The real reason Obamacare has Failed us all?

Oh, I know I have it. Drained two big abscesses yesterday

By 'gotten it', what do you mean? Skin infection, line infection?

I mean that the wound (surgical incision, or wound being treated by the hospital) has become infected badly enough to require rehospitalization, and in two cases a second surgery to clean the wound.

Oh, I know I have it. Drained two big abscesses yesterday

By 'gotten it', what do you mean? Skin infection, line infection?

i know/hope this is tongue in cheek, but i think i just lost my lunch appetite.:sick:

Oh, I know I have it. Drained two big abscesses yesterday

And can I just say, better you than me....:leaving:

Well, there you go.

What percentage of the populace do you estimate your cited example represents, and do you think a solution exists that will make everyone happy?

I would define catastrophic as a condition that results in hospitalization. The diagnosis of cancer? A catastrophe, and perhaps for those unfortunate enough to be diagnosed with cancer, there could be a specific coverage offered by the government.

We can go back and forth, tit-for-tat all day long about this stuff. The bottom line is that there will always be people who are not satisfied, but catering to a vocal minority that derails common sense reform for the majority makes no sense.

Probably a higher percentage of the population than you and I could hypothesize because we both know medicine and diagnosis is not always so cut and dry. Symptoms overlap for different diseases and what is and isn't attributed to "it's all in the head syndrome".

As far as a solution, I have not seen one specific plan yet that sounds ideal, which is why the quandary. However, I do know that I find it ludicrous that we pay more for prescription drugs than other Countries, that premiums on health care have risen 15- 25% every year with no added benefits, that the US has more malpractice suits per capita than any other industrialized nation and this is all affecting the majority, not the minority.

SSB, it saddens me to hear this about your father.

a big part of the conditioning that Skunky speaks of comes directly from the marketing departments of the insurance companies; their lobbyists regularly contribute to most of the members of Congress re-election campaign; the problem is not that we do not have good health care; it is that an insurance executive is standing between the patient and the docs, making life decisions..for everyone.

it is beyond me why so many people are worried about a government employee being there; but, are perfectly content to have an insurance company executive making those decisions.

Can any of these US Healthcare haters name one drug in the last 20 years that was not developed in the United States? Also there are very large differences in how countries tally their life expectancy and infant mortality. In the US if a child is delivered and takes a single breath and then dies they count against both. In most of those countries ahead of us that child must survive 24 hrs. Considering the age of death, that skews the data quite dramatically.

Speaking of skewed data, did you guys know that of those 46 million uninsured in America: 12 million are illegal immigrants and 9 million are under 35, can afford health insurance and simply choose not to carry it. That really leaves only 25 million without it. There is not an exact number for those that qualify for public assistance but have not taken the time to do so. Even at that number, it is about 9 percent of the population. Personally, I do not understand why we are willing the screw up healthcare for 90% of Americans to cover the very few.

I agree with removal of pre-existing condition exclusions and a windfall profits tax on the insurers, but a public healthcare option is the 1st step to Socialized Medicine, and this is why the Florida Medical Association and 18 other State Medical Associations oppose HB 3200 and are urging its members to speak to their patients in efforts to abort this legislation. If the President and Congress was serious about health reform, they would include medical malpractice reform which increases the cost of every medical visit. Unfortunately, they are owned by the Trial Lawyers Association and will not even consider it.

What is the problem with Socialized Medicine? The rationing of healthcare. After age 75, most medical procedures improve quality of life, but don't on average extend life. Heart valves, bypass surgery, cancer treatment, joint replacement are quite the drag on healthcare costs. Without a doubt costs are going to soar initially and when the central planners look where to cut costs it will be with the elderly. I am advising all of my older patients who think they might need joint replacement soon, to go ahead with it because there is a good chance in 2 years they will not be allowed to do so without paying for it themselves.

Interesting information. Can you cite your source. (apparently your are an MD; I'm not questioning your opinion/professional thoughts, just would like to know the source of your data/statistics.)

It's my understanding that child health care available by the "government" or individual States is based on income, and it's usually close to the poverty line.

These catastrophic plans you speak of, who determines what is catastrophic? Is it an automobile accident, cancer? What about chronic disease? My sister has had to be rushed to the hospital several times in the past year and a half, has seen numerous specialists, and none of them, until recently, was able to diagnose her with a rare, but manageable disease; one that she was able to punch in all her symptoms into Web MD and figured out herself. Yes, it is rare, but give me a break. Had the physicians had looked at ALL her charts, they would have easily figured it out, but rush them in and rush them out seems to be the mantra these days.

I'm guessing a catastrophic plan would have been catastrophic for her financially after doling out $300 a visit, ambulatory services, blood work, emergency room and hospital stays after the "plan" determined that nothing was really wrong with her prior to be diagnosed. Chances are she would have been one of the Bankruptcy cases that 2/3rd's of the cases are which are related to medical financial hardship.

"catastrophic plans" are just regular health plans with high deductibles. My HDHC from BCBS of Florida was 110 a month, 7.5K deductible with 5 million in coverage beyond that.

Take a look at BCBS's options -

BCBSF - Health Coverage for Individuals & Families Under 65

Make the assumption that exclusions become outlawed and government regulation insures all insurers provide at least one low cost plan with basic coverage for the poor and I don't see why we need to change anything.

I just went through their screening and found an HDHC -

$124 a month
3.5K in network deductible
0% in-network copays after deductible is reached
coverage: up to 5 million

The only issue I could find with a plan like this is that it didn't cover maternity, but I'm sure there are plans out there that do. If not, maybe we could regulate that as well. Can anyone give me good reasons why a plan like this isn't acceptible for most everyone?

And can I just say, better you than me....:leaving:

To clarify, I was the drainer, not the drainee

Someone has to do it

a big part of the conditioning that Skunky speaks of comes directly from the marketing departments of the insurance companies; their lobbyists regularly contribute to most of the members of Congress re-election campaign; the problem is not that we do not have good health care; it is that an insurance executive is standing between the patient and the docs, making life decisions..for everyone.

it is beyond me why so many people are worried about a government employee being there; but, are perfectly content to have an insurance company executive making those decisions.

I don't understand this claim people keep making. When I have a medical issue, I go to my doctor, and he hooks me up with whatever treatment I might need if it's warrented. I have never in my life had to go through an insurance executive in order to get treatment. Can you cite some examples of how this manifests?

"catastrophic plans" are just regular health plans with high deductibles. My HDHC from BCBS of Florida was 110 a month, 7.5K deductible with 5 million in coverage beyond that.

Take a look at BCBS's options -

BCBSF - Health Coverage for Individuals & Families Under 65

Make the assumption that exclusions become outlawed and government regulation insures all insurers provide at least one low cost plan with basic coverage for the poor and I don't see why we need to change anything.

I just went through their screening and found an HDHC -

$124 a month
3.5K in network deductible
0% in-network copays after deductible is reached
coverage: up to 5 million

The only issue I could find with a plan like this is that it didn't cover maternity, but I'm sure there are plans out there that do. If not, maybe we could regulate that as well. Can anyone give me good reasons why a plan like this isn't acceptible for most everyone?

This is exactly what I am talking about. People of modest means gladly spend $125 monthly on cell phone service, cable and freaking cigarettes, but boy, if you try to point out that there is health insurance out there that most likely will provide what they need, at a price they can afford, look out! True, it does not allow for twice monthly doctor visits for self limited conditions, endless bloodwork and imaging-and that is a good thing, in my opinion.

30A Shopper, we have discussed this before, but the easiest and most common example is the company that refuses to cover a certain procedure regardless of what the doctor says; the lack of coverage for pre-existing conditions; the fact that insurance companies (or the underwriters as they always say) refuse to pay for a mammogram if it has been less than 366 days since one was administered, regardless of what the doctor says; that if you have two eye exams that need to be done, they have to be done on separate visits, or the insurance won't cover them...bone density scans that are needed according to the doctor, for baseline information, but will not be covered unless there is a "medical necessity", at which time, there is already a problem that could have been prevented; all too often, it seems to me, the insurance company is making the decision for the doctor.
Perhaps some of this is that more procedures are covered for men than for women and children...I don't have any data for that, but I do know that many of the tests that are regularly covered for men as it has to do with heart disease, are not covered for women--I could go on and on, but those are just what come quickly to mind.
I have been fortunate to have good health; have always managed to have decent insurance, which I have paid for myself most of the time, as a self employed person; but there is little importance given to preventive health measures and for those people who may be sicker, or not as fortunate as I have been to have access to insurance, life can be pretty miserable when dealing with insurance companies; I think we should be able to do better in America for all people--not just for the most fortunate or the ones who are able to understand the deliberately confusing insurance world. I do not believe that making health care more accessible and more affordable for more people will take anything important away from me--a healthier society should benefit all of us. While there will always be those who make choices that do not make sense, and result in bad outcomes, I do believe the majority of people will do what they have to do to provide health care for their family--there are many right here in our area who daily must make a choice between food, mortgage or rent payments, and doctor bills--they survive from one day to the next and work everyday--I would much rather see some reform that would give these folks a break, rather than continue to see huge profits going into the insurance exec's bank account--when they already make $65 million a year, what's a few thousand here and there!

I don't understand this claim people keep making. When I have a medical issue, I go to my doctor, and he hooks me up with whatever treatment I might need if it's warrented. I have never in my life had to go through an insurance executive in order to get treatment. Can you site some examples of how this manifests?

I don't think the extreme scenario happens to everyone or maybe even most people. My problem is that once the care is provided, premiums escalate because the insurance company still needs to make a profit for the shareholders. And it's not much of a "free market" because for many people options are limited.

I don't think the extreme scenario happens to everyone or maybe even most people. My problem is that once the care is provided, premiums escalate because the insurance company still needs to make a profit for the shareholders. And it's not much of a "free market" because for many people options are limited.

And the premiums have gone up at least 10% each year, for at least the last 20 years, from what I read, the docs are not making that much more money--so where is the profit going?

30A Shopper, we have discussed this before, but the easiest and most common example is the company that refuses to cover a certain procedure regardless of what the doctor says; the lack of coverage for pre-existing conditions; the fact that insurance companies (or the underwriters as they always say) refuse to pay for a mammogram if it has been less than 366 days since one was administered, regardless of what the doctor says; that if you have two eye exams that need to be done, they have to be done on separate visits, or the insurance won't cover them...bone density scans that are needed according to the doctor, for baseline information, but will not be covered unless there is a "medical necessity", at which time, there is already a problem that could have been prevented; all too often, it seems to me, the insurance company is making the decision for the doctor.
Perhaps some of this is that more procedures are covered for men than for women and children...I don't have any data for that, but I do know that many of the tests that are regularly covered for men as it has to do with heart disease, are not covered for women--I could go on and on, but those are just what comes quickly to mind.
I have been fortunate to have good health; have always managed to have decent insurance, which I have paid for myself most of the time, as a self employed person; but there is little importance given to preventive health measures and for those people who may be sicker, or not as fortunate as I have been to have access to insurance, life can be pretty miserable when dealing with insurance companies; I think we should be able to do better in America for all people--not just for the most fortunate or the ones who are able to understand the deliberately confusing insurance world. I do not believe that making health care more accessible and more affordable for more people will take anything important away from me--a healthier society should benefit all of us.

I'm not sure of the specific incidents that you are talking about, but my experience has been that insurance companies will pay for just about anything that can be reasonably justified. In a few cases this involves your physician speaking to the insurance company's physician. It usually works.

I am also unaware of any company that will not cover routine screens when they are performed consistent with a schedule that is accepted as being of benefit. Women actually have more screenings than men, and there are no screenings for heart disease for either sex, save an EKG done for a 'welcome to medicare' exam.

I'm not sure of the specific incidents that you are talking about, but my experience has been that insurance companies will pay for just about anything that can be reasonably justified. In a few cases this involves your physician speaking to the insurance company's physician. It usually works.

I am also unaware of any company that will not cover routine screens when they are performed consistent with a schedule that is accepted as being of benefit. Women actually have more screenings than men, and there are no screenings for heart disease for either sex, save an EKG done for a 'welcome to medicare' exam.

Well, maybe my current doctor and the one I had for 20 years before that, can talk with you about your experiences vs. theirs. And, the next time I have to spend 45 hours over a three month period on the phone with the insurance company representative to process a claim for a procedure that even they admit is covered, I will call you! I am glad that you and your patients (who include some of my family) are having a better experience.

"catastrophic plans" are just regular health plans with high deductibles. My HDHC from BCBS of Florida was 110 a month, 7.5K deductible with 5 million in coverage beyond that.

Take a look at BCBS's options -

BCBSF - Health Coverage for Individuals & Families Under 65

Make the assumption that exclusions become outlawed and government regulation insures all insurers provide at least one low cost plan with basic coverage for the poor and I don't see why we need to change anything.

I just went through their screening and found an HDHC -

$124 a month
3.5K in network deductible
0% in-network copays after deductible is reached
coverage: up to 5 million

The only issue I could find with a plan like this is that it didn't cover maternity, but I'm sure there are plans out there that do. If not, maybe we could regulate that as well. Can anyone give me good reasons why a plan like this isn't acceptible for most everyone?

I have a friend on a similar plan with BCBS of FL. He hasn't ever met his deductible in a year yet. However, last year he had to go to the emergency room and BCBS negotiated the price down from over $4,000 to about $1,200.

Interesting information. Can you cite your source. (apparently your are an MD; I'm not questioning your opinion/professional thoughts, just would like to know the source of your data/statistics.)

The data on the uninsured came from a presentation I attended by the Florida Medical Association Council on Legislation. I must admit that I did not know the source, but that I tend to trust their research department.

The argument of performing procedures that may not extend life, but improve quality of life is pretty well established in the medical literature.

The data on the uninsured came from a presentation I attended by the Florida Medical Association Council on Legislation. I must admit that I did not know the source, but that I tend to trust their research department.

The argument of performing procedures that may not extend life, but improve quality of life is pretty well established in the medical literature.

Thanks.

I don't think the extreme scenario happens to everyone or maybe even most people. My problem is that once the care is provided, premiums escalate because the insurance company still needs to make a profit for the shareholders. And it's not much of a "free market" because for many people options are limited.

The only way to eliminate a need for profit in our system would be to convert to a full on government managed system. All medical professionals would become employees of the federal government, all hospitals and labs would be owned and run by government, etc..

And the premiums have gone up at least 10% each year, for at least the last 20 years, from what I read, the docs are not making that much more money--so where is the profit going?

US insurance premiums increased 3.6% from 2007 to 2008. The docs are not making that much more money, so I would like to know the answer to that question as well. By the way, I am in support of a non-government subsidised Co-op. plan that the Senate Finance committee is talking about. I do think that a not for profit plan should be allowed to compete with private insurers and it should help everybody.

The funny thing is that everybody thinks that Republicans are opposed to reforms when that is not the case. We just want thoughtful reforms that protect individual choice and do not break the bank.

So sorry about your Dad, SSB. If I broke my front tooth on Wednesday from gritting my teeth because I was so mad at Medicare that gave us only four days notice that Mom would be kicked out of the nursing home, I can't imagine how sad and mad you were.

Yeah, the government does a great job at health care.:roll:

You probably have it, too. That isn't an insult, simply a reality as MRSA is now common skin flora.

That, and other infections. I know someone who went to the hospital with a high temp. He was given antibiotics and sent home with a diagnosis of acute bronchitis. The next day he had a higher fever, so he was admitted. Turns out it was staph infection, not bronchitis. The physician told him the infection was from a dental cleaning.

Can anyone give me good reasons why a plan like this isn't acceptible for most everyone?

It would be acceptable to the person I mentioned earlier; the problem is that the person wouldn't be accepted by BCBS because of taking antidepressants.

I don't understand this claim people keep making. When I have a medical issue, I go to my doctor, and he hooks me up with whatever treatment I might need if it's warrented. I have never in my life had to go through an insurance executive in order to get treatment. Can you cite some examples of how this manifests?

Goodwitch58, it sounds like you've had some bad experiences with insurance companies. The only thing I've had a problem with is insurance not paying for my infertility treatments. So they won't pay for Pergonal if a woman's reproductive organs don't work properly, yet they'll pay for Viagra if a man's organ doesn't work.

If people have trouble with insurance companies being the stumbling block between them and good health care because of denial of benefits, think about how bad it'll be when the government is added to the mix. The government doesn't give a darn about people IMO -- that was confirmed to me by the way my Mom was treated this week. I mean, doesn't a family need at least a week or two to make arrangements to move a sick person and interview and hire CNAs to take care of the person? I'm certainly not qualified to take care of a person in Mom's condition, plus I can't give up my job to care for her because then I'd lose MY health insurance.

The only way to eliminate a need for profit in our system would be to convert to a full on government managed system. All medical professionals would become employees of the federal government, all hospitals and labs would be owned and run by government, etc..

Do you really think so? There are great companies like USAA that share profits with its members and provide excellent auto, life and homeowners insurance as well as great banking and credit card options. USAA isn't government run. It's not a bunch of bureaucrats.

A 1999 editorial in the New England Journal of Medicine said studies show that for-profit hospitals don't necessarily give better or less expensive care than non-profit hospitals. I just never understood the reason why these companies went for profit anyway. The existence of "shareholders" when it comes to managed care has always seemed to me to be at the root of the problem.

Edit to add that I guess "profit sharing" is different from "non-profit" and I suppose the former is what makes more sense to me.

Do you really think so? There are great companies like USAA that share profits with its members and provide excellent auto, life and homeowners insurance as well as great banking and credit card options. USAA isn't government run. It's not a bunch of bureaucrats.

A 1999 editorial in the New England Journal of Medicine said studies show that for-profit hospitals don't necessarily give better or less expensive care than non-profit hospitals. I just never understood the reason why these companies went for profit anyway. The existence of "shareholders" when it comes to managed care has always seemed to me to be at the root of the problem.

Edit to add that I guess "profit sharing" is different from "non-profit" and I suppose the former is what makes more sense to me.

Is that different than buying shares of an insurance company? Sharing profits with members vs sharing profits with investors.

BeachRunner, I really have not had any seriously bad problems; all of the ones I mentioned were issues that came up, but I happen to have a lot of information available to me about insurance laws in Florida, so I have been able to get my issues handled eventually. Some of the ones I mentioned are from friends/family, etc.

My point is that, in my experience, given the choice, the insurance company will rule against the consumer every time...they will sometimes pay up if pushed far enough (I would hate to total up the amount of income I have lost by time spent on the phone with an insurance company) but the system is designed to profit the insurance company, not provide the best health care to the consumer.

I have no problem with the companies making a profit--although I do like TFT's profit sharing idea, just as I like credit unions, instead of banks--I just have a problem with them making HUGE profits, at the expense of the people least able to contribute to that HUGE profit.

I would like to see a competent system that treats most people fairly, including the doctors...I do not see that at the present time from the insurance companies, and there really is no reason other than profit that prevents them from doing it, IMO.

Consumer Reports this issue has an interesting report.Not sure it is on their website Find Product Reviews and Ratings from Consumer Reports., but it may be. Take a look hhttp://www.consumerreports.org/cro/magazine-archive/may-2009/health/health-insurance/overview/index.htmere:
Some points:

1. Only 64 percent of readers said they were very or completely satisfied with their plan; down from 67% from the 2007 report;
2. In terms of service rated by CR, that puts satisfaction with health insurance plans above satisfaction with cable TV, but below pharmacies and real estate agencies;
3. $500 is the median increase in what readers paid for annual premiums since 2006; 38% increase from two years ago;
4. Choosing an HMO over a PPO is apparently better now;
that is a change from the last survey;
5. Rating of PPO health plans puts Anthem BC/BS (Ct) at the top; BC/BS Fl is #11 on a chart of 41 rated;
6. Rating of HMO health plans shows Group Health of ID and WA at the top; Humana Medical Plan of Florida was #23, out of a possible 35 rated

This article points out just how difficult and time consuming it is for a consumer to "figure out" insurance--the sad part of this is that the people least able to "figure it out" are the ones most often hurt the most.

Given my choice, I would vote for the compassionate family doctor who charges a reasonable rate for his or her services, and has at his/her deepest level, the desire to serve and to heal; and I would eliminate insurance companies! LOL. But, as some on this board will quickly point out that is idealistic...and unreasonable. And, of course it would also necessitate the elimination of trial lawyers--the infamous tort reform! So, I will continue to be thankful that I am healthy and informed about how insurance companies work--and not think about how much time I have wasted on the phone with the insurance claims departments over the years! Now, that I have more time to give, I will work relentlessly for a better system.

Is that different than buying shares of an insurance company? Sharing profits with members vs sharing profits with investors.

USAA is fabulously run and my credit card rate is 7.75 percent. Bank account fees are very very low, insurance is reliable and well-priced. Owners/members get a modest check every year. USAA is one of this country's greatest companies. Only problem is it's only open to military and former military and families. Also, when it comes to homeowners insurance they are selective. But I guess who isn't these days?

When I envisioned a non-profit cooperative, something like USAA is what popped into my head. My expectations are probably too high. :roll: