us make the decision itself, IYKWIM?
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Post by Darcy Collins on Nov 10, 2016 23:54:32 GMT
I'll throw out a nice ugly statistic for you 50% of that $3.3 trillion is spent on 5% of the population with 1/3 of that in their last year of life. It's one of the big reason this is hugely difficult politically. Even if various studies show that increasing spending in that year of life is correlated with DECREASING quality of life metrics - very, very few politicians want to stand up and say - well what we need is more palliative care and hospice. People often talk about how we're different than other countries. Well we need to acknowledge that we're ALREADY spending more GOVERNMENT money than the vast majority of other countries on health care. Culturally this country is hell bent on our doctor's preventing dying. I'm not saying there aren't things that can be done to help the problem - but until we tackle that big ugly reality - we won't see appreciable movement on controlling our spending. And it's a political hand grenade. I would really like to learn more about how other countries/cultures handle this issue. When my dad was at the end of his life last year, there were some rough patches in making the decisions on palliative care and hospice. And when everyone came together on it, it was such a relief and a blessing. Once the decision was made, the resources were fabulous. But there was nothing to really help us make the decision itself, IYKWIM? I know exactly what you mean. For too many doctors death is the enemy and they want to win the war at all costs. Several times we've had to make the decision to stop aggressive treatment and it's ALWAYS been family led. This article talks a bit about it. They mention the UK implementing mandatory end-of-life with the NHS. We have quite a few peas from the UK, I'd be interested to hear your experiences with family members with terminal illnesses if you're comfortable sharing. www.healthline.com/health-news/who-does-end-of-life-care-right-022215#1
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Post by crazy4scraps on Nov 11, 2016 1:16:48 GMT
I firmly believe insurance should be for catastrophic large events and not for every hangnail, sniffle, etc. Those services should be more doable out of pocket. I think this is important. If everyone had to pay a portion of their bill they would make more responsible medical decisions. We sent a kid home today with a fever of just over 100, not even 101. When mom finally got around to picking him up she said she was taking him right to the ER. Really? The kid needed some tylenol, gatorade and a blanket, nothing that justified hundreds of dollars of care. While I agree with this to some degree (using services responsibly) what about those times when you really need to bring your kid in? We have a higher deductible plan and an HSA so we do pay a good amount out of pocket. We're lucky that we can afford it. Last year was a good example for us. I'm not the type to drag my kid (or myself) in for every sniffle, I tend to wait until it appears to actually be something. A couple weeks after school started, my kid was having some sinus issues and since DH and I were too we just figured it was seasonal allergies. She didn't have a fever and wasn't acting sick. By the beginning of October, she developed a nasty cough too and had a bit of a fever so I brought her in. She had double lobe pneumonia and an ear infection. The office visit, x-rays, labs and prescribed meds (more than one, since she ended up not tolerating the first one at all) cost us around $400 or so out of pocket. With insurance, at an in network provider. Her ped said that it was bad enough that in the past she would have been sent to the hospital to be treated. Roughly three weeks later, she was complaining that her ear hurt. Went back in again and the ear was still infected. Another office visit, more meds and another $250+ out of pocket. A month after that, she was complaining of severe stomach pains and had the runs. Took her in yet again for another office visit, more labs, another Rx because this time it was c-diff. Another $300-400 out of pocket later and the kid was finally healthy. The bottom line was, we didn't have the option to not bring her in. Our normally pretty healthy kid was sick and no amount of waiting it out was going to help in any of those situations. While it sucked to fork out all that money for the office visits, labs, Rx, etc. it would have sucked that much more if we would have waited longer only to have to take her to the hospital. I guess my point is, I would much rather have people go in and be seen earlier when it's quicker and less expensive to treat than to have people put off care and end up dealing with a much more serious (and expensive) condition.
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Deleted
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Post by Deleted on Nov 11, 2016 1:44:57 GMT
And yet no one seems to notice that the insurance companies are still bringing in BILLIONS in profits. Profiting off disease and illness and sadness. You want to cut costs - non-profit healthcare only. Sure docs, techs, nurses, admins should make good salaries. But NO MONEY TO SHAREHOLDERS in China or Hong Kong or anywhere else profiting off misery. Want more savings, public option - where they don't have to spend even more billions on marketing and sales.
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johnnysmom
Drama Llama
Posts: 5,682
Jun 25, 2014 21:16:33 GMT
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Post by johnnysmom on Nov 11, 2016 12:05:21 GMT
I think this is important. If everyone had to pay a portion of their bill they would make more responsible medical decisions. We sent a kid home today with a fever of just over 100, not even 101. When mom finally got around to picking him up she said she was taking him right to the ER. Really? The kid needed some tylenol, gatorade and a blanket, nothing that justified hundreds of dollars of care. While I agree with this to some degree (using services responsibly) what about those times when you really need to bring your kid in? We have a higher deductible plan and an HSA so we do pay a good amount out of pocket. We're lucky that we can afford it. Last year was a good example for us. I'm not the type to drag my kid (or myself) in for every sniffle, I tend to wait until it appears to actually be something. A couple weeks after school started, my kid was having some sinus issues and since DH and I were too we just figured it was seasonal allergies. She didn't have a fever and wasn't acting sick. By the beginning of October, she developed a nasty cough too and had a bit of a fever so I brought her in. She had double lobe pneumonia and an ear infection. The office visit, x-rays, labs and prescribed meds (more than one, since she ended up not tolerating the first one at all) cost us around $400 or so out of pocket. With insurance, at an in network provider. Her ped said that it was bad enough that in the past she would have been sent to the hospital to be treated. Roughly three weeks later, she was complaining that her ear hurt. Went back in again and the ear was still infected. Another office visit, more meds and another $250+ out of pocket. A month after that, she was complaining of severe stomach pains and had the runs. Took her in yet again for another office visit, more labs, another Rx because this time it was c-diff. Another $300-400 out of pocket later and the kid was finally healthy. The bottom line was, we didn't have the option to not bring her in. Our normally pretty healthy kid was sick and no amount of waiting it out was going to help in any of those situations. While it sucked to fork out all that money for the office visits, labs, Rx, etc. it would have sucked that much more if we would have waited longer only to have to take her to the hospital. I guess my point is, I would much rather have people go in and be seen earlier when it's quicker and less expensive to treat than to have people put off care and end up dealing with a much more serious (and expensive) condition. The difference, imo, is that you took her to her ped for a diagnosis/treatment rather than straight to the ER where the cost is exponentially higher. I hate high deductible plans as much as the next guy but I think if everyone had to pay a portion of each visit (even $50) they would think before heading to the ER for a low grade fever.
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pridemom
Pearl Clutcher
Posts: 2,843
Jul 12, 2014 21:58:10 GMT
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Post by pridemom on Nov 11, 2016 13:39:12 GMT
While I agree with this to some degree (using services responsibly) what about those times when you really need to bring your kid in? We have a higher deductible plan and an HSA so we do pay a good amount out of pocket. We're lucky that we can afford it. Last year was a good example for us. I'm not the type to drag my kid (or myself) in for every sniffle, I tend to wait until it appears to actually be something. A couple weeks after school started, my kid was having some sinus issues and since DH and I were too we just figured it was seasonal allergies. She didn't have a fever and wasn't acting sick. By the beginning of October, she developed a nasty cough too and had a bit of a fever so I brought her in. She had double lobe pneumonia and an ear infection. The office visit, x-rays, labs and prescribed meds (more than one, since she ended up not tolerating the first one at all) cost us around $400 or so out of pocket. With insurance, at an in network provider. Her ped said that it was bad enough that in the past she would have been sent to the hospital to be treated. Roughly three weeks later, she was complaining that her ear hurt. Went back in again and the ear was still infected. Another office visit, more meds and another $250+ out of pocket. A month after that, she was complaining of severe stomach pains and had the runs. Took her in yet again for another office visit, more labs, another Rx because this time it was c-diff. Another $300-400 out of pocket later and the kid was finally healthy. The bottom line was, we didn't have the option to not bring her in. Our normally pretty healthy kid was sick and no amount of waiting it out was going to help in any of those situations. While it sucked to fork out all that money for the office visits, labs, Rx, etc. it would have sucked that much more if we would have waited longer only to have to take her to the hospital. I guess my point is, I would much rather have people go in and be seen earlier when it's quicker and less expensive to treat than to have people put off care and end up dealing with a much more serious (and expensive) condition. The difference, imo, is that you took her to her ped for a diagnosis/treatment rather than straight to the ER where the cost is exponentially higher. I hate high deductible plans as much as the next guy but I think if everyone had to pay a portion of each visit (even $50) they would think before heading to the ER for a low grade fever. Where are these plans that don't have copays, other than Medicaid, which is for the poor who simply don't have the money? I have $300 ER copay. The ER is for life or death, or things that can't wait until the doctor's office opens.
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Deleted
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Post by Deleted on Nov 11, 2016 14:11:01 GMT
A lot of people are under the misunderstanding that ER care means free care. You still pay if you go to the ER. Unless you're indigent. If you're not, you'll get a bill.
The problem is so many won't or can't pay the ER bill when it comes, so the rest of us have to pay for their careless use of the ER cuz. And they're carelessly using the ER because that is the only place they are guaranteed treatment.
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Post by crazy4scraps on Nov 11, 2016 15:00:37 GMT
The difference, imo, is that you took her to her ped for a diagnosis/treatment rather than straight to the ER where the cost is exponentially higher. I hate high deductible plans as much as the next guy but I think if everyone had to pay a portion of each visit (even $50) they would think before heading to the ER for a low grade fever. Where are these plans that don't have copays, other than Medicaid, which is for the poor who simply don't have the money? I have $300 ER copay. The ER is for life or death, or things that can't wait until the doctor's office opens. We don't have co-pays, we pay the full amount minus something of a discount negotiated by our insurance plan. So every time I go to the doctor (or take my kid to hers) or go to urgent care, it's going to cost me at least $250 until I hit my personal deductible (which is something like $5,000-6,000) or our family combined total which I think is around $12,000. So even at that, somebody has to be really, actually sick before any of us will think about going to the clinic. We'd have to be spurting blood, having a heart attack or missing a limb to go to the ER.
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pyccku
Pearl Clutcher
Posts: 2,817
Jun 27, 2014 23:12:07 GMT
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Post by pyccku on Nov 11, 2016 15:06:09 GMT
I'll throw out a nice ugly statistic for you 50% of that $3.3 trillion is spent on 5% of the population with 1/3 of that in their last year of life. It's one of the big reason this is hugely difficult politically. Even if various studies show that increasing spending in that year of life is correlated with DECREASING quality of life metrics - very, very few politicians want to stand up and say - well what we need is more palliative care and hospice. People often talk about how we're different than other countries. Well we need to acknowledge that we're ALREADY spending more GOVERNMENT money than the vast majority of other countries on health care. Culturally this country is hell bent on our doctor's preventing dying. I'm not saying there aren't things that can be done to help the problem - but until we tackle that big ugly reality - we won't see appreciable movement on controlling our spending. And it's a political hand grenade. I would really like to learn more about how other countries/cultures handle this issue. When my dad was at the end of his life last year, there were some rough patches in making the decisions on palliative care and hospice. And when everyone came together on it, it was such a relief and a blessing. Once the decision was made, the resources were fabulous. But there was nothing to really help us make the decision itself, IYKWIM? There was a podcast I heard a while back that discussed this very issue. The interviewee lived in the US and his father was in Europe. The dad's dr called the son and told him the dad had cancer and he should probably come to say goodbye. The son said "but should I bring him here to the US so we can fight it?" The response was "no, it's terminal...we will make him comfortable but there is nothing to fight." Here we see a diagnosis like that as a challenge. Death MUST be defeated at all costs. It doesn't increase the quality of life for the person and the quantity - well, only a little bit if at all. So we spend tons of $$$ fighting a battle that we have no chance of winning rather than allowing people to be comfortable and to say goodbye in peace. DH's family still lives in Europe. His aunt was diagnosed with stage 4 cancer two weeks ago. She died about 5 days later. There wasn't anything to do, the doctors didn't sugar-coat it or pretend that their treatments would make a difference. Maybe with treatment she could have spent her last 5 days throwing up and believing falsely that she had a chance with the treatment. Instead, she was able to say good-bye to her loved ones and pass peacefully. Save
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Post by crazy4scraps on Nov 11, 2016 15:06:50 GMT
The bottom line was, we didn't have the option to not bring her in. Our normally pretty healthy kid was sick and no amount of waiting it out was going to help in any of those situations. While it sucked to fork out all that money for the office visits, labs, Rx, etc. it would have sucked that much more if we would have waited longer only to have to take her to the hospital. I guess my point is, I would much rather have people go in and be seen earlier when it's quicker and less expensive to treat than to have people put off care and end up dealing with a much more serious (and expensive) condition. The difference, imo, is that you took her to her ped for a diagnosis/treatment rather than straight to the ER where the cost is exponentially higher. I hate high deductible plans as much as the next guy but I think if everyone had to pay a portion of each visit (even $50) they would think before heading to the ER for a low grade fever. Even taking her to the clinic will set us back by a minimum of $250 and that's just to be seen. Add on any lab work, throat cultures, x-rays, prescription meds and the cost just goes up, up, up from there.
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Post by Darcy Collins on Nov 11, 2016 16:26:21 GMT
I would really like to learn more about how other countries/cultures handle this issue. When my dad was at the end of his life last year, there were some rough patches in making the decisions on palliative care and hospice. And when everyone came together on it, it was such a relief and a blessing. Once the decision was made, the resources were fabulous. But there was nothing to really help us make the decision itself, IYKWIM? There was a podcast I heard a while back that discussed this very issue. The interviewee lived in the US and his father was in Europe. The dad's dr called the son and told him the dad had cancer and he should probably come to say goodbye. The son said "but should I bring him here to the US so we can fight it?" The response was "no, it's terminal...we will make him comfortable but there is nothing to fight." Here we see a diagnosis like that as a challenge. Death MUST be defeated at all costs. It doesn't increase the quality of life for the person and the quantity - well, only a little bit if at all. So we spend tons of $$$ fighting a battle that we have no chance of winning rather than allowing people to be comfortable and to say goodbye in peace. DH's family still lives in Europe. His aunt was diagnosed with stage 4 cancer two weeks ago. She died about 5 days later. There wasn't anything to do, the doctors didn't sugar-coat it or pretend that their treatments would make a difference. Maybe with treatment she could have spent her last 5 days throwing up and believing falsely that she had a chance with the treatment. Instead, she was able to say good-bye to her loved ones and pass peacefully. SaveThanks for sharing. I was trying to find more info yesterday and one study was saying that by far the biggest differences in the US and other countries were the number of cancer patients who underwent additional chemotherapy treatments in their final month and ICU admittance in that final month (this study was specifically looking at terminal cancer patients, so didn't delve into aggressive treatment for other terminal illnesses). The US actually was pretty comparable in where death occurred (home vs hospital) - so clearly people are making it known that they ultimately want to go home - but there is definitely much more aggressive treatment during those final days in the US versus other countries. I'll say as a family, we're pretty typical. Several family members fought until the bitter end - and yes probably gained several months - but I do question the physical and mental toll. Recently one family member made the decision to go hospice - it was a pretty controversial decision within the family.
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Post by ntsf on Nov 11, 2016 16:44:31 GMT
I was just in the emergency room this morning.. dh woke up at 4 am in pain, waited til 5.. temp on his bad leg elevated.. off to emergency room for treatment for cellulitis. If a doc was available elsewhere at 5 am we would have gone.. but we had to pay $75. we have good insurance. we need to be able to do this without feeling we are putting our financial lives at risk. dh has chronic orthopedic issues..so we knew what was happening. unfortunately, we were supposed to be going on vacation.
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Anita
Drama Llama
Posts: 5,662
Location: Kansas City -ish
Jun 27, 2014 2:38:58 GMT
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Post by Anita on Nov 11, 2016 16:55:04 GMT
End of life care is such a complex, heartbreaking topic. I completely understand what you mean about the expense. I think the medical community looks at it with the "first do no harm" mentality, as they should, but sometimes dragging out the inevitable is a form of torture. I know my grandfather begged for someone to overdose him and let him die. It still upsets me to this day. There just aren't any easy answers.
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Post by kellybelly77 on Nov 11, 2016 17:50:15 GMT
The national organization that I belong to (welfare and benefits) had a webinar yesterday related to this subject. They had several people on and they all said that even with Trump as the Pres he cannot fully repeal the ACA. There is not a 60 seat filibuster proof majority in the Senate. To fully repeal Trump would need 60 R's and he will only have 51 to 53. So full repeal is not possible.
However, using budgetary means they could defund key provisions that relate to taxes. Subsidies on the exchange, the individual mandate and the employer mandate. If they get rid of subsidies, the ACA has a clause that insurance companies can drop out at any time if they go away. So if the subsidies go, so do the insurance carriers who sell the plans on the exchange. They could cripple the best working part of the ACA by removing that funding.
Everything else though, that is a mandate on the insurance companies and not related to tax provisions would remain. Dependents covered until age 26. no lifetime max, no denial for pre-x.
They also speculated that there is no way premiums will go down even if they repeal parts of it. In fact, they estimate that premiums will rise about $1,600 per person. If you get rid of the individual mandate, the young healthy people will drop out, leaving all the sick people who still can't be denied coverage. Then you have a pool of very sick people whose claims are astronomical. And premiums wouldn't be able to rise fast enough to keep up with claims cost. 10% of your pool causes 90% of your claims dollars spent is what underwriters say.
It will be a mess for sure. I just hope the R's have a good plan to replace it with. 11 million people currently have coverage on the exchanges.
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Post by iamkristinl16 on Nov 11, 2016 19:05:22 GMT
We really don't know what will happen because Trump hasn't told us what his plan is, if he has one.
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