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Thread: An example of our broken current health care system... and why Obamacare will do nothing to fix it

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    Owner Dan Druff's Avatar
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    An example of our broken current health care system... and why Obamacare will do nothing to fix it

    My biggest criticism of Obamacare is NOT the failed website or the increased costs for healthy Americans on individual plans, though I am critical of those, as well.

    There are currently three big issues in American health care:

    1) Inability for certain people to get insured due to pre-existing conditions, including minor ones.

    2) Terrible cost structure, where some things are far too expensive compared to others, thus often rewarding doctors/labs for performing unnecessary tests, exams, and office visits, and reward actual useful treatment too little.

    3) Highly confusing billing system where patient rarely understands the cost of his tests or procedures until after they are already completed. Severe penalty to those without insurance or with the wrong insurance, where costs to the patient for the same procedure can be up to 20 times higher.

    Obamacare handled #1 (somewhat poorly, but it was at least handled), but not #2 or #3.

    Now I will give you a real-life example which illustrates the whole thing perfectly.

    Two weeks ago, Benjamin was running around and hit his head on a corner of a table. This resulted in a large, deep cut near his eyebrow, and it was clear he was going to need stitches. In situations like this, you always want a plastic surgeon doing the stitches. If you just get some scrub doctor doing it, it will look terrible. The scrub doctor is probably fine if it's somewhere like your hand, but you want a really good job done if it's on your face, for obvious reasons. This is especially important for kids, whose skin is tighter and scars show more easily.

    This occurred on a Sunday at about noon. There were no plastic surgeon offices open at that time. Obviously our only choice was the ER. While there are cheaper "Urgent Care" options available, those do not have access to a plastic surgeon.

    The ER did the following:

    - Quick examination of the wound

    - Put crude bandage over it

    - Made us wait about 3 hours while they called in the plastic surgeon on duty

    - Put him in a bed in a partitioned "room" (note it wasn't a real hospital room -- just an ER partition)

    - Gave him a sedative so he could be worked on by the doctor (otherwise a 3-year-old would not sit still for this).

    - Assisted the doctor with the ER's nurses.

    - Allowed him to stay until the sedative wore off.

    The doctor was an on-call plastic surgeon who did NOT directly work for the hospital. He billed us separately.

    Both of the ER and the doctor were on our insurance plan. The ER we chose for that reason (it was also closest). The doctor we just lucked out that he was on our plan.

    Each submitted their bill, and then the insurance company "charges off" (reduces) the bill to their "allowable amount", where the doctor is forced to accept the lesser amount as per their agreement. This is where you get a huge advantage by having insurance, as there is price control. Often your greatest savings are by money "charged off" rather than actually paid by your insurance company to the doctor.

    The doctor was excellent and very knowledgeable.

    We just got the explanation of benefits (statement from the insurance company regarding what was charged & paid). I was very surprised to see the way it broke down.

    The ER billed $3048. The insurance company allowed most of it, and sent them a check for $2770.60! We are also responsible to pay $125.

    The doctor billed $3600. The insurance company charged off most of it, and send him a check for $374.02. We are not on the hook for anything else. That's all the doctor will be making on this.

    So, unbelievably, the ER is going to get paid $2895.60 for simply admitting us, giving Ben a sedative, and allowing 2 nurses to assist. The talented doctor who actually performed the surgery -- the most important part -- is getting a measly $374.02.

    This is really amazing (and not in a good way), because the most difficult and important part of the treatment was worth about 13% as much as the very standard and easy-to-provide ER services.

    Keep in mind that there was no ambulance involved or anything else complicated about the visit. The only "extra" needed was the sedative, due to Ben's age.

    The doctor took a good 20-30 minutes to do his part, so it's not like he just came in, did the work in seconds, and left.

    You might say "The ER is always expensive", but keep in mind that this is a preferred provider for our insurance company, and this is specifically done to keep costs down for them. Yet they had to send out a check for almost $3000 for something that honestly should have been much cheaper. At the same time, I actually felt the doctor got underpaid, given that he had the expertise, did 30 minutes of real tough and critical work, and had to come in on a Sunday.

    This is just one of many examples. There needs to be a realistic cost to these services. The recent prevalence of "urgent care" places is directly in response to the outrageous ER prices, but those places are typically staffed by terrible doctors. (Both times I took Benjamin to these, they made mistakes.) But somehow the urgent cares otherwise provide a lot of the same services for a fraction of the price.

    There really just needs to be reform across the board regarding the cost for a lot of medical procedures/services/tests, to where they don't drain our economy so badly. When I saw the report of the huge check sent to the ER, I realized why everyone's rates are so high.

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    Gold Bootsy Collins's Avatar
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    This site needed another Obamacare thread.

     
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    Obamacare will affect # 2 with better coordination of care in a bundled payment model. The fee for service model is the reason that people perform unnecessary procedures/tests/etc. When you reward people for doing more, guess what? They do more. In home health, Medicare used to reimburse cost + profit margin for supplies. People were getting paid more for providing more. When they moved to a bundled payment model, agencies stopped providing so many supplies.


    #3 we're pretty much SOL since most people don't have a clue about reimbursement. There will be greater transparency though so people who have half a brain can shop for their healthcare. The impact won't be immediate but opening the market to greater transparency will drive down costs.

    RE: the surgeon's rate - he got paid what he or his IPA negotiated with the payer. If he doesn't like it, he can cancel the contract. Realistically though, he doesn't have the overhead that an ER does. He showed up for 20 minutes and got paid almost 400.00. That's 1200.00/hr. The ER has to keep people on staff, keep the lights on, etc. That costs a lot of money. 3k seems high, but when you consider that most uninsured get their healthcare in the ER, it's probably in line with the costs to provide care. Realize too that these rates are negotiated with the payer and provider ahead of time. If the payer thought the rate was out of line they would renegotiate the contract.

    One thing I will tell you is that insurance companies have not been held accountable for keeping costs low until recently. They simply charged more for their policies. Now that they have some skin in the game, they are paying attention to everything they reimburse for.

     
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    Benji should be ashamed because Obamacare will now cover him when he gets pregnant and for all his contraception needs, including abortion. And that somehow, is the only argument i've heard out of the mindless twits on TV on why this thing should be saved.

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    Quote Originally Posted by gauchojake View Post
    Obamacare will affect # 2 with better coordination of care in a bundled payment model. The fee for service model is the reason that people perform unnecessary procedures/tests/etc. When you reward people for doing more, guess what? They do more. In home health, Medicare used to reimburse cost + profit margin for supplies. People were getting paid more for providing more. When they moved to a bundled payment model, agencies stopped providing so many supplies.


    #3 we're pretty much SOL since most people don't have a clue about reimbursement. There will be greater transparency though so people who have half a brain can shop for their healthcare. The impact won't be immediate but opening the market to greater transparency will drive down costs.

    RE: the surgeon's rate - he got paid what he or his IPA negotiated with the payer. If he doesn't like it, he can cancel the contract. Realistically though, he doesn't have the overhead that an ER does. He showed up for 20 minutes and got paid almost 400.00. That's 1200.00/hr. The ER has to keep people on staff, keep the lights on, etc. That costs a lot of money. 3k seems high, but when you consider that most uninsured get their healthcare in the ER, it's probably in line with the costs to provide care. Realize too that these rates are negotiated with the payer and provider ahead of time. If the payer thought the rate was out of line they would renegotiate the contract.

    One thing I will tell you is that insurance companies have not been held accountable for keeping costs low until recently. They simply charged more for their policies. Now that they have some skin in the game, they are paying attention to everything they reimburse for.
    The unneccesary tests and extras MDs do which drive up bills is because the fucking lawyers have made them gunshy due to malpractice claims out the ass so badly that they have to practice CYA medicine. They have to basically do everything and anything to rule out any remote possibility otherwise they risk getting sued by some ambulance chaser. Reality is MDs are human. Don't get me wrong some MDs deserve to be sued but because some MD didn't consider some rare issue as a possibility and gets sued and therefore his malpractice insurance pays millions out to settle and then his rates skyrocket, they have no choice. Hell I had a 10k fucking ER bill once due to some heart palpitations one night they kept me and ran a Nuclear stress test on me the next AM which I passed with flying colors (oddly 7 yrs prior I failed one on the basis of essentially being out of shape). Honestly given my history they over-reacted but again CYA medicine comes into play. Cut out the lottery ticket mentality with malpractice lawsuits and you'll be surprised how much costs drop.

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    Owner Dan Druff's Avatar
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    Quote Originally Posted by gauchojake View Post
    Obamacare will affect # 2 with better coordination of care in a bundled payment model. The fee for service model is the reason that people perform unnecessary procedures/tests/etc. When you reward people for doing more, guess what? They do more. In home health, Medicare used to reimburse cost + profit margin for supplies. People were getting paid more for providing more. When they moved to a bundled payment model, agencies stopped providing so many supplies.


    #3 we're pretty much SOL since most people don't have a clue about reimbursement. There will be greater transparency though so people who have half a brain can shop for their healthcare. The impact won't be immediate but opening the market to greater transparency will drive down costs.

    RE: the surgeon's rate - he got paid what he or his IPA negotiated with the payer. If he doesn't like it, he can cancel the contract. Realistically though, he doesn't have the overhead that an ER does. He showed up for 20 minutes and got paid almost 400.00. That's 1200.00/hr. The ER has to keep people on staff, keep the lights on, etc. That costs a lot of money. 3k seems high, but when you consider that most uninsured get their healthcare in the ER, it's probably in line with the costs to provide care. Realize too that these rates are negotiated with the payer and provider ahead of time. If the payer thought the rate was out of line they would renegotiate the contract.

    One thing I will tell you is that insurance companies have not been held accountable for keeping costs low until recently. They simply charged more for their policies. Now that they have some skin in the game, they are paying attention to everything they reimburse for.
    What do you mean by a "bundled payment model"?

    Why can't they just raise rates next year if their costs are too high?

    I do agree with you that insurance companies have been part of the cost problem. I am not defending them at all.

    I know that the rates were negotiated between the insurance and both the ER and the doctor. I just find it outrageous that the doctor has to settle for $374 here, which doesn't sound bad until you realize that the ER got 8x that for doing much less.

    I do know that the Ken Scalirs of the world use the ER and don't pay, and that there's a lot of those people out there, but those charges are just excessive. It's also not fair to penalize the paying customers for the non-paying ones. That's another place reform is needed -- disallowing use of the ER by serial abusers, unless they truly have a clear life-threatening condition. At the moment, you can walk into the ER, say you have a cold, and they have to see you.
    Doesn't matter if you've rolled them countless times before.

    As you said earlier, the insurance companies are letting the ERs get away with this because they just raise rates to make up for it. They haven't tried very hard to keep costs down. It's been ingrained in the industry that certain things cost a whole lot, regardless of the reason.

    How can you say we will be SOL for #3? I mean, we will be under Obamacare, but this is an easy fix. In 2013, all offices should be able to interface with all insurance plans (or at least it wouldn't be too hard to require this) to where the patient will have a clear and accurate estimate -- just like you get when you take your car in for repair.

    For some reason, it's considered a huge sin for a mechanic to do work and present us with a surprisingly high bill at the end, but totally okay for a doctor to do the same. That needs to change, especially when it should be easy in this day and age to access the proper information.

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    Quote Originally Posted by ftpjesus View Post
    Quote Originally Posted by gauchojake View Post
    Obamacare will affect # 2 with better coordination of care in a bundled payment model. The fee for service model is the reason that people perform unnecessary procedures/tests/etc. When you reward people for doing more, guess what? They do more. In home health, Medicare used to reimburse cost + profit margin for supplies. People were getting paid more for providing more. When they moved to a bundled payment model, agencies stopped providing so many supplies.


    #3 we're pretty much SOL since most people don't have a clue about reimbursement. There will be greater transparency though so people who have half a brain can shop for their healthcare. The impact won't be immediate but opening the market to greater transparency will drive down costs.

    RE: the surgeon's rate - he got paid what he or his IPA negotiated with the payer. If he doesn't like it, he can cancel the contract. Realistically though, he doesn't have the overhead that an ER does. He showed up for 20 minutes and got paid almost 400.00. That's 1200.00/hr. The ER has to keep people on staff, keep the lights on, etc. That costs a lot of money. 3k seems high, but when you consider that most uninsured get their healthcare in the ER, it's probably in line with the costs to provide care. Realize too that these rates are negotiated with the payer and provider ahead of time. If the payer thought the rate was out of line they would renegotiate the contract.

    One thing I will tell you is that insurance companies have not been held accountable for keeping costs low until recently. They simply charged more for their policies. Now that they have some skin in the game, they are paying attention to everything they reimburse for.
    The unneccesary tests and extras MDs do which drive up bills is because the fucking lawyers have made them gunshy due to malpractice claims out the ass so badly that they have to practice CYA medicine. They have to basically do everything and anything to rule out any remote possibility otherwise they risk getting sued by some ambulance chaser. Reality is MDs are human. Don't get me wrong some MDs deserve to be sued but because some MD didn't consider some rare issue as a possibility and gets sued and therefore his malpractice insurance pays millions out to settle and then his rates skyrocket, they have no choice. Hell I had a 10k fucking ER bill once due to some heart palpitations one night they kept me and ran a Nuclear stress test on me the next AM which I passed with flying colors (oddly 7 yrs prior I failed one on the basis of essentially being out of shape). Honestly given my history they over-reacted but again CYA medicine comes into play. Cut out the lottery ticket mentality with malpractice lawsuits and you'll be surprised how much costs drop.
    That's some of it, yes. But many doctors prescribe these tests because they get a cut of it (or all of it), and they can stretch medical justification to where it technically isn't fraud.

    As many of you know, my brother is a doctor, and you would be surprised how many times a test is prescribed to one of our family members, we ask for his opinion, and he says it's of zero value.

    I do find that these hotlines where a nurse or doctor advises you what to do is pretty useless. Due to fear of lawsuits, they frequently advise a visit to the ER. I even had a nurse telling me recently that I should visit the ER if Benjamin's temperature exceeds 104, which is extremely common for children under 5. That was actually harmful advice, as a child with a 104 temperature needs a calm, relaxing environment, not a stressful ER where nothing of use will be discovered. However, if they don't tell me that, and his temperature rises to 107 and he gets brain damage, I can sue them, so they always just default to the most overly cautious answer.

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    Bundled payments or episodic payments are when a provider or group of providers get a pool of money to care for a patient. This creates a team approach to healthcare and disincentives providers to over utilize. The ACA allows for a number of different "experiments" if you will for this model. Google ACO's, value based purchasing, p4p, or the coordinated care initiative...it's super exciting.

    They can raise rates if their costs go up, but remember that they need to provide medical loss ratio rebates if they exceeded certain thresholds. It basically stops profit grab on the basis of "higher costs".


    Number 3 is a lot more complicated that it seems, but we will get there at some point. There are a few big problems that exist. One is that there is no universal healthcare programming language. The systems can't talk to each other. There is HL7 but not every back office system is utilizing this language. Getting the info interfaced between pharmacy, nursing home, hospital, clinic, home health agency, and other providers is nearly impossible at this point. It is however a provision of the ACA so they will get it done. Being able to have the electronic medical record migrate across providers will be a key for cost transparency. The health plans also rely on HCPCS and CPT codes for goods and services that don't translate well to actual consumers of healthcare. They don't reflect the quality of care given, only a universal code to describe a procedure.

    Eventually you will be able to see the quality of care given by provider, plan, and costs goods. We have a long way to go on this before we see a la carte pricing. The good news is that we have physician, home health, health plan, and nursing home rating systems that are pretty easily accessible so you can choose quality healthcare.

    I don't disagree with you on the cost of the ER. The cost should be less, but there's very little evidence that ER's are a profit center for acute care providers. Most for profit entities have closed their ERs because they are a red figure on the balance sheet.

    Also agree that most health plans/Medicare/Medicaid have paid ridiculous rates on products and procedures that they just didn't do a good job of pricing themselves. Take for instance Medi-Cal's rates on a standard wheelchair. For purchase it's over 600.00. Now you need someone to measure the patient and to deliver the chair and get some basic instructions so that they don't roll off the side of a cliff. If we're generous, let's say that costs a company 200.00 in overhead. That's one hundred percent profit at the cost to tax payers. That's fucking stupid. More good news - the ACA is forcing the plans to change their mindset and shop for better deals. Also competitive bidding is forcing Medicare rates down.

    Eventually the ACA will do away with most fee for service models that encouraged this type of abuse. Is the ACA the best law ever for healthcare? Probably not. I have a fundamental disagreement with the government forcing anyone to do anything (ie individual mandate). The ideas behind the law otherwise are pretty well thought out and have a good amount of evidence to show reduction in healthcare costs.

    I can't believe I just typed that. TL;DR

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    Quote Originally Posted by gauchojake View Post
    Bundled payments or episodic payments are when a provider or group of providers get a pool of money to care for a patient. This creates a team approach to healthcare and disincentives providers to over utilize. The ACA allows for a number of different "experiments" if you will for this model. Google ACO's, value based purchasing, p4p, or the coordinated care initiative...it's super exciting.

    They can raise rates if their costs go up, but remember that they need to provide medical loss ratio rebates if they exceeded certain thresholds. It basically stops profit grab on the basis of "higher costs".


    Number 3 is a lot more complicated that it seems, but we will get there at some point. There are a few big problems that exist. One is that there is no universal healthcare programming language. The systems can't talk to each other. There is HL7 but not every back office system is utilizing this language. Getting the info interfaced between pharmacy, nursing home, hospital, clinic, home health agency, and other providers is nearly impossible at this point. It is however a provision of the ACA so they will get it done. Being able to have the electronic medical record migrate across providers will be a key for cost transparency. The health plans also rely on HCPCS and CPT codes for goods and services that don't translate well to actual consumers of healthcare. They don't reflect the quality of care given, only a universal code to describe a procedure.

    Eventually you will be able to see the quality of care given by provider, plan, and costs goods. We have a long way to go on this before we see a la carte pricing. The good news is that we have physician, home health, health plan, and nursing home rating systems that are pretty easily accessible so you can choose quality healthcare.

    I don't disagree with you on the cost of the ER. The cost should be less, but there's very little evidence that ER's are a profit center for acute care providers. Most for profit entities have closed their ERs because they are a red figure on the balance sheet.

    Also agree that most health plans/Medicare/Medicaid have paid ridiculous rates on products and procedures that they just didn't do a good job of pricing themselves. Take for instance Medi-Cal's rates on a standard wheelchair. For purchase it's over 600.00. Now you need someone to measure the patient and to deliver the chair and get some basic instructions so that they don't roll off the side of a cliff. If we're generous, let's say that costs a company 200.00 in overhead. That's one hundred percent profit at the cost to tax payers. That's fucking stupid. More good news - the ACA is forcing the plans to change their mindset and shop for better deals. Also competitive bidding is forcing Medicare rates down.

    Eventually the ACA will do away with most fee for service models that encouraged this type of abuse. Is the ACA the best law ever for healthcare? Probably not. I have a fundamental disagreement with the government forcing anyone to do anything (ie individual mandate). The ideas behind the law otherwise are pretty well thought out and have a good amount of evidence to show reduction in healthcare costs.

    I can't believe I just typed that. TL;DR

    Evidence to reduce costs ? Are you fucking high ? Where do get the reduction in costs ? Turn on the news everyones premiums are skyrocketing (unless your getting medicaid / subsidies) ! And it will only get worse and worse as the young healthy 20-30 year olds like me refuse to pay for everyone else's care and ill just opt to pay the fine , and then get covered once/if I get sick . By next year premiums will be even higher then they are now , and will continue to get worse and worse as the majority of people signing up will the sick and older pre medicare crowd !

    Socialism doesn't work never has and never will , eventually the actually productive people just stop working to pay for everyone else !

    EDITED = you talk about all them shopping around for wheelchairs but what about the provision put in by big pharma that you can no longer get knockoff brand drugs , you have to buy the name brand lol ! Thats def gonna help patient and system costs loooooooooooooooooooool
    Last edited by sah_24; 11-19-2013 at 01:27 AM.

  10. #10
    You need to buy more accidental death insurance.
    You know that junk mail you get from your credit card company every week.
    Buy $1 million in insurance coverage and make your girlfriend sole beneficiary.
    Your girlfriend will find a way to kill you "accidentally" so she can run off with her yoga instructor.

    Or if you really trust her just arrange your "death" and go hide out in Mexico.

    Look the U.S. Health Care system has always been designed so that the poor,
    sick and elderly pay the least and rich, unmarried assholes pay the most.










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    Quote Originally Posted by TheXFactor View Post
    You need to buy more accidental death insurance.
    You know that junk mail you get from your credit card company every week.
    Buy $1 million in insurance coverage and make your girlfriend sole beneficiary.
    Your girlfriend will find a way to kill you "accidentally" so she can run off with her yoga instructor.

    Or if you really trust her just arrange your "death" and go hide out in Mexico.

    Look the U.S. Health Care system has always been designed so that the poor,
    sick and elderly pay the least and rich, unmarried assholes pay the most.










    Ya nice argument lol .......I will just sit back and watch your big liberal dream die ! Que the rollo failtage

  12. #12
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    Quote Originally Posted by sah_24 View Post
    Quote Originally Posted by gauchojake View Post
    Bundled payments or episodic payments are when a provider or group of providers get a pool of money to care for a patient. This creates a team approach to healthcare and disincentives providers to over utilize. The ACA allows for a number of different "experiments" if you will for this model. Google ACO's, value based purchasing, p4p, or the coordinated care initiative...it's super exciting.

    They can raise rates if their costs go up, but remember that they need to provide medical loss ratio rebates if they exceeded certain thresholds. It basically stops profit grab on the basis of "higher costs".


    Number 3 is a lot more complicated that it seems, but we will get there at some point. There are a few big problems that exist. One is that there is no universal healthcare programming language. The systems can't talk to each other. There is HL7 but not every back office system is utilizing this language. Getting the info interfaced between pharmacy, nursing home, hospital, clinic, home health agency, and other providers is nearly impossible at this point. It is however a provision of the ACA so they will get it done. Being able to have the electronic medical record migrate across providers will be a key for cost transparency. The health plans also rely on HCPCS and CPT codes for goods and services that don't translate well to actual consumers of healthcare. They don't reflect the quality of care given, only a universal code to describe a procedure.

    Eventually you will be able to see the quality of care given by provider, plan, and costs goods. We have a long way to go on this before we see a la carte pricing. The good news is that we have physician, home health, health plan, and nursing home rating systems that are pretty easily accessible so you can choose quality healthcare.

    I don't disagree with you on the cost of the ER. The cost should be less, but there's very little evidence that ER's are a profit center for acute care providers. Most for profit entities have closed their ERs because they are a red figure on the balance sheet.

    Also agree that most health plans/Medicare/Medicaid have paid ridiculous rates on products and procedures that they just didn't do a good job of pricing themselves. Take for instance Medi-Cal's rates on a standard wheelchair. For purchase it's over 600.00. Now you need someone to measure the patient and to deliver the chair and get some basic instructions so that they don't roll off the side of a cliff. If we're generous, let's say that costs a company 200.00 in overhead. That's one hundred percent profit at the cost to tax payers. That's fucking stupid. More good news - the ACA is forcing the plans to change their mindset and shop for better deals. Also competitive bidding is forcing Medicare rates down.

    Eventually the ACA will do away with most fee for service models that encouraged this type of abuse. Is the ACA the best law ever for healthcare? Probably not. I have a fundamental disagreement with the government forcing anyone to do anything (ie individual mandate). The ideas behind the law otherwise are pretty well thought out and have a good amount of evidence to show reduction in healthcare costs.

    I can't believe I just typed that. TL;DR

    Evidence to reduce costs ? Are you fucking high ? Where do get the reduction in costs ? Turn on the news everyones premiums are skyrocketing (unless your getting medicaid / subsidies) ! And it will only get worse and worse as the young healthy 20-30 year olds like me refuse to pay for everyone else's care and ill just opt to pay the fine , and then get covered once/if I get sick . By next year premiums will be even higher then they are now , and will continue to get worse and worse as the majority of people signing up will the sick and older pre medicare crowd !

    Socialism doesn't work never has and never will , eventually the actually productive people just stop working to pay for everyone else !

    EDITED = you talk about all them shopping around for wheelchairs but what about the provision put in by big pharma that you can no longer get knockoff brand drugs , you have to buy the name brand lol ! Thats def gonna help patient and system costs loooooooooooooooooooool
    You'd be hard pressed to find someone in healthcare who doesn't believe that coordination of care across providers saves money. It's not even a question.

    How is a market socialism?

    Not sure what you're talking about with pharma. As far as I know generics are still available and probably preferred by the health plans as they cost less.

    Look, as much as people want to politicize this, I don't look at it in that light. I work in healthcare so I look at it from a provider/sales point of view. We're better off now than we were 12 years ago when I started. Less fraud, less waste, better care.

  13. #13
    Quote Originally Posted by Bootsy Collins View Post
    This site needed another Obamacare thread.
    At what point does Todd change the name of the site to ObamacareFraudAlert.com?

     
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      simpdog: lol

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    Quote Originally Posted by DirtyB View Post
    Quote Originally Posted by Bootsy Collins View Post
    This site needed another Obamacare thread.
    At what point does Todd change the name of the site to ObamacareFraudAlert.com?

    Quote Originally Posted by godaddy.com
    obamacarefraudalert.com is available. $12.99*

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    Quote Originally Posted by gauchojake View Post
    Quote Originally Posted by sah_24 View Post


    Evidence to reduce costs ? Are you fucking high ? Where do get the reduction in costs ? Turn on the news everyones premiums are skyrocketing (unless your getting medicaid / subsidies) ! And it will only get worse and worse as the young healthy 20-30 year olds like me refuse to pay for everyone else's care and ill just opt to pay the fine , and then get covered once/if I get sick . By next year premiums will be even higher then they are now , and will continue to get worse and worse as the majority of people signing up will the sick and older pre medicare crowd !

    Socialism doesn't work never has and never will , eventually the actually productive people just stop working to pay for everyone else !

    EDITED = you talk about all them shopping around for wheelchairs but what about the provision put in by big pharma that you can no longer get knockoff brand drugs , you have to buy the name brand lol ! Thats def gonna help patient and system costs loooooooooooooooooooool
    You'd be hard pressed to find someone in healthcare who doesn't believe that coordination of care across providers saves money. It's not even a question.

    How is a market socialism?

    Not sure what you're talking about with pharma. As far as I know generics are still available and probably preferred by the health plans as they cost less.

    Look, as much as people want to politicize this, I don't look at it in that light. I work in healthcare so I look at it from a provider/sales point of view. We're better off now than we were 12 years ago when I started. Less fraud, less waste, better care.
    http://articles.mcall.com/2013-09-11...s-notification

    Lol , you seriously call 4 companies in my state on an exchange a market ? A market would be allowing companies to sell insurance across state lines , a market would not be requiring individual mandates , a market would not require a 29yr old single male such as myself to have maternity coverage and birth control covered under my "new better" plan . That is not a free market , that is not even close lol !!!!

    Government regulations always increase cost and they never have once decreased cost of anything over time , look it up ! By creating another gigantic bureaucracy with a bunch of paper pushers that will raise everyone's cost .

    Socialism is an economic system characterised by social ownership of the means of production and co-operative management of the economy.
    (that sounds awfully familiar to our current government taking over 20% of our economy ? LOL)

    Your just another lowfo libtard that has no clue about the "law" you love so much ! At least there is some entertainment value in watching this huge failshow !!! popcorn.gif

  16. #16
    An example of what Druff mentions in number two.

    My wife is a therapist.

    The fee structure for Therapy appointments goes something like this at most insurance companies (driven off of what Medicaid and Medicare will pay which is about 20% less).

    30 minutes - $30
    45 minutes - $75
    60 minutes - $120

    In what possible scenario is my wife ever not going to see a client for an hour with this pricing structure?

    At minimum they should be priced incrementally the same.

    One could argue that they should pay more per minute for shorter appointments to encourage shorter appointments and lower overall cost.

    Instead we have a system that pays more per minute the longer you see a person, which makes no sense and no business works this way.

  17. #17
    Quote Originally Posted by abrown83 View Post
    An example of what Druff mentions in number two.

    My wife is a therapist.

    The fee structure for Therapy appointments goes something like this at most insurance companies (driven off of what Medicaid and Medicare will pay which is about 20% less).

    30 minutes - $30
    45 minutes - $75
    60 minutes - $120

    In what possible scenario is my wife ever not going to see a client for an hour with this pricing structure?

    At minimum they should be priced incrementally the same.

    One could argue that they should pay more per minute for shorter appointments to encourage shorter appointments and lower overall cost.

    Instead we have a system that pays more per minute the longer you see a person, which makes no sense and no business works this way.
    Bingo. The only way this billing system works is if you're paying out of pocket.

    Obviously out of your own wallet you're going to go with 30 or 45 mins tops....You will never ask for the full hour.

  18. #18
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    http://www.marketplace.org/topics/he...value-whatever

    Interesting article and series on the way the ACA is changing healthcare.

  19. #19
    I'm beginning to think that the only way to get decent health care coverage is to marry a Canadian, UK Citizen, or French person, and become a dual citizen.

    Anyone know someone who has done this and does it mean you have to pay higher taxes?




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