Why do People Hate Obamacare?

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

Postby Josh » Tue Aug 01, 2017 11:23 am

Robert wrote:
Josh wrote:$350k salaries? No human being needs to make that much money, especially if they want to pretend they are "helping people".


They make those amounts because there is little competition. I can get an MRI off site of a hospital for the same price as an x-ray at a hospital. 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.


Robert, I worked as a consultant in the field of care management & payor systems for years, and frankly you don't know what you're talking about, and I do. There used to be some flexibility to shop around for better prices. These days, there is quite little, particularly for uninsured patients. Most providers will not even tell an uninsured patient what the cost is of a procedure upfront.

This is less true in an area heavy with plain people who has providers who cater to cash payments, but most people don't live in such areas. I can think of a few provider networks who will not provide upfront pricing at all in my area at all. If you are below the poverty line, some of them will allow you to pay Medicare's prices plus a percentage (around 20% I think), and the state of Ohio has an assistance programme or Medicaid eligibility for very poor people, but that doesn't apply for a single person once you make over $12,000 a year, which is not exactly "wealthy".

One provider network here (which operates the largest ER) will not, under any circumstance, let a cash pay patient pay UCR. Their financial counselling office offers two options: try to get Medicaid to pay for it, or else they actually have a referral service to bankruptcy petition filers. They also have a staff of in house attorneys and they sue uninsured patients at the six-month mark like clockwork.

As far as "find a better doctor", it's challenging to even find a doctor taking new patients, particularly if you want to shop on price.

We 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.


So what do you do when something happens and you need to go to the ER? Tell the ambulance driver, "Hold on, make sure you take me to the place with the cheapest appendectomies!"?
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Bootstrap
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Re: Why do People Hate Obamacare?

Postby Bootstrap » Tue Aug 01, 2017 11:52 am

Josh wrote:So what do you do when something happens and you need to go to the ER? Tell the ambulance driver, "Hold on, make sure you take me to the place with the cheapest appendectomies!"?


I collapsed on an international flight once. They asked if there was a doctor on the flight, checked me out, gave me oxygen and had me rest. When the flight arrived, they asked everyone to wait until I was taken off, which caught me by surprise. Three people arrived to whisk me off to the emergency room. I asked them if this was necessary and how much it would cost. They had no idea what it would cost. At this particular airport (Frankfurt), there was a clinic where I could go get checked out. I asked if I could just walk to it, assuming that if I collapsed someone would notice. They said would be fine.

But that's an unusual kind of negotiation. You can't often do that.
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Bootstrap
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Re: Why do People Hate Obamacare?

Postby Bootstrap » Tue Aug 01, 2017 11:55 am

Josh wrote:I worked as a consultant in the field of care management & payor systems for years.


That's interesting. Can you say more about what you did?
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Bootstrap
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Re: Why do People Hate Obamacare?

Postby Bootstrap » Tue Aug 01, 2017 12:01 pm

Josh wrote:Most providers will not even tell an uninsured patient what the cost is of a procedure upfront.


Very true. And often, doctors have no idea what the things they are prescribing will cost the patient, so they aren't even thinking about what is cost-effective. It's hard to have a free market if the costs are not known.
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Robert
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Re: Why do People Hate Obamacare?

Postby Robert » Tue Aug 01, 2017 1:30 pm

Josh wrote:Robert, I worked as a consultant in the field of care management & payor systems for years, and frankly you don't know what you're talking about, and I do.


Well, I guess I am just a stupid ignorant jerk that should just shut up and all those bills I paid out of my pocket were just delusions.

If this is the way you want to talk to others who see things different, i am done.

Just remember who can pull the plug on you any time I want. I grow tired of your attitude. Improve it or I will consider action.
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Josh
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Re: Why do People Hate Obamacare?

Postby Josh » Tue Aug 01, 2017 1:35 pm

Bootstrap wrote:
Josh wrote:I worked as a consultant in the field of care management & payor systems for years.


That's interesting. Can you say more about what you did?


An insurance company has access to a lot of data about a patient - probably more than any other single entity. The field of care management involves looking at all of that data to get an overall picture of a patient's health. For example, if I look at a patient's pharmacy claims and see they have filled 30 different prescriptions in the last 90 days, they have had 3 ER admits, and that some of the procedure codes or disease codes in some of their claims indicate a medium or high risk condition like diabetes or MDD, then it's safe to say they are having trouble managing an illness. Using all of that data, a clinical nurse who works for the insurance company will contact the patient and contact all the providers to try to coordinate the patient's care. This team usually is structured under the insurance company's chief medical officer, who is an MD and is overall responsible for improving the health of covered members (as opposed to responsible for financial targets).

It works for the insurer since they will save money if the patient doesn't have another high cost event like an ER admit, or is able to cut down on the number of prescriptions they're taking. At a typical insurance company, a small number of covered individuals are responsible for nearly all claims in terms of dollars paid out.

With the pressure under the ACA to make it even harder for insurance companies to make a profit and to cover all kinds of things that didn't used to be covered before, and restrictions on charging more for patients who cost more to insure, care management was a very hot item around 2013 - 2014 - the cost of implementing a care management programme and hiring the staff to run it (plus consultants like me to help you implement it) was more than paid for by the cost savings of improving the outcomes of medium risk patients.

Payor systems are a lot simpler: that's just the part of an insurance company's business that receives claims, adjusts them, and then pays providers. My role with that was that claims were a good source of information about patients for care management purposes.

Probably the biggest thing I learned from working in that space is that insurance companies really, really aren't the bad guys at all - they're the only people who really have an incentive to improve patient outcomes, and they live in an extremely regulated environment. Regulatory compliance was pretty much at the forefront of everything we did, both from a medical perspective and from an insurance perspective.
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Josh
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Re: Why do People Hate Obamacare?

Postby Josh » Tue Aug 01, 2017 1:36 pm

Robert wrote:Just remember who can pull the plug on you any time I want. I grow tired of your attitude. Improve it or I will consider action.


Fine, Robert. I'll consider myself checked out of here.
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appleman2006
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Re: Why do People Hate Obamacare?

Postby appleman2006 » Tue Aug 01, 2017 1:55 pm

Josh wrote:Probably the biggest thing I learned from working in that space is that insurance companies really, really aren't the bad guys at all - they're the only people who really have an incentive to improve patient outcomes, and they live in an extremely regulated environment. Regulatory compliance was pretty much at the forefront of everything we did, both from a medical perspective and from an insurance perspective.


Yup. As in every industry the insurance industry also has it's bad eggs but due to the extreme regulations they are under I would say they are less than in most. Unfortunately as I have sad before very few people truly understand how insurance works or even what the real purposes for having insurance are.
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Robert
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Re: Why do People Hate Obamacare?

Postby Robert » Tue Aug 01, 2017 3:40 pm

Josh wrote:
Robert wrote:Just remember who can pull the plug on you any time I want. I grow tired of your attitude. Improve it or I will consider action.


Fine, Robert. I'll consider myself checked out of here.

Some people only want headship for others and can not accept it for themselves.
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lesterb
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Re: Why do People Hate Obamacare?

Postby lesterb » Tue Aug 01, 2017 6:10 pm

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.
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