patrick.net

I laugh at them when they tell me about benefits, I want a cash raise, stick your benefits up your ass.

TPB Deplorable proud Obamacare exemption tax payer.

Tenpoundbass says

I laugh at them when they tell me about benefits, I want a cash raise, stick your benefits up your ass.

Fuck it. I'm getting the absolute cheapest bullshit plan available, and we'll self treat. This may become the new reason why people go to medical school....

Ironman says

That's been the BIGGEST complaint so far. People have paid for insurance that they can't afford to use.

I heard it was going up, but this is ridiculous. I love how it says on page one, "premium increase of 19%." Which would be accurate if it were still the same plan. But since my plan got halved, what you really have is a much more substantial increase to what was essentially a bronze EPO plan from the prior year. Those plans last year could be had for around $700/month. So, what looks like an increase from $1,000 to $1,200 is really an increase from $750 to $1,200. It's not even a PPO plan anymore!

turtledove is deplorable says

Tenpoundbass says

I laugh at them when they tell me about benefits, I want a cash raise, stick your benefits up your ass.

Fuck it. I'm getting the absolute cheapest bullshit plan available, and we'll self treat. This may become the new reason why people go to medical school....

only people who aren't in denial about medicine being a business

On the bright side, it will get painful enough that when the govt finally does seriously consider "medicare for all," (aka single payer) there won't be a bunch of hired trolls at those town hall meetings screaming "there will be death panels !"

Or if there are, people and the media will wise up and say bullshit !

turtledove is deplorable says

And that legislating insurance simply provided insurance companies (who are buying hospitals... Who are buying up practices, now) with a captive market to charge whatever they please?

And they control the pricing at the hospitals and practices and labs... "Wow, look at the rising charges our businesses charge our other business. Have to raise premiums!"

The deadline for Obamacare Premium resets is just before Election day. Don't be surprised if there is big push to delay it - not that I think it's feasible. That's the other October Surprise, as Turtledove just discovered.

turtledove is deplorable says

And the best part is they don't even pay the doctors! AND -- All your costs are out of pocket.... I bet most go the whole year without reaching their out of pocket max. So welcome to the biggest single regressive tax in history. You are forced to pay thousands upon thousands a year for the privilege of paying out of pocket for all your medical costs. You pay a fortune for absolutely nothing. Brilliant!

Your solution other than complaining is what exactly?

bob2356 says

Your solution other than complaining is what exactly?

what have you ever offered anyone in your entire life besides sneering patnet comments?

bob2356 says

Your solution other than complaining is what exactly?

Look at Trumps plan for healthcare reform. Things like upfront pricing will reduce costs

All Republican plans will work, provided Democrats don't enact the Republican plan. It's also important to remember to never vote on principles, because it's better to vote against your own plan if it's sponsored by Anyone (D).

marcus says

seriously consider "medicare for all," (aka single payer)

So you don't mind a big check you're just splitting hairs over the options of who to write the check to.

Agreed. It is amazing how premiums, co-pays and deductibles have sprung up. This is an unmitigated disaster.
turtledove is deplorable says

And the best part is they don't even pay the doctors! AND -- All your costs are out of pocket.... I bet most go the whole year without reaching their out of pocket max. So welcome to the biggest single regressive tax in history. You are forced to pay thousands upon thousands a year for the privilege of paying out of pocket for all your medical costs. You pay a fortune for absolutely nothing. Brilliant!

You nailed it. Every procedure is now in question since Obummercare and the insurances adjusted the out-of pocket deductibles to the point where every "averagely" healthy family now pays 100% of the deductible out of pocket by the end of the year. I'm sure they used good heuristics to arrive at that sum. Also you would assume that they still pay part of the doctor's fees and procedures while you max out your deductible, but yeah for many plans you pay now 100% of those fees.

landtof says

bob2356 says

Your solution other than complaining is what exactly?

what have you ever offered anyone in your entire life besides sneering patnet comments?

More than you apparently. So this means you don't have any idea what the actual price of health care insurance has done or how it compares to the historical norms, you just know your's went up . Very good.

The question stands, what drives the high cost of us health care and what do you see as a realistic solution. Ive posted my thoughts on this subject in great detail with lots of supporting research dozens of times.

Last I checked, health care inflation went down after Obamacare. Has this changed, or are we just sharing some anecdotes and venting?

This is a pretty hot topic. The Republican research units must be churning out some studies, no?

Booger says

Look at Trumps plan for healthcare reform. Things like upfront pricing will reduce costs

As much as I think Trumps is an idiot, this is a good idea. I also think it's one of those good ideas that are obvious but would never pass. Still, it's great that someone has the balls to put it out there in their plan. On the off chance that Trump is elected, he tries to get this passed, he is successful, and someone brings up this thread. I'll happily admit that he did something good.

Who else is going to pay for all those Obamacare recepients? After all insurance is nothing more than a basic pass through of everyone pays into the pot and a few take money out of the pot.

Obama is a moron when it comes to business!

Tenpoundbass says

So you don't mind a big check you're just splitting hairs over the options of who to write the check to.

I don't know what you're saying, but then you don't either. I guess getting all cryptic and mysterious is about as close to sounding intelligent as you're going to get ?

Single payer gives huge negotiating power to the entity (medicare) that ultimately pays the hospitals and doctors. Under single payer this becomes possible.

turtledove is deplorable says

When will The idiots who thought this was a good idea realize that not focusing on wastes and costs was a huge mistake?

Of course what TD is complaining about is paying so much for major medical, when all the low cost doctor visits aren't even covered by the less expensive plans that are designed to cover only major medical (catastrophic costs of something major). But Medicare manages to cover a majority of the major medical already that is for seniors. This is simple common sense, pool everyone's major medical together with the seniors.

thunderlips11 is deplorable says

The deadline for Obamacare Premium resets is just before Election day

Ours is Anthem... So, at least in CA... One of the biggest insurers has already released the info.

I'm sure that most Trump voters support a sensible fix or replacement for BenghaziCare. Just as they (cough - excuse me!) were and are open to considering a single payer solution (cough).

I just know there will be a workable Republican proposal to stabilize or cut health care costs. I (cough) believe it in my heart.

Republicans are dedicated to finding the lowest-cost solution. They would (cough - sheesh, the dust in here) never support legislation which baked in the profits of their biggest rent-seeking campaign contributors.

That's insurance for you. They codicil you to death, and eventually sell your policy to underwriters in Bangladesh who black market human organs on the side.

bob2356 says

Your solution other than complaining is what exactly?

I believe I already covered that... "fuck it... go with cheapest plan.... self treat (in our case) and negotiate directly with providers for the regular stuff..." Personally, I think more people should do that. Just go with major medical on the off chance you get into a car accident or develop a serious illness, or something. And then negotiate your own prices with the providers on the rest of it.

Believe it. The doctors would rather work with you than the insurance companies. I bet your monthly costs don't even come close to what you're paying now in premiums. Personally, I think you should save your premiums and negotiate your own rates... But that's probably a little scary for people who don't feel they know enough about it to negotiate on their own behalf. Of course, if pricing were readily available, it would no longer be a big secret.

As I've said many times, after being screwed by insurance companies for 18 months, I decided that I no longer work with insurance companies. On our most popular surgical procedure (10-20 cases/month), I charge a flat rate for the entire package, which includes everything from pre-op, the surgery, and post op... Patients aren't charged anything if they need extra attention. It's just the flat $2k rate. I tell them they are welcome to try to get reimbursed by their insurance companies, but I'm out of it. The fact is, what we're charging isn't as much as most of their deductibles. We are in lines with the contracted rates, so no one is taking advantage here. They end up thanking me for it. It works. For those who want to try to get reimbursed, I tell them to bring me their claim form and I will code it for them. All they have to do is sign it and put a stamp on it. I group the cases, and it makes for a decent earnings day that I don't have to spend months fighting with insurance companies over. From the practice's point of view, it was the best thing I ever did. And it reduces our costs, which is something we share with the patients.

They need to get rid of this notion that insurance is the answer. Insurance isn't healthcare... It doesn't guarantee access to healthcare... It doesn't really do anything... but enrich the wrong people... the ones with absolutely NO stake in the process, profiting off of your misfortune.

YesYNot says

Has this changed, or are we just sharing some anecdotes and venting?

Then why the increase to the cost of my plan... along with the decrease to its benefits? Why have all the companies filed for increases to premiums? If costs are now so low, I mean... Why were their requests for premium increases approved? You believe the nonsense, if you want. The increases are either there because costs are going up or insurance companies are profiting additionally. Either is a problem. Neither is being addressed.

YesYNot says

As much as I think Trumps is an idiot, this is a good idea.

It is a good idea, and it's essentially what we've instituted at our practice. The only thing I take insurance for are garden variety office visits. Everything else is cash pay. Sometimes (in cases of surgical procedures) it's covered and sometimes it isn't (like with infertility treatments). We have a very reasonable rate for what we do. I package things so people don't have to worry about surprises. So, whether you need to be seen two, three, or four times... Once you pay the global fee on the surgery, for example, you don't have to worry. Our job is to get you well or get you pregnant. What it takes to get you there is on us.

I think you are doing it right.

My wife's cousin (an anesthesiologist with a private practice for chronic pain) also stopped taking insurance. It's entirely a transaction between her and the patient.

Booger says

bob2356 says

Your solution other than complaining is what exactly?

Look at Trumps plan for healthcare reform. Things like upfront pricing will reduce costs

Bob doesn't believe in that

rando says

My wife's cousin (an anesthesiologist with a private practice for chronic pain) also stopped taking insurance. It's entirely a transaction between her and the patient.

The problem with that is the Doctor only has control over things done in his office. He can schedule a simple procedure on you that's he's practically doing for peanuts.
But the facility where he performs the procedure at will be required to have ambulatory service on stand by that you have to pay for whether it's needed or not, by state and federal law in Florida.
So you show up at the outpatient clinic on the day of the procedure prepared to pay your measly $700 that your Doctor is charging you. The receptionist will then start asking you for your insurance provider information, and if you don't have insurance. They will tell you to sit down, while they disappear in the Admin Accounting room for a 20 minute discussion then return and tell you that you can't have the operation done there until you get insurance. That if you need the Ambulance it can be a $5K minimum, then the Hospital you would be transported to want's their pound of flesh.

That's a true story.

- Upfront pricing
- Socialize malpractice insurance
- More medical schools
- Treat the AMA like the cartel that it is, and break it like a corrupt union
- Ban waitstaff from singing "Happy Birthday" or any foreign-language equivalent in all restaurants nationwide.

Much of what doctors do is easily accomplished in other countries by people paid upper-middle-class salaries. Cardiac and neurosurgeons should earn plenty; other specialties, not so much.

Tenpoundbass says

He can schedule a simple procedure on you that's he's practically doing for peanuts.

But the facility where he performs the procedure at will be required to have ambulatory service on stand by that you have to pay for whether it's needed or not, by state and federal law in Florida.

Actually, I negotiated a deal with both the surgery center and the anesthesiologist on behalf of the cash paying patients. I argued that if I group the like surgeries together, it reduces their costs. We do one thing all day long. With patients paying cash, they don't have to deal with insurance companies, either. I negotiated facility and anesthesia on these cases to $3,500. So, that's one operating room, five almost identical cases, $17,500 for a days work by one operating room, all cash, no insurance companies. So, the total cost to the patient is $5,500, which includes everything but pathology (about another $200). For us, it's a $10k day, five identical cases, all cash, no insurance companies. We're covering costs, as well as the risk we take with each patient... and I don't have to have people with PhDs in medical coding and billing that I have to keep on staff to appeal all the bs insurance companies throw our way. All the while the patient's needs are covered from end to end. There are no surprises. Whatever the patient needs to be healed is what she gets. I do four groups like this a month. Some patients need more, some need less... but no one has to worry about needing an extra ultrasound. The only thing I'd love to add is a radiology certificate so we can add that service as part of the global... so we don't ever have to use a full size hospital for these types of cases...

A similar case that had to be done at a full blown hospital, due to the additional requirement of radiology - metal fragments -- needed a picture, was charged $55,000 for facility and that didn't even include anesthesia. I'm telling you, the answer is to go out on our own and take the middleman out of the equation. Insurance is the middleman. With insurance companies buying into these corporations, hospitals are looking more like insurance companies and less like places that provide a service. They add no value to the process. But they sure as heck are taking their cut. The small-time providers aren't the problem. It's the hospital owned by a huge corporation that's in bed with insurance companies that's telling you the same thing costs $55,000. When we do it ourselves, the cost is a fraction of that.

rando says

also stopped taking insurance. I

Good money tough gig....

This type of clinic has virtually 0% no shows. Patients are often Doctor shoppers and many are addicted to opioids

YesYNot says

Has this changed, or are we just sharing some anecdotes and venting?

Medical price inflation has accelerated, due to the design of the legislation:

"Medical costs jump in August by largest amount in 32 years, CPI shows"

The Democrats have two losing issues: Obamneycare (FKA "Hillary's Plan") and Islam (including Hillary's wars on behalf of her corporate and Saudi sponsors).

If Democrats have any sense at all, they will change the subject to their winning issues, e.g. SCOTUS. For example, Senator Rubio says (consistent with the Republican platform) that pregnant women with Zika must be required to deliver babies with microcephaly, and then sacrifice whatever other family and career plans they may have had. That's the sort of thing you should be talking about if you want Democrats to win.

We have two historically unpopular major party nominees, and they will most likely focus on each other's weaknesses, but some partisans have a weird tendency to focus attention on their own party's weaknesses without admitting them. When you try to defend Obamneycare and Islam, you sound like Jeb Bush claiming his brother W "kept us safe." You don't persuade anyone, because the weight of evidence and reason are both against you; you end up seeming delusional or dishonest.

It's too bad that R & D voters can't do anything about healthcare cost.

Everyone before ACA had affordable health insurance & never had any bankruptcies due to medical cost.
The status quo was perfect.

HEY YOU says

Everyone before ACA had affordable health insurance & never had any bankruptcies due to medical cost.

And the bad guys are exactly the same. It's just that after ACA you are required by law to play it their way. This was a stick up, and you don't even know it.

curious2 says

but some partisans have a weird tendency to focus attention on their own party's weaknesses

This may be true, but I asked a question
YesYNot says

Last I checked, health care inflation went down after Obamacare. Has this changed, or are we just sharing some anecdotes and venting?

because I wanted to know the answer. Not because I'm trying to win a debate. I just don't want to know badly enough to research it, and was hoping someone here did. You came the closest by pointing to one data point, but apparently no one cares enough to see what inflation was like in the 5 years before Obamacare through now.

I'm not in love with Obamacare as it is. But I trust HRC to make incremental improvements more than I trust Trump to replace it with something awesome.

YesYNot says

I just don't want to know badly enough to research it....

and you prefer instead to state a counterfactual opinion. Contrary to politicians' obviously false promises that insurance premiums would "go down," premiums have continued to increase, as was predictable at the time based on the experience of Romneycare in Massachusetts. Nominal percentages are similarly misleading, because the relevant measure is the real rate of inflation relative to other sectors. Medical price inflation has continued at least double the rate of CPI inflation generally. Meanwhile, technology has driven deflation in other sectors, so now we are told to oppose deflation, and to celebrate paying more for things, especially via medical price inflation. It's bizarre. We have a policy designed to maximize spending, which the authors perceive as revenue, and it operates as designed. When technological progress offered the prospect of reducing costs, Democrats decided to bend the cost curve: upward. Americans had already been paying more, both per capita and in total, than any other country in the history of the world; instead of bringing our costs into line with others, the legislation pushes American costs even higher.

You might not be trying to win a debate, but you do appear to be trying to lose an election. Since enacting Obamneycare, Democrats have lost both houses of Congress, and now polls put the Presidency within the margin of error. The only time Democrats prevailed since enacting this legislation was 2012, when Republicans nominated the only other person in the history of the world to sign the same thing, when it was called Romneycare. Democrats don't have that advantage this time.

curious2 says

and you prefer instead to state a counterfactual opinion.

Wtf are you talking about?

turtledove is deplorable says

This was a stick up, and you don't even know it.

A first of it's kind thanks to Justice Roberts.

I'm insured through my employer and had to dig through my tax records last week. I came across a proof of health insurance form and for about a nanosecond felt a cognitive dissonance: 'why would this be in here?' Then I remembered, 'Oh yeah, the Federal government is now forcing people to buy something, right.'