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Aaron747
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American Internists Call for 'Systematic Reform' Of Healthcare

Tue Jan 21, 2020 3:43 pm

In stark contrast to what lobbying groups representing the insurance industry say, the American College of Physicians, representing 159,000 internal medicine specialists, has put forth a comprehensive proposal for massive healthcare reform, including this statement:

“ACP set out to develop this new vision for health care by asking, ‘What would a better health care system for all Americans look like?” said Robert M. McLean, MD, MACP, president, ACP. “We believe that American health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and under invests in public health; spending too much on administration at the expense of patient care; and fosters barriers to care for and discrimination against vulnerable individuals.”

This is a pretty hefty endorsement for substantial change from physicians. They seem to be supporting either a single payer model or a public-option model. Obviously a public-option model makes more sense since those preferring their current private plans can stay on them, and those who wish to go onto a reformed all-access Medicare could choose that.

https://www.acponline.org/acp-newsroom/ ... ealth-care
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casinterest
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Tue Jan 21, 2020 4:37 pm

We need one, but there is too much lobbying by insurance companies.

We need to go to single payer, but that will kill the insurance lobby.

The biggest joke that conservatives tell is that they don't want to pay for someone else's insurance.

Guess what, you are, whether you believe it or not.


We got told directly in our company that our premiums went up due to usage this year. We might as well have single payer or all-access medicare with people choosing to buy their own private insurance for better "beds" or "Better" othopedic support devices.
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LCDFlight
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Tue Jan 21, 2020 9:51 pm

It appears they are hitting familiar talking points that are utterly routine. My specialty deserves more renumeration than other specialties, and the money spent on administrators should be spent on me and my specialty. This has been the same talking point for at least 50 years. They appear to make it a "public health" statement, without making the statement any different from decades of traditional lobbying positions.
 
tommy1808
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 6:27 am

casinterest wrote:
We need one, but there is too much lobbying by insurance companies.

We need to go to single payer, but that will kill the insurance lobby.

The biggest joke that conservatives tell is that they don't want to pay for someone else's insurance.

Guess what, you are, whether you believe it or not.

We got told directly in our company that our premiums went up due to usage this year. We might as well have single payer or all-access medicare with people choosing to buy their own private insurance for better "beds" or "Better" othopedic support devices.


Well, "conservatives" somehow also seem to believe that Hospitals and doctors just write off invoices out of the goodness of their hearts instead of increasing prices for everyone accordingly.

There are two way to handle healthcare:

a) Let everybody die that can´t pay for care
b) everyone is paying for everybody else

best regards
Thomas
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Jouhou
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 6:57 am

LCDFlight wrote:
It appears they are hitting familiar talking points that are utterly routine. My specialty deserves more renumeration than other specialties, and the money spent on administrators should be spent on me and my specialty. This has been the same talking point for at least 50 years. They appear to make it a "public health" statement, without making the statement any different from decades of traditional lobbying positions.


Insurance companies will always be middle men skimming wealth from the system with no value added.

Healthcare might even be affordable if insurers didn't exist and we ALL payed out of pocket. Instead everything is just horribly distorted.
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tommy1808
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 7:48 am

Jouhou wrote:
LCDFlight wrote:
It appears they are hitting familiar talking points that are utterly routine. My specialty deserves more renumeration than other specialties, and the money spent on administrators should be spent on me and my specialty. This has been the same talking point for at least 50 years. They appear to make it a "public health" statement, without making the statement any different from decades of traditional lobbying positions.


Insurance companies will always be middle men skimming wealth from the system with no value added..


that is not correct, in plenty of places health insurances are not allowed to turn a profit for providing that legal minimum coverage by law, for example Germany and Switzerland. If they want to make money, they have to sell extensions beyond that.

best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
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Jouhou
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 8:01 am

tommy1808 wrote:
Jouhou wrote:
LCDFlight wrote:
It appears they are hitting familiar talking points that are utterly routine. My specialty deserves more renumeration than other specialties, and the money spent on administrators should be spent on me and my specialty. This has been the same talking point for at least 50 years. They appear to make it a "public health" statement, without making the statement any different from decades of traditional lobbying positions.


Insurance companies will always be middle men skimming wealth from the system with no value added..


that is not correct, in plenty of places health insurances are not allowed to turn a profit for providing that legal minimum coverage by law, for example Germany and Switzerland. If they want to make money, they have to sell extensions beyond that.

best regards
Thomas


In the US system, by definition of what they are, they add no value.
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Dutchy
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 8:11 am

For society, the cost benefits is rather low, but apparently the US voters are ok with that because they continue to vote Republican.
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Aaron747
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 9:20 am

LCDFlight wrote:
It appears they are hitting familiar talking points that are utterly routine. My specialty deserves more renumeration than other specialties, and the money spent on administrators should be spent on me and my specialty. This has been the same talking point for at least 50 years. They appear to make it a "public health" statement, without making the statement any different from decades of traditional lobbying positions.


It doesn’t sound like you actually read their bullet point objectives for new policy.
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mmo
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 10:05 am

After growing up in the US (born in Republic of Ireland) and having a father who was a surgeon and then living in other countries such as the UK and Spain where there are state health and private insurance, I feel I can comment with a good perspective on the issue.

Currently, we live in Spain and have both private and public medical care available, as was the case in the UK also. Our private health care is provided by my wife's employer and she pays a monthly premium of about 50 Euros/month for both of us.

I can remember my father making the statement that anyone who thinks the US doesn't have a state-run medical care system doesn't know what they are talking about. It is just disguised as for profit insurance companies. Insurance companies in the US scrutinize physicians' treatment plans and encourage the physicians to get the patients in and out to "manage costs". All of our three children were born in the US and at the time I had great health insurance at no cost to me. However, there was great pressure to get my wife in and out of the hospital. If she arrived early in the morning she was supposed to be discharged later that evening. Luckily, her OB was very good at providing care above and beyond and in the case of our third child managed to have her stay in for two days. However, the insurance company put up a very big stink and the OB had to justify his decision. For me, I had arthroscopic surgery on my shoulders and knees and there were complications with one shoulder surgery but I was still discharged as a day surgery patient. All at the behest of the insurance company.

In the UK, the NHS provides the state run medical care. It's not perfect by any means but depending where you live it can be very good. Luckily, we lived in a rather well off area and the care and waiting times were very manageable. I had both hips and one knee replaced there with the knee being done privately and the waiting time was about the same for both public and private care. The best thing is the pharmaceutical program. If you are under 60 you pay a flat fee per prescription, over 60 it is free. If you have an income below a certain level or have a long term condition, your meds are free. My wife has hypothyroidism and all of her meds were free when we lived in the UK.

Spain is somewhat different. Here I have had a knee replaced, along with shoulder surgery and hand surgery to replace arthritic knuckles and what would be considered day surgery in the UK here you were planned on spending at least one night in the hospital. This is both public and private. My wife had a detached retina and she was treated great. Saw the ophthalmologist was admitted for surgery the next day. Stayed for three days. We had a period of a few months with only state medical and I waited perhaps a few days to see an orthopedic surgeon. Here the surgery, if needed, has to be done within 90 days from your first visit. In my case after 45 days, I received a letter asking me to call the hospital because they couldn't meet the 90-day rule and I would be referred to a hospital of my choice. By that time, my wife had changed employers and had private medical coverage. I have a native Spanish friend who gave a cautionary piece of advice. He said if you ever have a very serious accident or condition such as a severe heart attack, make sure you go to the State hospital. The reason is money is no object and while I haven't seen it in private hospitals, he did say the state hospitals will spare no expense to treat you while the private one might have some cost limitations.

Pharmaceutical products are extremely inexpensive when compared to the US. For example, I take a drug for arthritis, I remember having to pay for it because it wasn't on the insurance company's drug formulary and it was over $200/month. Here in Spain, it 12 Euros/month. Your income determines the price but no matter what your income there is an annual cap of what you will pay.

Both Spain and the UK fund their state medical programs via a specific tax. In the UK, you pay 7% of your gross and in Spain, you pay 8% of your gross. Right now Spain is ranked as the healthiest place to live followed by Italy, Iceland, Japan, and Switzerland. The US is ranked 35th.

From my perspective, if we were to ever move back to the US, I would gladly welcome a state run medical system over the for profit system managed by insurance companies. Anyhow just my opinion. And we all know what people say about opinions!!
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trpmb6
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 3:15 pm

Having had two recent hospitalizations in my immediate family, (myself, and a young child) I am acutely aware of the fallacies of our health care system. The way I see it, it's not really the "how" we pay for health care. It's the "how" health care is administered. Tests that are performed that are unnecessary. Scans that are unnecessary. Services that are not needed. Basically, the way I've experienced it, everything becomes an a la carte up sell. "we are pretty sure you have X, but we should run this test Z to rule out condition Y just to save our bacon" That's what I've experienced. I have a child in the hospital right now who could be taken home, but because of what I'm almost certain was a previous lawsuit, they now have rules in place that won't let us take him home until certain conditions are met. The thing is, I know I've already hit my OOP max for the year (thanks to my hospitalization) and so there is no questioning coming from my end because it's not going to cost me a single penny. Similarly, any test, any diagnostics, any sort of care that is suggested, it becomes a, sure why not I'm not paying for it. I had ultra sounds performed on one of my legs to check for blood clots (I had numbness, and still do, because of too much IV fluid), despite the fact that I'm young, not diabetic and at virtually no risk for blood clotting. But they wanted to rule it out. Well, that's just an upsell for them and it didn't cost me a dime.

You want to lower health care costs? You get someone inside the hospitals policing the care and making sure the things being done are in the best interest of the patient, both from a health care perspective AND a financial perspective. As it is right now, there is no incentive for hospitals to provide competitive pricing.
 
LCDFlight
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 3:55 pm

trpmb6 wrote:
Having had two recent hospitalizations in my immediate family, (myself, and a young child) I am acutely aware of the fallacies of our health care system. The way I see it, it's not really the "how" we pay for health care. It's the "how" health care is administered. Tests that are performed that are unnecessary. Scans that are unnecessary. Services that are not needed. Basically, the way I've experienced it, everything becomes an a la carte up sell. "we are pretty sure you have X, but we should run this test Z to rule out condition Y just to save our bacon" That's what I've experienced. I have a child in the hospital right now who could be taken home, but because of what I'm almost certain was a previous lawsuit, they now have rules in place that won't let us take him home until certain conditions are met. The thing is, I know I've already hit my OOP max for the year (thanks to my hospitalization) and so there is no questioning coming from my end because it's not going to cost me a single penny. Similarly, any test, any diagnostics, any sort of care that is suggested, it becomes a, sure why not I'm not paying for it. I had ultra sounds performed on one of my legs to check for blood clots (I had numbness, and still do, because of too much IV fluid), despite the fact that I'm young, not diabetic and at virtually no risk for blood clotting. But they wanted to rule it out. Well, that's just an upsell for them and it didn't cost me a dime.

You want to lower health care costs? You get someone inside the hospitals policing the care and making sure the things being done are in the best interest of the patient, both from a health care perspective AND a financial perspective. As it is right now, there is no incentive for hospitals to provide competitive pricing.


Those are called medical doctors. They "police the care." That's exactly what they do.... Or, what do you think they do, offer uninformed opinions?

I totally agree with you about pricing and insurance. It would be best for me if all insurance goes away. Middle class people had better access to the doctor 50 years ago than they do now. Without insurance, just paying cash.
 
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trpmb6
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 5:19 pm

LCDFlight wrote:

Those are called medical doctors. They "police the care." That's exactly what they do.... Or, what do you think they do, offer uninformed opinions?

I totally agree with you about pricing and insurance. It would be best for me if all insurance goes away. Middle class people had better access to the doctor 50 years ago than they do now. Without insurance, just paying cash.


So, I'm not trying to suggest that Doctors don't have their patient's best interest in mind. I'm just saying that when it comes down to it, no one really questions a doctor when they say "we should do this test". Is the test really necessary? What is the cost vs risk vs reward? Is it going to cost me (my insurance) 15,000 dollars to rule out something that is extremely unlikely? The insurance companies do police this to a certain extent, but ultimately they relent on a lot of nickel and dime stuff. And of course the patient isn't really in a position to make informed decisions about such things. You're in a lot of pain and want a solution, who are you to say no to a doctor who is proposing a potential solution?

The other ridiculous thing, that I didn't really mention, is how they mark everything up. If you get an itemized list you'll find something that is as simple as an ABD pad that you could buy at a grocery store for 10 dollars for a pack of 5 would be 10 dollars for a single at the hospital.
 
LCDFlight
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 5:46 pm

trpmb6 wrote:
LCDFlight wrote:

Those are called medical doctors. They "police the care." That's exactly what they do.... Or, what do you think they do, offer uninformed opinions?

I totally agree with you about pricing and insurance. It would be best for me if all insurance goes away. Middle class people had better access to the doctor 50 years ago than they do now. Without insurance, just paying cash.


So, I'm not trying to suggest that Doctors don't have their patient's best interest in mind. I'm just saying that when it comes down to it, no one really questions a doctor when they say "we should do this test". Is the test really necessary? What is the cost vs risk vs reward? Is it going to cost me (my insurance) 15,000 dollars to rule out something that is extremely unlikely? The insurance companies do police this to a certain extent, but ultimately they relent on a lot of nickel and dime stuff. And of course the patient isn't really in a position to make informed decisions about such things. You're in a lot of pain and want a solution, who are you to say no to a doctor who is proposing a potential solution?

The other ridiculous thing, that I didn't really mention, is how they mark everything up. If you get an itemized list you'll find something that is as simple as an ABD pad that you could buy at a grocery store for 10 dollars for a pack of 5 would be 10 dollars for a single at the hospital.


you are right that defensive medicine (tests that are not supported by medical science, but ARE supported by a legal liability review) is a huge problem. These costs should be charged to attorneys only! They do not benefit anyone else. So I have to admit that doctors are sometimes giving you legally justified tests that are not medically justified. That is extremely sad, too.

The allocation of costs is all a silly exercise that takes zillions of financial analysts and billing clerks to accomplish. All of these people draw salaries and need their own healthcare. It is a totally broken system that is only enabled by the immense wealth of the US. That isn't a justification, just an explanation of how the system can continue while being so broken. Morally, I believe the system should be taken apart now, while the economy is strong. Send all the billing people home. Medicare for all. As long as we agree about what Medicare is and should cover. I believe it should be pretty rationed. To back it up, let there be a cash for services market.
 
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Aaron747
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 5:55 pm

LCDFlight wrote:
trpmb6 wrote:
LCDFlight wrote:

Those are called medical doctors. They "police the care." That's exactly what they do.... Or, what do you think they do, offer uninformed opinions?

I totally agree with you about pricing and insurance. It would be best for me if all insurance goes away. Middle class people had better access to the doctor 50 years ago than they do now. Without insurance, just paying cash.


So, I'm not trying to suggest that Doctors don't have their patient's best interest in mind. I'm just saying that when it comes down to it, no one really questions a doctor when they say "we should do this test". Is the test really necessary? What is the cost vs risk vs reward? Is it going to cost me (my insurance) 15,000 dollars to rule out something that is extremely unlikely? The insurance companies do police this to a certain extent, but ultimately they relent on a lot of nickel and dime stuff. And of course the patient isn't really in a position to make informed decisions about such things. You're in a lot of pain and want a solution, who are you to say no to a doctor who is proposing a potential solution?

The other ridiculous thing, that I didn't really mention, is how they mark everything up. If you get an itemized list you'll find something that is as simple as an ABD pad that you could buy at a grocery store for 10 dollars for a pack of 5 would be 10 dollars for a single at the hospital.


you are right that defensive medicine (tests that are not supported by medical science, but ARE supported by a legal liability review) is a huge problem. These costs should be charged to attorneys only! They do not benefit anyone else. So I have to admit that doctors are sometimes giving you legally justified tests that are not medically justified. That is extremely sad, too.

The allocation of costs is all a silly exercise that takes zillions of financial analysts and billing clerks to accomplish. All of these people draw salaries and need their own healthcare. It is a totally broken system that is only enabled by the immense wealth of the US. That isn't a justification, just an explanation of how the system can continue while being so broken. Morally, I believe the system should be taken apart now, while the economy is strong. Send all the billing people home. Medicare for all. As long as we agree about what Medicare is and should cover. I believe it should be pretty rationed. To back it up, let there be a cash for services market.


What you’re suggesting almost makes too much sense. Why, one could look up the service they are seeking online, and see what it would cost as an elective procedure. Docs would have two clear billing rates, necessary and elective. No surprises on either side. Oh yeah, that was the system I experienced in Japan. Sheesh...it’s ridiculous that we have all this know-how yet Americans get screwed for decades because some jerkoffs figured out how to transition non-profit care plans into a for-profit model.
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afcjets
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 7:26 pm

Jouhou wrote:
Insurance companies will always be middle men skimming wealth from the system with no value added.

Healthcare might even be affordable if insurers didn't exist and we ALL payed out of pocket. Instead everything is just horribly distorted.


:checkmark:


Back when doctors made house calls and rode horses no one worried about the cost of health care. The insurance companies allow doctors to be extremely wealthy. If we all had to pay for their services ourselves, they wouldn't all get away with making a half million + per year But the real issue is the drug companies. They are a multi-TRILLION per year industry. They're not going anywhere and they're not looking for ways to reduce revenue. They actually write medical school curriculum. Most of what they do is supress symptoms and cause more disease and create more revenue streams. They are rarely interested in healing. It costs a half million on average to die from cancer and is the second leading cause of death. They're getting their half million and if they can treat you for that amount over a lifetime they'll do it but there not going to cure it because that would ultimately mean significantly less revenue. Unless something worse comes along.
 
frmrCapCadet
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Wed Jan 22, 2020 10:12 pm

Medicare pays out about 97% to providers, insurance companies 80-85%.
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Aaron747
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 1:23 am

afcjets wrote:
Jouhou wrote:
Insurance companies will always be middle men skimming wealth from the system with no value added.

Healthcare might even be affordable if insurers didn't exist and we ALL payed out of pocket. Instead everything is just horribly distorted.


:checkmark:


Back when doctors made house calls and rode horses no one worried about the cost of health care. The insurance companies allow doctors to be extremely wealthy. If we all had to pay for their services ourselves, they wouldn't all get away with making a half million + per year But the real issue is the drug companies. They are a multi-TRILLION per year industry. They're not going anywhere and they're not looking for ways to reduce revenue. They actually write medical school curriculum. Most of what they do is supress symptoms and cause more disease and create more revenue streams. They are rarely interested in healing. It costs a half million on average to die from cancer and is the second leading cause of death. They're getting their half million and if they can treat you for that amount over a lifetime they'll do it but there not going to cure it because that would ultimately mean significantly less revenue. Unless something worse comes along.


One of the first reactions European and Asian friends tell me when visiting the states is shock and surprise at the level of nonstop pharma advertising on TV. It’s quite a racket they have going.
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WarRI1
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 2:46 am

What the hell do they know? The Insurance Industry, corporations and the Republican Party know what is good for them. :rotfl: :rotfl: :sarcastic:
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casinterest
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 2:52 am

trpmb6 wrote:
LCDFlight wrote:

Those are called medical doctors. They "police the care." That's exactly what they do.... Or, what do you think they do, offer uninformed opinions?

I totally agree with you about pricing and insurance. It would be best for me if all insurance goes away. Middle class people had better access to the doctor 50 years ago than they do now. Without insurance, just paying cash.


So, I'm not trying to suggest that Doctors don't have their patient's best interest in mind. I'm just saying that when it comes down to it, no one really questions a doctor when they say "we should do this test". Is the test really necessary? What is the cost vs risk vs reward? Is it going to cost me (my insurance) 15,000 dollars to rule out something that is extremely unlikely? The insurance companies do police this to a certain extent, but ultimately they relent on a lot of nickel and dime stuff. And of course the patient isn't really in a position to make informed decisions about such things. You're in a lot of pain and want a solution, who are you to say no to a doctor who is proposing a potential solution?

The other ridiculous thing, that I didn't really mention, is how they mark everything up. If you get an itemized list you'll find something that is as simple as an ABD pad that you could buy at a grocery store for 10 dollars for a pack of 5 would be 10 dollars for a single at the hospital.



I am just tired of going to a Dr's office and the Administrative staff is larger than the doctors staff.
Seriously this is a problem.
When billing is so complicated, that I have to wait for a bill, that usually only arrives after 3 months and after the doctors sent it to collections due to insurance issues, it is a broken system,

Why do I have to pay an out of state collection agency, when I can't even get out of state insurance?
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trpmb6
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 3:13 am

Honestly, and I write this as I sit by my son's bedside at the hospital, the biggest travesty is that they don't serve beer here.
 
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Jouhou
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 5:25 am

trpmb6 wrote:
Honestly, and I write this as I sit by my son's bedside at the hospital, the biggest travesty is that they don't serve beer here.


I live near 2 hospitals, one in my own city that sucks in every way imaginable and is run by hospital corp, and one a couple of towns away (new england towns, so it's a short distance) that's non-profit and has better doctors in general. When I have to take a friend to the ER, I drive further to the other hospital not just because they provide better care, but also because the waiting room is nice, has a water feature, cookies, and coffee. If I'm going to be waiting for a friend to be treated, I'd rather not be in the ghetto waiting room with cheap plastic chairs with pieces falling off of them, stains everywhere and a general appearance of being unclean. I'm not gonna lie, in that situation my decision is primarily based on the waiting room, the fact that the better hospital has better care is #2. The fact that the better hospital charges less and leaves my friends less burdened is #3.

Only time I took a friend to my city's hospital is when my friend started having a miscarriage in my car, we were already on the road, and were literally less than a mile from that hospital at the time. And boy, that waiting room wait sucked.


afcjets wrote:
Jouhou wrote:
Insurance companies will always be middle men skimming wealth from the system with no value added.

Healthcare might even be affordable if insurers didn't exist and we ALL payed out of pocket. Instead everything is just horribly distorted.


:checkmark:


Back when doctors made house calls and rode horses no one worried about the cost of health care. The insurance companies allow doctors to be extremely wealthy. If we all had to pay for their services ourselves, they wouldn't all get away with making a half million + per year But the real issue is the drug companies. They are a multi-TRILLION per year industry. They're not going anywhere and they're not looking for ways to reduce revenue. They actually write medical school curriculum. Most of what they do is supress symptoms and cause more disease and create more revenue streams. They are rarely interested in healing. It costs a half million on average to die from cancer and is the second leading cause of death. They're getting their half million and if they can treat you for that amount over a lifetime they'll do it but there not going to cure it because that would ultimately mean significantly less revenue. Unless something worse comes along.


So, because of my interest in infectious disease and previous experience working in a pharmacy long ago, I lurk in pharmacy forums. From what I'm seeing from pharmacy related discussion, a lot of the issues with our drug prices are because of insurance companies too. Co-pay doesn't go towards the cost of the drug, it's literally the FEE your insurance company is charging the pharmacy to serve you. They then proceed to not pay full reimbursement anyways leaving pharmacies with a net loss. This is why independent pharmacies are going out of business and only large chains can survive this and they are taking a financial beating too. Drugs are literally cheaper if you pay in cash instead of paying through insurance. The prices are intentionally inflated while charging to insurance because the insurance companies will always under pay the pharmacy later.

That's not to say some drug prices aren't being manipulated and abused by pharmaceutical companies, but they aren't the only cause of our messed up drug costs.
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tommy1808
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 5:59 am

frmrCapCadet wrote:
Medicare pays out about 97% to providers, insurance companies 80-85%.


The Republican ban on Medicare negotiating with providers is still in force, right?

best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
DLFREEBIRD
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 8:00 am

casinterest wrote:
We need one, but there is too much lobbying by insurance companies.

We need to go to single payer, but that will kill the insurance lobby.

The biggest joke that conservatives tell is that they don't want to pay for someone else's insurance.

Guess what, you are, whether you believe it or not.


We got told directly in our company that our premiums went up due to usage this year. We might as well have single payer or all-access medicare with people choosing to buy their own private insurance for better "beds" or "Better" othopedic support devices.



exactly, My husband just went on medicare, the government negotiated a lot better rate to treat my husband condition than our private insurance company. I think our private insurance company 4th largest in the US. Could you imagine the negotiating power of our govt, if we went to a single-payer? the medical costs might go down to that of other countries.
 
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T18
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 12:21 pm

I think that one of the biggest failures of the ACA/ObamaCare was that they seem to have invited the Insurance and Drug companies to the table to write the thing.

I feel that if we want a system that is truly meant to treat and heal everyone, it cannot be a for profit system. I do not believe that both the goal of curing and preventing illnesses and making an insane profit are compatible.
“Racing's important to men who do it well. When you're racing, it's life. Anything that happens before or after is just waiting.” ― Steve McQueen (Le Mans) 1971
 
tommy1808
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 12:55 pm

T18 wrote:
I think that one of the biggest failures of the ACA/ObamaCare was that they seem to have invited the Insurance and Drug companies to the table to write the thing. .


that is by design. No way to pass it without congressman and senators getting bribed donations for their campaign. The US system is so rotten that they can say as much on television (~donars told me to vote for it, or i don´t need to call for donations anymore) without getting indicted, a Senator can tell Zuckerberg, again on Television, in essence that killing a bill in the US currently costs 10 Million.

best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
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DL717
Posts: 2153
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 1:35 pm

trpmb6 wrote:
Having had two recent hospitalizations in my immediate family, (myself, and a young child) I am acutely aware of the fallacies of our health care system. The way I see it, it's not really the "how" we pay for health care. It's the "how" health care is administered. Tests that are performed that are unnecessary. Scans that are unnecessary. Services that are not needed. Basically, the way I've experienced it, everything becomes an a la carte up sell. "we are pretty sure you have X, but we should run this test Z to rule out condition Y just to save our bacon" That's what I've experienced. I have a child in the hospital right now who could be taken home, but because of what I'm almost certain was a previous lawsuit, they now have rules in place that won't let us take him home until certain conditions are met. The thing is, I know I've already hit my OOP max for the year (thanks to my hospitalization) and so there is no questioning coming from my end because it's not going to cost me a single penny. Similarly, any test, any diagnostics, any sort of care that is suggested, it becomes a, sure why not I'm not paying for it. I had ultra sounds performed on one of my legs to check for blood clots (I had numbness, and still do, because of too much IV fluid), despite the fact that I'm young, not diabetic and at virtually no risk for blood clotting. But they wanted to rule it out. Well, that's just an upsell for them and it didn't cost me a dime.

You want to lower health care costs? You get someone inside the hospitals policing the care and making sure the things being done are in the best interest of the patient, both from a health care perspective AND a financial perspective. As it is right now, there is no incentive for hospitals to provide competitive pricing.


That and deregulate the health insurance industry letting them sell nationwide instead of State to State. Holy hell there is a lot wasted setting up companies in different States because each State has different regulatory standards. There are only about 10 parent companies anyway. Pass a deregulation law and require protections/standards of care that they must provide for like pre-existing conditions, etc. Kick those that can’t afford it to Medicare or some State managed program, and knock this health care debate nonsense off. This bastardized program that has been languishing for a decade needs a vasectomy. It is beyond me how politicians didn’t see deregulation with reasonable legislative guidance on standards of care as the first step toward affordable health insurance.

Aviation could use a modification or two as well in terms of standards of service. Something like, you’re still deregulated, but cramming a passenger in a seat with 29” pitch won’t cut it. 32” pitch minimum or go home.
Last edited by DL717 on Thu Jan 23, 2020 1:42 pm, edited 1 time in total.
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DL717
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 1:37 pm

T18 wrote:
I think that one of the biggest failures of the ACA/ObamaCare was that they seem to have invited the Insurance and Drug companies to the table to write the thing.

I feel that if we want a system that is truly meant to treat and heal everyone, it cannot be a for profit system. I do not believe that both the goal of curing and preventing illnesses and making an insane profit are compatible.


The States are also part of the problem. They like to have their own regulatory oversight/government jobs program.
Last edited by DL717 on Thu Jan 23, 2020 1:42 pm, edited 1 time in total.
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DL717
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 1:38 pm

DLFREEBIRD wrote:
casinterest wrote:
We need one, but there is too much lobbying by insurance companies.

We need to go to single payer, but that will kill the insurance lobby.

The biggest joke that conservatives tell is that they don't want to pay for someone else's insurance.

Guess what, you are, whether you believe it or not.


We got told directly in our company that our premiums went up due to usage this year. We might as well have single payer or all-access medicare with people choosing to buy their own private insurance for better "beds" or "Better" othopedic support devices.



exactly, My husband just went on medicare, the government negotiated a lot better rate to treat my husband condition than our private insurance company. I think our private insurance company 4th largest in the US. Could you imagine the negotiating power of our govt, if we went to a single-payer? the medical costs might go down to that of other countries.


The ability to negotiate is lost as soon as an insurance company, no matter how big, has to negotiate on a State by State level.
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frmrCapCadet
Posts: 4256
Joined: Thu May 29, 2008 8:24 pm

Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 4:05 pm

tommy1808 wrote:
frmrCapCadet wrote:
Medicare pays out about 97% to providers, insurance companies 80-85%.


The Republican ban on Medicare negotiating with providers is still in force, right?

best regards
Thomas

Prescriptions yes
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apodino
Posts: 3926
Joined: Mon Apr 04, 2005 2:11 am

Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 8:18 pm

T18 wrote:
I think that one of the biggest failures of the ACA/ObamaCare was that they seem to have invited the Insurance and Drug companies to the table to write the thing.

I feel that if we want a system that is truly meant to treat and heal everyone, it cannot be a for profit system. I do not believe that both the goal of curing and preventing illnesses and making an insane profit are compatible.

That is the problem with the entire ACA. The law was literally written by lobbyists of the Insurance and Drug industries. The only good thing I saw out of the law is the Pre Exisiting conditions clause, which is a big deal to me. I am all for that. Every thing else about the law has made care worse. My union negotiated health insurance plan is much worse after this law was passed than it was before. (And other unions have now realized this, and it is actually a huge issue in the NV Democratic Caucus because Union workers are fearing losing these plans under what Warren and Sanders have proposed)

The Drug companies are the biggest extortionists in this country and people don't realize how firm a grip they have over the entire health care industry. As people have said, because of the Drug Companies influence on the healthcare industry, especially in medical schools, Doctors are just treating symptoms with medication which help the symptoms, but they don't treat the cause. If they treated the cause and stopped it, there would not be a need for all the drugs that are prescribed. And the fact that we pay so much more for drugs in the US than abroad sends shivers down my spine. And then conservative free market people actually try to defend these practices? I am sorry, but the free market should not determine whether someone lives or dies. If you want a textbook case into how these companies think, research the name Martin Shkreli. This guy literally price gouged on the drugs his company sold and then when called out on it he arrogantly and smugly just smirked with no remorse at all.

The actions of the drug companies in my opinion are also responsible for the Anti-Vax movement. .I don't condone the Anti-Vax movement at all and I think they are dangerous, but when Drug companies in this country act the way they have, its not hard to be skeptical of drugs.

We need to guy the entire healthcare system in this country and start over. I am convinced of that, and my father in law, who is a big time capitalist, also believes we need an overhaul and he is all for single payer. Sadly, the republicans have no interest in anything but the status quo as it was before Obamacare, and the Democrats all talk a bunch of hot air, but no action. (Vermont and California have both failed to implement single payer despite being the two most liberal states in the Country). And we would already be there if Harry Truman had followed the Churchill model after WWII, rather than the private model which passed because government run was deemed too Hitler like at the time. Sadly, an uber powerful insurance lobby coupled with massive deficits are making it very difficult to get the reforms that are obviously needed. The ACA was not the right answer, as it made the problem worse.
 
PPVRA
Posts: 8515
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Re: American Internists Call for 'Systematic Reform' Of Healthcare

Thu Jan 23, 2020 9:08 pm

Jouhou wrote:
Healthcare might even be affordable if insurers didn't exist and we ALL payed out of pocket. Instead everything is just horribly distorted.


This part I can agree with. There’s too much insurance involvement in American healthcare.

In every other area of life where insurance works well, insurance is only involved in accident or unlikely events and those are almost always very large bills.

As important as preventive care is, preventive is predictable and therefore not an accident or unlikely event. Nobody should use insurance for preventive care visits—it should be 100% out of pocket.

Nor would preventive care visits cost an arm and a leg were it not for the bureaucracy of insurance companies and the bloated office staff at medical facilities to deal with the paperwork the insurance companies demand. Oh, and the biggest disgrace: the loss of productivity of actual medical staff....
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