How does this happen?
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14-09-2017, 11:48 AM
RE: How does this happen?
There is a lot to unpack there my friend but before I do I need a bit of clarification which is ....what would cost less and be more efficient? Sorry, I just woke up and I might be totally spaced out but I'm not sure what alternative to the current American system of healthcare you're proposing. Single payer? A system totally without health insurance companies and 100% owned and operated by the government?

When valour preys on reason, it eats the sword it fights with.
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14-09-2017, 12:02 PM (This post was last modified: 14-09-2017 12:11 PM by Rockblossom.)
RE: How does this happen?
Here's a look at what Sanders is proposing:

Quote:Sanders' plan touts the promise of efficiency, much of which comes from eliminating the operating costs of insurance companies. About 21 percent of every dollar spent on health insurance goes to overhead and profit, according to America's Health Insurance Plans, the insurance industry trade group. For Medicare, the comparable figure is less than 3 percent. That's because Medicare doesn't have marketing expenses and because of its scale.

"Medicare is more efficient," said Gerald Friedman, an economics professor. "Even large insurers are more efficient than small insurers. It's not just that the public system is less expensive."

But some see the downside:

Quote:Health benefits, just as they're prohibitively expensive for small businesses, are a competitive advantage for many large corporations. And in the current system, where wages are taxed but employer-provided health insurance isn't, it's cheaper for a company to spend $18,000 on health care for an employee's family than to put that same $18,000 into the worker's paycheck.

Perhaps the biggest impact of a Medicare-style system would be in the stock valuations and market capitalizations of companies that profit from the system's high costs, such as health insurers, for-profit hospital chains and pharmaceutical companies. That would have a cascading effect on mutual funds and pension plans that have invested in those companies.

https://www.cbsnews.com/news/sanders-med...d-it-work/
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14-09-2017, 12:14 PM
RE: How does this happen?
Just a quick comment. Through means of my own stupidity I ended up in the Tulane Hospital in New Orleans with a blood clot and without insurance. I spent one night in the hospital. I paid something like $6000 for that event. My younger son with insurance crashed his bike in San Francisco breaking a tooth and also spent one night in the hospital. His insurance company paid something like $17000 for that event.

I think that those two events tells one what the real cost of health service is and what the horrible system we have in the US costs all of us.
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14-09-2017, 12:38 PM
RE: How does this happen?
(14-09-2017 12:14 PM)JAH Wrote:  Just a quick comment. Through means of my own stupidity I ended up in the Tulane Hospital in New Orleans with a blood clot and without insurance. I spent one night in the hospital. I paid something like $6000 for that event. My younger son with insurance crashed his bike in San Francisco breaking a tooth and also spent one night in the hospital. His insurance company paid something like $17000 for that event.

I think that those two events tells one what the real cost of health service is and what the horrible system we have in the US costs all of us.

My experience has been basically the opposite of that. I had an accident a few years ago and was taken to the emergency room. After a few hours, they decided they didn't have the resources to handle my injuries, and shipped me off to another hospital.

For now, we'll just focus on the first hospital. I was only there for a few hours. A few weeks later, I got a "statement of benefits" from my insurance company. Total cost for those few hours: around $7000. Amount covered by insurance: $0. Amount owed by me: around $7000. This was more traumatic than the accident.

Fortunately, what had happened is that the insurance claim hadn't gone through yet. When it finally did, costs were "adjusted", and the total amount paid by my insurance and me was about half of that original $7000. Neither of us paid anywhere near that amount.

Something like this happens every time I get an insurance statement. There is a basic cost (what I would pay if I had no insurance), an adjustment, an insurance payout, and an amount that I owe. The sum of the last two is always significantly less than the "basic cost". I realize that a lot of this is fudging and "nudge nudge wink wink" between the hospital and the insurance company, but I've never heard of an insurance payment being more than what I would have to pay without insurance. My experience is that it's always substantially less.
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15-09-2017, 11:51 AM
RE: How does this happen?
(14-09-2017 12:38 PM)Grasshopper Wrote:  
(14-09-2017 12:14 PM)JAH Wrote:  Just a quick comment. Through means of my own stupidity I ended up in the Tulane Hospital in New Orleans with a blood clot and without insurance. I spent one night in the hospital. I paid something like $6000 for that event. My younger son with insurance crashed his bike in San Francisco breaking a tooth and also spent one night in the hospital. His insurance company paid something like $17000 for that event.

I think that those two events tells one what the real cost of health service is and what the horrible system we have in the US costs all of us.

My experience has been basically the opposite of that. I had an accident a few years ago and was taken to the emergency room. After a few hours, they decided they didn't have the resources to handle my injuries, and shipped me off to another hospital.

For now, we'll just focus on the first hospital. I was only there for a few hours. A few weeks later, I got a "statement of benefits" from my insurance company. Total cost for those few hours: around $7000. Amount covered by insurance: $0. Amount owed by me: around $7000. This was more traumatic than the accident.

Fortunately, what had happened is that the insurance claim hadn't gone through yet. When it finally did, costs were "adjusted", and the total amount paid by my insurance and me was about half of that original $7000. Neither of us paid anywhere near that amount.

Something like this happens every time I get an insurance statement. There is a basic cost (what I would pay if I had no insurance), an adjustment, an insurance payout, and an amount that I owe. The sum of the last two is always significantly less than the "basic cost". I realize that a lot of this is fudging and "nudge nudge wink wink" between the hospital and the insurance company, but I've never heard of an insurance payment being more than what I would have to pay without insurance. My experience is that it's always substantially less.

Depends if the hospital knew you were "self-pay" before they prepared your billing statement. The charges that will be submitted as an insurance claim are always outrageously high, because the insurance company will knock them down to the allowable amount, therefore the submitting entity has nothing to lose. These are in no way shape or form their actual costs for the services rendered.

I saw this with the birth of my two children. First child, had corporate insurance. Total billed amount was north of $22,000, insurance paid about 8,000 and I was on the hook for my deductible of $2,000. Second child 18m later, no insurance, worked out payment plan with hospital up front - total billed amount was around $7,500.

Where you get into trouble is if they think they are billing insurance and then find out either 1. you don't have it or 2. they aren't part of the network. At that point you're stuck fighting against the higher insurance billed amount, and they may or may not be willing to reduce it for you.

All this really does point out how broken our system is.
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15-09-2017, 03:04 PM
RE: How does this happen?
In Australia, we have a two-tiered healthcare system as far as hospitalisation and emergency medical transport goes.

The first one is "public" hospitals; the second is "private" hospitals.

The first charges the patient for all services rendered, which means that the smart private patient has personal medical insurance. The second does not charge the patient anything at all for services rendered; the government's medical insurance pays for it all—providing certain stipulations are in place. In my case, as an aged pensioner, I meet those stipulations of age, assets, and income.

Likewise, emergency transport such as by helicopter (as for where I live) or road ambulance is covered by the government for pensioners and the unemployed, but other people have to pay the full costs—which, again, is why insurance is a must for them.

Also, a visit to a general practitioner (MD) is free for pensioners and the unemployed, but costs around $60 to $75 for a 15-minute consultation for other people—although the government does reimburse the latter for around $36 after a claim is lodged post-service.

This is a very loose description of health services in Australia; there's a hundred other ifs, buts, and maybes involved. Undecided

I'm a creationist... I believe that man created God.
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