5 ms·

This is where I think political leaders (Democrat or Republican) could do really well. It's not just making sure people are covered. It's the existential dread

• onemoresoop 7y ago
  Most political leaders both dems and reps are in bed with the insurance companies who are heavily lobbying to keep things as they are. But why not, they're cashing in big and the system is so convoluted that you cannot point any fingers.
• pnutjam 7y ago
  This is literally the argument that Liz Warren and Bernie have been making, not to mention other Democrats.
  • beat 7y ago
    Eh. I'm watching it pretty closely, and I don't hear them talking in detail about how difficult it is.
    • pnutjam 7y ago
      https://elizabethwarren.com/plans/health-care https://elizabethwarren.com/plans/health-care
• codegeek 7y ago
  "isn't just bad for the poor. It's bad for everyone" Thank you for saying that. I am amazed at how so many people don't see and understand this. It is not just about Cost which is insane alright. It is about the BS we have to go through after a visit to a doctor or hospital. I am scared about the type of bills and claim fights I have to do if I visit a doc. Not because I cannot afford it necessarily. But because I have to spend may be like 5 hours calling doctor's offices, insurance admins, billing departments and what not.
  • beat 7y ago
    I went through a billing/process dispute with a provider last year after a change in their process led to a 30x increase in out-of-pocket costs for necessary treatment. It ended with them flatly lying to me that the changes were for my "safety". When I first dealt with all the new process, I asked my doctor why they were doing it, and he said "I think they just want to charge more money".
• elihu 7y ago
  It's the same thing with taxes: we can debate about what the right level of taxes should be for this person or that, but all the effort and money spent filling out tax returns is pure waste.
  • RickJWagner 7y ago
    Yes, and the tax labyrinth is kept artificially complicated due to lobbying, too!
• sjg007 7y ago
  One problem is that a bunch of folks have gold platinum private insurance. Things like $0 copays, no co-insurance etc... A lot of that was union negotiated. Some high end jobs have similar perks. Regular rank and file workers use to have HMOs but those plans have given way to HSAs and PPOs. PPOs were advertised as doctor choice but that's really misleading, all they really do is increase your out of pocket. For a condition that can't be handled in network within a reasonable distance of your house then the HMO insurer has to allow out of network access. HSAs are a great deal if you don't get sick, are rich or can put money in them... but if you need health care they aren't so good since the out of pocket is high. If we don't get a public option or Medicare for all then I think HSAs will be the future, basically pushing insurance as catastrophic care with some legally mandated primary care covered by default (with a copay). At least with a $25k deductible you generally won't go bankrupt and you just have to imagine paying off that imaginary new car for 5 years.
  • beat 7y ago
    I'm on a PPO right now, new to me this year, and it's great. I have a chronic condition that requires surgery about three times a year, so I'm used to just maxing out my costs. There are two levels of the surgery, and the higher level is full general anesthesia, with all that entails. In practice, it was less expensive out of pocket for the intensive surgery (a bit over $1000) than it was two months ago for the low-intensity local anesthesia surgery ($1300), even though the initial bill was over twice as high. At any rate, because of my chronic condition, I'm very sensitive to costs. I'll take the good insurance, thank you!
    • sjg007 7y ago
      I am curious, why does the PPO make a difference here? Is it vs the HSA or vs HMO or in network? Is your provider in network?
      • beat 7y ago
        Basically, I have one provider, except for emergency care - a large local network. It's fine for me, because my family doctor and both the specialists I need regularly for chronic conditions are in that network. For my condition that requires regular surgeries (like 3x/year), there are two levels of surgery - one local anesthetic, one general anesthetic. The first time I got the general one done, the bill to my insurance was $35k. This time, with the new insurance, the bill was $19k. So I think the PPO relationship is making a huge difference in how the internal billing works. At a higher level, the full hospital general anesthetic surgery in January on new insurance cost me less out of pocket than the much less complex local anesthetic surgery cost me in December, on previous insurance.
• usaar333 7y ago
  > We just can't deal with it, because we are exposed directly to unnecessary complexity. I'd argue though that those best adept at handling the complexity are actually winning in this model. If you are reasonably healthy already and can navigate HDHP/HSA rules, you can have a much higher take-home income + savings than in other countries with government run healthcare systems.
  • codegeek 7y ago
    You are missing the point. It is not about being healthy. You are always worried about the "what if I have to go see a doctor" situation in America because you don't know what it will cost and you definitely don't know what kind of issues you will have to fight through with incorrect claims, incorrect bills and what not. If someone can address that here in US, I am willing to keep the current system as is.
    • usaar333 7y ago
      I agree there is complexity cost, but that doesn't mean you can't benefit from it if you generally can navigate said complexity. I've never had issues getting reasonable price estimates from independent doctors (large systems refuse to reveal their negotiated rates) - emergency situations are certainly costly, but under a plausible worse-case scenario I'm still solidly saving having an HDHP. Ironically, the whole point of HDHPs was to put downward pricing pressure on the medical system by encouraging people to price-shop. Alas, due to a variety of market/regulatory factors, that hasn't happened.
    • mrep 7y ago
      My max out of pocket spending is $2,600 a year and I can put $3,500 pretax money into my HSA every year which I do. What I am supposed to worried about?
      • codegeek 7y ago
        worry about the fact that your health insurance company can change or they can change the terms on you. That a starting point. Plenty more to worry about but I have typed enough on other threads here.
• abruzzi 7y ago
  My favorite story to tell (favorite in a horrible way) about these kind of issues is this: After an accident ~15 years ago, I had an open wound that wouldn't close because it was infected with MRSA which had lodged itself in the hardware that was screwed to my tibia. I was wearing a wound vac--a device that was attached to the open wound and maintained a constant suction to pull out any bad stuff. It was there to keep the infection from spreading long enough for the bone to heal so they could remove the hardware. I had a weekly doctors appointment at the local hospital check on the condition of the wound and change the dressing on the vac. I was very careful. The doctor was in network, the hospital was in network, and my copay was, I believe, $30 for each visit, covered under my insurance. One day I showed up for my appointment, they led me to a room where I waited 10 minutes. Then the doctor came in, and it wasn't the guy I had been seeing for the last three months. He told me my doctor had taken ill and he was covering the appointments. He asked me how I was doing, and had the nurse redo the dressing on the wound vac. Then we were done. A month later I received a bill from this doctor for $1900 because he was out-of-network, and while my insurance covered out of network at 80%, they covered it at 80% of the in-network rate. The doctor billed out of network patients at about twice the negotiated in-network rate (a fairly common occurrence), so the 80% coverage was actually 40% coverage, and I owed the other 60% which came to about $1900 for 5 minutes of work (the nurse who changed the dressing worked for the hospital so her work and materials were covered in network.) And the kicker was that I didn't know a different doctor was going to be attending me until he walked in the door. If you think that maybe your "max out of pocket" will save you, it won't. If the insurance lists a "out of network max out of pocket" it only covers expenses at a negotiated in network rate. Any amount your out-of-network doctor bills that is over the insurance company's in network rate is effectively unlimited. Despite having a $2500 in network max, ad a $5000 out of network max, and a very good health plan. I left that accident with about $35k in medical debt. (An interesting side note, when it came time to remove the hardware, I went back to the same hospital/trauma center and doctor who had installed it--though a different hospital from above. A day before the surgery I went to the hospital for the pre-op stuff. At the end of the process, the hospital admin met with me to take my payment. I was expecting a $30 copay or similar, but I found out that while the hospital was in network six months before, they had dropped their contract with my insurance company a month prior and the pre-op was going to cost me $800. So of course I cancelled the surgery, but I was still on the hook for the pre-op work. Today every time I visit a medical professional of any kind, no matter how many times I've visited them before, I ask about in network coverage.)
• ykevinator 7y ago
  I'm not sure that's fair. There is only one party that has ever put forth serious health care legislation in this country. I wish we had two parties policies to debate but we don't.