Freedom or Socialism?

[MorkandMindy]

In our healthcare system, the inefficiencies of socialism have been, I would suggest rivaled by the inefficiencies used for hiding human greed.

Each medical procedure usually involves dividing up every cost among all the different payers, in differing proportions, taking into account in-practice and in-network and out-of-network costs, discounts and prepays and copays and deductibles, and so on.

So right now, I'm getting electronic bills which I pay, and then a few days later, I also get a bill in the mail for the items I'd already paid for on the Internet.

Along with it come 'Explanation of Benefit' letters from the health insurance company detailing how the costs were divided up.

The overall picture is that huge charges are divided into a matrix of smaller charges and discounts and things like refunds for which I should be grateful.

Two aspects of freedom are time and money and our insane healthcare system can take away substantial amounts of both.

The simplicity of the free market works well with so many things but it can't where such a high level of sophistication and trust is needed as in a healthcare system.

Underneath it all is a wonderful country.

 

[Clare73]

Very true, though the UK system was designed with government-owned hospitals and government-paid medical staff, so with the means of 'production' collectively owned, I think it could be described as socialist, though entirely different from what many Americans think of as socialist (Stalinist).
Yes, all the varieties of universal healthcare included in the OECD studies are far more efficient.

Every one of the medical professionals I have met so far in the US medical 'system' has been doing an excellent job, but the system itself is an absolute horror show.

And still the best medical care in the world.

Perhaps checking in with England or Canada on how long it takes to get care would be enlightening.

And we're heading there fast.

 

[Clare73]

In our healthcare system, the inefficiencies of socialism have been, I would suggest rivaled by the inefficiencies used for hiding human greed.

Each medical procedure usually involves dividing up every cost among all the different payers, in differing proportions, taking into account in-practice and in-network and out-of-network costs, discounts and prepays and copays and deductibles, and so on.

So right now, I'm getting electronic bills which I pay, and then a few days later, I also get a bill in the mail for the items I'd already paid for on the Internet.

Along with it come 'Explanation of Benefit' letters from the health insurance company detailing how the costs were divided up.

The overall picture is that huge charges are divided into a matrix of smaller charges and discounts and things like refunds for which I should be grateful.

Two aspects of freedom are time and money and our insane healthcare system can take away substantial amounts of both.

Where are these definitions of "freedom" coming from?

Time and money?
Lack of enablement?

Freedom is: no required forced external constraints on your speech and actions.

Time and money. . .lack of enablement? Nothing to do with freedom.
Don't want to spend the time, then don't, no one is forcing you to do so.
Don't want to spend the money, then don't incur the expense, no one is forcing you to incur it.

Can't find what you consider an opportunity to do something. . .I also can't find a gold mine. . .where is it promised that whatever opportunity we desire shall be given to us?

Lack of fundamental knowledge doesn't bode well for our future.

The simplicity of the free market works well with so many things but it can't where such a high level of sophistication and trust is needed as in a healthcare system.

Underneath it all is a wonderful country.

 

[comana]

And still the best medical care in the world.

Perhaps checking in with England or Canada on how long it takes to get care would be enlightening.

And we're heading there fast.

Perhaps the best if you can afford it. As far as UK and Canada, I wish we were heading towards something like what they have fast, but I can’t see that happening for a couple more decades at least. Insurance industry has a stranglehold on preventing our country progressing towards better healthcare coverage.

 

[Clare73]

Perhaps the best if you can afford it.

Well, yeah. . .it's not an entitlement. Same goes with education. I'm not entitled to a degree from Harvard or Yale, nor to the safest car being made, nor to the best coat, nor to the best size house for my family, nor. . .

As far as UK and Canada, I wish we were heading towards something like what they have fast, but I can’t see that happening for a couple more decades at least. Insurance industry has a stranglehold on preventing our country progressing towards better healthcare coverage.

Have you actually talked to some folks from those places to see what they think?

 

[comana]

Well, yeah. . .it's not an entitlement. Same goes with education. I'm not entitled to a degree from Harvard or Yale.

Have you actually talked to some folks from those places to see what they think?

I’m not talking about elite hospital care. Many can’t afford early intervention let alone cutting edge treatments. And yes, those I have known who get care in Canada, UK, other European countries as well, all love the care they receive. You can always find the outliers if that’s what you want to hear.

 

[Clare73]

I’m not talking about elite hospital care. Many can’t afford early intervention let alone cutting edge treatments. And yes, those I have known who get care in Canada, UK, other European countries as well, all love the care they receive. You can always find the outliers if that’s what you want to hear.

Or are the ones you've talked to the outliers?

 

[comana]

Or are the ones you've talked to the outliers?

No. On the whole, Canadian and UK populations would not trade what they have for our mess if a system.

 

[Clare73]

No. On the whole, Canadian and UK populations would not trade what they have for our mess if a system.

My information indicates otherwise.

 

[comana]

My information indicates otherwise.

Really? You have information that people in those countries would rather pay thousands a year to an insurance company in premiums and then thousands more in deductibles, co-pays, co-insurance before their generous insurance company will pay a dime? And then have that same insurance company deny their claims because reasons? Fascinating.

I’ll take what they have any day.

 

[Clare73]

Really? You have information that people in those countries would rather pay thousands a year to an insurance company in premiums and then thousands more in deductibles, co-pays, co-insurance before their generous insurance company will pay a dime? And then have that same insurance company deny their claims because reasons? Fascinating.

I’ll take what they have any day.

What company are you doing business with? I recommend a change.

The insurance company "pays a dime" for covered expenses shortly after you buy the policy, you don't "pay thousnds a year in premiums, thousands in deductiles, co-pay, co-insurance before they will pay a dime."

How informed are you?

 

[comana]

What company are you doing business with? I recommend a change.

The insurance company "pays a dime" for covered expenses shortly after you buy the policy, you don't "pay thousnds a year in premiums, thousands in deductiles, co-pay, co-insurance before they will pay a dime."

How informed are you?

How informed are you?

my career is medical billing. It is my hob to know what insurance will pay for or not.

I am also a customer of medical insurance. I paid 4K deductible prior to insurance paying anything that wasn’t a routine screening. My annual share of my premium is also about 2k, my employer pays the rest. I can’t even add my husband to my plan because I can’t afford to pay 100% of what his premium would be so he gets even worse coverage from his employer.

please go on about how great medical coverage is in the US.

 

[pacomascarot]

It is my hob to know what insurance will pay for or not.

Now if only the CUSTOMERS knew!

Recently I had a serious medical issue that could really only be treated by an out-of-network physician. I called the insurance company and they couldn't tell me how much they were going to cover until AFTER I PAID THE BILL IN FULL and submitted a claim.

They literally could not tell me how much they were going to cover until after I paid it.

When I DID file the claim they initially told me the CODES were incorrect. So I asked them which codes should apply and the person at the insurance company said they didn't know because they were not in the codes section but they couldn't find out from the codes people what the proper code was and I wasn't able to talk to anyone in the codes section.

It was hilarious and surreal.

Once I FINALLY got them to accept the claim they only paid out a tiny fraction of the cost.

 

[comana]

Now if only the CUSTOMERS knew!

Recently I had a serious medical issue that could really only be treated by an out-of-network physician. I called the insurance company and they couldn't tell me how much they were going to cover until AFTER I PAID THE BILL IN FULL and submitted a claim.

They literally could not tell me how much they were going to cover until after I paid it.

When I DID file the claim they initially told me the CODES were incorrect. So I asked them which codes should apply and the person at the insurance company said they didn't know because they were not in the codes section but they couldn't find out from the codes people what the proper code was and I wasn't able to talk to anyone in the codes section.

It was hilarious and surreal.

Once I FINALLY got them to accept the claim they only paid out a tiny fraction of the cost.

Well sadly I can’t know the dollar amount. It is so complicated. Every practice, doctor, hospital will have their own contract with each insurance company and can have very different reimbursement per that contract. And the contract won’t actually list numbers but formulas based on many factors. Good luck getting a quote from anyone.

what I can figure out is if specific codes are covered, how often they can be billed, what conditions will be considered “medically necessary” for those codes, etc. even this task can be woefully challenging, though, because insurance companies like to “hide” this info deep inside complicated payer websites. Why make it easy to provide care to patients that providers will know will be covered?

In summary, commercial insurance is absolutely miserable to navigate.

I really do like dealing with Medicare however. Clear about what is covered. I can act they a solid number on reimbursement and easily calculate a patient’s portion (20% for non inpatient). The CMS website is so easy to navigate with tools to easily see if a patient has a condition that medically necessary for a procedure.

 

[Clare73]

How informed are you?
my career is medical billing. It is my hob to know what insurance will pay for or not.
I am also a customer of medical insurance. I paid 4K deductible prior to insurance paying anything that wasn’t a routine screening.

My annual share of my premium is also about 2k, my employer pays the rest

That is cheap!

I can’t even add my husband to my plan because I can’t afford to pay 100% of what his premium would be so he gets even worse coverage from his employer.

please go on about how great medical coverage is in the US.

Your employer can't afford better insurance for you.
However, there are companies which can, and their employees have better coverage.

It's not about the system, it's about how much of the cost your employer can afford to absorb for you and stay in business.

 

[comana]

The only thing I know about the marketplace plans in my state is that they are very restrictive in networks and people don’t like them. They likely do have high deductibles though. The only plans I come across without high deductibles are Medicare plans.

I have no choice what my employer chooses for us.

step one of improving healthcare coverage would be to remove the insurance linkage with employers. Insurance will never be competitive until each individual has full control over their options of what they can buy.

 

[Clare73]

Now if only the CUSTOMERS knew!

Recently I had a serious medical issue that could really only be treated by an out-of-network physician. I called the insurance company and they couldn't tell me how much they were going to cover until AFTER I PAID THE BILL IN FULL and submitted a claim.

They literally could not tell me how much they were going to cover until after I paid it.

When I DID file the claim they initially told me the CODES were incorrect. So I asked them which codes should apply and the person at the insurance company said they didn't know because they were not in the codes section but they couldn't find out from the codes people what the proper code was and I wasn't able to talk to anyone in the codes section.

It was hilarious and surreal.

Once I FINALLY got them to accept the claim they only paid out a tiny fraction of the cost.

I'm hearing competent employee problem, and deficient coverage problem. . .not the fault of insurance itself.

 

[Clare73]

Well sadly I can’t know the dollar amount. It is so complicated. Every practice, doctor, hospital will have their own contract with each insurance company and can have very different reimbursement per that contract. And the contract won’t actually list numbers but formulas based on many factors. Good luck getting a quote from anyone.

what I can figure out is if specific codes are covered, how often they can be billed, what conditions will be considered “medically necessary” for those codes, etc. even this task can be woefully challenging, though, because insurance companies like to “hide” this info deep inside complicated payer websites. Why make it easy to provide care to patients that providers will know will be covered?

In summary, commercial insurance is absolutely miserable to navigate.
I really do like dealing with Medicare however. Clear about what is covered. I can act they a solid number on reimbursement and easily calculate a patient’s portion (20% for non inpatient). The CMS website is so easy to navigate with tools to easily see if a patient has a condition that medically necessary for a procedure.

Indeed. . .there is no limit to the funds available, no need to try to reduce expenses to stay in business.

"Pre-existing" is what wrecked it all.
It violates the basis of affordable insurance. . .which buys "risk," not claims.

Insurance is affordable when the company covers only risk--chance of the unknown expense, which is what insurance is, until it was required to buy claims (the known expense of pre-existing conditions).

Insurance no longer buys just risk, it is required to buy sure and certain claims. . .and that's a whole other much more expensive animal for which you are paying.

 

[comana]

Indeed. . .there is no limit to the funds available, no need to try to reduce expenses to stay in business.

"Pre-existing" is what wrecked it all.
It violates the basis of affordable insurance. . .which buys "risk," not claims.

Insurance is affordable when the company covers only risk--chance of the unknown expense, which is what insurance is, until it was required to buy claims (the known expense of pre-existing conditions).

Insurance no longer buys just risk, it is required to buy sure and certain claims. . .and that's a whole other animal much more expensive animal for which you are paying.

I’m not sure what your post has to do with my post you quoted.

Insurance based healthcare coverage is the problem though.

 

[Clare73]

The only thing I know about the marketplace plans in my state is that they are very restrictive in networks and people don’t like them. They likely do have high deductibles though. The only plans I come across without high deductibles are Medicare plans.

I have no choice what my employer chooses for us.

step one of improving healthcare coverage would be to remove the insurance linkage with employers. Insurance will never be competitive until each individual has full control over their options of what they can buy.

Are you serious?

You have full control over what you can buy.

If your company coverage is inadequate, you're free to go out and buy additional insurance, or to opt out of your employer's plan and buy your own individual complete plan.

It's not about insurance competitiveness, it's about how much of the plan cost your employer can afford to pay for you and stay in business.
Workers have not always had company plans.
In the history of insurance, that is a relatively recent development.