Why do People Hate Obamacare?

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

Postby Judas Maccabeus » Wed Aug 02, 2017 10:39 pm

Robert wrote:
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.


This is why I strongly suggested that you chose a not-for profit, and get to financial counseling ASAP. Not-for-profits have an obligation to preform charity care in exchange for their not-for profit status. They did not change the rate they charged, they used the 900,000 to offset this obligation, which, BTW has to be reported to the IRS, to make sure they are actually doing it.

Robert wrote: 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.


Depends on what KIND of an X-Ray and what KIND of an MRI. You can bet that they are listing the price of the least expensive one in their charge master. I am sure many if not most are more expensive. For comparison, the least costly Nuclear Medicine test I do costs about 46$. The most expensive, and most frequent one I do now is an FDG PET/CT whole body, which has a price of $3446. I could advertise that you could get a test for 46$, and it would be the truth.......unless you really needed a PET/CT.

Robert wrote: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 could not conceive of the chaos and unnecessary deaths that would occur if you let patients administer their meds brought from home. There is a valid reason for this. Everyone up an down the line needs to know what was taken and when. If this is not the case, I would not want to be responsible for the adverse reactions and drug interactions that would occur. A really bad deal all around. A hospital would be crazy to allow this on a routine basis

Robert wrote: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.


Likely a good idea, unless the test is a high complexity test, or there is a chance you may have a reaction from the Iodinated contrast agent. Than you are better off in the hospital.

Robert wrote: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.


You did not need that knee replacement, did you?

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.


Robert wrote: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.


Most of that administrative overhead is caused by the fact that you have literally dozens of different insurance companies with hundreds of different policies, all with varying rules, and all with different requirements and forms.

The way to get rid of this overhead is either a single payor system, where you have only one insurance to deal with, or a universal multi-payor system, with an all payor model (like most of Europe, except the UK). Germany, in particular uses this system, with much success.

J.M.
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Judas Maccabeus
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Re: Why do People Hate Obamacare?

Postby Judas Maccabeus » Wed Aug 02, 2017 10:45 pm

mike wrote: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.


Usually it is something like Medicare +5% or Medicare +10%. The Old Order Amish down near my parts have that, it is set up as a co-op. Seems to work well. Had to explain it to my registration person X3.

mike wrote: 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.


To us, this looks like any other insurance.

mike wrote: 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.


You NEVER want to be caught paying the charge master price. Almost any negotiated rate is better than none at all.

J.M.
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Judas Maccabeus
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Re: Why do People Hate Obamacare?

Postby Judas Maccabeus » Wed Aug 02, 2017 10:52 pm

Bootstrap wrote:There's also waste when a doctor orders the same test another doctor ordered recently or when duplicate services are offered.


In most national health systems, their EMR has all the records from everywhere. Sadly, here that is not the case. None of our systems seem to talk, and we are stuck calling around for prior studies, which can be an exercise in futility if the patient does not remember where he had it done.

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


So are we.

J.M.
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temporal1
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Re: Why do People Hate Obamacare?

Postby temporal1 » Thu Aug 03, 2017 2:46 am

Page 9:
ken_sylvania wrote:
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.
a few months ago, a medical doctor tried to explain something to me about recent changes in (what is now allowed by Congress) "Large price spikes in off-patent drugs."

Sudden Price Spikes in Off-Patent Prescription Drugs:
The Monopoly Business Model that Harms Patients, Taxpayers, and the U.S. Health Care System

https://www.aging.senate.gov/imo/media/ ... Report.pdf

Why Patent Protection In The Drug Industry Is Out Of Control
https://www.forbes.com/sites/robertpear ... 06bf7978ca

EpiPen is getting crushed by a $10 copycat
http://www.businessinsider.com/after-ye ... hed-2017-3

The EpiPen scandal (i believe) is what brought the problem to the attention of the public.
i believe it is an example of what he was trying to explain to me.

Often, doctors are too busy to discuss (world problems) but, occasionally, some doctors will open up about different problems they witness and are attempting to cope with, which i appreciate.
similar to ways Judas Maccabeus shares on forum. :)

i empathize with doctors.
what changes they have to deal with, so many changes in my lifetime.
they do not have the respect and regard they did, just a few decades ago.

many of us are having a hard time trying to cope, wondering what-on-earth the future holds; doctors, no less so. it's sad to me.

until now, a hope for lower drug costs, was to manage to out-live the patent, when less expensive generics would be available. evidently, this may no longer be the case (?)
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Bootstrap
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Re: Why do People Hate Obamacare?

Postby Bootstrap » Thu Aug 03, 2017 9:01 am

Judas Maccabeus wrote:Most of that administrative overhead is caused by the fact that you have literally dozens of different insurance companies with hundreds of different policies, all with varying rules, and all with different requirements and forms.

The way to get rid of this overhead is either a single payor system, where you have only one insurance to deal with, or a universal multi-payor system, with an all payor model (like most of Europe, except the UK). Germany, in particular uses this system, with much success.


I agree with you. And living in Germany for 8 years was one of the big things that convinced me this can work well. Not only do you have dozens of different insurance companies, you have 50 states with different laws and regulations and forms of their own.

I remember an HL7 meeting where we discussed ways of making this more efficient and a federal employee gave a speech where he said that he appreciated our ideals, but really, every time someone tries to make something more efficient they have to figure out how to implement that for all 50 states and it becomes complicated and inefficient again. Just keeping track of all the forms is a nightmare.
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Robert
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Re: Why do People Hate Obamacare?

Postby Robert » Thu Aug 03, 2017 9:34 am

Judas Maccabeus wrote:This is why I strongly suggested that you chose a not-for profit, and get to financial counseling ASAP. Not-for-profits have an obligation to preform charity care in exchange for their not-for profit status. They did not change the rate they charged, they used the 900,000 to offset this obligation, which, BTW has to be reported to the IRS, to make sure they are actually doing it.


They thought he was covered under workman's comp, but was not. They had no coverage at all. No for profit, or non-profit coverage, as we lived for over 20 years.

The hospital would only negotiate down at the rate the doctors did. She had to negotiate down the doctors, then go back to the hospital and work out what she could get reduced at the hospital. The hospital was a non-profit, but the doctors were not. Then she had to work with each bill that came in. It took work, patience and effort, but it kept them out of bankruptcy.

Different states and hospitals have different policies. It is not a one size fits all. You have to talk, ask, and challenge.
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temporal1
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Re: Why do People Hate Obamacare?

Postby temporal1 » Thu Aug 03, 2017 10:11 am

Robert wrote:
Judas Maccabeus wrote:This is why I strongly suggested that you chose a not-for profit, and get to financial counseling ASAP. Not-for-profits have an obligation to preform charity care in exchange for their not-for profit status. They did not change the rate they charged, they used the 900,000 to offset this obligation, which, BTW has to be reported to the IRS, to make sure they are actually doing it.


They thought he was covered under workman's comp, but was not. They had no coverage at all. No for profit, or non-profit coverage, as we lived for over 20 years.

The hospital would only negotiate down at the rate the doctors did. She had to negotiate down the doctors, then go back to the hospital and work out what she could get reduced at the hospital. The hospital was a non-profit, but the doctors were not. Then she had to work with each bill that came in. It took work, patience and effort, but it kept them out of bankruptcy.

Different states and hospitals have different policies. It is not a one size fits all. You have to talk, ask, and challenge.
Robert, having lived through mountains of paperwork required to get through my husband's illness, including problems that arose BEFORE his diagnosis, when we did not know what the problem was .. he made some serious financial errors that caused me to have to deal with IRS for an extended time, and, some other matters. then, the mountains of paperwork (learning each step along the way, with no mentor) .. i admire your daughter's effort, and success, at keeping them out of bankruptcy.

there were times when i wondered, what happens to people with no one available+able to devote such care+time to deal with the bureaucracy and red tape?! all the time, years, reading the fact of life that most bankruptcies are due to egregious medical bills. :(

there were times when i consulted with a bankruptcy attorney. i was able to keep us out of it.
not sure i'll be able to keep me out of it! it's not that i have great debt now, it's that increasing medical costs are taking what i have (and i live in a state where work is hard to find, i'm at an age when i can't "do everything,") options are limited. the 2007 bank failures caused real estate losses .. i lost property that had been paid-in-full for decades, due to inflated property taxes. the tragic irony being, if i'd had a mortgage, i would NOT have lost those properties! - the bank would have paid the taxes, then i would have paid the bank. i try not to think of this often, it's upsetting, and nothing can change it.

i have been thankful my loved ones passed before the bank failures and all the social problems that have fired-up since 2007. these years would have been painful for them, they left this earth not knowing. i have peace about that, i know some others feel the same about their loved ones.

my husband worked so hard, was so effective in his work, i am glad he did not have to experience all this. my parents and in-laws, the same. they all worked so hard, faced so much, in their lives. had so much hope for younger people. i would not have wanted them to see what has become of it.

i miss them. but i'm also happy for them they left unaware of the world post-2007.
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temporal1
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Re: Why do People Hate Obamacare?

Postby temporal1 » Thu Aug 03, 2017 10:31 am

one thing about comparing our U.S. to other countries that have succeeded in various ways.
i live in a lib university area where these types of big ideas are floated regularly.
comparing apples-to-apples is important, and difficult.

example.
in my area, university folks LOVE the dreamy ideas of everyone using bicycles rather than cars. i like that idea, too. i understand, some European countries are quite successful with it.

but, our area has weather extremes that interfere with the practicality of it. add to that, short daylight hours in winter, longer distances between services .. it just cannot be effectively transferred.
there are some attempts at bicycle areas, lanes, et al., built at taxpayer expense.
all that results is, cramped driving for vehicles - empty, unused bike lanes! away from campus, i rarely see anyone bicycling. so many things run against it.

bike theft is "out of this world," even for children's bikes. :shock:

the U.S. is not like small, wealthy countries that have, or have had, simpler demographics and economies. not just Europe, Japan is one example of a country with a simpler demographic.

not everything transfers well, for various reasons that won't just conveniently disappear.
too often, people try to obsessively "pound square pegs into round holes." :(
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appleman2006
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Re: Why do People Hate Obamacare?

Postby appleman2006 » Thu Aug 03, 2017 11:09 am

Bootstrap wrote:Well, estimates were $65,000 to $160,000, I would assume they would choose a lower bid over a higher bid.

Maybe in your fair land but here? I would not bet on it. The point is that it still cost well over 10000.00 from the last I heard. I will guarantee that there would of been companies that could of put up a perfectly safe step for a lot less had they truly put it out to all bidders.

I could personally give you enough examples of extreme government waste to make you want to pull your hair out but I will spare you. Someday I am afraid that our grandchildren will curse our generation.
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ken_sylvania
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Re: Why do People Hate Obamacare?

Postby ken_sylvania » Thu Aug 03, 2017 11:18 am

appleman2006 wrote:
Bootstrap wrote:Well, estimates were $65,000 to $160,000, I would assume they would choose a lower bid over a higher bid.

Maybe in your fair land but here? I would not bet on it. The point is that it still cost well over 10000.00 from the last I heard. I will guarantee that there would of been companies that could of put up a perfectly safe step for a lot less had they truly put it out to all bidders.

I could personally give you enough examples of extreme government waste to make you want to pull your hair out but I will spare you. Someday I am afraid that our grandchildren will curse our generation.

When the invitation to bid is a thousand pages long, and requires the bidder to certify and acknowledge compliance with all items and government policies (most of which are not even applicable to the situation, but the bidder doesn't know unless he actually researches and analyzes each one), under threat of fine or imprisonment, the bidder is very likely to tack an extra $50k to $100k on to a $25,000 project just for his trouble. Dealing with the paperwork on a government project can be almost enough to make a grown man cry!
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