Health care - administrative incompetence

[kellyb]

Hey, xjx...

You think FP's under the NHS have it rough?

Look at what the insurance companies (that designed and supported Obamacare) think of PCP's:

http://covertrationingblog.com/heal...-need-to-know-about-our-new-healthcare-system

Second, the new law proposes to fund new training opportunities for PCPs. This also sounds nice. But DrRich wonders what effect these new training programs will have, when the training programs that already exist cannot come close to filling their slots.

DrRich contends that these two stated “fixes” for manufacturing more PCPs cannot possibly provide an actual solution to the PCP shortage, and further, that the authors of the Senate bill cannot possibly believe they will. And so, DrRich decided to look a little deeper.

The answer to the PCP shortage – at least, the answer our political leaders are actually relying upon – is revealed deep in the Senate bill, in Section 5501, where the definition of “Primary Care Practitioner” is actually provided. Note, first of all, that once this bill becomes the law of the land, “PCP” will no longer mean “primary care physician,” but rather, will mean “primary care practitioner.”

And here’s how the new law defines Primary Care Practioners:

The term ‘primary care practitioner’ means an individual who —

(I) is a physician (as described in section 1861(r)(1)) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or

(II) is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in 9 section 1861(aa)(5))

And so, to his readers who are primary care physicians, DrRich must report that the real “fix” your political leaders have envisioned for the PCP shortage has been to declare you and nurse practitioners to be functionally (and legally) equivalent.

In the free market, insurance companies see no need to pay MDs who might not like rationing care at the bedside with another red cent when they can write up their own "health care that doesn't actually cost money, ie, denial of care" guidelines and have NPs obey like robots.

 

[kellyb]

Where have you opposed Obamacare? Sorry if I missed it.

What you advocate IS Obamacare!

 

[Tatyana]

Our employees have the same coverage at the same or lower prices. We contribute into their savings accounts as well as provide their catastrophic insurance. It's out there, but no one bothers to look. They'd rather whine about how unfair everything is.

I posted earlier a catastrophic plan for a family of four that would cost ~$260. I've attached a PDF. This was from ehealthinsurance.com. I'm sure there are conditions, etc. but it proves the point.

Let me see if I understand this.

This plan covers a family of four for a year for $ 3180 (is there tax on this?).

If one of the members of the family is sick or injured, initially, you have to pay $ 7 500.

If the entire family is sick or injured (for example, a car crash), then the maximum you have to pay is more or less for three family members, or $ 22 500.

You basically have to pay for all of your prescription medications up to $ 1000 for the year, and then after you have paid $ 1000, the costs are:
Once you've met your deductible, then you pay a copay:
••$15 / level 1: low-cost generic and brand-name drugs
(These drugs are covered before meeting your deductible)
••$40 / level 2: higher cost generic and brand-name drugs
••$65 / level 3: high-cost, mostly brand-name drugs
••35% / level 4: some drugs you inject and other high-cost drugs
($5,000 out-of-pocket maximum per person per calendar year on level 4 drugs)

If you go to an emergency room, there is an additional $ 125 fee.

You do not have to pay for a general check up, a well-baby check up, or a gynaecological screen (I would think this is a cervical screen and/or mammogram).

All of this is subject to:

IMPORTANT NOTICES AND DISCLAIMERS
THE BENEFITS MATRIX IS A SUMMARY FOR INFORMATIONAL PURPOSES ONLY.
REVIEW THE EVIDENCE OF COVERAGE AND INSURANCE POLICY (PLAN CONTRACT)
FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS, LIMITATIONS, AND
EXCLUSIONS. ONLY THE TERMS AND CONDITIONS OF COVERAGE BENEFITS LISTED IN THE POLICY ARE BINDING.

The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.


The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.

Each insurance carrier may have unique Notices, Disclaimers, and Fees.

Please check below for information regarding the plans and carriers you selected.

The quotes or rates shown above are estimates only. Your premium is subject to change based on your medical history(pursuant to state law of residence), the underwriting practices of the insurance company, the optional benefits you selected, if any, and other relevant factors, such as changes in rates which take effect before your requested effective date.


The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification

If you have a road traffic accident out of your network area and you are taken to an ER outside your network area, then you will have to pay costs up to $ 10 000 for the individual or $ 30 000 for the family.

This doesn't cover any ante-natal, labour or post-natal coverage.

Have I got this more or less correct?

 

[Gandalfs Beard]

Subsidies to help pay for low-incomes
What we need to do is eliminate is Medicare and Medicaid as they currently exist. As long as govt. is a payer, there will always be problems with healthcare in America.

Doublespeak again. What the hell do you think Medicaid and Medicare are?...SUBSIDIES TO HELP PAY FOR LOW INCOMES is what they are. And Medicaid is particularly sucky as you have to humiliate yourself on a yearly basis to prove that you are poor enough to need it, and you can't qualify if you are a single minimum wage worker.

Calling for the elimination of Medicaid and Medicare is calling for murdering millions of people through willful negligence.

But thanks for letting the cat out of the bag. I bet you want to Privatize Social Security too.



Uncayimmy, I apologize for anything snarky I said to you on other threads. Our disagreements were on inconsequential topics compared to the very importance of the topic of this thread.

GB

 

[kellyb]

Uncayimmy, I apologize for anything snarky I said to you on other threads. Our disagreements were on inconsequential topics compared to the very importance of the topic of this thread.

GB

Me, too.
This is the the biggest human rights issue facing the developed world at the moment and the future of the American economy all wrapped into one. Wow.

If we do not put a steak through the heart of these vested interests writing our health laws (under the guise of "preserving the free market" ) America will not be a developed nation much longer.

 

[Shalamar]

It's crazy that I expect doctors to get paid what they are worth? I see.

I guess you want everyone to get paid the same. It's not fair! Right?

Doctors should be paid whatever it takes to let people die without healthcare.

 

[Gandalfs Beard]

Ah. But forcing people on to a single-payer system isn't Fascism?

No! It's a Social Democracy. You pay your taxes to a representative democratic institution, you get your benefits. Private businesses are still allowed to operate in a Social Democracy. No-one is forced to do anything.

The fact is, you just can't stand the idea that you should pay taxes; or the idea that vast disparities in wealth should be minimized by redistributing the wealth that LABOURERS create back to the LABOURERS instead of the wealth being sucked up (upward redistribution, aka Profits and Government Subsidies to the Rich) by Parasites at the Top of the Food Chain.

GB

 

[kellyb]

Ah. But forcing people on to a single-payer system isn't Fascism?

We ALREADY PAY enough to fund it in Medicare taxes. All the money is just going to lab work company profits and insurance company profits, etc (insurance companies are paid to "administer" and "manage" Medicare.)

We don't get to vote on what they charge, or what they think FP reimbursement rates should be, or anything. At the moment, we (and that includes PCPs) are their SURFS.

And it's literally killing PEOPLE and the ECONOMY. 8% of our GPD right down the drain!

 

[Ampulla of Vater]

Let me see if I understand this.

This plan covers a family of four for a year for $ 3180 (is there tax on this?).

If one of the members of the family is sick or injured, initially, you have to pay $ 7 500.

If the entire family is sick or injured (for example, a car crash), then the maximum you have to pay is more or less for three family members, or $ 22 500.

You basically have to pay for all of your prescription medications up to $ 1000 for the year, and then after you have paid $ 1000, the costs are:
Once you've met your deductible, then you pay a copay:
••$15 / level 1: low-cost generic and brand-name drugs
(These drugs are covered before meeting your deductible)
••$40 / level 2: higher cost generic and brand-name drugs
••$65 / level 3: high-cost, mostly brand-name drugs
••35% / level 4: some drugs you inject and other high-cost drugs
($5,000 out-of-pocket maximum per person per calendar year on level 4 drugs)

If you go to an emergency room, there is an additional $ 125 fee.

You do not have to pay for a general check up, a well-baby check up, or a gynaecological screen (I would think this is a cervical screen and/or mammogram).

All of this is subject to:



If you have a road traffic accident out of your network area and you are taken to an ER outside your network area, then you will have to pay costs up to $ 10 000 for the individual or $ 30 000 for the family.

This doesn't cover any ante-natal, labour or post-natal coverage.

Have I got this more or less correct?

The theory behind these high deductible/high out-of-pocket plans is you pay less in premiums every month/year and you sock away your premium savings into a savings account. You are gambling that nothing happens that causes you to have to seek medical care. After several years of this you will have saved more money (in premium payments) than what your deductible equals. So if, in 2014, your kid breaks an arm and you have to pay out-of-pocket you are still ahead by tens of thousands of dollars. It is a good plan for younger, healthier people.

I do something similar for my employees where there is a large deductible (which I pay) before 100% coverage kicks in. I still make out at the end of the year because, even with paying any deductible amounts accumulated throughout the year, the total spent between premiums and deductibles is less than had I purchased a 100% plan for everyone. It is a gamble that you are going to be healthy. It also serves a purpose (not necessarily in my case because my employees have me to pay the deductible but in xjx's case) to make you more responsible to stay as healthy as possible. It makes a direct relationship between the state of your health and how much money you pay out.

It is the same theory behind the $10 or $20 copay: sharing the cost of a visit makes it just a little painful to go to the physician but if you need to, you can.

 

[Tatyana]

The most you would be out of pocket in a given year in that plan is 22k. And that's only if some really :ed-up : went down. An HSA (or savings account) could take care of your out of pocket expenses.

Now, what's the next issue yer going to bring up . . .

In your network area for your family, it is $ 22, 500 (plus drugs as well, which you can more or less assume if you have something this catastrophic), so $ 23, 500 minimum, plus your insurance premiums which are $ 3180, so $ 26, 680 US, or £ 17, 300.

The NHS costs for a family of four would be £ 12, 000 (national average).

Catastrophic health insurance is sort of like a lottery with how much you might have to pay for your health.

All it takes is one drunk driver, one icy road.

The national median wage is $ 44, 389. I am not sure if that is before or after taxes.

 

[Garrison0fMars]

Oh lulz, look what I just found.

Health insurers are preparing to capitalize on $40 billion of new opportunities to run privately managed Medicaid plans for the states, which would position insurers to benefit from the health overhaul's expansion of Medicaid in 2014.

Medicaid is one of health insurers' few bright spots, as their margins are pressed by regulatory crackdowns on premiums in their traditional policies. Gail Boudreaux, UnitedHealth's executive vice president, told investors last month that: "The Medicaid space is a significant long-term growth opportunity for us. It's a big market that's getting even bigger."

Budget crises mean cash-strapped states are more willing than ever to outsource their programs to private companies.

Source

 

[Gandalfs Beard]

The theory behind these high deductible/high out-of-pocket plans is you pay less in premiums every month/year and you sock away your premium savings into a savings account. You are gambling that nothing happens that causes you to have to seek medical care. After several years of this you will have saved more money (in premium payments) than what your deductible equals. So if, in 2014, your kid breaks an arm and you have to pay out-of-pocket you are still ahead by tens of thousands of dollars. It is a good plan for younger, healthier people.

I do something similar for my employees where there is a large deductible (which I pay) before 100% coverage kicks in. I still make out at the end of the year because, even with paying any deductible amounts accumulated throughout the year, the total spent between premiums and deductibles is less than had I purchased a 100% plan for everyone. It is a gamble that you are going to be healthy. It also serves a purpose (not necessarily in my case because my employees have me to pay the deductible but in xjx's case) to make you more responsible to stay as healthy as possible. It makes a direct relationship between the state of your health and how much money you pay out.

It is the same theory behind the $10 or $20 copay: sharing the cost of a visit makes it just a little painful to go to the physician but if you need to, you can.

Gambling is for Casinos, not people's Lives.

GB

 

[Ampulla of Vater]

We ALREADY PAY enough to fund it in Medicare taxes. All the money is just going to lab work company profits and insurance company profits, etc (insurance companies are paid to "administer" and "manage" Medicare.)

We don't get to vote on what they charge, or what they think FP reimbursement rates should be, or anything. At the moment, we (and that includes PCPs) are their SURFS.
And it's literally killing PEOPLE and the ECONOMY. 8% of our GPD right down the drain!

You don't understand. Medicare and Medicaid pay next to nothing. You can charge $10,000 for a strep test if you want, you are still only going to get $3.22 and you cannot bill the patient the difference (over Medicare's allowable).

This is where it gets hairy. Take vaccinations for example. A physician might pay $42.50 for 1 specific vaccination. Medicare will only reimburse their established allowable. Often that is, maybe $38.00. Medicare pays 80% = $30.40 and you have to bill the patient for the remaining $7.60. By the time you paid your employee to generate and send a bill (or 2 or 3) you have paid out more than $7.60 to collect that $7.60. And, if you do manage to collect the 20% you still paid more for the vaccine than what you were paid. That is what our government has done with the portion of healthcare they are running.

 

[kellyb]

No! It's a Social Democracy. You pay your taxes to a representative democratic institution, you get your benefits. Private businesses are still allowed to operate in a Social Democracy. No-one is forced to do anything.

The fact is, you just can't stand the idea that you should pay taxes; or the idea that vast disparities in wealth should be minimized by redistributing the wealth that LABOURERS create back to the LABOURERS instead of the wealth being sucked up (upward redistribution, aka Profits and Government Subsidies to the Rich) by Parasites at the Top of the Food Chain.

GB

And it's just so ironic, if his wife is really an MD PCP.

He's so afraid of health care being in the hands of democracy instead of the free market. We the people would vote to SAVE MD PCPs. We the people don't want insurance company guideline following NP robots as our PCPs!

 

[Ampulla of Vater]

Gambling is for Casinos, not people's Lives.

GB

In the US, you are still free to gamble with your own life. This is insurance you choose.

 

[xjx388]

Doublespeak again. What the hell do you think Medicaid and Medicare are?...SUBSIDIES TO HELP PAY FOR LOW INCOMES is what they are.

Medicare and Medicaid are not subsidies. They are direct payments to physicians, hospitals and ancillary services on a fee-for-service basis. A subsidy is a payment to an insurance plan to pay for part or all of their premium.

And Medicaid is particularly sucky as you have to humiliate yourself on a yearly basis to prove that you are poor enough to need it, and you can't qualify if you are a single minimum wage worker.

What, we should just hand it out on a person's word?

Calling for the elimination of Medicaid and Medicare is calling for murdering millions of people through willful negligence.

C'mon man, murdering? Exaggerate much? Eliminating Medicaid and Medicare and replacing it with subsidies to cover insurance assures coverage.

But thanks for letting the cat out of the bag. I bet you want to Privatize Social Security too.

I want people to have a say in how their SS funds are invested.

 

[Garrison0fMars]

Medicare and Medicaid are not subsidies. They are direct payments to physicians, hospitals and ancillary services on a fee-for-service basis.

Not anymore. Medicaid and Medicare were the last fee-for-service insurance plans in the nation, and now the insurance companies have got their little mitts on it as well. My state by 2012 I believe is moving every Medicaid and Medicare recipient to "managed care" (IE, financed and run by private insurance companies).

 

[xjx388]

And it's just so ironic, if his wife is really an MD PCP.

He's so afraid of health care being in the hands of democracy instead of the free market. We the people would vote to SAVE MD PCPs. We the people don't want insurance company guideline following NP robots as our PCPs!

Ya know, Kelly, you spend a lot of time on here bashing my position. Not only that, you really don't even understand what my position is. Yet, I haven't seen you put one idea of your own forth. So let's have it: What is Kellyb's plan for improving healthcare in America. Be specific.

 

[Ampulla of Vater]

Not anymore. Medicaid and Medicare were the last fee-for-service insurance plans in the nation, and now the insurance companies have got their little mitts on it as well. My state by 2012 I believe is moving every Medicaid and Medicare recipient to "managed care" (IE, financed and run by private insurance companies).

But ultimately Medicare and Medicaid are going to pay for the premiums for that "managed care" are they not?

 

[xjx388]

I
All it takes is one drunk driver, one icy road.

The national median wage is $ 44, 389. I am not sure if that is before or after taxes.

That's what auto insurance is for.

How many people do you think will spend 22k+ on their health care a year? Very few. And it won't be every year. Your savings build and build and when you need it, it's there.