patrick.net

That sounds like a great health care plan don't it? Something our government should be meeting behind closed doors with that industry forging a plan for our citizens. Hey let's ask the crooks and Healthcare Thugs, how to do it.

Insurance is a shakedown and is "Extortion" on this countries health and well being, it's no wonder we're the brunt of the worlds jokes.

1. the video said that the father is not getting job because of his wife needs chemo.
a. What happens if he does not mention his wife needs chemo.
b. Would he be legally bound to say that?
c. What happens if the small business hires the father and is buying insurance for the family?

a. If he didn't answer, they surely wouldn't have renewed his contract. But he did anyway.
b. I'm sure that his employer can't be held legally responsible for lack of renewal of a contract employee - but that the employer could terminate the contract at any time, for any reason. Ah, the glories of having contract at-will employees.
c. Not sure what you meant by that one, my computer shut down 6:00 into the film and so I lost the last three minutes. But IMHO, any small business that hires a person with a high-risk illness risks their premiums increasing to unmanageable amounts.

2. It looks like they could sell their house and pay for the CORBRA - that will get treatment a bit longer. Is it true that if the cost of the health services are so great and it depletes all your funding, then the insurance coverage will be terminated because of the insurance payment?

a. Sure, they could have sold. But where would they live? The story didn't discuss how much equity they had - just that they depleted savings after 6 months & relied upon family. Is it helpful to become homeless in order to pay for another few months of treatment. Then you're homeless & dying without treatment.

3. So if a person is in 40’s and is having cancer, there is no gov founding for them to at least get some treatment?

a. That's correct. There is no government funding for them to obtain treatment. Some states or counties offer treatment (although the eligibility process is extremely demeaning), but most states don't. And in most cases, Medicaid is only available for persons who are younger than 18 years old or older than 65, unless they are disabled and have no work history & receive SSI. SSI is not available to people with a work history.

Medicare is available to people who have been disabled 2 years - but Social Security decides when one becomes disabled so it can take longer. Some states allow Medicaid to be paid retroactively when the Medicare is approved, as long as you can find a provider that will wait 2-1/2 years to be paid. Good luck with that. Medicare has rules and limitations. And the Medicare Part C Advantage plans cost the govt billions while insurance companies rake in billions per year.

Ya gotta question why Medicare has a drug prescription plan that pays full price to providers. With the humongous purchasing power of the Medicare program, we should be saving billions each year by forcing them to bid, or at least put a cap on the prices they charge for medications. And why in the hell would a program designed to help cover medications require that patients pay $3,850 out of pocket on co-pays & deductibles in a calendar year - then stop covering medications until they pay another $3,051.25 out of pocket - before making medications affordable? This applies to every senior, whether they make $800/month or $8,000 per month.

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I just watched the video and started crying for this family. This is not the way our nation healthcare system should be run....

I know Liberals want to be enable with free healthcare, but I wonder how other conservatives feel about the revenue before life policies of the healthcare industry?

@Elliemae

I read this on wikipedia:

On May 5, 2009, the U.S. Senate Finance Committee held hearings on Health care reform. On the panel of the "invited stakeholders," no supporter of the Single-payer health care system was invited. The panel featured Republican senators and industry panelists who argued against any kind of expanded health care coverage. The preclusion of the single payer option from the discussion caused significant protest by doctors in the audience.

It seems like the Doctors are on to something that congress does not want to explore...I wonder why?

Healthcare should be medical based, not political or payor based. Although people assume that physicians are in it for the money, my experience has been that docs would prefer to spend more time being healthcare providers and less time managing the tangle of insurance billing, meeting regulations related to healthcare billing, etc.

Docs have to code everything right to get blood tests for their patients, rather than be able to test on a hunch (even for blood tests) in order for it to be covered. ICD-9 codes are difficult to keep up on and require staff trained in coding & billing issues. Docs have to hire collections & billing clerks, clerks to keep the paperwork straight, pay huge malpractice insurance premiums, and have to see tons of people every day in order to keep their insurance contracts or be able to pay their bills, their staff and still make a comfortable living. They're on-call 24/7, they're well-paid but due to their work & responsibilities don't always have the opportunity to enjoy the fruits of their labors. Their families often benefit financially, but have to make huge concessions like knowing that dad (or mom) won't be around for holidays, etc.

I received an EOB (explanation of benefits) from the insurance company for my last visit, a follow-up that took about 20 minutes. The original bill was $75 (pretty cheap, I'd say); I paid $15 co-pay and the insurance paid $12.00 and this is not an HMO. No wonder MD's have to see so many patients every day.

IMHO MD's are hard-working professionals who would like to return to practicing medicine without all the bullshit - but I could be wrong. I've been wrong sooooo many times before.

By the way, I believe that people should be able to sue for malpractice, but that it should be more reasonable. I've seen docs operate on the wrong hip, shoulder, etc or ignore symptoms that lead to patient deaths. Negligence, not oversight. I've also seen a few drug-addicted docs, and two that were essentially homeless and practiced out of their cars. I've also seen a few uncontrolled, mentally ill physicians. Seriously. The current system makes it hard to get rid of these doctors, even though they're such a tiny part of the population.

I am hearing a lot of the costs can be avoided with a single payer system, which Congress refuses to acknowledge as an option. I believe these type of systems would lower the need for Health insurance and/or discard the need period.

What are your thoughts on the single payer systems like Medicare, Britains National Health Care system? Do you know of any downsides?

If your not familiar you can read up here: http://en.wikipedia.org/wiki/Single-payer_health_care

Medicare isn't really a single-payor system, altho it parades as one.

There are companies, called Intermediaries, that process the billings and send out EOB's (explanations of benefits). Patient sees doctor, doctor sends bills to intermediaries, intermediaries process the bills & send out the EOB's (that say "this is not a bill") to the patients and a notice to the providers, then Medicare pays its portion and the patient pays his. Along the way, there are agencies that provide oversight of the doctor's offices for licensure, oversight of the billing procedures, and ways to appeal on every level. One visit could result in a 3-4 month or longer wait for the provider to be paid. And the intermediaries are paid handsomely for processing the billings.

Or, there are the "Advantage Plans" (giving the advantage to the plan, ha!). They're HMO's for Medicare. Patient sees doctor, doctor bills patient the co-pay and the Advantage plan decides how much, if any, additional amount they'll pay to the MD. This system works on contracted providers: The HMO pays MDs to be the primary MD for up to a certain number of patients, regardless of whether they're seen each month. ($15-$20/patient per month a few years ago). This encourages docs to see patients less because they're not reimbursed for it for the most part, and also means that MDs might have 10-15 minutes to see the patients, dictate notes and do whatever else is needed to get the visit done & resolved in that time frame. Medicare (you & me) pay the Advantage plan around $1,000 per month per patient they sign on, regardless of how much they need. The goal is to have the high-cost patients balance out the low-cost patients.

Out of that money, by the way, they pay $500/pt per year to the salespeople who literally answer the phones and enroll the patients, often with a bonus the 3rd year of 2-3 times that. And they can bill Medicare (you & me) for higher-cost patients. Oh, and they pay case managers whose job it is to deny benefits if at all possible to hold their costs down. These Advantage plans are HUGE PROFIT GENERATING MACHINES for the insurance industry and they lobby hard to ensure there will be no change to their program.

As in some countries with socialized medicine, there are waiting periods and denials for some procedures. Look at it this way, we already have "socialized" medicine, which allows insurance company fatcats to socialize in their fancy homes and swanky clubs while people are denied care. If we spent more money on actually providing care, instead of finding ways NOT to provide care, our national health would be better and we could move on to other issues. We need to move away from insurance/provider based medicine to patient-based medicine.

Elliemae's mantra: Healthcare should never be an option.

"Elliemae’s mantra: Healthcare should never be an option."

TOC [applauding]

We need to move away from insurance/provider based medicine to patient-based medicine.

Are there any options currently being used by other countries?

4X says

We need to move away from insurance/provider based medicine to patient-based medicine.

I would like to add that we need to keep physicians (they're providers, too) in the ideal "patient-based" model. As Leigh pointed out, patients don't always know best. But if the payment wasn't an issue, MD's would be able to practice medicine. Docs are people and you're paying for their opinion (and not every doc is always right), but they're highly trained people whose opinion is based on more than money.

Just checking the time stamp on this comment to be sure daylight savings time is not in the future...

Ummm....Ellie mae.

That was your stateement, I asked if there were any nations that you new of that had a good plan?

I think a combo of many - there was a frontline episode that talked about one system, swiss maybe?

The whole thing needs to be developed from scratch, without prejudice. Like that can happen...

Many on these threads are anti-socialism....I agree that these programs need reform but do not have the answers as to how they can be successful. How else would we protect our elderly that are vulnerable if not for social security, medicare and welfare?