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  1. #1481  
    Quote Originally Posted by KAM1138 View Post
    ...I don't have dental insurance--I simply pay for dental care, and while the costs aren't cheap, they aren't spiraling out of control either (can't speak universally, only for my dentist).

    KAM
    I had a women who use to work in a dentist office tell me that the dentist she was working for would charge more to a person who didn't have insurance. I asked her why and she said because he knows he can get away with it.

    This was just one dentist and I doubt its a common practice, but it does prove a point that insurance helped keep pricing in line for the insured.

    For what it's worth.
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  2. Micael's Avatar
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       #1482  
    Quote Originally Posted by palandri View Post
    I had a women who use to work in a dentist office tell me that the dentist she was working for would charge more to a person who didn't have insurance. I asked her why and she said because he knows he can get away with it.

    This was just one dentist and I doubt its a common practice, but it does prove a point that insurance helped keep pricing in line for the insured.

    For what it's worth.
    Part of that problem would be resolved. If people were paying cash for standard, non emergency treatment, what doctors charge would become known and compared between consumers. Right now, its all transparent... "the insurance company takes care of it... I just know what I pay for co-pay".

    So consumers could shop for dentists who's charges are in line. This will lower overall costs because they'll compete for clients. Its the beauty of capitalism, versus socialism where every thing is "free" and money is exchanged behind the scenes.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  3. KAM1138
    KAM1138's Avatar
    #1483  
    Hello,

    Quote Originally Posted by palandri View Post
    I had a women who use to work in a dentist office tell me that the dentist she was working for would charge more to a person who didn't have insurance. I asked her why and she said because he knows he can get away with it.

    This was just one dentist and I doubt its a common practice, but it does prove a point that insurance helped keep pricing in line for the insured.

    For what it's worth.
    That is surprising, and in fact--I would bet that the opposite is more common. That also contradicts the free market concept, because if a patient who is paying directly feels the price is too high they will tend to look elsewhere. Perhaps his patients are rich and don't care.

    I have an example of the opposite case being true--with medical, not dental. Recently, a family member was hospitalized overnight (turned out to be nothing), but very large costs were incurred (many unreasonable). A bill was submitted to the insurance company for "professional services" and they refused to pay. They never sent us the bill, and we looked into it, and were told this is somewhat common--they essentially throw that up to the insurance companies and some will pay it, others won't but they don't bother trying to bill the patient (presumably because they can't justify it to someone who knows what was going on). Essentially--they go for the deep pockets (insurance) because they can. Now, that seems very questionable to me.

    Here's a similar analogy. If I walk into a convenience story and bring a bottle of soda pop to the counter and they say "That will be $40." I laugh at them and leave. If I have a card that I just hand to them, and they charge $40 on it without my knowledge and my "drink insurance" plan negotiates that down to $20--I figure "Wow I'm saving $20 because of my insurance" forgetting that $20 is a ridiculous cost in the first place.

    No one need agree with me, but I think that a free market system basically works. Not perfectly, but pretty well. An indirect payment system drives a wedge into that free market system and prevents it from working naturally.

    KAM
  4. KAM1138
    KAM1138's Avatar
    #1484  
    Hello Again,

    Quote Originally Posted by Micael View Post
    Part of that problem would be resolved. If people were paying cash for standard, non emergency treatment, what doctors charge would become known and compared between consumers. Right now, its all transparent... "the insurance company takes care of it... I just know what I pay for co-pay".

    So consumers could shop for dentists who's charges are in line. This will lower overall costs because they'll compete for clients. Its the beauty of capitalism, versus socialism where every thing is "free" and money is exchanged behind the scenes.
    Exactly. Put a wall between the purchaser and the provider and you block free market benefits.

    KAM
  5. #1485  
    Quote Originally Posted by KAM1138 View Post
    ...Here's a similar analogy. If I walk into a convenience story and bring a bottle of soda pop to the counter and they say "That will be $40." I laugh at them and leave. If I have a card that I just hand to them, and they charge $40 on it without my knowledge and my "drink insurance" plan negotiates that down to $20--I figure "Wow I'm saving $20 because of my insurance" forgetting that $20 is a ridiculous cost in the first place....
    My wife and I went to Nogales, Mexico, which is a tourist town. My wife wanted this painted mask that was priced at $40. I negotiated the price down to $10 and thought I got a great deal.

    We continued to go east in Mexico and crossed over into a regular Mexican town, not a tourist town. They had the same painted mask for $5.
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  6. KAM1138
    KAM1138's Avatar
    #1486  
    Quote Originally Posted by palandri View Post
    My wife and I went to Nogales, Mexico, which is a tourist town. My wife wanted this painted mask that was priced at $40. I negotiated the price down to $10 and thought I got a great deal.

    We continued to go east in Mexico and crossed over into a regular Mexican town, not a tourist town. They had the same painted mask for $5.
    Buyer Beware!

    KAM
  7. #1487  
    I don't have dental coverage either. In fact, even my dentist agreed it is probably not the best deal out there.

    Kam, you and I are on the same page (I think) about what insurance should be about, and that is protecting against a catastrophic loss. Even though palandri and zelgo make fun of me for being on an HSA plan (zelgo will deny this, but I have the reply where he in fact said this), I am more concerned with the $50,000 claim then the $40 prescription. Yes, when I had to pay $350 for the cardiologist visit (to save having to pay for a $2100 test my primary care doctor was recommending, that wasn't needed) it would have been nice to have just paid $40 or $50 under a co-pay visit, but, I had to remind myself of the premium dollars I save each month. If I was going for a $350 visit each month, it would suck, but at least those dollars would be going to my over all deductible. But bottom line, it forces me....yes....forces me....to analyze my medical expenses....which is what most people don't do in this country.

    I've used this analogy before, but imagine if our home owners insurance had co-pays for things like a broken toilet, or a deductible and co-insurance for a new roof. Our premiums would be much higher. Now, I agree, that to compare an MRI and a new roof isn't completely fair, but, my point is we use home owners insurance primarily for catastrophic loss by flood/hurricane/earthquake etc. Why not a state run catastrophic program for healthcare? This will prevent all the bankruptcies I keep hearing about related to not having health coverage. But noooooo....gotta provide the "mack daddy" plan that the person making $250,000 has.
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  8. KAM1138
    KAM1138's Avatar
    #1488  
    Quote Originally Posted by davidra View Post
    It's the nature of the for-profit industry that contributes to many errors....limited time with patients, forcing the involvement of people who aren't as responsble. The series of errors that killed Sebastian involved mistakes by nurses, pharmacists, doctors, and staff.
    So, being for profit creates errors that sometimes lead to deaths. So...are you in a non-profit organization? Are you donating your services and not taking any profits? Do you or do you not get paid for providing medical services? Perhaps you don't. If you are willingly participating in for-profit business as a medical professional, then why? Why would you willingly participate in something that you say leads to errors and death?

    Do you run a a non-profit clinic, so you can provide better health care, or better yet, a free clinic, and refuse payment of any type. If you're a doctor, you have the power to provide these services, so are you doing that currently? Or do you earn a salary and benefit as part of the for-profit industry that you identify as a problem--one that increases medical errors that result in deaths of 3 year old children.

    If you aren't accepting money for your services (earning profit) and are donating all your time to help those who need medical care then let me congratulate you on being a very selfless person. In fact--I'd say you are nearly a saint if that's the case.

    KAM
  9. KAM1138
    KAM1138's Avatar
    #1489  
    Quote Originally Posted by clemgrad85 View Post
    Kam, you and I are on the same page (I think) about what insurance should be about, and that is protecting against a catastrophic loss. Even though palandri and zelgo make fun of me for being on an HSA plan (zelgo will deny this, but I have the reply where he in fact said this), I am more concerned with the $50,000 claim then the $40 prescription. Yes, when I had to pay $350 for the cardiologist visit (to save having to pay for a $2100 test my primary care doctor was recommending, that wasn't needed) it would have been nice to have just paid $40 or $50 under a co-pay visit, but, I had to remind myself of the premium dollars I save each month. If I was going for a $350 visit each month, it would suck, but at least those dollars would be going to my over all deductible. But bottom line, it forces me....yes....forces me....to analyze my medical expenses....which is what most people don't do in this country.
    Why would anyone make fun of you for choosing an HSA for yourself? If I had an HSA instead of the insurance plan I do (not been able to convince my employer to switch), I'd have saved a lot of money recently. Instead I am out thousands of dollars and paid (along with my employer) higher premiums for years and years getting zero benefit.
    Now if someone else doesn't want that, and they want to pay for insurance or out of pocket...that's their choice. However, having that choice is the key element here. You do what's good for you, and pay for it, then it is none of my business.

    Quote Originally Posted by clemgrad85 View Post
    I've used this analogy before, but imagine if our home owners insurance had co-pays for things like a broken toilet, or a deductible and co-insurance for a new roof. Our premiums would be much higher. Now, I agree, that to compare an MRI and a new roof isn't completely fair, but, my point is we use home owners insurance primarily for catastrophic loss by flood/hurricane/earthquake etc. Why not a state run catastrophic program for healthcare? This will prevent all the bankruptcies I keep hearing about related to not having health coverage. But noooooo....gotta provide the "mack daddy" plan that the person making $250,000 has.
    Of course the costs would be higher. I don't support a state-run program, but I think that private insurance for catastrophic events would be a much more viable and economical system that would be affordable for many more people--which would in turn enhance the viability further.

    KAM
  10. #1490  
    Quote Originally Posted by palandri View Post
    My wife and I went to Nogales, Mexico, which is a tourist town. My wife wanted this painted mask that was priced at $40. I negotiated the price down to $10 and thought I got a great deal.

    We continued to go east in Mexico and crossed over into a regular Mexican town, not a tourist town. They had the same painted mask for $5.
    Hmmm....this could be a crisis. I wonder if the Federal Government should develop some type of government run agency to protect people from such things while traveling abroad? How many dollars are wasted each year by this abuse? Maybe those making over $250,000 could pay an extra 1% in taxes to be able to offset those that get taken advantage of! There is no reason you should have to be subject to that additional $5. Please...please Mr. Government, protect us!
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  11. #1491  
    Quote Originally Posted by Toby View Post
    LOL...You just can't be satisfied apparently.
    Apparently not.


    Here's where you're being the 'misinformed' one. As I said, I have worked as an HR clerk in administration of an employer group plan, and have served on employee committees. I've dealt with people covered by a fully self-funded plan from the janitor to the executives. They're not a stupid and incapable as you'd like to make them out to be.
    All it takes is one wrong choice to destroy a family.

    Ah...when logic and reason fail we resort to the emotional appeal.
    That's what you don't get. It's not an emotional appeal. It's reality, day to day reality. I live it, you don't.

    So, we should force them to change their behavior since they obviously can't do it on their own.
    If they are crooks, they should literally go to jail. If they don't know any better, they should be educated. In either case, we can determine what best practices are. We already have, but they are totally optional. I will refer you again to guidelines.gov.


    Ooh...I can play that game too. Public option. Duh. Real specific idea there.
    In actuality, I was very specific. We should expand Medicare downwards to cover everyone. Is that not specific enough for you?

    You didn't really read the whole article, did you?
    Actually, I did. Nothing specific there.

    I
    suppose this is where I'm at a disadvantage not being a doctor. I was under the impression that congenital diseases were mutations or defects acquired in the womb. That would certainly make her a zebra if we're still referring to PKD. Was this the same 30 year old student you mentioned a day or so ago? She aged 4 years already? If she has insurance currently, she cannot be denied insurance for a pre-existing condition provided she does not let her coverage lapse for an extended period. It was part of HIPAA passed in 1996 by a Republican Congress and signed by a Democratic President. Of course, that's completely ignoring that as far as PKD goes, the majority of the current treatments are lifestyle changes. But again, I'm not a doctor, I'm just a guy married to someone with autosomal dominant PKD
    OK, thirty-ish. Sorry for the latitude. She is 34 precisely.

    Then you must know that it's relatively common, and since it's dominant, almost everyone in her family on her mother's side has it; her grandmother died after hemodialysis; her uncle is awaiting transplant; her mother just had an AV shunt placed; and her younger sister has it. And no, she doesn't have insurance. She works as a billing supervisor in an orthotics practice part-time and is just finishing up school after many years of taking classes. She has student health insurance. Because she's part-time, her employer has chosen not to provide her insurance, and even if he did, she will likely be going to grad school soon, or changing jobs, or moving....and she wouldn't be able to take it with her for longer than a year. HIPAA is not that generous. First, she would likely be excluded from coverage for a year, since she has not been covered previously. Second, she almost certainly would have to join a group plan. If she chooses to leave after being diagnosed, nobody is required to sell her a plan unless it's a group plan, and some of those are excluded; at that point she can be excluded based on pre-existing condition.

    And if by lifestyle changes you mean BP control and protein dietary restriction, the first isn't really lifestyle change and the second may or may not have any significant benefit. The treatment for renal failure in patients with PKD is hemodialysis followed by renal transplant. While the severity and the age of declline varies from person to person, esentially everyone with the disease gets progressive renal failure at some point, regardless of lifestyle changes. And given your situation. you should be very very thankful for Medicare, because without it your future would be quite muddy. I will be willing to bet that whoever insures your wife will rapidly deflect her to Medicare renal coverage if she ever needs it. And if she ever needs a transplant, the most that will be covered is 80%...and 20% of a transplant is a lot of money. Why don't you just check that out; ask your insurance company if they will cover those costs if they should happen to occur in the future. Maybe you will change your mind about Medicare.
  12. Micael's Avatar
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       #1492  
    Quote Originally Posted by palandri View Post
    My wife and I went to Nogales, Mexico, which is a tourist town. My wife wanted this painted mask that was priced at $40. I negotiated the price down to $10 and thought I got a great deal.

    We continued to go east in Mexico and crossed over into a regular Mexican town, not a tourist town. They had the same painted mask for $5.
    How dare you bregrudge that poor mexican mask salesman his extra 5$ profit! Do you not realize that he probably doesn't have healthcare insurance?
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  13. #1493  
    Quote Originally Posted by KAM1138 View Post
    Why would anyone make fun of you for choosing an HSA for yourself? If I had an HSA instead of the insurance plan I do (not been able to convince my employer to switch), I'd have saved a lot of money recently. Instead I am out thousands of dollars and paid (along with my employer) higher premiums for years and years getting zero benefit.
    Now if someone else doesn't want that, and they want to pay for insurance or out of pocket...that's their choice. However, having that choice is the key element here. You do what's good for you, and pay for it, then it is none of my business.


    KAM
    Go figure. If you had only KNOWN you weren't going to need insurance, you would have been so much better off. Hey, when you figure out how to do that, let me know. And $350 to a cardiologist is painful? How about a simple appendectomy? Is that "catastrophic"? It will cost $8000. Average hospital admission cost per day in my hospital? $1500 PER DAY. Even for "non-catastrophic illness". Yeah, HSA's are fine....as long as you don't get sick.
  14. rebirth24's Avatar
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    #1494  
    Is there a good breakdown anywhere of what this bill is all about?
  15. #1495  
    No, and that's Obama's mistake. There isn't one bill. He tried to involve congress in coming up with something because Clinton did it the other way and failed. Now he is stuck with nothing to formally explain because the house and senate bills are different and not finalized. He should have developed the bill he wanted and provided it to congress. He was too idealistic and actually thought the republicans wanted some kind of health care reform. Now it's clear they don't, and he has wasted time screwing with them. He still is, in fact. Poor leadership, actually.
  16. KAM1138
    KAM1138's Avatar
    #1496  
    Quote Originally Posted by davidra View Post
    Go figure. If you had only KNOWN you weren't going to need insurance, you would have been so much better off. Hey, when you figure out how to do that, let me know. And $350 to a cardiologist is painful? How about a simple appendectomy? Is that "catastrophic"? It will cost $8000. Average hospital admission cost per day in my hospital? $1500 PER DAY. Even for "non-catastrophic illness". Yeah, HSA's are fine....as long as you don't get sick.
    Perhaps you aren't aware, medical expert, that HSA's are normally (or perhaps even required to be) coupled with "high deductible" insurance. So...I'd still have had insurance all those years--just with a higher deductible. So, your exposure per year is still limited to your deductible.

    And yes, it is a pretty good bet that a young person (as I was) starting out in a career has a relatively low chance of catastrophic illness, which makes an HSA an attractive option. Of course it is an OPTION, and my choice so I'm not sure what the hell you have to say about it anyway. Oh right--you are a medical expert, and I'm not so I'm not qualified to make those choices for myself.

    KAM
  17. rebirth24's Avatar
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    #1497  
    Quote Originally Posted by davidra View Post
    No, and that's Obama's mistake. There isn't one bill. He tried to involve congress in coming up with something because Clinton did it the other way and failed. Now he is stuck with nothing to formally explain because the house and senate bills are different and not finalized. He should have developed the bill he wanted and provided it to congress. He was too idealistic and actually thought the republicans wanted some kind of health care reform. Now it's clear they don't, and he has wasted time screwing with them. He still is, in fact. Poor leadership, actually.
    Peachy. All I have found are the 1000 page PDF's and a bunch of arguments. Would be nice to have some (several for arguments sake) breakdowns of the ins/outs of what is proposed.

    I personally work for a large company, don't pay much (if anything) for health care and don't really see the need for change (oh I am so selfish...yes).
  18. #1498  
    Quote Originally Posted by davidra View Post
    Go figure. If you had only KNOWN you weren't going to need insurance, you would have been so much better off. Hey, when you figure out how to do that, let me know. And $350 to a cardiologist is painful? How about a simple appendectomy? Is that "catastrophic"? It will cost $8000. Average hospital admission cost per day in my hospital? $1500 PER DAY. Even for "non-catastrophic illness". Yeah, HSA's are fine....as long as you don't get sick.
    Actually....you are wrong good doctor. The HSA actually works best if you have a bad year health wise. Let's say I go in for something major to start the year off....let's say that $8000 appendectomy you mentioned. After I pay $4,000 of that, my plan will pay 100% of the remaining costs! Even better, I have now hit my out-of-pocket for the year! So, everything....prescriptions....doctor office visits...MRI....x-rays.....you name it.....is covered at 100%!

    So, the HSA is the worst if you just have a "medium" year, let's say an MRI....maybe a couple of specialist doctor visits....and some major prescriptions and don't hit your deductible. Of course, if you're saving a couple of hundred dollars a month in premiums (a husband/wife, for example), then over that year you do have $2400 in your pocket to offset those pesky expenses I mentioned. If you have no doctor visits then I will agree with you, it works out good because of the premium savings and no medical expenses.

    Now....I didn't get personal....so please, please don't report me to palandri for saying you were wrong. Grrrr, so difficult for me to end my comments here....so tempting, but again, don't want to get "reported".
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  19. KAM1138
    KAM1138's Avatar
    #1499  
    Quote Originally Posted by davidra View Post
    No, and that's Obama's mistake. There isn't one bill. He tried to involve congress in coming up with something because Clinton did it the other way and failed. Now he is stuck with nothing to formally explain because the house and senate bills are different and not finalized. He should have developed the bill he wanted and provided it to congress. He was too idealistic and actually thought the republicans wanted some kind of health care reform. Now it's clear they don't, and he has wasted time screwing with them. He still is, in fact. Poor leadership, actually.
    You are spreading misinformation. President Obama didn't need any Republican votes to get this bill passed. The House of Representatives is heavily controlled by the Democrats and the Senate is controlled by a Democrat Super majority. The resistance is coming from his own party, because of Citizens reaction to these various bills, and the Republicans can't do a thing about it either way. He simply is trying to blame Republicans, because that's what he does, and uninformed people, such as yourself are parroting that.

    Additionally, most Republicans do want healthcare reform. Again--that's a false premise forwarded by the Obama administration, the media and other opponents. Its a lie which attempts to create an all or nothing scenario, my-way-or-the-highway scenario. It's dishonest at best.

    KAM
  20. #1500  
    Oh....and I forgot to mention....since I hit the $4000 deductible, my wife will have her expenses also paid at 100% for the remainder of the year. Umm....learn your products doctor before typing.
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