In America...

[Moliphino]

Don't forget that all those with insurance, unless it's company supplied with no weekly charge for the insurance you are paying that even if you aren't sick. Then you usually have a deductible and and a co-pay.

All this concern about not wanting a good for all system is just another example of how so many have been brainwash by big business to thinking it would be awful and us buying into it are just plain unable to count. Think about it! Right now if you get sick with anything from flue to cancer will have to pay whatever you are paying for the insurance, and your deductible and your copay by yourself. With the coverage for all the population of the country is paying for it or help you to pay for it.

Perhaps when you are working you don't like paying for all that stuff, but you know you have income. Think ahead to the day when it is very possible that you will have a whole different income in the form of Social Security only. Then the co-payments and deductibles are on a sliding scale based on income. I have that right now. Because I actually served in country in Vietnam and am a Veteran almost all my medical is taken care of by the V.A. Because my income is only SS the only thing I have for a co-pay is my meds and that is ridiculously low. I can't tell you how much of a wonderful thing that is when you get older and don't have any other income. So far I have had two kidney stone removals, both eyes were taken care of when I had Cataract Surgery, a pacemaker installed and just had a Cervical fusion of two vertebrae in my neck and I have yet to see a bill. And that is not to mention the amount of testing that I had leading up to the fusion at no charge to me. I don't even want to think about how much that all would have cost me. I know that all of my retirement savings would be gone. Heck, one of the tests I had was a Cardiac MRI which is quite complex. I saw what the Hospital billed the V.A. just for that was $10K. That was just about an hour long procedure. Here's the kicker because the VA can set the maximum they will pay regardless of what the are billed, they will probably pay only 10% of that number. As an individual you do not have that power. Everyone should be wanting the medical for all possibility. Sometimes we are our worst enemy and can't see the forest for the trees.

Just for fun lets think about it. I'm going to take a guess and say that there are 220,000,000 tax payers in the country.,
That $10,000 MRI would have cost you a very large portion of the 10 grand, all by yourself even with insurance. Now let's look into the coverage for all direction. All 220,000,000 tax payers including yourself would have to pay $0.00004545. That would be everyone's share. That is a very, very, very small fraction of a penny. Which one makes the most sense. Big business and sadly a lot of people with power want you to believe that it is bad because it will take lots and lots of money out of their pockets.

Insurance companies make profits. Remove the insurance company and there's more money to go around for actual healthcare costs.

 

[lovesmurfs]

Care to inform the rest of us how to "play the HMO game"? Unless you're referring to meeting the deductible early in the year and having high value procedures after that at no out of pocket cost (hard to plan a heart attack that way)?

HMOs don't have deductibles. You have a primary care physician who is the gatekeeper for specialists, such as dermatologists, etc. I use the system hospital and have any pre-planned surgeries pre-authorized. I've had several emergencies (gall bladder, kidney stones), all of which were paid 100% by the insurance company (BC/BS HMO).

 

[jo-jo]

Not heart attack, gallbladder gone bad, A-FIB, hernia. Been on Medicare for years. Paid something everytime. Not thousands and thousands, but hundreds.

 

[sam_gordon]

HMOs don't have deductibles. You have a primary care physician who is the gatekeeper for specialists, such as dermatologists, etc. I use the system hospital and have any pre-planned surgeries pre-authorized. I've had several emergencies (gall bladder, kidney stones), all of which were paid 100% by the insurance company (BC/BS HMO).

How?

 

[goofyernmost]

There are many versions of insurance. I had one that, yes, we paid the premium, and a deductible for "non-routine" visits, but no copay. After meeting the deductible, everything was covered at 100%. "Preventive" procedures (annual physical, teeth cleaning, colonoscopy (at a certain age) were covered at 100%, no deductible or copay.

And, while your math is correct about everyone paying an extremely small fraction of a single MRI, how many MRIs are done every day across the country?

Now, that being said, I think I would be happy with a single payer/"medicaid for all" (whatever it is called) system. But I'm sure it will have it's bad points also. And, since we can't discuss politics, that's all I have to say about that.

First at that rate you will still be paying one hell of a lot less than you currently are for equal usage. No one would have to worry about losing their life savings when an unexpected illness happens. Just think about couldn't afford insurance what would happened to you if you didn't have insurance or what will happen when you get to old to work! I know it isn't the tendency of people to think that far ahead, but if life has taught me anything it is that, in a heartbeat one can go from healthy and able, to totally dependent and no one, no one will care. You can be on your own that quickly.

As far as the bad points, I think the massive up front deductibles that most current health insurance policies have is almost criminal. You'd be far better off with co-pays because then the bet is that you will not get real sick. The bet you are making is that you will not need to use it. Your insurance company is betting that you will never use enough of it to get past the deductible and they become the odds on winner. They have used the algorithms that say that for the most part you will not use anymore health care then what they give out as a deductible and that you will pay 100% of before they spend a nickel of your premium you have paid to them.

Whatever the bad is for having insurance for all, it is far out weighed by the scam that insurance companies offer. Even if you reach the deductible they can, and have, caps on how much they will pay over time. As a society we are suckers for every good sounding offer or, as is most cases, have no real choice based on what type of plan our employer decides to go with and you can rest assure that, for the most part, they will choose whichever one cost them the least and put the excessive expense on your shoulders. Presently insurance is better than nothing, but for most of society they will never surpass that deductible yearly, therefore, you will pay the premiums and that deductible and they will pay nothing and keep your premium payments. Insurance is a necessary evil right now, but it doesn't have to be that way if informed people stopped fighting something that would help us instead of thinking it is some evil scheme. There is strength in numbers only if we are wise enough to utilize the power of those numbers.

 

[sam_gordon]

As far as the bad points, I think the massive up front deductibles that most current health insurance policies have is almost criminal. You'd be far better off with co-pays because then the bet is that you will not get real sick.

This entire discussion can be it's own thread. And as I said, I would be interested in a new health care system, but I don't think I'll see it in my life time.

As far as the above quote, I stayed with PPO system as long as I could. Then my employer decided to not offer those any more and everyone HAD to go to high deductible plans (or venture out on their own). My new employer provides a PPO system, curiously with the same company I had with my former employer.

 

[dioxide45]

With my employer provided healthcare, I have a $3000 deductible with a $6000 out of pocket maximum. Next year I may go with $1500/$3000. With these plans I contribute to an HSA as does my employer. The goal is to always have the amount of the out of pocket maximum available in the HSA. My premiums are under $30 per pay period and the lower OOP and deductibles are about $50 per pay. My employer perports to pay 75% of healthcare costs.

I think that an HSA is a powerful healthcare planning tool. It makes me more accountable for healthcare costs because I am spending my own money. While it isn't perfect, I don't think single payer is perfect either. If we have any problem with healthcare today it is that there is too much government involvement, not too little. Regulation, paybacks, oversight, members of congress financially investing in what they are supposed to be overseeing, etc. Single payer just creates people who aren't invested in their financial costs.

 

[dez1978]

Charges yes, responsible as patient, no. Over the past 35 years, we've learned to play the HMO game. As long as you play it right, they pay 100% of nearly everything, including my two knee replacements (which totaled over $175,000).

HMOs don't have deductibles. You have a primary care physician who is the gatekeeper for specialists, such as dermatologists, etc. I use the system hospital and have any pre-planned surgeries pre-authorized. I've had several emergencies (gall bladder, kidney stones), all of which were paid 100% by the insurance company (BC/BS HMO).

We used to have an HMO option but now only HSA or PPO thru BC/BS. When we did have it, you still had to be a copay for procedures or hospital stays. It was certainly cheaper than the 20% co insurance I pay after my deductible now, but never 0. Like my 1st kid, c-section was $300 copay for the hospital stay for me and $300 for him.

As far as the bad points, I think the massive up front deductibles that most current health insurance policies have is almost criminal. You'd be far better off with co-pays because then the bet is that you will not get real sick.

My total family deductible is $1500/year w/ $3000 OOP max. I don't think that is massive. I pay under $400/month for my family of 4. My job hasn't offered a HMO option for several years, but when it did, copays were $25 for a regular visit. Idk what they would be now.

 

[sam_gordon]

For general routine stuff when you have kids, my insurance pays nearly nothing.

Just to look at the glass as half full instead of half empty, you do save money by having insurance. Insurance companies will negotiate rates for everything that is less than what someone with no insurance gets billed.

When my first employer first offered high deductible plans (when we had a choice between those and PPO), I took every medical bill (thank you online EOBs), added up all the costs we would have paid for the previous year, and while a large amount, it wasn't close to any individual, much less the group deductible. I'd do the same math every couple of years until the high deductible plan was forced on us.

 

[dez1978]

No idea with my insurance how a large thing would work.

For general routine stuff when you have kids, my insurance pays nearly nothing.

Mine pays 100% of well child checks and vaccines as well as sports physicals. Then it pays the same for anything else as it would for me or my husband. Yours doesn't cover wellness exams like yearly physicals or well woman checks or anything?

 

[mrodgers]

Mine pays 100% of well child checks and vaccines as well as sports physicals. Then it pays the same for anything else as it would for me or my husband. Yours doesn't cover wellness exams like yearly physicals or well woman checks or anything?

General kids get sick a lot kind of routine stuff is what I meant.

Regular exams I have a copay. Anything other than regular annual visit stuff, about 25% of the bill comes off the deductible.

 

[Neapolitan Ice Cream]

It sounds to me that insurance rules the roost.... would it be logical to assume that people with chronic illnesses such as Cystic Fibrosis would be stuffed?

 

[Kennywood]

The main caveat in your question is "emergency". With that in mind, it would depend upon whether or not the hospital to which you're taken and the cardiac surgeon are covered by your insurance. Now, in an emergency, most insurance coverages would pay a large portion of the expenses. But, if the hospital and/or surgeon are not part of the insurance plan, you could be held responsible for charges not covered by your insurance.

More often than not, "emergencies" can be problematic when it comes to insurance payments.

As someone once said, "They that pay the bills makes the rules."

 

[sasywtch]

I pay zero monthly and would not be charged for anything other than the pharmacy upon discharge as I'm assuming I'd be picking up new medications. That would be $5 for a 3 month prescription. For the above poster who mentioned brainwashed, I am not brainwashed and I do not want universal healthcare. I do not want the government involved. I have relatives in the UK who come here for medical procedures not allowed by their government. This was life saving procedures. What needs to get fixed are those in the middle that work for small companies, own small businesses etc. Those below income levels receive state medi-cal or medicade (depending on your state), those with high income levels can afford the deductables. It's those in the middle that they need to concentrate on.

 

[beckicnm]

I would pay nothing because that surgery would be in the hospital. I have a $50 copay for an outpatient surgical center.

I have an HMO plan, I have no deductible but I do have an out of pocket max for the year. Most of my copays are $10.

 

[DisneyHardin]

I have really good insurance, but it does have a deductible, so if I had a major health event like that, I would have to pay $2000 (my max out of pocket).

 

[sam_gordon]

I pay zero monthly and would not be charged for anything other than the pharmacy upon discharge as I'm assuming I'd be picking up new medications. That would be $5 for a 3 month prescription. For the above poster who mentioned brainwashed, I am not brainwashed and I do not want universal healthcare. I do not want the government involved. I have relatives in the UK who come here for medical procedures not allowed by their government. This was life saving procedures. What needs to get fixed are those in the middle that work for small companies, own small businesses etc. Those below income levels receive state medi-cal or medicade (depending on your state), those with high income levels can afford the deductables. It's those in the middle that they need to concentrate on.

Why do you pay zero per month and have no kind of copay? Is your employer that generous that they pick up your entire premium? Are you a congressman or military?

I would pay nothing because that surgery would be in the hospital. I have a $50 copay for an outpatient surgical center.

I have an HMO plan, I have no deductible but I do have an out of pocket max for the year. Most of my copays are $10.

So emergency surgery would have a $0 deductible? What plan is that?

 

[bcla]

Possibly, but generally handed over to insurance. And also with the possibility of indigent care. Emergency rooms can't deny anyone care, but they will attempt to collect afterwards.

 

[beckicnm]

Why do you pay zero per month and have no kind of copay? Is your employer that generous that they pick up your entire premium? Are you a congressman or military?

So emergency surgery would have a $0 deductible? What plan is that?

It is a HMO plan. I have no deductibles at all, even for surgery.

 

[jalapeno_pretzel]

I want to know more about these employers who are providing HMOs that result in $0 outlay for the insured! I'm in the tech field and led to believe our coverage is top notch, but it's a high deductible family plan (we have no option for anything but a high deductible + HSA plan), and so in addition to the maybe $6k in premiums that come out of my paycheck, we pay literally thousands more per year. Don't even get me started on the 'mental health coverage' which has everything out of network and has the out of network deductible set so high we will never see a penny reimbursed for that. That adds up to thousands per year alone.