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  #21  
Old 25 June 2017, 16:51
Steve83 Steve83 is offline
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Originally Posted by Steve40th View Post
I just paid 68 dollars for two pills similar to Valium for my daughters dental surgery. WTH.
Looking for a single villain is impossible, a task where'd we get lost in the minutia of the bureaucracy.

In the case of the above, this is another example of the consumer being separated from the bill and the resulting departure of market forces. In this case, formularies:

https://www.nerdwallet.com/blog/heal...prescriptions/

This to me is more evidence that insurance needs to play an ever-diminishing role in healthcare.
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  #22  
Old 2 July 2017, 09:29
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Originally Posted by btq96r View Post
These two are incompatible. Medicare and Medicaid distort the free market aspect of healthcare completely. From the rates for each procedure (CPT Code), to the associated value units for them (RVU's) the commercial companies then use that as a baseline measure for their own costs instead of letting any kind of market based drivers (like supply and demand) set the prices.

Put simply, if the govt pays x for a procedure, and it has y RVU's, your insurance has negotiated rates with the providers that accept them at rates either as a percentage of that rate, or based on the RVU's for such with a modifier. The cost of healthcare in the commercial market starts in government, so if we aren't cutting of Medicare and Medicaid at some point, we're just going to deal with the mess it creates on the commercial size.

This is all going to be interesting as a law virtually unknown outside of the medical provider industry comes into effect where Medicare doctors are going to be graded on a bell curve against others with their Medicare reimbursements going up or down based on how they come out. This will all be done as Medicare is locked into a near zero growth rate until 2025.
Agree. I didn't express myself adequately. And I don't have the best answer on how to fix it other than what I previously stated and am going to say after this. If I was THAT smart I'd be running the world.

Fraud needs to be aggressively rooted out so those who are truly on the poverty level or below it can use Medicare & Medicaid. I really don't mind my tax dollars going toward these programs but there needs to be very strict oversight to weed out all but those who have a real need for it.

Fraud has run rampart for so long that these programs are bloated to the max and virtually bankrupt having consequences for those who are truly in need.

I'd support mandatory drug tests for recipients. Also criminal prosecution for the cheats, the lazy people (able bodied both physical and mental). Plus those who can really work need to get to work and pay for their own insurance rather than being in these entitlement programs. Other things I would support are radical such as "sorry you don't get to be on the taxpayer's dime and have kid after kid after kid." If you want to be nuts like the Duggars and have one child after another then pay for your own insurance.

And any non-US citizen shouldn't receive benefits from food stamps, Medicare, Medicare, and Pell grants (and yes I personally know of one non-citizen receiving a Pell grant) etc. etc. etc. If you're not a US citizen you shouldn't be eligible for ANY government assistance. Period.

For that matter I believe no one is entitled to insurance. It's a luxury not something you feel is owed to you because it's not and nowhere in the Constitution does it say otherwise. People should be expected to pay their own way unless you truly have significant medical problems which prevent you from working and paying your own way.

No easy answer but total repeal of Obamacare is a good place to start then taking those like I mentioned above out of the programs and then really tightening up eligibility for current and future Medicaid and Medicare reciepents. There needs to be severe legal penalties for fraudulent claims and I mean criminal charges.

And I still see the need for there to be guidelines for all the states because Medicaid varies so drastically from state to state. I know it's "jointly" funded between the federal government but each individual state manages what is covered and what isn't. Some states like Alabama, IMHO, chooses not to cover certain things like Vision and dental. These can be serious health issues.

But the my bottom line is a total repeal of Obamacare. Audit eligibility requirements to make sure only those truly indigent, who are US citizens and truly in need receive these benefits.

It's a place to start. And I realize the maximum coverage for medical care under various insurance programs and the medical facilities which render this care for those facilities puts a cap on what they can charge per procedure. That does prevent overcharging for procedures. And private insurance IS negotiated between the insurance companies and the medical suppliers/doctors/facilities.

The above is on my mind quite a bit currently because I'm having to go through a lot of procedures and tests right now (I have insurance through my husband's work). Medical facilities try and get around that "what they are allowed to charge" per procedure even when they're in the insurance network.

I recently had to have a cat scan and my insurance company had a maximum amount the facility could charge for the procedure yet they tried to get me to pay five times higher than they should. Plus they dragged their feet on getting me pre-certified which would've allowed them to charge whatever the hell they wanted.

There are also responsibilities for the patients to to check out. Some people would've gone ahead and not questioned it. And most do not ask for a complete breakdown on their bills and medical facilities most certainly take advantage of people being ignorant regarding these type charges.

I was able to shave off between $1,500 and $2,000 from past hospital stays in the past couple of years by doing that. I'm all for Drs and medical facilities making a profit but not gouging. People are very surprised when they ask for a line by line breakdown of their bills. I've found some totally ridiculous shit I was charged for including things I never used or being overcharged in the extreme for basic meds. I even went so far as to get retail prices for some meds through 4-5 retailers then did an average and told the hospital I'd pay that average retail price but not the ridiculously over inflated price I WAS charged for.

I usually get these kinds of amounts taken off bills without even having to fight with them over it.

Then again maybe I have more brain damage from my stroke than I think I do and don't completely understand every aspect of insurance coverage.
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  #23  
Old 2 July 2017, 19:49
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Hmm,


First, eliminate all governmental interference and funding with medical care; at the federal and state level. Medicine is a fee-based service, the market needs to decide cost.

Second, any medical insurance, pharmaceutical, etc. must be set up as a cooperative or credit union: member owned.

Third, have the Federal government sponsor selected medical or pharmacological research. Any breakthroughs will be released under license to medical companies with strict price guidelines.
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  #24  
Old 2 July 2017, 20:41
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Originally Posted by anachranerd View Post

But yet, we spend our time bickering over who should pay the most percentage, and forget to ask why the FUCK is the bill 35000 bucks in the first place?
because your bill was inflated to pay the bills of all the people that didnt pay thiers.

Since we passed a law that said people HAD to be treated wether they can pay or not, THAT and that alone is the main reason for the high costs of health care. The people that pay have to be charged enough to cover the costs of the people that dont.
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  #25  
Old 18 July 2017, 07:54
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Well, yet again more dysfunction and defeat brought about by the GOPe's insistence they (read: their donors) get a piece of that lucrative gov't free money pie. What's that saying about the GOPe possessing a supernatural ability to snatch defeat from the jaws of victory?

Quote:
Republican Senators Mike Lee, of Utah and Jerry Moran, of Kansas joined Senators Rand Paul, of Kentucky and Susan Collins of Maine. Republicans hold onto a 52-48 majority and the two senators’ opposition means the bill is effectively dead.
Good on Mike Lee and Rand for being able to stop this nonsense. I really don't get what is so damn hard about just getting rid of it like they campaigned on (naive opinion). But I guess that ignores their greed.

POTUS tweeted out last night: “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”. Which is a great bait and switch tactic, IMO, and should have been goal in the first place. But I suspect that the GOPe knows this and still wants to leverage the conservative desire to get rid of Obamacare to get their own version of (R) socialism. And they'll drag the entire country down with them to get their way. Like a bunch of greedy little children.
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  #26  
Old 18 July 2017, 08:21
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I sure am glad I have VA health care and do not have to deal with all this anymore.
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  #27  
Old 18 July 2017, 09:25
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I sure am glad I have VA health care and do not have to deal with all this anymore.
Me too.
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  #28  
Old 18 July 2017, 10:40
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Originally Posted by KidA View Post
I propose fixing the astronomical costs associated with care here first, then let's talk about any funding necessary.
It's a Mexican standoff with multiple competing interests: the insurance industry, the legal industry, the pharmaceutical/medical supply/equipment industry. Until one makes a move, none of them will.
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  #29  
Old 18 July 2017, 10:48
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There should be no "replacement". Total repeal of Obamacare. Then do the following and let the market sort itself out through competition.

1. Cut through the bullshit of middlemen regarding drug prices, equipment and procedures. I'm a little touchy on that subject just now because I'm having some health problems so have to get some costly tests done and the facility doing the tests needs to pre-certify w/ my insurance company. No problem there except my insurance company subcontracted out to another company for them to determine if the procedures were necessary. It was a total bitch to get done.

2. Allow the pharmaceutical companies to make a profit (they DO spend a lot to get a drug to market) but they should not be allowed to price gouge as much as they do.

3. Get rid of pre-existing conditions.

4. Allow consumers to shop for insurance across state lines. This is the biggest thing they need to do to get coverage costs down.

5. I don't have kids & don't care whether parents want to pay for their insurance or not but pick an age for parental coverage to end.

6. Insurance should not be mandatory. If ppl want it then fine but the government shouldn't force anyone to purchase it.

7. No immigrant should be allowed financial assistance paid by my/our tax dollars unless they serve in the military. Especially those who entered the country illegally. Y'all know more about military service than I do. Maybe let their service be a pathway for citizenship but maybe not with security clearances. Medicaid and Medicare should be for U.S. citizens only.

8. Medicaid and Medicare for the lowest income people but create a standard for all the states. For instance my sister has epilepsy and the myriad of health problems that come from that and anti-seizure medications. She's never been able to work or drive a vehicle because she's never been seizure free. In Alabama no dental is covered period. Not even routine cleanings and one of her side effects from her medication is her gums and mouth. My husband and I have literally spent thousands and thousands for her dental care and other support. Alabama is one of the states which offer no dental care with Medicaid. Hers is serious enough to affect her overall health thus the standard for all states to be the same.

And still on number eight and include Medicare. My parents have supplemental insurance but no dental for them under both Medicare & supplemental either. Again we've spent thousands helping them out with this. I want to add Vision into my item eight as well. Just basic vision and dental.

It pisses me off beyond measure that some damn illegal alien or drug junkie who spits out kid after kid can pretty much get whatever assistance they need but my sister and parents who desperately need help don't qualify or the state has diffferent coverages than others. Parents and sister are very, very low income.

I'm just thankful we're in a position to help them when they need it. A lot of families are not so fortunate.

And that's all I think needs to be done legislatively. Pass the above. Keep it simple stupid then get the government out of it. Alll they do is create a bureaucracy and cost more money.

Oh and I would add make the freaking politicians in Congress have to be on the same insurance plan or pay their medical bills themselves.

I have talked about the above with Big Luther (senator appointed to replace Jeff. Though I cannot stand the man personally). I also told him I'll be voting for Mo Brooks against him.Talked with Richard Shelby and every representative from Alabama. When I say talked I mean I spoke directly with them on the phone. I also told them term limits are needed. Go to D.C. SERVE the country and represent Alabama then get their asses home and get a real job. Being a senator or congressman isn't a career it's serving your country. That last part isn't something they haven't heard from me before. I've known most of them for many years. I think if they didn't hear from me about something they would think the apocalypse was upon us.

Off my podium.
You can't have it both ways. I agree with getting .gov and burdensome regulation out of healthcare, but you should not tell an insurance company they shouldn't cover someone kids. That ought to be up to the insurer and insured. If Daddy Warbucks wants to ensure their kids to age 50, and can afford it, so be it. I can pay for you to be on my car insurance forever, why not my health insurance?

The rest of your post I more/less agree with....
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  #30  
Old 18 July 2017, 15:12
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It seems the biggest dog in this fight seems to be Medicaid.

As I've posted over and over, minimizing insurance to just emergencies would solve the "insurance" problem. For the rest of healthcare, a cash-based system that allows the price discovery system to work would be our best option.

But again, there's a problem with Medicaid.

Well, I did some back of the envelope math:

There's about 73-75 million enrollees on Medicaid. Let's assume the higher end of 75 million and not subtract the Medicare dual-enrollees.

As a whole, all the states spend almost $553 Billion per year. Per person, that's $7373 per year or $614 per month.

http://www.kff.org/medicaid/state-in...2:%22asc%22%7D


Meaning that the states could give $200 per month cash per enrollee and save over a third of the money on their budgets.

You could tie this into a HSA. Meaning the money could directly into an HSA to be spent on procedures and more expensive doctor visits. Money not spent stays in the account, grows, and never goes away until its spent on a Health care procedure. As the individual goes up the economic ladder, the monthly cash goes away, but the money stays in the account to be used when its needed. This will also go a long way in combating the welfare cliff.

It's an idea.
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  #31  
Old 31 July 2017, 14:57
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I do not know if Pres. Trump can just cancel congress's health care plans at will and place them onto Obamacare.

But I like the idea and wish it was more than repeal or else. I wish he would just saunter on in and let them know which way the sun set.

So, if he gets his way, and O'care is repealed, they can keep their current plans? I see both sides digging in over this. "Don't take our free shit".

What a joke.

http://www.foxnews.com/politics/2017...e-benefit.html
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  #32  
Old 2 August 2017, 12:40
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Originally Posted by KidA View Post
I propose fixing the astronomical costs associated with care here first, then let's talk about any funding necessary.

We are the most expensive country in the world to give birth in, yet infant and maternal deaths are astronomical compared to most anywhere else.
It's interesting how costs are never the issue on the floor, probably because a big chunk goes to lobbyists that fund the action for each party and they all benefit from higher costs. Yet costs compound every issue.

The supply of doctors is fixed. It's good for med students so that they know for sure their MD will guarantee a job as a doctor though not all graduates go into medicine. So either loosen restrictions to more closely match demand (average wait times are in the weeks to schedule an appointment) or free the market a bit.

Equipment is also heavily regulated. A doctor told me years ago that a simple tool like a scalpel costs over $100 due to the regulatory steps. Quality assurance is needed but these prices are just bureaucratic inefficiency. Apply industry standards for quality levels at a certain price.

Spend more time in schools on health topics like nutrition and fitness. My schools had fries for lunch. Many kids can eat junk food without looking unhealthy during childhood so it forms bad habits early on.
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  #33  
Old 2 August 2017, 13:08
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The reason why there is a perceived shortage of doctors is because many medical prospects are opting for RN to Nurse Practicioner or Physician Assistant roles. The schooling is only two years from start to practice, the salaries are very good by today's standards, there is little overhead or liability, and you have many of the same privileges as an MD/DO.

Another reason is that not many medicine prospects want to do primary care... It's unglamorous, pays the least, and monotonous. Why spend 8 or so of your years on Earth in school to work primary care and deal with oan overload of patients with diabetes, hypertension, obesity, and the common cold for a living? (Whom mostly refuse to take care of/manage their conditions outside of the doctors office).

Most MD/DO prospects desire to go into a specialty; as do the advanced practitioners mentioned above. People don't typically want to be a "basic" doctor, and most with the fortitude and commitment to become physicians in the US system are the type of personalities that won't sell themselves short. Unfortunately, by design and compensation, primary care is the least desirable and least sexy field of medicine. It's inconvenient that primary care is where most of the need for physicians and advanced clinicians is.

Not to mention the salary is the lowest by significant margins. Where I am at, for instance, an MD in a primary care role could make $90-160k a year (gross) whereas an ER doctor could take in north of $250k a year (gross).
Get into cardiology, obstetrics, or neuro and you're looking at $350-500k a year. Thinking of becoming a plastic surgeon? How does $800k-$1+ million sound?

There are those who enter the field of medicine for reasons other than glamour or money, or to prove something to their fathers, et al. Many genuinely care to help others and give back. However, this up an coming generation is more likely to seek "glamorized" roles in medicine, higher paychecks (higher returns on their education investment), and even more so a quicker path to practice (NP/PA).

My goal is that of primary care in underserved communities, where the need is the greatest, and you can still lead a relatively normal life. Hopefully I can become part of the solution.

The healthcare debate in this country has multiple issues, a shortage of primary care providers only being one of them.

Last edited by justamedic; 2 August 2017 at 13:14.
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  #34  
Old 2 August 2017, 13:10
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I find it interesting that nobody mentioned tort reform.
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  #35  
Old 2 August 2017, 14:37
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Originally Posted by justamedic View Post

Another reason is that not many medicine prospects want to do primary care... It's unglamorous, pays the least, and monotonous. Why spend 8 or so of your years on Earth in school to work primary care and deal with oan overload of patients with diabetes, hypertension, obesity, and the common cold for a living? (Whom mostly refuse to take care of/manage their conditions outside of the doctors office).

Most MD/DO prospects desire to go into a specialty; as do the advanced practitioners mentioned above. People don't typically want to be a "basic" doctor, and most with the fortitude and commitment to become physicians in the US system are the type of personalities that won't sell themselves short. Unfortunately, by design and compensation, primary care is the least desirable and least sexy field of medicine. It's inconvenient that primary care is where most of the need for physicians and advanced clinicians is.

Not to mention the salary is the lowest by significant margins. Where I am at, for instance, an MD in a primary care role could make $90-160k a year (gross) whereas an ER doctor could take in north of $250k a year (gross).
Get into cardiology, obstetrics, or neuro and you're looking at $350-500k a year. Thinking of becoming a plastic surgeon? How does $800k-$1+ million sound?

However, this up an coming generation is more likely to seek "glamorized" roles in medicine, higher paychecks (higher returns on their education investment), and even more so a quicker path to practice (NP/PA).

My goal is that of primary care in underserved communities, where the need is the greatest, and you can still lead a relatively normal life. Hopefully I can become part of the solution.

The healthcare debate in this country has multiple issues, a shortage of primary care providers only being one of them.
I'm an entrepreneur in this field. Everything you mentioned in this post is part of the software that's being developed. (Along with other things as well)

You're type of thinking is what I based my designs on for one of the products I'm developing.

Feel free to PM me if you want to know more.
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  #36  
Old 3 August 2017, 16:46
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Originally Posted by Devildoc View Post
You can't have it both ways. I agree with getting .gov and burdensome regulation out of healthcare, but you should not tell an insurance company they shouldn't cover someone kids. That ought to be up to the insurer and insured. If Daddy Warbucks wants to ensure their kids to age 50, and can afford it, so be it. I can pay for you to be on my car insurance forever, why not my health insurance?

The rest of your post I more/less agree with....
Agree regarding the kids. I don't have kids. I just think they should be made to get off their lazy, entitled asses and become independent adults & productive members of society. Gotta cut the cord at some time or they will never accomplish that.

I've worked and supported myself all my life from mowing lawns to baby sitting etc. I want to be self sufficient. Literally when I was 16 I contributed to our household. Paid some utilities and purchased all my clothes & necessities.

The kids today are too entitled & lazy.

Ba humbug kids give me hives anyway. I am SO glad neither myself or my husband wanted children.

I'm as sick and tired of the Republicans as I am of the Democrats because they're all politicians & it's all about "me", "me", "me" and how much power can I accumulate.
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  #37  
Old 3 August 2017, 17:59
AKAPete AKAPete is offline
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Originally Posted by P304X4 View Post
... Since funding is the main rub the proposal would be to take a point one percent (0.1%) tax off the gross of both business and personal income; example: X's $50,000.00 would pay $50.00. ....
Not No but Fuck No!

Have you learned nothing about Washington?

Small tax? Once you create a small tax it only grows to feed the ever expanding belly of Washington.

Kinda' like my "free for life" health care that suddenly became Champus and then Tricare. Every time it cost me more out of pocket. And now they are talking about increasing fees, co-pays and CatCap.
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  #38  
Old 6 August 2017, 15:31
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Don't see any need for referrals in certain cases. Played a lot of ball, right knee talking to me and I know I need arthro to clean up meniscus. Had to go to the regular doc. He asked what was wrong, told him knee was hurting. He said ok, I'll refer you to this guy, that guy, etc. I already knew who I was going to go to re orthopod, so what the hell was the big deal? Went to the guy, they did MRI, etc., and I know what I have to get done. Waste of time re office visit to regular doc.

Now I have to get a full physical a month out at regular doc to see if ok to put me under and operate. Glad there's nothing REALLY wrong.......
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  #39  
Old 20 September 2017, 16:03
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Originally Posted by justamedic View Post

Another reason is that not many medicine prospects want to do primary care... It's unglamorous, pays the least, and monotonous. Why spend 8 or so of your years on Earth in school to work primary care and deal with oan overload of patients with diabetes, hypertension, obesity, and the common cold for a living? (Whom mostly refuse to take care of/manage their conditions outside of the doctors office).


The healthcare debate in this country has multiple issues, a shortage of primary care providers only being one of them.

I wanted to revisit this topic to address the concern you brought up here.

http://www.dpcfrontier.com

The above is a website that shows and maps where Primary Care providers are located in the United States. As you would expect, they tend to up show where regulations allow for that type of care to be facilitated. I.E, skipping insurance.

The prices range for a single person from $45-60 per month on average. A family of 4 will typically pay $120-150 per month with the lower end charging an additional $3-10 dollars ala carte for some items such as labs and blood work.
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