Insurance and Healthcare

[DaemonSeid]

What is your opinion of healthcare as it stands now in the US?

Is it getting better or worse?

How do you feel about pharmacy companies and research agencies?

Are they making money to bandage symptoms of the populace or do you feel that they really are pushing forward to cure illnesses?

For those that work within the medical community what concerns do you have about how our healthcare treats the general populace?


What would you change about your insurance carrier if you had a chance to rewrite your policy?

What are some things in your policy that you feel is harmful to you as a patient and conversely what are somethings that you have in your insurance that you really like, especially when it comes to covering your children from both aspects?

[AKA_Monet]

Originally Posted by DaemonSeid

What is your opinion of healthcare as it stands now in the US?

Is it getting better or worse?

How do you feel about pharmacy companies research agencies?

Are they making money to bandage symptoms of the populace or do you feel that they really are pushing forward to cure illnesses?


What would you change about your insurance carrier if you had a chance to rewrite your policy?

What are some things in your policy that you feel is harmful to you as a patient and conversely what are somethings that you have in your insurance that you really like, especially when it comes to covering your children from both aspects?

The NIH budget was cut by $2 billion last year. Many researchers and projects lost funding. New researchers were not awarded much either and most of the money is not competitive for molecular genetic based research.

There is more sponsored research in Global Public Health than ever before. With the Gates Foundation (Buffet's money included), as well as UN, governmental and NGO's funds, conquering "infectious disease" is the name of the game. Money is being put into small wand technology - like "pregnancy tests" that are resistant to the heat or the elements for interpretation.

Basic science has not been done...

Most basic science is "stem cell research" and it is only competitive in Asia and maybe California. Everywhere else, justice system has not kept up...

Overall, the US is NOT competitive in science and technology. In 20 years (or less), we will be at a disadvantage. Aging systems, drugs used to treat ailment discovered over 100 years ago for newly evolved bugs, and there will be a total breakdown of the healthcare system as we know it, today...

The main culprit, education and information... People are not taught basic hygiene like they were in the '60s and 70's... It is not being passed down from the parents. And let's not get into contraception education... And no one is being informed or the information is ineffective. Tactics have to be changed: i.e. maybe to inform the youth about HIV treatment we have to text message them rather than call their "momma's or grandmomma's house"...

We will have a public health disaster worse than Hurricane Katrina if these "systems problems" are not solved--not bandaids, but SOLVED...

I am not the only one saying this...

[Scandia]

I am very skeptical about socialized healthcare. Cannot say I am opposed to it. But I like being able to choose my providers. I like being able to keep the endocrinologist who has been treating me for over 12 years without having to go to a primary care physician first.

[cuteASAbug]

Originally Posted by Scandia

I am very skeptical about socialized healthcare. Cannot say I am opposed to it. But I like being able to choose my providers. I like being able to keep the endocrinologist who has been treating me for over 12 years without having to go to a primary care physician first.

What type of insurance do you have, because I always have to have a referral to see a specialist, unless (s)he is out of network.

[AKA_Monet]

Scandia,

I think Daemon and I are talking about overall examples of healthcare, rather than your own personal healthcare.

My Disclaimer I have to put on here now to not appear threatening to "ultra sentive GCers": Your opinion is RIGHT!!! No one should be forced to leave a specialist physician they like and have a rapport. That is an example of beauty of healthcare as it is, now...

The reality is, it cannot stay the same. All of us in this field are bracing for the impact. There is no money that can fund the kinds of treatments required in case a person has an emergency. It has been band-aided too much. Something will give. I don't know how long it will be, but it will be in our lifetimes...

[Tom Earp]

Originally Posted by cuteASAbug

What type of insurance do you have, because I always have to have a referral to see a specialist, unless (s)he is out of network.

I have had over the years different ones and they always promote cheaper and better.

But, what it boils down to whether you have any claims, after a certain period of time they will raise the rates. Not because of you, but other claims.

If you have Insurance and they want to raise the rates, you can do one of several things.

1. Raise your deductable.

2. Drop Office Co-Pay.

3. Drop medication.

So basically you get screwed!


There will never be a National Health Care Program as the Canadians have, the drug companies or Doctors Union will not allow it! They spend to much money to make sure of that!

[KSig RC]

Originally Posted by Tom Earp

I have had over the years different ones and they always promote cheaper and better.

But, what it boils down to whether you have any claims, after a certain period of time they will raise the rates. Not because of you, but other claims.

If you have Insurance and they want to raise the rates, you can do one of several things.

1. Raise your deductable.

2. Drop Office Co-Pay.

3. Drop medication.

So basically you get screwed!

Seriously?

Insurance is pooled risk - as you age and other people get hurt (and treatments get more expensive), the risk goes up. So your costs go up, because even if you never use it, you still have a non-zero risk.

Besides this, if I fall and break my arm, you help pay for it - I'm no more likely to have a recurrence than you though.

Also, if your particular pool has a good year, your rates can indeed go down - see your car insurance, which often goes down. It's just that medicine continuously finds new ways to keep the old and infirm alive, which costs money - if these people would just die, then Tom's insurance wouldn't go up! Wouldn't that be better?

Seriously, the insurance company is only screwing you based on the percentage they take as profit (assuming they're not doing anything illegal like lying to you or denying covered claims) - everything else is incredibly regulated. Guess what? Most insurers (essentially) have identical policy language, as dictated by your state ins. comm., it's the implementation that changes - so do the homework and find a company that takes a lower cut or maximizes your dollar. You're a customer - act like one.

Originally Posted by Tom Earp

There will never be a National Health Care Program as the Canadians have, the drug companies or Doctors Union will not allow it! They spend to much money to make sure of that!

There are very good reasons that have nothing to do with profit to avoid a system like Canada's - to start, we have 300,000,000 more people, and if you think prices are out of control now, just eliminate any last semblance of market forces from the equation.

Socialized medicine is a great-sounding idea that is incredibly difficult to implement, and difficult to envision working well in America.

[cuteASAbug]

My insurance rates are low because I'm young and in good health. I was recently sick and spent nearly a month in the hospital. My insurance company had to pay over $100,000 for it.

[bejazd]

The best insured patients- people who can afford to pay cash and negotiate their own fees for routine and outpatient care. Next are probably are Medicare patients with military or government insurance as their secondary.

I would like to see the candidates support two things: stop referral for profit (i.e. MDs owning MRI machines and ancillary care facilities) and stop MDs from accepting anything from drug companies or hospitals in exchange for writing Rx's for their products or directing their patients to their facilities.

Other than that, don't smoke, get your weight under control and enjoy your life the best that you can whatever your state of health is!

[DaemonSeid]

Originally Posted by AKA_Monet

Scandia,

I think Daemon and I are talking about overall examples of healthcare, rather than your own personal healthcare.
.

SCRRREEEEEEEEEEEEEEEEECCCCCHHHHHH


doc....slow down.


ummmm.....I am in a sense asking for both....the first question in the OP is overall...BUT...the last 2 questions will require people's personal opinions and person experiences...besides...even if it wasn't 'asked for' personal experience is the ultimate teacher.....right?

And in all actuality...I can empathize with Scndia as I am going thru the same experience shopping for a new General Practicioner.

1. I am looking for one close to home
2. A male
3. One that speaks in clear English
4. Decent hrs.
5. Covered under my plan


And because I had the same one for 7 years I can't really go back because

1. She is 45 mins away
2. Is not covered under my insurance

It was a convenience having her, because I worked in teh same medical center when she was located so it was no big deal when I needed an appt however because of the above, I have to find a new one. The one I had last year, altho he was a very nice guy, I didn't stick with him because he had too many people and poor time management skills so now I am looking for a mid size office with a group that can handle a decnet case load.

So, think of it like this: one of the first things that we as patients want in a doc when doc shopping is convenience and comfort.

So really, there is nothing wrong with Scandia's reply.

[Scandia]

I have an Open Access EPO. It costs me more than the regular HMO. That one would be covered completely by my employer. The one I have involves a small payroll deduction that I find completely worth it. Why? It covers the one I visit the most- the endocrinologist.

[AGDee]

Well, I have an HMO that I pay a small premium for. In order to get the HMO plan that would allow me to see my original gastroenterologist, I would have to pay over $100 per pay period. I can't afford it. In the mean time, my new gastro thinks my new PCP should be writing my Crohn's scripts and managing my disease. My PCP (and I) think a gastro should be doing it. The result? I'm almost out of meds and can't get anybody to renew them. Now what? When I showed the old gastro the list of 4 gastros I could pick from in the new plan, he highly recommended this one.. in fact, he goes to this guy himself. His PA told me that she wouldn't send her dogs to any of the other 3 because they are that bad. I'm not sure what to do at this point.

(And yeah, I got the only female PCP who speaks English clearly who was taking new patients, so don't suggest I change PCPs) I'm pretty stuck.

Anyway, I've been working in health care for 20 years now. I've seen it go nothing but downhill in those 20 years. The system is going to crash and I don't know what will happen then. I do know that no hospital should have to provide $300 mil in free care a year. It's not fair to inner city hospitals and could drive them away from indigent areas which obviously would be awful. Co-pays are going up and up and up every year.

I am proud of some steps that my health care system have taken. They have been totally vendor incentive free for a full year now. It used to be ridiculous to see how many people those pharmaceutical reps would feed and how much stuff they gave away every single month. So, no more vendor gifts allowed to anybody in our system by any vendor. Vendors have to register with our health system and take a one day certification course to be allowed on the premises at all. Seems to be working.

Since most of the work in my department is NIH based research, I can concur with AKA Monet about that. Funding has gone way down. Grants that make extremely high scores now aren't being funded. It's getting a little scary. Seriously, people don't go into research to make money. If you want to make money, there are a zillion other things to do. Auto line workers make more money than a entry level PhD biostatistician or epidemiologist. They are doing this to follow their passion and make a difference in the world (they hope). Me? I just keep their computers going. I know that I could make a whole lot more money in IT in other industries but I am proud of what they do, proud to make it possible for them and I don't think I could handle a more "corporate" atmosphere. (I'm also never on call, which is very good).

On top of the huge issues related to payment, we have a serious shortage of RNs and Doctors. Big problem.

[DaemonSeid]

Originally Posted by AGDee

Well, I have an HMO that I pay a small premium for. In order to get the HMO plan that would allow me to see my original gastroenterologist, I would have to pay over $100 per pay period. I can't afford it. In the mean time, my new gastro thinks my new PCP should be writing my Crohn's scripts and managing my disease. My PCP (and I) think a gastro should be doing it. The result? I'm almost out of meds and can't get anybody to renew them. Now what? When I showed the old gastro the list of 4 gastros I could pick from in the new plan, he highly recommended this one.. in fact, he goes to this guy himself. His PA told me that she wouldn't send her dogs to any of the other 3 because they are that bad. I'm not sure what to do at this point.

(And yeah, I got the only female PCP who speaks English clearly who was taking new patients, so don't suggest I change PCPs) I'm pretty stuck.

Anyway, I've been working in health care for 20 years now. I've seen it go nothing but downhill in those 20 years. The system is going to crash and I don't know what will happen then. I do know that no hospital should have to provide $300 mil in free care a year. It's not fair to inner city hospitals and could drive them away from indigent areas which obviously would be awful. Co-pays are going up and up and up every year.

I am proud of some steps that my health care system have taken. They have been totally vendor incentive free for a full year now. It used to be ridiculous to see how many people those pharmaceutical reps would feed and how much stuff they gave away every single month. So, no more vendor gifts allowed to anybody in our system by any vendor. Vendors have to register with our health system and take a one day certification course to be allowed on the premises at all. Seems to be working.

Since most of the work in my department is NIH based research, I can concur with AKA Monet about that. Funding has gone way down. Grants that make extremely high scores now aren't being funded. It's getting a little scary. Seriously, people don't go into research to make money. If you want to make money, there are a zillion other things to do. Auto line workers make more money than a entry level PhD biostatistician or epidemiologist. They are doing this to follow their passion and make a difference in the world (they hope). Me? I just keep their computers going. I know that I could make a whole lot more money in IT in other industries but I am proud of what they do, proud to make it possible for them and I don't think I could handle a more "corporate" atmosphere. (I'm also never on call, which is very good).

On top of the huge issues related to payment, we have a serious shortage of RNs and Doctors. Big problem.

you know...10 yeas ago my co pay was 5 dollars....now it's $25.....and sometimes just 25 just for them to say







"HHHmmmmm...."

[PhiGam]

1. Ron Paul 7 3 2. Mitt Romney 6 4 3. Mike Huckabee 5 5 3. Barack Obama 5 5 4. Hillary Clinton 4 6 4. John McCain 4 6

[PhoenixAzul]

I have to warn you that this is a rather sore subject for me. Please don't be offended.

1) if we are talking about the standard of care in the states, then from my perspective, it's stayed about the same. I've got a chronic illness that requires dr visits and the whole nine every 3 months, so I guess I'm a frequent consumer. If we are talking about the standards of health INSURANCE in the states, then it is abysmal. It isn't the very poorest and it isn't the very rich getting squeezed out, it's working class and middle class families getting blocked from quality care, being priced out.

And the system of "pre existing conditions" is absolute and complete bullocks. I've got to pay double what someone else pays because of something that I couldn't control? And then pay more for medications? My rates were $900/ month without prescriptions to keep my insurance. Medications were probably another $200+/- a month. And then rent. And food. And gas. If I hadn't gone to graduate school, I'd have been bent over the table...I don't know anyone who can make the $1700/month right out of school, and few who had health care right out of school.

2) Pharm reps. Oh how I hate them. I want to chuck eggs at their cars. Before I left for Glasgow, I had to go and get a TB test and a meningitis shot at my GP. So I go in, and the waiting room is PACKED. So I sign in, present my card. And I sit...and wait....and wait....and wait. Finally I got up to check and make sure my appointment was on the right day/time. And through the window, I see that all of the Dr's and nurses are enjoying sanwiches, coffee, cake and such with a drug rep sitting there with his case open....

The waiting room itself has an LCD monitor that just constantly flashes direct-to-consumer drug adds. We're one of only two countries in the world that allow direct to consumer advertising, and it costs the pharmaceutical companies BILLIONS of dollars a year. I'd really rather they kept that money for research or, *shock* reduced the price of the medication. I've got zero sympathy when they lose a patent and a generic comes available.

3) The absolute cluster-f*ck of red tape associated with health care does my head in. Why am I paying someone the above $900/ month to DENY ME CARE? And it isn't the Dr that makes that decision, it's some paper pusher in an office somewhere that says, "nope, can't have that procedure". I pay you to WORK FOR ME, not to put up barriers to my care. That's not the way this system works....you pay, you receive services. We wouldn't accept this type of abuse from any other industry, but health insurance gets away with it because we've got to have it.

When I was getting ready to leave for Glasgow, we were trying to get the insurance company to give me a year's dispensation of my medication at one time. This was a nearly 4 MONTH process of phone calls, faxes, letters, complaints, threatening legal action (I owe my lawyer friend a nice bottle of Scotch for that one), in order for them to say, "oh! ok." (I should note that this is the only time that I have dealt with one person on a consistent basis and she was fantastic...it was a pharm services person in my health insurer, who said to me, "yea this system is shit, we'll get you that med one way or another")

4) The fear-mongering surrounding countries with national insurance is ridiculous. I've lived in the UK for a while now, and I've got a phenomenal GP who is literally 100 yards from my front door. I was immediately given an appointment, physical, podiatrist (which my old insurer wouldn't cover even though I'm diabetic), diabetes specialist, and a prescription waver form. The standard rate of prescriptions in the UK is 6.18 GBP...about $12 USD with exchange rate. But if you've got a condition that requires constant medication/monitoring, or if you're in a couple of other situations, the prescriptions are absolutely, positively, free. I don't pay a pence for them. And it isn't just insulin, it's flu shots (weren't covered under my old insurance), biohazard bins, they'll pay a good portion of orthotics should I need them....

And I've never waited to see a Dr. here. I've always gotten prompt appointments and treatments. My flatmate (also american) had a stroke (she's 22) the third week of us being here, and she was given treatment at no cost, and she continues to recieve treatment for the blood thinners and other things she takes, again at no cost. She might even be able to apply for transport funds, because the neurology clinic she has to attend is cross town from our flat.

But I guess my point is that treatment is no good if it is only for the rich. It would make more sense to me to given EVERYONE access, especially the working class. If you've got a healthy person who isn't having to scrape and decide between medicine and food or medicine and rent, then surely they'll be a better employee. Surely if they've just got a GP to go to for a blood test, that can prevent them from being disabled later. I don't know, to me it seems that if we make an investment in the health of EVERYONE then we should see the economic gains in productivity.