Socialized medicine

[wenglund]

3 hours ago, Scott said:

Here are some conflicting comments from another thread (Bad Intentions thread), but it deserves it's own topic:

This is one instance where I would agree with Rob.

Why are so many LDS people so against any form of socialized medicine?  

For many of those that need healthcare, the only choices are either to let your loved one die or to go bankrupt and to lose everything.   I don't see how this is true agency.

It is important to understand that the disagreement isn't so much over motives (like love and compassion,) or objectives (like achieving reasonable levels of health care for all) since most of us share and desire those things. Rather, it is primarily about the method used to satisfy the motives and meet the objective.

What LDS are against, like other Conservatives and Libertarians and Classical Liberals, is using a centralized government bureaucracy for health care funding and/or to provider healthcare services.  It is the same objection they have regarding welfare and other social services.

The primary reason for their objection is that centralized government control over social issues tends to be  unsustainable and ultimately not work--i.e. invariably there are the unintended negative consequences that make matters worse for all parties.

I won't clutter this thread with reasons and evidence for this position, but will refer the interested reader to my blog on the subject: What Causes Leftist LUNCS--the Law of Unintended Negative Consequences.

I happen to be in a unique position to speak in an informed way about Medicare since I care-take for my 90-year-old mother who is covered by an Advantage Medicare Plan, and I am currently eligible to receive Medicare, but I can't afford it because of poor finances.

Thanks, -Wade Englund-

 

[Guest Scott]

Anyway, for anyone that wants some more details:

My previously healthy son unexpectedly got sick at the end of March.    It was completely unexpected and there was no warning.  He has been in the treatment facility since April and the doctors said he will need to be in for another eight months.   

We had the expectation that we would be covered medically.  We didn't have a clue about the battle we were about to up against. Our deductible is $1500 (individual)/$3000 (family) for In Network and $3000/$6000 Out of Network.  Our maximum out of pocket expenses were $6250/$12,500 In Network and $11,000/$22,000.  Our insurance premiums between us and my employer are $2400 a month.

I fully thought that we were covered since worst case scenario, as far as I knew was $22,000 out of pocket, which we would make work.

The insurance company said that there were no In Network Facilities anywhere in our geographic area.  So, we asked them if they could help us find care for him somewhere else outside the geographic area.  They said that there were no In Network Facilities and that we would need to go out of Network.   We got all of his care approved.  Everything was pre-approved and authorized.

He has been in the facility for four months and every few days we got authorization and approval letters saying that all of his treatment was covered by insurance.

After four months we just started getting bills for tens of thousands of dollars.   We just found out last week that we owe six figures in medical bills; it was a complete surprise because everything was pre-authorized and approved and there was no warning.  

Here's where they got us.   For In Network Facilities, the facility isn't allowed to bill you for the difference after your out of pocket maximums are paid.  For out of Network Facilities, they are allowed to bill you for the difference.  

For expensive procedures and care, insurance companies are simply telling people that there aren't any In Network Facilities to go to so they can avoid paying more.

We had no idea we owed $141,734.21 until last week.  It was a complete shock.   So was learning that our portion will be about $600,000.    We thought we would only pay up to our out of pocket maximum on the policy.

Anyway, here are a few examples of recent bills (all of them are similar):

 

This is just a warning to others, but the insurance companies all have us by the neck.   Just because you think you are covered, might not mean that you are.

I really hope that this doesn't happen to anyone else on this forum.

 

[anatess2]

19 minutes ago, zil said:

The number of pens isn't the problem - I have more than enough pens I could ink up.  The problem is that it takes too long to use up the ink therein.    People keep posting afternoon talk-show topics that don't inspire me to doodle replies.

You have every opportunity to use your nice sample inks and you wasted it on blue!  @Just_A_Guy will be so disappointed.  

 

[wenglund]

36 minutes ago, Scott said:

This is just a warning to others, but the insurance companies all have us by the neck.   Just because you think you are covered, might not mean that you are.. I really hope that this doesn't happen to anyone else on this forum. 

Trust me, you aren't alone.  What you need to know, is that while the so-called health insurance industry has been highly flawed for decades (it has gone from covering catastrophic conditions as designed, to paying third party for across-the-board treatment), the staggering increases in premiums, deductibles, co-pays and other out-of-pocket expenses is due, in large part, ironically, to Obamacare (see HERE). 

And, it isn't just private insurance that has suffered. Obamacare raided the Medicare coffers for funding, causing Medicare Advantage Plans like my mother's to hike premiums and start charging co-pays. For example, since Obamacare was instituted, my mother's premiums have gone up 40% or more, and she recently suffered from a stroke, and had to pay $320 co-pay a day for the 4 day hospital stay, and is also being charged $320 a day for 5 of the days ofi inpatient rehab, etc. which she didn't have to pay 10 years earlier, pre-Obamacare, when she had a stroke and a hip operation..  Since she is on a nominal fixed income, and this last bout significantly drained her savings, she now can't very well afford to go to the hospital were she to get seriously sick or injured--which, at her age and physical condition, are both very high risk.

In other words, because of Obamacare, she now can't afford to use the Medicare insurance my Dad and the taxpayers paid for and what she supliments each moth through increasing premiums. All the good intentions behind Medicare and Obamacare have failed, at least for her, and I dare say for others like her who may be less fortunate.

Thanks, -Wade Englund-

Edited July 31, 2018 by wenglund

[anatess2]

35 minutes ago, Scott said:

Anyway, for anyone that wants some more details:

My previously healthy son unexpectedly got sick at the end of March.    It was completely unexpected and there was no warning.  He has been in the treatment facility since April and the doctors said he will need to be in for another eight months.   

We had the expectation that we would be covered medically.  We didn't have a clue about the battle we were about to up against. Our deductible is $1500 (individual)/$3000 (family) for In Network and $3000/$6000 Out of Network.  Our maximum out of pocket expenses were $6250/$12,500 In Network and $11,000/$22,000.  Our insurance premiums between us and my employer are $2400 a month.

I fully thought that we were covered since worst case scenario, as far as I knew was $22,000 out of pocket, which we would make work.

The insurance company said that there were no In Network Facilities anywhere in our geographic area.  So, we asked them if they could help us find care for him somewhere else outside the geographic area.  They said that there were no In Network Facilities and that we would need to go out of Network.   We got all of his care approved.  Everything was pre-approved and authorized.

He has been in the facility for four months and every few days we got authorization and approval letters saying that all of his treatment was covered by insurance.

After four months we just started getting bills for tens of thousands of dollars.   We just found out last week that we owe six figures in medical bills; it was a complete surprise because everything was pre-authorized and approved and there was no warning.  

Here's where they got us.   For In Network Facilities, the facility isn't allowed to bill you for the difference after your out of pocket maximums are paid.  For out of Network Facilities, they are allowed to bill you for the difference.  

For expensive procedures and care, insurance companies are simply telling people that there aren't any In Network Facilities to go to so they can avoid paying more.

We had no idea we owed $141,734.21 until last week.  It was a complete shock.   So was learning that our portion will be about $600,000.    We thought we would only pay up to our out of pocket maximum on the policy.

 

You didn't say anything about your copay.  Your copay for out of network is normally 30% of the cost, whereas it is 10% for in-network.  Copay is not the same as deductible.  Deductible simply means, you are not covered by insurance until you have paid $22K and then the insurance starts paying for 70% of the cost while you pay the copay.  Unless you're in one of those HMO plans where you don't have copays, your deductible does not mean that's your maximum out of pocket.

Now, before Obamacare, I had an individual coverage insurance plan in Florida.  My husband and I were independent contractors so we didn't have "company insurance".  I chose this Hospital and Surgical plan.  I had zero deductible and zero copay.  But the plan only covers any cost associated with a hospital stay or ER treatment and anything associated with an out-patient surgery and nothing else.  I paid $120/month for a maximum family membership of 4, non-smoking, non-drinking, in our 20's with no pre-existing conditions.  I budgeted $500 per month for healthcare, so I put $380 per month on a tax-free Health Savings Account. 

So I got pregnant.  I paid for everything up to the time I went to the hospital to deliver the baby.  This included the OB visits, the sonograms, the labwork, etc. etc.  All out of pocket.  I told my OB that I'm self-pay and he worked with me on structuring the charges from day 1 to the birth of my child and gave me very favorable pricing.  He listed what lab work I will need and I shopped labs until I found one that worked with me as a self-pay patient and gave me favorable pricing.   My OB decided to leave his OB group and start his own group and I didn't have to worry.  I just followed him wherever he went and he kept our charge structure that we already agreed upon. Then I developed complications and the doctor had to send me to the hospital 2 weeks before my due date and induced labor... ended up with a c-section and ended up in the hospital for over 2 weeks.  Everything 100% paid for by insurance.

I went through pregnancy and the birth of my child without ever spending more than what was on my HSA.  My son was born, another son was born, also with c-section, the first son broke his elbow, the other son got his head bashed by a metal pipe... all 100% covered by insurance - we even got the city's leading plastic surgeon (who works on breast enhancements and facelifts and such) to do the surgery on my son's head, covered 100%.  There's no in-network or out-of-network anything.  There's only, takes my insurance, doesn't take my insurance.  And I haven't found any hospital or surgeon that doesn't take the insurance.

But then to go with that insurance, we got a holistic pediatrician.  I love my pediatrician.  She is expensive for self-pay but worth it.  We got her after my first son was already born.  So when my 2nd son was born, she went to the hospital the day he was born and gave him an inspection.  We went through my diet because I was breastfeeding, she talked to my OB about post partum stuff... anyway, she was at the hospital with us for about 2 hours.  I paid the regular office visit fee.  My son got ear infection - no antibiotics.  Garlic/Willow oil eardrops, and a change of diet for me... I paid for vaccinations out of pocket so she helped me structure the shots so I can pay for it comfortably and still be within legal requirements.

Then Obamacare made that insurance illegal and my insurance company dropped the product, so I had to figure something else out.  I hated Obamacare with a passion.

Edited July 31, 2018 by anatess2

[estradling75]

1 hour ago, wenglund said:

It is important to understand that the disagreement isn't so much over motives (like love and compassion,) or objectives (like achieving reasonable levels of health care for all) since most of us share and desire those things. Rather, it is primarily about the method used to satisfy the motives and meet the objective.

Bingo....

Anyone paying any attention to health care in the USA understands it has problems.  The Democratic/liberal answer was Obama Care, and the Republicans/Conservatives were all predicting it would be a massive costly failure that will not solve the problem.   History has proven one side completely right.

Sadly stories of health care disasters (like the ones shared in this thread) then get blamed on the Republicans/Conservatives by the Democratic/Liberals limiting the ability of the Republican/Conservatives to fix it because they are going to cut cost (no duh) and if we spend less well then we are part of the problem.  Because apparently the only way one can care about/for the poor and needy is by being willing to spend massive amounts of money

 

 

Edited July 31, 2018 by estradling75

[zil]

4 hours ago, zil said:

Meanwhile, ten years or so ago, a Canadian wrote an article to Americans (who were just beginning to openly discuss socialized healthcare), and he pointed out, among other problems, that at present, in his area, the waiting list for a spot in the maternity ward was 9 months long - yes, you would have to reserve your spot before you even knew you were pregnant.  Not sure this is a good indicator of "success".

Was looking for another article and found this one instead.  It was ten months.

[mirkwood]

2 hours ago, zil said:

photoupload

[mirkwood]

1 hour ago, zil said:

I kinda like Visconti Sepia.  Both are just samples and I won't be getting more of either.  But I've decided that once I start on a sample, I'm finishing it, so they'll both be around for a while.  I'll be inking up Sailor Sei Boku   in a different pen this weekend, though - I have to initial 56 change records on Saturday - in a permanent blue ink.  (I got a stamp for the date, but still have to initial manually. )

photoupload

[Guest MormonGator]

1 minute ago, mirkwood said:

photoupload

Where did you get that?! I told you to stay out of my special, private drawer you jerk. 

[mirkwood]

Just now, MormonGator said:

Where did you get that?! I told you to stay out of my special, private drawer you jerk. 

You and wife # whatever (I forget which one @zil is), have a serious addiction problem.

 

Get. Help.

[unixknight]

50 minutes ago, estradling75 said:

  Because apparently the only way one can care about/for the poor and needy is by being willing to spend massive amounts of other people's money

Fixed that for ya.

[zil]

1 hour ago, anatess2 said:

You have every opportunity to use your nice sample inks and you wasted it on blue!  @Just_A_Guy will be so disappointed.  

[Guest Scott]

Quote

You didn't say anything about your copay.  Your copay for out of network is normally 30% of the cost, whereas it is 10% for in-network.  Copay is not the same as deductible.  Deductible simply means, you are not covered by insurance until you have paid $22K and then the insurance starts paying for 70% of the cost while you pay the copay.  Unless you're in one of those HMO plans where you don't have copays, your deductible does not mean that's your maximum out of pocket.

No it is different.

Copay is what you pay for a doctor visit.  It's usually $30.   

Coinsurance is what you are referring to and is the portion we pay after the deductible is met.  

The deductible is $1500/$3000 individual/family In Network and $3000/$6000 Out of Network.   After the deductible is met they cover a certain percent up to the out of pocket max at which point they are supposed to cover 100%. The out of Pocket max is $11,000/$22000 individual/family

Here are the definitions as cut and pasted directly from the insurance website:

Copay

This is a fixed amount you pay for a covered health service at the time of service. The amount may change based on the service.

Coinsurance

Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.

You generally pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.

You generally pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

Deductible

The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won't pay anything until you've met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

Out-of-Pocket Max

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of your co-payments, deductibles, coinsurance payments, out-of-network payments or other expenses toward this limit.

Here is an insurance link to various definitions:

https://www.uhc.com/individual-and-family/understanding-health-insurance/common-terms

[wenglund]

15 minutes ago, unixknight said:

Quote

Because apparently the only way one can care about/for the poor and needy is by being willing to spend massive amounts of other people's money they haven't yet earned and the burden for which the will likely have to shift to their future children and grandchildren, assuming no complete financial collapse occurs in the interim.

Fixed that for ya.

Additional fix as well.

Thanks, -Wade Englund-

[Guest MormonGator]

2 hours ago, mirkwood said:

You and wife # whatever (I forget which one @zil is), have a serious addiction problem.

 

Get. Help.

Yes. Yes. It was one of the wives. Yup. I'll, um, be sure to look into that. 

[Vort]

@Scott, if you're trying to convince us that the US health insurance system is corrupt and messed up, you're preaching to the choir. I doubt anyone here will dispute that point.

On the other hand, if you're trying to convince us that placing health insurance under government control -- i.e. socializing it -- is the appropriate method, you will get lots of pushback from people who simply don't buy the premise. (npi)

What it actually sounds to me like you're saying is something along the lines of, "The US health care system is messed up, so therefore government-controlled insurance is the only viable answer." This is a false dichotomy; there are any number of other possibilities.

[Jersey Boy]

8 hours ago, Scott said:

 

Here are some conflicting comments from another thread (Bad Intentions thread), but it deserves it's own topic:

 

This is one instance where I would agree with Rob.

Why are so many LDS people so against any form of socialized medicine?  

For many of those that need healthcare, the only choices are either to let your loved one die or to go bankrupt and to lose everything.   I don't see how this is true agency.

 

 

 

From an address concerning the evils of socialism given at BYU in 1977 by Ezra Taft Benson, who was then President of the Quorum of the Twelve Apostles:

“The chief weapon used by the federal government to achieve this “equality” is the system of transfer payments. This means that the federal governments collects from one income group and transfer payments to another by the tax system. These payments are made in the form of social security benefits, Medicare and Medicaid, and food stamps, to name a few. Today the cost of such programs has been going in the hole at the rate of 12 billion dollars a year; and, with increased benefits and greater numbers of recipients, even though the tax base has been increased we will have larger deficits in the future.

Today the party now in power is advocating and has support, apparently in both major parties, for a comprehensive national health insurance program—a euphemism for socialized medicine. Our major danger is that we are currently (and have been for forty years) transferring responsibility from the individual, local, and state governments to the federal government—precisely the same course that led to the economic collapse in Great Britain and New York City. We cannot long pursue the present trend without its bringing us to national insolvency.

Edmund Burke, the great British political philosopher, warned of the threat of economic equality. He said,

A perfect equality will indeed be produced—that is to say, equal wretchedness, equal beggary, and on the part of the petitioners, a woeful, helpless, and desperate disappointment. Such is the event of all compulsory equalizations. They pull down what is above; they never raise what is below; and they depress high and low together beneath the level of what was originally the lowest.“  (A Vsion and a Hope for the Youth of Zion, April, 12 1977)

 

[mrmarklin]

8 hours ago, Scott said:

 

Here are some conflicting comments from another thread (Bad Intentions thread), but it deserves it's own topic:

 

This is one instance where I would agree with Rob.

Why are so many LDS people so against any form of socialized medicine?  

For many of those that need healthcare, the only choices are either to let your loved one die or to go bankrupt and to lose everything.   I don't see how this is true agency.

 

 

 

The National Health Service of the U.K. dispenses “free” health care in that country. It is a big political football. 

One of my best friend’s wife just sold her business there. Her business?  Health insurance. 

So if one really wants decent health care in Britain, one pays to a private system. There is a reason for that.......

[Guest Scott]

Quote

 So if one really wants decent health care in Britain, one pays to a private system. 

OK, so I looked up the prices of "private medical insurance" in Britain.   Here's the first site that pops up concerning the UK:

https://boughtbymany.com/news/article/private-health-insurance-cost-uk/

I have no idea as to the accuracy of the website, but here's what it says:

The average premium for UK private health insurance is £1,435 per year (source: ActiveQuote). But you might pay much less than that for health insurance depending on the two factors that influence the cost.

Here's the currency conversion: 

1,434 pounds = $1882 per year.  

It seems that the type of policies people are buying in the UK are supplementary and costs around $157 a month.

You probably couldn't even get a glass of water in a US hospital for $157.  

Quote

"The US health care system is messed up, so therefore government-controlled insurance is the only viable answer."

I don't know if it is a viable answer.   I think if done properly it might be worth a try,  or at least worth trying a single payer system. 

I already knew and know that I'd be in the minority here and just wanted to hear what others are saying.

To me the best system would be for insurance companies to be ethical and caring, while still trying to make a profit.   Of course I have little faith that that will ever happen.  

 

Quote

This is a false dichotomy; there are any number of other possibilities.

Then we should try them.   

As I said earlier, in my opinion at least both main political parties in the US are trying to hold voters hostage with fear about healthcare.   And judging what we and others are going through, they should be scared.   

We shouldn't be held hostage by politicians though.   Perhaps that is the main fear for socialized medicine.

What we're doing now isn't working and it sounds like 100% of people here agree on this (correct me if wrong).

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

Here's another question.   

Do you (anyone in this thread) feel that the insurance company is being ethical for not paying much of our medical bills even though we have paid into the system for 27 years?

Edited August 1, 2018 by Scott

[Guest Scott]

Quote

From an address concerning the evils of socialism given at BYU in 1977 by Ezra Taft Benson, who was then President of the Quorum of the Twelve Apostles:

I know Ezra Taft Benson and Spencer W Kimball were all very anti-socialism.   (In most respects, so am I).

We are all just cherry picking comments from the prophets that most align with our beliefs though aren't we?

Here's what Brigham Young said about capitalism:

Capitalists put me in mind of some men I have seen who, when they had the chance to buy a widow's cow for ten cents on the dollar of her real value in cash, would then make the purchase, and then thank the Lord that he had so blessed them. Such men belong to the class of Christians referred to on one occasion by Charles Gunn; and, if you will excuse me, I will tell you what he said about them. He said that 'hell is full of such Christians' (Working Toward Zion, pg. 133).

As mentioned I believe in capitalism, but if we're going to quote the prophets, let's quote more than just one.

Anyway, perhaps the best system when it comes to healthcare is a kinder and fairer version of capitalism.  Is such a thing possible?

Edited August 1, 2018 by Scott

[zil]

23 minutes ago, Scott said:

Do you (anyone in this thread) feel that the insurance company is being ethical for not paying much of our medical bills even though we have paid into the system for 27 years?

I don't know the technical answer to this - you weren't building up savings, you were gambling on a need and each year's bet was lost at the end of that year (or won, if you happened to get more benefits than the amount you paid in for the year).  They played by the rules of the insurance / healthcare industry in the US.  But I will say this is 100% why I'm opposed to insurance.  Had you put all that money into some sort of investment (or even just a CD or HSA-style account without all the strings), you would presumably be better off.  But insurance is there so that the responsible, hard-working earners among us can pay for the irresponsible and greedy.  IMO, rarely does insurance help those who need it most, and if it weren't for all the trappings, we could go back to paying our own ways at the doctor's office.  (Of course, someone could opt to do that anyway, but costs are jacked due to the non-value-added expense of the insurance / legal red tape tangled around what used to be healthcare.)

Edited August 1, 2018 by zil

[Guest Scott]

Quote

They played by the rules of the insurance / healthcare industry in the US. 

If so, that is a big problem.

Anyway, concerning socialized anything, an government spending, supposedly the real cost of the Iraq War was three trillion dollars according to several sources.  When you factor in interest and other things, the cost may be as high as six trillion.   

That's a whole lot of money and it didn't make us safer one bit.  

I guess that's another topic though.  

[zil]

2 minutes ago, Scott said:

If so, that is a big problem.

Duh.  Did I mention I'm opposed to the whole idea of insurance?

2 minutes ago, Scott said:

Anyway, concerning socialized anything, an government spending, supposedly the real cost of the Iraq War was three trillion dollars according to several sources.  When you factor in interest and other things, the cost may be as high as six trillion.   

That's a whole lot of money and it didn't make us safer one bit.  

And you want the same people in charge of your healthcare?

[Guest Scott]

Quote

And you want the same people in charge of your healthcare?

Um no, I do not want the same people who made the decisions on the Iraq War to be in charge of my healthcare.