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  1. #1241  
    Quote Originally Posted by clemgrad85 View Post
    Before you go blaming the insurance companies, and by the way that would be auto, not health, but still, this issue comes up quite a bit when folks see this "discount" through insurance vs if you had to pay straight up for it. It's call "negotiated discount" via your network. This is actually good! The insurance company sets up networks of providers and if you use those, the providers have agreed to accept set prices for that particular service (in exchange they get patients directed towards them). This discount can be quite substantial. I've seen MRI's billed at $1500 and end up getting processed for $600 or less. Of course, the patient sometimes think they owe that difference (often cussing the no good insurance company) only to find out that they can't be billed for that difference (of course, that doesn't stop the doctor from sometimes trying to bill for the difference, but that's another issue). Anyway, these discounts are good in that they are an attempt to keep medical costs down. Isn't that what we want?...
    So if you land on Marvin Gardens while playing Monopoly and it's one of the provider where they have a negotiated discounts you only have to pay half the rent, but if you land on Park Place where they don't have a negotiated discount, you have to pay the full rent.

    I am glad the private insurance companies have set it up like a game of Monopoly. That really shows how stupid our current system is.
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  2. #1242  
    Quote Originally Posted by palandri View Post
    So if you land on Marvin Gardens while playing Monopoly and it's one of the provider where they have a negotiated discounts you only have to pay half the rent, but if you land on Park Place where they don't have a negotiated discount, you have to pay the full rent.

    I am glad the private insurance companies have set it up like a game of Monopoly. That really shows how stupid our current system is.
    Well....it's called "incentive". You tell a group of doctors that if they will accept $100 for a procedure, rather than the $225 they would normally charge, they will in turn direct more patients to them to make up the difference. It's called giving someone an incentive to bring the cost down. If you didn't have this, then the doctor could charge $400 for that procedure, see how much the insurance company would pay, and then either charge the patient the difference or be happy that they got the max out of the insurance company and waive the difference. I'm really stumped why you would have a problem with this. It is no different than Medicare telling a doctor how much they will accept for a procedure if they want to have Medicare patients. So, it's okay for the government to do this but not the evil private sector. WTF? The difference, of course, is at least the providers are involved in negotiations (you know, capitalism, what America is based on) with the insurance companies vs the government having a true monopoly. It's weird, liberals like palandri get upset when a company has a monopoly over something except when it is a government monopoly. This is baffling....by having networks and negotiated fees, this is an effort to keep costs down....and why is that bad palandri?

    Oh wait....palandri was just trying to "stir the pot"....whew....I thought he was serious....good one!
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    #1243  
    Quote Originally Posted by mdmogren View Post
    Eliminate the FDA and the AMA and allow private institutions to fill their roles both cheaper and more effectively, that'd be a great start.
    Ding. Hello? The AMA is private.
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  4. #1244  
    WTF does this have to do with the pre?
  5. #1245  
    Quote Originally Posted by rhare3 View Post
    WTF does this have to do with the pre?
    As stated many times before this is the OFF TOPIC section. It's not about the Pre in here. Why don't you go play with your new phone.
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  6. #1246  
    Quote Originally Posted by clemgrad85 View Post
    Well....it's called "incentive". You tell a group of doctors that if they will accept $100 for a procedure, rather than the $225 they would normally charge, they will in turn direct more patients to them to make up the difference.
    Some get it, some don't. That really makes a lot of sense

    I would rather have a planned economy on healthcare, rather than an unplanned economy on healthcare.

    Keeping it private and everyone needs to hopes they spin a 7-7-7 on the slots. That makes a lot of sense.
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  7. #1247  
    Quote Originally Posted by palandri View Post
    Some get it, some don't. That really makes a lot of sense

    I would rather have a planned economy on healthcare, rather than an unplanned economy on healthcare.

    Keeping it private and everyone needs to hopes they spin a 7-7-7 on the slots. That makes a lot of sense.
    Again....liberals believe government is like Big Daddy....he can help with everything. I believe that the more the government is in my life the worse it is. Just different philosophies.

    I think you're just trying to stir the pot by pretending you don't see that networks setting prices, trying to keep costs down, is the same as what the government does with Medicare reimbursements. You seem fine with the government setting such fees, but are appalled when an insurance company does it? That would make no sense. You seem like a smart guy, so the only reason you would not be able to see this is if you were just trying to get a reaction......which is fine. But I'm not buying that you're that hard headed. But good try!
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  8. #1248  
    Quote Originally Posted by clemgrad85 View Post
    Again....liberals believe government is like Big Daddy....he can help with everything. I believe that the more the government is in my life the worse it is. Just different philosophies.

    I think you're just trying to stir the pot by pretending you don't see that networks setting prices, trying to keep costs down, is the same as what the government does with Medicare reimbursements. You seem fine with the government setting such fees, but are appalled when an insurance company does it? That would make no sense. You seem like a smart guy, so the only reason you would not be able to see this is if you were just trying to get a reaction......which is fine. But I'm not buying that you're that hard headed. But good try!
    Meanwhile, I just watched this video again, by Carl Sagan, and realized that none of this matters in the grand scheme of things.

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  9. #1249  
    Quote Originally Posted by palandri View Post
    Meanwhile, I just watched this video again, by Carl Sagan, and realized that none of this matters in the grand scheme of things.

    Grand scheme?
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  10. Micael's Avatar
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       #1250  
    Quote Originally Posted by zelgo View Post
    Oh, now your following the insurance industry's current campaign to blaming everyone else...Private insurance skims 30% off the top of healthcare funding for profit and administrative costs. They use that money to do all they can to deny people care--so they make profits.

    The fact that every insurance company has its own forms and rules requires doctors and hospitals to use 30% of their costs for administrative costs. Tort reform is certainly necessary, but it is private insurance has the big price tag.

    In Europe, when they got rid of the dominance of private insurance, costs dropped immediately.

    As you blame the Democrats for being in bed with lawyer lobbiests, let's specifically blame Republicans for being in bed with insurance lobbiests--or why else would they be so against health reform?? Just follow the money...
    Man, you really have the democrat blinders on. Do you see everything through your ideological glasses?

    Where did you get the figure that insurance companies skim 30% off the top of healthcare funding? What funding? Where is this funding coming from? If they're skimming off the top, wouldn't they be in trouble with the law? I'm sure they should be.

    And where did you come up with the assertion "that every insurance company has its own forms and rules requires doctors and hospitals to use 30% of their costs for administrative costs"? This doesn't even make sense. The insurance companies have rules that require doctors and hospitals use 30% of their costs for administrative costs? Really? Can you quote one such rule from any company?

    I'll tell you where the rules and the forms come from, Zelgo. They come from the government. This is a fact. But you're not interested in facts, only in dancing to Obama's drum.
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  11. #1251  
    “There are four boxes to be used in defense of liberty: soap, ballot, jury, and ammo. Please use in that order.”
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  12. #1252  
    Well....after hearing the latest news from Obama and his crew, sounds like the public option is not as important as initially thought! "Health and Human Services Department Secretary Kathleen Sebelius on Sunday said private insurers would face competition under the Obama administration's health plan, but that an alternative option wouldn't necessarily have to be government run." (from WSJ) Of course, this could be a little democratic ploy to get the spotlight off that part of the plan, but will be interested to see how all this effects the plan. I'm sure Pelosi (what is up with that smile on her face, seriously, it seems stuck on her) will be rather annoyed as she already promised she had the votes.

    It was nice to see Obama get some decent questions last night at his Town Hall meeting....I'm glad the children questions have been addressed. I particularly liked the question on how private companies can compete with a government plan. Part of Obama's reply was as follows:

    "So that’s why I say, this is actually a legitimate debate. I think that we can craft a system in which you’ve got a public option that has to operate independently, not subsidized by taxpayers — it would be nonprofit, but we’ve already got nonprofits out there like BlueCross BlueShield — that they would have to go on the market and get a market price for capital, so they wouldn’t be able to just have the Federal Reserve write them a check. I think there are ways that we can address those competitive issues. And you’re absolutely right, if they’re not entirely addressed, then that raises a set of legitimate problems."

    I'll give Obama credit here for acknoledging this is a reasonable concern. Now, we'll see if his response is just a bunch of "who-ee" (some Fritz Hollings lingo there) or if he agrees it can't be just taxpayers subsidizing the plan constantly.

    This again brings up the fact that all this debate has been helpful for the process as our representatives are actually listening to the folks that sent them up there. It's been mentioned before, but had the evil Republicans been forced to keep their mouths shut we would have likely had a non-read bill rushed through the process only to now be being scrutinized. Still a long way to go, and while I doubt I'll be totally happy with the outcome, at least gives me a glimmer of hope for our country.
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  13. #1253  
    Quote Originally Posted by Woof View Post
    Woof....you beat me to the punch! Nice to see democracy working....maybe....not ready to believe them yet.
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  14. groovy's Avatar
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    #1254  
    Quote Originally Posted by clemgrad85 View Post
    Woof....you beat me to the punch! Nice to see democracy working....maybe....not ready to believe them yet.
    Dropping the public option is only part of it. We'll have to wait and see what the compromise bill looks like but if it contains all of the same restrictions and regulations and health care "exchanges", etc, that the original plan placed on the insured, but just pastes in "co-op" instead of "government-funded", its not going to be much better.
  15. #1255  
    Quote Originally Posted by groovy View Post
    Dropping the public option is only part of it. We'll have to wait and see what the compromise bill looks like but if it contains all of the same restrictions and regulations and health care "exchanges", etc, that the original plan placed on the insured, but just pastes in "co-op" instead of "government-funded", its not going to be much better.
    I know....that's why I'm not ready to get too excited....still much to get worked out. But with the democrats in control, gotta expect some disappointments.....after all....they can vote through anything they want without having to worry about the Republican's participation.
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  16. groovy's Avatar
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    #1256  
    Quote Originally Posted by clemgrad85 View Post
    I know....that's why I'm not ready to get too excited....still much to get worked out. But with the democrats in control, gotta expect some disappointments.....after all....they can vote through anything they want without having to worry about the Republican's participation.
    Yeah, that's why I laughed when I read the first line in that article you posted. "Bowing to Republican pressure..." Oh right, as if all the Dems were in lock step and its the evil Republicans who are once again denying the most basic human right to our kids and elderly!
  17. #1257  
    Quote Originally Posted by Micael View Post
    Man, you really have the democrat blinders on. Do you see everything through your ideological glasses?

    Where did you get the figure that insurance companies skim 30% off the top of healthcare funding? What funding? Where is this funding coming from? If they're skimming off the top, wouldn't they be in trouble with the law? I'm sure they should be.

    And where did you come up with the assertion "that every insurance company has its own forms and rules requires doctors and hospitals to use 30% of their costs for administrative costs"? This doesn't even make sense. The insurance companies have rules that require doctors and hospitals use 30% of their costs for administrative costs? Really? Can you quote one such rule from any company?

    I'll tell you where the rules and the forms come from, Zelgo. They come from the government. This is a fact. But you're not interested in facts, only in dancing to Obama's drum.
    I'll tell you where misinformation comes from....people that don't know what they're talking about. I am a doctor. My office has to hire multiple people just to deal with multiple insurance companies. Each company has different things that they cover; in my case, they even require the patients to go to different laboratories, some of which are miles out of their way. It requires my employees to spend much of their time sorting through all the differences and making sure patients end up where they belong. So that's what is meant by what was said. Do you want to debate whether that makes sense or not?

    The companies themselves have to hire large numbers of employees to screen all the submissions so they can determine which to deny, which to delay, and which to approve. While the approval rate is reasonably high, the manpower required is significant. It is estimated that most health plans have between 17 and 25% administrative costs, compared to Medicare which is likely somewhere in single digits. That is money that doesn't go to the doctor, doesn't go to the shareholders of the company if it's for profit...so it's money that doesn't go to care.

    And this is the private medicine and insurance companies that everyone seems to think is so precious that we should just let them go on continuing to deny treatments and refusing to provide insurance coverage for people who actually own their insurance. While Medicare is no bed of roses, it's actually easier to deal with Medicare than with most private companies.

    I heard the president-elect of the AMA speak the other night and spoke to him afterwards. While they do not favor a "public option", they strongly favor health care reform and they have planned suggestions for how a public option should be designed. He feels that in states that have offered public options, most people don't choose them, so he thinks much of the arguments for and against public options are ridiculous. Regardless, I am sick and tired of having to argue with for-profit companies about providing care for patients who have paid their premiums and then try and deny care by delaying tactics. My hospital sued one HMO for delayed payment two years ago and now they are filing againt BCBS for non-payment.

    Anybody that thinks private insurance is the way to great care for all is smoking something...
  18. #1258  
    Quote Originally Posted by davidra View Post
    I'll tell you where misinformation comes from....people that don't know what they're talking about. I am a doctor. My office has to hire multiple people just to deal with multiple insurance companies. Each company has different things that they cover; in my case, they even require the patients to go to different laboratories, some of which are miles out of their way. It requires my employees to spend much of their time sorting through all the differences and making sure patients end up where they belong. So that's what is meant by what was said. Do you want to debate whether that makes sense or not?

    The companies themselves have to hire large numbers of employees to screen all the submissions so they can determine which to deny, which to delay, and which to approve. While the approval rate is reasonably high, the manpower required is significant. It is estimated that most health plans have between 17 and 25% administrative costs, compared to Medicare which is likely somewhere in single digits. That is money that doesn't go to the doctor, doesn't go to the shareholders of the company if it's for profit...so it's money that doesn't go to care.

    And this is the private medicine and insurance companies that everyone seems to think is so precious that we should just let them go on continuing to deny treatments and refusing to provide insurance coverage for people who actually own their insurance. While Medicare is no bed of roses, it's actually easier to deal with Medicare than with most private companies.

    I heard the president-elect of the AMA speak the other night and spoke to him afterwards. While they do not favor a "public option", they strongly favor health care reform and they have planned suggestions for how a public option should be designed. He feels that in states that have offered public options, most people don't choose them, so he thinks much of the arguments for and against public options are ridiculous. Regardless, I am sick and tired of having to argue with for-profit companies about providing care for patients who have paid their premiums and then try and deny care by delaying tactics. My hospital sued one HMO for delayed payment two years ago and now they are filing againt BCBS for non-payment.

    Anybody that thinks private insurance is the way to great care for all is smoking something...
    Well....I do respect your view from the doctor's side and the hastle of dealing with multiple insurance companies, but let's face it, many issues arise from the doctor's office as well.

    Now, some are related to physicians being concerned with missing a test and then later getting sued over not ordering a test....and I can respect that point of view. Just recently my primary care doctor wanted me to go for an expensive Thallium Stress Test ($2100 +) when a trip to the cardiologist showed I didn't need it ($350 for that visit rather than $2100). My physician had no idea the test would cost that much (at least that is what she said). Had I not asked about some options I would have gone the more expensive route (I told the cardiologist that if I needed the Thallium test I would go in for it, but if I didn't, would prefer not spending $2100). Secondly, when I was first put on HBP medication, she originally put me on a 3 week trial medication that seemed to work just fine. It was a new medication and when I asked the price, she said it would be about $85 per month. I asked if there was another generic and she said, "sure", and I now pay $5.60 for a low dose of Lisinopril....but only because I asked about my options. Third....a couple of years ago I went in for my annual physical and they filed it with a diagnostic code rather than preventative code, and so it was processed as diagnostic and went to my deductible rather than paying it as 100% (I have an HSA plan which covers annual physicals at 100% and no deductible while diagnostic visits are applied to my deductible and therefore I must pay from my pocket). The insurance processed it exactly as it was sent to them, but it was the doctor's office that screwed up (same thing just happened to my wife as well) and I never could get them (the doctor's office) to process it correctly. I finally told them it was their mistake and I wasn't going to pay them, and they finally ate it. Go figure, not sure why they wouldn't just resubmit the claim as preventative.

    So, while there may be issues with the insurance company, I'd just like to point out that the physicians also cause problems. I have dealth with many claims for my clients and it is amazing how many errors started at the doctor's office. Do insurance companies make mistakes? Sure they do....but they can only process what is sent to them. Garbage in, garbage out. I won't even get into the case with my client who went in for a pacemaker, had an infection afterwards, and after 2 more operations they discovered a sponge was left inside him from the initial surgery.

    I guess my point is many areas can be made more efficient without throwing out the good part of our health care simply because some areas need to be fixed. While I do get calls to help clients with claim issues, I also know way more go through with no problems and they are quite happy with the results. But, these fixes can be done, in my opinion, without a public option which will eventually lead to single payer plans such as in the UK and Canada.

    Oh....almost forgot....not smoking anything! Never have, never will!
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  19. #1259  
    Quote Originally Posted by davidra View Post
    ...Anybody that thinks private insurance is the way to great care for all is smoking something...

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  20. #1260  
    Quote Originally Posted by Woof View Post
    Seems we're making progress....
    You're not. Because progress is not your goal.

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