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Author Topic: The Tyranny of Medical Bills in America  (Read 94751 times)

AlterEgo

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Re: The Tyranny of Medical Bills in America
« Reply #40 on: September 09, 2015, 03:56:44 pm »

When I go to my regular doctor, I generally know how much it is going to cost me.

right, with a regular office visit you do ... but that was/is a low hanging fruit, Slobodan... why use such an example at all.

When I go to a new doctor, a specialist, etc., I ask in advance how much it is going to cost me and actually shop around. You'd be surprised to learn that shopping around could lead to as much as 80-90% savings for the same service.

ever tried to shop about for a surgery (hospital, surgeon, backup surgeon, guy who will knock you out, etc) like gall bladder removal with a hospital ?  get a quote in writing  ;) ? sure - they say we don't know what might happen, so try to get the price list for the various possible charges then ?

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AlterEgo

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Re: The Tyranny of Medical Bills in America
« Reply #41 on: September 09, 2015, 04:04:17 pm »

Can you explain, we Europeans know far to little about how the system works...

typical (there are other types) insurance has a concept of provider being in-network, that means that provider agrees to use certain procedures, etc and accept certain prices from insurance... they will still "bill" insurance for whatever they want, but insurance will write off the difference between the bill and agreed price and pay percentage of that price...good insurance (rare thing nowadays) will pay 100% no deductible... average insurance will pay 80%, you 20% or 85/15 or 90/10 and often after deductible (which again may be as low as some hundreds a year or as much as several thousand a year  and you still pay your monthly premiums)... when Slobodan says vast majority is covered he forgets to mention that vast majority does not get the same insurance as FTE employee of Adobe has...  and omits the devils about coverage, deductibles, percentage, etc... good insurance is when you go a physician or even a specialist and pay zero for a visit... but you can as well pay $20, $40, $50... and then there is a concept of lifetime max in many (if not all) insurances saying how much they will spend on you in total... which may or may not be the issue - it is with cancers for example... so you might need to find some other options when the timing is not exactly good
« Last Edit: September 09, 2015, 04:09:23 pm by AlterEgo »
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Alan Klein

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Re: The Tyranny of Medical Bills in America
« Reply #42 on: September 09, 2015, 04:06:27 pm »

Oh, I can't wait for the next thread from our Aussie friends complaining how much more expensive everything photographic is down under, compared to America ;)
The reason is because of the high import duties, excise taxes,  VAT and other taxes added on to pay for 'free" medical care "paid" for by the government. That's the main point frequently missed by those who support government paying for everything.  There is no such thing as a free lunch.  The people pay for everything one way or the other.  

Currently medical care runs 17% of GDP in America going up to 25%.  That's huge mainly caused by Medicare, Obamacare, insurance, and lack of enough competition and going up because competition will decrease faster as these government plans are instituted.   Of course, doctors are figuring ways around the rules.  My friend went to an eye doctor for an annual checkup.  The doctor tested him with a half dozen different devices and tests and charged Medicare for each one of them.  Although the rate for each was low, the quantity made up for it.  Of course my friend didn't care because he wasn't paying for any of it.  But the taxpayers are raising the overall cost of medical care and adding to wasteful procedures.  If my friend had to pay himself, he would have not allowed all those tests.  They were all BS.  This is what happens when the user is not directly paying for things.  The price goes up and the quality goes down.  

Rob C

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Re: The Tyranny of Medical Bills in America
« Reply #43 on: September 09, 2015, 04:12:37 pm »

I used to have painting lessons with Fred, a highly successful travel agent who was quite wealthy.

I've taught in inner city high schools with mainly newly arrived immigrant students.

We got along very well. Our core belief was we wanted a better life for ourselves and others.

One thing that we were in complete agreement was that governments should forget political point scoring. They should be working together to make our lives better.

Something for Americans to think about!

Cheers,




Ah! Just like olde Britain then!

(I think you might have meant parties, rather than governments working together, but I get your idea.)

Funny things going on right now within the Brit Labour party: one old guy seems to be on top at the moment for espousing the dogma of the 40s, 50s and all the way up to Blair, who realised that in the modern world, it made the party unelectable, changed to a more balanced point of view, and scored big. Beaten to a pulp at the last election, with the Conservatives in the saddle today, Labour again sees salvation in returning to the dogma that killed it earlier on. Progress. But then, I suppose there are still those who'd vote for Stalin. Or Hitler.

Must be the human condition.

Rob C

Slobodan Blagojevic

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Re: The Tyranny of Medical Bills in America
« Reply #44 on: September 09, 2015, 04:29:46 pm »

...  One thing that we were in complete agreement was that governments should forget political point scoring. They should be working together to make our lives better...

And life should be fair, and all people should be good and smart (good looking wouldn't hurt too), etc. Alas...

Alan Klein

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Re: The Tyranny of Medical Bills in America
« Reply #45 on: September 09, 2015, 04:37:50 pm »

I get that. But why on earth are people so worked up about getting health care from their goverment? I still don't get why that is seemingly the turning point of living in a "free" society vs a "non-free" one. You guys (like us, like anyone) have so many other issues that ought to inspire a lot more enthusiasm or anger.

It is analogous to photographers getting worked up over minute compression artifacts in Sonys raw files, forgetting to check if the image quality is actually better or worse than the alternatives.

-h
Why are we worked up?  Medical care currently is at 17% of GDP going up to 25%.  I'd like to take the 8% difference and save it for a vacation, others might want to save it for the child to go to a better college.  Also, why should the government tell me how I should deal with one of the most important aspects of my life -  my life and health.  Do you know I couldn't go to a doctor because being on Medicare for elderly people over 65 years, there are doctors that have opted out and I had to spend $500 just for an initial visit?  But it's not just medical care.  People are tired of the government butting in all parts of their lives with higher taxes, deficit spending and debt (cause by Obamacare, Medicare and other medical programs as well as other government programs.)  We don;t want to wind up like Greece.   What's wrong with that?  We don't want government telling us how to live?  What's wrong with that?  We're giving up our freedoms to a bunch of bureaucrats in Washington DC who really don't care about us but their own jobs and power.  That's where all the resentment is coming from.  That's why we're worked up. 

Europeans are use to their governments telling then what to do.   The only difference is today the kings and queens are bureaucrats.  Americans threw off the yoke of noble power when we defeated the British King George III.  Americans grew up free and responsible for taking care of themselves.  That's what made us a great nation and people.  We helped each other, we got assistance from our places of worship, neighbor helped neighbor, and most importantly we took pride in helping ourselves.  Unfortunately, our spirit has been worn down by years of handouts by politicians wanting to gain our votes by giving us things seemingly for free.  So now many of us go along because they are looking only at the gifts, not what they have to pay.  But many of us don't want the handouts because we know that there is a catch.  The catch being you have to give the power to make decisions about your life to others.  And then you become serfs just like the Europeans were at the time of nobles.   And that's anathema to most real Americans.

Slobodan Blagojevic

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Re: The Tyranny of Medical Bills in America
« Reply #46 on: September 09, 2015, 04:40:12 pm »

right, with a regular office visit you do ... but that was/is a low hanging fruit, Slobodan... why use such an example at all..

Because it constitutes 90% of my encounters with doctors?

The issue here is probability. Only a fraction of Americans are ever going to end up in the situation your OP bills indicate. And only a fraction of those who do would end up paying such bills in full.

Isaac

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Re: The Tyranny of Medical Bills in America
« Reply #47 on: September 09, 2015, 04:45:18 pm »

But why on earth are people so worked up about getting health care from their goverment? I still don't get why that is seemingly the turning point of living in a "free" society vs a "non-free" one.

The propaganda put forth, by the many vested interests, portrays change as an attack on enshrined freedoms. It's a variation on the tactic that prompted Samuel Johnson to opine - "Patriotism is the last refuge of a scoundrel".
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RSL

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Re: The Tyranny of Medical Bills in America
« Reply #48 on: September 09, 2015, 05:45:21 pm »

And what is rarely acknowledged is that, insofar as we're able to keep it this way here in America, it is through a process of debate, often rancorous. It is by not giving in to any specific ideology, any specific panacea, by forcing continuous change and improvement as best we're able, that we maintain this state of "more or less good, more good than bad"

Without the debate, without the fighting, without the vicious backstabbing, there's no change. Without change, incredibly creative and motivated people will work out how to game the status quo, placing themselves as feudal lords over the starving serfs. The status quo is always bad, objectively so, because any status quo can and will be gamed by these people, who are not particularly evil, they are simply humans.

Wow, Andrew, sometimes we disagree but when we agree we really agree! Not long ago I wrote a short essay titled "Talking About Politics" and put it on one of my webs. It was for my own family: actually, the four families of my four sons. A couple of the wives are scared to death of political discussions, and I pointed out the importance of rancorous discussions in developing worthwhile political solutions to our problems. Political discussion tends to be rancorous when people are committed. Which, by the way, is what's wrong with a lot of our politicians. They're committed all right, but committed to themselves.
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AlterEgo

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Re: The Tyranny of Medical Bills in America
« Reply #49 on: September 09, 2015, 05:54:26 pm »

Because it constitutes 90% of my encounters with doctors?

right, but the issue is exactly the rest of situations... why don't we simply stop treating 10%, the most expensive, cases and let those folks to die off... profit... it is only 10%, right... 90% is what matters
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AreBee

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Re: The Tyranny of Medical Bills in America
« Reply #50 on: September 09, 2015, 05:56:59 pm »

Russ,

Quote
A couple of the wives are scared to death of political discussions...

They are scared to death of the adverse effect that political discussion can have on family relationships.
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Slobodan Blagojevic

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Re: The Tyranny of Medical Bills in America
« Reply #51 on: September 09, 2015, 05:57:59 pm »

... why don't we simply stop treating 10%, the most expensive, cases and let those folks to die off... profit...

Straw-man argument.

RSL

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Re: The Tyranny of Medical Bills in America
« Reply #52 on: September 09, 2015, 06:16:24 pm »

Russ,

They are scared to death of the adverse effect that political discussion can have on family relationships.

No, Actually, Rob, they feel personally threatened. Both come from families where discussion of serious topics of any kind was unusual and political discussion was verboten.
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tom b

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Re: The Tyranny of Medical Bills in America
« Reply #53 on: September 10, 2015, 02:30:26 am »

"And life should be fair, and all people should be good and smart (good looking wouldn't hurt too), etc. Alas..."

Yes, the Swiss have governments that cooperate and work for the benefit of the people. It is not fairyland stuff. They have around seven major political parties. That is, their governments do not have a political party that holds anywhere near of all of the power. They have to work together if they want to get things done, fancy that.

At least we have had one bit of revenge, we did give you Rupert Murdoch!

Cheers,

The point that Fred made that I really liked was for example, if they wanted to make a change to their healthcare system there would have to be some sort of consensus. That is, you couldn't have Obamacare, it would be a joint decision. The major result seems to be the disappearance of flip flopping every time there is a change of government. Wedge politics has lost its power.

« Last Edit: September 10, 2015, 03:34:47 am by tom b »
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Tom Brown

Robert Roaldi

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Re: The Tyranny of Medical Bills in America
« Reply #54 on: September 10, 2015, 08:12:22 am »

The reason is because of the high import duties, excise taxes,  VAT and other taxes added on to pay for 'free" medical care "paid" for by the government. That's the main point frequently missed by those who support government paying for everything.  There is no such thing as a free lunch.  The people pay for everything one way or the other.  

I won't wade into this discussion, but want to make a couple of comments (I was born and live in Canada). The above characterization of "free" medical coverage is loaded and basically incorrect way to describe the situation. That language is deliberately chosen to load the discussion, imo. Everyone knows it's not free, and it's silly to describe it that way. What we have in Canada, at least, is a nation-wide health insurance policy that we decided to buy for ourselves, nothing more. (To be accurate, it's actually 10 such systems, since each province administers its own.) There is a set of medical procedures that are covered for everyone in the country paid for out of general tax revenues, but if you want to call them premiums instead of taxes, go ahead if that makes you feel better. For some reason, people get their backs up when they hear the word taxes, but are somehow ok with fees and premiums. Whatever floats your boat. We can travel from province to province, get taken care of with no out-of-pocket expenses (with some exceptions), and the agencies involved figure out how to pay each other inter-provincially.

Almost everything we hear in the US media about Canadian socialized medicine and civil servants deciding who lives or dies is just plain stupid nonsense. Our doctors are all self-employed professionals, some are in individual practices, others in more complex arrangements. They just do most of their billing, not all, to one agency, simplifying their overhead.

Some people feel that they are better served by a system of private insurers, because, presumably, they "compete" to lower costs. I used to know something about the internal workings of insurance companies and that statements makes me laugh out loud.

On vacation once, I met a surgeon from Michigan and we started talking about how our medical systems differ. I am a layman, not an expert, but did my best to describe our system. He viewed the Canadian single-payer system as a godsend. He said that his greatest office overhead expense was catering to the different demands of all the different insurance systems that he had to deal with. He was disgusted at the amount of time he had to spend with insurance company staff debating the merits of his medical choices for his patients, calling it a huge bureaucratic interference in private matters, and it came from many different companies, each with their own agenda. He considered it the worst part of his job and consumed for too much of his time that should have been spent with patients. Of course, it's just one story.

One aspect of private insurers, and it happens with car insurance, is that you have to renew it periodically (typically, yearly) and at some point, if they consider you too great a risk, they refuse to renew, leaving you in the lurch. It's not unknown for companies to dump you as a client if you get really sick, I've heard/read the anecdotal evidence and I sincerely hope they are exaggerated stories. Personally, a system that allows companies to dump coverage precisely when it is most needed is repulsive.
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Otto Phocus

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Re: The Tyranny of Medical Bills in America
« Reply #55 on: September 10, 2015, 08:39:57 am »


One aspect of private insurers, ... if they consider you too great a risk, they refuse to renew, leaving you in the lurch. It's not unknown for companies to dump you as a client if you get really sick, I've heard/read the anecdotal evidence and I sincerely hope they are exaggerated stories. Personally, a system that allows companies to dump coverage precisely when it is most needed is repulsive.

You could fill many forum pages of examples of insurance companies delaying decisions, not following the laws and for all I know, hoping that the patient dies before they have to pay.

My wife needed a spinal/skeletal surgery.  The state law stated that these types of surgeries must be approved by the insurance company immediately and with no adjudication.  The reason being that delays can result in serious and permanent disabilities. Our insurance company (a major company) put it under adjudication for almost a year. Surprisingly, the adjudication came to a halt when our lawyer got in touch with the state health board.

One should not need a lawyer to get an insurance company to comply to the state law... but I guess you do. I would suggest that all American's budget for lawyer expenses as part of their health care budget.  :( 
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Slobodan Blagojevic

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Re: The Tyranny of Medical Bills in America
« Reply #56 on: September 10, 2015, 09:30:44 am »

I guess American apprehensions about government-controlled health care stem from the current and vivid experience with the existing one: VA (veteran affairs). If that's how they treat their own, those who sacrificed their heath for the country, what's left for the rest?

tom b

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Re: The Tyranny of Medical Bills in America
« Reply #57 on: September 10, 2015, 10:10:14 am »

"One aspect of private insurers, and it happens with car insurance, is that you have to renew it periodically (typically, yearly) and at some point, if they consider you too great a risk, they refuse to renew, leaving you in the lurch. It's not unknown for companies to dump you as a client if you get really sick, I've heard/read the anecdotal evidence and I sincerely hope they are exaggerated stories. Personally, a system that allows companies to dump coverage precisely when it is most needed is repulsive."

I don't fear getting sick in Australia, I do fear getting sick. Bugger, getting older is a pain!

Cheers,
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Rob C

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Re: The Tyranny of Medical Bills in America
« Reply #58 on: September 10, 2015, 10:42:47 am »

I think Robert Roaldi explains it very well.

Here, in Europe, you can get a card (in my case, from Britain) that allows you the same treatment across Europe (in state medicine), should you find yourself travelling within the European Union, as you would have received under your home jurisdiction. This does not replace a normal travel insurance policy, by the way. I think that traveller's insurance card is called the E111 or similar.

If you are legally a resident in Spain, you can be put onto the 'host' country's list and get all the medical help you need. In theory. I say that, because there's a complication: unlike what I take to be the Canadian example, here the country (Spain) is split into provinces, but each seems to issue its own version of the local medical card for internal use. For example: I have one for the Balearic region. Once, getting my regular prescription from the local chemist, I asked what would happen if I found myself in another part of Spain, wanting to use my card. She told me that I would need to register in that other place. Now, I have not asked my doctor this question, but as a dispensing chemist of many years, I'd imagine the chemist knows her stuff because she obviously deals with many Spanish tourists from around this relatively large country.

Actually getting registered for these 'host's' benefits can be quite time-consuming and was once a very heavily bureaucratic adventure. Having been here many years I have no idea how newbies get handled today.

If one thought too deeply, one would stay at home all day long.

Rob C

Alan Klein

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Re: The Tyranny of Medical Bills in America
« Reply #59 on: September 10, 2015, 10:44:51 am »

I was perfectly happy with the insurance i had.   Recently my wife went to the doctor for an injury.   The doctor wanted to see an mri.  We went across the street to a lab and had it done and was back to the doctor in two hours.   He reviewed the mri that day.   It cost us a co-pay of $15 or $20. 

  The insurance company paid the lab probably $500.  I hear in Canada,  you can wait months until they approve an mri.  That's the reason many Canadians come over the border to the USA when they need an mri and pay fully out of pocket for it.   What good is cheap if you can't get it when you need it?
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