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Xceler8x
Xceler8x GRM+ Memberand UltraDork
5/7/12 12:28 p.m.
madmallard wrote: As i see it, NONE of the problems that people have can be effectively addressed until we as a population raise our collective intelligence to accept this: health insurance ≠ health care coverage The purpose of insurance is to mitigate risk, yet people have an expectation that all of these terms and items are the same or interchangeable. until that changes, we haven't correctly defined the parameters of the discussion :(

I think the problem here is that some folks, maybe most, don't have the disposable income to pay for preventative maintenance visits. That or they choose to spend that money on other things. This makes insurance more costly as instead of getting your cholesterol checked frequently Joe Schmoe waits for his heart to be 90% clogged and then it's a catastrophic cost along with catastrophic care. Ultimately, it's more cost efficient to pay for preventative maintenance than it is to pay for costly heart rebuilds. Therefore, health insurance then becomes health coverage.

We would be arguably healthier, as a society, if we had low to no cost clinics available to society as a whole. I'll bet most problems that develop into much larger ones could be handled earlier, and cheaper, than when problems are neglected/ignored. The "head in the sand" approach raises the cost of healthcare as much as the "hospital visit for a splinter" approach.

madmallard
madmallard HalfDork
5/7/12 12:33 p.m.

In reply to Xceler8x:

there is nothing wrong with this line of reasoning RIGHT UP UNTIL the expectation that health insurance should have anything to do with it.

Its NOT more cost effective for health insurance to offer mainentance coverage, they are required to by law in many states. its not a question of economical viability.

Thats why I as a single male with no expectation to be married anytime soon has prenatal care coverage that I can't opt out of.

Hello~~~~~~? How is that more cost efficient?

Ian F
Ian F UberDork
5/7/12 12:52 p.m.
madmallard wrote: Hello~~~~~~? How is that more cost efficient?

Because the money you pay helps pay for everyone who uses the system more than you have to...

Oh wait, you meant cost efficient for you...

The idea of a clinic is possible. There is one of those near work that I first went to when my kidney stone attacks first started and I didn't know what it was. Seems like a nice idea: more available services than a typical GP office, but not like a full-on hospital. Was a much lower bill than a typical ER, which I had to pay since I'm on a high deductible plan. Fortunately, I was a couple of years into my HSA at that point, so paying the bills wasn't a problem.

92CelicaHalfTrac
92CelicaHalfTrac MegaDork
5/7/12 1:17 p.m.
Ian F wrote:
madmallard wrote: Hello~~~~~~? How is that more cost efficient?
Because the money you pay helps pay for everyone who uses the system more than you have to... Oh wait, you meant cost efficient for you... The idea of a clinic is possible. There is one of those near work that I first went to when my kidney stone attacks first started and I didn't know what it was. Seems like a nice idea: more available services than a typical GP office, but not like a full-on hospital. Was a much lower bill than a typical ER, which I had to pay since I'm on a high deductible plan. Fortunately, I was a couple of years into my HSA at that point, so paying the bills wasn't a problem.

It's not cost efficient at all. As was pointed out earlier, "cash prices" for doctor visits are way cheaper than if insurance gets involved.

So... because these people are having insurance pay for their yearly "turn your head and cough, i'm going to fondle your testes," your insurance premiums are increased.

I've already made the car insurance vs. health insurance reference. That should really explain it.

madmallard
madmallard HalfDork
5/7/12 1:29 p.m.
Ian F wrote:
madmallard wrote: Hello~~~~~~? How is that more cost efficient?
Because the money you pay helps pay for everyone who uses the system more than you have to... Oh wait, you meant cost efficient for you...

If it were that simple, then there's a flaw in your remark:

i -can't- use the system. Not only biologically, but in most cases I still have to be married to have a mother of my child be able to consume that benefit.

Ian F
Ian F UberDork
5/7/12 1:40 p.m.
madmallard wrote: If it were that simple, then there's a flaw in your remark: i -can't- use the system. Not only biologically, but in most cases I still have to be married to have a mother of my child be able to consume that benefit.

That was my point.

madmallard
madmallard HalfDork
5/7/12 2:32 p.m.

In reply to Ian F:

Ah, i would have read it better if I just used Cereberus's voice in my head instead, then. :/

anyways, i fail to see how mandatory participation in any plan that someone can't actually participate in serves either a functional system, or any interpretation of 'fair.'

Even with mandatory liability car insurance, I'm still able to actually use it.

Xceler8x
Xceler8x GRM+ Memberand UltraDork
5/7/12 2:47 p.m.
madmallard wrote: In reply to Xceler8x: there is nothing wrong with this line of reasoning RIGHT UP UNTIL the expectation that health insurance should have anything to do with it. Its NOT more cost effective for health insurance to offer mainentance coverage, they are required to by law in many states. its not a question of economical viability. Thats why I as a single male with no expectation to be married anytime soon has prenatal care coverage that I can't opt out of. Hello~~~~~~? How is that more cost efficient?

I'm not justifying or saying it's right. I am saying that I believe this is how we've come to this.

You want to opt out of prenatal coverage? Seems a bit odd. But then again if you're having sex you're a broken condom away from needing that prenatal coverage. I'm not trying to curse you but it's something to keep in mind...when you're not having sex that is. Otherwise it's a boner killer.

madmallard wrote: anyways, i fail to see how mandatory participation in any plan that someone can't actually participate in serves either a functional system, or any interpretation of 'fair.'

Here's another way to think about...a bit like paying taxes for public schools. Even if you don't have kids educating those kids is in your best interest. It keeps them occupied with doing something besides breaking your windows. Once they are educated and working it helps them to make more money so they can pay more in taxes to support your old decrepit butt. In the short term it may seem like an expense that doesn't directly benefit you. In the long run it most certainly benefits you and society as a whole.

Zomby Woof
Zomby Woof UltraDork
5/7/12 3:47 p.m.

Come to Canada. We think like you.

So speaking of those wait times, I wanted to see my doctor last week. I called Monday, they asked me if Thursday was OK. It was. Doc suggested a ct scan. They called me today with my appointment. It's this Thursday.

m4ff3w
m4ff3w GRM+ Memberand SuperDork
5/7/12 3:53 p.m.
Zomby Woof wrote: Come to Canada. We think like you. So speaking of those wait times, I wanted to see my doctor last week. I called Monday, they asked me if Thursday was OK. It was. I am having occasional dizziness. Doc says let's get a ct scan just in case. They called me today with my appointment. It's this Thursday.

My wife noticed the abdominal bulge that led her to calling the doctor for this cyst on Wed evening. Called the Doc at Thursday at 9:00 when they opened, appointment was at 4:30 that afternoon. He said lets do a CT scan and we were at the imaging center that day as well.

fast_eddie_72
fast_eddie_72 SuperDork
5/7/12 3:56 p.m.

Lookie there. This debate is raging along just fine without me. Who'd-a-thunk?

Curmudgeon
Curmudgeon MegaDork
5/7/12 4:08 p.m.
m4ff3w wrote:
Zomby Woof wrote: Come to Canada. We think like you. So speaking of those wait times, I wanted to see my doctor last week. I called Monday, they asked me if Thursday was OK. It was. I am having occasional dizziness. Doc says let's get a ct scan just in case. They called me today with my appointment. It's this Thursday.
My wife noticed the abdominal bulge that led her to calling the doctor for this cyst on Wed evening. Called the Doc at Thursday at 9:00 when they opened, appointment was at 4:30 that afternoon. He said lets do a CT scan and we were at the imaging center that day as well.

Remember I mentioned the broken leg?

I showed up at the Doc in a Box at ~9:30 AM on a Monday, no appointment. I was in and seen within 30 minutes. They wrapped that damn $375 splint around my leg and sent me to the specialist who was 15 minutes away, by lunchtime I had a cast and was released. Along with a scrip for pain pills that I refused to fill because I do not like those things.

Health care down here might be out of control cost wise but it's damn sure fast.

Zomby Woof
Zomby Woof UltraDork
5/7/12 4:24 p.m.

In reply to m4ff3w:

If it was important, or I asked for it, I could get in sooner. Each time I was asked if the appointments were OK.

madmallard
madmallard HalfDork
5/7/12 5:55 p.m.
Xceler8x wrote: I'm not justifying or saying it's right. I am saying that I believe this is how we've come to this.

~i know~

You want to opt out of prenatal coverage? Seems a bit odd. But then again if you're having sex you're a broken condom away from needing that prenatal coverage. I'm not trying to curse you but it's something to keep in mind...when you're not having sex that is. Otherwise it's a boner killer.

But here's the deal: no i'm not. Most insurance policies do not cover prenatal care for unmarried, non-dependant women.

how stupid is that? If I sire children by 5 women, none of them could redeem this coverage if they weren't my wife or dependant?

Yet there is some kind of expectation that I opt in to this coverage?

What about a woman who has had her tubes tied? This is clearly not her problem anymore, and she is also required to pay for this 'benefit' she can never actually use.

What about an impotent man? A post menopausal woman? They also are forced to have this by proxy, because the government forces the insurance company to have this benefit in the first place.

and back to the MRI thing. Under general situations, an MRI is not a routinely used diagnostic tool unless something very specific calls for it to be used. You don't just expect to use an MRI once every couple of years or even a decade unless your doctor sees a need to diagnose something. An MRI to me is a risk-mitigated procedure that should be covered by insurance and usually is.

Getting an MRI is not something anyone in otherwise acceptable help is expected to partake in in this day and age.

and that shouldn't stop something like an MRI pool from forming; a group, a company or even a hospital chain trying to negotiate a bulk rate on a procedure cost. Thats how most companies negotiate insurance for their employees to begin with.

but many other compulsory coverages? Like prenatal?

gamby
gamby PowerDork
5/8/12 12:13 a.m.

I have good insurance (through my wife), but meanwhile, my cat has to get some teeth pulled (she started clawing at her mouth and grimacing after eating and it turns out her molars are rotted to the roots ) and the estimate is $500-$900, depending on how many need to be pulled.

Hooray...

Curmudgeon
Curmudgeon MegaDork
5/8/12 6:38 a.m.

MRI's: the first time I had kidney stones neither I or the docs had any idea of what was wrong. So they stuck me in the MRI which promptly had a nervous breakdown. (There's a joke in there somewhere...) They then used their old standby X ray machine to find the damn thing. The doc handled it like a complete idiot, but that's another story.

The point of all this: MRIs are overprescribed sort of like pills. It's a combination of 'we gotta pay for this freakin' thing so run as may people as possible through it' and gotta have the latest toy so the proletariat will know you are on the bleeding edge of medicine.

While on the subject of pills: Viruses are not affected by antibiotics. If you have a cold penicillin won't help for instance. I took my kid to a doc when she had really severe congestion (she has asthma, you can't play around with that) and he said she had basically a cold, then asked if I wanted an antibiotic. I looked at him funny and said 'Why? It won't work against a virus' and he said that 99% of his patients demanded an antibiotic even if he said that it would be useless. So he figured I wanted them, too. That's another example of the masses being conditoned that a pill will fix any damn thing and the pharmaceutical companies both bolster and take advantage of that.

Not to mention that we here in the US subsidize the rest of the world. Government controls keep the price of different medications down overseas. Here in the Great Satan there's no controls. That's why my kid's Advair is ~$70.00 in Canada and ~$220.00 down here.

92CelicaHalfTrac
92CelicaHalfTrac MegaDork
5/8/12 7:50 a.m.
madmallard wrote:
Xceler8x wrote: I'm not justifying or saying it's right. I am saying that I believe this is how we've come to this.
~i know~
You want to opt out of prenatal coverage? Seems a bit odd. But then again if you're having sex you're a broken condom away from needing that prenatal coverage. I'm not trying to curse you but it's something to keep in mind...when you're not having sex that is. Otherwise it's a boner killer.
But here's the deal: no i'm not. Most insurance policies do not cover prenatal care for unmarried, non-dependant women. how stupid is that? If I sire children by 5 women, none of them could redeem this coverage if they weren't my wife or dependant?

Not true.

Xceler8x
Xceler8x GRM+ Memberand UltraDork
5/8/12 9:06 a.m.
92CelicaHalfTrac wrote:
madmallard wrote:
You want to opt out of prenatal coverage? Seems a bit odd. But then again if you're having sex you're a broken condom away from needing that prenatal coverage. I'm not trying to curse you but it's something to keep in mind...when you're not having sex that is. Otherwise it's a boner killer.
But here's the deal: no i'm not. Most insurance policies do not cover prenatal care for unmarried, non-dependant women. how stupid is that? If I sire children by 5 women, none of them could redeem this coverage if they weren't my wife or dependant?
Not true.

I'm with BeefSup..I mean 92CelicaLaughTrac on this one. If this kid is yours, your insurance will cover it. That's one reason why you have prenatal care on your insurance plan. Also, your insurance plan will not be cheaper if you opt out of prenatal coverage. The coverage is there but not used until you need it. The cost of your health insurance takes into account many factors but it's not like buying a product at the drug store. You don't pay more because you're buying more product. You pay more according to your risk factors and projected use of product.

92CelicaHalfTrac
92CelicaHalfTrac MegaDork
5/8/12 9:09 a.m.

And just to head off any "what's your source?" questions ahead of time for anything i've said about what insurance companies cover and don't... i work for the nation's largest health insurance provider and have access to benefits for millions of accounts. I'm directly responsible for a certain portion of business across 1.4 million of them.

madmallard
madmallard HalfDork
5/8/12 11:37 a.m.

I'm happy for you, but thats anecdotal info just like me until you source it, you realise ;p And it may not be universally true, but it -is- a facet often times where state government mandate a certain type of coverage from an insurance company. Also, aside from that, all of my other examples stand %100~

Also, your insurance plan will not be cheaper if you opt out of prenatal coverage. The coverage is there but not used until you need it.

but there's 2 problems here with that. 1: asserting that has no impact on end user cost is something I just can't agree with, especially considering those people I listed are being forced to bear to financial consequences of the state laws on the insurance company as well as the choices of other people's lives -and- being unable to draw a benefit from it... and . And 2: its still trying to treat something with insurance that shouldn't be.

Despite most panick stricken accounts to the contrary, becoming pregnant or getting a woman pregnant is not an unexpected occurrence, short of a crime being comitted, that can't be successfully prevented with a %100 success rate based on your lifestyle choices. Insurance is SUPPOSED to exist to mitigate unexpected risk.... but then we lump all of these care expectations on top of treatment expectations and wonder why insurance costs so much money without being honest and truthful with ourselves that just maybe, between all the laws we pass on insurance companies, and the misunderstanding and lack of knowledge how ins co's make money, and our emotional prejudices revolving around being healthy do in fact reflect more of the reality of cost than not? The problem I have with most commentary is that it runs along the lines of "it shouldn't cost this much,' to which i ask "what do you base that on?" and get nothing but emotional appeals. For another example, most people don't realise this:

MRIs are ...a combination of 'we gotta pay for this freakin' thing so run as may people as possible through it' and gotta have the latest toy so the proletariat will know you are on the bleeding edge of medicine.

While there's some truth to that last part, the first part of 'we gotta pay for this thing' is off the mark. Believe it or not, the medical diagnostic industry is alot more like the manufacturing industry than it is the health care industry.

You know how a hydro-jet, stamper, or any number of specialty equipment, you can't own it & you actually lease it? Most complicated medical gear is like that too. They have their own 'odometer' of sorts to track its use, and depending on your lease terms, you pay for the operation of the equipment. Most companies have a proprietary interest in never selling their gear, and a financial interest in knowing EXACTLY how much their clientelle uses their gear.

So a hospital doesn't make money off of you having an MRI done just because its there, the only thing they make money on in the procedure is the labor of the professional who does the test. They pretty much only break even on the equipment use of the leased MRI machine in most cases.

Basically, I want more people to become more personally invested in their own health care before I hear a commentary from them on what it should cover for other people. (Most people I get into this about can't tell me how much they pay for their own care or even insurance rates annually.) Then, like Beef, I want more people to understand what insurance actually is vs what they just -feel- it should be.

92CelicaHalfTrac
92CelicaHalfTrac MegaDork
5/8/12 11:41 a.m.

I can't really legally source it... That would be a breach of HIPAA regulations.

Either way, there are no states that mandate that a single mom cannot have prenatal care, or their baby cannot have care.

I should say at this point that i agree with your overall points/stance, just that some of the examples have been wonky. (And you're not the only one.) There's misconceptions out there by many people as to what's normal for insurance to cover/exclude, and what's not.

madmallard
madmallard HalfDork
5/8/12 12:22 p.m.

i knew you couldnt just because if what you said is true you couldnt. I work in insurance services, so I'm kinda in the same boat. -_-

But even tho this(and cash health care costs) are a serious concern, i think i'm even more worried about the state of physical fitness and obesity in the western hemisphere...

92CelicaHalfTrac
92CelicaHalfTrac MegaDork
5/8/12 12:26 p.m.
madmallard wrote: i knew you couldnt just because if what you said is true you couldnt. I work in insurance services, so I'm kinda in the same boat. -_- But even tho this(and cash health care costs) are a serious concern, i think i'm even more worried about the state of physical fitness and obesity in the western hemisphere...

Preach it, brother!!!

Duke
Duke UberDork
5/8/12 12:35 p.m.
92CelicaHalfTrac wrote: Either way, there are no states that mandate that a single mom cannot have prenatal care, or their baby cannot have care.

I don't really think that's what he was saying, at all.

92CelicaHalfTrac
92CelicaHalfTrac MegaDork
5/8/12 12:38 p.m.

In Reply to Duke:

That was a follow up to the below.

92CelicaHalfTrac wrote:
madmallard wrote:
Xceler8x wrote: I'm not justifying or saying it's right. I am saying that I believe this is how we've come to this.
~i know~
You want to opt out of prenatal coverage? Seems a bit odd. But then again if you're having sex you're a broken condom away from needing that prenatal coverage. I'm not trying to curse you but it's something to keep in mind...when you're not having sex that is. Otherwise it's a boner killer.
But here's the deal: no i'm not. Most insurance policies do not cover prenatal care for unmarried, non-dependant women. how stupid is that? If I sire children by 5 women, none of them could redeem this coverage if they weren't my wife or dependant?
Not true.
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