In America...

[sam_gordon]

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

Do you pay any premium?

 

[Kwami]

I'd get a $200 copay charge for visiting the ER. The rest would be covered by my health insurance plan.

 

[beckicnm]

Do you pay any premium?

No. It's built into my benefits package.

 

[Worfiedoodles]

Here’s a different situation…my dad was not happy when he was drafted in 1958, but he served for 2 years and now his health care is through the VA system. They take excellent care of him, and he pays nothing.

 

[goofyernmost]

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.

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.

What part of insurance for all are you missing. For a steady small amount paid by every taxpayer into a fund at a much smaller rate then you currently pay for insurance and it is always there. You don't have to pay $3000 deductible (up front) or $400.00 per month ($4800 before you even have an appointment). If you have an illness that goes even a dollar over your Deductible you will be paying $7800.00 and if no one needs medical after that, you will never see that $4800.00 again... guess who keeps it. You may have a few co-pays but you basically are pre-paying the co-pays at $400.00 per month even if you don't use them. And there will be a cap on the total that will be paid for certain services for any very serious long term illness.

The only way you can get even that small a rate is because the insurance company is using a likelihood algorism to figure out that you are the one taking the risk, not them. Try getting support on items that might be labeled pre-existing conditions. They play the odds. They are saying that you will be well and you are insisting that you will be sick. Either way you lose money.

So where do you get the money to support insurance for all, from the massive premiums and co-pays that you are currently paying and will not have to ever pay again. That may not mean much to you now, but someday when you are no longer on an employer sponsored health care program you are volatile at that point. I had that problem before I realized that I could get health care through the VA. Without that I would still be trying to work everyday no matter what my health might be. It means a lot then because at that point medical health costs will skyrocket and what you put away for retirement will be used up faster then you can imagine. (unless, of course, you are a millionaire) I'm not and most of us aren't. I stayed relatively healthy until I got to 67 years old and now at 75, just eight short years, I would have used up all my retirement savings just with the few problems that I have had.

 

[goofyernmost]

Here’s a different situation…my dad was not happy when he was drafted in 1958, but he served for 2 years and now his health care is through the VA system. They take excellent care of him, and he pays nothing.

I can certainly relate to that. I enlisted in 1968. At the time the draft was still happening. I spent four miserable years including an awful year of my life in Vietnam and got out as soon as I could. It took nearly 50 years before it started to pay off in the form of the VA. I didn't know it was even available, I found out by accident.

They have been great to me, I have had about 6 surgeries since then and around the same number of high cost tests and careful oversight of my thankfully slow growing Prostate Cancer. All at no charge except an average of $5.00 per month co-pay for each medication. I kind of made the misery worth while. Kinda!

 

[dioxide45]

What part of insurance for all are you missing. For a steady small amount paid by every taxpayer into a fund at a much smaller rate then you currently pay for insurance and it is always there.

The only problem is that the government is very inefficient. Anything run by the government is a mess. They really can't do anything as good as private enterprise can. Insurance companies and medical providers have a goal to make a profit and provide efficiencies. When the government starts paying for everything, costs increase significantly. Just look at the mess that federally guaranteed student loans made of college/university tuition costs.

While single payer sounds great, at some point costs increase due to the bloat of government bureaucracy and then they put pressure (or laws) on medical providers to be compensated less money.

 

[jalapeno_pretzel]

The only problem is that the government is very inefficient. Anything run by the government is a mess. They really can't do anything as good as private enterprise can. Insurance companies and medical providers have a goal to make a profit and provide efficiencies. When the government starts paying for everything, costs increase significantly. Just look at the mess that federally guaranteed student loans made of college/university tuition costs.

While single payer sounds great, at some point costs increase due to the bloat of government bureaucracy and then they put pressure (or laws) on medical providers to be compensated less money.

I find the bolded section to be part of the problem. I think making a profit for shareholders is not compatible with operating in the best interest of patients.

Insurance companies put pressure on medical providers to limit tests or expensive procedures. I watched this play out with a family member who suffered an extra month with something completely treatable because the doctor didn't want to run the test because of upsetting the insurance company. I've seen several of my physician practices get threatened to be dropped by my insurance companies over disputes about running too many tests or issues of compensation. I know this because I receive letters. 'Dear patient, please be aware we are negotiating with xyz insurance company to remain in-network, but as of now have not come to an agreement.'

My previous insurance company liked to pretend they didn't understand a billing code associated with hospital lab work and tried to stick me with an $800 lab bill, saying they had already paid the lab. After many hours round and round between insurance and the hospital lab insurance specialist, I learned to use the magic words and tell them to look at the 'dash modifier.' Once I pointed this out, they suddenly were able to pay it. I wouldn't have caught this if it had been a small amount, because I wouldn't have bothered looking into it. Just 2 months later, we had another family member at the same hospital, and we had the EXACT same issue with the lab work bill. It's not that they don't know how to correctly handle it, they were intentionally trying to avoid paying something that they were obligated to pay, and they rely on the confusion and the time it takes to resolve anything to discourage patients from doing anything about it. Then you hear about their CEO making many millions, and their stock price soaring.

It used to be we had insurance companies and hospitals in our area that were non-profits. Not the case anymore. When the insurance company is for-profit, it's primary responsibility is to the share holder, not the patient. And the share holder's profits come at the expense of quality care for the patient. Personally I like the idea of single-payer, but another solution could be that hospitals and insurance companies operate as non-profits. Their costs are covered, their employees are paid, but they're not making profits for share holders.

 

[Cogswel_Cogs]

Working in a hospital and knowing the difference that insurance companies pay versus medcaire/medcaid. Medicare/caid would have to pay so much more per client than they do now.

 

[Moliphino]

I find the bolded section to be part of the problem. I think making a profit for shareholders is not compatible with operating in the best interest of patients.

Insurance companies put pressure on medical providers to limit tests or expensive procedures. I watched this play out with a family member who suffered an extra month with something completely treatable because the doctor didn't want to run the test because of upsetting the insurance company. I've seen several of my physician practices get threatened to be dropped by my insurance companies over disputes about running too many tests or issues of compensation. I know this because I receive letters. 'Dear patient, please be aware we are negotiating with xyz insurance company to remain in-network, but as of now have not come to an agreement.'

My previous insurance company liked to pretend they didn't understand a billing code associated with hospital lab work and tried to stick me with an $800 lab bill, saying they had already paid the lab. After many hours round and round between insurance and the hospital lab insurance specialist, I learned to use the magic words and tell them to look at the 'dash modifier.' Once I pointed this out, they suddenly were able to pay it. I wouldn't have caught this if it had been a small amount, because I wouldn't have bothered looking into it. Just 2 months later, we had another family member at the same hospital, and we had the EXACT same issue with the lab work bill. It's not that they don't know how to correctly handle it, they were intentionally trying to avoid paying something that they were obligated to pay, and they rely on the confusion and the time it takes to resolve anything to discourage patients from doing anything about it. Then you hear about their CEO making many millions, and their stock price soaring.

It used to be we had insurance companies and hospitals in our area that were non-profits. Not the case anymore. When the insurance company is for-profit, it's primary responsibility is to the share holder, not the patient. And the share holder's profits come at the expense of quality care for the patient. Personally I like the idea of single-payer, but another solution could be that hospitals and insurance companies operate as non-profits. Their costs are covered, their employees are paid, but they're not making profits for share holders.

I have a friend who needs spinal surgery. Had to fight insurance to get the MRIs in the first place, now the doctor has told her she needs surgery, but the insurance is having their "independent doctor" review everything before they'll agree to cover the surgery. Meanwhile she's in constant pain.

 

[dez1978]

What part of insurance for all are you missing. For a steady small amount paid by every taxpayer into a fund at a much smaller rate then you currently pay for insurance and it is always there. You don't have to pay $3000 deductible (up front) or $400.00 per month ($4800 before you even have an appointment). If you have an illness that goes even a dollar over your Deductible you will be paying $7800.00 and if no one needs medical after that, you will never see that $4800.00 again... guess who keeps it. You may have a few co-pays but you basically are pre-paying the co-pays at $400.00 per month even if you don't use them. And there will be a cap on the total that will be paid for certain services for any very serious long term illness.

The only way you can get even that small a rate is because the insurance company is using a likelihood algorism to figure out that you are the one taking the risk, not them. Try getting support on items that might be labeled pre-existing conditions. They play the odds. They are saying that you will be well and you are insisting that you will be sick. Either way you lose money.

So where do you get the money to support insurance for all, from the massive premiums and co-pays that you are currently paying and will not have to ever pay again. That may not mean much to you now, but someday when you are no longer on an employer sponsored health care program you are volatile at that point. I had that problem before I realized that I could get health care through the VA. Without that I would still be trying to work everyday no matter what my health might be. It means a lot then because at that point medical health costs will skyrocket and what you put away for retirement will be used up faster then you can imagine. (unless, of course, you are a millionaire) I'm not and most of us aren't. I stayed relatively healthy until I got to 67 years old and now at 75, just eight short years, I would have used up all my retirement savings just with the few problems that I have had.

Where did I say that I didn't understand what you were saying? That doesn't mean I have to agree with it. Also never ever have I had to pay anything "up front, before I even have an appointment". And considering I have 2 young rambunctions boys, there will never be a year where I don't need medical care. I am perfectly ok with what I have and what I pay. My son broke his leg, so I paid his $750 dollars worth of bills to meet his deductible and a whole 20% after that. The other 3 of us combined meet a 750 deductible. That is basically 1 appointment each with a strep test or basic blood test thrown in. The max I would ever spend in 1 year on medical care, including premiums and deductibles is less than 10k because we have an out of pocket max. So having a csection, including all prenatal care and us being in the hospital for 3 days after cost me around $1700. I also do not have a cap on coverage. If I have a serious illness there isn't a max on what they will pay.

But I'd like to point out that while you have had a good experince with the VA, lets not pretend that it is not a flawed system with decades of problems and a history of refusing treatment to veterans. Or that we don't hear stories about how veterans have been neglected and denied mental health treatment.
https://inewsource.org/2021/11/01/va-doctors-overruled-on-veteran-treatments/

Our system could certainly use some help, but insurance for all also needs some work.

 

[sam_gordon]

You know what I REALLY wish would happen...
1) No multiple bills from a hospital stay/procedure. You pay a single provider, and THEY take care of paying others.
2) None of this in network/out of network crap by individuals. It goes by FACILITY. You can have a procedure done at a facility, and the doctor who is doing the treatment is "in network", but the anesthesiologist is out of network, the recovery room is out of network, the person doing the blood draw is in network, but the person reading your x-rays is out of network. When's the last time you've been told who your anesthesiologist is and you can choose another?
3) A single charge for a procedure. The "list" price is 'x', but since you belong to "Insurance A", you pay 'y'. Oh, you belong to "Insurance B"? That will be 'z'.
4) An EASY way to find out what the TOTAL procedure will cost. I think this is mandated, but I haven't found a way to utilize it.

Off the soapbox for now.

 

[china mom]

I know its not perfect but the system we have now works well for me. My share of my premiums for a family of four is $3285/yr. I have a deductible $1,000 which I have met for the year but I don't have to pay $1,000 before I get any coverage. I am not sure how it works but I typically only pay my co-pay ($30) and occasionally co-insurance but never more than $100 here or there.

I just had my foot rebuilt and the total cost was $48,000 (so far - I am still doing post-op stuff) . My co-insurance was $1200. I have had three foot reconstructions since 6/2020. I also have a recurring $1,000 treatment about every 6-8 weeks which only cost me a $30 co-pay and a myriad of other medical expenses that are covered.

But, here is what I prefer over government run programs: I decided that I no longer wanted to endure foot pain so I found a doctor that I believed in, made an appointment without any referral from my primary physician, got in to see him in less than a month and was scheduled for surgery less than a month after that. And, it wasn't life saving surgery.

In the mean time, my aunt lives in a country with government supplied medical care and she had to fly to another country to have surgery done at her expense because the wait for medical care was so long.

I don't have all of the numbers but some countries with government healthcare pay more than 50% income tax. The difference between when I pay in taxes now and what I would pay at 50% would be a much higher amount than I am paying now for premiums and all healthcare costs.

 

[Worfiedoodles]

I can certainly relate to that. I enlisted in 1968. At the time the draft was still happening. I spent four miserable years including an awful year of my life in Vietnam and got out as soon as I could. It took nearly 50 years before it started to pay off in the form of the VA. I didn't know it was even available, I found out by accident.

They have been great to me, I have had about 6 surgeries since then and around the same number of high cost tests and careful oversight of my thankfully slow growing Prostate Cancer. All at no charge except an average of $5.00 per month co-pay for each medication. I kind of made the misery worth while. Kinda!

Thank you for your service!