SICKO

[ISiddiqui]

Originally Posted by Galaril

Answer to the first question is no they haven't sent me a notification they won't pay for it yet. All they sent me was this questionaire and a paper with a company which apparently is medical history investigation company which when I called the number was no longer is service.
And yes I did have medical healthcare before and I did go to see my primary care doctor once about a sore back which she just prescibed me to take a few aspirin.

I might be freaking out for no reason but with a wife that doesn't work and two young children (one 5 years old and another 6 months old) at home as well as my elderly mother living with us I can't afford to lose my healthcare.

If you had medical healthcare before for 12 months and haven't had a break in coverage for over 63 days, then they can't assign preexisting condition exclusions on you. It'd violate HIPPA. Furthermore, if they were going to put an exclusion on you, you'd have to be notified of it when you join up, and for how long (they can only do 12 months, or 18 for late enrollees... which is offset by your prior coverage).

And if you are getting it through an employer, you won't lose your health care. They wouldn't be able to drop you due to a health factor (that'd also violate HIPPA).

[ISiddiqui]

Originally Posted by Warhammer

My mother went in to the doctor for a routine checkup. She offered to pay up front what the insurance would pay, plus her co-pay for the checkup (long story there). She was told she could not pay that way.

This is my problem, why can't she pay them the same amount as the insurance company would pay?

Because the insurance company negotiates a lower rate. They can do that because the insurance company represents a great mass of people. Doctors would prefer to get higher amounts, but realize the insurance companies have them over a barrel.

[Galaril]

Originally Posted by ISiddiqui

If you had medical healthcare before for 12 months and haven't had a break in coverage for over 63 days, then they can't assign preexisting condition exclusions on you. It'd violate HIPPA. Furthermore, if they were going to put an exclusion on you, you'd have to be notified of it when you join up, and for how long (they can only do 12 months, or 18 for late enrollees... which is offset by your prior coverage).

And if you are getting it through an employer, you won't lose your health care. They wouldn't be able to drop you due to a health factor (that'd also violate HIPPA).

Awesome thanks for that .

[Mac Howard]

Originally Posted by MrBigglesworth

The US government spends more per capita on healthcare than any other industrialized nation. That's just the US government, that doesn't even include private spending. One possible explanation is that our government bureaucracy is inherently multiple times more inefficient and wasteful than any other government bureaucracy in the world. That sounds far-fetched to me. Another possibility is that our patchwork system of insurers drives costs up everywhere, with such costs including profit, paperwork hassles, and decreased drug bargaining power. I think that is much more likely, as it is the thing that is unique about American healthcare. Any healthcare plan must address this issue, or else it will be a waste, like Medicare Part D, which may get drugs to seniors, but will cost us an arm and a leg. It's easy to say that we need to cover any uninsured American, but we need to find the money to do that.

I think the reason may well be, MrBigglesworth, that your government isn't in control of pricing - it's the cosy deals between insurance companies and the medical providers that decide this and government has, to some extent, to go along with this.

The European systems do not have the government running the health systems - they are merely a very large insurance company. The hospitals, the doctors etc are all privately run businesses, with the efficiencies that go with that, and negotiate pricing with government. So bureaucracy is limited. The advantages of government negotiating prices are these:

1) Governments, unlike insurance companies, have no interest whatsoever in seeing high medical costs. That would mean high taxes and even socialist governmets know that loses them votes.

2) being by far the largest insurance companies that only a relatively few medical practitioners can ignore, they can nail down the prices. A GP gets just $30 from government for a single patient visit here. GPs can charge more which the patient will pay but he has to declare the charge and the patient can choose which ever GP he wishes. So few charge more than $10 a visit extra and some charge no excess.

3) Governnent has no "front office" costs. Because every tax payer is a "member" there are no selling or marketing costs. Because the money is collected through an already existing tax collection system there's little in the way of collection costs. Only the costs of price negotiations and paying the bills are involved.

Though most Europeans will complain about their systems they're merely complaining that they're not comprehensive enough. Any government that argued for even reducing the spend on the national system would be unelectable and many tax payers would forego tax cuts or agree to tax increases if they were sure they would go into the health system.

A study of the British and American health systems revealed that a UK citizen pays just less than half than that of the USA citizen for roughly equivalent health care.

Alongside the national, government run systems there are private insurance systems for those who can afford it and want to avoid waiting lists (the main advantage of private insurance). However, even these people, will use the national system before their insurance system in many cases where delays are not involved or weigh the cost of delay. That, in turn, keeps the cost of private insurance down.

Just to give you an idea of why Europeans (and I include Australia in these as their system is similar) love their health systems.

Some of the people reading this will suffer later on in life from prostate cancer. Even if it doesn't kill you it's a very nasty problem. There is drug treatment - it will cost you approximately $30,000 per treatment. To some Americans this is pocket money, others will need to re-mortgage the house and others simply will have to do without the drugs.

Two weeks ago the Australian government added these drugs to the PBS list (Pharmaceutical Benefits Scheme) and an Australian will pay just $28 per treatment. If he's a pensioner he'll pay just $3.

Try telling an Australian this scheme should be dropped for a private funded system

[Warhammer]

Originally Posted by ISiddiqui

Because the insurance company negotiates a lower rate. They can do that because the insurance company represents a great mass of people. Doctors would prefer to get higher amounts, but realize the insurance companies have them over a barrel.

This is the one area I would like to see the government involved in. Force the insurance companies to charge the consumer a lower rate, and have the doctors charge the insurance companies and the consumer the same price.

The way the insurance companies would make money would be the way they are supposed to now, through sound investment. The benefit to their customer is that any large unexpected expense is covered based upon the monthly fee and their investments. As it is, why should any insurance company charge good rates? I think they realize this, and that is why rates constantly go up.

[Mac Howard]

Originally Posted by Warhammer

This is the one area I would like to see the government involved in. Force the insurance companies to charge the consumer a lower rate, and have the doctors charge the insurance companies and the consumer the same price.

The way the insurance companies would make money would be the way they are supposed to now, through sound investment. The benefit to their customer is that any large unexpected expense is covered based upon the monthly fee and their investments. As it is, why should any insurance company charge good rates? I think they realize this, and that is why rates constantly go up.

The insurance companies will charge whatever they can get away with.

Here in Oz, 3 years ago John Howard, in a pork-barreling move before the last election, gave a tax rebate on private health insurance premiums - the saving amounting to 30% of the premium (he argued that this would increase the take up of private insurance reducing the pressure on the Medicare system ) but it took less than two years for the insurance companies to cancel out that 30% with premium increases. They effectively turned the tax rebate into a direct contribution to their bottom line.

[molson]

Originally Posted by Mac Howard

The insurance companies will charge whatever they can get away with.

Here in Oz, 3 years ago John Howard, in a pork-barreling move before the last election, gave a tax rebate on private health insurance premiums - the saving amounting to 30% of the premium (he argued that this would increase the take up of private insurance reducing the pressure on the Medicare system ) but it took less than two years for the insurance companies to cancel out that 30% with premium increases. They effectively turned the tax rebate into a direct contribution to their bottom line.

With all the people in the world, you'd think at least some of the smart ones would go into politics.

[Mac Howard]

Originally Posted by molson

With all the people in the world, you'd think at least some of the smart ones would go into politics.

It helped win him the election so who are we mere mortals to say?

[lynchjm24]

Originally Posted by Warhammer

As it is, why should any insurance company charge good rates? I think they realize this, and that is why rates constantly go up.

You are wrong. The rates go up because medical costs go up. Competitive pressures keep the rates from going higher.

[sterlingice]

Originally Posted by lynchjm24

You are wrong. The rates go up because medical costs go up. Competitive pressures keep the rates from going higher.

I think that's the really rosy picture painted every day in a lot of industries in this country which are more and more run by oligopolies. The entry barriers are so large that you can easily collude among the top few companies and not have to worry about competition from the little guys because they don't have the clout to get discount rates. So, in essence, they reap the rewards of the large entry barriers right into their pockets rather than having to use them to compete with other companies.

SI

[lynchjm24]

Originally Posted by sterlingice

I think that's the really rosy picture painted every day in a lot of industries in this country which are more and more run by oligopolies. The entry barriers are so large that you can easily collude among the top few companies and not have to worry about competition from the little guys because they don't have the clout to get discount rates. So, in essence, they reap the rewards of the large entry barriers right into their pockets rather than having to use them to compete with other companies.

SI

The competition between the major carriers is as intense in the industry as it has ever been. While this might be true in other areas of the economy, major medical insurers are beating each other up every day.

[Galaril]

Originally Posted by lynchjm24

The competition between the major carriers is as intense in the industry as it has ever been. While this might be true in other areas of the economy, major medical insurers are beating each other up every day.

Sorry, I am not sure what your inference is but if it is related to giving accuses for healthcare/drug companies that are in it for the money and money alone than no thanks I don't have an sympathy for these a-holes.

[lynchjm24]

Originally Posted by Galaril

Sorry, I am not sure what your inference is but if it is related to giving accuses for healthcare/drug companies that are in it for the money and money alone than no thanks I don't have an sympathy for these a-holes.

Accuses? I'm not giving accuses for anything, but I can promise you not every person at health insurance companies are in it for money and money alone. They aren't all a-holes.

[Galaril]

Originally Posted by lynchjm24

Accuses? I'm not giving accuses for anything, but I can promise you not every person at health insurance companies are in it for money and money alone. They aren't all a-holes.

Point taken and you are right. I am referring mainly to the folks in senior management in these HMOs and those who set up these firms which includes alot politicians,

[M GO BLUE!!!]

I was thinking again of this film this past weekend. I found out that on another message board I post on occasionally, someone I knew from the board was going without insurance, and saving up to get insurance. She had been having some shortness of breath and was afraid of going to see a doctor before getting insurance. She figured that if she had asthma and it was diagnosed before she had insurance it would be classified as a pre-existing condition.

She finally got insurance and went to a doctor. Turns out she doesn't have asthma... Lung cancer. It has already spread to her spine.

All I can think of is that if she was in England she would have been diagnosed a long time ago and would not have been just told she has terminal cancer.

It's depressing just thinking about it...

[Warhammer]

Originally Posted by M GO BLUE!!!

I was thinking again of this film this past weekend. I found out that on another message board I post on occasionally, someone I knew from the board was going without insurance, and saving up to get insurance. She had been having some shortness of breath and was afraid of going to see a doctor before getting insurance. She figured that if she had asthma and it was diagnosed before she had insurance it would be classified as a pre-existing condition.

She finally got insurance and went to a doctor. Turns out she doesn't have asthma... Lung cancer. It has already spread to her spine.

All I can think of is that if she was in England she would have been diagnosed a long time ago and would not have been just told she has terminal cancer.

It's depressing just thinking about it...

With lung cancer by the time you get to see many of the symptoms its already too late.

[molson]

Originally Posted by Warhammer

With lung cancer by the time you get to see many of the symptoms its already too late.

I was thinking that story sounds a little made-up (not by M GO BLUE!!!, but wherever he got it).

Who saves up for insurance? Do they know you have to pay every month (or quarter?). Lung Cancer is pretty rare in younger people who don't smoke (which I assume is the case here - someone posting on a message board, can't afford insurance, assuming asthma instead of worse).

Not that something like that couldn't happen in our system, but it sounds like someone was just trying to make a point here.

[Arles]

Originally Posted by M GO BLUE!!!

I was thinking again of this film this past weekend. I found out that on another message board I post on occasionally, someone I knew from the board was going without insurance, and saving up to get insurance. She had been having some shortness of breath and was afraid of going to see a doctor before getting insurance. She figured that if she had asthma and it was diagnosed before she had insurance it would be classified as a pre-existing condition.

She finally got insurance and went to a doctor. Turns out she doesn't have asthma... Lung cancer. It has already spread to her spine.

All I can think of is that if she was in England she would have been diagnosed a long time ago and would not have been just told she has terminal cancer.

It's depressing just thinking about it...

Just to play devil's advocate, but I'm guessing that she would have had some sort of wait (given her age and the fact it wasn't extremely serious from her standpoint) before getting the battery of tests in England required to determine she had lung cancer. So, in the end, her best bet for early detection was having some sort of PPO in the US as opposed to waiting in line for X-Rays/tests in England/Canada.

[Warhammer]

Originally Posted by molson

I was thinking that story sounds a little made-up (not by M GO BLUE!!!, but wherever he got it).

Who saves up for insurance? Do they know you have to pay every month (or quarter?). Lung Cancer is pretty rare in younger people who don't smoke (which I assume is the case here - someone posting on a message board, can't afford insurance, assuming asthma instead of worse).

Not that something like that couldn't happen in our system, but it sounds like someone was just trying to make a point here.

Not only that, but beating lung cancer very much depends upon which form of it you get. One is small cell and the other large cell (for lack of better terms) and if you get the small cell version (I could have them backwards, the rarer type is more deadly than the prevalent one) you are hosed. I've lost an uncle and my grandfather to lung cancer (grandfather's started as breast cancer which spread to his lungs) and in both cases no one suspected they had lung cancer until it was too late.

[flere-imsaho]

Originally Posted by Arles

So, in the end, her best bet for early detection was having some sort of PPO in the US as opposed to waiting in line for X-Rays/tests in England/Canada.

I love a good battle of anecdotes.

[sabotai]

Originally Posted by molson

Who saves up for insurance? Do they know you have to pay every month (or quarter?).

I guess you could say I'm "saving up" for insurance. But not really. Just trying to pay off other debt that requires montly payments (namely credit cards) before I can afford it. I guess they could have meant that, even though it would be worded weirdly.

It also could mean that the person would have zero disposable income if they got insurance, so maybe she wanted to save up a few months worth of income in case of any emergencies.

[flounder]

An interesting tidbit from the Wikileaks cables.

Cuba banned Michael Moore's 2007 documentary, Sicko, because it painted such a "mythically" favourable picture of Cuba's healthcare system that the authorities feared it could lead to a "popular backlash", according to US diplomats in Havana.

The revelation, contained in a confidential US embassy cable released by WikiLeaks, is surprising, given that the film attempted to discredit the US healthcare system by highlighting what it claimed was the excellence of the Cuban system.

But the memo reveals that when the film was shown to a group of Cuban doctors, some became so "disturbed at the blatant misrepresentation of healthcare in Cuba that they left the room".

Castro's government apparently went on to ban the film because, the leaked cable claims, it "knows the film is a myth and does not want to risk a popular backlash by showing to Cubans facilities that are clearly not available to the vast majority of them."

[RainMaker]

Originally Posted by Arles

Just to play devil's advocate, but I'm guessing that she would have had some sort of wait (given her age and the fact it wasn't extremely serious from her standpoint) before getting the battery of tests in England required to determine she had lung cancer. So, in the end, her best bet for early detection was having some sort of PPO in the US as opposed to waiting in line for X-Rays/tests in England/Canada.

I know this is an old, old, old post, but as someone who lived in Canada, this is just not true. You wouldn't have to wait that long for an X-ray/tests. Especially when it comes to something like your lungs.

There is a lot of misinformation about the health care system in Canada passed around by partisians in this country.

[sabotai]

Originally Posted by flounder

An interesting tidbit from the Wikileaks cables.

Heh, awesome.