Even if you ask outright, you don’t always get a clear and accurate answer from service providers.
Because they often do not know. And they have to look it up. And even then the negotiated price will sometimes vary by insurance company.
There are too few incentives in the system to reduce costs.
Oh, but in the instances I’m talking about, we asked ahead of time. They took weeks to get back to us during which one would assume they were checking with the insurance company and they still got it way wrong. The error was in their favor and they made no effort to correct the overpayment until we proactively called weeks later. I’m sure they would have been in touch right away if they were owed the money. A lot of it borders on being a scam to the consumer, IMO. One provider in my area was sued by the state’s attorney general because his office didn’t refund overpayments unless a customer specifically called and asked for it.
@VeryHappy, I was working from @ucbalumnus’s worst case. I think it is highly likely that Ryan and friends will rediscover the (to which they’ve just added $1.5 trillion). Instead of trying to raise taxes to recover the $1.5 trillion, they will instead claim that we need to cut entitlements and specifically Medicare and Medicaid. He’s said what he’d like to do with Medicare: http://www.latimes.com/business/hiltzik/la-fi-hiltzik-medicare-ryan-20161114-story.html. I am sure that’s not the latest, but the keys are voucher financing which increases more slowly than health care inflation, cap the Federal contribution, let states have more say in designing their own, and shifting more of the burden of health care to consumers. People at the high end of the income distribution will be fine but have less available for retirement than they planned for. People at the not so high end who counted on Medicare may find it very difficult over time.
What we pay for 2ndary insurance (secondary to Medicare) may go up as Medicare coverage shrinks. IDK.
How much the insurance model changes is anyone’s guess.
Ryan has said it as recently as this month:
https://www.washingtonpost.com/news/wonk/wp/2017/12/01/gop-eyes-post-tax-cut-changes-to-welfare-medicare-and-social-security/
We shall see what they do. They have been talking about social security and medicare reform pretty much my entire adult life. Only to kick the can down the road a little with no meaningful reform. Maybe it will be different this time? Certainly not just because they say so though. And the current crew took almost a full year before enacting their first major piece of legislation. And it wasn’t easy. In a couple weeks they will be down a vote in the Senate making it a little tougher to get anything done. And as they move closer to midterms it will be less likely they get anything done.
But social security and medicare need reformed. We can disagree with what should happen to them but neither is sustainable in present form. Medicare less so than social security because with social security, you can run actuarial analysis to find a working solution. That cannot be done with the exponentially rising costs of medicine.
For social security there’s really only three choices:
- Eliminate the fiction that people are making an “investment” in something, and raise the income ceiling/tax rate without raising benefits
- Cut benefits
- Add more means testing beyond what taxing benefits does (why are Roths (which are paid for with after-tax dollars) tax free, when SS (which is paid for with after-tax dollars) is taxed? Hmm)
or some combination.
There’s a few more options which I don’t think will fly - privatize SS (people can’t be trusted to manage their own money, and what to current beneficiaries do when the revenue stream is diverted since it is largely a pay-as-you-go program?), raise the retirement age even further (which is really a benefit cut), and massive immigration of young people (10’s of millions) who will pay into the system for 30 or 40 years.
Medicare… no idea what will work. Unless costs can be driven down, I fear it’s doomed as it currently exists.
Massive immigration of young folks will not work. Where will they all be employed to pay those taxes?
There are millions of unfilled jobs in our country, many of them that pay reasonably and provide a road to a decent middle class lifestyle, that people already here don’t seem to want, either because they require hard work or they are lazy, not sure which.
https://www.bls.gov/news.release/jolts.nr0.htm
It wouldn’t fly politically though.
Speaking of positions paying living wage… Judging by job hunting by CC kids and by my personal mingling with employers in my neck of the woods, I would say that 25% of those job ads is puffery to create an impression that the employer is doing great. Maybe 50% or so are looking for the ultimate purple squirrels to fill positions that are “nice to have” but not critical to have. That still leaves a solid chunk of “we need talent now” jobs that pay a living wage… where most would require a solid grasp of the English language.
If you started an immigration program offering green cards to people who can speak English, I bet you would have millions applying almost immediately, and millions more frantically learning as fast as possible.
There’s an estimated 1-1.5 billion people who speak English. India alone is estimated to have 125 million English speakers.
They might speak English, but not that kind of English. Trust me, I ride the bus that feels like I am in India (AMZN folks). Sure it works ok if one sits at her desk and codes all day long or stands in the lab and mixes chemicals and does not have to interact with others or write. 
But most of the jobs that need to be filled are not in those fields.
What we need to do is to offer some sort of a path to green cards to folks that graduate from accredited US colleges - they have the education and the language skills. A person I know well was trying to hire their summer intern, a bright college kid from China. Nope, can’t. Visa was valid for only 6 months after the graduation. Sad situation - perfect fit for a position, can’t hire the person.
I also agree with the ones that call for a reform of the visa lottery program. It used to be very different… a winner was required to show that they had either a job lined up in the US or funds sufficient to live off for a year or more until they find employment. The first wave of these green card winners included quite a few scientists and engineers (we personally helped a handful of them secure a postdoctoral position here). But it all went downhill from there.
I see lots of brown people walking down the street and in public transport, but it still feels like the US. Such brown people speak perfectly understandable English.
Good luck getting any increase in any immigration category that is likely to be mostly non-white immigrants in the current white nativist political climate.
If you mean the diversity visa lottery described at https://en.wikipedia.org/wiki/Diversity_Immigrant_Visa , it and its predecessors were intended to legalize a population of unauthorized immigrants mainly from Ireland.
You can cite Wiki all you want, but I read the actual eligibility rules of the inaugural DV of the nineties. No, it was not designed to legalize illegals as illegals were ineligible. It was designed to bring a diverse crop of immigrants from the countries with little immigration to the US, like Sweden and the former Soviet Union. The latter was quickly cut off as soon as we got a flood of immigrants from there. China and Mexico were never eligible, as far as I can remember, but I have not looked at the lottery rules in a while, so maybe they now are.
Anyway, filling all these jobs with qualified immigrants is a fantasy, so let’s not get sidetracked here.
If we were looking at all sorts of utopian ideas, maybe we should have a mandatory retirement age. That would free up a bunch of well paid jobs with good benefits, like federal court judges and senators… 
Sundar Pichai, Google CEO came to the US after he finished college in India.
The main reason that immigrants cannot fill political jobs is they don’t have enough voters of the same ethnic group.
But we digress too far from the main topic of this thread.
“Sundar Pichai, Google CEO came to the US after he finished college in India.”
Thank you for confirming what I am saying: of we want more immigrants to increase the number of workers per retiree, we need a merit-based immigration system that gives preference to young and educated regardless of their country of origin, young folks who are already here working regardless of their immigration status, and new US college grads. But whether such “draconian” system is any good is a topic for another thread.
The best way to prop up SS is to make folks live less. There are many ways to do so, but again, those would trigger political discussions.
So instead of giving away free cheese the gov’t should be giving away free cigarettes?
I’ll take free booze.
I’ll go for the free booze, too. But it has to be the good stuff or they can keep it.