Nasty455

The kids filed into class Monday morning. They were all very excited. Their weekend assignment was to sell something, then give a talk on salesmanship.
Little Sally led off. "I sold Girl Scout cookies and I made $30," she said proudly. "My sales approach was to appeal to the customer's civil spirit and I credit that approach for my obvious success."
"Very good", said the teacher.
Little Debbie was next. "I sold magazines" she said, "I made $45 and I explained to everyone that magazines would keep them up on current events."
"Very good, Debbie", said the teacher.
Eventually, it was Little Johnny's turn. The teacher held her breath. Little Johnny walked to the front of the classroom and dumped a box full of cash on the teacher's desk. "$2,467", he said.
"$2,467!" cried the teacher, "What in the world were you selling?"
"Mouthwash", said Little Johnny.
"Mouthwash?", echoed the teacher. "How could you possibly sell enough mouthwash to make that much money?"
"I found the busiest corner in town", said Little Johnny, "I set up a Dip & Chip stand and I gave everybody who walked by a free sample."
"They all said the same thing: 'Hey, this tastes like dog poop!' Then I would say, 'It is dog poop. Wanna buy a bottle of mouthwash?' I used the President Obama method of giving you some crap, dressing it up so it looks good, telling you it's free and then making you pay to get the bad taste out of your mouth."
Little Johnny got five stars for his assignment. Bless his heart.

oldcutlass

Although I've heard this before, but sometimes the truth hurts.

GAOldsman

Bwahahahahaha Yes Eric it sure does

69ishHoliday

The Economist magazine a couple years ago when affordable health insurance was being passed into law wrote that it's about time that the U.S. joined the rest of the civilized world. I have in-laws in New Zealand that can't fathom that in our country the quality of health care one receives is dependent on their job. Sad but true.

69ishHoliday

This thread should be deleted if moderation is sincere about staying away from politics. The "joke" posted is one anyway.

MDchanic

I must say that I agree with both the OP (darned funny) and with Holiday.

I could discuss the subtleties of why I agree and disagree with both, but that would be political, so I'll keep a lid on it.

Suffice to say that on the one hand, not having any sort of real health care system is crazy, and causes a real economic drag on the whole country, while on the other hand, the law is as described above, and a particularly fragrant version, I might add.

I'd love to be an insurance company exec. though, and have the government order the entire population to hand me their money.

- Eric

69ishHoliday

A single payer system eliminating the insurance companies would have been my personal preference but there would be an big instant slam to employment and the stock market that would take some time to heal. I've been told that there is a large group of doctors in favor of a single payer system, and not for selfish reasons.

We already pretty much live in a world comprised of the have-nots working for the haves. Doesn't it make sense to keep the have-nots healthy? What is the motive of denying health care to anyone? Aren't we above that?

MDchanic

There is a large group of doctors who favor single-payer, see Physicians for a National Health Program, BUT, the major US single-payer-like system in effect now, MediCare, pays very low rates (not enoug to keep the pracice open, never mind pay themselves any salary at all), and increasing numbers of doctors are opting out, so, from a practical perspective, it would be hard to convince the majority of doctors that the new system would pay them enough to keep their lights on.

- Eric

jaunty75

Let's get one thing straight. No one is ever denied health care in this country. Anyone can walk into any hospital emergency room anywhere, and you will not be turned away regardless of ability to pay.


The truth is, polling at the time Obamacare was passed showed that 85% of Americans were perfectly happy with the health insurance coverage they had prior to Obamacare. So we had 15% of the population that needed help, and we could have helped them without blowing up the system for the other 85%. We're seeing the fruits of government-run health insurance right now as Obamacare is being dismantled bit by bit by noneother than the president himself.

z11375ss

This is a payoff for the insurance companies that wrote the bill. Good thing Congress didn't read it before the Dems passed it in the dead of night on Christmas Eve! Perfect bill for these lying, scheming, spinning, times. What's good is bad, and so on. Bleck.

jaunty75

Except that all of the changes being made, including delaying the individual mandate, which was just announced Thursday, is causing the insurance companies to be royally screwed.

69ishHoliday

Sorry, Jaunty, but I know someone personally that had to pay $1200 on the spot to receive treatment at a hospital after a bicycle accident. Try walking into an "Urgent Care" with no funds and you will be directed to the door.

z11375ss

jaunty you may be right. I don't know. That's the beauty of this law, no one knows what the hell is in it. I found this however;
Take this week’s third-quarter earnings report and financial projections of Wellpoint (WLP), one of the nation’s largest health insurers, which earlier this week raised its earnings guidance for the third time this year. Amid a flurry of stories about the troubled launch of the federal health insurance marketplace web site known as healthcare.gov, Wellpoint said its improved outlook is due in part to gains from the Affordable Care Act. On Friday, the Obama administration named a contractor to fix the site, saying it should be fixed by the end of November.

From this article;
http://www.forbes.com/sites/brucejap...well-underway/

No happy pics this time. This doesn't deserve any! LOL!

MDchanic

In the US, emergency rooms are required by the "EMTALA" law to treat all comers who require treatment (actually, to "stabilize" them), but nobody else is, and that includes urgent care centers.

Urgent care centers are usually either private for-profit businesses, or are owned and operated by hospitals, in which case they are probably the only outpatient unit that makes a profit instead of a loss (family practice, pediatrics, and internal medicine usually lose money because of extremely low Medicaid and Medicare reimbursements, which is also why there are so few independent doctor's offices still around in the US - they can't afford to stay in business, and so sell out to the hospitals, which have the ability to divert profits from other departments to subsidize their primary care). Because of this, urgent care centers expect to make money. They're not charities, and have no obligation to treat those who can't pay. If they are hospital-owned, those who can't afford their bills can appeal to an office in the hospital, and will likely receive a "charity care" discount.

I'm sorry that your friend got stuck for $1,200, but, in the context of the American medical system today, that's actually pretty cheap, especially when you consider that lots of insured people have ER copays between $100 and $500, with a $1,000 to $10,000 annual deductible (which they have to pay out of pocket before their insurance kicks in).

Like I said, crappy system, but just try to get a better one instituted.

- Eric

jaunty75

What Eric said is correct.

In this case, did this person not receive medical care? Apparently, he did, which is the point. If he was asked to pay upfront, he must have had the means to pay. If he couldn't pay, a hospital emergency room (not an "urgent care" center, as Eric points out) would not have turned him away.

I did not say he or anyone is entitled to free health care, which is what you seem to be implying this guy was owed.

oldcutlass

An urgent care center is not an emergency room at a hospital.


I recently suffered a heart attack and my wife drove me to the ER at our local hospital. At the time I had no insurance and was unemployed, they were told that up front. They wheeled me into the ER anyway, determined I was indeed having a heart attack. They put a stent in me to open up a 100% blockage and after an overnight stay, they checked me out, patted my butt and sent me home.


The people in the billing office at the hospital were extremely helpful and went way beyond the call of duty to work with me. Needless to say, I was able to get my COBRA insurance (another story), and out of a $88k bill my end was just a bit over $2200 + the monthly. Outside of the exorbitant costs, I believe our current system, before ACA, was working well.


I would like to see an honest discussion and not get into a pissing or political contest over this. If it gets ugly, we close the thread.

brddg

In a single payer system your "time to heal" is while your waiting in line (it'll be a while). Meanwhile, the real world is consisting of willing and not willing to. I haven't been to the DMV in about 15 years. I go to the "privately owned" DMV, far more courteous, exponentially faster, but costs more why does somebody get paid while they do none of the work here? No politics here. Nothing to see. Just pointing out that when accountability is completely absent you get far less product for far more money. BTW they will miss the money less if you take it right out of their check. Can't miss what you never had right?

MDchanic

Very true, but let's not assign this principle preferentially to private or to government situations - either can create circumstances where there is more or less accountability, as we can see with US health insurers who answer meaningfully to nobody but their shareholders.

- Eric

jaunty75

I'm sure at least some people in this thread saw the thread by "Kyle's 77 Cutlass" (I think that's his username is) who lives in Canada and whose 11 year old son had some sort of strange disorder. He discovered it would be many months before anything could be diagnosed or accomplished if he went the through the Canadian system, which is the system we in the U.S. are constantly beat over the head with because it's supposed to be so wonderful and we should adopt it here.

But what does this fellow do about his son? He voted with his feet. He comes to the U.S. to get modern, timely care. He has such a good experience that he now wants to relocate to the U.S. This speaks volumes about the Canadian system we're all supposed to hold in such high regard. I don't know all the details. I don't know how he's paying for the care his son received. I'm sure something was worked out between his family and the Mayo Clinic. But the overarching point is, his son received the needed care. In the U.S. The home of this supposedly awful health care system.

I said above that the old system was working for the majority of Americans. I'm the first to admit it wasn't perfect. But let's not throw the baby out with the bathwater. Common-sense reforms could have been enacted that preserved the system that most Americans found satisfactory while making it better for those for whom it was failing. But no, we got Obamacare, which is unraveling right before our very eyes and mostly due to the actions of the administration itself. I half expected Obamacare to be repealed at some point down the road. I never expected it to be this soon and that it would be Obama himself doing the repealing.

http://online.wsj.com/news/articles/...70252042143502

RandyS

You realize of course that that article was ONE PERSON"S OPINION............

jensenracing77

Sorry to hear that. All any of this will do is increase demand and not increase supply. That will cause rationing health care to those that the government sees fit. Why do you think so many people come here from Canada? It is because there system is screwed up. Ours may be expensive but at least you can git it...for now. I am a mamber of the hard working middle class so I will be the one to be turned down.

69ishHoliday

Being able to get it is a component being addressed by the legislation and being a member of the hard working middle class doesn't mean that a pre-existing condition couldn't render you unable to buy insurance for yourself or another family member. When the small company I work for picked-up health insurance for the employees, one employee had to be excluded because he has diabetes and including him with his condition would have made the costs for everyone unmanageable. It's too bad, he's a nice person, just unlucky enough to have diabetes so he is denied insurance in general.

jensenracing77

So you want insurance companies forced to accept him and therefore making everyones insurance unmanageable?

Let me not carry insurance on my W-30 and after i crash it go and get insurance so they can fix my cars pre existing condition. I understand that GOOD people have bad things happen but even without insurance your friend can get health care. What I don't like about these laws are that insurance or not, you will not be able to get health care when they start rationing it. Just like a memeber here from Canada.

69ishHoliday

I have one of those family policies that includes a huge annual deductible before insurance pays for anything. It is 'catastrophe' insurance, not health insurance. I'd like to have affordable care for my family, my wife or I neither one have the right job to get it, that is our fault since we are aware that the right job is what's needed to receive affordable care.

MDchanic

Jaunty, I wouldn't use Kyle's example without knowing more specifics about his situation. He was very vague about a number of things, and we didn't press him on them, as it is really none of our business.

His son has an unusual, but not super-rare, form of childhood arthritis, which any pediatrician should at least know to suspect, and any pediatric (or adult) orthopedist should be able to diagnose. Why he was sent on a wild goose chase after a geneticist appointment (with its inherent long wait), we do not know, but it sounds more like incompetence from his local yokels than like a failure of the whole system. Even in the US, it's not quick to see a geneticist, mostly because a geneticist can't DO anything - they can just tell you "Yup, you're ar risk for getting X, Y, and Z." You will note that he did NOT say that he ever saw a geneticist in the US, mostly because he never needed to see one in the first place.

And, Eric (JensenRacing), I agree that the supply and demand issue is a serious one, especially in the primary care specialties. Note that one major proposal is to use more physician assistants ans nurse practitioners in primary care due to the shortage of doctors, which would, of course, reduce the quality level of primary care overall and increase use of specialists ("I'm not sure what that is, better go see Dr. X..."), which would increase expenses.

I would argue with the "rationing" argument, though, in that there is genuine "rationing" right now, only now it is caused by folks just plain old not being able to afford some treatments. Medical care (in the form of doctors, nurses, medicines, CAT scans, lab tests, etc.) is not infinite, though. There are a limited number of all of the above elements.
If the number of each element is sufficient for all of the demand, and there is enough money to pay for them, then there will need to be no rationing.
Unfortunately, in the real world, there will never be enough of all of these things (including the money to pay for them), to eliminate any possibility of some sort of "rationing" somewhere in the system. At some level of pay, doctors will start to quit and go into some other field, GE will stop making CAT scanners, and Quest will stop doing lab work.
There will always be a compromise somewhere, because, 1. this stuff is expensive, and, 2. Americans WANT a LOT of health care, and will use up whatever they can get their mitts on.
Most people in this country will never say, "That's enough, Doc, I'll just look after it at home and see how it goes." Some will, especially the old farmer types, but these days, most people (and, fortunately, most of the folks on this board, and their families are NOT this type) will say "What else can you do?" "Are you sure it doesn't need an X-ray" "Shouldn't I get a CAT scan?" "Aren't you going to run some labs?" "I'd be happier seeing a specialist," etc.

Rationing is a valid point of discussion, but the question isn't whether it will exist, but how it will be done.

- Eric

jaunty75

I'm sorry, but he posted his situation on here voluntarily. It IS our business because he chose to make it so. And none of what you say alters the basic facts of the situation as I summarized them above.

MDchanic

That's a false-choice question.

In Holiday's case, the insurance company intended to share the risk among the few employees in the small company in question. The insurance could also be structured to share the risk among a larger group, such as all employed people, all people in the state, or all people in the country.

How to share the risk is another valid question for discussion in this matter, especially since it appears that the US has already decided to share the risk of all elderly people among all federal taxpayers (through Medicare) and to share the risk of all poor people among a combination of federal and state taxpayers (through Medicaid). My point being that even now, this is not a black and white question, but one that has been partially decided, and one which may have been partially decided in ways that some of us might disagree with.

A larger question, though, which you alluded to in your post, is, What is insurance for?
Most of us would agree with your general point that insurance is for significant unforeseen events.
We would think that it's nonsensical for our car insurance to pay for oil changes.
However, most today believe that health insurance should pay for routine doctor visits for healthy people, at which point, in my opinion, it ceases to be insurance, and starts to become something else.

In the specific case of the diabetic person, in many cases, getting diabetes is an unforeseen event, which is not avoidable by anything the person can do, and it would seem reasonable that this person should be covered for this (though in this case, the condition apparently started while he was uninsured, and so we gat back to the "shared risk" question), but in many other cases, diabetes is a predictable result of voluntary behavior, to wit: Eating too much and not exercising enough. Should people with Type II diabetes from obesity not be eligible for insurance because they caused their own conditions (and may well be able to cure them by losing weight)? It's a valid question.

That question, of course, begs another question: If you voluntarily drive in a car that is demonstrably less safe than a modern car (no crumple zones, no airbags, no rollover protection if it's a convertible), should you be covered for injuries you sustain from a car accident? If so, what pool of people should share that risk? Only people who drive antique cars? All drivers? All people? And what about motorcyclists? And what about people who enjoy mountain climbing, or skydiving, or SCUBA diving, or drag racing? People who live in cities, who walk or take public transportation, and never drive, have a much lower chance of injury from car accidents (even if you include getting run over) - should they get a discount?
All of these questions are related to the original question of the one diabetic employee, and need to be considered in any discussion like this one.

- Eric

jaunty75

Hardly.

It is not an opinion that, last Thursday, the president unilaterally (and extralegally) suspended the penalty that would have had to have been paid by anyone who failed to sign up for a health insurance plan. Thus he has suspended the individual mandate. It is not an opinion that the individual mandate is the core, the heart of the Affordable Care Act. Everyone was supposed to pay into the system, either by buying an insurance plan or by paying the penalty. That was how insurance companies were supposed to balance the costs of insurance plans and make them less expensive for older people. Now that that's gone, the whole premise of the law falls apart.

That article did not appear on the Wall Street Journal's Op-Ed page. It hit the nail right on the head.

MDchanic

Jaunty, I don't wish to argue, but I will offer my opinion that he was more the victim of one or more marginally competent doctors, than of his health insurance. He was sent in completely the wrong direction.

Like I say, I don't know the specifics, and I can't speak as an expert, so I'll drop it there.
I just believe that whether the Canadian system is good or bad, his case is not a good example of that system as a whole, but rather is an example of someone giving him a bum steer, which could happen anywhere.

I do not have any personal experience with the Canadian health care system, and so cannot comment on it directly as a whole.

- Eric

MDchanic

Actually, Jaunty, it did.

It's right in the rotating feature articles here, at the top of the "Opinion" section.

That being said, I agree with it, and with it's key point that "The only political explanation for relaxing enforcement of the individual mandate—even at the risk of destabilizing ObamaCare in the long term—is that the White House is panicked that the whole entitlement is endangered."

I would emphasize that there are two discussions going on here: One regarding the advisability and best structure for some sort of universal health insurance, and a second regarding the current Affordable Care Act itself.

- Eric

oldcutlass

Jaunty I agree, I couldn't see dismantling our complete healthcare system for less than 15% of the populace either. What bothers me is after reading what the new coverages would cost and doing a value vs cost analysis, the American public was sold this whole package the same way lil Johnny sold his crap. The only difference is we never got the mouthwash. Here's what I see happening in 2014. Employers will start dumping there insured into the pool and taking the penalty. Why, because it's cheaper to do it that way. If the majority of American families make around $45k average, then the government will subsidize the insurance premiums. System will cost a lot more and there will be a big fight in Congress. All you have to do is the math.


The other problem is the cost. Typical family bronze plan is about $7200 for a family, it has a $6k deductible, so a family is paying $13200 before the insurance pays a dime or not shouldering much medical costs. It's basically a catastrophic plan that most families cannot afford.


I just don't see how this is going to work.

jaunty75

Possibly, but not necessarily. I based on my arguments on what he actually said in his thread, not speculation.

If all it was was a poor doctor, could he not have sought the opinion of another one before coming to the U.S.? As Kyle himself pointed out, it was the system that was causing him the problem. There was a need to go through a pre-specified series of doctor visits and tests, most of which were apparently boiler-plate and unrelated to the matter at hand and that could take a year or more to happen, before a focus on his kid's specific problem could occur. By then, who knows what his son's condition could have degenerated into?

jaunty75

Oops. My bad. But it's still spot on.

MDchanic

You're speculating too. I'd ask him, but I don't think I want to drag him into this.

We have each applied our own viewpoints to it, and made our own arguments, and others can see our opinions and consider it any way they wish to.

I'm dropping this point, as I'm not here to argue, only to exchange ideas.

- Eric

69ishHoliday

I don't think you can overlook the fact that the system had too many failures in registration to penalize someone until the system issues were resolved. Was this suspension indefinite?

jaunty75

This is a great point. Health insurance today isn't really "insurance" in the classical sense. But it's health insurance companies themselves that offer these "well-care" visits with the whole idea being that, if they pay to keep you healthy by paying for these routine visits (akin to changing your car's oil), then you'll be less likely to get ill and require the much more expensive treatments.

The insurance companies are acting in their own self-interest here, of that there is no doubt. But the side-effect is that it is better for us, the health care-consuming public, as well.

jaunty75

This is an exact quote from his very first post in his thread asking for advice about the Mayo Clinic.


"His problems are getting worse and fast. Seen 7 doctors here at home in Canada, they are sending us to a genetic specialist which they said would take from 6 to 9 months to see the specialist. We can't wait that long, by then he won't be able to walk."


Seven doctors?!?! That's hardly a single, incompetent doctor leading them astray. Six to nine months to see a specialist? That's not an isolated case. That's the Canadian system at work.

69ishHoliday

Some are more fortunate than others, but the 'Bronze' plan is better than I have right now through Coventry. I wonder if people bailing on there current coverages and opting for the lower cost ACA product is a concern to insurance companies?

MDchanic

A common misconception, actually.

Statistically, the average American keeps a given health insurance policy for about five years, but not for longer.
The insurance companies are no dopes, and have no desire to spend money to keep you healthy past the time that they have you - it only benefits their competitors.
Many insurance policies will not pay for smoking cessation treatments, or will require absurd precertification runarounds before doing so (Chantix is the only medicine ever to succeed with most who try it, so going through a bunch of other things that have been proven not to work well first is silly), even though stopping smoking is the single best thing a person can do to improve his health long-term, because the company paying for the medicine will not see the benefits of the health improvement it will create.

- Eric

jaunty75

Apparently it's a "temporary exemption," but there's no mention of an end date that I've seen.

Here's a couple of good reads on it. The second one is an opinion piece, but, like the WSJ article, it's spot on. These are both from the Washington Post, a newspaper that could hardly be accused of being traditionally hostile to the Obama administration.


Obama administration relaxes rules of health-care law four days before deadline

http://www.washingtonpost.com/nation...6a3_story.html



Meddling with Obamacare could undermine the whole law

http://www.washingtonpost.com/opinio...02c_story.html