Why do People Hate Obamacare?

Events occurring and how they relate/affect Anabaptist faith and culture.
silentreader
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Re: Why do People Hate Obamacare?

Postby silentreader » Tue Aug 01, 2017 7:22 pm

lesterb wrote:When I was on STD, I wanted to go back to work. But the insurance facilitator I was working had gotten to know me fairly well throughout, and she refused to let me go back for at least a month after I thought I could. Then she worked out a part time schedule for me. I found her a very caring and thoughtful person.

In fact that pretty well changed my mind about insurance companies.


As in every service industry, there are good ones, and then there are others. I have experienced both.
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ken_sylvania
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Re: Why do People Hate Obamacare?

Postby ken_sylvania » Tue Aug 01, 2017 8:24 pm

appleman2006 wrote:2. Drug costs. Again I am not sure if you took the free market component out of this whether nearly as much research would actually get done.

Not sure about Canada, but in USA there is an amazing amount of medical/drug research financed by government grants where the resulting drug patents end up in the hands of private companies who make a fortune off of the government-funded research.
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Judas Maccabeus
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Re: Why do People Hate Obamacare?

Postby Judas Maccabeus » Tue Aug 01, 2017 10:04 pm

Robert wrote:.
They make those amounts because there is little competition.


If it is a physician, at that level of income, you are talking about a fellowship trained sub specialist. There is little competition, because very few people are willing to go through 4 years of college, than 4 years of med school, than a 3-4 year residency, than go through 2-3 more years of fellowship training BEFORE THEY MAKE A SINGLE DIME OVER THEIR MINIMAL LIVING EXPENSES. Really, people are standing in line to put in 10 years of 80 hour weeks. Only a few have the dedication and stamina to do this. I don't begrudge them a big paycheck for their fewer earning years.

Most doc's don't make anything near that.

If it is a corporate MBA type, they really don't do anything anyone else could not do, with some training. They are where they are because they were ruthless to climb the corporate ladder. Wr could do with far less of these.

Robert wrote:I can get an MRI off site of a hospital for the same price as an x-ray at a hospital.


If that was actually possible, I would be most surprised. I looked at both the charge master and Medicaid R&C. The ratio of a plain film to an MRI of the same part is like 80-100 to one. Hospital outpatient services are regulated by HOPPS. (Hospital outpatient prospective payment system) and in general won't be more than 1.5-2 to one, compared to a standalone. No one can charge you less than they collect from medicare. Medicare billing must be at the most favorable rate. If you charge anyone else less than you do medicare, that becomes your new medicare rate. Some insurance companies also negotiate contracts for the most favorable rate you charge non-medicare clients. Being found out charging rates lower than you charge these systems can be expensive. REAL expensive. Waiver of copays and deductibles also has to be handled with considerable care. Typically managed care companies won't allow this at all.

In the days of paper billing, I know a bit of this went on. Now with EMR, your chance of getting caught is rather high. The only way you can actually negotiate a rate is if you find a non-participating provider. Good luck on that, most of them run boutique practices.

Robert wrote: The more we ask for prices and seek out better deals, the more the market will adjust. We do not need government to do that. We have to take responsibility and do it. Don't go to the doctor thinking they know it all and you have to do what they say. Have a conversation. Ask for less expensive treatment options. They know their industry. A good doctor will jump right in and help you keep costs down. One that doesn't, well find a better doctor.


Most of them try to do this anyway. Mine sure does. Problem is, the resources they need to do their job are largely controlled by corporate forces that don't really care all that much for patients, but for their quarterly earnings call.

Robert wrote: were self pay for over 10 years and always found a way to get treatment and the things we needed. We were fortune not to have major medical expenses, but my wife had a chronic illness all that time. I knew we had the odds on our side. Things can happen, but the odds that a major issue develops are less then the odds that it would not. We had faith that God would help us through whatever we faced, and were never disappointed.


I am glad that God protected you, but not all of us are that blessed. Many of us are one major illness away from financial ruin, and for many of us, bankruptcy is not an option. Josh is right, the room to negotiate a lower price on bills is likely long past. You are just so constrained as to how much you charge, you really can't just negotiate wily nilly. My advice is to find a not-for-profit and try to see what financial counseling can do for you, before you have a bill you can't pay.


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Robert
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Re: Why do People Hate Obamacare?

Postby Robert » Wed Aug 02, 2017 11:02 am

Judas Maccabeus wrote:I am glad that God protected you, but not all of us are that blessed. Many of us are one major illness away from financial ruin, and for many of us, bankruptcy is not an option. Josh is right, the room to negotiate a lower price on bills is likely long past. You are just so constrained as to how much you charge, you really can't just negotiate wily nilly. My advice is to find a not-for-profit and try to see what financial counseling can do for you, before you have a bill you can't pay.


My son-in-law was electrocuted trimming trees 2 years ago. My daughter negotiated one million down to $100,000. Then she got financial assistance for that 100,000 and was able to get Medicaid and disability.

Not long gone to me. I helped talk her through it from our experiences. The hospitals and doctors do not WANT to write that stuff off, but it can be done. if they made it easy, everyone would do it. It has to be hard, but for my daughter's efforts of months working on this, the saved over $900,000.

I speak from experience. Long gone and recent. We have and an x-ray at a hospital and was charged $300. We know. We paid the bill.

Off site MRI centers were in our area in Indiana. They were doing MRI for $300-$500. Maybe I am remembering the low end wrong. But I know they were advertising $500 MRI. To me, that is close to the same price.

When in the hospital, they will dispense your prescriptions from their pharmacy and charge about 10x the amount you can buy them at the pharmacy. You can take your own to keep the price down, but they make it very hard to do that so they can charge more. Again, it takes effort, but you can keep the cost down.

I do not begrudge the hospitals for charging the rates they do. I am saying we can do things to keep a lot of that cost down. NEVER get a test or lab work done at a hospital unless there is no other option.

The HSA program is geared to start getting consumers to start shopping around. If you are spending your own money, it is worth the time and effort. If you are spending the insurance money, you don't really care how much it costs. Just like those who call for government to pay, it is easier to spend someone else's money then spend your own.

Judas Maccabeus wrote:There is little competition, because very few people are willing to go through 4 years of college, than 4 years of med school, than a 3-4 year residency, than go through 2-3 more years of fellowship training BEFORE THEY MAKE A SINGLE DIME OVER THEIR MINIMAL LIVING EXPENSES.


I have no issue with GP and other doctors making good salaries. What I remember was a GP had one nurse and MAYBE one bookkeeper. They would care for all their patients. Today, you go into a doctor's office and they have 4 bookkeepers, several nurses, and one doctor. This means it is taking a lot more money to do all the bookkeeping that the government requires then it used to. Want to bring down medical costs? Reduce(improve) regulations and reporting, and you will take a big chunk out of the cost.
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mike
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Re: Why do People Hate Obamacare?

Postby mike » Wed Aug 02, 2017 3:49 pm

There is quite a bit that can be done, like Robert is describing, to bring down the cost of medical bills. I don't know much about direct personal price negotiations, but have some knowledge of group negotiating. In our area, a wide range of conservative Mennonite churches have an agreement with the largest local health system. They agree to pay bills within 30 days and in return receive rates comparable to Medicare rates, which are often around 50% off regular direct pricing.

Those churches that have their own medical mutual aid funds pay the bills out of their fund. Some members, like myself, are members of Christian Healthcare Ministries. CHM counts billing discounts obtained against deductible. A friend of mine incurred a $13,000 hospital cost. Membership in the above described group discounted his bills to around $6,000. The $7,000 saved counted against his CHM deductible and so CHM would cover 100% of the $6,000 he owes. He did have to pay the $6K within 30 days per the agreement, but will be reimbursed by CHM.

The government is not involved in any of this, and it doesn't have to be. Arrangements such as these bring costs much closer to what they actually should be.
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mike
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Re: Why do People Hate Obamacare?

Postby mike » Wed Aug 02, 2017 5:18 pm

Here is another aspect of cost. The quality and pace of medical advances have made things possible that were almost unthinkable just a few years ago. All of this comes at a price. And just because something is possible does not mean it is advisable, feasible, or morally imperative. Sometimes you have a case such as that of the child in the UK recently where the government health system refused to continue with care that the parents wanted to have done. This situation caused a great outpour of protest against the UK health system.

It is easy to sympathize with the parents and the love for human life, and decry the official refusal not to finance some possible options. But there are limited resources. Somebody has to pay the piper. World-class care and cutting edge technology must somehow be paid for. Decisions about what care is advisable will be made by the ones paying the bill. If the government is going to be paying the bill, then somewhere there will be what detractors call a death panel - people who decide when to pull the plug, when to say that enough is enough. I don't know that I can criticize the government making these decisions in these sorts of cases because the government has a finite amount of resources. What are they supposed to do?

If we are going to take advantage of every possible medical technology in pursuit of living a few more years, then why do we complain about the cost? I believe that in the United States we have access to some of the best, if not the best, quality of healthcare in the world. Well, of course the costs are high. What else do we expect?
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appleman2006
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Re: Why do People Hate Obamacare?

Postby appleman2006 » Wed Aug 02, 2017 5:38 pm

I agree with you in principle Mike and you make a lot of good points.

I will say this though. If it were possible to take the extreme waste out of the system and I am primarily speaking of the government here I believe there would be enough money and then some to go around even to pay for most of the extreme cases.

Google the case of the park steps recently built in Toronto where the original estimate was 160,000.00. A 73 year old man went to Home depot and bought $550.00 dollars worth of material and built a pretty decent set of stairs far safer that the loose stones people were crawling over prior. Of course they did not meet city code and the city came and tore them out the next day. However they were shamed into providing stone steps for what they estimated would be just over 10 thousand dollars. And the job was done within a week.

This is just one example of literally millions of projects in our countries that are costing not millions but billions if not trillions of dollars more than they should each year.
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haithabu
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Re: Why do People Hate Obamacare?

Postby haithabu » Wed Aug 02, 2017 7:13 pm

Just a little factual correction on the Charlie Gard case in the UK: it was not a matter of the government refusing to pay for further treatment for their son; the parents had independently fundraised GBP 1,300,000 to cover the cost but the hospital refused to allow the treatment or permit their child to be transferred for treatment anywhere else.

That was the issue which got so many people upset. The government was effectively making Charlie a ward of the state and mandating his death in spite of his parents being willing and able to pay for his continued treatment.
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Bootstrap
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Re: Why do People Hate Obamacare?

Postby Bootstrap » Wed Aug 02, 2017 8:00 pm

haithabu wrote:That was the issue which got so many people upset. The government was effectively making Charlie a ward of the state and mandating his death in spite of his parents being willing and able to pay for his continued treatment.


Under British law, the State can overrule parent's decisions in many ways that it cannot in the United States. Maybe this will prompt some politicians to consider changing those laws? But my guess is that nothing will change, this is pretty ingrained in their legal system.
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Bootstrap
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Re: Why do People Hate Obamacare?

Postby Bootstrap » Wed Aug 02, 2017 8:15 pm

appleman2006 wrote:I will say this though. If it were possible to take the extreme waste out of the system and I am primarily speaking of the government here I believe there would be enough money and then some to go around even to pay for most of the extreme cases.

Google the case of the park steps recently built in Toronto where the original estimate was 160,000.00.


Well, estimates were $65,000 to $160,000, I would assume they would choose a lower bid over a higher bid. I assume the bidders were private firms. I suspect the lesson is that government does need to keep an eye on costs to make sure they are reasonable when dealing with private firms.

I remember a story of a woman who was facing bankruptcy because her husband had died, leaving huge hospital bills behind. After three years, she hired a lawyer to help her negotiate, and he hired someone who worked for a health insurance agency. First step was to negotiate the prices down to what insurance companies pay, and lower than that based on her ability to pay without going bankrupt. But then the guy from the insurance company said that they routinely reject many of the charges because they are not valid and encouraged them to challenge many of the remaining charges.

There's also waste when a doctor orders the same test another doctor ordered recently or when duplicate services are offered. Recently, I was going to have a procedure that cost $400.00 and a doctor I had seen earlier said she thought it was important for me to talk to her first. Her bill was about $900.00, I talked to her for 30 minutes, and I don't understand why it was important. And she is not an MD, she is a PA, a position originally created to provide services cheaper than MDs. Then the law was changed so that PAs can charge at the rate of their supervising doctor ...

Insurance companies, Medicare, Medicaid, etc. have ways of dealing with many of these issues. A private individual is outgunned.
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