<p>Here is the problem with unions, public employees, retirees, veterans being asked to pitch in for the costs. Some of them have already been promised a certain cost and benefit in terms of health care. My brother is a case in point. He spent 20 years of his life in the military and one of the things that was part of the package was free healthcare for himself and family at retirement. And now the military not only has reneged, but has cut the quality of his benefits so that he and his family cannot get decent health care easily through his retirement health insurance plan. Doctors refuse to take those so covered. We have veterans in Oklahoma going to Seattle for treatment for things because no one closer will take that payment for the process. And Tri Care is so aware of this that it actually channels you that way. You need a bone marrow transplant and you are in NYC. Of course MSK is where you would want to go. Nope. You go to Cincinnati, because they will take the Tri Care payment. Crazy? Yes, but believe me, it works that way. Unless you fight them which takes a lot of time that acutely stricken folks don’t have and energy/focus that they don’t have either. </p>
<p>A lot of union and government workers have enjoyed a status quo for a long time in terms of pay and benefits that the market is no longer supporting. I feel strongly that we are obligated to maintain what is contracted to them and promised to them, but when it comes to renegotiation, reality is going to have to hit everyone. What happened in Wisconsin was a travesty all around. It went too far and too long, and the bipartisan showmanship really took center stage instead of really working through the issues. When it comes to health care coverage, I am very biased in that I believe it should be thorough coverage with the ability of the patient to choose where to go to get treated on all but the most pedestrian medical situation. </p>
<p>Actually George W Bush made some major inroads in the ER situation with some non urgent care centers, that just did not take off for some reason or other. There are just too many special interests in all of this, down to the state, locality and hospital so that I think federal control is going to be necessary as it was for social security. Yes, I hate big government, but this just isn’t working with too many hands in the pot. There will be waste, and mistakes and problems but maybe 10 years down the road, things will be better than they are now. It’s been going south in the last 15 years, I can tell you. It’s now a house of cards with the consumers, us right in the midst of it all.</p>
<p>So, yes, the unions and employees are going to have to pay something. Everyone will have to pay for the basic and acute health care, no exceptions. Not for congress, not for doctors, not for anyone who gets a check that can be tracked. Perhaps boutique care can be negotiated, but not the necessities. But those contracts made prior to this have to be honored. When we go back on our word on things, it leads to paths of greater destruction. The cost of past assurances has to be built into whatever structure we put together for the future.</p>
<p>I’m IN your area, Zoosermom. And yes, I see the problems with the unions. Gonna take a strong federal mandate to get around that one and a Democrat to boot. Yes, lots of problems with Obamacare, especially after the compromises, but it is a start. Should have been more encompassing, but the danged Republicans won’t let go of their non government interference in exchange for the Democrats giving the unions a reality check. That’s what is needed. </p>
<p>And I mean really, if your kid gets cancer, where are you gonna go? To exclude Memorial Sloan Kettering is ridiculous and the reimbursement schedule for their serves is at 10% rates. You tell me if that isn’t kicking everyone who is down, down the stairs. We are kicking them down the stairs. The cuts that a lot of states are making right now are hitting those most vulnerable medically. Parents with acutely and chronically ill kids are really getting the foot in the teeth with the cuts. It’s not right.</p>
<p>Cpt, I actually agree with you, particularly on the issue of choice. I am deeply concerned that choice will be lost completely if changes aren’t made to Obamacare. I agree with you that we need to keep our promises to current workers and retirees with regard to pensions, at least, but I actually do think changes should be made to the contribution system for current workers. They’re not a sacred class of people more deserving than the folks in the private sector. We’ve all been beaten up by the economy and have to work together to fix things. We can’t have a protected class of workers just based on being politically connected. It’s particularly troubling when you see the age of some of the retired workers (in their 40s) and some of the fraud perpetrated. I understand your passion for critically ill kids, but I’m really not comfortable with age being a guiding factor. My best man’s wife passed away two years ago at 37 leaving three children and huge medical bills. I think she was just as vulnerable. I’m not sure what the answer is, but I don’t think Obamacare as it stands is it, and I think we all need to consider what we can do to help, not just what we can get. I’m also really scared about access to doctors in the coming years. I think that’s going to be the big unintended consequence.</p>
<p>When D1 was born 22 years ago, my doctor charged $3K for delivery. When D2 was born 17 years ago, it went up to $8K for delivery. It was with the same doctor. I asked him why the cost has gone up so much. He said it was due to his malpractice insurance, too many people were suing ob-gyns. Americans do not believe anything should go wrong when it comes to medical care, especially with child birth, and when it does then it must be the doctor or hospital´s fault. The consumers are paying for those law suits and awards (in my case it was a difference of $5k).</p>
<p>I went to pick up some antibiotics one time, and I forgot to bring my insurance card with me. I told the pharmacy to just charge me and I would file a claim later. They told me it would be $350, but if I had insurance it would be $50. I was very puzzled, “So if I was some poor person who couldn´t afford insurance, you would charge me 7 times more for the same medicine?” It is the case with doctors, labs, their fees are much lower for people with insurance than for people without insurance, which to me is wrong.</p>
<p>I think it is great WI was able to break the insurance monopoly, money saved could be used for the students instead of to the insurance company. </p>
<p>I just worked with D1 in choosing health insurance coverage at her new job. I told her to choose a PPO (not HMO) with high deductibles, and put pre-tax money away to cover the deductibles. When it comes to health care, for me the most important thing is to be able to go to the best doctor (hospital) possible when there is a mjaor medical problem. Her monthly insurance premium will be around $50, a lot cheaper than for me to keep her on my plan. If her company only offered ONE plan, like WI teacher´s union, D1 wouldn´t be able to have that choice.</p>
<p>As Oldfort pointed out with the pharmacy charges, there is also a two tier system for hospital charges. DH had outpatient surgery and the hospital billed $6400. The insurance company paid $350. We had a $75 copay. The hospital then stated on the bill that they were writing off the difference. It was eye opening! I now wonder what the insurance company is doing with the $1000/month we pay for health insurance if they aren’t reimbursing the providers at a higher rate.</p>
<p>The premium increases were also necessary for insurance companies to recoup losses from the real estate crash in the early 90’s. Insurance companies were heavily invested in real estate.</p>
<p>Well, I am also living through the hell of chronic illnesses. My husband and younger daughter have a genetic disease that costs thousands to treat every year. My oldest daughter has lupus. My husband works for a very small company and our insurance is dropping the company as of next year…we aren’t dumping them, they are refusing to provide coverage probably because we don’t make them a profit. And while it wasn’t perfect coverage, it was a lot better than others. I have no idea what will happen. If we can’t go to the Cleveland Clinic my daughter will be in serious trouble. We could conceivably lose our home if we have high out of pocket costs. And of course, we make way too much to qualify for anything. Even if I quit my job we still wouldn’t qualify- and Yes, I would quit my job to save my daughters life.</p>
<p>So far she is doing well but her cousin with the same illness already at 14 has a pancreatic and pituitary tumor. Luckily, she has the Cleveland Clinic and is under amazing care. And thank God nothing malignant yet.</p>
<p>My Amish neighbors have “Amish insurance.” Each member of the church district is required to give what they can afford. Those who make more, give more. Our area hospitals including Cleveland Clinic and Akron, Canton actually have different rates for Amish because they pay in cash. What the church district can’t pay, then is turned over to the larger Amish community and everyone gives. The Budget newspaper is a great example of this if anyone cares. Socialism works very well on this scale.</p>
<p>Another thing I have learned from mt Amish neighbors is compassion and forgiveness. They may vote republican because of abortion and gay marriage and a general mistrust of government but they are amazingly charitable and kind. When we have tragedies in our communities, even if you are English, the Amish come running to help. A small tornado ripped apart my grandparents barn and destroyed a small home and tore the roof off another house. Within a matter of hours most of the mess was cleaned up, the roof covered in plastic etc… And it was done at no cost. This doesn’t happen in a lot of places.</p>
<p>In certain areas, the Amish are great role models.</p>
<p>Free Market religion – it’s like the Trickle Down Economics religion except unlike the latter it hasn’t gotten fully debunked yet. </p>
<p>I love it how the public defends exploitative,greedy companies run by exploitative greedy people who just keep getting richer while the majority of the country sinks lower and lower economically.</p>
<p>Feudalism, anyone? Hey, we’re living it! God bless America indeed.</p>
<p>Regarding Oldfort’s post about rising charges due to Ob/Gyn malpractice premiums and our culture of expectations of perfect medical outcomes:</p>
<p>Obstetricians are required to have “tail” insurance for around 20 years after the date of the LAST delivery they are involved in. Each state has its own satute of limitations, but the average for most state laws is 2 years from the time of the discovery of the injury. The statute of limitations for MINORS in most states doesn’t start until the minor reaches the age of 18. Yearly malpractice premiums for Ob/Gyns range from around $35,000/year in Missouri to over $150,000/year in New York. In other words, you can sue your OB for malpractice when your baby is 17 years old. The OB has to continue malpractice coverage (costs less and less each year after discontinuing practicing obstetrics, but still…) for many years after they retire from obstetrics.</p>
<p>Your OB may be making so little money on each normal pregnancy and delivery, and the liability is so high, that he or she may very well discontinue providing OB services. This all adds to our inability to find physicians, and the rising costs of health care.</p>
<p>My doctor never dealt with insurance. We had to pay cash and claim later. I remember back then I had to pay 100% of his service by 5th or 6th month, and received my reimbursement after delivery (we made sure we had $8k cash). He was a very well known doctor in NYC at the Cornell hospital, and he taught there too. He did say that due to high cost of insurance fewer and fewer doctors want to provice OB services.</p>
<p>eastcoascrazy is right. I have midwife nurse practitioner friends who are back to staff positions in med surg or ob due to inability to pay malpractice insurance which they still have to have even though they work under a physician. I hear Dr’s complaining about malpractice insurance but I also know they make a good living and can afford it a lot more than the NP’s - also know of one Dr who puts assets in his wifes name and shifts money around to protect himself. </p>
<p>I am not adovocating people continue to sue but to put strong limitations on pts ability to collect when there has been a serious error is wrong. I also know we protect each other. A lot. Especially Docs but nurses too. If every pt sued for every error, large or small they actually knew about we would be in pretty bad shape. Luckily, most people don’t sue and most healthcare workers are diligent in trying to maintain safety.</p>
<p>Just saw my ob/gyn yesterday. They sold the clinic of about 6 doctors to the hospital mainly because of the cost of malpractice insurance, which the hospital will now cover. Her individual malpractice insurance 15 years ago was $6000. Today it is $80,000. And she no longer will handle high risk pregnancies. We will have a shortage of OB doctors everywhere before too long, and I can’t say I blame medical students for shying away from the field. America is so “sue happy” that people try to find something wrong!</p>
<p>The insurance companies are doing well with their PR, but this is a myth. It is much more likely that suits are not filed when they should be than for suits to be filed when they should not. There are very few frivolous med mal suits - they are just to expensive to bring. It is more likely that a person who is truly injured can’t find a lawyer to take the case because of the up front expenses.</p>
<p>momofbassist, they are using that 1000 a month to pay for your neighbor five houses up 120k stroke that they just had. Insurance premiums are the law of averages.</p>
<p>BF was at the hospital 2 months ago, just at the ER. Has a 1100 deductible. Is now paying back 900 dollars for his ER bill. The pre-insurance rate was in the thousands.</p>
<p>If anyone needs help figuring out their insurance you’re more then welcome to PM me…</p>
<p>cartera45 - how do you know that? I am not in the the insurance business, so I don’t opine on it, but I do know few frivolous lawsuits aginst my family and frieds.</p>
<p>We used to have really great insurance. Just a copay every time we went to the doctor. Now we have some kind of deductible, even though we’re still with a very good, nationally known company.</p>
<p>I’ve had ear pain for six months, and haven’t gone to the doctor because I know I will have to pay for it out of pocket, just like I had to pay out of pocket for my regular yearly checkup, the chest Xray the idiot ordered for my cold, and sent me away with not even a prescription for antibiotics, nor the tons of blood work that my son was ordered by a “specialist” who didn’t even put his hands on him.</p>
<p>I’m finally going tomorrow to an ENT as I’m done with this suffering and hearing loss, as my work depends on my hearing. I know I will pay dearly for it, but at least, or I hope, I get to see a doctor, not just a resident, which is what I’ve been getting the last few years with my high priced insurance. I wouldn’t get so angry if it weren’t for the fact that the welfare people go to the charity hospital and see doctors with the same amount of training I’m getting, and they don’t have a chunk of money taken out of their paychecks to pay the premium!</p>
<p>I know, I know, I’m paying the premium so in case I go to the hospital, I won’t have to declare bankruptcy, but it is very frustrating to have to worry about high deductibles when you have private insurance.</p>
<p>On a different note, I generally find people always associate providers and lawyers to be on opposite sides of the table. Looking “at the forest”, I really find them both on the same side - providers justify an increasing amounts of testing citing malpractice lawsuits as a reason which increases their revenue even after splitting a portion in settlements. That’s one of the reasons why healthcare costs keep rising as they are.</p>