Insurance and Healthcare

[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...

[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...."

[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.

[RACooper]

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.

... and what makes you think that those of us living with "socialized healthcare" can't choose our providers?