Name:	Talullahhound -	Reply
Subject:	Healthcare question
Date:	10/7/2016 11:52:19 AM

With all the discussion about the inadequacies of the ACA, I started thinking about what would good health insurance look like?

In the interest of full disclosue, I am covered by what some people think is the "gold-plated" health insurance available to current and former federal employees. (the premiums are going up on average 6.2% next year).  It is affordable, and it provides reasonable coverage for basic health care services.  My deductible is $375.  But it gets complicated by in-network Drs., versus out of network Drs., and for the most part, every year it pays a little less than the going rate for medical procedures, and the rates go up every year.

1.  How much would be a reasonable cost a month for health insurance?  What would be a reasonable deduction? 

2.  What would it cover?  Pre-existing conditions, catastrophic illness, specialists?  Would it have a cap on these costs? 

3.  Who would provide it?  Your employer?  Would you buy it yourself?  Could groups be created for insurance purchases?

You get the idea.  Anyone want to think this out and provide some thoughts?

Name:	copperline -	Reply
Subject:	Healthcare question
Date:	10/7/2016 2:05:31 PM

1.         Setting a reasonable cost per month for health insurance would be hard, especially since the cost would mean different things to people depending on their financial situation.   Deductibles have a different purpose… they are used by insurance companies to keep people from over-utilizing their benefits… by “increasing the skin they have in the game”.   An annual deductible in the $1000-2000 ballpark seems reasonable, but $6000 per year seems excessive to me.
2.        There should be no restrictions like life-time maximums, pre-existing condition exclusions, or access to specialist care.  At some point in the continuum of care, gatekeepers may be needed to determine if/when specialist care is warranted by the patient’s condition.     In all cases you have to ask “why would you want to take insured healthcare away from people when they need it the most?”   Besides that, when someone ‘runs out of insurance’, they don’t stop needing treatment… they have to let their conditions worsen (and become more expensive to treat) and go to Emergency Rooms (where the cost of care is much higher than an MD office).
3.        Providing insurance thru employers is a flawed system.   Allowing people to purchase insurance by forming their own ‘insurance pools’ (think the government insurance exchanges), allows people to change jobs without interruptions of coverage, removes the burden of managing health insurance from employers, and allows coverage for people who are not working but not disabled.  (Think stay-at-home Moms, self-employed workers, or retirees).
4. A national single payer system (like Medicare) would ease the administrative burdens of health care providers and reduce their operational costs... right now, if 10 patients came into a doctor's office, they may have 10 different insurance plans with different forms, different procedures for requesting payment, different payment rates for procedures.   These billing differences are not minor, and billings that are not exactly what an insurer wants to see is reason for denial of payment.   For instance, a form may not be accepted if it is filled out by hand, in the wrong color ink, or the insurer rejects the procedure coding used.   Insurance companies use the variation in their billing procedures routinely to deny payments, costing either the provider who has to appeal & refile, or the patient who gets stuck.   A standardized billing procedure under a single payer would eliminate a lot of that needless complexity.

Federal retirees have a spectacularly generous healthcare plan compared to most everyone else.   Better hope that the spotlight never shines on this benefit and people start looking at this as one of those over-the-top federal giveaways.......

Name:	Talullahhound -	Reply
Subject:	Healthcare question
Date:	10/7/2016 5:16:24 PM

It is not an over the top giveaway.  The only real benefit I get is to stay in the group after I retired, but I have to pay the full cost of my health insurance, i.e., it is not subsidized by the government.  The premiums stay low, because the population of the group is so large.  to realize any savings, I have to stay with the network drs., the network hospitals. And some procedures they pay a very low amount so my copayment is really high.  And the will not pay for bloodwork.  Whenever I have to get a blood test, I will get a bill for $150 and that is just the basic screen. I'm waiting to see now if they will pay for Braca genome testing.

I know a lot gets written about it, but most of what you read is not correct.  And for years, this is the same insurance that Congress had. The only additional benefit they got was access to military hospitals (particularly Bethesda) and they had a free clinic in the Capitol.  the insurance is not free at all.

Name:	Classified -	Reply
Subject:	Healthcare question
Date:	10/7/2016 5:45:59 PM

Any plan administered by the government would be costly and filled with fraud, just like Social Security and Medicare are now.

The government is not as good at running healthcare like say BCBS and other companies that know how to assess and control costs.

A great example of how bad things have gotten is as follows:  A friend of mine had a heart attack, was taken to the hospital, had a stint put in to resolve the blockage, only stayed in the hospital overnight.  He was only given a local for insertion of the stint.  His part of the bill was over $25,000.  His employer told him that if this had occurred before the ACA, his part would have been around 10%, I think the estimate was $2650.

The ACA is ridiculous.  He might have been better off not having any insurance in which case Medicaid would have paid all or most of it.

Name:	Lifer -	Reply
Subject:	Healthcare question
Date:	10/7/2016 5:53:31 PM

In Alabama Noone who has more than $700 some odd dollars qualifies for medicaid. Not sure on financial limits of other states.

Name:	Classified -	Reply
Subject:	Healthcare question
Date:	10/7/2016 6:01:58 PM

You just helped me make my point...........thanks.

Name:	Lifer -	Reply
Subject:	Healthcare question
Date:	10/7/2016 6:34:44 PM

Not sure how but your welcome.

Name:	Lifer -	Reply
Subject:	Healthcare question
Date:	10/8/2016 11:19:34 AM

Personally I think health insurance should be for long term and catastrophic care only.  Other than that if we went to a direct pay system share consumers were responsible for the full cost of their treatment without cost shifting prices would drop precipitously. No more $70 aspirins and such.  Full detailed billing with reasonable margins.  I think if folks k ew they had to pay directly they would shop for what they could afford. Third party payers is what has run up the cost exponentially. With today's pricing this seems undoable but once the insurance companies are out of the picture the free market will adjust to what can be afforded by the masses. I realize this is totally unrealistic in today's world, but we are talking fantasy utopia here.

I once had occasion to see a detailed billing from a hospital stay at UAB years ago. I was amazed at some of the things I found. Several instances of treatments, procedures and meds I never received totalling a couple of thousand dollars.  I contacted the insurance company to dispute the claims. They didn't care. One rep finally asked me why I cared so much because I wasn't paying it they were.  I was trying to look out for the interest of my employers and protect the rates we paid.  They just didn't care. Ironically there was a charge of $165 they refused to pay.  The charge was for insertion of a breathing tube when I died (I'm much better now though... Lol). The reason for the denial is the clinical note was signed by a nurse and this is the and not an MD. To the best of my recollection before I died there were 5 or 6 doctors and several nurses, and even one housekeeper, in the room at the time. I contacted UAB to see if they would resubmitted the charge with and MD's signature but they refused. After several frustrating phone calls I gave up. I did however refuse to pay pointing they were still several thousand to the good with erroneous charges that did get paid. That collection stayed on my credit for a while. I had to write a letter of explanation  when I applied for a mortgage because I still refused to pay it.

As I I have stated several times I am a much higher than average consumer of health care goods and services. It gives me a different perspective on the whole issue than the average consumer. I don't know an absolute solution but I do know single payer and more government intrusion  is NOT the answer.

Name:	Talullahhound -	Reply
Subject:	Healthcare question
Date:	10/8/2016 3:18:50 PM

You really do have to scrutinize bills, because you will find charges for Drs. that perhaps walked past your door, and a lot of tests/procedures that you didn't have. When you call them on it, they will usually claim it was a billing error due to miscoding.  I remember when my mother was ill with a chronic illness that eventually took her life.  As you say, she was a better than average health care consumer.  He scrutinzed her bills and was constantly on the phone with the insurance company.  When she died during surgery, he refused to allowt them to bill for the entire surgery - which was $69,000 (this was almost 20 years ago).  He insisted that they reduce it since she died in the middle of surgery.  And then there was an unknown Dr. who contiually billed him for $7.98.  He refused to pay it because it wasn't a Dr. that was part of her care team.  That dr. continued to bill him for 4 months, then startd sending threatening notices.  He finally called the Dr. and they waiverd the bill.

I also check my billing statements, because I have found charges for office visits and blood work I did not have.  It's always written off as a coding error, but I really wonder if Drs sometimes misbill someone with good insurance  for people that can't pay.  I could live with that better than just being mischarged. 

The big problem with single payer would be the government would contract the execution out to a contractor and totally lose control. In my insurance program, the government negotiates with the various insurance providers (there is a choice of about 25 providers, all with different charges and coverage) and has leverage becasue of the large base.  Individuals trying to get insurance for themselves have no leverage at all.