American Health Care: Educate Me! - Politics and War Forum

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American Health Care: Educate Me!
Monday, September 07, 2009 3:53 PM on j-body.org
I've come to the conclusion that I simply don't know enough about how Americans run health care to be able to attack it as good or bad. The problem, I think, is simply that I've only heard what rich people or people with an agenda think of it. And the biggest problem is that when I speak of it, I'm only saying what I think I know, and that can't go on anymore. It's not fair to you or me.

The problem, imo, is that Americans are talking one language and foreigners (like me) talk another, when it comes to health care. We're trying to "see" the other guy's system when all we know is our own.

So let's sit down, not raise our voices or get mad, let's not bring up religion, entitlement or politics and let's talk in calm voices until we understand what our own system is and what the other guy's system is. I'll answer any question about Universal Care, and you guys answer me about US Care? Deal?

So here goes: How does it work, exactly? If you have no money, can you still get treated? How much does it cost? How long do you wait for care? Is there a limit to how much an insurance company will pay? If you have a really serious cancer, and it costs 20 million to treat, would it pay that?




Re: American Health Care: Educate Me!
Monday, September 07, 2009 5:15 PM on j-body.org
Knoxfire Esquire wrote:

How does it work, exactly?

pay premiums monthly/quarterly/annually and receive care. usually you have a copay or coinsurance associated with services. ex: i just got glasses and the exam cost me $15. then the plan paid for my lenses/etc and $80 towards frames. anything more than that is the responsibility of the person. such as my frames cost $92, so i was responsible for the extra $12. had i upgraded my lenses they would have cost me the difference too.

now granted that is a vision plan and medical isnt the same...but its similar. the difference is that there isnt tiering with medical. if i broke my leg, i would pay X amount for an inpatient admission to a hospital, and the majority of the rest would be paid by the ins company, depending on the types of care i received. i might pay a copay to see a specialist or a copay for therapy. same for any prescriptions or medical equipment (like crutches) that i would need.

but the variety of plans out there means that there is a myriad of ways that each situation is handled.

Knoxfire Esquire wrote:

If you have no money, can you still get treated?

yes. emergency care is offered by hospitals. if you break your leg and dont have ins, you can get it fixed. its true that this is basic care and wouldnt pay for things such as therapy or stuff like that, but you arent left out on your own with a shattered bone sticking through your pant leg either.

Knoxfire Esquire wrote:

How much does it cost?

depends on your plan. i work for blue cross blue shield and its paid for completely. other people who arent as fortunate pay one or two hundred a month for their whole families. here is a recent thread with a variety of prices/plans
many companies are not paying as much as they used to towards employee's insurance costs because its costing them too much. but the solution isnt a govt option, its lowering the costs so that employers will be able to pay towards it like they used to.

Knoxfire Esquire wrote:

How long do you wait for care?

waiting? whats that?

no, seriously.....if you have insurance then its just up to finding a time you and the dr can schedule a day together.

Knoxfire Esquire wrote:

Is there a limit to how much an insurance company will pay?

generally, no. im sure there are a few rare cases that the left will try and present as being the norm...but unless your policy states there is an upper limit, then there isnt.

Knoxfire Esquire wrote:

If you have a really serious cancer, and it costs 20 million to treat, would it pay that?

again, it depends on the plan/insurer. in the end it is a business decision where sometimes bean counters do come into the situation. but its not like that happen 10% of the time, 1% of the time, or even .1% or .01% of the time. those are just horror stories either made up by, or blown out of proportion by universal health care advocates.

while you may have it in your mind that greedy corporations are in charge of who gets care and who doesnt.....its really not the case at all. there are things they can and cannot do--and those things are regulated by the people on capitol hill. if we cant trust them to regulate the people they are supposed to, how can we trust them to regulate themselves?

simply put, i would much rather trust my health care to a greedy company that has to answer to the govt, than to an incompetent govt who doesnt have to answer to anyone.


now, in the spirit of open debate, i would like to ask you the same questions about your health care system.






Re: American Health Care: Educate Me!
Monday, September 07, 2009 5:39 PM on j-body.org
Knoxfire Esquire wrote:

So here goes: How does it work, exactly? If you have no money, can you still get treated? How much does it cost? How long do you wait for care? Is there a limit to how much an insurance company will pay? If you have a really serious cancer, and it costs 20 million to treat, would it pay that?

Yes, if you go to a hospital, you can not be refused treatment, no matter what. This differs with a regular doctor's office, though. A private practice office is not required to treat someone. However, most doctors to some pro-bono work for the needy.

As for the cost, if you go to the hospital and get treated at the emergency room, it's quite expensive. However, if you tell them you're paying up front, they will usually be able to cut at least 25-30% off the bill, because it requires far lest administative work on their part. This is what everyone forgets about when screaming about healthcare costs. It's all the beurocracy involved in dealing with the insurance companies for everything that drives up a lot of the costs, because they have to pay people to process all of the crap. One of the reasons behind this was the advent of HMO's. 30 years ago, most people were used to paying out of pocket for everything except and emergency, injury, illness, or surgery. You paid for every office visit, you paid for every medication. Think of it as the same as car insurance. You only use it in the event of an emergency. Once HMO's started becoming popular, people started becoming used to the idea of office visits being paid for, and prescriptions being partially paid for. As traditional insurance was pretty much phased out of existance, paying for any health care became a repugnant concept to a large percentage of the population.

Now let's back up for a moment. When there was no HMO, and everyone paid for most of their checkups, other office visits, and prescriptions on their own, insurance was cheap. Why? You paid a yearly premium in case something happened. So the insurance companies weren't paying out even close to what they are now. Once they started covering everything, they still had to bring in more money than they were paying out, for their operating costs, their payroll, and yes, profit (the most evil word of the 21st century). As more and more people were covered by HMOs, and were using the coverage more (hell, if it's all covered, why not use it whenever you feel like it?), taking more prescriptions for more "illnesses" (this is a whole different topic, but seriously, how many people can remember a time when everyone wasn't on an anti-depressant, anti-anxiety, anti-adhd, weight loss, cholesterol reducer, etc. etc.?). You can clearly see the pattern of useage meant that the premiums had to increase to cover the pay-outs. Also, the co-pays had to start being increased, and the coverage had to start being backed down.

Now, over the same period of time, our culture began to believe more and more that any time something went wrong in life, there was someone you could sue for it, and become a millionaire. Doctors and hospitals became the primary targets (hell, why not? they made good money, so they had it to give, right?), and here is where the biggest cost of healthcare comes into play: malpractice insurance. This varies around the country, but I can tell you that in metropolitan areas, you will find that many malpractice insurance policies exceed the salary of the doctor they cover. This should put things into perspective for you. In the Boston area, it's very common for a general practitioner to have a $300K+ yearly premium for malpractice insurance.

Back to your original question of what happens if you need an expensive treatment, most hospitals will work out a payment arrangement with you, and they give you years to pay it off. Most of the time, they're not even worried about how long it's going to take, they just want you to keep paying toward it. Having paid for things out of my pocket plenty of times, I can tell you that every hospital I've dealt with is the worst bill collector ever. You can owe them $10,000, and tell them you can only afford $50 a month, and they'll take what they can get. The flip side of this is that it's another reason costs are high, because they have to keep paying administrative costs to maintain all of these accounts. Most of them are outsourced to a collection agency who simply gets a percentage of what they collect (unlike typical credit collections where companies actually buy the debt in most cases)

As far as how much an insurance company pays, the typical "covered" expense gets paid at around 80% from the plans I've seen. There are tons of plans out there, and some pay 100%, some even pay as low as 70%. As I mentioned in the previous paragraph, the hospital works with you to get your portion of an expense, so they might get their 80% within a month of treatment, but they'll work with you to get the other 80%.

As for waiting for care, for most things you don't really have to wait. Even most surgery that is not life-threatening will be scheduled for as early as the same week it's prescribed. However, patients get critical care by priority. If you need something that is time-dependant, you get right in. Anything that is not crutial runs the risk of getting bumped if something comes up. Personally, I believe this works very well in most cases. Doctors will decide if the schedule is full and someone needs critical care, who they can reschedule. They make these determinations solely on the needs of the patients, not any financial reasons.






Re: American Health Care: Educate Me!
Wednesday, September 09, 2009 6:53 PM on j-body.org
heres a few questions knoxy

i hear you guys dont have pediatricians for kids, just general practice doctors?

ive heard that there has been a heavy loss of doctors getting their medical liscence then coming to the u.s. to practice causing a shortage of doctors since they can make more money here?

ive heard that for a general doctor you sometimes have to schedule 6-9 months in advance?

ive heard general wait times in general are quite long




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Re: American Health Care: Educate Me!
Thursday, September 10, 2009 5:54 AM on j-body.org
sndsgood wrote:

heres a few questions knoxy

i hear you guys dont have pediatricians for kids, just general practice doctors?

ive heard that there has been a heavy loss of doctors getting their medical liscence then coming to the u.s. to practice causing a shortage of doctors since they can make more money here?

ive heard that for a general doctor you sometimes have to schedule 6-9 months in advance?

ive heard general wait times in general are quite long


Oh god... you've hit the nail on the head. Wait times, wait times, wait times... Yes, they're bad. Depends on the place, depends on the doctor, but it can be horrible. 6 to 9 months? 6 months is on the rare-ish high end, 9 would be pushing it (...and no doctor would make you wait 6 to 9 months if you had a serious problem. In fact, you can gauge the seriousness of your illness by how quickly the doctors see you). I'll give you an example, I took a doctor's appointment in late May and got it on October 4th.

Wouldn't know about pediatricians, don't have a kid. Wouldn't surprise me though.

Yup, there's a doctor shortage. I've always suggested that a simple fix for this would be that the government pay for the entire schooling of anyone who wants to become a doctor, under the condition that they practice only in Canada. Of course it's not happening, which means that there's money to be made by having less doctors.

The fact is, Canada is run by a bunch of incompetents and Canadians are like the Brits. They just take it up the a** and say nothing. I hate to trash my own people, but that's just the way it is. You Americans are different, you won't take this crap. If Health care was badly run you'd be tearing up the streets and lynching politicians.

As for a socialized services, in general, being badly run, it depends on the country and depends on the people. Hey, the armed forces are a socialized service. Compare ours to yours in terms of efficiency. There's a difference.



Re: American Health Care: Educate Me!
Thursday, September 10, 2009 6:49 AM on j-body.org
thats some of the things i worry about if it went to a goverment ran system. with my kid, he has a pediatrictian. if my kid is sick and he has had breathing issues since he was 1 year old . i know i can go grab him at daycare and be into see the doctor usually within an hour or two. heck i can call them at 2 in the morning if need be. the only other option would be going to the emergency room every time he got sick. same goes for my own personal doctor. i know i can usually get scheduled with a few days if not that very same day. i really like that option, i'd rather go to my doctor. pay a $10 copay and get a prescription if need be then to go to the e.r. and pay problaby a hudred or two. not to mention allot of places if you are sick want a doctors note that you were sick. hard to do that if u have to wait 3-4 months to see a doctor.


i think my biggest issue i have with the whole healthcare deal is the money. we can't meet a budget as it is. i dont understand how they can get away with not having a balanced budget, they just keep spending more and more and more and its going to destroy the country. we'll become another argentina if this keeps up. i do think the health care system needs a major overhaul. but deep down i know instead of making things easier the goverment will just make it 10x worse by trying to fix it. ive worked with the goverment and the crap you have to do to get things done is just insane.


interesting point about paying for the education to become a doctor if they stay in canada. i wonder what the average salary is compared from one of yours to one of ours.


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Re: American Health Care: Educate Me!
Thursday, September 10, 2009 10:13 AM on j-body.org
Today I took my little boy to the doctor.

I called the office at 8 o'clock, they made the appointment at 11:30AM,

got there, paid the 15.00 dollar co-pay, waited for 10 minutes, they were busy.

they gave him a special lotion for his skin,

and they sent an electronic prescription to my local CVS pharmacy.

and they also gave him a flu shot even tho it was not on my list.

He also has an appointment the 30th for his 18 month old check up.

we have blue-cross.


I have a feeling, after public option kicks in, blue-cross will go out of business

and that doctors office will be closed.

I feel I have the best doctor,

the best insurance ever!

I fear so much to lose it. any time we need something, they're right there for my son and they're very very friendly. The office is really nice! the insurance pays for everything.


What i don't like is if I lose my job, i lose my insurance because. It is hard to buy insurance on my own.
Re: American Health Care: Educate Me!
Thursday, September 10, 2009 2:29 PM on j-body.org
You go to the hospital get treated, even if you don't have insurance. Treatment takes about 5 hours of waiting with broken limbs. Than you get a bill in the mail for $600+ a few weeks later.

If you have insurance and your wrist is slit open to the point of where you can see your bones you still wait 5-6 hours to get sewn up and kicked out. Employment had to pay for that one since it was work related injury. Came out to over $1000 for that one even with the insurance.

Now I had Blue Cross Blue Shield when those situations happened. Currently my father has BCBS along with my mothers union insurance. He has IPF, and was diagnosed with it over a year ago(diagnosed April 2008), it's late stage as well. He is still waiting to even get his name on the transplant list, and we get monthly bills from insurance concerning treatments and standard doctor visits they won't pay for along with medications. But yet they'll spend thousands of dollars on a Pulse Ox meter that cost only $120. I don't have an exact number of the total cost but after the procedure my father is expecting to pay quite a bit of money (over $200K) that insurance won't cover.

All in all with my experience dealing with insurance and my education on this health insurance system. IT SUCKS... I don't know why people are so in love with this health care system, its going to make them poor once someone they know gets a serious illness. For minor colds and what not its great, but once you get something bad just get ready to be on the phone for hours talking to insurance.


I'm all for a government run system much like that of Germany's. Those who want the @!#$ty health care provided by insurance companies can stay with them, those who want gov't run can sign up for that.

If you want more info look for a PBS program called "Frontline: Sick Around the World". It compares the big name countries with united health care compared to that of the U.S.



Re: American Health Care: Educate Me!
Thursday, September 10, 2009 4:15 PM on j-body.org
Bubba, while you may be in a sh!tty situation, and I feel for anyone dealing with that, I suggest you do some research on the treatments your father is getting. Then see how many countries around the world have banned those treatments because of how expensive they are. I don't know the answer to it, but I would bet money that many countries don't offer some of them at all. This is one thing that is being ignored completely in this debate over government run healthcare vs. private. Many people around the world come here for treatments they can't get in their own country.





Re: American Health Care: Educate Me!
Thursday, September 10, 2009 5:14 PM on j-body.org
Greedy Capitalist Pig wrote:

Bubba, while you may be in a sh!tty situation, and I feel for anyone dealing with that, I suggest you do some research on the treatments your father is getting. Then see how many countries around the world have banned those treatments because of how expensive they are. I don't know the answer to it, but I would bet money that many countries don't offer some of them at all. This is one thing that is being ignored completely in this debate over government run healthcare vs. private. Many people around the world come here for treatments they can't get in their own country.



The only things my father has received believe it or not is a lung biopsy to confirm IPF, which he had a bill for. With that they noticed he need a stint for his heart, and random blood test to check if he has any diseases. Of course to add vaccines $15 a pop which is great, I pay $100 without insurance each shot. Other than that and prescriptions that sometimes cost a $100, insurance really hasn't helped. Now insurance is telling my father he needs approval before he can have a procedure done. The last one was a Gallium Scan in July, he had the script since April, I kept having to call insurance and the doctors to get approval before I could even schedule the appointment.

Take a look at that program I posted, it puts a lot of myths concerning national health care to rest. It covers England, Germany, Japan, Switz, Taiwan, and the US. It has info on all aspects GDP, ratings etc. go to PBS's website for all the info. A lot of people say the wait time is long which it may seem like it, but once your put in that position yourself even with private your still waiting a long time. Look at my fathers case with HBCBS insurance.



Re: American Health Care: Educate Me!
Thursday, September 10, 2009 10:37 PM on j-body.org
Let's let Glenn Beck tell you all about it.







Re: American Health Care: Educate Me!
Friday, September 11, 2009 5:36 AM on j-body.org
we sure he's still not on pain killers? didnt seem like he said to much there.







bubba, diffrence in insurance companies are huge, sounds like your dad isn't on the best one. just one that was offered. i dont think anyone here is saying that our system doesnt need fixed. were just saying we dont nessicarily think a universal health care is the best option.


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Re: American Health Care: Educate Me!
Friday, September 11, 2009 5:54 AM on j-body.org
sndsgood wrote:

i dont think anyone here is saying that our system doesnt need fixed.

Bingo. The favorite argument of the left these days: "if you disagree with our way, you're against reform in general." I love how in every speech Obama says "we can't simply do nothing", as if the opposition is advocating leaving everything alone.

The bottom line is that simply forcing insurance companies to cover more people and more illnesses, while letting the Federal Government throw their hat into the ring in the name of "competition" (seriously?) is not reform.






Re: American Health Care: Educate Me!
Friday, September 11, 2009 6:12 AM on j-body.org
sndsgood wrote:









bubba, diffrence in insurance companies are huge, sounds like your dad isn't on the best one. just one that was offered. i dont think anyone here is saying that our system doesnt need fixed. were just saying we dont nessicarily think a universal health care is the best option.





Horizon Blue Cross Blue Shield is one of the "best" ones in NJ. I've dealt with Aflac, Atena(or whatever their name is), and a few others and they all flat out sucked in terms of service and what not. HBCBS is slowing flowing in their foot steps as to being @!#$ty, but the problem is he can't switch due to the IPF, no other insurance will touch him now.

I think the system needs a universal health care for those who want it, and leave the private sector where it is with some overhauling done to it. It should be an option as to who wants in and who doesn't, not a forced issue. As I said if the US is willing to mimic Germany's health care system it'll be perfect for pretty much everyone. As it stands right now the health care system sucks badly in my eyes.



Re: American Health Care: Educate Me!
Friday, September 11, 2009 6:57 AM on j-body.org
The way I'm hearing it, if you're uninsured and break your leg or have appendicitis, you can show up at the hospital and they'll patch you up and send you a bill. What happens if you don't pay? Do they sue you? Do you have to declare bankruptcy? What if you you've already done this before? Do they treat you anyway?

The way it sounds, your system is even more expensive since you're paying for a bunch of people who never put a dime in the system. In Canada, at least, if you've worked a day in your life, you've sent about 7% of each paycheck to pay for your future illness.



Re: American Health Care: Educate Me!
Friday, September 11, 2009 7:34 AM on j-body.org
Knoxfire Esquire wrote:

The way I'm hearing it, if you're uninsured and break your leg or have appendicitis, you can show up at the hospital and they'll patch you up and send you a bill. What happens if you don't pay? Do they sue you? Do you have to declare bankruptcy?

This is correct. They treat you no matter what, then bill you later. If you don't pay, they hire a collection agency to try and collect it from you. However, and I'm not 100% sure on this, while medical bills do show up on your credit report (this was changed some time in the last decade: they used to be banned from reporting to credit agencies), they have no leverage to collect with, unlike other debt collectors.
Knoxfire Esquire wrote:

What if you you've already done this before? Do they treat you anyway?
Again, they are required to treat you, no matter what.
Knoxfire Esquire wrote:

The way it sounds, your system is even more expensive since you're paying for a bunch of people who never put a dime in the system.

This is a good part of it. As I've mentioned in other threads regarding health care, illegals get care because hospitals can not refuse to treat anyone.

However, it's not the biggest reason for the costs. As I mentioned in my first post here, malpractice suits have driven up the cost of malpractice insurance insanely in the past 20 years. Also, the whole "take a pill for everything" mindset has taken over our culture, and since everyone has been on HMOs, who pay at least part of the cost for most prescriptions, everyone expects that an insurance policy is like an all-you-can-eat buffet. You just pay your premium every month, and keep using the coverage.






Re: American Health Care: Educate Me!
Friday, September 11, 2009 8:41 AM on j-body.org
I think the take-a-pill mindset is fueled in large part by drug companies. In Canada, by law, a drug company has to sell their product in the generic market after five years. Literally, drugs here are sometimes 10 to 20 times cheaper in Canada. We also never have advertisments for pills on TV because it's not possible to advertise for drugs. Aspirin might be okay, Paxil definitely not okay.

It's also not possible to sue a doctor because you've signed forms consenting to their care. Literally, a doctor would have to screw up BAD, like showing up drunk for your vasectomy, for him to be sued. If the intent was to help a patient or save their life, and for whatever reason a mistake happened (IE: A one time thing, not done on purpose) you can't sue the doctor or the hospital.

I've always said we have a lot to teach other, if only we'd listen. Canada has some good ideas, but badly implemented.



Re: American Health Care: Educate Me!
Friday, September 11, 2009 9:48 AM on j-body.org
yeah you usually sign papers like that here but they get thrown out the window and ignored for the most part.

the problem i see is having this wonderful universal healthcare for some and then let others keep their policy sounds great. but what will and employer do. pay out the butt for his employees or pay a fee basically and let them all take universal healthcare. i think in the way it is allot of employeres will just find it easier to stop with the coverage that is in efffect and then people won't have any option but to take the universal health care.


also. do i have the option to only pay for my coverage i get now. i'd bet good money that when this goes thru, i'll be paying for my coverage, and paying for universal healthcare. if i have the option to opt out of universal healthcare, give me the option to not pay for it......... this doesnt even go into my major issue of being able to pay for it. we dont have a balanced budget as it is. and now were going to add free healthcare for millions of people. i think most people in the u.s. beleive that money is endless and it just falls from trees. this spending is going to destroy our country.


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Re: American Health Care: Educate Me!
Friday, September 11, 2009 12:22 PM on j-body.org
Knoxfire Esquire wrote:

I think the take-a-pill mindset is fueled in large part by drug companies.

I believe it's more of our culture. Everyone wants the quick and easy fix. American society has become so fast-food, instant-gratification, and low-effort, that the "just take a pill" mindset is only a further extension of it.
Knoxfire Esquire wrote:

It's also not possible to sue a doctor because you've signed forms consenting to their care.

[We have that here as well. You have to sign a consent. However, once a lawyer gets their hands on a situation, they can come up with 15 loop holes through the waiver and manage to get the doctor blamed for any mistake being malpractice, and the awards just keep getting ridiculously high. I don't think all cases are frivolous, but there is a significant number of them that should have been thrown out of court. And remember that win or lose, the doctor or hospital still has to pay their lawyers. Make the loser pay for all costs, including lawyers fees, and these would fall away, leaving only the cases with real merit.
Knoxfire Esquire wrote:

I've always said we have a lot to teach other, if only we'd listen. Canada has some good ideas, but badly implemented.

I agree, but the US has also taken plenty of good ideas and destroyed them with government waste and bureaucracy.





Re: American Health Care: Educate Me!
Friday, September 11, 2009 12:29 PM on j-body.org
I wasn't asked, but this will probably interest people. As a measure of comparison, I estimate that I spend under 150$ (perhaps well under) in health care costs per month. I can't give you an exact number because I simply don't know. However, I can guesstimate it by comparing US/Canada taxes and GDP spending on health insurance and such.



Re: American Health Care: Educate Me!
Friday, September 11, 2009 5:15 PM on j-body.org
addind to the frivoulous lawsuits lawyers know that in the majority of times the hospital will settle for x amount of dollars just to avoid the bad press and publicity. its easier for them to just pay out 100 grand then to fight it and risk the outcome. layers know this and take advantage of it big time.


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