The Goat Pen

"I never realized it at the time but I'm sure my parents just prayed that we never got seriously sick"

Well, that's the thing with almost all insurance: Most people never use it, or at the very least take out much less than they pay in. That's why insurance as an industry is so wealthy. And there's nothing wrong with that, except that in many cases consumers are forced to pay those premiums, but hardly anybody objects to having to pay liability auto insurance, although almost nobody gets into a horrible wreck where they total somebody else's car or hurt somebody else badly. So basically the entire auto insurance industry is set up to protect those few thousand people who that happens to at the expense of the millions of people who never have any major accident but still have to pay tens of thousands of dollars in premiums over the course of their lifetimes.

I suspect the same is true of medical insurance. I had back surgery when I was 18 and got an infection that required me to stay in the hospital for about a week and get IV antibiotics when I was in my late 20's. I'd say that is far outside the norm for most people, so outside two semi-major incidents, I've never spent any time in the hospital. I rarely go to the doctor for any reason, but even if I had had to pay out of pocket for all of those things, it would've still been far less than the total premiums I would've paid over my lifetime up until now if I had had health insurance that whole time, which I didn't. I doubt that the vast majority of people b/w the ages of 18 and 50 would spend a fraction of what they would pay in insurance premiums over that time on anything other than routine visits to the doctor, and I bet well over 50% of those routine visits were totally unnecessary in the first place. That's my main gripe with the whole business, that so many people run to the doctor for every minor scratch or cough that it jacks up the prices for everybody else...

"That health care plan you described was certainly better than what we have now. At least you could get the minimum amount of care for a few bucks. Now it costs a few hundred bucks just for some asshole in a white coat (not even a doctor) to write a 'script and tell you that you'll be fine in a few days."

Just what I was saying above, esp. the part about the faux doctor (or real doctor) just sending you on your way and telling you that you'll be fine in a few days, which you will. Insurance companies wouldn't even exist if they had to pay out more than they were taking in, but clearly they are taking in far more than they are paying out, b/c the vast majority of people barely use it at all and in some cases (like auto liability or homeowners insurance) never use it. Never! But yet they pay tens of thousands over their lifetime for something that they never use, and if they do end up filing a claim, their premiums go thru the roof, so in reality they pretty much end up paying for it out of pocket on the back end...

"and I can't remember what the mental health thing was."

LMAO...

hedge wrote:"I never realized it at the time but I'm sure my parents just prayed that we never got seriously sick"

I suspect the same is true of medical insurance. I had back surgery when I was 18 and got an infection that required me to stay in the hospital for about a week and get IV antibiotics when I was in my late 20's. I'd say that is far outside the norm for most people, so outside two semi-major incidents, I've never spent any time in the hospital. I rarely go to the doctor for any reason, but even if I had had to pay out of pocket for all of those things, it would've still been far less than the total premiums I would've paid over my lifetime up until now if I had had health insurance that whole time, which I didn't. I doubt that the vast majority of people b/w the ages of 18 and 50 would spend a fraction of what they would pay in insurance premiums over that time on anything other than routine visits to the doctor, and I bet well over 50% of those routine visits were totally unnecessary in the first place. That's my main gripe with the whole business, that so many people run to the doctor for every minor scratch or cough that it jacks up the prices for everybody else...

that is the crux of Obamacare though - those 18-50 year old's that never go to the doctor pumping money into the insurance companies to cover the costs of the chronically ill that are supposed to represent a very small number of the overall. One major problem is though that they made it easy for them to opt out - penalties can't be enforced other than thru tax refunds, so all you do is just structure your life so you'll never get a tax refund and you don't pay into the system. You save thousands of dollars each year and to a 30 year old trying to buy a house and has no medical issues, its a no brainer. Pissing blood one morning? guess what? just go sign up - insurance companies have to take you even if you have pre-existing conditions. After the bills are paid and you're healthy again? cancel it.

As for going to the doctor for every scratch, we'll we've been conditioned to do so with HMO's. If you're paying $200 a month for a premium with no co-pay then you gotta get your money's worth.
Doctor offices are like Jiffie Lube - in/out and we'll try to sell you as many add-ons as we can while you are here.

Now if they gave you say $2000 back every year that you spent less than $1K on medical expenses, then you'd break that cycle. You have to incentivise people to save money and demand the cheapest health care options. Its what auto insurance companies do.

Background on the dossier.

http://www.nytimes.com/2017/01/11/us/po ... gence.html

"Now if they gave you say $2000 back every year that you spent less than $1K on medical expenses, then you'd break that cycle."

I hadn't thought about that, but now that you mention it, I'm surprised some insurance company hasn't come up with something at least along the lines of "Didn't go to the doctor or file a claim last year? We'll pay your first two months premium the next year." Of course, the way it's set up now, they don't have to offer any incentives b/c there's no competition...

Today's trending Trump tweet:
".@CNN is in a total meltdown with FAKE NEWS because their ratings are tanking since election and their credibility will soon be gone!"

Meanwhile, in the short time since Buzzfeed made the dossier revelation, every news organization in the free world has taken up the story. You'll probably see something about it in your kid's school paper.

hedge wrote:"Now if they gave you say $2000 back every year that you spent less than $1K on medical expenses, then you'd break that cycle."

I hadn't thought about that, but now that you mention it, I'm surprised some insurance company hasn't come up with something at least along the lines of "Didn't go to the doctor or file a claim last year? We'll pay your first two months premium the next year." Of course, the way it's set up now, they don't have to offer any incentives b/c there's no competition...

yep - if you have 2 choices at best, they are setting the terms

Had to repost this...

eCat wrote:LOL

You got any more questions Wolf?


[youtube]s9xokE0fRok[/youtube]

I read somewhere that 90 % of all health care expenses is your last 6 months of life. even though most people would like to die at home many wind up in icu or hospitals with expenses mounting on people with little or no hope.

we need someone like hedge in charge of when its time to pull the plug on expenses.

hospice care and living will needs to be enforced and encouraged instead of last ditch efforts to save great grandpa by dialyzing or the latest cancer treatment or doing some expensive procedure to gain him and extra week of misery.

There's the rub. It's easy to talk about those last few weeks and months as being expendable when you're speaking in generalities, but when it's you or one of your loved ones, every moment is precious and nobody cares about the expense. Of course, that's also why Medicare and the insurance companies roll out the red carpet if you agree to hospice care.

I called a ACA rep today to see if we could get coverage for less. I was told that we (my wife and I) did qualify for a subsidy (but they said the same thing last year). However, the lowest premium was $88/month (for each) and that came with a $7K deductible and we'd have to pay for all dr's visits and meds. So I'm basically just paying the insurance company an extortion rate to cover castastrophic costs on a deductible that would be catastrophic for me to pay.

If we get hit with the full penalty of $695 each that would still be cheaper than handing money over to an insurance extorter.

They have got to come up with a better plan than this.

Saint wrote:I called a ACA rep today to see if we could get coverage for less. I was told that we (my wife and I) did qualify for a subsidy (but they said the same thing last year). However, the lowest premium was $88/month (for each) and that came with a $7K deductible and we'd have to pay for all dr's visits and meds. So I'm basically just paying the insurance company an extortion rate to cover castastrophic costs on a deductible that would be catastrophic for me to pay.

If we get hit with the full penalty of $695 each that would still be cheaper than handing money over to an insurance extorter.

They have got to come up with a better plan than this.

you and 120 million other people

Saint wrote:I called a ACA rep today to see if we could get coverage for less. I was told that we (my wife and I) did qualify for a subsidy (but they said the same thing last year). However, the lowest premium was $88/month (for each) and that came with a $7K deductible and we'd have to pay for all dr's visits and meds. So I'm basically just paying the insurance company an extortion rate to cover castastrophic costs on a deductible that would be catastrophic for me to pay.

If we get hit with the full penalty of $695 each that would still be cheaper than handing money over to an insurance extorter.

They have got to come up with a better plan than this.

I heard Pelosi this morning on NPR. She admitted that the ACA did not reduce premium costs but without the ACA, premium costs would have gone up much higher by % - so that by itself is an admission of failure of the ACA based on their promises - but its not even apples to apples. She ignores that probably the biggest driver of keeping premiums down is that many, many Americans have been saddled with a deductible that is the equivalent of them buying a used car every year.

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From the Department of Health and Human Services

The $10,345-per-person spending figure is an average; it doesn’t mean that every individual spends that much in the health care system. In fact, U.S. health care spending is wildly uneven.

About 5 percent of the population — those most frail or ill — accounts for nearly half the spending in a given year, according to a separate government study. Meanwhile, half the population has little or no health care costs, accounting for 3 percent of spending.

Of the total $3.35 trillion spending projected this year, hospital care accounts for the largest share, about 32 percent. Doctors and other clinicians account for nearly 20 percent. Prescription drugs bought through pharmacies account for about 10 percent.

The report also projected that out-of-pocket cost paid directly by consumers will continue to increase as the number of people covered by high-deductible plans keeps growing.

One problem is, if you can get good insurance for $88 a month, most people would be going to the doctor even more than they do now for even more bullshit aches and pains, and then the system gets clogged up even more. Having a high deductible is at least a disincentive for going to the doctor when you cut your finger, i.e., if you know you're going to have to pay $100 out of pocket to get a band aid, you probably won't go, which is good. The middle ground problem for many people, though, is if you have something slightly more serious or need to get something like a colonoscopy, you could have a few thousand in out of pocket expense b/c it doesn't meet the deductible, and that's a big issue for many folks...

"Of the total $3.35 trillion spending projected this year, hospital care accounts for the largest share, about 32 percent."

I know it's a very small sample size, but when is the last time anybody in here had to be admitted to the hospital or went to the emergency room? How many times in your life have you had to spend more than one day in the hospital?

hedge wrote:One problem is, if you can get good insurance for $88 a month, most people would be going to the doctor even more than they do now for even more bullshit aches and pains, and then the system gets clogged up even more. Having a high deductible is at least a disincentive for going to the doctor when you cut your finger, i.e., if you know you're going to have to pay $100 out of pocket to get a band aid, you probably won't go, which is good. The middle ground problem for many people, though, is if you have something slightly more serious or need to get something like a colonoscopy, you could have a few thousand in out of pocket expense b/c it doesn't meet the deductible, and that's a big issue for many folks...

what I can't figure out is - if the majority of costs are incurred by seniors, aren't they on medicaid at that point and not private insurance?

hedge wrote:"Of the total $3.35 trillion spending projected this year, hospital care accounts for the largest share, about 32 percent."

I know it's a very small sample size, but when is the last time anybody in here had to be admitted to the hospital or went to the emergency room? How many times in your life have you had to spend more than one day in the hospital?

I get what you're saying - so if the majority of costs are with seniors who are on medicaid - which I assume is government outsourced and not private insurance, then why are our medical costs so high?

hedge wrote:One problem is, if you can get good insurance for $88 a month, most people would be going to the doctor even more than they do now for even more bullshit aches and pains, and then the system gets clogged up even more. Having a high deductible is at least a disincentive for going to the doctor when you cut your finger, i.e., if you know you're going to have to pay $100 out of pocket to get a band aid, you probably won't go, which is good. The middle ground problem for many people, though, is if you have something slightly more serious or need to get something like a colonoscopy, you could have a few thousand in out of pocket expense b/c it doesn't meet the deductible, and that's a big issue for many folks...

That is why the minute clinics and such have popped up. Even our family doctor now has 2 offices. The first one is to see the doctor about physicals and other stuff. The other office which is attached in the same building is the wellness center. That one is for people that have the sinus infections, sick children, non-emergency type stuff. We have insurance so not sure how much it would be without but I assume it is no more than using a Wal-Green / CVS clinic for the same type of stuff.

zero admission maybe 2 Er visits both for stitches

wife has had 2 ER visits one for bad fever one for passing out likely dehydration.

the thing I learned the most and with my mother in law is how many specialists and tests every ER tries to order. working in the medical field myself I saw how dramatically my wife improved with just some iv fluids and yet these schmucks did everything in their power to twist our arms into multiple imaging studoies lab studies and made us sign out against medical advice for a 40 something year old who just needed hydration.

likely the BCBS policy influences that too

still got over a 10K bill

I think that if you pay insurance every month but then never go to the doctor, you should get something back at the end of the year.

Also, if you do go to the doctor, why can't you just sign up for a level of care. If you're one of these namby-pambys that has to have a bunch of tests done for a little blood in your urine, then you should pay for it. But if you're like me and just want to get some quick script meds and go home, why should I have to go through a bunch of costly tests?

This whole thing is a yuge racket.

I can't say that I'm going to be upset if they overturn Obamacare, to be honest. However, I doubt very seriously that whatever replaces is going to be much better unless we get a serious grip on medical/pharm costs.