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**Qqmike** · Dec 06, 2016, 06:53 PM

Ha! Always read the fine print! I sympathize, though. It seems that if it isn't one thing, it's another as far as the medical stuff goes.

Fact is, this is and always has been a fact of insurance: deductibles, copays, maximum annual out-of-pocket cash, and so on.

It's not Obamacare that is at fault; it is the health/medical/pharmaceutical system in USA. Extremely big business.

As for Medicare, GOP Paul Ryan is a dangerous man; his complex plan would hand you a voucher against this insurance. Good news, though: If Ryan ever succeeds in destroying Medicare, that would ruin the GOP for decades to come. Trump has said he would not reduce Medicare.

We have friends thrilled to get health insurance now, ages 45-60, only to find out that their CT scan just cost them $2500 to pay the annual deductible. That's insurance in action for ya.

How can anyone making $8-$12 an hour afford to pay a $1500-$2500 annual deductible? Well, they can't, plain and simple.

As for Medicare, it needs to be improved, not deprecated or destroyed. There are good things, though, like Medicare Advantage Plans--HMO, PPO, or other, and they are a deal, no need for any supplemental.

**GreyGeek** · Dec 06, 2016, 07:33 PM

Originally posted by Qqmike View Post

... As for Medicare, it needs to be improved, not deprecated or destroyed. There are good things, though, like Medicare Advantage Plans--HMO, PPO, or other, and they are a deal, no need for any supplemental.

PPO's are supplemental. So are HMO's. If a retired person depends on just Medicare alone they will have a tough time finding a doctor who will accept only Medicare. My wife and I supplement Medicare with a PPO that costs us each an additional $131.00/mo. Even then the "total out of pocket costs per year" is supposed to never exceed $10K... each. In my wife's monthly summary it states "For most covered services, the plan pays its share of the cost only after you have paid your YEARLY plan deductible." My wife's two operations, one on her heart in March of 2015, and one on her hip in July of 2015, cost $148,000 and $38,000 respectively. For 2015 my out of pocket expense came in at a hair under $10,000. Nine years ago she had a De Vinci Surgical Robot perform a Mitral valve replacement. The bill for the hospital, doctors and all came to $350,000. Our insurance at the time paid all but about $5,000, IIRC.

One gotcha that Medicare people should be aware of is the rehabilitation costs. Medicare pays for 20 days of rehabilitation with or without supplemental, then you are on your own. However, a clock starts and if you have to have another round of rehabilitation you'd better hope that it begins a few days past 60 days after the last day of your previous rehabilitation or you are in for the entire bill. Luckily, my wife's hip rehabilitation began 65 days after her heart rehab ended.

The CEO of the insurance company we have is paid $3M/yr and is re-reimbursed for air travel to and from his home, which is sometimes on a daily basis. He also gets bonuses that add significantly to his salary.

The problem started when Halderman walked into Nixon's office in the WhiteHouse and told him of a "neat" new kind of insurance called an HMO. Nixon bought it, pushed it, and it became law. The insurance companies loved it because to "Maintain Health" they had to divide the populous into groups based on age and wellness. Before that they used the amortization table which contained all Americans. Insurance rates were determined by taking the entire health costs of the population and dividing by the number of people in the population to get a per person cost. Multiply the cost by the number of people they had insured and they knew about how much the medical costs for their insured population would be. Add business expenses (salaries, property expense, etc..) and add a percentage of profit, usually twice the ROI of the stock market, divide by the number they had insured and they arrived at the per person insurance rate. Nothing too greedy.

After the HMO, which very few doctors or hospitals will accept these days, the PPO arose. In this system the populace is divided into groups based on health. The young and healthy are sold economical policies which have a high rate of return because they don't get sick as often as older folks do. This is where the Insurance companies made their money. Older folks were put into groups based on their health status and charged accordingly. The more sickly the higher their premiums will be. This is based on maximizing the profit, not spreading the costs, which the old insurance scheme did. After my wife's first heart operation our insurer, BC&BS dropped the category of policy in our area and immediately came out with a new category which was identical except for much elevated costs. We switched to Humana. Now that Medicare is where the profits are in the health insurance business, because of the exploding costs of Obamacare and people abandoning it in droves, BC&BS sent us an enrollment form. When Hell freezes over.

**Qqmike** · Dec 06, 2016, 07:57 PM

I'm starting to see that this whole issue is regional--dependent ... depends where you live. An HMO I am familiar with has zero premiums (you just pay your Medicare premium of $105 or $121/month). The PPO is an extra $70 about the Medicare premium. And here, Humana has a slippery reputation, it once targeted mainly at low-income/Medicaid segments. And BC&BS has always been stinky here, high premiums, low benefits, and they don't want to pay anything. And so on. The whole country needs to get this figured out. Healthcare expenses must be the #1 stressor for older Americans, as well as some younger people (among those who even think of their health! ).

**GreyGeek** · Dec 06, 2016, 08:54 PM

Originally posted by Qqmike View Post

...It's not Obamacare that is at fault; it is the health/medical/pharmaceutical system in USA. Extremely big business. ...

I'll have to agree with you about the Health/medical/pharm system in the US being a major contributor to the problems. I assume you are also including the AMA. However, the ACA was not and is not affordable. In fact, it was designed to fail, in order to justify bringing in the original goal, single payer health care with the Federal government being that payer. IOW, ACA was/is supposed to be so bad that the people would scream for a solution, any solution, even the Socialist one. From the WikiLeaks Podesta emails it seems obvious that both the Dems and Repubs conspired to do just that:
https://wikileaks.org/podesta-emails/emailid/54643

Given the politics now w bipartisan support including Schumer, I'll support repeal w "sense of the Senate" that revenues would have to be found. I'd be open to a range of options to do that. But we have to be careful that the R version passes which begins the unraveling of the ACA.
...
There remains a divide among your advisors with the economic team interested in you offering a "fix it" approach (Option 3) in the memo and your political team very interested in you coming out for full repeal because of the union implications (Option 1). Several of your advisors - Neera and Chris, chief among them - offered this middle ground that Jake and I thought could work (Option 2).

The "R" means Republican. "w" means with.
Apparently they worked out a "compromise" because earlier Hillary was warning them about "R Trojan horse to begin unraveling the ACA." The ACA gets repealed and the Repubs take the blame.

My view is the the ACA should be scrapped but that we NOT return to the business as usually that existed before the ACA became law. A solution would be for the Federal government to set regulations requiring insurance companies to use the methods generally in use before HMOs came out ... a single "amortization" table for ALL Americans, i.e., a tally of the total insurance costs per year of all Americans divided by the total number of Americans to obtain the cost of health care per American, regardless of age. That would be the base value of any yearly insurance premium. Every Insurance carrier would be required to offer insurance in every county of every state at the same base level to every person, irregardless of kind of employment or per-existing conditions, which would already be incorporated in the value of the base costs. Insurance would be separated from employers and individuals would purchase directly from insurance companies and pay premiums to them. The Amortization table would be generated and maintained by the Federal government and would also involve a cost of living index. And, just like it does for Medicare, it would maintain a cost of services database reference stipulating the maximum amount that would be paid for any particular procedure, so that hospital and doctor costs don't spiral out of hand. New drugs, devices and procedures would be approved by the FDA, as they are now.

One of my clients was an Anesthesiology Group of six physicians. I wrote their accounting and billing, and profit sharing software. Each one worked an average of six hours a day for four days and took two days off. (No operations on Sunday except for rare emergencies). Everyone of them took 3 months vacation per year. They each averaged $1M+/yr in income. That was when the average US income was $16-17K/yr. They were bonded for $10M/yr at the time, IIRC, while I was bonded at $1M/yr. Their liability rates have sky rocketed and must be reduced and contained. So must their sky rocketing incomes, but not by government regulations. By open competition. By breaking the strangle hold the AMA has on med schools enrollments and allowing a LOT more students to attend and earn MD degrees, without lowering standards. The law of supply and demand. Do the same for insurance companies as well.

On a dismal note, our country is so far in debt due to decades of deficit spending and unfunded mandates it probably won't matter which course of action is taken because all of them will be scrapped when the SHTF with the collapse of the economy. That's when E.O. 13603 takes over.

**Qqmike** · Dec 06, 2016, 09:04 PM

Interesting post, interesting points, GG. Yes, I was thinking of the AMA, too.

**vinnywright** · Dec 07, 2016, 05:21 PM

ACA ? is that Affordable Care Act .

I for one would not have insurance without it ,,,,,,,the insurance my work offers would cost me just about 1/2 my check every 2 weeks and has a $4000 deductible befor it covers anything .

my current ACA supplemented insurance is a $1000 deductible that I pay $38.00 a month for .

when the ACA gets over turned I will not have the $ to get any at all ,,,,,,,,,I am one of those 8-12 dollar an hour people and the only income in the house ,,,,,do the math ,,, their is nothing left after paying the bills and food is tuff to spend on,,,,my wife cant work.

VINNY

**whatthefunk** · Dec 07, 2016, 06:33 PM

I live in Japan which has a public health care system. My wife's company pays for half her insurance and i pay for all of mine. Total, we pay around $300 a month for coverage for the both of us. No deductible, no strings attached. The insurance covers 70% of all medical costs (excluding elective procedures) no matter how big or small. We also both have a supplemental private insurance which offers better payout for major illnesses/injuries etc. It pays a portion of major medical costs plus a daily sum for hospital stays. This costs us $20 a month each. So we pay around $340 a month.

My wife had a surgery earlier this year. The government insurance covered the bulk of the costs. The private insurance paid us a lump sum that actually ended up being more than the 30% we had to pay. Because my wife used sick leave/vacation time to have the surgery, her paycheck wasn't affected. So we made money

I don't know why America doesn't scrap the entire system and just start over. With all the political fighting and half the government being bought off by the medical industry, any bill they come up with is going to be crap.

**Qqmike** · Dec 07, 2016, 06:53 PM

@Vinny's post ... Yeah, well, you ain't alone, Vinny, that's for damn sure. I know dozens of people in this boat. Some qualified for the new Medicaid guidelines off of Obamacare, and for the first time in decades, they took care of some medical stuff, getting treatment for diagnoses, and stopping disease process in many cases (e.g., removing colon polyps during free colonoscopy; getting treatment for high blood pressure or high blood glucose). I know a dozen people who once were doing rather well, like in sole proprietorship business selling $1-$2 million/year, only to be blown out of the water by the recession 2007. I could write 5000 words on this subject from personal experience knowing what real-life people I know have been through. We've got friends and relatives who finally got into an ACA plan they could afford, only to find out about the high deductibles: the annual exam is free; but if you see a doctor for a specific problem--especially a specialist--you might be billed $50-$200 for the consultation PLUS more for any imaging (CT/MRI). Translation: you have the health insurance you can afford, but you can't afford to use it. (Btw, at the "free" annual exam, as you probably know, you can not address any special, ongoing or new issues--you gotta stick to the covered guidelines, or else you get billed for "part" of your annual exam!) And there's a lot of people "in the middle." They have some resources, but those resources are being strained big time. I'm in a Medicare Advanatge plan where the co-pay for a CT/MRI increased from $100 to $300 in one year (the year Obamacare went into law). There's tons of regular retired folks here for which that is a strain on their budget-savings. You get a good case of cancer, for example, and you're in for a shxtload of specialists and CTs/MRIs, and ongoing for the next 2-5 years. This country has to fix this mess.

**woodsmoke** · Dec 07, 2016, 07:15 PM

vinney.

aww..

woodsmoke

**Snowhog** · Dec 07, 2016, 07:19 PM

The 'real' problem with the ACA is that for it to work "as it was told to us it would work", EVERYONE who earns a pay check (NOT paid UNDER the table) would have to be participating; and that isn't the case. In order to 'sell' this to the American public, Obama had to 'exempt' "classes" of people.

I agree, that the American health care system is broken. It can/should be much better than it is. Medical torte reform is desperately needed in the United States. Medical malpractice cases, and the resulting ever rising cost of medical malpractice insurance contribute to the ever increasing cost of medical care in our Country. The U.S. is a 'sue happy' society. Medicine IS NOT a science; it's an art. That's why medicine is described as the "Art of Medicine" and not the "Science of Medicine". Americans don't get that; they don't want to get that. Doctors are supposed to be infallible. They aren't supposed to "make mistakes".

I don't have the conclusive answer to the problem. I have 'good' medical insurance that actually is costing me less now that I'm retired, than what it was costing me when I was still working. That said, my out of pocket expenses for the medical care I've so far received in 2016 has exceeded $3,000.00; more than 25% of my disposable retirement income.

If it were not for the incredible offer made by my sister and her husband to come live with them (after I retired), I would simply have had to forego the medical services I've received so far; I would not have been able to afford them. No one should have to forego medical care. Period. In my own opinion, necessary (not elective) medical care should be available to every American without having to worry if they can "afford" to pay for it.

**oshunluvr** · Dec 08, 2016, 09:49 AM

Let's be complete and point out that there is a ton of waste fraud and abuse in our medical system also. Some of it will be easy to fix - i.e. allow Americans to buy prescription drugs out of the country, some will not. My wife is in healthcare and I'm flabbergasted at what goes on. A GAO investigation and criminalizing some fraudulent behavior might help.

Personally, I think it mostly falls at the feet of the political system. Just like the military industrial complex, big oil, and others, the medical industry is securely embedded in the pockets of our legislators.

**GreyGeek** · Dec 08, 2016, 01:39 PM

Originally posted by oshunluvr View Post

...Personally, I think it mostly falls at the feet of the political system...

I would guesstimate that 95% of the problems are caused by government interference. In science gov funding totally controls the course of investigations in most avenues of research, especially those with a political agenda. It makes replication, one piece of the holy grail of science, impossible when the funding applications exclude those which test the validity of the "settled science". That term itself is a mockery of science because NO science is settled. Even long accepts "laws", like those of Newton, are regularly tested to verify them. As I used to tell my students: "A thousand experiments cannot prove an hypothesis right, but it takes only one to prove it wrong".

**woodsmoke** · Dec 08, 2016, 07:33 PM

As I used to tell my students: "A thousand experiments cannot prove an hypothesis right, but it takes only one to prove it wrong".

woodsmoke

Announcement

check your "out of pocket" insurance...what a joke

check your "out of pocket" insurance...what a joke

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