12 ms·

Stop the Medicare “Advantage” Scam Before Medicare Is Dead

244 points by MilnerRoute 4y ago

1letterunixname 4y ago
This is how most of Medicare works. 10 or so choices of co-insurance or unified Advantage, outsourced to private insurance. Private health insurance should be illegal just as it is in other countries.
PaulHoule 4y ago
It is not a popular opinion but I always thought the tv ads that spam the airwaves in the last few months of the year were harmful to the legitimacy of institutions. In this day and age most of us are so assaulted by spammed scams that we develop a sensitive sense of scamminess and like many of the ads aimed at seniors these ones scream “get grandma away from the tv!” Certain day parts on tv are dominated by ads for personal injury lawyers and things you can spend government benefits on and are a desert for ads for things you might spend your own money on. One series of ads that promoted getting some free medical equipment that ran for years and I thought looked scammy turned out to really be a scam. I’ve always thought these ads promote the idea that some chiselers somewhere are trying to rip off government benefits and they drive people, even the pensioners that these are aimed at, to vote Republican.
- messe 4y ago
  As someone living outside the US, I've rarely, if ever, seen any ads like the ones you're describing
  - libraryatnight 4y ago
    We also have ads in the US where aging actors sell questionable reverse mortgages to senors to help them pay for their expenses.
    - clivestaples 4y ago
      I recently saw Tom Selleck as a spokesman for reverse mortgages and googled his net worth which came back as $45M. Pretty slimy if you ask me.
      - deleted 4y ago
        [deleted]
      - dsfyu404ed 4y ago
        Hollywood celebs peddle public policy they are too rich be affected by during their working years. Selling reverse mortgages and other garbage they're too rich to need targeted at seniors is a perfectly sensible continuation of that income stream.
      - giardini 4y ago
        A reverse mortgage can be very helpful. Why the hate? There are all kinds of useful financial instruments: that's part of capitalism. Another example: J. G. Wentworth, who provide no only your favorite ads https://www.youtube.com/watch?v=pdPM6j1Q4sg https://www.youtube.com/watch?v=pdPM6j1Q4sg but also "structured settlements, annuities, and lottery payments in exchange for a lump-sum cash settlement." After all, it's your money, use it when you need it!
  - Jensson 4y ago
    US ads is such a cultural shock when you visit USA. The biggest surprise was all the lawyer ads, "Did something happen to you? You could get rich by suing them with our help!". So ads like this: https://www.youtube.com/watch?v=Q3wX5pOUIMw https://www.youtube.com/watch?v=Q3wX5pOUIMw
    - messe 4y ago
      I think the bigger shock is how frequent the ad breaks are. In Ireland, an ad-break 4 times an hour is typical, and often if a movie is showing, it'd be every half-hour or on the hour instead. In the US it feels like it's every 5 minutes. It's especially jarring watching a show that originally aired on network television in the US, seeing it cut to black or a title card every few minutes where an ad-break would've been.
      - nerdponx 4y ago
        This is anecdotal, but it feels like there are more ad breaks than there used to be. TV is unwatchable in the USA as a result, and I have little doubt that this was a big factor in the rise of streaming.
        toast0 4y ago
        Streaming with ads is worse; invariably they cut to the ad 2-3 seconds early, then when you get back it's the last two seconds and then the next segment. I know ad minutes per hour have increased, because older shows have to be slimmed to air. Sometimes that's fiddling with the credits, sometimes on stations that care less, it's dropping minutes of content; I tried to watch an episode of The Munsters on some sub-channel, and they cut to commercial over the punchline of a joke... which ended up just being omited. Thanks a lot.
        derivagral 4y ago
        As a child, I remember a "~30m" cartoon might run until :27 or :56 until credits, etc. As a teen, I remember the shows would end around :23 or :24. When it came out I enjoyed twitch, but now it feels worse than TV. Now I don't watch TV or much streaming content. I tried to find some record or source on length over time, but wasn't able to.
- libraryatnight 4y ago
  I've said this before but it was such a perfect moment that I share it whenever possible, my mother in law is one of these folks and once she said that she'd never support universal health care because there was a chance some immigrant might get free health care on her dime. She followed that statement up by mentioning she was going to Mexico for some dental work she couldn't afford.
  - zaroth 4y ago
    Seems like perfectly congruous statements from what I can tell.
    - PaulHoule 4y ago
      My wife’s uncle brought much of his family from Italy over to the US but I sometimes see him watching Fox News on the horror of ‘chain migration’.
      - nhchris 4y ago
        "We let some in so we should let all in."
        hezralig 4y ago
        Are you implying that we reached our European immigrant quota or just the Italian quota?
      - libraryatnight 4y ago
        In high school, my girlfriend's dad was Mexican born to illegals in the US, and we found it bizarre that he was a huge Rush Limbaugh fan and Fox News fan and regularly ranted about the border. His parents were different than the drug dealers and criminals coming over "now" and they eventually did become citizens was the logic if you asked about his origins.
        naniwaduni 4y ago
- vharuck 4y ago
  >One series of ads that promoted getting some free medical equipment that ran for years and I thought looked scammy turned out to really be a scam. Do you mean Hoveround¹, or was it something else? ¹https://oig.hhs.gov/oas/reports/region5/51200057.asp https://oig.hhs.gov/oas/reports/region5/51200057.asp
  - PaulHoule 4y ago
    No, this place would set you up with a knee brace or similar thing out of a catalog, the thing is they did not care if you really needed it. If it did turn out you needed something like that later you’d find that you already wasted your benefit on something you didn’t need.
- slackdog 4y ago
  Advertising is the business of converting good will and trust into cash.
- heavyset_go 4y ago
  If you think those are bad, try looking at the junk mail retirement-aged people get. My parents get "official" looking notices about owing money or being owed a lot of money, offers to reverse mortgage their house for a "retirement nest egg" without using the term reverse mortgage, and for different scam insurance plans that don't cover anything worth covering. If they ever went through with the offers they get in the mail, they'd be homeless, without insurance, cashless and asset-less within a year. They get that kind of junk mail literally everyday.
  - shaftway 4y ago
    My in-laws fell victim to this. When they moved they sat us down and started to talk about this "407-B" (not the real name, but I don't remember what it was) and how it's not a reverse mortgage. Then they proceeded to describe it as exactly a reverse mortgage. Meanwhile I was tap-tap-tapping on my phone. I called them out and said it was a reverse mortgage according this page titled "Everything you need to know about 407-B reverse mortgages". They asked what fly-by-night website it was and when I said "irs.gov" they grumbled and moved on. To this day they refuse to admit that it's a reverse mortgage. > If they ever went through with the offers they get in the mail, they'd be homeless, without insurance, cashless and asset-less within a year. Not that quickly, but yeah, they're on that road. They're trapped in that home until they die. They'll be needing hospice care soon, and they won't be able to get it. Nothing we can do to move them off of it now because it's basically irreversible.
    - ryandrake 4y ago
      Everyone needs to have that awkward "don't trust any unsolicited offers" conversation with their aging parents. They may seem sharp today, but people's mental faculties decline. My folks fell for one or two, and they're a lot more on the alert now. I'm glad they listened and understand not to trust any unknown callers or mail. Feel terrible for some other people I know who can't get through to their parents, who are convinced that "Rajesh" from the IRS needs to be paid $20K through Amazon gift cards. This generation who told us all to not believe what you read online... now trusts everything they see on Facebook, everything they get in the mail, and every phone call they get.
- otikik 4y ago
  “get grandma away from the tv!” That’s always a good idea, not only because of the ads, and not only grandma.
- epgui 4y ago
  In Canada we basically get no medical ads, and it’s great. We find US acceptance of direct-to-patient advertising… ethically problematic. Most developed countries are more like Canada than the US on this.
  - specialist 4y ago
    No Freemium Speeches™!? Sounds like a dystopian hellscape. Just as William Gibson describes. I couldn't imagine living there, deprived of carnival barkers yelling at me about erectile dysfunction, cybercriminals, and investing in gold.
- HyperSane 4y ago
  I don't watch TV anymore. I mainly watch YouTube with uBlock Origin. It is jarring whenever I watch TV or browse the web without adblock.
sclarisse 4y ago
So, before the 2028 solvency crisis?
- tedivm 4y ago
  The "solvency" crisis is one of the dumbest things that has been shoved down our throats. For decades there wasn't a social security or medicare fund. What was there was taxes. Workers paid taxes, and those taxes went to retired people. There was no fund. Then people freaked out about the boomers and what that would do to retirement. So they created a fund- they started collecting more than they needed, invested it in government debt so it would grow, and used that to get over the bump. We can easily solve the "solvency" crisis by simply raising taxes. Remove the "cap" that says people are only subject to the social security tax on the first $160,200 of their income and the "solvency crisis" completely disappears. In fact if we completely removed the cap, rather than just raising it, we could afford to pay out more in social security while still extending the life of the "surplus" fund for almost a century.
  - sclarisse 4y ago
    Nice diatribe. Anyway, if it is so simple and easy, it raises the question: why hasn’t anyone legislated this yet? You know, during one of those sessions where both houses and the presidency are of the same party (two occasions in recent memory, one for each party) and put all talk of crisis to rest?
    - AlexandrB 4y ago
      Probably the same reason the Democrats never legislated abortion rights into law: never let a good crisis go to waste. The priorities of both major parties are: 1. Keep the donors happy 2. Keep getting elected 3. Line up a cushy position as a lobbyist or other government orbiter after retirement Pretty sure actually serving their constituents is at the bottom of the list for most politicians.
    - Blammar 4y ago
      Perhaps because rich people would pay more, so they tell their pet legislators that bill better not pass? It's always about the money. I'm not saying this is actually true -- it's just my hypothesis.
CalChris 4y ago
When you sign up for Medicare Advantage, and you shouldn't, you will still have to apply for and qualify for Medicare (65, 40 quarters of work, ...). You will generally pay the Medicare Part B premium ($164.90/mo this year) and any Medicare Advantage premium. But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage. With Medicare Advantage, you get to spend the rest of your life fighting health insurance companies. And for the most part, you're stuck on Medicare Advantage. Guaranteed enrollment is only in your first year. BTW, brokers are incentivized to sign you up for Medicare Advantage. Their commission is much higher for Medicare Advantage than for a Medigap plan. Medicare Advantage is vulture capitalism. Traditional Medicare generally pays 80% and you get a Medigap plan for the other 20%. My UHC Plan G costs $139.28/mo with a $226/yr deductible, no copays, no coinsurance, no restricted network. And you'll need a Part D drug plan. My SilverScript SmartRX PDP costs $4.50/mo. Bernie is right. Medicare for all would be awesome.
- toast0 4y ago
  > But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage. I'm much too young to figure this stuff out now, because it will be drastically different by the time I would need to use it, but ... If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? Or does medicare not deny or delay coverage? Not all doctors take Medicare either, but I do understand it's pretty widely accepted. I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up? And doesn't the patient have to pay some portion of some procedures etc? You could get Medigap insurance for the patient pays portion, but does that have limits or judgement, or are they compelled to follow Medicare's decisions?
skrowl 4y ago
[dead]
SoftTalker 4y ago
The entire health care system for seniors is a scam to drain them of their wealth and/or government benefits until they are broke or dead.
- lmm 4y ago
  Isn't it the opposite? It's a bottomless money pit set up to ensure that everyone is motivated to work themselves to the bone throughout their productive years, since you never know how much money you'll need for healthcare in retirement.
  - convolvatron 4y ago
    seems like they get you coming _and_ going
- OrvalWintermute 4y ago
  I always thought that Medicare & Medicaid are a scam to drain the nation of their wealth, until the nation is dead AND healthcare used to be a great deal more affordable before Medicare & Medicaid got involved in it. Now, senior folks get on Medicare until they've tapped out its lifetime benefits and then they go onto Medicaid. This is part of what has created the upteen millions of Medicare scams.
  - deleted 4y ago
    [deleted]
  - arrosenberg 4y ago
    The programs only exist because health insurance became unaffordable for seniors. Healthcare is expensive for the old! I’m not arguing against the idea that the program has fraud issues (Rick Scott made a fortune off of it), but its not going to be cheaper or better for the elderly if we let private companies exploit them individually instead of forcing them to defraud the government.
    - OrvalWintermute 4y ago
mindslight 4y ago
My dad was on a Medicare Advantage plan offered by a traditional "insurer", and it seemed to be worthwhile - it covered some drugs better than OG Medicare, and had fixed copays rather than anything percentage based. Towards end of life (pre-hospice) they proactively sent a doctor out a few times for housecalls, with the goal of keeping him out of the hospital. And the baseline Medicare rules reigned in a lot of the usual "insurance" company shenanigans. If he had longer term health issues perhaps Medicare plus a Supplement plan would have made sense, but as it was it seemed to work out - had two years of paying the drug coverage gap (paying a few thousand dollars is essentially table stakes for health "care" in this country). I'm not a fan of "insurance" companies in general, rather just reporting my experience. I kept his phone number (VOIP is like $1/mo), and I still get spam calls from scammers claiming to be "from Medicare" that "have a new card" for him - shamelessly pretending to be part of Medicare itself rather than a private company that's trying to steal his Medicare payments. Many times I'll ask them if their parents know they scam old people all day, or if they would want their parents getting scammed in their old age. Most of the time they just try to get me back to the script and think they'll convert me somehow ("I am not scammer"). I'm ambivalent on medicare advantage as a concept, but the scam companies are really what needs to be reigned in. Given that the benefits of medicare advantage is supposedly better coverage, I think a great way of doing reform would be to make it so people could change back to regular medicare at any time, and doing so would end up yanking back the premiums from the private company for the past year or two, unless they had actually paid them out for bona fide services. In addition to a lot more criminal enforcement against fraud, of course.
- sicromoft 4y ago
  > they proactively sent a doctor out a few times for housecalls The article talks about these housecalls: "The home health visits are designed to look for illnesses or codings that can increase risk scores. They very much are not looking for conditions that require medical intervention. This “free home health visit” scam is so profitable that an entire industry has sprung up of companies that send nurses out on behalf of the insurance companies."
  - mindslight 4y ago
jpollock 4y ago
I just saw a podcast about a startup that was working with Medicare/Medicaid to reduce costs by improving preventative care [1]. They look for people at risk, target them and take a cut of the overall reduced spend. If Medicare is requiring the same outcomes and disbursing per-person based on the cost to Medicare, then the insurance company's profit would have to come from either selecting for healthier people on the input side, or keeping them healthier for longer. Selecting for healthier people might be hard if it's "all signups allowed". That sounds like a good thing. [1] https://www.pushkin.fm/podcasts/whats-your-problem/how-to-save-the-most-lives https://www.pushkin.fm/podcasts/whats-your-problem/how-to-sa...
Blammar 4y ago
I can speak about an apparently non-scam Medicare Advantage plan that my wife and I are on. It is effectively a PPO (similar to the Kaiser plan someone else mentioned), so we have access to exactly the same physicians that we had already where we were paying for private insurance. Our annual premiums went from about $85k a year (on the private insurance) to around $10k out of pocket. We are fairly healthy, though my wife is going to have some major joint surgery. What was interesting is that it was our PRIVATE insurance that stalled and stalled over approving the surgery. When she switched to the MA plan, it was approved immediately. (That stalling finally motivated my wife to make the switch out of the private insurance.) The downside of our MA plan is that we are not going to be able to move out of the area easily. But you always have that issue regardless -- finding a whole new set of doctors and dentists when you move... I do get these phone calls asking to schedule a "wellness" check that the article writer mentions. Oddly enough, my wife didn't get any (so far.)
- everybodyknows 4y ago
  > (That stalling finally motivated my wife to make the switch out of the private insurance.) They would have known that you had the option of going elsewhere. The stalling looks strategic and, unfortunately, successful.
  - Blammar 4y ago
    Indeed. Got to play the hand dealt.
- asah 4y ago
  She's probably already high risk, so the visit would be an additional cost to the insurance company.
- deleted 4y ago
  [deleted]
- Trisell 4y ago
  That call is because Health Plans are rated by CMS on if you get certain types of services, or skip them. By skipping those checkups you are reducing your health insurance plans STARS rating, which means they lose significant monies from the government. Each .1 of a start equals around 1 million US in government funding to a health plan doing MA.
wankle 4y ago
As someone who will be medicare age in a few years, I was following the article until it hit the [drat those darn republicans] comment and my attention quickly waned, and not because of age.
- nobodyandproud 4y ago
  Only several groups are consistently anti-national healthcare: Fiscal conservatives, anti-immigrants, and unions.
- LBJsPNS 4y ago
  Mmmhmm. And who else made it party policy to suggest sunsetting Medicare, Medicaid, and Social Security in five years? Or bring it up for a vote every year? Hint: NOT the Democrats.
more_corn 4y ago
My father in law had Medicare advantage. They denied his claims for skilled nursing that was getting him back on his feet. The facility just downgraded him from skilled nursing and left him in an hallway. He had a cardiac arrest due to low electrolytes ended up back in the ER and never recovered. (Pop quiz, how does someone on an IV end up with low electrolytes? Only way I can think is if they don’t fill the bag) Why did they deny him? No reason. It’s just standard procedure. They deny, get good justification and approve. They do that every 7 days. They prettied up the language but confirmed that this is exactly what they do. They literally killed him as part of standard operating procedure. This country is fucked. Y’all better hope you have enough money to go be old somewhere else.
- giardini 4y ago
  Yep, this sounds like "the whole story...", doesn't it? Nothing missing here: - FIL has MA, - FIL (somehow, no explanation given) is in a "facility" (hospital, ER, doctor's office, bus depot, ???), - FIL is "downgraded" and "had a cardiac arrest... and never recovered...) ... - "They literally killed him as part of standard operating procedure." Sounds like quite a few grounds for a lawsuit but I'm neither a lawyer nor a doctor. Neither am I a fool: this is waaay to iffy a story/description to be useful in judging most anything mentioned in the story, be it MA, the "facility", the FIL, the writer, or the diagnosis. As for who's fucked, the writer should worry about himself first.
larrymyers 4y ago
When talk about Medicare they are usually talking about Part A (hospital care) and Part B (provider coverage), and sometimes Part D (prescription drug coverage). You are on your own for everything else, including dental and vision care. Adding dental coverage to Medicare continues to die in committee every year in congress. So if you know you'll need continued care from your dentist and eye doctor then Medicare Advantage can be a good thing, since most of the highly rated plans provide that coverage as part of their benefits. You can also get benefits for things hearing aids, and transportation to and from your provider visits, etc. Yes, if you sign up for Medicare Advantage you'll find yourself back in the world of the In-Network and Out-of-Network care model. At the end of the day though it's disingenuous to just label Medicare Advantage as solely the privatization of Medicare. The only way insurance companies that provide Medicare Advantage stay in business is if they provide a high standard of care for their members. The payment model set by CMS incentivizes them to do so.
refurb 4y ago
This is an odd rant. Medicare Advantage is simple - instead of getting regular Medicare (Part A,B and D) through the government (though Part D is always private), you elect for your Medicare dollars to be used as premiums for a private Medicare Advantage Plan that offers similar coverage. Thats it. It’s nice because it offers options. For some people with chronic conditions a MA plan might offer better coverage than regular Medicare for your treatment in exchange for less coverage in another area. And it’s entirely the patient’s choice. Don't like Medicare Advantage? Good, don't choose it.
- yuliyp 4y ago
  Yeah the article spends a very long time ranting about... medical insurance as a concept. Which, yeah, there are lots of problems with medical insurance. The doom and gloom and scare words do a lot to mask some of the more interesting points that the author is making, such as the flaws with the risk score system and its enforcement.
- JoBrad 4y ago
  The article was a bit of a rant. But the part that stuck out to me was the irreversibility of Medicare advantage, in some cases. That definitely excludes your last statement as a possible choice. If you’re battling a life-threatening disease, and are also facing overwhelming bills, being locked into a choice you made without realizing the full ramifications would make me rant, too.
- mehlmao 4y ago
  If Medicare Advantage is good for its customers, they shouldn't need to trick people into signing up.
  - refurb 4y ago
    They dont trick anyone. Its very clear when you sign up what youre getting and that youre opting out of normal Medicare. And like i said it’s can be better thab normal Medicare for some people. Thats why they choose it.
rayiner 4y ago
I don’t like the idea of private Medicare but this article is populist handwaving. Here is an article from real healthcare researchers with aggregates statistics: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465897/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465897/ Notable: > Private health insurers in Medicare Advantage must abide by all explicit Medicare coverage determinations including national coverage determinations (NCD) and local coverage determinations (LCDs). In the absence of an NCD, LCD, or other explicit Medicare coverage determination, however, Medicare Advantage insurers can apply additional coverage restrictions if they determine that a service fails to meet the “reasonable and necessary” standard. It sounds like virtually no claims are denied even under Medicare Advantage: > Denied services accounted for 1.40% (95% CI 1.39–1.41) of total services (paid and denied services), and denied spending accounted for 0.68% (95% CI 0.67–0.70) of total spending (paid and denied spending). However, it sounds like MA plans will deny things that the ordinary Medicare rules by themselves wouldn’t deny. > On average, Medicare coverage rules accounted for 85% of denied services and 64% of denied spending, with Aetna Medicare Advantage coverage rules accounting for the remainder.
- pettusftw 4y ago
  It seems like an unaccounted for confouder that LCD/NCD/MUE denials are the bread and butter of a claims clearinghouse and the claims would not be sent to the payer if they failed those tests. My bias may be showing, but it doesn't seem like they accounted for that at all..
MagicMoonlight 4y ago
I’m so glad I don’t live in America and get forced to watch ads like that
- kingsloi 4y ago
  I haven’t watched a single second of live TV, because of ads like that.
exabrial 4y ago
I agree with the author, but for far different reasons. Anytime taxpayer money is up for grabs by private companies, there is almost no oversight and things get out of hand quickly. This is the wrong way to go about things and it never works. I don't think the US government is capable of running large programs efficiently. They're universally understaffed, the staff that does work there is under-qualified, and they don't have to answer to anyone because they can't be fired for missing budgets, goals, or deadlines. I don't know what the right answer is honestly, so I do enjoy ready other people's views in this thread.. but I'm certain its not what we're doing now.
expertentipp 4y ago
To say we already live in Idiocracy would be too banal. I'll only say these ads infurate me even though I don't live in US.
MomoXenosaga 4y ago
I live in a country with socialised medicine and wanted to give some counterpoints to "the grass is always greener in socialist utopia". 1 yes they scam boomers. An actual funded pension system means boomers are the richest people in the country. Everyone wants a slice. 2 healthcare is expensive as fuck so the government is only providing the bare minimum they can get away with. Think "when was the last time my 80 year old mother had a shower". 3 commercials aimed at boomers for private healthcare services: you can get your own private nurse (because the one provided to you by the government only shows up for an hour a week). Obviously most people can't afford such luxuries. 4 community care. Please volunteer in your local nursing home because they are chronically understaffed. They have an entire propaganda campaign on this. The Philippine nurses did not work out.
cat_plus_plus 4y ago
The root of the problem is pre-insurance costs. If an average person was able to pay for their and their kids health care out of pocket, the problems of being sicker than average or poorer than average would be solved without much controversy. And to address costs, we need transparency, freedom, competition and more healthy attitudes towards personal health. No payment system will get us out of this problem, it will be high out of pocket expenses, or high taxes, or limited care or some combination of the three.
- eitally 4y ago
  100%. It's just impossible as things stand. My daughter required heart surgery when she was 24mo. Overall price billed to insurance for everything was about $250k, including several pre-surgery procedures (MRIs, cardiac cath, etc). I believe we paid about $7k after insurance. My son is currently on isoretinoin (Accutane generic) for systemic acne. Because of the severe side effects isoretinoin can have, they force you to come in for an office visit / check-in monthly, and only dole out the meds one month at a time (no refills). Thus far, we've received from our pharmacy prescriptions from three different manufacturers, ranging in price (to us, post insurance) from $7 to $120. Pre-insurance prices are in the $500-700/mo range. There seems to be no rhyme nor reason for these dramatic monthly fluctuations ... so if we can't even get something like this to be predictable and simple, what hope is there for treatments requiring complex care?
chkaloon 4y ago
Medicare for All would be great, at the prices being quoted by folks on here. But I bet your premiums and deductibles aren't covering your costs, especially at your age. Over 65 spending is around $18K per year. Average in the US is $7-12K across age groups and genders (depending on how it's counted). The problem with traditional fee-for-service Medicare is that there is no mechanism to reign in those costs - doctors get paid pretty much no matter what they order. So they order a lot. For Medicare Advantage, it's more a capitation model where the insurance co is paid per patient, and their incentive is supposed to be to keep the patient healthy and thus less costly. That's the theory. Incentives matter, and getting them right in healthcare is a messy task.
- kevviiinn 4y ago
  The issue with the medical system is that there are a whole bunch of middle men leeching cash out at every possible point. Medicare for all would be one step to cutting back on this waste

244 points by MilnerRoute 4y ago

This is how most of Medicare works. 10 or so choices of co-insurance or unified Advantage, outsourced to private insurance. Private health insurance should be illegal just as it is in other countries.

PaulHoule 4y ago

It is not a popular opinion but I always thought the tv ads that spam the airwaves in the last few months of the year were harmful to the legitimacy of institutions. In this day and age most of us are so assaulted by spammed scams that we develop a sensitive sense of scamminess and like many of the ads aimed at seniors these ones scream “get grandma away from the tv!” Certain day parts on tv are dominated by ads for personal injury lawyers and things you can spend government benefits on and are a desert for ads for things you might spend your own money on. One series of ads that promoted getting some free medical equipment that ran for years and I thought looked scammy turned out to really be a scam. I’ve always thought these ads promote the idea that some chiselers somewhere are trying to rip off government benefits and they drive people, even the pensioners that these are aimed at, to vote Republican.

messe 4y ago
As someone living outside the US, I've rarely, if ever, seen any ads like the ones you're describing
- libraryatnight 4y ago
  We also have ads in the US where aging actors sell questionable reverse mortgages to senors to help them pay for their expenses.
  - clivestaples 4y ago
    I recently saw Tom Selleck as a spokesman for reverse mortgages and googled his net worth which came back as $45M. Pretty slimy if you ask me.
    - deleted 4y ago
      [deleted]
    - dsfyu404ed 4y ago
      Hollywood celebs peddle public policy they are too rich be affected by during their working years. Selling reverse mortgages and other garbage they're too rich to need targeted at seniors is a perfectly sensible continuation of that income stream.
    - giardini 4y ago
      A reverse mortgage can be very helpful. Why the hate? There are all kinds of useful financial instruments: that's part of capitalism. Another example: J. G. Wentworth, who provide no only your favorite ads https://www.youtube.com/watch?v=pdPM6j1Q4sg https://www.youtube.com/watch?v=pdPM6j1Q4sg but also "structured settlements, annuities, and lottery payments in exchange for a lump-sum cash settlement." After all, it's your money, use it when you need it!
- Jensson 4y ago
  US ads is such a cultural shock when you visit USA. The biggest surprise was all the lawyer ads, "Did something happen to you? You could get rich by suing them with our help!". So ads like this: https://www.youtube.com/watch?v=Q3wX5pOUIMw https://www.youtube.com/watch?v=Q3wX5pOUIMw
  - messe 4y ago
    I think the bigger shock is how frequent the ad breaks are. In Ireland, an ad-break 4 times an hour is typical, and often if a movie is showing, it'd be every half-hour or on the hour instead. In the US it feels like it's every 5 minutes. It's especially jarring watching a show that originally aired on network television in the US, seeing it cut to black or a title card every few minutes where an ad-break would've been.
    - nerdponx 4y ago
      This is anecdotal, but it feels like there are more ad breaks than there used to be. TV is unwatchable in the USA as a result, and I have little doubt that this was a big factor in the rise of streaming.
      - toast0 4y ago
        Streaming with ads is worse; invariably they cut to the ad 2-3 seconds early, then when you get back it's the last two seconds and then the next segment. I know ad minutes per hour have increased, because older shows have to be slimmed to air. Sometimes that's fiddling with the credits, sometimes on stations that care less, it's dropping minutes of content; I tried to watch an episode of The Munsters on some sub-channel, and they cut to commercial over the punchline of a joke... which ended up just being omited. Thanks a lot.
      - derivagral 4y ago
        As a child, I remember a "~30m" cartoon might run until :27 or :56 until credits, etc. As a teen, I remember the shows would end around :23 or :24. When it came out I enjoyed twitch, but now it feels worse than TV. Now I don't watch TV or much streaming content. I tried to find some record or source on length over time, but wasn't able to.
libraryatnight 4y ago
I've said this before but it was such a perfect moment that I share it whenever possible, my mother in law is one of these folks and once she said that she'd never support universal health care because there was a chance some immigrant might get free health care on her dime. She followed that statement up by mentioning she was going to Mexico for some dental work she couldn't afford.
- zaroth 4y ago
  Seems like perfectly congruous statements from what I can tell.
  - PaulHoule 4y ago
    My wife’s uncle brought much of his family from Italy over to the US but I sometimes see him watching Fox News on the horror of ‘chain migration’.
    - nhchris 4y ago
      "We let some in so we should let all in."
      - hezralig 4y ago
        Are you implying that we reached our European immigrant quota or just the Italian quota?
    - libraryatnight 4y ago
      In high school, my girlfriend's dad was Mexican born to illegals in the US, and we found it bizarre that he was a huge Rush Limbaugh fan and Fox News fan and regularly ranted about the border. His parents were different than the drug dealers and criminals coming over "now" and they eventually did become citizens was the logic if you asked about his origins.
      - naniwaduni 4y ago
vharuck 4y ago
>One series of ads that promoted getting some free medical equipment that ran for years and I thought looked scammy turned out to really be a scam. Do you mean Hoveround¹, or was it something else? ¹https://oig.hhs.gov/oas/reports/region5/51200057.asp https://oig.hhs.gov/oas/reports/region5/51200057.asp
- PaulHoule 4y ago
  No, this place would set you up with a knee brace or similar thing out of a catalog, the thing is they did not care if you really needed it. If it did turn out you needed something like that later you’d find that you already wasted your benefit on something you didn’t need.
slackdog 4y ago
Advertising is the business of converting good will and trust into cash.
heavyset_go 4y ago
If you think those are bad, try looking at the junk mail retirement-aged people get. My parents get "official" looking notices about owing money or being owed a lot of money, offers to reverse mortgage their house for a "retirement nest egg" without using the term reverse mortgage, and for different scam insurance plans that don't cover anything worth covering. If they ever went through with the offers they get in the mail, they'd be homeless, without insurance, cashless and asset-less within a year. They get that kind of junk mail literally everyday.
- shaftway 4y ago
  My in-laws fell victim to this. When they moved they sat us down and started to talk about this "407-B" (not the real name, but I don't remember what it was) and how it's not a reverse mortgage. Then they proceeded to describe it as exactly a reverse mortgage. Meanwhile I was tap-tap-tapping on my phone. I called them out and said it was a reverse mortgage according this page titled "Everything you need to know about 407-B reverse mortgages". They asked what fly-by-night website it was and when I said "irs.gov" they grumbled and moved on. To this day they refuse to admit that it's a reverse mortgage. > If they ever went through with the offers they get in the mail, they'd be homeless, without insurance, cashless and asset-less within a year. Not that quickly, but yeah, they're on that road. They're trapped in that home until they die. They'll be needing hospice care soon, and they won't be able to get it. Nothing we can do to move them off of it now because it's basically irreversible.
  - ryandrake 4y ago
    Everyone needs to have that awkward "don't trust any unsolicited offers" conversation with their aging parents. They may seem sharp today, but people's mental faculties decline. My folks fell for one or two, and they're a lot more on the alert now. I'm glad they listened and understand not to trust any unknown callers or mail. Feel terrible for some other people I know who can't get through to their parents, who are convinced that "Rajesh" from the IRS needs to be paid $20K through Amazon gift cards. This generation who told us all to not believe what you read online... now trusts everything they see on Facebook, everything they get in the mail, and every phone call they get.
otikik 4y ago
“get grandma away from the tv!” That’s always a good idea, not only because of the ads, and not only grandma.
epgui 4y ago
In Canada we basically get no medical ads, and it’s great. We find US acceptance of direct-to-patient advertising… ethically problematic. Most developed countries are more like Canada than the US on this.
- specialist 4y ago
  No Freemium Speeches™!? Sounds like a dystopian hellscape. Just as William Gibson describes. I couldn't imagine living there, deprived of carnival barkers yelling at me about erectile dysfunction, cybercriminals, and investing in gold.
HyperSane 4y ago
I don't watch TV anymore. I mainly watch YouTube with uBlock Origin. It is jarring whenever I watch TV or browse the web without adblock.

sclarisse 4y ago

So, before the 2028 solvency crisis?

tedivm 4y ago
The "solvency" crisis is one of the dumbest things that has been shoved down our throats. For decades there wasn't a social security or medicare fund. What was there was taxes. Workers paid taxes, and those taxes went to retired people. There was no fund. Then people freaked out about the boomers and what that would do to retirement. So they created a fund- they started collecting more than they needed, invested it in government debt so it would grow, and used that to get over the bump. We can easily solve the "solvency" crisis by simply raising taxes. Remove the "cap" that says people are only subject to the social security tax on the first $160,200 of their income and the "solvency crisis" completely disappears. In fact if we completely removed the cap, rather than just raising it, we could afford to pay out more in social security while still extending the life of the "surplus" fund for almost a century.
- sclarisse 4y ago
  Nice diatribe. Anyway, if it is so simple and easy, it raises the question: why hasn’t anyone legislated this yet? You know, during one of those sessions where both houses and the presidency are of the same party (two occasions in recent memory, one for each party) and put all talk of crisis to rest?
  - AlexandrB 4y ago
    Probably the same reason the Democrats never legislated abortion rights into law: never let a good crisis go to waste. The priorities of both major parties are: 1. Keep the donors happy 2. Keep getting elected 3. Line up a cushy position as a lobbyist or other government orbiter after retirement Pretty sure actually serving their constituents is at the bottom of the list for most politicians.
  - Blammar 4y ago
    Perhaps because rich people would pay more, so they tell their pet legislators that bill better not pass? It's always about the money. I'm not saying this is actually true -- it's just my hypothesis.

CalChris 4y ago

When you sign up for Medicare Advantage, and you shouldn't, you will still have to apply for and qualify for Medicare (65, 40 quarters of work, ...). You will generally pay the Medicare Part B premium ($164.90/mo this year) and any Medicare Advantage premium. But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage. With Medicare Advantage, you get to spend the rest of your life fighting health insurance companies. And for the most part, you're stuck on Medicare Advantage. Guaranteed enrollment is only in your first year. BTW, brokers are incentivized to sign you up for Medicare Advantage. Their commission is much higher for Medicare Advantage than for a Medigap plan. Medicare Advantage is vulture capitalism. Traditional Medicare generally pays 80% and you get a Medigap plan for the other 20%. My UHC Plan G costs $139.28/mo with a $226/yr deductible, no copays, no coinsurance, no restricted network. And you'll need a Part D drug plan. My SilverScript SmartRX PDP costs $4.50/mo. Bernie is right. Medicare for all would be awesome.

toast0 4y ago
> But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage. I'm much too young to figure this stuff out now, because it will be drastically different by the time I would need to use it, but ... If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? Or does medicare not deny or delay coverage? Not all doctors take Medicare either, but I do understand it's pretty widely accepted. I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up? And doesn't the patient have to pay some portion of some procedures etc? You could get Medigap insurance for the patient pays portion, but does that have limits or judgement, or are they compelled to follow Medicare's decisions?

skrowl 4y ago

[dead]

SoftTalker 4y ago

The entire health care system for seniors is a scam to drain them of their wealth and/or government benefits until they are broke or dead.

lmm 4y ago
Isn't it the opposite? It's a bottomless money pit set up to ensure that everyone is motivated to work themselves to the bone throughout their productive years, since you never know how much money you'll need for healthcare in retirement.
- convolvatron 4y ago
  seems like they get you coming _and_ going
OrvalWintermute 4y ago
I always thought that Medicare & Medicaid are a scam to drain the nation of their wealth, until the nation is dead AND healthcare used to be a great deal more affordable before Medicare & Medicaid got involved in it. Now, senior folks get on Medicare until they've tapped out its lifetime benefits and then they go onto Medicaid. This is part of what has created the upteen millions of Medicare scams.
- deleted 4y ago
  [deleted]
- arrosenberg 4y ago
  The programs only exist because health insurance became unaffordable for seniors. Healthcare is expensive for the old! I’m not arguing against the idea that the program has fraud issues (Rick Scott made a fortune off of it), but its not going to be cheaper or better for the elderly if we let private companies exploit them individually instead of forcing them to defraud the government.
  - OrvalWintermute 4y ago

mindslight 4y ago

My dad was on a Medicare Advantage plan offered by a traditional "insurer", and it seemed to be worthwhile - it covered some drugs better than OG Medicare, and had fixed copays rather than anything percentage based. Towards end of life (pre-hospice) they proactively sent a doctor out a few times for housecalls, with the goal of keeping him out of the hospital. And the baseline Medicare rules reigned in a lot of the usual "insurance" company shenanigans. If he had longer term health issues perhaps Medicare plus a Supplement plan would have made sense, but as it was it seemed to work out - had two years of paying the drug coverage gap (paying a few thousand dollars is essentially table stakes for health "care" in this country). I'm not a fan of "insurance" companies in general, rather just reporting my experience. I kept his phone number (VOIP is like $1/mo), and I still get spam calls from scammers claiming to be "from Medicare" that "have a new card" for him - shamelessly pretending to be part of Medicare itself rather than a private company that's trying to steal his Medicare payments. Many times I'll ask them if their parents know they scam old people all day, or if they would want their parents getting scammed in their old age. Most of the time they just try to get me back to the script and think they'll convert me somehow ("I am not scammer"). I'm ambivalent on medicare advantage as a concept, but the scam companies are really what needs to be reigned in. Given that the benefits of medicare advantage is supposedly better coverage, I think a great way of doing reform would be to make it so people could change back to regular medicare at any time, and doing so would end up yanking back the premiums from the private company for the past year or two, unless they had actually paid them out for bona fide services. In addition to a lot more criminal enforcement against fraud, of course.

sicromoft 4y ago
> they proactively sent a doctor out a few times for housecalls The article talks about these housecalls: "The home health visits are designed to look for illnesses or codings that can increase risk scores. They very much are not looking for conditions that require medical intervention. This “free home health visit” scam is so profitable that an entire industry has sprung up of companies that send nurses out on behalf of the insurance companies."
- mindslight 4y ago

jpollock 4y ago

I just saw a podcast about a startup that was working with Medicare/Medicaid to reduce costs by improving preventative care [1]. They look for people at risk, target them and take a cut of the overall reduced spend. If Medicare is requiring the same outcomes and disbursing per-person based on the cost to Medicare, then the insurance company's profit would have to come from either selecting for healthier people on the input side, or keeping them healthier for longer. Selecting for healthier people might be hard if it's "all signups allowed". That sounds like a good thing. [1] https://www.pushkin.fm/podcasts/whats-your-problem/how-to-save-the-most-lives https://www.pushkin.fm/podcasts/whats-your-problem/how-to-sa...

Blammar 4y ago

I can speak about an apparently non-scam Medicare Advantage plan that my wife and I are on. It is effectively a PPO (similar to the Kaiser plan someone else mentioned), so we have access to exactly the same physicians that we had already where we were paying for private insurance. Our annual premiums went from about $85k a year (on the private insurance) to around $10k out of pocket. We are fairly healthy, though my wife is going to have some major joint surgery. What was interesting is that it was our PRIVATE insurance that stalled and stalled over approving the surgery. When she switched to the MA plan, it was approved immediately. (That stalling finally motivated my wife to make the switch out of the private insurance.) The downside of our MA plan is that we are not going to be able to move out of the area easily. But you always have that issue regardless -- finding a whole new set of doctors and dentists when you move... I do get these phone calls asking to schedule a "wellness" check that the article writer mentions. Oddly enough, my wife didn't get any (so far.)

everybodyknows 4y ago
> (That stalling finally motivated my wife to make the switch out of the private insurance.) They would have known that you had the option of going elsewhere. The stalling looks strategic and, unfortunately, successful.
- Blammar 4y ago
  Indeed. Got to play the hand dealt.
asah 4y ago
She's probably already high risk, so the visit would be an additional cost to the insurance company.
deleted 4y ago
[deleted]
Trisell 4y ago
That call is because Health Plans are rated by CMS on if you get certain types of services, or skip them. By skipping those checkups you are reducing your health insurance plans STARS rating, which means they lose significant monies from the government. Each .1 of a start equals around 1 million US in government funding to a health plan doing MA.

wankle 4y ago

As someone who will be medicare age in a few years, I was following the article until it hit the [drat those darn republicans] comment and my attention quickly waned, and not because of age.

nobodyandproud 4y ago
Only several groups are consistently anti-national healthcare: Fiscal conservatives, anti-immigrants, and unions.
LBJsPNS 4y ago
Mmmhmm. And who else made it party policy to suggest sunsetting Medicare, Medicaid, and Social Security in five years? Or bring it up for a vote every year? Hint: NOT the Democrats.

more_corn 4y ago

My father in law had Medicare advantage. They denied his claims for skilled nursing that was getting him back on his feet. The facility just downgraded him from skilled nursing and left him in an hallway. He had a cardiac arrest due to low electrolytes ended up back in the ER and never recovered. (Pop quiz, how does someone on an IV end up with low electrolytes? Only way I can think is if they don’t fill the bag) Why did they deny him? No reason. It’s just standard procedure. They deny, get good justification and approve. They do that every 7 days. They prettied up the language but confirmed that this is exactly what they do. They literally killed him as part of standard operating procedure. This country is fucked. Y’all better hope you have enough money to go be old somewhere else.

giardini 4y ago
Yep, this sounds like "the whole story...", doesn't it? Nothing missing here: - FIL has MA, - FIL (somehow, no explanation given) is in a "facility" (hospital, ER, doctor's office, bus depot, ???), - FIL is "downgraded" and "had a cardiac arrest... and never recovered...) ... - "They literally killed him as part of standard operating procedure." Sounds like quite a few grounds for a lawsuit but I'm neither a lawyer nor a doctor. Neither am I a fool: this is waaay to iffy a story/description to be useful in judging most anything mentioned in the story, be it MA, the "facility", the FIL, the writer, or the diagnosis. As for who's fucked, the writer should worry about himself first.

larrymyers 4y ago

When talk about Medicare they are usually talking about Part A (hospital care) and Part B (provider coverage), and sometimes Part D (prescription drug coverage). You are on your own for everything else, including dental and vision care. Adding dental coverage to Medicare continues to die in committee every year in congress. So if you know you'll need continued care from your dentist and eye doctor then Medicare Advantage can be a good thing, since most of the highly rated plans provide that coverage as part of their benefits. You can also get benefits for things hearing aids, and transportation to and from your provider visits, etc. Yes, if you sign up for Medicare Advantage you'll find yourself back in the world of the In-Network and Out-of-Network care model. At the end of the day though it's disingenuous to just label Medicare Advantage as solely the privatization of Medicare. The only way insurance companies that provide Medicare Advantage stay in business is if they provide a high standard of care for their members. The payment model set by CMS incentivizes them to do so.

refurb 4y ago

This is an odd rant. Medicare Advantage is simple - instead of getting regular Medicare (Part A,B and D) through the government (though Part D is always private), you elect for your Medicare dollars to be used as premiums for a private Medicare Advantage Plan that offers similar coverage. Thats it. It’s nice because it offers options. For some people with chronic conditions a MA plan might offer better coverage than regular Medicare for your treatment in exchange for less coverage in another area. And it’s entirely the patient’s choice. Don't like Medicare Advantage? Good, don't choose it.

yuliyp 4y ago
Yeah the article spends a very long time ranting about... medical insurance as a concept. Which, yeah, there are lots of problems with medical insurance. The doom and gloom and scare words do a lot to mask some of the more interesting points that the author is making, such as the flaws with the risk score system and its enforcement.
JoBrad 4y ago
The article was a bit of a rant. But the part that stuck out to me was the irreversibility of Medicare advantage, in some cases. That definitely excludes your last statement as a possible choice. If you’re battling a life-threatening disease, and are also facing overwhelming bills, being locked into a choice you made without realizing the full ramifications would make me rant, too.
mehlmao 4y ago
If Medicare Advantage is good for its customers, they shouldn't need to trick people into signing up.
- refurb 4y ago
  They dont trick anyone. Its very clear when you sign up what youre getting and that youre opting out of normal Medicare. And like i said it’s can be better thab normal Medicare for some people. Thats why they choose it.

rayiner 4y ago

I don’t like the idea of private Medicare but this article is populist handwaving. Here is an article from real healthcare researchers with aggregates statistics: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465897/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465897/ Notable: > Private health insurers in Medicare Advantage must abide by all explicit Medicare coverage determinations including national coverage determinations (NCD) and local coverage determinations (LCDs). In the absence of an NCD, LCD, or other explicit Medicare coverage determination, however, Medicare Advantage insurers can apply additional coverage restrictions if they determine that a service fails to meet the “reasonable and necessary” standard. It sounds like virtually no claims are denied even under Medicare Advantage: > Denied services accounted for 1.40% (95% CI 1.39–1.41) of total services (paid and denied services), and denied spending accounted for 0.68% (95% CI 0.67–0.70) of total spending (paid and denied spending). However, it sounds like MA plans will deny things that the ordinary Medicare rules by themselves wouldn’t deny. > On average, Medicare coverage rules accounted for 85% of denied services and 64% of denied spending, with Aetna Medicare Advantage coverage rules accounting for the remainder.

pettusftw 4y ago
It seems like an unaccounted for confouder that LCD/NCD/MUE denials are the bread and butter of a claims clearinghouse and the claims would not be sent to the payer if they failed those tests. My bias may be showing, but it doesn't seem like they accounted for that at all..

MagicMoonlight 4y ago

I’m so glad I don’t live in America and get forced to watch ads like that

kingsloi 4y ago
I haven’t watched a single second of live TV, because of ads like that.

exabrial 4y ago

I agree with the author, but for far different reasons. Anytime taxpayer money is up for grabs by private companies, there is almost no oversight and things get out of hand quickly. This is the wrong way to go about things and it never works. I don't think the US government is capable of running large programs efficiently. They're universally understaffed, the staff that does work there is under-qualified, and they don't have to answer to anyone because they can't be fired for missing budgets, goals, or deadlines. I don't know what the right answer is honestly, so I do enjoy ready other people's views in this thread.. but I'm certain its not what we're doing now.

expertentipp 4y ago

To say we already live in Idiocracy would be too banal. I'll only say these ads infurate me even though I don't live in US.

MomoXenosaga 4y ago

I live in a country with socialised medicine and wanted to give some counterpoints to "the grass is always greener in socialist utopia". 1 yes they scam boomers. An actual funded pension system means boomers are the richest people in the country. Everyone wants a slice. 2 healthcare is expensive as fuck so the government is only providing the bare minimum they can get away with. Think "when was the last time my 80 year old mother had a shower". 3 commercials aimed at boomers for private healthcare services: you can get your own private nurse (because the one provided to you by the government only shows up for an hour a week). Obviously most people can't afford such luxuries. 4 community care. Please volunteer in your local nursing home because they are chronically understaffed. They have an entire propaganda campaign on this. The Philippine nurses did not work out.

cat_plus_plus 4y ago

The root of the problem is pre-insurance costs. If an average person was able to pay for their and their kids health care out of pocket, the problems of being sicker than average or poorer than average would be solved without much controversy. And to address costs, we need transparency, freedom, competition and more healthy attitudes towards personal health. No payment system will get us out of this problem, it will be high out of pocket expenses, or high taxes, or limited care or some combination of the three.

eitally 4y ago
100%. It's just impossible as things stand. My daughter required heart surgery when she was 24mo. Overall price billed to insurance for everything was about $250k, including several pre-surgery procedures (MRIs, cardiac cath, etc). I believe we paid about $7k after insurance. My son is currently on isoretinoin (Accutane generic) for systemic acne. Because of the severe side effects isoretinoin can have, they force you to come in for an office visit / check-in monthly, and only dole out the meds one month at a time (no refills). Thus far, we've received from our pharmacy prescriptions from three different manufacturers, ranging in price (to us, post insurance) from $7 to $120. Pre-insurance prices are in the $500-700/mo range. There seems to be no rhyme nor reason for these dramatic monthly fluctuations ... so if we can't even get something like this to be predictable and simple, what hope is there for treatments requiring complex care?

chkaloon 4y ago

Medicare for All would be great, at the prices being quoted by folks on here. But I bet your premiums and deductibles aren't covering your costs, especially at your age. Over 65 spending is around $18K per year. Average in the US is $7-12K across age groups and genders (depending on how it's counted). The problem with traditional fee-for-service Medicare is that there is no mechanism to reign in those costs - doctors get paid pretty much no matter what they order. So they order a lot. For Medicare Advantage, it's more a capitation model where the insurance co is paid per patient, and their incentive is supposed to be to keep the patient healthy and thus less costly. That's the theory. Incentives matter, and getting them right in healthcare is a messy task.

kevviiinn 4y ago
The issue with the medical system is that there are a whole bunch of middle men leeching cash out at every possible point. Medicare for all would be one step to cutting back on this waste