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 AUTHOR
 Yule_liquor
Joined: 12/7/2011
Msg: 101
Life without health insurancePage 5 of 6    (1, 2, 3, 4, 5, 6)
msg 98


That insurance is even employer-based at all in the United States is nothing more than an accident of history and somewhere down the line someone should have said “This is nonsense. Let’s do something else.”


Health insurance was given out as a "perk" (Like vacation pay; personal days; even life insurance) by most big businesses back in the 40's + 50's. At that time, a typical policy was cheap as crap because there was no high tech procedures or expensive medications to cover for, so it was thrown into the package.

Couple that with the fact that most doctors and the AMA, did not want the gov't to get involved in healthcare as it was happening in post war Europe, fearing loss of independence and revenue. They much preferred to deal with insurances which at the time were not as threatening or as powerful as they are now.

Of course this changed in 1965 when Medicare was created (The AMA and many doctors were opposed fearing that it would lead to socialized medicine); but most doctors fared well because the Gov't behaved like a typical insurance company, and most of their incomes doubled.

This changed in the 70's and 80's as a result of the technology explosion; which resulted in increasing costs for drugs and procedures; and henceforth the era of the HMO was brought upon the society in the 1990's, leading to what we have now. What the HMo does well is to reduce access and perhaps over-utilization; so as to make more money for its own respective company. It does not have anything to do in reducing costs of healthcare/supplies/drugs/ procedures; though they usually opt for the providers who charge a bit less.

In establishing the ACA, Obama wanted strongly for a "public option" but the GOP & conservative Dems opposed this (they were bought off by the insurance industry); fearing that the private sector could compete with the gov't in terms of affordability in that they would be forced to become more efficient in the way they operate in order to survive. Instead, they were given the whole basket of eggs.


Health insurance is a massive drain on American corporations. Of course, somebody still would have to pay for the insurance, but I think we’d all be better off if it was paid for by a tax (maybe both on “the people” and businesses).


Which is why the GOP is full of Hypocrites!
On one hand they say that they wanna make it easier for companies to do business (and therefore create more jobs); but they don't wanna take the necessary steps for that to happen (single payor insurance; tort reform, etc); yet they say nothing when companies uproot and move overseas for the purpose of lowering their overhead.

At least, Trump indicated that he was for "single payer insurance" (though I'm sure of the breakdown of his proposal), because as a businessman, he has to understand the burdens that the costs of doing business has on a typical company in the US.
............................

post 100


Pharmaceuticals is another one: look up what Teva (Isreali company I think) is doing. Tetracycline's and other cheap generics are now expensive. Used to be 4 dollars!


Plus the fact that in Israel, the citizens there pay nothing for Tetracycline (and most other drugs) as they have Universal healthcare, which is healthcare that America helps to subsidize; (if that isn't a kick in the balls for us!).
 dragonbytes
Joined: 12/25/2014
Msg: 102
Life without health insurance
Posted: 8/13/2015 1:40:20 PM

Plus the fact that in Israel, the citizens there pay nothing for Tetracycline (and most other drugs) as they have Universal healthcare, which is healthcare that America helps to subsidize; (if that isn't a kick in the balls for us!).


People are often surprised to learn that Israeli tax rates are not the highest in the world.

The maximum combined income-tax and National Insurance Institute rate is 48% to 50% above NIS 518,880.

But there is a narrow annual income bracket of NIS 501,960 to NIS 518,880 where the combined rate can reach about 60%.

http://www.jpost.com/Business/Business-Features/Your-taxes-Tax-rates-for-2014-339665

I don't think there are many free lunches in the world.
 11qq
Joined: 7/17/2015
Msg: 103
Life without health insurance
Posted: 8/14/2015 9:46:39 AM
I want to publicly thank Sharon Tube Company and my union for providing me with Cadillac insurance that pays for all of my medical bills with only a $10 co-pay. it also pays for my dental and optical services and discount drug program.

I worked there from 18 to 48 and when you get those 30 years in, the very next month they begin paying you a hefty pension that I will receive for life. some of my friends questioned my decision to retire at 48 with 30 years in but a few years later they were calling to tell me it was a great move. on the very next contract the company asked for all employees to begin contributing to their health insurance. the contract they signed made me grandfathered in with no change and the union members who stayed to put in more years agreed to pay $400 a month for their share. that's almost $5000 a year and an actual $48,000 in 10 years and closing in on $100,000 in 20 years.
 vlad dracul
Joined: 4/30/2009
Msg: 104
view profile
History
Life without health insurance
Posted: 8/14/2015 10:37:27 AM
We register with doctors surgeries here in Scotland. In my area eh17 we have two surgeries. The nhs ones anyway. You can pay to go private as well. So when you are no well you make an appointment with the doc. They check you out and if they think medication will sort you out you get your prescription to take to your local chemist.

If they think it needs looking further into they will refer you to the specialists. So with my arthritis i get prescribed naproxen anti inflammatory tablets, co codamal pain killers, tramadol painkillers and amitriptyline for sleeping. But the doc reffered my to the orthpaedics who had a gander then they sent me for operations on my knees to st johns hossie.

All this is free to residents in scotland. As are your first eye tests at the opticians. The nhs also do dental care which is free to those out of work or on low pay.

"Healthcare in Scotland is mainly provided by Scotland's public health service, NHS Scotland, that provides healthcare to all permanent residents that is free at the point of need and paid for from general taxation. Health is a matter that is devolved, and considerable differences are now developing between the public healthcare systems in the different countries of the United Kingdom.[1] Though the public system dominates healthcare provision, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay."

"In 2008, the NHS in Scotland had around 158,000 staff including more than 47,500 nurses, midwives and health visitors and over 3,800 consultants. In addition, there are also more than 12,000 doctors, family practitioners and allied health professionals, including dentists, opticians and community pharmacists, who operate as independent contractors providing a range of services within the NHS. Prescriptions are entirely free from May 2010. Fees are still payable to dentists and opticians."

https://en.m.wikipedia.org/wiki/Healthcare_in_Scotland


"Scottish health boards are chasing overseas patients for £1.86m in unpaid hospital bills, according to data obtained by BBC Scotland. Most debt is for treatment given in the past year, but one boards is still pursuing a bill from 2003. The bulk of outstanding charges are due from citizens of the USA, Canada, Nigeria and India.

The Scottish government said it represented a small proportion of the NHS budget. Half of the overall debt - £893,368 - is owed to NHS Greater Glasgow.
The figures, obtained by BBC Scotland through a series of coordinated freedom of information requests, also reveals the total of unpaid bills has more than doubled over the past two years.

In April 2013, it was reported Scottish health boards were owed £1.1m by overseas patients - compared to £712,182 in 2012.
And the data shows part of the problem is the exponential build-up of patient debt from previous years.
NHS Fife is still chasing a US citizen for £2,602 for treatment dating back to 2003; NHS Grampian is trying to recoup £2,485 from an Indian citizen for treatment they received in 2007.
A spokeswoman for NHS Grampian said the overdue debts were often due to "claims against the estate of deceased persons, insurance companies disputing charges, lack of insurance or an ability to pay."
http://www.bbc.co.uk/news/uk-scotland-30378481

So personally i would like to see health tourism stopped and MAKE visitors to my homeland have insurance. The money owed would be better spent on our own citizens. Our hossies are understaffed and over worked. But when in hossie it is just luck the staff you get. A massive issue is cleanliness. The cleaning was privatised and of course you pay peanuts you get monkeys. There are far too many managers and useless non jobs which should be binned and frontline staff taken on instead.

Sometimes there are outbreaks of illnesses in hossies but hey we cant live forever.

As for this stupid trout she defies belief. Open mouth stuff this is.

"Healthy nurse chooses to die aged 75 at Swiss suicide clinic rather than grow old
10:48, 2 AUGUST 2015 BY MIKEY SMITH
Gill Pharaoh was determined not to become a burden to her family or the NHS in her old age saying "I am told I look ok and I take no medication,however, I feel my life is complete and I am ready to die'"
http://www.mirror.co.uk/news/uk-news/healthy-nurse-chooses-die-aged-6179969
 dragonbytes
Joined: 9/15/2015
Msg: 105
view profile
History
Life without health insurance
Posted: 2/6/2016 7:56:17 AM
Well, this is the first month I have had to pay for health insurance. First time ever.

It's ridiculously overpriced and provides no benefit unless I get cancer, need a heart transplant, have a recurring long term medical need or similarly catastrophic medical problem.

Being healthy and having little need for doctors, I would never pay for health insurance but under the affordable care act I am pretty much forced to buy it or pay a tax penalty that is equal to the cheapest bronze plan I can buy. I could request my wife to not work, and then we would could fall under medicaid, but my wife couldn't get it since she isn't a USA citizen.

The only thing remotely good about it is that since I have a high deductible plan, I can contribute to a HSA, a Health Savings Account, but the rules are a little complex about how much I can contribute without tripping another tax penalty.

I delayed getting health insurance until Jan 31st, to start on March 1st, at least I avoided paying for two months, just went without any health insurance. I had no health insurance for the last 11 years or so, not a big deal as you can negotiate rates and usually find a fairly inexpensive alternative.

Though I did have eye surgery in Thailand and dental work in Cambodia, not everyone would be willing to do that. However, that does make much of the travel tax deductible.

Even having a job that "provides" healthcare while usually better that buying if from the market place, still you have to pay for it, and it's still not cheap. (Cheap is less than $100 for two people per month.) When I was working, I didn't pay anything, though for dental I had co-pays and deductible. Those days for most people are long gone.

So does anyone have any suggestions of how to avoid paying for healthcare but not pay a tax penalty? I don't see any loopholes.
 8inscrew
Joined: 11/17/2014
Msg: 106
Life without health insurance
Posted: 2/6/2016 8:40:02 AM
I waited too. Ran into the same problem....

My out of pocket would have been $1000 a month, or twelve thousand dollars up front
before insurance even takes effect. Or about $4800 a year if I don't use it. It is mandatory.
I must pay. Even then the coverage is minimal.

So I decided to go to college.
Right now 6-7 credits a semester qualifies me for the student plan, as well as financial aid.
The student plan is pretty great. About $2800 a year, with $6200 out of pocket max.
Yet the co pays are only $10, drugs $10, an mri is $100.
It even cover vision and dental if there is injury or accident.

I decided to self pay for two classes. About $400. This semester the insurance is $1300. Next $1500.
Best I came up with... you can even just do online classes in your spare time.

It still costs me $3600 a year if I don't use it.
But at least I am not fined and get the benefit of four classes, as well as a good plan if I do need it.

Seems like I had to read about 300 pages to find this out. Hope this "loophole" doesn't get shut down.
I may even go full time in the fall.... or just start collecting certifications.

Also get to use all the gyms, libraries, computers, mentoring and tutoring, discounts on many things.
I can ask to just sit in on classes I find interesting ect. Win win?
 BigBadNIrish
Joined: 1/31/2011
Msg: 107
Life without health insurance
Posted: 2/6/2016 9:32:48 AM
I'me 59 and have a gold ACA plan...My cost is $832/month..which was somewhat cheaper than my retired employee insurance of $1400/month-very similar benefits)...Last year I had my 5 year (family history of colon cancer) colonoscopy...no out of pocket....here that procedure is about $3000.

A couple of people here say "why do I need insurance, I've never been sick?" Well, the only answer I can give is I'm glad you have a plan not to become ill or get injured-let me know how well that works out for you.

My spouse, who was 37 at the time, started to have slurred speech. After several different doctors we finally ended up at the neurologist who sent us to a "center of excellence" hospital...I found that's protocol for determining when someone has ALS (or Lou Gehrig's disease.) In the year it took for the disease to take my wife's life she was in the hospital a total of something like 30 days-we went to Columbia Presbyterian Hospital for her care-we received in home care as well as hospice care-we had medical devices provided to us (hospital bed and power wheel chair)-or in dollar costs-something in excess of $250,000....occupational therapy, speech therapy, respiratory therapy, neurologist, ect...and she stayed at home for the most part and I was the caregiver.....and my out of pocket was $1000...Thank God for insurance...I never thought to tell my wife her plan not to become ill didn't work.

There is not one person here who buys a new car who wouldn't put casualty insurance on that vehicle...because the cost of a replacement would be too great...yet, byatche about the cost of health insurance for something of much greater value than a car. Hopefully, you understand the concept of insurance...not everyone who has it will see the full benefit (claims equal to or greater than premium paid)...because someone out there will receive well in excess of premiums paid in claim...it's suppose to balance out that way.

Very few homes burn down, but no one goes without homeowners insurance.
 Yule_liquor
Joined: 12/7/2011
Msg: 108
Life without health insurance
Posted: 2/6/2016 9:51:35 PM
#105


So does anyone have any suggestions of how to avoid paying for healthcare but not pay a tax penalty?


Don't fool yourself into thinking that you don't pay (or pay less) for insurance if you get it through your job!

You (the employee) always pay for insurance either directly or indirectly.
If you do get it through employee "group rates"; your employer will factor that cost against your starting salary.

In other words; lets say that it costs your employer $5000/year to insure you. That breaks down to $96 per week, and divided by a 40 hour week, it is $2.40 per hour of insurance cost.

So if this job (with insurance) paid you $15 per hour, you should realize that without health insurance, your employer would be able to pay you $2.40/hr more without affecting his profit margin.


So does anyone have any suggestions of how to avoid paying for healthcare but not pay a tax penalty?


move to any other country where there is socialized healthcare
 8inscrew
Joined: 11/17/2014
Msg: 109
Life without health insurance
Posted: 2/7/2016 7:53:51 AM
I should have added... there is a tuition waiver for senior citizens.
No offense if you aren't there yet dragon.

Also many grants out there. Takes a bit of work to sort through and apply.


Condolences for the loss of your wife, Irish.
 sillysarainsask
Joined: 1/12/2016
Msg: 110
Life without health insurance
Posted: 2/7/2016 8:15:02 AM
I have an American brother inlaw. He's lived in Canada with my sister for 25 years and goes back and forth across the border. He keeps a US address in Washington state. He's never made a mortgage payment on my sisters house (she had the house before she met him). He owns nothing except two cars and a motorcycle with a combined value of 7 grand, tops. He couldn't get on my sister's health plan because he's an American so he's never had health insurance because he's cheap. He says if he has a heart attack in Canada, or the US, they HAVE to treat him. He brings gas back from the US in jerry cans, he shops at Costco in Bellingham because it's cheaper, he worked for an American company so his taxes go south. Yet he lives in Vancouver. I've called him a cheap fvcker more than once.

And what is worse, he's a user. A user. He buys his vehicles from EBay from some state, last one came from Texas, he plates it and registers it in Oregon because it's cheaper than Washington and spends 95% of driving time on Canadian roads he doesn't contribute taxes to. He's a Fvcking user cheap SOB. He's coming up to his 69th or 70th birthday so I think he gets some kind of medical insurance shortly. It's got to be free or he wouldn't be getting it. So maybe now he can partially live off the good ole US of A instead of just living off my sister.

I can't believe what you guys pay down south for health insurance. We don't pay a quarter of that.
 dragonbytes
Joined: 9/15/2015
Msg: 111
view profile
History
Life without health insurance
Posted: 2/8/2016 6:35:07 AM
8inscrew
My out of pocket would have been $1000 a month, or twelve thousand dollars up front before insurance even takes effect. Or about $4800 a year if I don't use it. It is mandatory.

I must pay. Even then the coverage is minimal.


You must be paying for two or more people.

The college idea is a good one, I didn't think about that.

BUT when I just looked into health insurance for the community college my wife was attending, they do have age adjusted rates. It still it looks a lot cheaper, though she would have to juggle work and school, and if she quit work health insurance would be nearly free. I suppose I could take classes, though it makes more sense for her to attend school.

BigBadNIrish
My spouse, who was 37 at the time, started to have slurred speech. ... I found that's protocol for determining when someone has ALS (or Lou Gehrig's disease.)


My condolences about your wife, that is a heartbreaking way to die an early death. Modern medicine can really only provide palliative care for ALS.

(I did state that health insurance even though over priced is good for major medical problems)

IMO this life event likely shaped your thinking about not only healthcare but many aspects of life.

However, your post does illustrate several problems with healthcare.


I'me 59 and have a gold ACA plan...My cost is $832/month..which was somewhat cheaper than my retired employee insurance of $1400/month-very similar benefits)...Last year I had my 5 year (family history of colon cancer) colonoscopy...no out of pocket....here that procedure is about $3000.


$3000 is the suggested retail price, no insurance company ever pays that much. I use the healthcare blue book to estiamte expenese, it should be more like $1900. I would only pay $500-$600 for this procedure, that is the price of a simple colonoscopy without polyps from a top rated hospital international hospital outside of the USA. It's $900-1000 if there are polyps, biopsy surgery.

In the USA under ACA, a colonoscopy falls under "Preventive Services Covered". It's free regardless of if you have a bronze plan and pay $180 a month or a gold plan and pay $832.

BTW, I did get a colonoscopy last year, but the only reason I got it was that it was free. No one in my extended family has ever had any type of cancer, with the exception of an uncle that had leukemia.


There is not one person here who buys a new car who wouldn't put casualty insurance on that vehicle...because the cost of a replacement would be too great...yet, byatche about the cost of health insurance for something of much greater value than a car. Hopefully, you understand the concept of insurance.


Casualty insurance is legally required by 48 states and you have to post a bond in the other state. So I guess the reason they passed a law is because some people didn't get it.

BTW, likley you are talking about collision insurance, not casualty insurance. Collision covers the cost of replacing a vehicle, and if you get a car loan it's required that you buy it. So how many buy their new car for cash? They are the only ones that could avoid collision insurance. But I will grant you, most peoplewith new cars probably have it.

The reason casualty insurance is required, is because it's a tort issue. You can cause injury and damage to others when you have an accident, they need to be assured they can collect.


Very few homes burn down, but no one goes without homeowners insurance.


It is required if you have a mortgage, but not legally required. I think 97% have home insurance but only 29 percent of renters have renter’s insurance.
----------------------------------------------------------------------
No other insurance product pays for routine repair and maintenance, it doesn't pay for plumbers, inspectors, oil changes, etc. However health insurance is designed to cover everything provided by the medical industrial complex. And as a result, everthing is grossly overpriced.

Many people with health insurance pretend they don't have insurance so they can pay the cheaper cash / self pay rate. Health insurance isn't worth the price for anything outside of major medical problems. You can get a cheaper rate if you don't have insurance!

I resent getting sucked into the ACA, though likely it won't be an issue for more than 3-4 months. So I am making the best out of it.

My point was that the whole medical industrial complex is grossly overpriced and ACA is more like a tax designed to support this industry and shift the costs to the middle and lower class in the US. It will probably be several decades before the government can reign in this industry and get more rational pricing.

 BigBadNIrish
Joined: 1/31/2011
Msg: 112
Life without health insurance
Posted: 2/8/2016 7:28:53 AM

IMO this life event likely shaped your thinking about not only healthcare but many aspects of life.


That it has, but I'd like to point out that I had other options at the time with my group insurance. I worked for a company that had 30,000 employees...I could have had a lesser coverage plan for a lower cost share, but chose not to. My thoughts about insurance were formed by my parents, life experience, education, and job. I was a financial planner in my professional career.


I did state that health insurance even though over priced is good for major medical problems


Absolutely true. So, when does one plan to have major medical problems? Should one be allowed to buy the insurance after they know about the major medical issue? Because if so, then they'd only have to pay premium of about 115% the cost of the medical care (true cost of care plus administration)


$3000 is the suggested retail price, no insurance company ever pays that much


That's true, because the insurance company negotiates with the leverage of numbers, whereas, an individual has no volume of numbers to negotiate.


I would only pay $500-$600 for this procedure, that is the price of a simple colonoscopy without polyps from a top rated hospital international hospital outside of the USA. It's $900-1000 if there are polyps, biopsy surgery.


Don't forget to add in the super-saver airfare and AirNB costs.


In the USA under ACA, a colonoscopy falls under "Preventive Services Covered". It's free regardless of if you have a bronze plan and pay $180 a month or a gold plan and pay $832.


That was not the point I make...if the difference between plan levels is the discussion you'd like to make then I would point out that the level of plan determines the amount of risk one wishes to assume. Clearly a gold plan takes on premium risk and puts the insurance risk burden on the insurance company...A bronze plan puts the insurance risk on the insured who assumes a lower premium risk.


Casualty insurance is legally required by 48 state


Yes it is...it is a social insurance required so that the actions of one does not become the burden of others. Yet, my point was about the property insurance that 99.99999% of all new car buyers maintain to protect their investment. My point was that people discount the value of their lives.


Many people with health insurance pretend they don't have insurance so they can pay the cheaper cash / self pay rate.


I've read this before, but in my personal life haven't found this to be true....some of the tests that we'd had done oh not so long ago were deemed experimental and thus no insurance coverage...I tried negotiating with Columbia Presbyterian...uh, that didn't work.


However health insurance is designed to cover everything provided by the medical industrial complex. And as a result, everthing is grossly overpriced.


How does one eat an elephant? One bite at a time. The medical industrial complex (love that term) isn't just health insurance....it's pharma, tort, devices, hospital, and people....in essence-the whole kit-n-kabootal.. Which part should be eaten first? For the social welfare of the country, our President chose to work in healthcare insurance...to reduce the numbers of uninsured. I believe there is bi-partisan support to tackle pharma next...all because of Martin Shkreli....I like Sanders single payer plan...medicare, which is a single payer, pretty much determines the reimbursement rate for the largest of insurers...has the lowest administration cost...and ends up being the cheapest insurance for the most likely segment of Americans to actually use insurance....why not forgo a premium for a lower net cost in taxes? I'll tell you why...because the uneducated masses cannot do the math.


ACA is more like a tax designed to support this industry and shift the costs to the middle and lower class in the US.


But, who actually uses healthcare services? Everyone. So, who should pay for healthcare insurance?


It will probably be several decades before the government can reign in this industry and get more rational pricing.


Yea, without doubt...one bite at a time.
 dragonbytes
Joined: 9/15/2015
Msg: 113
view profile
History
Life without health insurance
Posted: 2/8/2016 8:40:38 AM

That's true, because the insurance company negotiates with the leverage of numbers, whereas, an individual has no volume of numbers to negotiate.


That's how they rationalize it, but IMO it's more a ploy to be able to pass on deductibles to those who buy insurance and to make it look like you are saving money. It's hard to guess, but maybe only 2% of colonoscopies where they get that $3000 rate. They suppress competition and make it difficult to even find out what the price is. Still, you can get $1900 if you shop around, though I guess the hospital typically gets $900-$1000, if that. from 98% of their colonoscopies.

That is why I call it a suggested retail rate, they seldom if ever collect that much for such a routine procedure.

Five years ago when I didn't have any earned income, I could have gotten a colonoscopy for free from a community program, I just didn't feel motivated enough to follow up on it. (BTW they don't count unearned income like stock profits}.


Absolutely true. So, when does one plan to have major medical problems?


It's an actuarial decision based on personal history, ongoing medical tests and being sensitive to your own body.

It's not perfect, but it's the basis of how they price insurance. So you can stack the odds in your favor. Generally speaking, we know something is wrong way before any doctor tells us. It's not like they discover problems with no symptoms we weren't aware of. I think that is pretty rare to happen.

This also requiers you to save the money you would normally pay out to health insurance for whatever medical needs come up, and being able to order your own private blood tests helps.


Clearly a gold plan takes on premium risk and puts the insurance risk burden on the insurance company.


I agree, you confused the issue by bringing up a common procedure covered under "Preventive Services".

Though I wouldn't call it a burden the insurance companies, they are more than compensted and don;t lose money regardless of your plan level.

It would be interesting to know which level they make more money on. If I had to guess, it would be whatever level the majority of people buy into. My guess is they make the most money from their bronze plans, likley the most healthy people pick those. Though the lower middle class might also sign up, I guess that group signs up most often for silver.


I've read this before, but in my personal life haven't found this to be true....some of the tests that we'd had done oh not so long ago were deemed experimental and thus no insurance coverage...I tried negotiating with Columbia Presbyterian...uh, that didn't work.


I would assume so, it's difficult to negotiate when there are no other options to go elsewhere, time is of the essence, they are the only sellers of this and it's a life and death decision.

On the other hand, a tooth implant is subject to negotiation. The vast majority of our medical procedures aren't an emergency and are offered by multiple sources. So you have time and places to search around.

A few years ago I tried pricing out epiretinal membrane (eye) surgery and I wanted to include cataract surgery. It was nearly impossible to get a complete price from a USA doctor. Though after a few months, they did say there was some sort of needs based price program. But I already decided to get the surgery on my next trip to Thailand.

Martin Shkreli is just the most egregious example of a common practice among the pharma industry. Typicality, I buy prescription drugs mail order from London unless I have some sort of very cheap drug insurance or the USA retail price is only say 20% more expensive. But more often the USA drug price is 100-300% more expensive than you could get it in London.

I can see we largely agree, and are approaching this from two ends of a spectrum. I think the ACA was a necessary first step in getting a handle on the medical industrial complex, I am mostly looking for ways to minimize my personal costs. And it's annoying to knowing have to over pay.
 BigBadNIrish
Joined: 1/31/2011
Msg: 114
Life without health insurance
Posted: 2/8/2016 9:45:48 AM
I'm glad you brought up medical service pricing. Because there is no standard price. There's the Medicaid rate, the Medicare rate, the Anthem rate, the Aetna rate...cryste if I wanted to buy a fvckin car I'd go to a car dealership and hassle out the price with the sales guy-who would have to go see his manager to see how much money he'd make today...but, I don't want to negotiate the cost of my healthcare...and I sure as heII don't want to trust my healthcare to the lowest bidding doctor.


I would assume so, it's difficult to negotiate


I wonder how many hospitals perform an EMG and how many neurologists know how to interpret them?


Martin Shkreli is just the most egregious example of a common practice among the pharma industry.


I actually don't think so....he's just the most visible one with a target on him...I think it's bullshyte that medicare, the largest insurer in America, cannot negotiate drug pricing. All this bullshyte about research and developement-so Pharma can stick it to American's...just why is it that drugs are cheaper right across the border in Canada..or GB? It's called profit...and we know who is all about profit for their corporate masters.


It's an actuarial decision based on personal history, ongoing medical tests and being sensitive to your own body.
It's not perfect, but it's the basis of how they price insurance.


Claims paid + administration=premium...but, private insurance includes the cost of advertising and commissions paid in their administration costs....plus those million $+ salaries of the execs...along with the corporate G5...


I am mostly looking for ways to minimize my personal costs. And it's annoying to knowing have to over pay.


Sounds like the mission of every consumer. We all over pay....until something serious happens...then we get even...


personal history


One last thing...personal history...while a statistically good indicator of future health issues...it's only that...it's not a guarantee of health issues nor a guarantee of no health issues....that my mothers mother lived to be 100 and my father and his sister lived to be 90 is no indication that I will.
 caballerosiempre
Joined: 12/5/2015
Msg: 115
Life without health insurance
Posted: 2/8/2016 10:59:24 AM


Don't forget to add in the super-saver airfare and AirNB costs.


and consider the bonus that you get to see another country, something outside of your little block in your little street in your little town..with luck the timing can be set so as to enjoy some time in the other location as well..medical/vcacation
 8inscrew
Joined: 11/17/2014
Msg: 116
Life without health insurance
Posted: 2/9/2016 2:11:42 AM
^^^^ I agree. You get more for the money. Like with college.

My explanation above must have been muddy. Sorry.

I pay for just me, right now. Spouses are covered with the same rate.
The bigger your family, the better geared for them.
New. I have never qualified. My work has cost me in all ten figures


For the silver plan if I pay out of pocket...
About 400+ a month. Max self pay 6800.
Mri 2000. Copays 10-40.
No prescription savings unless high cost/deeply involved treatment.
No dental no optical.
Basically I pay up to 6800 + the copays + the monthly rate.... before I get any treatment.
Totaling about 12k a year.
4800 mandatory. Without treatment. bronze plan is a joke.

The student deal is closer to the gold plan.
About 1400 for six months. Things change for the fall. It will be 14 and 14.
Who thought of 15/13 anyways?
plus mri is 100. Dental accidents free. Eye also. 10 dollar copay.
health and insurance companies developed that word.
Copay.


I wish I could insure myself so swell. As Saul might say...
plus i get the benefit of an education.

Gratitude is not a ****ing emotion.
As Jimmy would say.

Irish.... with your background. What do you say?
cheapest conformitory out there?
hedge?

i dont like the 5k price tag. Mandatory. Yearly.
I buy my own teeth. No gubment english knotty pine here.
my teeth are diamond. No help of any one but my 22 thousand dollars.
and my kind mechanic.

Dnr takes care of my fiscal responsibility to society.
My executor will take care of the rest.
Living wills remove all ambiguity.
I had this conversation tonight with a lady waiting on her ssi/dis to come through.
ima home sick gypsy.

Homeward bound.
 BigBadNIrish
Joined: 1/31/2011
Msg: 117
Life without health insurance
Posted: 2/10/2016 9:14:09 AM
Insurance is regulated by each state. And because of that each state plan of insurance is different causing increased administration costs. ACA brought essential services and a somewhat plan standard, but there still are specific state nuances. Anyway, when it came time for me to shop insurance I chose the coverage and premium that I specifically wanted. To each their own. I stopped giving advice to others about their insurance when I retired.

A DNR is a good start, but you might want to add an advanced healthcare directive and medical/healthcare POA...I'm fairly sure that a DNR alone won't cover enough bases to do the job you want.

Little story...back around 1968 my father had a frontal lob aneurysm. He was 52...he was in intensive care for a week and the hospital for a month...fortunately my dad was retired career military and a working teacher so he had great insurance...my parents didn't have to sell the house and pull my brother from college. The mortality rate for a frontal lob aneurysm was something like 55% and very few were whole if they lived...my father was undamaged-though he was on meds for 20 years after. he lived to be 90...

I wonder what life would have been like if my mom pulled the plug on my dad in 1968?
 dragonbytes
Joined: 9/15/2015
Msg: 118
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History
Life without health insurance
Posted: 2/10/2016 11:11:02 AM
bigbadnirish
Sounds like the mission of every consumer. We all over pay....until something serious happens...then we get even..


IMO most consumers make all sorts of value mistakes. Either buying shoddy products at a cheap price, overpaying for a brand that doesn't provide any added value, buying too large a quantity or too small a size, etc.

Easy for instance, my single 40 year old neighbor used to buy most his groceries at 7-11, paying 50% more than for the same product that he could have purchased at Aldis, basically the same distance from his house.

Healthcare rules are especially byzantine and intertwined with tax laws. I spent at least 4 days tweaking the numbers.

My analysis was that for an individual making between 17K-29LK, silver plans were the best value because the Government not only gave a subsidy, but payed for some of your deductions and copays.

Under 17K you qualified for medicaid, the cheapest way to go.

Over 29K, there was virtually no difference in total cost per year of a bronze Vs gold plan, assuming you went to a doctor at least a 4 times per year. If you didn't visit a doctor except for free preventative medical services, the best value was a bronze plan since you were only paying the premium.

High Medical anticipated

18 Doctor visits
13 Lab or diagnostic tests
48 Prescription drugs
4 days in the hospital
$20,800 in other medical expenses

Low medical anticipated
4 Doctor visits
2 Lab or diagnostic tests
9 Prescription drugs
$100 in other medical expenses

Low medical TOTAL YEARLY COSTS premium, deductible and copay)
Bronze $4,658-$10,183
gold $6,815-$9,796 ($15,080 outlier high gold plan)

High Medical TOTAL YEARLY COSTS premium, deductible and copay)
Bronze $10,842-$16,193
Gold $10,427-$15494 ($19,663 outlier high gold plan)

If you earn between $17-$29 K, a Silver plan looks best because the Gov not only gives you a subsidy, but helps pay down part of your deductible, co payments, and coinsurance.

So you don't save any money by buying a gold plan. You pay higher premiums which more than makes up for the lower deductibles.
Of course, if you select a bronze plan, you need to save the difference between your lower bronze premium basis and the higher gold premium. You would need to use this saving to pay for the higher deductible of any medical you needed.

Now if you created a HSA, Health Savings Account, then that lowers your AGI, lowers your tax burden, and increase the subsidy the Goverment gives you.. You can only create a HSA if you have a high deductible bronze plan.

As you say, the nuances will change from state to state, and the numbers change if you are married or if you have dependants, but the ratios stayed the same. Note I didn't do a lot of checking into other states, but I did spend a few hours checking.

So it seems to me, bronze is the clear winner if you create the HSA, and without the HSA it's kind of six of one and 1/2 dozen of the other between bronze and gold. Even if you are a heavy user of medical services. Because all the plans have a yearly cap on out of pocket expense.

Maybe I overlooked something, what might that be?
 BigBadNIrish
Joined: 1/31/2011
Msg: 119
Life without health insurance
Posted: 2/10/2016 1:13:11 PM
Well, I relooked at the lowest cost Bronze plan in CT and my Gold plan...premium+max out of pocket=$13,000 for both...

The rub is with any prescriptions and health issue the Bronze plan is pure cost till the out of pocket max of $6500. While I pay $5 for prescriptions and $20 for Dr. visits. It takes forever to get to my out of pocket max. Where I would hit my out of pocket max with a Bronze plan in month 8.
 dragonbytes
Joined: 9/15/2015
Msg: 120
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Life without health insurance
Posted: 2/10/2016 7:32:44 PM

Well, I relooked at the lowest cost Bronze plan in CT and my Gold plan...premium+max out of pocket=$13,000 for both...

The rub is with any prescriptions and health issue the Bronze plan is pure cost till the out of pocket max of $6500. While I pay $5 for prescriptions and $20 for Dr. visits. It takes forever to get to my out of pocket max. Where I would hit my out of pocket max with a Bronze plan in month 8


So I guess that means the bronze plan is $6500 or $541 a month in premiums?

The gold plan is $832 a month, or $9984 a month.

If you have the bronze plan you can spend up to $3484 before the gold plan makes more sense. And if you have a very serious medical problem and you use up the out of pocket max, then the two plans are the same.

They even wrote some stories about this.

When cheaper health insurance is unwelcome news for some
http://www.chicagotribune.com/business/ct-cook-county-aca-subsidies-1105-biz-20151104-story.html

This all reminds me of the tax code, where it appears you get a benefit by being able to claim various deductions like for medical, until you actually try and take advantage of it. Then find out about all the limitations.

In a related note, when I was looking at different zip codes I discovered that if I live another r7 miles west of here, I would be in a different county, same state. The premium tax credit would be $630 Vs $275 where I live, and a bronze plan would be over 50% cheaper. More than a nuance.

Another odd note, if you buy a bronze plan, the cheapest of them have some sort of benefit like generic drugs are $20. The $20 makes it ineligible for HSA, even though it's not that big a deal. BUT IF you want to buy a HSA eligible plan, you have to pay more for it even though it covers less. My guess is they price it higher because it allows you to have a HSA.

Basically, the ACA is forcing healthy people to pay for a health insurance they don't want.

I really can't wait to get out of this system. (Either get employer provided health insurance or Medicare.)

No doubt if I was a diabetic or had crohn's disease, I would have a totally different feeling about this.
 BigBadNIrish
Joined: 1/31/2011
Msg: 121
Life without health insurance
Posted: 2/10/2016 7:57:17 PM
OK..I'll bite.

The bronze plan is roughly $500/month or $6000/year+$5500 deductible/ $6500 max out of pocket..no copays no coinsurance...the cheapest plan=$12500...no prescription coverage until deductible is met

I pay $832X12=$9984+max out of pocket $3000=$12984

the difference is $5 prescription copays and $20 doctor copays...not to get into my medical history I would reach my max out of pocket in a bronze plan in 8 months and never come close with my gold plan...just one of my prescriptions runs around $150/month...that's $1800 that would go to a bronze plan deductible and max out of pocket cost that runs me $60/year ($5/month X 12 months)...now you can attempt to analyze this front and back...but, that's the facts...for me the gold plan is net cheaper. I never approach max out of pocket.



No doubt if I was a diabetic or had crohn's disease


These are not the only chronic conditions.
 ohenryx
Joined: 3/12/2010
Msg: 122
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Life without health insurance
Posted: 2/11/2016 1:41:43 PM
Thankfully, I don’t have to sweat this. I am a retiree from a major oil company, and I can participate in their insurance plan, paying full rate of course. Still much cheaper than what is being discussed here.

But I did want to chime in on the issue of costs for a procedure. My younger brother has a hernia, and needs surgery. No job, no insurance, no nothing. I did quite a bit of research online, insurance companies pay $1,800 for this surgery. But no insurance, you pay $5,000. Actually a little more, but I don’t remember the exact number, just that it was $5,xxx.

Trying to negotiate was a fool’s play. They would hang up on me, or put me on hold and never get back to me. No leverage, no joy.

And this isn’t the only area where insurance companies pay less. Back in 2013, feral cats tore up the wiring under the hood of my new Ford F150. This was not covered under the new car warranty, and the dealer wanted a little over $1,800 for the repair. I talked to my insurance company; they covered it with a $100 deductible. The final bill was $1,150, more than a third less than what the car dealer had asked from me.

Unfair? You bet. Anything we as individuals can do about it? Not that I can see.
 mrmagogle
Joined: 2/7/2016
Msg: 123
Life without health insurance
Posted: 2/11/2016 1:52:59 PM
Don't fret. When Trump wins, he is going to get rid of Obama care and replace it with something "terrific". He is just going to waive a magic wand and everything will be okay.
 mrmagogle
Joined: 2/7/2016
Msg: 124
Life without health insurance
Posted: 2/11/2016 1:55:04 PM
[quote ]Trying to negotiate was a fool’s play. They would hang up on me, or put me on hold and never get back to me. No leverage, no joy.

All medical bills are negotiable . . . especially after the fact. Once you get the treatment and the bill, you are in the cats-bird seat. They take something reasonable or they take nothing at all.

I don't understand why people go bankrupt to avoid medical bills. . . just don't pay the damn things if they are outrageous.
 dragonbytes
Joined: 9/15/2015
Msg: 125
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Life without health insurance
Posted: 2/11/2016 3:10:02 PM

All medical bills are negotiable . . . especially after the fact. Once you get the treatment and the bill, you are in the cats-bird seat. They take something reasonable or they take nothing at all.


Have you actually tried that, and did they ruin your credit rating first before relenting and accepting a lower fee?

I wonder what happens if you need any follow up :) ?
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