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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 59685  
Subject: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 3:34 AM
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http://www.nytimes.com/2008/02/19/business/19health.html?_r=1&oref=slogin

Let the patient beware. Going outside your insurer’s network of preferred doctors or hospitals could be even more hazardous to your financial health than you suspected.

The broad investigation that New York’s attorney general announced last week, questioning the “reasonable and customary” calculations on which insurers base reimbursements for out-of-network medical services, raised the lid on a particularly confusing part of the nation’s health care system.

<snip>

Through the insurer’s calculations, for example, a $100 charge for a doctor’s office visit may be assigned a “reasonable and customary” value of $60. And so the insurer, paying 80 percent of that amount, reimburses the patient only $48. The remaining $52 comes from the patient’s pocket.

Ingenix, the company that provides the information insurers use to calculate those reimbursements, defends the accuracy of its data. Ingenix, owned by one of the nation’s largest health insurers, UnitedHealth Group, says its data is based on the actual billed charges that it gathers from insurers nationwide.

But some consumers have started questioning those methods — like Errol Reiter, a 59-year-old consultant in a small Oregon city, Medford, who is suing his insurer, Aetna, in small-claims court.

Mr. Reiter has been insured by Aetna for the last 10 years and said he had generally “just grinned and bore it” when his benefit statements showed the insurer was paying only a fraction of his actual out-of-network medical bills. But then he had an opportunity to compare benefits statements for two exams he had — one in network and the other out — to which Aetna assigned the same medical code.

The in-network exam was conducted by a nurse-practitioner in Medford in April 2006. Aetna paid $92.70 for the visit, and Mr. Reiter owed nothing. Last July, he went to a doctor at the Mayo Clinic in Scottsdale, Ariz., who is not under contract with his insurer.

The Mayo doctor charged him $149.80. What surprised Mr. Reiter was that Aetna calculated the prevailing charge for that exam as just $90. He found it odd that Aetna would say that an exam conducted by a well-regarded doctor at the prestigious Mayo Clinic, in a metropolitan market, had a lower prevailing value than the exam conducted at a contracted discount rate by a nurse-practitioner in his small home city.

</snip>


The sooner we take for-profit health insurers out of the healthcare equation, the better.

intercst
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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11565 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 7:44 AM
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<<The sooner we take for-profit health insurers out of the healthcare equation, the better.

intercst
>>


The sooner we get national health care, the sooner the option to get care at nationally prestigious health centers will be eliminated as an option people can choose.



Seattle Pioneer

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Author: Goofyhoofy Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11566 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 8:05 AM
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The sooner we get national health care, the sooner the option to get care at nationally prestigious health centers will be eliminated as an option people can choose.

So you think there are no prestigious hospitals in Canada? You believe there are no great hospitals in Britain? None that stand out in France?

Try Google and see if you can't find some.

Then stop making things up out of the prejudiced clouds of your mind.
 


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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11567 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 8:15 AM
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<<The sooner we get national health care, the sooner the option to get care at nationally prestigious health centers will be eliminated as an option people can choose.

So you think there are no prestigious hospitals in Canada? You believe there are no great hospitals in Britain? None that stand out in France?
>>


As I understand it, Canadian health care aimed to forclose the option of people paying for health care unless it was offered by the state healthcare system.


The British health care system traps people in whatever the state health care systems offers them, but at least offers those with their own money the option to fund 100% of private health care on their own.

These days, a lot of health insurance in the United States is just as intercst describes, with substantial penalties for going outside the providers designated by your insurance company. Mine is the same way.

The disadvantage of that approach seems to leave two groups exposed to financial hazards ---- travelers who get ill away from their home area and those sick with some hard to diagnose problem, or one needing some exotic treatment not available in their own area on some acceptable basis.


Those people are burdened by extra costs, but at least their insurance company still makes a substantial payment towards such costs in many cases. Whether a nationalized health insurance program would offer any payment in such circumstances is open to question.

People needing such options might find that the current benefits paid by health insurance companies are better than the goose egg offered by a national health care plan.



Seattle Pioneer

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Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11569 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 9:27 AM
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The sooner we take for-profit health insurers out of the healthcare equation, the better.

Healthcare is only one problem we face today. The housing and mortgage sector also has huge problems. The sooner we take for-profit mortgage companies our of the housing equation, the better!

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Author: buzman Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11571 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 10:31 AM
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I paid over twice as much as my wife did for an identical procedure.

I think the hospitals bear some of the blame also.

buzman

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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11572 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 10:53 AM
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buzman writes,

I paid over twice as much as my wife did for an identical procedure.

I think the hospitals bear some of the blame also.


Would that have happened if both of you were on Medicare? I doubt it.

intercst

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Author: Goofyhoofy Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11573 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 10:54 AM
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The housing and mortgage sector also has huge problems. The sooner we take for-profit mortgage companies our of the housing equation, the better!

A non-sequitur. There are many options for housing, including "not buying one and renting instead." And, in fact, we have a plan in place for "bottom of the barrel" options, including subsidized housing, shelters, etc. (Some people don't use even those, but then some people probably don't use their "universal" health coverage in "universal coverage" countries, either.)

Health is different. Everybody benefits when health is universal; disease travels more slowly, people are more productive, costs are lower. It's like education: universal is better than "some get, some don't."

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Author: crassfool Big funky green star, 20000 posts Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11574 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 11:30 AM
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The eminent Dr. SeattlePioneer (I'm sure he has at least an honorary doctorate) says

As I understand it, Canadian health care aimed to forclose the option of people paying for health care unless it was offered by the state healthcare system.

You understand wrong. One province (Quebec?) had such a policy but the courts struck it down. The option is there.


The British health care system traps people in whatever the state health care systems offers them, but at least offers those with their own money the option to fund 100% of private health care on their own.

So the option is there, also.


People needing such options might find that the current benefits paid by health insurance companies are better than the goose egg offered by a national health care plan.

It's not a "goose egg." Your objection is made up out of thin air (not surprisingly).

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11576 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 1:34 PM
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<<The eminent Dr. SeattlePioneer (I'm sure he has at least an honorary doctorate) says

As I understand it, Canadian health care aimed to forclose the option of people paying for health care unless it was offered by the state healthcare system.

You understand wrong. One province (Quebec?) had such a policy but the courts struck it down. The option is there.


The British health care system traps people in whatever the state health care systems offers them, but at least offers those with their own money the option to fund 100% of private health care on their own.

So the option is there, also.


People needing such options might find that the current benefits paid by health insurance companies are better than the goose egg offered by a national health care plan.

It's not a "goose egg." Your objection is made up out of thin air (not surprisingly).>>



My Liberal friends fund public schools out of tax dollars and then permit parents who don't like their public schools to send their children to private schools ---if they pay 100% of the cost of doing so in addition to paying the taxes for schools.


As I understand it, that's pretty much the situation in Britain. And yes, Canadians have escaped from the stranglehold of state health insurance, again if they pay 100% of the cost of private care plus the cost of the taxes to fund the state system. I believe I am correct on that?


By contrast, my health insurance and most health insurance pays some substantial part of the cost for out-of-system cost. That's a big improvement over the British and Canadian systems for those who wish to use private care.




Seattle Pioneer

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11577 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 1:38 PM
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<< It's like education: universal is better than "some get, some don't."

>>


Heh, heh! I thought the results of public education were proof positive that some get, some don't" no matter what.




Seattle Pioneer

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Author: ariechert Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11578 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 1:44 PM
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Heh, heh! I thought the results of public education were proof positive that some get, some don't" no matter what. - Seattle Pioneer
-------------

When I taught school in East Tennessee there were quite a few functional illiterates in my classes. I taught ninth grade Physical Science and quite a few of the kids just could not read. Some read so slow that by the time they got to the end of a sentence they'd forgotten what it said at the begining.

When I did some student teaching in a 6th grade class there was one table of 5 boys where none of them could read. It was unbelieveable and made teaching extraordinarily difficult. They just pass kids on when they get a certain age regardless whether they can read or write or not.

Art

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Author: Ahote Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11589 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/19/2008 11:34 PM
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The sooner we get national health care, the sooner the option to get care at nationally prestigious health centers will be eliminated as an option people can choose.

I'm so tired of hearing this rubbish.

I lived in Germany for almost 18 years. During that time I paid my medical insurance according to national requirements - it's basically law. As a self-employed reasonably high-earner, my insurance was around $360 per month which included 100% dental and 'sick-pay' - money I would get paid on a daily basis after the 14th day of being unable to work.

As an employee, your total insurance bill would be higher because they reckon self-employed people are sick less often - but your employer had to foot half of your medical insurance so you're out of pocket about the same.

One of my best friends - an architect - was laid off about 8 months ago. He's been unable to find employment and money is getting low. The government subsidizes his insurance so his monthly total is around $80.00

Zero copay for medical examinations
Zero copay for drugs
He recently went to "Kur" which is like a week long spa for treatement where you are fed specific diets and are generally purged of toxins. Cost to him was zero. He was able to pick the spa retreat of his choice and the one that suited him best. If you want to complain that the Hotel Eggensberger or the Kaiser Kurbad, both some of the most expensive luxury spa treatment houses may not have been on the list, go ahead - but he was thrilled.

Regardless of national health care, luxury will always be affordable to those who have the cash to pay for it. It's nonsense to believe that that'll be taken away from you if legislation is passed to allow 40 million American kids to have health insurance and insurance companies are forced to actually care for their customers, not just rip them off.

It's quite frankly the height of selfishness - but that's really the hallmark of the right isn't it?

Me, me, me, me & eff the rest.

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Author: salaryguru Big gold star, 5000 posts Top Recommended Fools Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11591 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 12:27 AM
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. . . It's quite frankly the height of selfishness - but that's really the hallmark of the right isn't it?

Me, me, me, me & eff the rest.


It seems that way to me.

My DW and I are pretty healthy -- no chronic problems requiring regular treatment or medication. We are fortunate enough to be able to afford health insurance. At age 53 & 52 we have the occasional medical problem that requires attention. Usually, this takes the form of an illness that requires urgent attention. Whenever we have to cross paths with the health care system in the US, it becomes obvious very quickly that it is very broken. The ordeal of finding and getting appropriate care and then dealing with the paperwork, billing, tax implications, etc. is obscene. It always seems to involve numerous phone calls, long lines, stacks of paperwork, more paperwork, discussions with hurried nurses and doctors, more paperwork, more long lines at test centers, more hurried discussions, more long lines at the pharmacy,. . . Then the real paperwork shuffle begins. Doctor and facility bills arrive, insurance statements that are undecipherable come. Phone calls to obtain translations. Payments are made but you're still not done. Income tax time arrives and you get to shuffle through the stacks of paperwork to complete your filing.

Only a selfish idiot could look at the US healthcare system and not think it needs to be gutted.

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Author: TMFJeanie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11592 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 1:13 AM
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Then the real paperwork shuffle begins. Doctor and facility bills arrive, insurance statements that are undecipherable come. Phone calls to obtain translations. Payments are made but you're still not done.

That's exactly what it was like when my husband had hip replacement surgery five years ago.

Ten weeks ago he had his other hip replaced.

Same surgery, same orthopedic surgeon, same hospital.

In 2003 he was covered under our private insurance policy which was costing us nearly $1000/month.

The hospital and doctor charges were just over $35,000

Now he's covered under Medicare ($96/mo) + a supplemental ($140/mo)

This time the charges came to about $16,000

And this is five years later!

We've received exactly three provider mailings that just itemized the list of charges that were being billed to Medicare and his supplemental provider.

In 2003 our out-of-pocket costs on that $35,000 tab was approx $4000.

In 2003 the paperwork filled a 3-inch file folder.

This time I have exactly three pieces of paper in a file, and our out-of-pocket cost is $0.

If this is representative of how government-managed health care can operate, I say "priceless".



Jeanie

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Author: alan81 Big gold star, 5000 posts Old School Fool CAPS All Star Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11593 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 1:55 AM
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Only a selfish idiot could look at the US healthcare system and not think it needs to be gutted.
call me a selfish idiot:-)
I think the problem is that we have decided to provide some level of universal coverage, but have stubbornly stuck with an ad hoc payment system. I wouldn't change the delivery system at all, but would switch to a single payer system.
--Alan

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11594 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 2:38 AM
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<<If this is representative of how government-managed health care can operate, I say "priceless".



Jeanie
>>


My insurance company charges me an extra $900/year because government health care programs don't pay enough to providers, so they have to cost shift on to provate paying patients.


I imagine that accounts for a good deal of your good fortune.


Of course, if everyone tried to get that deal, it wouldn't work.



Seattle Pioneer

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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11596 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 3:11 AM
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alan81 writes,

selfish idiot could look at the US healthcare system and not think it needs to be gutted.
call me a selfish idiot:-)
I think the problem is that we have decided to provide some level of universal coverage, but have stubbornly stuck with an ad hoc payment system. I wouldn't change the delivery system at all, but would switch to a single payer system.


If it would help with the Republicans, I'd gladly give them the option of having the Gov't route their premium invoice through Aetna or Cigna so that they can add the customary 30% overhead and profit that private health insurers siphon from the system. For some reason they seem to want to maintain this exhorbitant "tax" on our healthcare spending.

Just give the rest of us the choice of avoiding these bandits in the health insurance industry.

intercst

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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11597 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 3:35 AM
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SeattlePioneer writes,

My insurance company charges me an extra $900/year because government health care programs don't pay enough to providers, so they have to cost shift on to provate paying patients.

I imagine that accounts for a good deal of your good fortune.

Of course, if everyone tried to get that deal, it wouldn't work.

</snip>


I took a look at the financials for your health insurer Premera Blue Cross.

https://www.premera.com/stellent/groups/public/documents/associatedfiles/dynwat%3B7072_72325192_960.pdf

In 2006 they collected $3,039 million in premiums and paid out $2,400 million in benefits (i.e., payments to providers which includes the $900 in "overcharges" you mention) The $639 million in overhead and profit accounts for the difference and amounts to 26.6% of benefits paid.

If the average family in Washington State pays an annual premium anywhere near the national average of $11,480 per year, that's $2,411 lost to insurance company overhead. It's also more than 2-1/2 times the cost of the $900 you're bitching about.

intercst

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Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11598 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 4:43 AM
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In 2006 they collected $3,039 million in premiums and paid out $2,400 million in benefits (i.e., payments to providers which includes the $900 in "overcharges" you mention) The $639 million in overhead and profit accounts for the difference and amounts to 26.6% of benefits paid.

I think you are overstating the case somewhat. They collected $2,918 million in premiums, and paid out $2,400 million in benefits. But they also paid out $44 million in "premium taxes" and $30 million in income taxes. Government plans have no such expenses (obviously!). Part of their income statement is $16 million in depreciation, government plans have no such thing (again, obviously). In addition, insurance companies have requirements regarding reserves to pay for future claims, government plans have no such reserve requirements (that I am aware of).

Using these numbers, I show a 14.7% overhead. Eliminate this insurance company and you will save 14.7%. At least initially, assuming zero administrative cost for the new government plan.

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Author: cattleman22 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11599 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 8:11 AM
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{{It's quite frankly the height of selfishness - but that's really the hallmark of the right isn't it? }}


I think you are confused. The hallmark of the left is selfishness as they want government to take more money from the rich capitalist bastards and redistribute it to themselves. It is all about me, me, me to the liberals.



c

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Author: Goofyhoofy Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11600 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 9:10 AM
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My Liberal friends fund public schools out of tax dollars and then permit parents who don't like their public schools to send their children to private schools ---if they pay 100% of the cost of doing so in addition to paying the taxes for schools.

I'm not sure what your point is here. That you have to pay taxes for schools, and if you choose not to use them, you still have to pay taxes for schools? OK, you got me.

Don't you have to pay taxes for roads, and if you choose not to use them, still pay taxes for roads? Indeed, aren't there roads which you have to pay tolls to use, even if you pay taxes for the other roads?

The market is very good at invoking pricing mechanisms for scarce commodities. It is exceptionally bad at providing universal services, since there are always free riders, people who cannot pay, and people who will not pay. We, as a society, get to decide what will be "universal." In an earlier time it was thought education didn't need to be universal, and if your parents cared enough they would find a way to educate you - or you could just weave rugs in the basement or something for the rest of your life. Eventually "society" realized what a waste of human capital this was and elected that education should be universal.

So it is true with roads. We have even come to the point where we think "food" should be universal, and have developed programs by which children (in particular) and others can get food to keep themselves from starving.

There is no question that society is better off when people are generally healthy, when disease does not course through the populace because people are disinclined to get diagnosis and medicine; having a healthy body of citizens enhances productivity and has other ancillary benefits for business and for progress.

You complain that people who want "private school" have to pay for public school too. Good; somebody has to pay if there is to be a public school system, and that somebody is everybody. That is as it should be. "Everybody" gets a benefit of a more educated society, just as everybody gets a benefit from having a vast infrastructure of roads, even if they are housebound and don't drive.

I'm not sure I find much difference with roads, school, or health. We just haven't gotten that far with health because of the screaming of the corporatists, the same ones who opposed public schools in the late 19th and early 20th centuries, because "it's fine the way it is", even though it was no such thing.
 


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Author: cattleman22 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11601 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 9:24 AM
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{{Don't you have to pay taxes for roads, and if you choose not to use them, still pay taxes for roads? Indeed, aren't there roads which you have to pay tolls to use, even if you pay taxes for the other roads?}}

Depending upon the state, gas taxes pay are sometimes dedicated to paying for roads. This way, people who use the service, pay for the service. In this spirit, off road vehicles, such as tractors, can be fueled using gas or diesel that does not have an attached road tax.



{{You complain that people who want "private school" have to pay for public school too. Good; somebody has to pay if there is to be a public school system, and that somebody is everybody. That is as it should be.}}

Again, this is not exactly true. Education in some local districts is paid for using property taxes. Some jurisdictions tax properties less if those properties are less likely to have houses that contain children who would utilize the service of public schools. The best known example is that tax rates for farm land are less than the tax rates for residential houses. In this way, the taxes to fund education come more from people who are more likely to utilize the services.



{{I'm not sure I find much difference with roads, school, or health.}}


I guess if you ignore that roads and schools are to some degreed paid for by those who use the service, then what you said makes sense.


c

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11603 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 10:34 AM
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<<In 2006 they collected $3,039 million in premiums and paid out $2,400 million in benefits (i.e., payments to providers which includes the $900 in "overcharges" you mention) The $639 million in overhead and profit accounts for the difference and amounts to 26.6% of benefits paid.

If the average family in Washington State pays an annual premium anywhere near the national average of $11,480 per year, that's $2,411 lost to insurance company overhead. It's also more than 2-1/2 times the cost of the $900 you're bitching about.

intercst
>>


Are you you suggesting there is room for government to nearly treble the cost shifting that is being done? Then there are the taxes paid by this insurance company to support other worthy causes, such as the state high risk health insurance pool, which presumably come out of this pot (and my pocket) as well.

The profits this non profit make go into expanding reserves to pay future claims. Of course, most government health care plans like Medicare have staggering obligations and negligible reserves, and are highly unstable and subject to insolvancy because of it. I suppose that helps to justify making inadequate payments to doctors and hospitals for the services they want.


In short, I see private health insurers as generally taking responsibility for their insureds seriously, while government health insurance is often grossly underfunded and unstable because of it. When I read British Columbia newspapers, it seems like there are always stories about the underfunded BC health plan and the various emergencies, compromises and consequences it is suffering. I'm just not interested in expanding that kind of drama to the United States more than is already the case.

So I'm quite content to pay for my insurance. I'd just prefer not to have your government health care plans leaching off of my company. While stirring up the usual dust, I don't think you denied that was, in fact, what is happening.




Seattle Pioneer

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 1:20 PM
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alan81 says

I think the problem is that we have decided to provide some level of universal coverage, but have stubbornly stuck with an ad hoc payment system. I wouldn't change the delivery system at all, but would switch to a single payer system.

That's exactly what I'd do – at least for starters, to see how it would work.

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at least for starters, to see how it would work.
Sounds good to me. Ignoring the foreign models for a minute, we really have US models for this. Medicare is government financed and government paid, and privately operated. VA is govenment financed, government paid, and government operated. The rest of the mess is privately financed, paid, and operated. Given a choice of the three I opt for the medicare model. I think the potential problem is how well the private operation will hold up to a standardized payment system. I think by keeping operations private it maintains the option for people to buy "above and beyond the basics" health care if they so choose.
--Alan

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 2:08 PM
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In 2006 they collected $3,039 million in premiums and paid out $2,400 million in benefits (i.e., payments to providers which includes the $900 in "overcharges" you mention) The $639 million in overhead and profit accounts for the difference and amounts to 26.6% of benefits paid.

If the average family in Washington State pays an annual premium anywhere near the national average of $11,480 per year, that's $2,411 lost to insurance company overhead. It's also more than 2-1/2 times the cost of the $900 you're bitching about. - intercst

---------------------------------------------------

This is why I'm for socialized medicine.

It think it would be be more fair.

Art

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 2:14 PM
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I think you are confused. The hallmark of the left is selfishness as they want government to take more money from the rich capitalist bastards and redistribute it to themselves. It is all about me, me, me to the liberals. - cattleman
----------------------------------

Life is inherently unfair. From the moment of birth, and perhaps even before, the DNA we inherit affects the development of our brain, and even how our thoughts are generated, the speed at which our synapses fire, our motivation, our size, who and what we are and who we become. Not to mention that no one chooses their parents or the environment they grow up in. Science doesn't have a clue how our thoughts are generated or where they come from.

A little bit of socialism seeks to undo some of this unfairness. It adds a little bit of compassion and charity into a system that inherently unfair.

Art

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{{It adds a little bit of compassion and charity into a system that inherently unfair. }}


Charity and generosity are based on voluntarily giving of oneself. Forced redistribution through taxation is neither generous nor charitable.


c

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Charity and generosity are based on voluntarily giving of oneself. Forced redistribution through taxation is neither generous nor charitable. - cattleman
---------------------------

It's unfortuneate but studies have shown that individuals left up to themselves will not contribute sufficient charity to lift the less fortuneate out of poverty. Individuals are just not good enough in and of themselves to contribute enough to cover the needs of those who, for whatever reason, can't or wont' take care of themselves.

There are in fact societies where there is no goverment welfare, and where the only generosity comes from individuals. Indonesia. My brother has been there three times. He saw an elderly man retching and dying on the street. His new Indonesian wife quickly ushered him away and told him to walk around the old man. She told my brother that the little kids begging for food in the street were just lazy and wouldn't work.

Indonesia is a picture of what we would look like if there were no goverment welfare programs. People retching and dying in the streets. Yes, there would be small amounts of charity, just enough to assuage people's guilt, giving a few coins to those who begged them from us, but very few would give enough to make a difference.

Those of us who are successful not because of some moral superiority but because we were dealt a hand of cards which just happened. Consciousness? Thoughts? Motivation? Where do they come from? Why are some people highly motivated and successful and some not? Why is one man successful and the next guy end up a drunkard? Moral superiority? I don't think so. I think it has more to do with DNA and genetics than some inherent morality coming from God knows where.

Art

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 2:34 PM
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{{It's unfortuneate but studies have shown that individuals left up to themselves will not contribute sufficient charity to lift the less fortuneate out of poverty. Individuals are just not good enough in and of themselves to contribute enough to cover the needs of those who, for whatever reason, can't or wont' take care of themselves.}}

Those may be true, but do not try to call it charity or generosity when a person is forced to contribute.



c

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 5:44 PM
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{{The boy has never read Wealth of Nations and doesnt understand economics nor the nature of rights, wealth, work, risk, responsibility or Life itself}}


Because I do not think that charity or generosity is involved when an armed person take money from Peter to pay Paul, you declare that I know nothing about responsibility, rights or life.




c

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Those may be true, but do not try to call it charity or generosity when a person is forced to contribute. - cattleman
---------------------------

Translation = "I got mine, screw everyone else!"

Congratulations on your PhD. I'm sure that your success was entirely of your own making.

Art

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What people do with their own money voluntarily means nothing to you? -cattleman
--------------------

Why should you be paid more than the next guy? Why is your work more valuable than anybody elses?

Charity and welfare is just a very small effort to make life's inherent inequalities a little more equal.

Art

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The boy has never read Wealth of Nations and doesnt understand economics nor the nature of rights, wealth, work, risk, responsibility or Life itself - FCorelli
--------------------------

He's terrified that we're all going to be made financially equal.

LOL! Wait till he gets to heaven. Everyone gets paid the same there.


Art

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{{Translation = "I got mine, screw everyone else!" }}


Where did I ever say that I do not think people should not give back? The key word being give.


c

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{{Charity and welfare is just a very small effort to make life's inherent inequalities a little more equal. }}

That all is true. However, that does not mean that welfare is charity or that it is generous. Both charity and generosity require that a person voluntarily give of themselves.


c

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Because I do not think that charity or generosity is involved when an armed person take money from Peter to pay Paul, you declare that I know nothing about responsibility, rights or life. - cattleman
-------------------

The question is, why is your work more valuable than anyone elses? Why should you be paid more than anyone else? Where does your success come from? What did you do to deserve the success you've found in life? Why are you more equal than some guy bagging groceries at Wal-mart?

Art

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That all is true. However, that does not mean that welfare is charity or that it is generous. Both charity and generosity require that a person voluntarily give of themselves. - cattleman
--------------------------------------------------------------------

You need to take a trip to Jakarta, Indonesia and see how that's working out. It's a lovely place with polluted water, kid's begging in the streets, and old men standing in the middle of the sidewalk retching and dying.

Art

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{{You need to take a trip to Jakarta, Indonesia and see how that's working out. It's a lovely place with polluted water, kid's begging in the streets, and old men standing in the middle of the sidewalk retching and dying.}}


What does that have to do with my insisting that words have meaning and that both generosity and charity can only be used to labels acts that are completely voluntary?

c

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He's terrified that we're all going to be made financially equal.

LOL! Wait till he gets to heaven. Everyone gets paid the same there.

Art


I don't know what kind of "capitalist" he is since I almost never read his stuff. Does he believe our Rights (read: HIS rights to HIS stuff)come from God? If so he hasn't read THAT frikkin book either.

Instead of worring about how a Free People choose to manage their society including its economy and how it affects his wallet in the short term he should be worrying about fitting his corpus & his suitcase full of money through the Eye of that Needle of which The Boss spake.

If he is a royal libertarian type who believes there is no god but One's own bank balance, then it's a Hobbsian world wherein he has all the "rights" he can steal until he gets killed. So, whose money is it again...?

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 8:46 PM
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<<It's unfortuneate but studies have shown that individuals left up to themselves will not contribute sufficient charity to lift the less fortuneate out of poverty. Individuals are just not good enough in and of themselves to contribute enough to cover the needs of those who, for whatever reason, can't or wont' take care of themselves.
>>


Thus we have Fidel Castro, who is finally retiring (but not early) from running a police state to redistribute wealth in Cuba, and a greatly reduced amount of wealth there has been to redistribute, once people saw that hard, shrewd work and risk taking (other than in politics) was not desired.



Seattle Pioneer

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 8:52 PM
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<<Why should you be paid more than the next guy? Why is your work more valuable than anybody elses?
>>


The customers of my furnace repair business were always free to repair their own equipment when it didn't work. They hired me because my work in that specialized area was a lot more valuable than their own labor, and they knew it.



Really Art, be serious.



Seattle Pioneer

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/20/2008 8:53 PM
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This time I have exactly three pieces of paper in a file, and our out-of-pocket cost is $0.

If this is representative of how government-managed health care can operate, I say "priceless".



Jeanie



I agree that the ideal health care system would allow everyone to receive any medical care they want for $236/month, no matter how expensive the cost of the underlying medical care. I agree with you that an ideal health care system is one in which not only your family, but everyone's family, is able to pay far less than fair market value for the receipt of medical care, goods, and services.

The ideal society is one in which we all receive everything we want for nothing--or for far less than fair market value-- and no one has to pay for it.

I look forward to Obama's election and anticipate our hopes and dreams for change will surely come to pass.

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There are in fact societies where there is no goverment welfare, and where the only generosity comes from individuals. Indonesia. My brother has been there three times. He saw an elderly man retching and dying on the street. His new Indonesian wife quickly ushered him away and told him to walk around the old man. She told my brother that the little kids begging for food in the street were just lazy and wouldn't work.

Indonesia is a picture of what we would look like if there were no goverment welfare programs. People retching and dying in the streets. Yes, there would be small amounts of charity, just enough to assuage people's guilt, giving a few coins to those who begged them from us, but very few would give enough to make a difference.


How richly ironic. You do realize the person who is on-odds favorite to be the first non-Caucasian president spent a good part of his formative years in...Indonesia.

Do you not see the possibility of a causal relationship?

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Why should you be paid more than the next guy? Why is your work more valuable than anybody elses?

Econ 101?


Charity and welfare is just a very small effort to make life's inherent inequalities a little more equal.

Art



Do you think the government will subsidize a basic economics class for you?

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Why should you be paid more than the next guy? Why is your work more valuable than anybody elses?

Econ 101?


Charity and welfare is just a very small effort to make life's inherent inequalities a little more equal.

Art



Do you think the government will subsidize a basic economics class for you?


These kinds of arguments always miss the point. When capitalism works, it tends to work really well. When it comes to commodities (toothpaste, shampoo, etc.) the laws of supply and demand tend to maximize profits for the efficient provider while minimizing costs for the consumer. Econ 101 fundamentals apply. We benefit from a system that rewards the most efficient providers.

But almost no one believes that capitalism is the best model to apply to national defense, or road systems, or food and drug safety regulations, . . . There are times when supply and demand forces will not produce the desired results. We don't want a thousand armies put together by competing rich people to defend themselves. That system is Medieval and has already been replaced by much more advanced sytems. We don't want a haphazard system of roads that start and stop at the edge of rich folks property. Road contractors might get rich from such a system, but the country as a whole would be much poorer and less secure. We don't want to risk our lives eating the food we got at a grocery store that was only regulated by the people rich enough to sell the items to the grocer. The food processors and packagers might increase profits that way, but the consumer would not benefit. And most of us don't want a healthcare system that works only to insure that insurance companies, pharmaceutical companies, hospital owners and doctors the maximum profit. We want a healthcare system that cares for health. Profit motive does not guarantee that.

And by the way, that stuff was covered in my Econ 101 course too. Maybe you should read past the first few pages of that text.

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/21/2008 2:02 AM
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The hospital and doctor charges were just over $35,000

Now he's covered under Medicare ($96/mo) + a supplemental ($140/mo)

This time the charges came to about $16,000

And this is five years later!


that's truly bizarre .. in five years, prices went Down?


If this is representative of how government-managed health care can operate, I say "priceless".


one possibility ... Providers charge private ins. a slightly inflated number, not knowing what they'll get. But charge Medicare what they know they will get.
the downside of that could be the Providers aren't getting enough from Medicare ...

but no telling --my Drs are happy with Medicare, so i guess they're doing alright


=

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and old men standing in the middle of the sidewalk retching and dying.

I think that's terrible! Instead, they should put them in hospitals, connect them to machines that breathe for them, pump and filter their blood, and keep them "alive". Then, every once in a while cut off, or cut out, parts that are causing them problems with "living". Sometimes you can even keep their body alive for an extra few years. :-(

One extreme to the other.

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/21/2008 11:45 AM
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I think that's terrible! Instead, they should put them in hospitals, connect them to machines that breathe for them, pump and filter their blood, and keep them "alive". Then, every once in a while cut off, or cut out, parts that are causing them problems with "living". Sometimes you can even keep their body alive for an extra few years. :-(

One extreme to the other. - Mark

-------------------------------------

How about putting him in a bed somewhere and give him sedatives to make him comfortable till he crosses over? Would that be too much to ask?

That's all I'm asking for. A minimal level of health care. I'm the guy who really believes in life after death; and that where we are going to is a million times better than here.

No heart transplants. No extreme measures for stage 4 cancer patients, no extreme care for preemie babies who are going to have health problems the rest of their lives, no keeping human vegetables alive, no extending the life of geriatric people who senile or demented, etc. No malpractice suits making people multi-millionaires, etc. Just good comfortable honest health care

Who will decide? Me! Let me decide. I think I'd be good at making those kinds of decisions. I did it everyday at the Vet School for animals. I can tell when they are needing to die and their time is almost come.

Art

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How about putting him in a bed somewhere and give him sedatives to make him comfortable till he crosses over? Would that be too much to ask?

That would be ideal, but I don't hear anyone in power (i.e. politicians) calling for such a thing. I think our society is afraid of death.

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/21/2008 12:08 PM
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How about putting him in a bed somewhere and give him sedatives to make him comfortable till he crosses over? Would that be too much to ask? - art
-------------------------------------------------------------
That would be ideal, but I don't hear anyone in power (i.e. politicians) calling for such a thing. I think our society is afraid of death. - mark
----------------------------

Well, when I talk about national health care that's what I'm talking about. An honest compassionate caring reasonable approach to health care. Using our heads.

I have no problem at all in letting dying people die. Or, people who are needing to die, letting them go ahead and die. To me, death isn't the worst thing, suffering and pain are.

Someone who has end stage cancer and is suffering should be allowed to die with dignity. In fact, I think it is selfish to keep people here because we don't want to let them go.

Artie

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How about putting him in a bed somewhere and give him sedatives to make him comfortable till he crosses over? Would that be too much to ask?

That would be ideal, but I don't hear anyone in power (i.e. politicians) calling for such a thing

That happens all the time in the US. It is called hospice care. A friend of mine was diagnosed with a terminal lung disease. They gave him an oxygen bottle and a morphine drip and sent him home. Inevitable, and reasonably inexpensive, and he got to spend his final moments with his family.
--Alan

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/21/2008 12:25 PM
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That happens all the time in the US. It is called hospice care. A friend of mine was diagnosed with a terminal lung disease. They gave him an oxygen bottle and a morphine drip and sent him home. Inevitable, and reasonably inexpensive, and he got to spend his final moments with his family.
--Alan

Who paid for this munificence? Him? Or insurance? If he was homeless on the street, then what?

cliff

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/21/2008 1:59 PM
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that's truly bizarre .. in five years, prices went Down?

one possibility ... Providers charge private ins. a slightly inflated number, not knowing what they'll get. But charge Medicare what they know they will get.


You got it. But it's mostly the ancillary charges that are grossly over-billed. I'm convinced that's the answer because those providers try to make up the losses they sustain from the indigent and uninsureds who will never pay their bills.

The saddest victims are those who are uninsured or under-insured who *do* attempt to pay these medical bills, putting their families in financial jeopardy while enduring the stress of predatory collection agencies and risking bankruptcy to do so.

The downside of that could be the Providers aren't getting enough from Medicare ...

I've been studying these bills more carefully since we began this conversation. DH's surgeon (a leading orthopod in this area and in great demand) billed exactly the same amount as Medicare approved for the actual surgery plus each office visit pre- and post-surgery. Those amounts aren't all that different from what he was paid 5 years ago by our private ins.

The big difference was in what the hospital and the labs were billing.
One that stood out was a $1250 charge for something I can't identify, but whatever it was, Medicare paid $238. My first thought was, "oh, they got screwed out of a thousand dollars for that procedure". My second thought was that, a private ins co may have paid $900 - thus paying for four indigent patients who got it for free.
The sad result is that the insured person would get charged the $350 difference between that $1250 and the $900 -- and the uninsured person would have been dunned mercilessly for the whole $1250.

How much better would it be if every person was covered for the $238 under a national health care system?
Anyone who thinks we aren't *already* paying for poor people's health care, is kidding themselves.

but no telling --my Drs are happy with Medicare, so i guess they're doing alright

Yes, I think most doctors are happy with Medicare. They get their money quickly, they don't have to dedicate a staff member to deal with the paperwork or spend their own valuable time on the phone haggling with some clerk over why a heart monitor was ordered for a hip operation.




Jeanie

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Author: 0x6a74 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11653 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/22/2008 2:39 AM
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The saddest victims are those who are uninsured or under-insured who *do* attempt to pay these medical bills, putting their families in financial jeopardy while enduring the stress of predatory collection agencies and risking bankruptcy to do so.


yup.



The downside of that could be the Providers aren't getting enough from Medicare ...
---------
I've been studying these bills more carefully since we began this conversation. DH's surgeon (a leading orthopod in this area and in great demand) billed exactly the same amount as Medicare approved for the actual surgery plus each office visit pre- and post-surgery. Those amounts aren't all that different from what he was paid 5 years ago by our private ins.

The big difference was in what the hospital and the labs were billing.
One that stood out was a $1250 charge for something I can't identify, but whatever it was, Medicare paid $238. My first thought was, "oh, they got screwed out of a thousand dollars for that procedure". My second thought was that, a private ins co may have paid $900 - thus paying for four indigent patients who got it for free.
The sad result is that the insured person would get charged the $350 difference between that $1250 and the $900 -- and the uninsured person would have been dunned mercilessly for the whole $1250.

How much better would it be if every person was covered for the $238 under a national health care system?


would depend on how well the 238 covered the provider's expenses ..


but no telling --my Drs are happy with Medicare, so i guess they're doing alright
-=-=-=
Yes, I think most doctors are happy with Medicare. They get their money quickly, they don't have to dedicate a staff member to deal with the paperwork or spend their own valuable time on the phone haggling with some clerk over why a heart monitor was ordered for a hip operation.


and yet we hear Anecdotes that doctors turn away Medicare patients ... ???

none of mine did, and one did a little Happy Dance .. she said, "they pay slowly, but they NEVER say 'no' --they trust my professional opinion" [no haggling with some clerk, but there must be some paperwork ]


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Author: TMFJeanie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 11654 of 59685
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/22/2008 9:43 AM
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and yet we hear Anecdotes that doctors turn away Medicare patients ... ???

Yeah, I've heard the same anecdotes, which is why before DH turned 65, I called the hospital and all of his doctors to ask. I also asked if the testing labs they used accepted Medicare's assignment*. They all said, "of course we do".

*This is the key question to ask. Some providers might say, "sure we take Medicare patients", but they don't accept Medicare's assignment, which means they could bill you for the difference between what they charge and what Medicare pays them.

Since then, from talking to friends who are on Medicare it seems that every provider around here accepts it. Maybe it's peculiar to Maine, which has an older (and poorer) population.

Medicare isn't perfect. After the deductible, they still only pay 80% of the bills. A supplemental policy is optional, of course, but it will pick up the remaining 20% plus the deductibles, so the patient cost ends up being zero.

The Rx plan is another whole sack of snakes, but that's for another discussion :-)


Jeanie

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Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/22/2008 3:30 PM
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The Rx plan is another whole sack of snakes, but that's for another discussion :-)



yup.

only good thing i can say for it --better than Nothing.


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