Health Care Law is a tax

oldtin wrote: Generally cash paying patients get the highest rate (unless they ask for a break - most people don't think to do this) - insurers get a contracted/discount rate, medicare - pays whatever they pay and medicaid doesn't actually send the money.

No, generally cash payers get a big break. See people, even doctors, like to actually get paid. Insurance doesn't pay out for months while people deliberate on how much they are actually willing to pay. When you pay cash you don't pay for all the BS and overhead that comes with middle men.

I don't have insurance. I don't need it. I pay cash and have always paid way less for the same service. Insurers don't get discounted rates they get more costly rates to make up for the deadbeat government that doesn't pay full price ever.

fromeast2west wrote: We also have a pretty convoluted method for funding medical research. Only about one in ten drugs under development actually makes it to market, and it takes years for all the testing to complete. Even after a drug is released, if it's successful, there is still a huge potential liability if it doesn't work quite as well as hoped or it has a undiscovered side effect. So there is a huge risk for investors, who in turn require huge potential rewards. So while a pill may only take 1$ to produce, you have to cover the millions of development costs, plus enough to cover the failed development of 9 other potential products, plus enough to hedge future liability, plus enough to pay investors a return. Now lets say you make a great drug that will save the lives of people with a rare disease. You may only have 1,000 potential customers a year. So the price those 1,000 people actually have to pay for those 1$ pills is going to be huge. We can't charge much in other countries because we have to deal with their health care systems; so the US consumers foot the bill for the bulk of the cost. The rest of the world pays a reduced price, or just copies the drug in a generic form and sells it for something close to that 1$ production price. We could help lower the costs by reducing the liability portion (although US consumers hate to believe that any drug could have side effects, and love big pay outs). We could try to make other countries pay more (good luck), or we could cut the prices we pay and medical research would slow down. (or we could pay more public funding, but there you're up against the same argument as publicly funded health care)

And then....

Your patent runs out, the next company starts producing the very same drug, and advertises the E36 M3 out of it to generate sales, and lumps the advertising costs into the costs, and voila! $50/pill for something that cost that company $0.25 to make with no developmental costs.

ThePhranc wrote:

oldtin wrote: Generally cash paying patients get the highest rate (unless they ask for a break - most people don't think to do this) - insurers get a contracted/discount rate, medicare - pays whatever they pay and medicaid doesn't actually send the money.

No, generally cash payers get a big break. See people, even doctors, like to actually get paid. Insurance doesn't pay out for months while people deliberate on how much they are actually willing to pay. When you pay cash you don't pay for all the BS and overhead that comes with middle men. I don't have insurance. I don't need it. I pay cash and have always paid way less for the same service. Insurers don't get discounted rates they get more costly rates to make up for the deadbeat government that doesn't pay full price ever.

Insurers DO get discounted rates, but not directly from the provider. The provider bills the hideously inflated charge because that's the charge they used as a bargaining chip when negotiating for the rates insurance will pay on during their network agreement.

Then they write off a big chunk of it when insurance applies their contracted negotiated rate.

What they're doing when they give you a discount just because you're paying in cash is one of those things that makes Provider Relations gnash their teeth because it's not really "ethical" since it proves that the huge prices they throw out during negotiations are pretty much bullE36 M3.

That being said, the way these rates are arrived at, all parties are at fault, including insurance.

ThePhranc wrote:

oldtin wrote: Generally cash paying patients get the highest rate (unless they ask for a break - most people don't think to do this) - insurers get a contracted/discount rate, medicare - pays whatever they pay and medicaid doesn't actually send the money.

No, generally cash payers get a big break. See people, even doctors, like to actually get paid. Insurance doesn't pay out for months while people deliberate on how much they are actually willing to pay. When you pay cash you don't pay for all the BS and overhead that comes with middle men. I don't have insurance. I don't need it. I pay cash and have always paid way less for the same service. Insurers don't get discounted rates they get more costly rates to make up for the deadbeat government that doesn't pay full price ever.

Interesting - been in insurance and healthcare for 25 years - your experience is definitely not what I've seen as the norm - glad it works for you and wish you good health. I've seen too many financial disasters to go without - puts more risk on my family than I'm willing to accept with how things are now.

bravenrace wrote: So why do all the rich people in other parts of the world come here for major medical care?

I don't think that happens as often as people think. And even if it does, the answer is likely "because you get the medical care you can afford here." Does that mean you or I are going to get great medical care when you waltz into County General with our Advanta major medical card? Hell no. It means if you waltz into St God's Ultra Premium Facility for the Rich and Sick and promise an enormous donation to their hospital they shove you to the front of the line and miracle up a kidney from South Kackalacky to transplant. They can't get service like that in the UK because it's illegal - kind of like you can't (as easily) get out of a reckless op ticket here versus, say, Honduras.

So this is actually one way in which "rich people come here for x" is not a good thing. Rich people might go to Thailand for young tail and blow but that doesn't mean we should be emulating Thailand.

oldtin wrote:

ThePhranc wrote:

oldtin wrote: Generally cash paying patients get the highest rate (unless they ask for a break - most people don't think to do this) - insurers get a contracted/discount rate, medicare - pays whatever they pay and medicaid doesn't actually send the money.

No, generally cash payers get a big break. See people, even doctors, like to actually get paid. Insurance doesn't pay out for months while people deliberate on how much they are actually willing to pay. When you pay cash you don't pay for all the BS and overhead that comes with middle men. I don't have insurance. I don't need it. I pay cash and have always paid way less for the same service. Insurers don't get discounted rates they get more costly rates to make up for the deadbeat government that doesn't pay full price ever.

Interesting - been in insurance and healthcare for 25 years - your experience is definitely not what I've seen as the norm - glad it works for you and wish you good health. I've seen too many financial disasters to go without - puts more risk on my family than I'm willing to accept with how things are now.

Well, what he's doing is paying less than billed charge because he's settling on the spot. It's actually become pretty common.

However, it's probably only working because he's largely healthy and the biggest difference is coming from that he's not paying the insurance premiums.

If he had enough medical costs to fulfill a normal deductible on your run of the mill insurance plan, it'd be a different tune.

Myself, i've been to the doctor maybe once in the last 5 years. I could probably get away with no insurance and it WOULD save me money. However, i carry an HRA plan for that "just in case," because i've SEEN what a $5,000,000 claim looks like, and it would take me several lifetimes to see that same amount in savings vs. just paying my low premium for an HRA.

dculberson wrote: It means if you waltz into St God's Ultra Premium Facility for the Rich and Sick and promise an enormous donation to their hospital they shove you to the front of the line and miracle up a kidney from South Kackalacky to transplant. Rich people might go to Thailand for young tail and blow but that doesn't mean we should be emulating Thailand.

I laughed.

ThePhranc wrote: $1500 MRI? I just had one and it was only $200. Next time you people go to see a Doctor ask him what he would charge if you paid him in cash.

Yup.

True story: I got Strep on Father's Day last year. I went to the doctor and said "My throat hurts really bad and I have a fever. I think I have Strep." They did the swab (which they didn't charge me for because I was paying cash,) and sure enough I had strep. Saw the actual doctor for all of 5 seconds. I think the doctor's visit was $60. May have been $80, plus the $4 prescription of life saving antibiotics.

Father's Day THIS YEAR. I have a family member who has cancer and is on Medicaid. She is getting treated like a berkeleying rock star. I get a call from her boyfriend at 1AM because she has a fever and he is taking her to the ER. I go to the ER and say "How ya feelin?" She says "All fevery and my throat hurts really bad."

Dr. Poop sez "Hmmm. Fever + Sore throat. You probably have strep."

No berkeleying joke. We were there for 3 1/2 hours. They did xrays. They gave her a shot (don't remember what of - WAS NOT antibiotics,) some thing she had to put under her tongue that tasted really bad (come to think of it, I think one was for pain, and one was for nausea,) they did a urnalysis AND bloodwork, and I was in the room when the doctor said "We can't find anything wrong with you. Your fever is coming down. Go home."

I asked the Doc. if he ever looked at her throat. Annoyed, he grabbed the little flashlight deal and said "It looks a little red."

She went to her berkeleying oncologist the next day...who DID A berkeleyING STREP TEST. Sure enough. Strep.

So: Cash patient Poop pays $64. My "sis" pays $0. Taxpayers pay, I dunno, what do you guys figure between the xrays, tests, and oncologist? $3,000 to $5,000 for NO DIAGNOSIS OR TREATMENT!?

Yeah. Medicaid's great. We probably just need to throw more of my goddamned money at the problem.

Gearheadotaku wrote:

Knurled wrote:

ThePhranc wrote: The government now has the power to force people to buy things if they want it or not.

Does your state require you to have auto insurance?

do they require you to own a car?

Given the way cities are designed, yes, it does, assuming I want to have things like "a job".

92CelicaHalfTrac wrote: Even though the government just made a health insurance mandate under the guise of "health care," (It's not. Has nothing to do with health care.) the cost to the consumer probably won't decrease. If anything, you'll see a slight increase as the risk pool has just got deeper.

IIRC, the reason for the mandate was because healthy young adults opt to not get health insurance, figuring that they don't need it yet.

I will admit to having been one of these people. Yes, I feel bad. Yes, I have health insurance now. (No, I didn't get it because I suddenly needed it)

After reading through this and thinking about this...my head hurts.
Oh damn! That'll cost me.

vwcorvette wrote: After reading through this and thinking about this...my head hurts. Oh damn! That'll cost me.

I'm pretty sure healthcare is free now, as long as you own a Chevy Cr000zv0lt.

92CelicaHalfTrac wrote:

ThePhranc wrote:

oldtin wrote: Generally cash paying patients get the highest rate (unless they ask for a break - most people don't think to do this) - insurers get a contracted/discount rate, medicare - pays whatever they pay and medicaid doesn't actually send the money.

No, generally cash payers get a big break. See people, even doctors, like to actually get paid. Insurance doesn't pay out for months while people deliberate on how much they are actually willing to pay. When you pay cash you don't pay for all the BS and overhead that comes with middle men. I don't have insurance. I don't need it. I pay cash and have always paid way less for the same service. Insurers don't get discounted rates they get more costly rates to make up for the deadbeat government that doesn't pay full price ever.

Insurers DO get discounted rates, but not directly from the provider. The provider bills the hideously inflated charge because that's the charge they used as a bargaining chip when negotiating for the rates insurance will pay on during their network agreement. Then they write off a big chunk of it when insurance applies their contracted negotiated rate. What they're doing when they give you a discount just because you're paying in cash is one of those things that makes Provider Relations gnash their teeth because it's not really "ethical" since it proves that the huge prices they throw out during negotiations are pretty much bullE36 M3. That being said, the way these rates are arrived at, all parties are at fault, including insurance.

That discount isn't really a discount when the negotiations start at an inflated rate. Its like the buy 3 get one free tire sales where you are still paying for that 4th tire in the price of the first three.

ThePhranc wrote:

92CelicaHalfTrac wrote:

ThePhranc wrote:

oldtin wrote: Generally cash paying patients get the highest rate (unless they ask for a break - most people don't think to do this) - insurers get a contracted/discount rate, medicare - pays whatever they pay and medicaid doesn't actually send the money.

No, generally cash payers get a big break. See people, even doctors, like to actually get paid. Insurance doesn't pay out for months while people deliberate on how much they are actually willing to pay. When you pay cash you don't pay for all the BS and overhead that comes with middle men. I don't have insurance. I don't need it. I pay cash and have always paid way less for the same service. Insurers don't get discounted rates they get more costly rates to make up for the deadbeat government that doesn't pay full price ever.

Insurers DO get discounted rates, but not directly from the provider. The provider bills the hideously inflated charge because that's the charge they used as a bargaining chip when negotiating for the rates insurance will pay on during their network agreement. Then they write off a big chunk of it when insurance applies their contracted negotiated rate. What they're doing when they give you a discount just because you're paying in cash is one of those things that makes Provider Relations gnash their teeth because it's not really "ethical" since it proves that the huge prices they throw out during negotiations are pretty much bullE36 M3. That being said, the way these rates are arrived at, all parties are at fault, including insurance.

That discount isn't really a discount when the negotiations start at an inflated rate. Its like the buy 3 get one free tire sales where you are still paying for that 4th tire in the price of the first three.

Agreed. But this is why you also aren't truly getting a discounted rate.

The original rate is the same one they gave the insurance company for negotiations. They're just hoping you're dumb enough to pay it.

You aren't paying less than the negotiated rate when you pay cash. All you're getting is the "insurance" rate, and they're getting paid without waiting.

not sure how this will affect me ... so many of the parts are going to be phased in over "x" amount of yrs .... I'm 63 .. will be leaving/loosing my job later this yr, early next yr .... so far the best ins option for me is COBRA ... (anyone priced that lately ? ) NC's at risk program is more expensive ... ~ $10,000 / yr ( almost $500 / mo and $5000 deductible ) = $10,000+ whereas COBRA ( for 18 mo ) would be $550 / mo and $500 deductible ...

so like I said ... not sure how this will help/not help me .. oh well ... wait and see

Knurled wrote:

Gearheadotaku wrote:

Knurled wrote:

ThePhranc wrote: The government now has the power to force people to buy things if they want it or not.

Does your state require you to have auto insurance?

do they require you to own a car?

Given the way cities are designed, yes, it does, assuming I want to have things like "a job".

Its a good idea to get a car and have a job but the feds aren't telling you to do it.

Health care is berkeleyed, but making more people pay into a system that is berkeleyed is like putting more holes in a sinking boat.

The system is mostly berkeleyed.

Having people opt out of the system doesn't actually prevent them from impacting the system, or how the system in turn impacts those who didn't opt out.

One thing I'm curious about is how putting everybody in one boat will affect attempts to rectify that boat (if at all).

At least a COUPLE good things got thrown in there.
Medicaid is a little easier to qualify for now, and for incomes up to 400% of the poverty level, insurance rates will be on a sliding scale, so they can't berkeley you too hard from that direction.
I'm still ready to move to Australia or Canada at a moment's notice, though.

poopshovel wrote:

vwcorvette wrote: After reading through this and thinking about this...my head hurts. Oh damn! That'll cost me.

I'm pretty sure healthcare is free now, as long as you own a Chevy Cr000zv0lt.

well now that your a strep DR maybe you can step up to a Crosstour.

wbjones wrote: not sure how this will affect me ... so many of the parts are going to be phased in over "x" amount of yrs .... I'm 63 .. will be leaving/loosing my job later this yr, early next yr .... so far the best ins option for me is COBRA ... (anyone priced that lately ? ) NC's at risk program is more expensive ... ~ $10,000 / yr ( almost $500 / mo and $5000 deductible ) = $10,000+ whereas COBRA ( for 18 mo ) would be $550 / mo and $500 deductible ... so like I said ... not sure how this will help/not help me .. oh well ... wait and see

Cobra is insanely expensive.
I was actually going to get health insurance at the most recent open enrollment, because they had decent rates. THEN they decided to switch to BCBS Florida. We are in NC.
BCBSFL, the cheapest plan, for my wife and I, is $83 a week. I only make 330 a week here. That cheap plan requires a $5000 deductible to be met for ER visits, generics are cheaper WITHOUT using insurance than with, etc etc.
IT's pretty damn ridiculous.
Before they had much better terms and it would have been $34 a week instead...

corytate wrote: Cobra is insanely expensive.

Yeah, because you pick up the full tab instead of your employer paying a large %

SyntheticBlinkerFluid wrote: Haha people are Saying they're moving to Canada because of Obamacare.

I don't really understand this statement... care to expand?

Our healthcare costs per person, spread over a lower population density, are cheaper than yours. "Health care insurance" up here is basically provided to anyone with a full-time job, doesn't matter if you are earning minimum wage at some dinky little corner-store. Purchasing your own health car is super affordable (for instance, in Alberta, Alberta Blue Cross is an independent, not for profit organization that provides health care insurance). I don't think it would be $4000 a year for 2 adults and 2 kids, but I can't say that with 100% certainty. Of course, in Alberta, two adults bringing in minimum wage is $18/h gross, and that is a low enough combined wage you don't pay taxes. That's $40k of net income essentially. Running through expenses, it'd be tight, but that household could live a "comfortable" but lean lifestyle, even with $4k per year in health insurance.

You might say "well, you are taxed more up there" to cover additional costs of the system... it's been shown that ON AVERAGE, taxes in Canada on an individual aren't much different than in the US.

https://www.ab.bluecross.ca/

oldtin wrote: then again, we're a free market system so people should have the right to promote their service....

No you're not, so no they shouldn't, that's lala land fairy tale BS. At least pull your head out of the sand to realize that. I personally believe that systems that basically require an opt-in (such as car insurance, because as others said, driving in 95% of either of our countries is essentially mandatory) or in this case, health insurance (as everyone has the chance of getting sick and it affecting other individuals) should be ran in a not for profit setting. What's interesting is that being a not-for-profit industry does not take away from earning people money, it takes away from earning INVESTORS money.

Public auto insurance (available in many provinces EXCEPT Alberta) is typically cheaper and earns money for the governments implementing them because the desire is not to use it as a cash cow (which insurance in the automotive industry is, as it is basically mandatory, so insurance companies can charge whatever they want to meet their % corporate contributions and nobody can do anything about it).

HiTempguy wrote:

SyntheticBlinkerFluid wrote: Haha people are Saying they're moving to Canada because of Obamacare.

I don't really understand this statement... care to expand? Our healthcare costs per person, spread over a lower population density, are cheaper than yours. "Health care insurance" up here is basically provided to anyone with a full-time job, doesn't matter if you are earning minimum wage at some dinky little corner-store. Purchasing your own health car is super affordable (for instance, in Alberta, Alberta Blue Cross is an independent, not for profit organization that provides health care insurance). I don't think it would be $4000 a year for 2 adults and 2 kids, but I can't say that with 100% certainty. Of course, in Alberta, two adults bringing in minimum wage is $18/h gross, and that is a low enough combined wage you don't pay taxes. That's $40k of net income essentially. Running through expenses, it'd be tight, but that household could live a "comfortable" but lean lifestyle, even with $4k per year in health insurance.

Holy E36 M3. If i brought in $40k/yr net here, i'd be living like a king. Luckily, i don't pay anywhere near $4000/yr for health insurance for two people.

Anyways, i think the point was merely that he found it amusing that people were saying they were going to move to Canada for something that likely won't affect most people in a negative manner, and if so, certainly not enough to want to defect over it. Basically laughing at the overreactions.

HiTempguy wrote:

oldtin wrote: then again, we're a free market system so people should have the right to promote their service....

No you're not, so no they shouldn't, that's lala land fairy tale BS. At least pull your head out of the sand to realize that. I personally believe that systems that basically require an opt-in (such as car insurance, because as others said, driving in 95% of either of our countries is essentially mandatory) or in this case, health insurance (as everyone has the chance of getting sick and it affecting other individuals) should be ran in a not for profit setting. What's interesting is that being a not-for-profit industry does not take away from earning people money, it takes away from earning INVESTORS money. Public auto insurance (available in many provinces EXCEPT Alberta) is typically cheaper and earns money for the governments implementing them because the desire is not to use it as a cash cow (which insurance in the automotive industry is, as it is basically mandatory, so insurance companies can charge whatever they want to meet their % corporate contributions and nobody can do anything about it).

Perhaps not a perfect free market, but companies/individuals can invest/get a return on healthcare services from private practice to hospital systems, equipment manufacturers, home health services.... How things" should" be vs what they are...two different animals. As far as non-profit, don't be fooled by the label - at least here, that is a tax status designation with no bearing on whether an entity earns a profit (called reserves in non-profit world) or can find a way to host investors. The underlying debate is more about what kind of country we are shaping - the extremes are no govt vs big brother...

Okay, I tried this on another forum and it quickly devolved into stupidity, but I have higher expectations from this crowd.

How do we fix healthcare?

Without reciting a political talking point, I want to know what it will take to fix this overpriced system we have, regardless if it's government run or not. Make your argument; bring the tech. I've developed a theory of my own, but I'll shelve it for the time being to see what you all come up with. Sell it. And if you disagree with an idea, don't dismiss it with a snarky comment; explain WHY it won't work.