Flame Suit on - doesn't Darren C have insurance? [Archive]

yellowbritches

Mar. 31, 2008, 07:44 PM

A legitimate question...one I can answer specifically, though.

Yes, as a professional, having health insurance would be a very good thing to have. But often times, at the end of the month, it just doesn't work out in the math! Especially for "older" riders and/or riders with previous issues (bad backs, etc). It can be very hard to afford, and you often just hope that things will work out.

Speaking from experience, the boss is covered by his SO's insurance (she has a great "real" job)...they HATE him, especially after his major back surgery last fall. He pays for my insurance, which, while inexpensive, comparatively speaking (considering I'm young, healthy, don't smoke, and have no real issues), can be a huge chunk of the checkbook if the month is running thin. It only gets more expensive as you get older (mine went up $30 a month this year because I'm another year older!!!!!).

So, while it SHOULD be a top priority for pros, it often isn't. I don't know what the statistics are, but I bet quite a few don't have it.

I, frankly, am ALL about socialized medicine. I think our health industry is truly effed up. :no:

DMK

Mar. 31, 2008, 07:45 PM

Speaking as a person who works in the health insurance industry, it's safe to say most people do not have enough insurance to cover situations like these. If you had really good STD/LTD (short/long term disability), you would probably get 66% of your paycheck, with some variations for self employed business owners. But it's not meant to be a total replacement of income, and most people couldn't afford that policy. Most people don't do well on less than 70% of their old pay, especially if they are not able to run the business.

And health care insurance is not really designed to address long term care needs. Benefits are not unlimited, families have to pitch in and provide care giving services once a disabled person is well enough to be out of daily medical care, but this requires a person who may have needed to be an income earner to spend more time at home as a caregiver.

I don't have a clue what Darren's insurance situation is. I just know that if I - who am by definition very well insured and extremely educated on how my insurance works and what its benefits/limitations are - would most likely be financially ruined if I was in a similar situation.

LexInVA

Mar. 31, 2008, 07:54 PM

I, frankly, am ALL about socialized medicine. I think our health industry is truly effed up. :no:

+650 points to Gryffindor!

yellowbritches

Mar. 31, 2008, 08:01 PM

+650 points to Gryffindor!
hehehe....:winkgrin:

I've always thought this, then I made the mistake of dating a Canadian for awhile, who now lives in the states. He has his issues with socialized medicine, but HATES the American idea of health care...most people who know anything about the two will agree. :yes:

RunForIt

Mar. 31, 2008, 08:01 PM

I'm a 58 year old public school teacher in GA - we have GREAT insurance (Blue Cross- Blue Shield) on which the premiums have increased the past 3 years MORE than our whopping 2 1/2 % raise! I cannot imagine paying all of this without my employer's part of the premium...:eek:

brindille

Mar. 31, 2008, 08:06 PM

hehehe....:winkgrin:

I've always thought this, then I made the mistake of dating a Canadian for awhile, who now lives in the states. He has his issues with socialized medicine, but HATES the American idea of health care...most people who know anything about the two will agree. :yes:

hmmm...i would say most people who know about both systems would opt for public...especially if they weren't rich. too bad our system is going the american way...

FlightCheck

Mar. 31, 2008, 08:07 PM

when I was trying to decide whether to change careers (from farm owner to announcer), one of the items in the "pro" column was insurance.

Even with great insurance through Mr.FlightCheck's work, if I had been seriously injured and unable to take care of the farm, the (a) loss of income + (b)cost to hire someone to take care of boarders and horses would have devastated us.

No one should have to worry about stupid money when their whole life and the lives of their loved ones has been brutally changed due to illness or injury.

J Swan

Mar. 31, 2008, 08:21 PM

A friend of mine had a 10K bill for a broken arm. Insurance paid all but 2K.

Imagine had that been a more serious injury.

On the other hand, the problem with socialized medicine is that everyone gets crappy health care. But it's free. If folks have money - they fly to the US to get treatment.

At least in the US, you don't have to be on a waiting list for 2 years to get a joint replacement.

Lived under both systems; the American one is more expensive - but at least I can get surgery when I need it - not when my name eventually comes up on a list. My great aunt spent her final days dying of cancer laying on a bed in a hospital hallway. No privacy, no dignity, no place for family to sit with her.

I bet Darren is getting better care - and better quality care. I have no doubt it will make a tremendous difference in his recovery - which I hope is quick and complete.

Jeannette, formerly ponygyrl

Mar. 31, 2008, 08:36 PM

I have BCBS.
My gynecologist has been wanting me to go in for some testing.

WHen I found out my share of the testing would be about 4500 bucks if done outpatient in the hospital as he suggested, I said, umm, no, give me extra tylenol or whatever and do it in the office.

Cannot imagine what "my share" of even a brief stay in an ICU would run.

2ndyrgal

Mar. 31, 2008, 08:53 PM

As a small business owner, and ehem, older, the coverage per month on our company policy, Anthem BCBS, top tier, is @$1300/month. My husband had triple bypass surgery 3 years ago this July, the bill was nearly $100K. I think our out of pocket was about $2500. That said, he did not have to saddle up anything and kick on to make a living, and could afford to recover, though was back at work two weeks out. He has disability insurance (can't remember the premium), which would cover his income 85% if he's out a while, we didn't choose to file for this, as I work in the business as well and just rode it out. But, my little blossoming lesson business went bye bye, and I quickly re homed two of the four horses, it was just way too much to deal with. There is not an insurance policy in the world that can cover these kind of injuries completely and the loss of income. And depending on the outcome, some of the horses in training, or people, will never come back. The pros will fill in for a while, but eventually, if you are a client, you are going to find a permanent solution, especially for an upper level horse or rider in training. The question is well asked, I know the USTA (United States Trotting Association) used to have some kind of insurance (bottom tier) if you were a member and employed in the racing industry. Not that a smart insurance company is going to be knocking down doors to sign up eventers, but maybe there could be some kind of "gap" insurance or something. Of course Kentucky is trying to get all the backside workers some kind of insurance and we can see that's not exactly working out either, so, probably raising money to help with expenses, not necessarily just medical, but life expenses, is probably the best way. Odd that both Darren's and Ralph's injuries were right before Rolex, but since that's the big dance, at least it puts a lot of folks with dosh in the right place to raise $$.

pooh

Mar. 31, 2008, 08:55 PM

not only do deductibles and co pays add up if you have insurance, there are also many things that aren't covered. You have to start looking towards the future - what equipment may he need to be able to live Independently again - hopefully none, but at this point noboy knows. Without realizing it a critcially injured person can start to rack up thousands plus dollors in medical bills. And - if they are self employed like many professionals - they also now have no income to pay these bills, along with other "normal" bills they may have - mortgage, horse care, etc.

IFG

Mar. 31, 2008, 09:07 PM

On the other hand, the problem with socialized medicine is that everyone gets crappy health care. But it's free. If folks have money - they fly to the US to get treatment.

At least in the US, you don't have to be on a waiting list for 2 years to get a joint replacement.

I wouldn't be so sure that the quality of care is "crappy" with socialized medicine, it is more that there is a queue for care, and that the amenities (as you describe for your aunt) are less prevalent. If the quality of care in the US were so high we would not have such a high infant mortality rate compared with those countries with socialized medicine.

snoopy

Mar. 31, 2008, 09:13 PM

gully's pilot

Mar. 31, 2008, 09:41 PM

This is getting OT, but you can't say that the high rate of infant mortality, tragic though it is, reflects crappy care. It may reflect poverty--lack of prenatal care--but it might reflect our very high rate of casaerians, it might reflect the age at which we have children (older mothers are at much higher risk of premature delivery), it might reflect the very high number of multiple births we have in this country as a result of pretty decent infertility treatments. I don't know what it does reflect--haven't studied the question--but it's not a given that one reflects the other.

As for insurance, I only know about one pro, my sometime trainer--she doesn't have any. It's expensive--and for her it's not as much a priority as being able to have several dogs and go out to eat fairly often. (I have dogs and go out to eat--but don't have to pick between that and insurance). If she gets injured, she will get treatment--not a hospital in the country will or legally can refuse to treat emergencies. However, she'll be in pretty big trouble from the bill, loss of income, etc.

And even the best insurance policies often have "lifetime caps" of 1-3 million. That sounds like a lot until the 3rd month in ICU, the rehab, etc. I'm happy to join in the fundraising regardless of whether or not Darren has insurance.

naters

Mar. 31, 2008, 10:00 PM

My OBGYN calls BCBS "Blue Cross Blue Screw"

eqsiu

Mar. 31, 2008, 10:03 PM

My OBGYN calls BCBS "Blue Cross Blue Screw"

Try having Healthlink.

Jeannette, formerly ponygyrl

Mar. 31, 2008, 10:04 PM

This is getting OT, but you can't say that the high rate of infant mortality, tragic though it is, reflects crappy care. It may reflect poverty--lack of prenatal care--but it might reflect our very high rate of casaerians, it might reflect the age at which we have children (older mothers are at much higher risk of premature delivery), it might reflect the very high number of multiple births we have in this country as a result of pretty decent infertility treatments. I don't know what it does reflect--haven't studied the question--but it's not a given that one reflects the other.

Well, given that what, the 22 other industrialized countries all manage to have lower infant mortality rates, and several have better cervical cancer survivals, and so on, I would have to say that reflect on the overall quality of care. If some people get care or jobs, or to survive a situation, great for them, but if overall more people in other countries survive, and you're one og the ones in this country who doesn't, it doesn't matter if you call the qualiity here "crappy" or just"not as good" but the fact remains, more people die of a variety of conditions here.n Things are not as good here as we would like to believe!

onthebit

Mar. 31, 2008, 10:18 PM

hehehe....:winkgrin:

I've always thought this, then I made the mistake of dating a Canadian for awhile, who now lives in the states. He has his issues with socialized medicine, but HATES the American idea of health care...most people who know anything about the two will agree. :yes:

My hubby is Canadian and has been in the states for 4 years now, and spent the other 30 years just outside Toronto. He would totally disagree with the person you dated. As he states, at least here he can get timely diagnostics and treatment. If it takes paying a lot for health insurance he is down with that.

Sassenach

Mar. 31, 2008, 10:25 PM

My OBGYN calls BCBS "Blue Cross Blue Screw"

Points to your OBGYN!

naters

Mar. 31, 2008, 10:27 PM

LOL..... she's pretty awesome!

Bensmom

Mar. 31, 2008, 10:33 PM

FWIW -- Ralph did have insurance when he got injured, but the fundraising was absolutely crucial to his recovery effort as the unpaid costs were truly astronomical, before you figure in the total loss of income.

So, even if Darren has the best insurance available, the unpaid costs on an injury like this, plus the loss of income will be devastating.

My first cousin was in a bad auto accident at the age of 19 -- his mom was very well set for health insurance, but still had to liquidate her biggest asset before his treatment was over and he was semi-functional again. It is the kind of mind-boggling problem you usually aren't aware of until you face it and have to figure out how to keep going and still receive treatment.

Best wishes to Darren for a speedy recovery -- the news about his first steps is AWESOME! :yes:

libby

cowboylogic

Mar. 31, 2008, 10:47 PM

Does anyone know why we are not offered the option to purchase health insurance thru the USEF? They are a large group- one would think they could offer it to their members and help make it affordable (or at least more affordable)...I believe many in the business probably do not have insurance, or proper coverage, due to the high costs.

Outyougo

Mar. 31, 2008, 10:52 PM

it is difficult to estimate how much one will need for health care. insurance policies are tough to read and understand. A friend of mine id having great difficulty in obtaining the benefits from a disability policy she paid on for many years and she worked for a very well known company..Most employers now offer rather expensive health insurance and say little about disability policies--try to find one--then try to find one that pays with out involving lawyers!

Christopher Reeve had insurance and had huge expenses before he died.

Galileo1998

Mar. 31, 2008, 10:53 PM

On the other hand, the problem with socialized medicine is that everyone gets crappy health care. But it's free. If folks have money - they fly to the US to get treatment.

I've lived most of my life in Canada and 5 years in England, I've never had crappy health care, and despite knowing one or two folks that "have money" I don't know a soul that has ever needed or wanted to fly to the US for health care.

molliwog

Mar. 31, 2008, 11:05 PM

I also know in some states, if you are a sole proprietorship or individual looking to obtain health insurance, some "high-risk" activities such as skydiving, scuba-diving, rock climbing, and 3-day eventing are specifically called out as activities where related injuries will not be covered by some carriers.

Ashby

Mar. 31, 2008, 11:05 PM

Well, given that what, the 22 other industrialized countries all manage to have lower infant mortality rates, and several have better cervical cancer survivals, and so on, I would have to say that reflect on the overall quality of care.

I work for a major research agency that studies who gets what kind of health care, how much it costs, and who's paying for it (or not paying for it). Without getting too political, there are a lot of reasons for higher infant mortality rates in the US but they have nothing to do with quality of care; it's usual for the baby of the most impoverished mother to receive seven figures' worth of neonatal intensive care unit treatment. There is a great deal of free care available in the US, and when I examine the medical records of study patients, rich and poor alike, I'm amazed at the sophisticated care destitute people can receive. However, even the best NICU can't overcome the challenges of a baby who received no prenatal care because his mom was living in a poor foreign country prior to his birth or was doing major drugs all day. Many of our higher morbidity rates are due to demographic problems other nations don't have, not to lack of quality care. You can't force people to get Pap smears or mammograms.

You will notice that rich Britons, Canadians, Frenchmen, Arabs, etc. head to major US medical centers for treatment of the most serious diseases. They know that much of the best care is available here because much of the research is being done here. The survival rate for cancer is much better in the US than in the UK.

I did not come into this study with preconceptions about this issue, but the raw data I've been confronting every day for the past six years does not lie.

This poor man is going to face a horrendous struggle, with or without insurance. God bless and help him. We should all be glad to contribute.

snkstacres

Mar. 31, 2008, 11:09 PM

Touche Galileo, I am canadian living in the US, I never ever had bad medical care, nor waited for what was necessary. I could go to any doctor I wanted and it cost me nothing. I met many many americans in Canada getting treatment cause they couldnt afford medical in the US.

I got a bone infection several years ago. Two seconds in a doctors chair to tell me I had an infection cost me $2600 cause he was a professional. Heck, I knew the same thing he told me.

He wanted me to come back for a follow up, I told him I would simply drive home for a tenth of the price and get treated for free.

My kids still get all there prescriptions from home, they go home for medical treatment. Its a whole lot cheaper and a whole lot faster.

I am very sorry for Darren, (isnt he Canadian), and I can sympathize with what this is going to cost him for sure.

When my daughter evented professionally, every olympian she ever rode with told her to get a back up career. Absolutely necessary because what has happened now to Darren has happened to many a rider before him. " And then what" has just happened.

My daughter is graduating from University next month and then will resume her eventng career. NOt only will she be able to afford her habit, she will have something to fall back on when she is finished riding. We all finish at some time.

Sure hope all works out well for Darren and that he can indeed to go back to what he loves.

HappyHoppingHaffy

Mar. 31, 2008, 11:21 PM

I work for a major research agency that studies of who gets what kind of health care, how much it costs, and who's paying for it (or not paying for it). Without getting too political or too OT, there are a lot of reasons for higher infant mortality rates in the US but they have nothing to do with quality of care; it's usual for the baby of the most impoverished mother to receive seven figures' worth of neonatal intensive care unit treatment. There is a great deal of free care available in the US, and when I examine the medical records of study patients, rich and poor alike, I'm amazed at the sophisticated level of care poor people can receive. However, even the best NICU can't overcome the challenges of a baby who received no prenatal care because his mom was living in a poor foreign country prior to his birth or was doing crack all day. Many of our higher morbidity rates are due to demographic problems other nations don't have, not to lack of available care. You can't force people to get Pap smears or mammograms.

You will notice that rich Britons, Canadians, Frenchmen, Arabs, etc. get on planes and head to major US medical centers for treatment of the most serious diseases. They know that much of the best care is available here because much of the research is being done here. The survival rate for cancer is much better in the US than in the UK.

I did not come into this study with preconceptions about this issue, but the raw data I've been confronting every day for the past six years does not lie.

This poor man is going to face a horrendous struggle, with or without insurance.

Agreed. I run clinical research trials for large and small companies. You go into the best hospitals in the US (Cleveland Clinic, Mass General, etc.) and you will find people from all over the world come here for treatment. I see them when I'm visiting my surgeons and have had at length conversations regarding this issue with said surgeons/doctors. The US has truly great health care even if the system is flawed.
I also recently learned that if you don't pay your hospital bills they can't use it against you on your credit report. I think this both a blessing and a curse and partly to blame for the mess. Sometimes if you don't hold people accountable, well, they just won't be.

I don't blame you for questioning the insurance aspect. I think it was a legitimate question and not a snarky wtf post /p*ssing contest like I've seen a lot of on here.

No matter what it will be a long/slow road back and finances should be the last thing on his/his family's mind. I think we all probably feel that way.

RedMare01

Mar. 31, 2008, 11:29 PM

I work for a major research agency that studies who gets what kind of health care, how much it costs, and who's paying for it (or not paying for it). Without getting too political, there are a lot of reasons for higher infant mortality rates in the US but they have nothing to do with quality of care; it's usual for the baby of the most impoverished mother to receive seven figures' worth of neonatal intensive care unit treatment. There is a great deal of free care available in the US, and when I examine the medical records of study patients, rich and poor alike, I'm amazed at the sophisticated care destitute people can receive. However, even the best NICU can't overcome the challenges of a baby who received no prenatal care because his mom was living in a poor foreign country prior to his birth or was doing major drugs all day. Many of our higher morbidity rates are due to demographic problems other nations don't have, not to lack of quality care. You can't force people to get Pap smears or mammograms.

You will notice that rich Britons, Canadians, Frenchmen, Arabs, etc. head to major US medical centers for treatment of the most serious diseases. They know that much of the best care is available here because much of the research is being done here. The survival rate for cancer is much better in the US than in the UK.

I did not come into this study with preconceptions about this issue, but the raw data I've been confronting every day for the past six years does not lie.

This poor man is going to face a horrendous struggle, with or without insurance. God bless and help him. We should all be glad to contribute.

I also work in the health care industry, and in my experience have found this to be true also. And, not to take this any further off track, but I attended a presentation of a study that had been done in North Carolina about infant mortality rates, and came away with some interesting info. Not only is there an infant mortality rate, there is a fetus mortality rate. In some cases when a baby is delivered very pre-term (24-30ish weeks), and survives only minutes, it is pretty much up to the doctor to determine whether to classify it as an infant death or a fetus death. The researchers felt that the IMR in this country could be up to 2% less if these births were classified as fetus deaths. Some countries with lower IMRs could be (or are) classifying them as fetus deaths and not infant deaths.

Anyway, jingles to Darren!

Caitlin

blackwly

Mar. 31, 2008, 11:41 PM

This is pretty OT, but I can't even believe there are eventing pros out there who are spending $100's on magnetic blankets and not buying themselves health insurance! (Not speaking of Darren here, I have no knowledge of his situation)

Honestly, the people who are hurt by the uninsured are those of us who pay a premium for private insurance. The hospital charges us $7 for a tylenol to offset the costs of those who are uninsured. It's one thing, in my mind, if people can't get insurance because of preexisting conditions, extreme poverty, etc. But I recently had a patient who got a bill for $10,000 for the repair of her ankle fracture and a stay in the trauma ICU. She was upset, because while she was offered insurance through her work at a bank, she chose not to buy it as it seemed more logical just to keep the extra cash each month. So, instead of just paying the bill, she decided to sue Coyote Ugly- where she was dancing drunk on the bar at her bachelorette party before falling off and breaking the ankle. AAARRGGGG! That, to me, is not far off from being an eventing professional whose livlihood is physical and dangerous and thinking, "ah, to hell with medical insurance...we need a new Living Quarters!"

And if you want a sense of how socialized medicine will work in the US- just check out the VA. It has its pros and cons and in general the vets get good care, but there would be a lot of upset private citizens if everyone had to wait 3 months before getting in to see a neurosurgeon about their ruptured disc.

Anyway, those that mentioned high out-of-pocket expenses are exactly right- even with good insurance you can pay through the nose if you have a serious injury. Of course, part of the reason for that is that you're still subsidizing all of the free care that we're providing to others....

Chipngrace

Apr. 1, 2008, 12:11 AM

...

ThreeHorseNight

Apr. 1, 2008, 12:11 AM

Honestly, the people who are hurt by the uninsured are those of us who pay a premium for private insurance. The hospital charges us $7 for a tylenol to offset the costs of those who are uninsured.

I know many, many people who choose not to buy health insurance. When I say "choose", I mean that they could buy health insurance, as expensive as it is, but that money goes towards a horse, a car, a trailer, whatever. I totally understand those who truly cannot afford health insurance -- the cost can indeed be astronomical. And I realize that when you're young, or if you've always been healthy, you don't truly understand the need for health insurance. But I know several people who go to the low-income health clinic (funded by donations) or the county-funded low-income clinic for their care, yet they own horses. So I'm thinking, hmm, my tax dollars fund the county-funded clinic. It's kind of like I"m supporting their horses since they chose to spend their money on horses and not on health care. (And I am now going to get blasted for being elitist.)

Your quote about the $7 Tylenol is interesting. A few years ago I fell off a horse and spent 48 hours in the hospital, in a trauma unit. The bill for those two days was $12,000. (That didn't include the ambulance ride, CT scans, radiologist, trauma surgeon who was brought in to consult, etc.) I had an IV in me, and they changed the bag when it ran out, and they monitored my vitals. That was it. $12,000. Here's the really amazing part. I did have health insurance, and the contract rate my provider had with the hospital brought the cost down to $6,000. I had an enormous deductable, so I was responsible for the $6,000, but if I'd had no insurance, I'd have been responsible for the $12,000. Yes, the $12,000 bill makes up for the people the hospital treats who never pay.

I agree that there is a big problem with insurance in this country, but I'm not sure socialized medicine is the problem. Perhaps socialized medicine works OK for the usual stuff, but what about for more serious things? (Rhetorical question.)

This is all way off topic, but the original poster poses an interesting question. I do wonder how many professionals are out there without insurance, in a high-risk sport. As several have said, insurance does run out, especially when you have a condition requiring long-term care, but at least the insurance can help out initially.

Regardless, jingles to Darren, and as somebody said, insurance or not, he's got quite the road ahead of him.

Paragon

Apr. 1, 2008, 12:27 AM

Honestly, the people who are hurt by the uninsured are those of us who pay a premium for private insurance. The hospital charges us $7 for a tylenol to offset the costs of those who are uninsured.

It cuts both ways.

Insurance companies and government agencies, because of their leverage and bargaining power, are able to undercut everyone else, in much the same way that Wal-Mart can buy and sell for less than Mom & Pop stores. My husband is emphatically opposed to insurance - adamantly refuses to have it - and my stepson and I were between providers when our son needed an appendectomy. The bill for the thirty-minute surgery and less than 24-hours in the hospital came to $16k. Through discussions with friends who've been working in hospital billing for years, I was able to locate tables and scales indicating what insurance companies and government organizations would pay.

They were charged well under $10k for the same operation and stay.

Over the next weeks, I spent hours on the phone with the hospital billing offices. More than one person informed me that I could not have such a low rate because I didn't have bargaining power, and that they were essentially underpaid by governmental organizations, therefore needing to charge the rather-helpless uninsured even more to make up the difference.

The studies revealing this disparity are many, and they are shocking. Uninsured are sometimes charged more than twice what insurance companies are willing to pay, and as far as I'm concerned, such a gap is unacceptable.

FYI - in the end, I bargained the hospital down to about $11k. Still more than an insurance company would have paid. Them's the breaks, I guess.

poltroon

Apr. 1, 2008, 02:03 AM

Here in California, insurance companies don't have to sell you an individual policy if they don't want to. It's obvious that they don't sell insurance to, for example, cancer survivors, but they have been documented to deny people for fairly benign and surprising reasons - among the most often quoted, "jock itch treated successfully with cream." Simply asking about a freckle can make you uninsurable. Or, being in the wrong profession, which includes:

- roofers
- agricultural workers
- professional athletes
- horse trainers or grooms

So it may be that someone you know doesn't choose to spend the median $12,000 a year per family on health insurance - or it may be that they've tried and can't get coverage.

Even when you have coverage, most policies don't cover 100%. 30% of a million dollars is a lot of money when your income has gone to zero, and your ordinary expenses increase, too. For example, someone who is very sick or injured probably will also be unable to cook, may need extra assistance with house chores or just getting around, help with shopping, etc. Maybe special furniture will be needed or some home modifications. Some of these things may be provided by friends or family - but it's all a cost, and eventually they'll need to go back to their lives. The travel and parking expenses alone add up.

As for whether the US is best or worst, there are some things we're good at and some things we're not. For example, we have nearly 2 million preventable hospital infections in the US each year - but the rate is nearly zero in Norway and Sweden. Many Americans wait weeks or months for appointments or for approvals from their insurance companies. There are some good comprehensive studies out there comparing results. Americans wait longer in the ER, for example. And plenty of Americans go abroad for medical care too.

I also think that because our payment situation is so convoluted, that it creates a lot of our liability and tort issues. If you trip over a sidewalk in Europe, your health care is taken care of. There's no worries about who will pay the bill. In the US, you might owe $30k or more if you had a serious fracture - or your insurance company, if they pay, can choose to sue to recover without your consent.

Even if Darren has some sort of miracle insurance and a speedy, perfect recovery, you can bet it will be a year or two before he is able to earn income at his old level. Even with a simple injury, it shocked me how much more money we spent when I was hurt on "non medical" expenses. When my dad had serious heart issues, they ended up having to buy a mobile home as a second residence near the hospital - it was cheaper and more practical than the constant travel or than staying in a hotel. They were lucky to have a level of credit that made that solution practical.

Foxtrot's

Apr. 1, 2008, 02:22 AM

What I am hearing from this is that even if a person is very well insured in the States, there are instances - like Darren's - where all the expenses will not be covered, hence the need to have a huge fundraiser. Good luck with it and he is in a wonderful community of horse people who are going at warp speed to put this thing on.
Here in Canada, contrary to what some people believe, we do have excellent care when necessary. We have world class hospitals, doctors, researach facilities and are on the cutting edge of all sorts of medical breakthroughs. Patients come from all over the world to have free operations that they would not have had in their own countries. Major work, like separating conjoined twins, facial tumours, brain surgery, etc. My husband did not have to wait to have his heart surgery, performed by a world class team, although elective surgery may be put on a wait list. He has to have hand surgery, and because he needs his hand to run our business, he is having it in ten days time, a month after first going to see the doctor.
My son was a passenger in a serious car accident - rehab center and every other specialist. For all this we pay $288.00 every three months, and that includes my husband, myself and dependent University student. We also have extended health through our company for the trimmings, that pays for things like ambulance rides, private hospital room, prescription drugs, limited physio, chiro, massage and acupuncture. While it is not perfect, and we pay higher taxes than if we were in the States, our system is the envy of many parts of the world and as voters we fight tooth and nail to protect it and not have a two-tier system, where "if you can afford it"
you get excellent care.

Meanwhile, the first thing I do every morning is click onto the thread
updating Darren's progress - best wishes, Darren.

Blugal

Apr. 1, 2008, 02:39 AM

I know this has come up before - why don't we have something similar to an Injured Jockeys' Fund? So that the fundraisers aren't just for the top well-known names, and don't fizzle out after 6 months. And so that there are funds in the bank immediately when someone is injured.

Are there good reasons? Is it too much to take on? I assume it would need an administrator. The next thing is I'd ask if it could be 501c3 or whatever - but then I'm Canadian and it would be nice to have this sort of thing for Canadians too (as everyone has pointed out, there are many non-medical expenses).

annikak

Apr. 1, 2008, 08:56 AM

I also recently learned that if you don't pay your hospital bills they can't use it against you on your credit report. [quote]

careful on that- a friend just lost her mortgage on this very issue- x was supposed to pay bill, did not, and she knew nothing about it. Appeared on her CR, and no mortgage for her. She is working it out, but it's been well over a year and a mess.

I do know some certain hospitals don't report- Mercy Hospitals in our area.

[quote=blackwly;3113569]This is pretty OT, but I can't even believe there are eventing pros out there who are spending $100's on magnetic blankets and not buying themselves health insurance! (Not speaking of Darren here, I have no knowledge of his situation)

Honestly, the people who are hurt by the uninsured are those of us who pay a premium for private insurance. ... But I recently had a patient who got a bill for $10,000 for the repair of her ankle fracture and a stay in the trauma ICU. She was upset, because while she was offered insurance through her work at a bank, she chose not to buy it as it seemed more logical just to keep the extra cash each month. So, instead of just paying the bill, she decided to sue Coyote Ugly- where she was dancing drunk on the bar at her bachelorette party before falling off and breaking the ankle. AAARRGGGG! That, to me, is not far off from being an eventing professional whose livlihood is physical and dangerous and thinking, "ah, to hell with medical insurance...we need a new Living Quarters!"

..

Totally agree with the above. It's hard to understand unless it has happened to you. Yes, insurance is very expensive- our costs have been steadily creeping up every year- but, all you need is one nasty fall and THEN you will be hitting yourself hard in the head.

Platinum Equestrian

Apr. 1, 2008, 09:11 AM

Well, given that what, the 22 other industrialized countries all manage to have lower infant mortality rates, and several have better cervical cancer survivals, and so on, I would have to say that reflect on the overall quality of care. If some people get care or jobs, or to survive a situation, great for them, but if overall more people in other countries survive, and you're one og the ones in this country who doesn't, it doesn't matter if you call the qualiity here "crappy" or just"not as good" but the fact remains, more people die of a variety of conditions here.n Things are not as good here as we would like to believe!

I would like to see the statistics on that... not quite sure I'm buying it. Wake up people, you have it pretty darn good here in the US. If you don't like it... leave.

I'm sure Darren's family is thankful the accident happened here in the US, so they can feel comfortable he's receiving the best care possible.

florida foxhunter

Apr. 1, 2008, 09:14 AM

Back to the original topic.......Darren's situation is horrible.....he may NEVER be back to his former abilities. I'm told he has nineteen horses at his farm in Ocala........and his income stream stops today. His students are having to move on to other trainers, etc..and they will be selling all the horses asap. There is no money to support them and this is a LONG term problem
I hope I'm not telling more than I should.....I have heard this from a very reputable source, but not directly from the family.
However, regardless, the money from this auction is NOT going towards supporting the horses or farm.........only for HIS medical/therapy and supportive care. We're told insurance won't begin to cover all that is and will be necessary................

Ashby

Apr. 1, 2008, 09:26 AM

I agree that there is a big problem with insurance in this country, but I'm not sure socialized medicine is the problem. Perhaps socialized medicine works OK for the usual stuff, but what about for more serious things?

When deciding whether you want nationalized health care, just ask yourself one question: do you want health-care decisions being made for you by the same lovely folks who brought you the IRS?

This article (originally from The Spectator) just about ends the debate: http://www.harrysnews.com/tgDieinBritain.htm

HappyHoppingHaffy

Apr. 1, 2008, 09:32 AM

Just for thought, but here in MA you have to have insurance now. I had to provide proof of having insurance when I did my taxes this year. I have insurance through my work, but from what I understand the state has very affordable plans for individuals and employers.
It's a start, but it only helps regain costs for those who are here legally. Which is part of the reason our health care system is so crippled/costly.

Ashby

Apr. 1, 2008, 09:36 AM

Back to the original topic.......Darren's situation is horrible.....he may NEVER be back to his former abilities. I'm told he has nineteen horses at his farm in Ocala........and his income stream stops today. His students are having to move on to other trainers, etc..and they will be selling all the horses asap. There is no money to support them and this is a LONG term problem

I can very well imagine the horrible grief this represents. Something quite similar happened to me many years ago--a catastrophic injury and illness, pain, loss of the beautiful stable and horses, utter impoverishment, loss of every hope except the hope to stay alive. A very dark time. This poor man. As someone who has been there, I'll pray that he receives the same blessings and help that I did.

Seeing that I survived my spinal injuries and went on to have a happy, productive life, what is the sense of the forum--does anyone think it would be a good idea if I wrote to him to encourage him?

HappyHoppingHaffy

Apr. 1, 2008, 09:44 AM

I can very well imagine the horrible grief this represents. Something quite similar happened to me many years ago--a catastrophic injury and illness, pain, loss of the beautiful stable and horses, utter impoverishment, loss of every hope except the hope to stay alive. A very dark time. This poor man. As someone who has been there, I'll pray that he receives the same blessings and help that I did.

Seeing that I survived my spinal injuries and went on to have a happy, productive life, what is the sense of the forum--does anyone think it would be a good idea if I wrote to him to encourage him?

I think it's a great idea to write to him and his family.
I haven't wanted to say this, but my brother passed from a closed head injury, and I know my family took great comfort hearing how other families had dealt with grief. Darren may not have the capacity right now to fully understand your words, but I'm sure his friends and family would love to hear your story.

NMK

Apr. 1, 2008, 09:46 AM

My beloved farrier had a triple bypass. He is worried, and says he has to get back under a horse asap. He has insurance but it does have a deductible. What he is left responsible for "covering" that did not fall under his insurance plan was simply outrageous.

Anyhow, what he did not yet know was that the farriers that stepped up to help him had his clients write out the checks to him instead of them. The one that helped me came out in the middle of the worst snowstorm of the year, on a Saturday. It brought a tear to my eye.

The horse world can be very competitive, but when it really matters we do have a community like no other. I don't know Darren, but I will join others in the community to support the fund raising efforts for him, just as the farriers did for a member of our horse community.

Nancy

cyberbay

Apr. 1, 2008, 10:03 AM

Well, if we would like to take the outpouring of energy that Darren's situation has unleashed, then maybe we can put it toward improving the health-insurance situation for equestrians. Yes, I realize that Darren's costs are outlandishly high, and that that would be true for anyone with those injuries regardless of cause -- but I'm talking about the few safety nets this industry has. At least, compared to other industries, like the guilds, or the unions, which cover people who are in outdoor, dangerous-machinery type of occupations.

There probably are sufficient numbers of participants to generate a worthwhile insurance coverage, if you include all racing, all western, all breeding, etc.

Rye

Apr. 1, 2008, 10:18 AM

FairWeather

Apr. 1, 2008, 10:26 AM

I would like to see the statistics on that... not quite sure I'm buying it. Wake up people, you have it pretty darn good here in the US. If you don't like it... leave.

Love that attitude, it helps keep things stagnant and unchanged. So you are saying, GTFO if we aren't entirely pleased with anything in the US? Or do you mean we should just GTFO if we are unhappy with healthcare? I just want to know the exact reason we should GTFO before I pack, ya know?

Damn those pesky women wanting to vote. They should have just left the country.

Point being, there is something seriously wrong with a system where an ambulance ride to a hospital and subsequent xrays should cost me $6000 out of pocket when I have top tier insurance.

All you whiners out there, GET BETTER INSURANCE! DONT GET HURT! OR LEAVE!!!
<stompstompstomp>

Ashby

Apr. 1, 2008, 10:30 AM

I think it's a great idea to write to him and his family.
I haven't wanted to say this, but my brother passed from a closed head injury, and I know my family took great comfort hearing how other families had dealt with grief. Darren may not have the capacity right now to fully understand your words, but I'm sure his friends and family would love to hear your story.

I meant, presumably I would write after he recovers consciousness a little. Not much point in writing to comfort him if he doesn't yet even know that he needs comfort.

Anybody know where I could address a letter or email?

I am so sorry for your loss. It's very hard to lose someone that close. The grief really doesn't go away.

magnolia73

Apr. 1, 2008, 10:45 AM

I think we have it good in that he was able to be life-flighted and get fantastic care that 15 or 20 years ago was not possible. Probably 20 years ago he would not have made it. Problem is that it is all very expensive. I bet 30 years ago it was difficult to run up $100,000 in medical bills. There just was not that much treatment. So insurance costs go up as we have more treatment. I have a friend who has seizures and other issues stemming from a stroke he had while skiing. $2000 a month now in meds. Damn lucky to be alive- no matter what the cost. And lucky to have insurance with a $2000 deductible per year. he gets $24,000 in services for $2000.

So, Darren is lucky he had his fall in the US- our system is great at caring for someone like him. Where our system fails is that the care costs so much that only the wealthiest can absorb it, even with most insurance policies. So how do you pay back $50,000, $150,000, $500,000 or a $1million in bills in a society where people take 30 years to pay back a house, 15 years for student loans....6 years for a car? You can't.

For a long time, I was against gvt health care- whoever made the IRS comment is spot on my feelings. But our current system- hope your insurance works or declare bankruptcy is pretty dehumanizing. I do agree that each individual needs to share substantially in the cost of their coverage and medical bills because care is not free or cheap and some problems can be prevented with responsibility. But not to the point where they lose everything. Either that or we need to simply run a credit check and start saying- oops- let her die, she can't afford treatment. (being sarcastic)

gortmore

Apr. 1, 2008, 11:03 AM

Just have to comment on the Canadian system. I am currently waiting to see an Orthopedic Surgeon for rotator cuff problems in both shoulders. My appointment was made Feb. 15. I get to go and see the specialist on July 3. In the meantime my shoulders are getting worse but at least I will get to see one of the top surgeons in BC. I know that here what they do is send a copy of all your reports and test results to the surgeon, they go through them and you get an appointment based on the seriousness of the problem from the info that is provided. I fall in the middle area as the wait for most orth surgeons is currently over 1 year. The specialists have to leave spots open every day for emergency cases and emergency surgeries. I love our system at least I can see the best surgeons and I am not out of pocket for it.

My mother had knee surgery and had to wait 1.5 years for the first knee replacement. The second knee was done 8 weeks later. She is now doing great and since she is "on the list" with the Ortho surgeon her wait time to see him is 4 weeks. Not bad at all and if she had an emergency it would be either that day or within 24 hours.

The Canadian system is abused. I have had people tell me to go to the ER and it will get me into the specialist sooner. Yeah right, it is not an emergency, I can wait. I know someone who uses the ER instead of going to her doctor as it gives her credibility for not having her work done. She could not sleep that night. Neither can I most of the time and I refuse to go. The ER is for emergency, such things as heart attacks, profuse bleeding requiring stiches, head trauma, etc not the inability to sleep.

I wish Darren a speedy recovery and hope that everything works out for him. The expenses for the everyday things that he will need for recovery are astronomical. I don't know about the US but here you pay for physio, special items required for your medical problem etc. I am sure the amounts are subsidized but it is still an expense. I pay $ 60 for a physio treatment. Our extended medical cover 80% up to 10 or 12 visits per year, after that you are on your own. When I had a really bad hand injury I had to go to physio three times per week. You are through any extended medical pretty quickly and $ 180 per week eats into your income pretty quickly. I could continue working to pay for it but I can not imagine what it will be like for Darren. It's not just about the medical bill at the hospital its about the extra help, the changes to living arrangements even if just temporary and the rehab. It's not free and I am not sure that any insurance will cover all of it.

eventmom

Apr. 1, 2008, 11:32 AM

As a home schooler I am a member of a group called the HSLDA Home school legal defense association. For $100 a year, I get the full backing of this group of legal advisors and such. If uncle Sam comes after me, they will run to my defense. Of course, it is in the best interest of these people to keep homeschooling legal in every state, and to keep government intrusion into the lives of its members to a minimal.
I love this plan! I, of course, each year need to declare to them my goals and such for homeschooling, thus keeping truancy out of the equation for them.
Why can't we as a group pull together and get insurance as a group. I should think any insurance company would be happy for the dollars! While accidents happen in eventing, and when they do, they can be devastating, we all know that it is not THAT common! Much worse to get in a car accident....right?!
Sounds like a great idea to me!

ideayoda

Apr. 1, 2008, 11:43 AM

Mozart

Apr. 1, 2008, 11:46 AM

The costs are going to be astronomical, even assuming an excellent insurance plan. This is one of the reasons people sue (well, their insurance companies sue).

Immediate medical costs, including emergency procedures, ICU care, procedures and medication.
Long term hospital stay, equipment, rehab, physiotherapy.
Long term physical therapy, on going medication
Assuming discharge to one's own residence...renovating the residence to make it wheelchair accessible
Transportation for medical appointments, possbily a "renovated" vehicle for self transportation.
Medical equipment for the home
Home care attendants

And no income to pay for any of this or your day to day living expenses.

I cannot imagine how much all of the above would cost over a five year period...:no:

magnolia73

Apr. 1, 2008, 11:49 AM

I should think any insurance company would be happy for the dollars! While accidents happen in eventing, and when they do, they can be devastating, we all know that it is not THAT common!

Mmmm. I don't know. A lot of ER trips, broken arms and just general long term problems- back aches etc. When coupled with catastrophic falls PLUS the general averages on people hurt in car accidents etc....

Insurance companies probably would not be eager.

ravenclaw

Apr. 1, 2008, 01:21 PM

Just have to comment on the Canadian system. I am currently waiting to see an Orthopedic Surgeon for rotator cuff problems in both shoulders. My appointment was made Feb. 15. I get to go and see the specialist on July 3.

The Canadian system is abused. I have had people tell me to go to the ER and it will get me into the specialist sooner. Yeah right, it is not an emergency, I can wait. The ER is for emergency, such things as heart attacks, profuse bleeding requiring stiches, head trauma, etc not the inability to sleep.

I don't know how everyone in the US is getting in to see doctors so fast. I live in the Southeastern US. I also have a mild heart condition and heart palpitations. Whenever I call the cardiologist to schedule an appointment, there is always a 3-4 month wait for an appointment unless there is a concern because my symptoms have gotten worse. In that case, they will give you one of the "emergency slots" and you can go sooner. Same thing with dentist, gynecologist, etc. No regular appointments available for 3-4 months and sometimes it's as long as 6 months.

American ER rooms are definitely abused, too. I have been to the ER three times over the past several years (for myself or my husband). Each time, I have been shocked at the number of people who seem to use the ER as a doctor's office. They go to the ER for a cold, a very minor rash, a sore finger, etc. Definitely stuff that could have waited until the regular doc-in-a-box was open the next day. I agree with gortmore that the ER should be reserved for actual emergencies!!

DMK

Apr. 1, 2008, 01:34 PM

I would like to see the statistics on that... not quite sure I'm buying it.

I suggest you invest the time to research it if you aren't buying it. But I promise you, as a person who makes her living in the insurance industry, that stat is absolutely NOT contested by anyone with any degree of knowledge in this area. Longer life expectancy and lower IMR are the hallmarks of every country with some sort of universal health coverage. The US historically ranks a wee bit above third world countries, although to be fair, our close rankings with some really deplorable countries probably has more to do with their under-reporting rather than us just being that bad. But yes, we just do not fair well in basic indicators of quality of care. However the reason this stat is lower is due to the disproportionate levels of uninsured. Our insured population is healthy. Overweight, but healthy.

We also don't fair significantly better when it comes to users of heath care and their opinions on health care services received. Turns out we bitch about our health care access and wait times about as much people in universal health care systems do. Oops. The only significant difference was in o/p diagnostic procedures - US (insured) wait times were significantly lower. However anyone who knows the US health care system knows that o/p dx was/is quite a profit center for clinics and hospitals and there is HUGE overcapacity in this area. Way more than we can justify based on a capacity/need/ROI basis. So you know the first thing that would happen in a universal health care system is all the overcapacity would get trimmed out of our systems and wait times would level out with other developed countries.

IFG

Apr. 1, 2008, 02:00 PM

From the CIA factbook. Look at where the US ranks in life expectancy:

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

poltroon

Apr. 1, 2008, 02:00 PM

For riders, there is NASE (national association for the self employed) and you can chose from a wide range of insurances under their umbrella. I have a $1500 deductible, and 2M cap, and its fairly inexpensive. Riders (in particular) NEED insurance.

I personally think this group is a scam. They cannot help you if you have a preexisting condition, and a friend of mine who had their insurance was shocked when he had a knee injury how terrible the plan was. When I called them, and talked about the preexisting conditions, they then tried to sell me junk discount plans and pretended it was insurance. All it is is an insurance company pretending to be something else, nothing more.

IFG

Apr. 1, 2008, 02:02 PM

Sorry to degenerate the conversation, but this is a pet peeve of mine. Same source. Look at how great the US does on infant mortality:

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

poltroon

Apr. 1, 2008, 02:11 PM

Here is a good source on how the US compares to other nations in health care:

http://www.commonwealthfund.org/newsroom/newsroom_show.htm?doc_id=482616

On measures of quality, the U.S. overall ranked 5th out of 6 countries. The U.S. ranked fifth in coordinated care, and last in patients reporting that they have a regular doctor (84% vs. 92%–97% in other countries).

On access measures the U.S. ranked last overall, including last on timeliness of care: 61% of U.S. patients said it was somewhat or very difficult to get care on nights or weekends, compared with 25%–59% in other countries.

On efficiency, the U.S. ranked last overall, including last on percent of patients who have visited the emergency room for conditions that could have been treated by a regular doctor if one had been available (26% vs. 6%–21% in other countries). The U.S. ranked fifth of six countries on primary care practices having "high clinical information functions," defined as practices having at least 7 of 14 office practice information functions, including electronic records, electronic prescribing, computerized safety alerts, and patient reminders systems and registries (19% compared with 8%–87% in other countries).

There are zillions of interesting papers and articles at commonwealthfund.org. It can be tricky to navigate, but there's a wide range of information.

poltroon

Apr. 1, 2008, 02:18 PM

When deciding whether you want nationalized health care, just ask yourself one question: do you want health-care decisions being made for you by the same lovely folks who brought you the IRS?

This article (originally from The Spectator) just about ends the debate: http://www.harrysnews.com/tgDieinBritain.htm

It's hard to say how the government could be worse than the nice people at <MegaHealth>. :)

For example, my friend had a child over a year ago, and her insurance company is refusing to pay the anesthesiologist, because he was out of network, though she was at an in-network hospital. Fun fact: in the entire San Francisco Bay area, they didn't have any in-network anesthesiologists when her daughter was born. Somehow they forgot to mention that.

Vice President Cheney has government health care. Senator McCain has had US government paid health care his entire life. It seems to work out well for them.

Our insistence on linking health insurance through employment stifles small business, and especially affects people like horsemen and farmers, who tend to be sole proprietors.

poltroon

Apr. 1, 2008, 02:27 PM

sorry to burst your bubble about the idea of setting up an association plan, like through USEF or like other trade unions do. I have worked for 16 years in the group insurance industry and I can tell you that trying to find insurers who will quote on these groups is like pulling teeth. They are poor risks. They are a catch-all for those who cannot otherwise obtain insurance. And before all the liberals puff up and declare how "Unfair" that is, consider

1) the fact that the insurers need to maintain a book of business where the healthy insureds can covers the loss of the sick ones.
2)that in the US, obesity and related conditions are out of control, over 60% of the population is considered over weight. As a nation, we're fat and unhealthy and it's just getting worse.

You want to know why health care insurance costs are out of control? Every American should strip down naked in front of their bathroom mirror and have an honest look at themselves. People are in such denial. (and no I am not a 90 pound skinny-minnie, and I honestly need to drop 15 pounds and start running again)

If he has medical insurance, it may have a lifetime maximum. It's common to have a $1M or $2M policy. Once he hits that limit, his only coverage option will be the high-risk state insurance pool product for his state of residence. The real need for him would have been STD and LTD to replace his lost income. If he doesn't have disability and remains disabled, Social Security disablity will have to be applied for. Eventually after his assets are gone, he will qualify for Medicaid. It's not a good situation to be in.

I became interested in this topic when I started my business and I tried to buy health insurance, thinking that it was a simple matter of choosing a plan and sending a check. We were healthy. I thought. My doctors thought. Who knew.

In my state, the high-risk pool has a lifetime maximum of $75,000, and it costs over $1000 a month. (That's a lot better than it once was.)

I have come to the conclusion that in the current regulatory environment, it's not possible to be an ethical insurance company. Any company that is a little better will be crushed by slightly sicker members, causing them to raise rates, causing them to lose healthy members, and so on. Health insurance is the kind of good you can't assess until you've had to use it - and then it may be too late to change anyway.

Rye is right - there is no way to set up a multi-state group of horsemen under these rules. You might be able to arrange a discount for the healthy ones, but the insurance companies don't want these groups because by definition they're going to be people who couldn't get it through employment or who didn't qualify individually - ie, bigger risks. The reason they like employment is because they figure if you can work, you're not likely to be too sick. Your employer won't tolerate a lot of absences for doctor appointment, anyway.

To top it off, the rules and regulations are totally different by state, so people in different states can't be in the same group. This is a real problem for a lot of internet startups that may be doing a lot of telecommuting and have one or two workers in each state.

The complexity of the whole arrangement is just mind-boggling.

DMK

Apr. 1, 2008, 02:53 PM

I have come to the conclusion that in the current regulatory environment, it's not possible to be an ethical insurance company. Any company that is a little better will be crushed by slightly sicker members, causing them to raise rates, causing them to lose healthy members, and so on.

I'll say that any insurance company can and should be ethical. But what they can't be (and this is true of insurers in every line, not just health insurance) is step outside a very tight line that is the prevailing market standard. Meaning, you can't set yourself up to attract more than your fair share of adverse risk. Risk is fine, it's what the business is about. But more than your fair share is a rapid downward spiral that leads to all those things you mentioned. But that isn't the same as behaving unethically. Unethically is to behave illegally or not uphold the contract you have with the member or the provider or to mislead them into believing a contract offers more than it does.

But it's a tricky issue. For instance every insurance contract on the planet has a subrogation clause. Subrogation figures heavily into insurance savings - maybe 4% of health care premium IIRC (which is about equal to the average insurer's PBIT). Subrogation means if the UPS driver rear ends you the insurance company has the right to go after UPS and reclaim any expenses it paid in relation to that injury. Fair enough, and most people would expect an insurer to do their part to reduce expenses. The problem arises when maybe YOU sue UPS. If you do, and you get an award, the insurance company gets it out of your settlement. Again, not for more than they paid out, but they are legally entitled to get that money. Again, over th year, this does have an impact on your premiums.

But if you have been following the WalMart debacle, Walmart who self insures, has gone after the settlement awarded to a seriously disabled former employee with a TBI, to the tune of her entire settlement (which is probably less than they paid in medical claims). But that settlement was probably not going to provide for this poor woman's lifelong care bill in a nursing home and she doesn't appear to have much in the way of reclaiming a functioning life, so lifelong care it is.

It's absolutely cold and heartless for Walmart to recoup that money given this particular woman's life circumstances, but is it unethical?

They have a contract to uphold with all the other members they cover and to step away from this case now that it has gained media attention could reasonably mean they will lose the right to subrogate in future cases. That could have a real impact on people who ares truggling to pay premiums. Is that ethical?

It's just never an easy choice, and while I don't think Walmart wins good citizenship of the year award in almost any circumstance, I kind of feel for them in this case.

LSM1212

Apr. 1, 2008, 03:02 PM

I used to have Humana HMO. Though you couldn't go to anyone you wanted to for healthcare... they paid everything. And I mean.... everything.

I had 3 surgeries over 3 years that cost probably 10-15k each. I didn't pay a dime for the 2 scheduled ones. But the one that I went to the emergency room and then was admitted, I paid the $50 co-pay.

I now have Aetna. I have to pay 20%. Had a few MRI's done. Paid out a few hundred for each. :(

But more Dr's take Aetna. Most don't want to deal with Humana so they dropped it. So I had to swap.

I hope Darren has good insurance... I'd hate to know what that bill is going to be. :no:

mairzeadoats

Apr. 1, 2008, 03:12 PM

I've lived most of my life in Canada and 5 years in England, I've never had crappy health care, and despite knowing one or two folks that "have money" I don't know a soul that has ever needed or wanted to fly to the US for health care.

I would add that I've known of more than one person who has flown from the US to Europe to get health care not available here in the states.

Back to the OT, you or I could have health insurance and be totally wiped out by a serious injury or disease. Insurance doesn't cover all the costs -- usually about 80%. And 20% of an extended stay in ICU, extended therapy, extended whatever, is astronomical. With this kind of injury, having insurance becomes essentially irrelevent. You're financially ruined either way.

Before the current mortgage crisis, the current administration made it a lot harder for individuals to declare bankruptcy because they weren't going to reward the lazy deadbeats. Problem is, had they actually bothered looked at the facts, they'd have learned that the vast majority of individual bankruptcies and foreclosures were due to serious illness in the family.

tx3dayeventer

Apr. 1, 2008, 04:12 PM

flshgordon

Apr. 1, 2008, 04:50 PM

I also recently learned that if you don't pay your hospital bills they can't use it against you on your credit report.

This is not true.

Several years ago I was kicked by someone else's horse (broke my leg) on a trail ride in a small town outside Houston. Went to the closest hospital, was xrayed, put in a splint, sent back to Houston to see regular dr the next day.

5+ years later I was checking my credit report for something and found a note in the delinquencies section. There was a non-payment in there for about $13.50. Some lab had sent a bill (supposedly) that I never got and in 5+ years they couldn't track me down to pay it? So it went to collections and then on my credit report. I called them to find out what it was and had it cleared up in a matter of weeks. But they have every right to put it on your credit report so be careful.

BarbB

Apr. 1, 2008, 05:00 PM

I would add that I've known of more than one person who has flown from the US to Europe to get health care not available here in the states.

Back to the OT, you or I could have health insurance and be totally wiped out by a serious injury or disease. Insurance doesn't cover all the costs -- usually about 80%. And 20% of an extended stay in ICU, extended therapy, extended whatever, is astronomical. With this kind of injury, having insurance becomes essentially irrelevent. You're financially ruined either way.

Before the current mortgage crisis, the current administration made it a lot harder for individuals to declare bankruptcy because they weren't going to reward the lazy deadbeats. Problem is, had they actually bothered looked at the facts, they'd have learned that the vast majority of individual bankruptcies and foreclosures were due to serious illness in the family.

Yep, the most common cause of bankruptcy is medical bills....great, huh.

My former SO was in an auto accident years ago and MAXED OUT his $1 million lifetime payable thru BCBS. They actually went over the limit because they paid for some followup years later.
He is now nearly uninsurable. He is well off financially and has the most insurance that he can get, which isn't much. He is 50ish, healthy, active, athletic and works in a foreign country. He has considered changing citizenship just for health care.
It is scary out there.
I hope the fund raisers for Darren at least make up his lost income.

RunForIt

Apr. 1, 2008, 05:09 PM

I was riding a baby OTTB and he fell. Actually we both fell. I was knocked out (with my helmet on). They had to airlife me to the hospital. The helicopter ride alone was $16,000!!!! That did not count any of the MRIs, xrays, etc etc. I think my total bill was close to $25,000. I had BCBS (my moms a teacher). They covered all but the helicopter ride. So my parents had to pony up $16K for a helicopter ride I will never remember. HAHA!! FLAME SUIT ON: I think my parents paid for every uninsured hispanic's trip to the ER that day. (I LIVE IN SAN ANTONIO, 76% Hispanic- 40% Illegal)

same thing happened to me in 2000 including the helocopter ride into Atlanta (only I DIDN'T have on a helmet! :eek: ) - we paid about $1500, which includes the bill for the surgery (whopper bill here) on my leg 6 months later, and all the doctor's visits leading up to the surgery (6weeks) and post op. Same thing now, with increases in cost would amount to over $6000 - small compared to the total bill

JER

Apr. 1, 2008, 05:24 PM

I've lived in Europe, the US and Canada and I've traveled all over the planet.

The 'health care debate' -- like the one on this thread -- is something peculiar to the US. Americans devote a lot of time to arguing, defending, griping and worrying about their health care system. The level of anxiety about health care in the US is far greater than I've seen anywhere.

Health care is often cited as a reason why Americans will stay in a job they hate or in a relationship they no longer want to be in. And there's that thing about bankruptcies that others wisely pointed out. None of this is too healthy, IMO.

To those who trumpet the "America's #1!" in response to any criticism of our healthcare colossus: Please realize there are a lot of countries with very good health care and a lot of countries with excellent hospital/surgical/care facilities. The US is just one of a number of countries that foreigners will go to for top-level treatment and Americans also travel outside the US for the best-available or most-affordable treatments.

What's happened to Darren is very sad. Here's a guy who's worked really hard, reached the top of his chosen profession and doesn't have anywhere near the kind of healthcare coverage he needs for his line of work. It' sno this fault, it's just that his line of work and its risks don't fit with the goals of the US health care industry.

deltawave

Apr. 1, 2008, 05:44 PM

I think my parents paid for every uninsured hispanic's trip to the ER that day.

And if an "uninsured Hispanic" had had the same accident the NEXT day, would you have elected to leave them lying there untreated? :no:

jn4jenny

Apr. 1, 2008, 06:08 PM

Soooooo getting back to the issue at hand and away from a general debate about medical insurance in the US...

I wish Darren all the best, and Ralph, and Kim, and every other eventer who's in a terrible freak accident...however, I admit that I find it hard to donate my money to their recoveries when I'm not sure if I'm helping someone who DID carry the best possible health and disability insurance but still has substantial expected bills, or if I'm "scabbing" for someone who didn't carry that insurance and is now in ten times the debt they'd be in if they had carried the appropriate insurance.

I agree that the costs of high-quality health and disability insurance in this country are absurdly high--I think it's disgusting, and I actually stay in my current job (which pays an absolute pittance) because I get very good health insurance through it. I agree that getting adequate health and disability insurance would present a substantial financial challenge to most eventing professionals given the risk--I was told by my own insurance agent that if I were a horse trainer as a day job, my risk category would be about five times higher than as a hobby horse owner with an office day job.

But to be asked for a handout when the pro had the best equipment, the best horses, the best everything-else-your-money-can-possibly-go-toward-except-insurance is very hard for me. It is a very different situation if the pros did everything they could to minimize the potential debt of an accident and are coping with the still-very-substantial bills that would result.

On the other hand, how on earth could we preserve their human decency by saying, "Okay, please cough up your health insurance and disability insurance information so that we can decide if you really need the help." That seems cruel, impolite, and unwieldy. :(

FlightCheck

Apr. 1, 2008, 06:18 PM

Jn4Jenny, that was a well-thought-out post.

florida foxhunter

Apr. 1, 2008, 09:57 PM

I try to live my life by the motto" Do unto others as you'd have them do unto you"......
not that I'm that perfect at it by any stretch........but I'm here in Tallahassee, and it ain't a pretty sight!!!!!

Catalina

Apr. 2, 2008, 11:59 AM

I recently had surgery to repair the ligament in my thumb that I shredded by bridging my thumbs on my horse's neck. I have BCBS and my out of pocket expense for a relatively minor outpatient surgery was over $1000. I cannot imagine what Darren's bills are going to be.
Health care is expensive. Everything about it: the machines, the professionals, the drugs, the hospitals, etc. The money to pay for all of that has to come from somewhere, I am just not sure what the best solution is.

Lookout

Apr. 2, 2008, 06:53 PM

It may interest you to know that towards the end of his life Christopher Reeve was no longer able to afford his medical care and had it paid for by his good friend Robin Williams.

Soooooo getting back to the issue at hand and away from a general debate about medical insurance in the US...

I wish Darren all the best, and Ralph, and Kim, and every other eventer who's in a terrible freak accident...however, I admit that I find it hard to donate my money to their recoveries when I'm not sure if I'm helping someone who DID carry the best possible health and disability insurance but still has substantial expected bills, or if I'm "scabbing" for someone who didn't carry that insurance and is now in ten times the debt they'd be in if they had carried the appropriate insurance.

I agree that the costs of high-quality health and disability insurance in this country are absurdly high--I think it's disgusting, and I actually stay in my current job (which pays an absolute pittance) because I get very good health insurance through it. I agree that getting adequate health and disability insurance would present a substantial financial challenge to most eventing professionals given the risk--I was told by my own insurance agent that if I were a horse trainer as a day job, my risk category would be about five times higher than as a hobby horse owner with an office day job.

But to be asked for a handout when the pro had the best equipment, the best horses, the best everything-else-your-money-can-possibly-go-toward-except-insurance is very hard for me. It is a very different situation if the pros did everything they could to minimize the potential debt of an accident and are coping with the still-very-substantial bills that would result.

On the other hand, how on earth could we preserve their human decency by saying, "Okay, please cough up your health insurance and disability insurance information so that we can decide if you really need the help." That seems cruel, impolite, and unwieldy. :(

SR Rider

Apr. 2, 2008, 09:07 PM

I broke my C1 two years ago while schooling cross country during a lesson with my
trainer. I had $5000 deductible. Then I found out I fractured 8 teeth that
needed caps...$8000 (no dental insurance). Ca Ching I am self employed as a realtor....and I
couldn't drive for 6 months. My disability wouldn't kick in for 6 months, so it was of
no benefit. No one will ever know the $$$ it cost me...like most of my savings. But I am
so glad I am back to "normal" even though I can never ride again.

Ilex

Apr. 3, 2008, 10:38 AM

I'm not sure that I really like the term "socialized medicine" ......

we don't call the k-12 education system here in the USA "socialized education".

And yet by definition that is what our education system is .... gov't based/tax payer supported education.

It's interesting to me that 'education' is a right to every USA citizen but 'health care' is not.

I think that individual states need to step up to the plate. There is no reason why Pennsylvania who has 12.5 million people residing in her can not bulk buy insurance and sell it to folks who do not have insurance. PA provides CHIP to all kids under the age of 18 who do not have insurance regardless of the parents financials.

But as an adult my husband and I made $1200 to much to buy into the Basic Care program. So I said fine I will pay the $50 monthly premium plus divide the $1200 over 12 months and pay that back to the state as well. That would give us insurance for $150 per month. The answer was NO.

When I had good insurance I did not abuse it. I got an annual pap smear. And maybe needed to go the doctors office 6 times over 10 years for illness and injury. And never to the ER. I had surgery on my neck and that cost us $8,000 out of pocket that had to be paid before the surgeon performed the surgery. Because he wasnt on our provider list (the surgeons who were on the provider list had never performed the surgery before....and recommended the surgeon we used).

We have not had insurance for four years now. No probable closer to five years. I've been to the doctor 3 times for various ailments. No pap smear/yearly....cause what's the point. I could pay for the yearly but if they find something wrong I can not pay for additional tests or treatment.

I assure you........not having insurance SUCKS! We could not afford the $450 a month that our catastrophic coverage only insurance went to.

To the poster who made the remark about .... if you don't like it you can leave. Do you really think that this is a healthy response?

Tami

silver2

Apr. 3, 2008, 12:19 PM

You will notice that rich Britons, Canadians, Frenchmen, Arabs, etc. head to major US medical centers for treatment of the most serious diseases.
The ultra-rich do come to American hospitals for care for rare conditions but there are also huge numbers of middle class Americans who go abroad for medical and dental care because they can't afford it here. I would bet the net flow is overseas by a large margain.

I'm one of them- I had knee surgery in europe- $5K out of pocket, entirely private, my own hospital room in a very well-respected clinic with a top surgeon. A lot of people here in CA go to Mexico or Argentina for care. India is incredibly affordable and the doctors are often US-trained.

And yeah, it's practically impossible to get insurance here in CA if you don't have an office job and perfect health. My employer offers free insurance, free long and short term disability insurance and dental care and they are the exception.

Fairview Horse Center

Apr. 3, 2008, 12:38 PM

IMO, we need to go backwards in time about 50 years to use that type of health care. Insurance was hospitalization, 80/20. You had to pay out of pocket 20% of any hospital bill. The exception was emergency room treatment, which was 100% covered. There was also a limit, and covered 100% over what would today be about $100,000. So at most you would have to pay $20,000. for a catastrophic injury or illness. So if the worst happens, you take out a loan for that and put off that new car for a few more years. It covered NO doctor bills, unless it was in the hospital, and then included in the 80/20. It also only covered prescriptions if over a certain amount in a year (maybe like $1000)

People were then more responsible about running up doctor bills for every sniffle, because it would cost them. They would actually have to give up something to go to a doctor, and it was not just an easy way to take an afternoon off. If you need to pay a doctor, and have to pack your lunch/drink tap water for a month to cover it, instead of just letting the insurance company take the hit, you treat is much differently, and don't abuse the system.

The reason we no longer have that system in place, is because many people figured out how to cheat it. Instead of going to their regular doctor for their kid's sprained ankle, they took them into the emergency room. Free instead of paying for them, but for the insurers, it was hundreds in ER bills, instead of $40 at the family physician.

We also live in a society that wants to be "risk free". X-ray that sprained ankle, instead of icing it and seeing how it is in a day or 2. AND make sure it is with a specialist. Oh, and BTW, give me a "free" prescription for an antibiotic, just in case.

Our other huge problem is that hospitals are now run as a for profit business, with stockholders that want their double digit growth rate. IMO, they should be run as a non-profit.

The old health care policies also did not cover doctor visits for maternity care, or well baby visits. These are office visits. It only covered the actual delivery. People also didn't wait until their 30s and 40 to try to start a family, so the insurance could pay because they are no longer fertile. Again, if something is free, people abuse it.

DMK

Apr. 3, 2008, 01:16 PM

You can argue all day long about the benefits/ills of stockholders (which is an entirely different issue from FP/NFP), but you are kidding yourself if you think NFPs are gloriously absent the same profit motives that drive FPs. About the only difference is a matter of bookkeeping.

Also, while I think it's very important for people to get a little more familiar with the price of the service they are buying (it's not a $15 copay), let's not get too cozy about the good old days of insurance. Remember those policies only covered illness or injury and a good many didn't cover o/p physician care, period. I don't think there are too many people that would prefer to pay for their preventive care (pap smears, mammograms, immunizations, wellness baby care, colonoscopies, etc.) out of pocket. And a good many more would go without that care, which of course would decrease early detection rates of disease.

Fairview Horse Center

Apr. 3, 2008, 01:56 PM

I don't think there are too many people that would prefer to pay for their preventive care (pap smears, mammograms, immunizations, wellness baby care, colonoscopies, etc.) out of pocket. And a good many more would go without that care, which of course would decrease early detection rates of disease.

Don't you think that is exactly what has happened to the millions of people that can't afford any insurance? I bet most people that can actually afford the premiums are also the ones that really could afford to pay for those services. Most would not even have to give up their Starbucks to pay for a pap smear. BTW, about 35 years ago, a pap smear added about $35 to the $25 office visit. My son's immunizations 20 years ago cost less than $300 including office visits for all thru when he started school. I think most people working jobs with health care could afford to take over that expense.

Routine things would be a lot more affordable too, if they were priced to encourage "customers" to use those services. Instead, they are priced thru the roof, because, ya know, the insurance will pay (and pay, and pay)

I have also been given several times a much different price when a doctor hears you are self pay, even if you are making payments. They pump those prices because they can.

deltawave

Apr. 3, 2008, 02:10 PM

I had an interesting experience this week--we're in Aruba and I ruptured my eardrum the day after we got here. (Ouch, by the way) Since this had happened to me once before and was a nightmare, I decided to go to the local hospital ER on a Sunday morning and get it looked at. Paid cash, it was $100 soup to nuts. No, nothing major diagnostically--just someone looking in my ear and seeing if it was infected or not--but I was shocked at the charge. A hundred bucks for an ER visit! Unheard of. I went to the ER the last time, too--in the US--because it was 2am, I was in horrible pain and couldn't stand up straight for the vertigo, and that charge was around $1500, not including the prescriptions! :eek:

I have very mixed opinions on the insurance industry, hospital charges, etc. for obvious reasons. It's too big and complicated for me to figure out. :sigh: But the reasons the system is broken aren't simple, nor will the solution be.

DMK

Apr. 3, 2008, 02:49 PM

Don't you think that is exactly what has happened to the millions of people that can't afford any insurance? I bet most people that can actually afford the premiums are also the ones that really could afford to pay for those services. Most would not even have to give up their Starbucks to pay for a pap smear. BTW, about 35 years ago, a pap smear added about $35 to the $25 office visit. My son's immunizations 20 years ago cost less than $300 including office visits for all thru when he started school. I think most people working jobs with health care could afford to take over that expense.

Routine things would be a lot more affordable too, if they were priced to encourage "customers" to use those services. Instead, they are priced thru the roof, because, ya know, the insurance will pay (and pay, and pay)

I have also been given several times a much different price when a doctor hears you are self pay, even if you are making payments. They pump those prices because they can.

In the test tube environment of your example, such things might be true, but in the real world, they'd run into trouble. First of all, the idea that "most people that can actually afford the premiums are also the ones that really could afford to pay for those services" is, well let's just say I wouldn't want to bet a lot of money on that assumption. "Most" insured people don't pay all the premium, they pay a portion of premiums, their employer pays the rest. The vast majority of people paying all the premiums would probably beg to differ with you on the idea that they could pay maybe 70% of their current premiums (assuming a reduction for no prev care cov'g) AND full nickel for preventive care procedures (priced a colonoscopy recently?)

More importantly, insurers themselves would not be too keen on this idea, because a failure to get preventive care done is not a SMRT business move for the insurer, If you cover catastrophic care and someone does NOT get early detection of diabetes, CHF or cancer, this costs MORE money. There are reasons insurance changed, and they weren't all bad. I mean, hello, there's a reason why IRS regs governing HSA plans specifically exempted preventive care procedures form HSA deductible guidelines, and it wasn't because the dweebs at the IRS thought it was a nifty idea. It's because providers, insurers and employers all agreed this was a critical component of the plan design.

Yes prices have risen, but it isn't entirely due to the insurer/provider equation (meaning the end user of services is completely removed from the cost equation). I'll grant you that is a significant part of it, and probably an issue I know a more about than your average bear, but bottom line is that health care delivery has increased considerably in technology and complexity, and this costs money and as in any industry, there is cost shifting. Certain procedures cost more to offset losses in other considerably higher cost procedures. Actually, Darren's case is an example of this. Very few facilities even break even on trauma cases. Yes, those cases cost insurers and patients an unbelievable amount of money, but it's a given that even the facility is also likely to have lost money on those cases - they are too (thank heavens) infrequent but still require a high degree of both technology and technical expertise that must be maintained year 'round waiting for a few (again, thankfully) cases. They do try to make it up the losses in other areas though, that's just the reality of health care economics.

Larksmom

Apr. 3, 2008, 02:59 PM

I wouldn't be so sure that the quality of care is "crappy" with socialized medicine, it is more that there is a queue for care, and that the amenities (as you describe for your aunt) are less prevalent. If the quality of care in the US were so high we would not have such a high infant mortality rate compared with those countries with socialized medicine.

The reason our infant mortality rate is so 'high' is because they are able to save infants that wouldn't even have a remote chance elsewhere. I have a best friend who just in the last month had a great niece born with out a 'ahem' butthole!! 1 small kidney, I thought they would be planning the funeral, but I just heard, they have improved her condition, and are taking her home with a colostomy bag.

FlashGordon

Apr. 3, 2008, 02:59 PM

A friend of mine had a 10K bill for a broken arm. Insurance paid all but 2K.

Imagine had that been a more serious injury.

Spent some time in and out of the hospital this winter and both hubby and I were :eek: at the co-pays and bills that came our way. Even with good insurance.

I can't imagine the kind of costs that long-term care would induce. Darren's got a long road ahead and I am sure there the costs will be astronomical.

On the other hand, the problem with socialized medicine is that everyone gets crappy health care. But it's free. If folks have money - they fly to the US to get treatment.

At least in the US, you don't have to be on a waiting list for 2 years to get a joint replacement.

My husband is English and their health care system is shocking at times. His grandma had to wait months for much-needed heart surgery. His mom's friend was denied chemo based on the county she lived in and the costs associated. Just waiting for an MRI can take several years.

Most of our friends and family in the UK are on private health care now and not even dealing with the system.

Larksmom

Apr. 3, 2008, 03:01 PM

JER

Apr. 3, 2008, 03:09 PM

It's interesting to me that 'education' is a right to every USA citizen but 'health care' is not.

I think that individual states need to step up to the plate. There is no reason why Pennsylvania who has 12.5 million people residing in her can not bulk buy insurance and sell it to folks who do not have insurance. PA provides CHIP to all kids under the age of 18 who do not have insurance regardless of the parents financials.

Tami, there is a very good group in your state that's lobbying for single-payer coverage. This (http://www.healthcare4allpa.org/home.php) is their website, which has lots of details on the legislation they're pushing for.

In CA, the governor vetoed a bill passed by both houses that would bring single-payer care to the state. The reason the state assemby and senate passed it was because studies showed the single-payer system would save CA taxpayers $8 billion. Not sure why Schwarzenegger vetoed, other than his cozy relationships in the health care industrial complex.:(

J Swan

Apr. 3, 2008, 03:32 PM

Someone beat me to it but I was just about to post that much of what may be wrong with healthcare in your state can be remedied by your legislature.

If you feel a portion of your population is underserved, or there are inadequacies, abuses, or other problems in your state, it's something you can take up with your state delegate/senator.

For instance, anti-subrogation statutes have been effective, laws about payment for mammograms, and without getting into a very non horse related discussion about health care (I'm no expert anyway) I can say that a lot of what is and isn't "covered" by your health care policy at work can also be remedied.

Your HR dept shops it around and gets prices from different companies for different levels of care. It's something you can help get involved in by advocating for practices that will help reduce premium costs. Not by eliminating coverage for riding, or parachuting (which is what some people want), but seeing if you can get reduced premiums by having a wellness program at work, anti-smoking stuff, a weight loss group, exercise groups - all sorts of things.

What I have learned in my admittedly limited exposure to our healthcare system, is that WE have to control our own healthcare. We have to manage it ourselves - and that means not just nodding at whatever our doctor or insurance company dictates - but being an active participant in our own health, our health care decisions, talking intelligently to our providers about options, and not taking "no" and "not covered" for an answer.

For truly catastrophic injury, such as the one Darren received, he is truly blessed to have family and friends to be his voice - and advocate for him. Many of us wouldn't have that if we were so badly injured. But really - how many of us would be able to make major health care decision for ourselves - much less an injured family member?

Do we really know whether a rehab facility is best? Or is a visiting nurse/PT the best option? We don't carry our policies around in our purses, right? Are all the tests necessary? Or not enough being done? Who is this person examining the patient? Where is the doctor?

I guess I'm going of just rambling - but for most things, even surgery, I've managed to walk out of the hospital with few to no money owed. But only because I was able to figure out ahead of time what was covered, what wasn't, which doctors I should use - and to make sure I dotted all the I's and crossed all the T's.

If I was in a truly serious accident...... that ability is taken away from me, and I can no longer participate in my healthcare decisions. For those of us who have friends and family, perhaps this is a discussion you can have with the person you've chose as your healthcare proxy.

God forbid something should happen to one of you - it's not only important to have a proxy to speak for you - but it would be helpful for that proxy to know a bit about what sort of insurance you have, and be able to converse with the billing people, the insurance company, or any other people. Since your proxy will be obliging you financially, you want to have a savvy person who also knows your final wishes should it come to that.

poltroon

Apr. 3, 2008, 03:38 PM

When I was uninsured, it was no big deal to pay for my own pap smear out of pocket. But I didn't. Why not? Because I thought about it: what is the point of a pap smear - to see if you have cancer. And what would be the advantage to finding out you have cancer while you're uninsured and unable to get cancer treatment?

RAND corp studied how a co-pay or full payment versus free affects how the patients utilize care. It is true that they use less as the payment increases. However, it also turns out that they avoid necessary and beneficial care at the same rate as unnecesary care - that is, civilians aren't doctors and are not terribly good at knowing when they need to see one and when they don't. The higher payment rates ended up with a net negative, because of the avoided necessary care.

In my own personal experience, time off from work plus parking plus gas generally costs as much or more than the full retail of a physician visit. Not to mention that it's really not any fun to go. YMMV.

Medical care has changed quite a bit since insurance plans were first offered. For example, many illnesses that used to require hospitialization and/or surgery are now treated instead outpatient, with expensive prescriptions. When I was shopping for insurance, I was looking at a hospital only plan - I figured I needed to be covered for a riding accident or a serious illness, but not, you know, doctor visits. The insurance agent explained to me that she had a client who had gotten cancer - but her chemo was done outpatient, and it's many thousands of dollars per visit. The hospital only policy doesn't cover that, and there are many scenarios for running up 6-figure medical bills without ever being admitted to a hospital, or with only a small portion of the cost being a day or two in the hospital.

Another place they get you is that they change the amount you pay in the ER based upon whether or not you're admitted. Sounds fair, right, you're thinking, oh, if I really needed to be at the ER, and it's pricey, they'll admit me, and if it was a frivilous visit, they won't. Nope - these days they can patch you up pretty well in the ER without admitting you - broken bones, asthma, even some serious heart ailments - and you can end up with a bill well north of $50k.

DMK

Apr. 3, 2008, 04:09 PM

PineTreeFarm

Apr. 3, 2008, 04:16 PM

really[/I] needed it, another report informs me I would be mistaken in my assumptions.

THat's fine except if you get sick on a Saturday or Sunday your GP is likely to be on the golf course and unavailable.
If you have a problem late in the evening there is no other choice.
Urgent care center? None of them near me.

JER

Apr. 3, 2008, 04:19 PM

heaven knows why one would want to go to an ER unles one had no other choice, but every time I get comfortable in the idea that insured people are too smart too use the ER unless they really needed it, another report informs me I would be mistaken in my assumptions.

That's why most insurers try to have urgent care centers at cost sharing considerably less than ERs, set ER copays high enough to deter incorrect use, and then waive the copay for people who are most in need of care - so for them the cost is not a barrier to care. Does it work perfectly? Of course not. But the logic behind it is purely driven by past behavior.

This is where the doc-in-the-box is a good option. You may have to go to a less-upscale part of town and the doctor may not be white and UMC but they'll be licensed and they'll have the skills to take care of you. They also won't be overwhelmed with patients like in the ER and you'll have time to ask all the questions you need.

I've worked in ERs (I'm an EMT). I could usually handle a good percentage of the patients on my own and with my limited scope of practice. I'd hate to see what the hospital is charging them -- I imagine many multiples of the $40 office charge at the doc-in-the-box.

FlashGordon

Apr. 3, 2008, 04:40 PM

That's why most insurers try to have urgent care centers at cost sharing considerably less than ERs, set ER copays high enough to deter incorrect use, and then waive the copay for people who are most in need of care - so for them the cost is not a barrier to care. Does it work perfectly? Of course not. But the logic behind it is purely driven by past behavior.

Whoa whoa whoa they will waive the copays if it is determined you really needed to be there? Seriously? We paid a boatload in copays because my docs kept sending me back to the ER (at some points, every other day) instead of admitting me. Numerous trips meant numerous ER copays, in addition to outpatient testing and treatment that cost a pretty penny.

tri

Apr. 3, 2008, 05:30 PM

Very good friend of mine moved to Germany temporarily with her husband who had a contract job there. She was pregnant. While she was in Germany with their "lovely" socialized healthcare system, she started having trouble and was spotting. The German doctors "treated" her under that "wonderful" socialized medicine system and she miscarried. She flew home as soon as she was able and went to her regular doctor who told her, after reviewing her medical record from Germany, that she should have been easily treated and would have been easily treated here in the U.S. and there was no reason whatsoever for that miscarriage to have progressed.

Also, I haven't read through the whole thread, but where oh where oh where are the Canadians, and the rest of the world's socialized medical systems going to find the money to pay for all that medical & drug research that you get mostly for free from the Americans if the Americans adopt socialized medicine? Canadians, you act so superior citing your cheap drugs - well AMERICANS ARE PAYING IT FOR YOU. And if we go socialist, we won't anymore and, guess what? Your "system" right along with the Germans and the rest, won't be quite so cheap anymore.

So, add higher cost because Americans won't be subsidizing it for you anymore right along with your long waiting lists and lack of care and watch the world catch on fire. You think our system here in the U.S. is bad now, wait until it become socialist.

Infant mortality rate? Do you realize that the 9 month pregnant women are crossing over deserts in 110 degree heat from Mexico to the U.S. to fall exhausted and often with fetal distress into U.S. emergency rooms to give birth so the baby - if it lives - can be an American citizen? And that counts in the U.S. infant mortality rates? Do other countries have this problem? No.

In other countries - like my example in Germany - the fetus is just allowed to miscarry and that does NOT count in the infant mortality rates for that country. A higher percentage of pregnancies go to term here in the U.S. that would NOT go to term in other countries. A higher percentage of those infants who are then actually BORN do die because they were high risk to start with. But that is not a reflection of bad health care. It is an indication of GOOD healthcare because they would be just counted as a miscarriage elsewhere.

JER

Apr. 3, 2008, 05:44 PM

Infant mortality rate? Do you realize that the 9 month pregnant women are crossing over deserts in 110 degree heat from Mexico to the U.S. to fall exhausted and often with fetal distress into U.S. emergency rooms to give birth so the baby - if it lives - can be an American citizen? And that counts in the U.S. infant mortality rates? Do other countries have this problem? No.

tri, could you post the statistics from which you draw this conclusion?

I really want to know how many of these women -- those pesky Mexican women who tromp through the desert when 9 months pregnant -- are coming to the US and inflating our infant mortality rates.

I'm from Germany. Never knew I was 'allowed to miscarry'. Now I just think of the road not taken. :eek:

deltawave

Apr. 3, 2008, 06:22 PM

And what would be the advantage to finding out you have cancer while you're uninsured and unable to get cancer treatment?

Huh?? Everyone in this country is able to get treatment, even the uninsured. Nobody is turned away from hospitals, ERs, offices. Yes, those people are billed for services rendered. Yes, it is a hassle and a pain in the butt. But health care IS available for everyone. Between 5-10% of my patients have NO INSURANCE at all. NONE. We still see them, do tests and procedures on them, with no holding back or second-best care because they have no insurance. And yes, of course I'm very well aware that my premiums and those who have insurance is paying for that. I haven't got a huge problem with that aspect, but as I said, it is hardly cut-and-dried or simple.

DMK

Apr. 3, 2008, 06:25 PM

Whoa whoa whoa they will waive the copays if it is determined you really needed to be there? Seriously? We paid a boatload in copays because my docs kept sending me back to the ER (at some points, every other day) instead of admitting me. Numerous trips meant numerous ER copays, in addition to outpatient testing and treatment that cost a pretty penny.

No, nobody makes a judgment call on whether you needed to be there, it's just some (not every) policies allow for the ER copay to be waived if you are admitted to the hospital within X hours of treatment in the ER.

And PineTree - as I said, the policy doesn't work perfectly for everyone, but it tries to not punish the most needy, while making sure abusers pay more than their fair share. It's hard to ask more than that out of a copay.

JER, I was going to mention telemedicine, doc in the box and minute clinics, but I thought I'd be going over the edge in technodweeb speak. ;)

PineTreeFarm

Apr. 3, 2008, 06:58 PM

No, nobody makes a judgment call on whether you needed to be there, it's just some (not every) policies allow for the ER copay to be waived if you are admitted to the hospital within X hours of treatment in the ER.

And PineTree - as I said, the policy doesn't work perfectly for everyone, but it tries to not punish the most needy, while making sure abusers pay more than their fair share. It's hard to ask more than that out of a copay.
;)

But DMK perhaps you missed the point. Even if you can get a Dr to see you that day ( non golf days ) it's possible that you will be told to go to the emergency room anyway even if it's not anything that you need to be admitted for. That seems to be what happened to FlashGordon.
No problem with the co-pay, I just have a problem with the assumption that everyone who uses the ER is stupid or lazy or doesn't utilize their GP.
And so you won't think I'm an ER abuser, I've only used it once in the last 15 years.

camohn

Apr. 3, 2008, 07:04 PM

deltawave

Apr. 3, 2008, 07:09 PM

camohn

Apr. 3, 2008, 07:21 PM

[QUOTE=Fairview Horse Center;3121177]

Our other huge problem is that hospitals are now run as a for profit business, with stockholders that want their double digit growth rate. IMO, they should be run as a non-profit.

QUOTE]
Unfortunately true. Take the largest local hospital near me, for instance. They have 2 divisions. A for profit and a not for profit side. They make 110 MILLION a year, funnel the funds throught the not for profit part an poof! No profit, a huge campus with marble floors and water fountains. Said hospital also has a billing rate of DOUBLE for uninsured folks than what they charge the insured folks "to make up for the losses on the insurance"> Ummm... 110 million? What losses???? So...another reason to need insurance. If you are uninsured our lovely local hospital will in fact charge you more....the person that can least afford it.

SaddleFitterVA

Apr. 3, 2008, 07:31 PM

So, the defenders of our crappy health care industry/insurance in this country defend it because the uber-rich of the world can come to our premier health care facilities for treatment?

This story of how the poor rich people of other countries with socialized medicine have to come to the USA for health care is just ripping my heart out. And, really, the rest of those Americans and others living in the USA who were stupid enough to not have wealth and adequate insurance deserve to declare bankruptcy and have financial ruin from health conditions that seem to get treated in other countries.

While a lower-middle class citizen in another country might have to wait a couple of years for a joint replacement, a lower middle class citizen in America is just plain out of luck because his out of pocket expenses on that insurance policy will make it unaffordable.

So, we have "you might have to wait" vs. "you can't get it unless you are rich".

I have what appears to be pretty good health insurance. When I had an injury many years ago....the only reason we did not owe several thousand is that my husband WORKED in the department that administered the insurance plan we were covered by and things just got paid.

DMK

Apr. 3, 2008, 07:36 PM

But DMK perhaps you missed the point. Even if you can get a Dr to see you that day ( non golf days ) it's possible that you will be told to go to the emergency room anyway even if it's not anything that you need to be admitted for. That seems to be what happened to FlashGordon.
No problem with the co-pay, I just have a problem with the assumption that everyone who uses the ER is stupid or lazy or doesn't utilize their GP.
And so you won't think I'm an ER abuser, I've only used it once in the last 15 years.

I didn't miss your point, I thought I was pretty clear when I said it wasn't perfect, which sort of left the door open for the idea that sometimes it wasn't, you know ... perfect in every situation, every time. Not sure if I can get get much clearer other than to say the old way screwed EVERYONE, the new system screws some people, and what we are discussing here is the fact that rather than apply the ER copay 100% of the time, golly gee whiz, some insurers thought it would be a nice thing to you know, waive it in certain instances. But if it would make you happier to have it there 100% of the time, I'm sure your insurance company will let you give that money to the hospital. ;). Because even though I really don't think everyone is stupid, lazy or just plain uninformed, the point is, enough of them are, and they were driving up your health insurance costs.

Now I've always been of the mind that I can write a policy or design a product that covers everything and anything and it sure would make my job superduper easpeasy, but that's not the point. The point is you can't afford it. I can't work in the world I'd like it to be, I'm stuck with the one we are all in. So if I see an area where there is abuse, the fairest thing I can do for the majority of policy holders is to try not burden them with the cost of the abusers, right?

As for docs that refer to the ER, that's a tricky one. Without personalizing or applying it to any one situation, I suspect some docs see some patients as walking lawsuits, and act accordingly, some docs may have agreements that reward/penalize them based on admissions (although this would more likely be in CA than NY) and may be trying to finagle the stats that way, and you know, sometimes you are dealing with a service, and anyone who has called their vet knows about services. And really, as well intentioned and necessary as the various prudent layperson statutes are, they really took a lot of the common sense and judgment calls out of potential emergencies.

Galileo1998

Apr. 3, 2008, 07:40 PM

tri

Apr. 3, 2008, 07:53 PM

JER???? You have got to be kidding? You say you live in the U.S. and don't know that hospitals, especially border state hospitals, are buckling under the strain of taking care of illegal immigrants??? Have you been living under a rock?

Since you asked for statistics - all you would have to do is a quick search on the Internet and get about a zillion returns, but here is a quick cut and paste:

nother significant issue, according to Langness, is that state funding for prenatal care has been needed to boost the number of private physicians and hospitals providing such care to illegal immigrants. That increase in service providers has been crucial because county facilities at one time did not have the capacity to service the skyrocketing number of pregnant illegal immigrants pouring into the system.

Another reason public health officials are critical of Wilson's proposal to cut state funding is that significant improvement has been made in reducing L.A. infant mortality rates in recent years. Many sources attributed that to state funding for prenatal care.

In 1986, the California Legislature added prenatal care to benefits provided to illegal immigrants in the state. Since then, L.A.'s infant mortality rate, defined as the number of infants who die in their first year of life, has been reduced dramatically.

Latest statistics, which were compiled in 1991, peg Los Angeles County's infant mortality rate at 7.8 deaths per 1,000 children born. In 1988, that ratio was 9.3 per 1,000 births.

Many health care experts said that trend could reverse if state funding for prenatal care is cut off. According to Susanna Molnar, paranatal coordinator at the National Health Foundation, a direct relationship exists between prenatal care and infant mortality rates. "We have seen that the increase in programs for prenatal care has helped to decrease the infant mortality rates," she said. According to the Wilson administration's calculations, elimination of prenatal care funding would save the State of California at least $82 million per year. Also of consequence, the Wilson proposal is likely to appease the growing number of anti-immigration activists in California during this election year.

Wilson claimed that in the four years since state-funded prenatal care for illegal immigrants was adopted, state spending in that area has increased from $17.7 million a year to $82 million a year.

However, some health care sources argued that one reason for the dramatic spending increase was that the state, and specifically Wilson, had actively supported the program until recently. National Health Foundation's Molnar said she is perplexed by Wilson's reversal on the program. "Actually, the state has spent quite a lot of money (on outreach) for women to get the prenatal care," she said.

Likewise, Langness of the hospital council said Wilson's turnaround on this issue is upsetting to the hospital community. "The governor himself pushed these programs in the past," he said. "We do not understand this sudden reversal." In addition, Langness said Wilson's reversal is politically motivated: "All it is, as far as we understand, is an election-year gambit by a politician whose ratings are low."

Beyond its possible political attractiveness, Wilson's proposal to eliminate prenatal care funding is likely to backfire as a cost-saving measure, according to several health care sources.

Prenatal care, which includes clinical care and education to pregnant women, is geared toward early detection of problems associated with pregnancy. Health care sources stated that prenatal care reduces the risk of children being born at low birth weights, with disabilities, drug addictions and other life-threatening complications. Treating such problems is almost always more costly than administering prenatal care, sources said.

In fact, numerous studies have concluded that, for every dollar spent on prenatal care, between $5 and $13 are saved on treating early childhood health problems.

One factor further complicating the issue is that California can legally eliminate prenatal care funding. Under federal law, however, it cannot do away with providing emergency services, including child birth services, to illegal immigrants.

Wilson's proposal is being widely criticized by health care professionals, who insist the plan is not likely to reduce Medi-Cal costs. Under state and federal law, hospitals are required to administer emergency care to any individual in need.

Women in labor will continue to show up at L.A. hospital emergency rooms to deliver babies whether they receive prenatal care or not. And if those women have not received prenatal care, chances are much higher that their children will require state-funded emergency care in their early years.

This article also talks about how Los Angeles had to start offering the illegal immigrants free pre-natal care to get the infant mortality rates down.....and how it worked which, logically, means that it has a huge effect. But look at the cost. The article tells that the cost went from $17 million a year to $82 million a year to do it. And they are anticipating the infant mortality rate to go back up if they cut that like has been proposed. That is a 65 million increase in cost to cover the illegal mexicans just in that part of Los Angeles...... I'd call that a little more than "pesky" but, hey, thats just me.

Now, if we have socialized medicine, I guess we will have to offer it to half of Mexico too. Wonder how much that is going to cost???

BarbB

Apr. 3, 2008, 08:15 PM

I'm not sure where you get those ideas about socialized medicine. :confused: My 66 year old uncle had a quadruple bypass two months ago and his waiting time for the surgery was 11 days - and cost $0. My grandmother had two hip replacements with no issues whatsoever when she was well into her 70's - and it cost $0.

And, just last week the spouse of a man I work with started having severe pain in her back and hip. She went to the doctor on Monday and was sent to the hospital on Thursday for a bone scan and MRI. On Friday morning the doctors called her with a diagnosis, and today she had an appointment with two "specialist" doctors at a regional cancer centre to start a treatment plan - less than two weeks from first visit to her own GP to an action plan and start of treatment. And all of this has cost them $0.

They get it from the don't-upset-the-applecart propaganda that the insurance companies distribute.
When they have time off from planning the construction of enormous high rise office buildings as tax write offs.

Before you all land on me with both feet....the insurance companies serve a purpose and are entitled to profits, even big profits.....just not the obscene ones that they have gotten used to.

And if you think I am exaggerating about the buildings....look up who built and who owns the biggest newest buildings in your area......some of the names will look just like the card you carry in your wallet.

JER

Apr. 3, 2008, 08:23 PM

Infant mortality rate? Do you realize that the 9 month pregnant women are crossing over deserts in 110 degree heat from Mexico to the U.S. to fall exhausted and often with fetal distress into U.S. emergency rooms to give birth so the baby - if it lives - can be an American citizen? And that counts in the U.S. infant mortality rates? Do other countries have this problem? No.

tri, I asked for your evidence for the above statement, not a general discussion of pregnancy and illegal immigration.

You claim the US infant mortality rate is affected by this particular group of women. I want to know the statistics behind your statement.

Otherwise, you kinda sound like a bigot, blaming the infant mortality rate on those waddling wetbacks. Can't decide whether you'd be more racist or sexist.

DMK

Apr. 3, 2008, 08:25 PM

They get it from the don't-upset-the-applecart propaganda that the insurance companies distribute. .

Yes, insurance companies would hate to have 43 million additional people on their coverage rolls. That makes perfect sense. :rolleyes:

(Because insurance companies actually know they aren't disappearing tomorrow or anytime after that regardless of what happens, most especially if we expand health care coverage. It is simply not possible given the system we have and and have built up over 100 years, whether you like it or not.)

Anyone who tells you simplistic crap like the above quote, be they an internet poster, a doctor an insurance company or a hospital, you can bet your bottom dollar they are a) not smart enough to tell you how it really is, or b) they are banking that you are not smart enough to figure it out yourself. That's a bit like being patted on the head and told everything's hunky-dory in eventing today.

Oh, and does anyone know what the average PBIT of health insurance is? Take a guess. Manufacturing is considered average if its PBIT is 10-14% so based on that, what does th average health insurer rake in over, let's say the historical 6 year cycle? (hint, the 6 year cycle is important because P&L traditionally cycles over 6 years). I'll even make it multiple choice:

a) 4%
b) 11%
c) 15%
d) 25%

BarbB

Apr. 3, 2008, 08:40 PM

Anyone who tells you simplistic crap like the above quote, be they an internet poster, a doctor an insurance company or a hospital, you can bet your bottom dollar they are a) not smart enough to tell you how it really is, or b) they are banking that you are not smart enough to figure it out yourself. That's a bit like being patted on the head and told everything's hunky-dory in eventing today.

Oh, and does anyone know what the average PBIT of health insurance is? Take a guess. Manufacturing is considered average if its PBIT is 10-14% so based on that, what does th average health insurer rake in over, let's say the historical 6 year cycle? (hint, the 6 year cycle is important because P&L traditionally cycles over 6 years). I'll even make it multiple choice:

a) 4%
b) 11%
c) 15%
d) 25%

San Fransisco Business Times:
Kaiser Permanente's 9-months' profit more than doubles to $2.5 billion
http://www.bizjournals.com/sanfrancisco/stories/2007/11/05/daily36.html

Whisper

Apr. 3, 2008, 08:50 PM

Ilex and Poltroon, in general, cervical cancer/pre-cancerous conditions found with the Pap are fairly cheaply and easily treated if caught early, with LEEP (http://www.healthsquare.com/fgwh/wh1ch38.htm), freezing, and a couple of other possibilities, rather than chemotherapy or major surgery. Often, if it is mild enough, they can just schedule more frequent Pap smears and see if it goes away on its own, and continue monitoring more closely in the future. Planned Parenthood offers sliding scale care for Pap smears and the associated treatment, so that might be a viable option for you. 5 years without getting one is a bad idea - it can turn from a mild, easily treated condition to very serious or even life-threatening in that period of time. The mortality rate from it would be close to zero if women would just get regular checkups!

Back to the general health care topic, it reminded me of this (http://www2.cruzio.com/~bbarrow/mcare.html). ;)

Uninsured and under-insuranced people (both health, and short/long term disability) are very common in equine industries. I agree with the poster who said we can't really ask what their health insurance plan covers, but it just seems like we're constantly in crisis mode. I hope we can pull something together like the Injured Jockey's Fund, or the USEF's program which offers liability insurance - in big groups like that, we should be able to get better purchasing power. I know several people who cannot get individual insurance at any price due to a pre-existing condition, or who can't get coverage for that problem in the future. Others spend a huge amount each month to pay the premiums. I've heard that some companies specifically exclude any horse-related injuries (and other high-risk activities), and that they sometimes go after a barn owner or trainer to recover money spent, despite liability releases/etc. I don't claim to have the answers, but I hope we can find some.

BarbB

Apr. 3, 2008, 08:59 PM

I've heard that some companies specifically exclude any horse-related injuries (and other high-risk activities), and that they sometimes go after a barn owner or trainer to recover money spent, despite liability releases/etc. I don't claim to have the answers, but I hope we can find some.

I was stunned when this happened to me. Years ago I had a jumping fall and the the horse kicked me (grazed really) and broke my hand.
I had insurance (not cheap) that covered everything with a low co-pay for the emergency room visit. It was about the only claim I had for years and years as we had physicals, screenings etc at work.

A few weeks later I got a letter from an attorney on behalf of the insurance company with a big long questionaire asking questions about 'unsafe activities' at the barn. I called the insurance company and asked what was going on and they told me that they were trying to 'recover their losses.'
Their form went in the round file. The BO/trainer said that she never heard anything about it.
So they were just fishing, hoping that I wanted to sue somebody.

Whisper

Apr. 3, 2008, 09:17 PM

Unfortunately, some of them *will* sue to recover their losses even if the insured party doesn't cooperate. Or, they refuse to continue coverage or otherwise cause financial distress. Most of the cases I've heard of involved death or serious/severe disability that had costs (to the company) in the tens of thousands of dollars or more, so they weren't willing to just let it go without a fight.

BarbB

Apr. 3, 2008, 09:34 PM

vineyridge

Apr. 3, 2008, 10:02 PM

This could be another topic to brainstorm about. Is there any way that the USEA/USEF/other equestrian organizations could make available to their participants catastropic accident insurance? I've been thinking that the cost cannot be extremely high, or the college football and basketball players who are high draft predictions wouldn't be able to afford the insurance policies that they buy for their last year in school.

Perhaps something through Lloyd's that could be re-insured would be reasonably inexpensive or not unreasonably expensive. I'm not sure exactly what kind of policy might be out there, but there's gotta be something or the college sports jocks wouldn't be able to get covered for career ending injuries.

Foxtrot's

Apr. 4, 2008, 12:02 AM

I'm not speaking for countries other than Canada, and possibly UK,
where we have "socialized" medicine. If you don't know the facts, you could refrain from some of the absolutely idiotic remarks about our healthcare. Quality healthcare is the right of every Canadian, equally. When my husband had his by-pass surgery (free and in double quick time) there was a gentleman in his 80's having the same surgery. True, elective surgeries can be put on a waitlist and there is lots of noise about that, but if it is an urgent maatter, we have world class surgeons with top notch care. Dialysis, also supplied to anyone who needs it. The comment about research: we have researchers here, too. Good ones. Some Americans posting
here seem to think the world owes them a big bow-down. Simply not true. Our healthcare, and we remain vigilant every election, is
one of the cornerstones of being "Canadian". Sorry to sound so
ticked off, but some posts put my hackles up, especially when I read the sad tales some people describe - responsible, ordinary, hard working people.

poltroon

Apr. 4, 2008, 01:33 AM

Poltroon, actually, the "waived if admitted" aspect of ER copays is an attempt to be fair to the people who use ERs as they were intended. The amount if unnecessary or inappropriate care that is rec'd in ERs is staggering (as is the cost of that care). While most horse people I know are pretty smart about ERs and would choose to avoid them at all costs, there is an entire segment of the (insured!) population that would very much like to wait until late Friday night to decide that nagging sore throat really might be strep and does need medical attention. The ER isn't the place to get that sort of care, and heaven knows why one would want to go to an ER unles one had no other choice, but every time I get comfortable in the idea that insured people are too smart too use the ER unless they really needed it, another report informs me I would be mistaken in my assumptions.

That's why most insurers try to have urgent care centers at cost sharing considerably less than ERs, set ER copays high enough to deter incorrect use, and then waive the copay for people who are most in need of care - so for them the cost is not a barrier to care. Does it work perfectly? Of course not. But the logic behind it is purely driven by past behavior.

I agree with the logic - it's just that things have changed dramatically over the past decade or so. Once upon a time, if there was anything really wrong with you, you'd be admitted. It was a pretty good marker for "Huh, you really could have waited."

Today, that's not true. There are plenty of things that you go to an ER for, that cannot wait, that can run up 5 figure bills. And for my particular plan, calling it a co-pay isn't quite the right implication - it was a $3500 deductible that would not have applied if I'd been admitted (for my horse-related injury ;) ). In the old days, they would've admitted me (ugh I hate hospitals). In the new shiny days, they can stick you in an MRI and say, "Oh, just a couple of cracked ribs, you're good to go home."

Old days: Insurance pays $4k for an overnight stay.
New days: Patient pays $4k for an MRI.

:D

DH has been to the hospital for asthma many times in his life. He doesn't go until the last possible moment. They can fix him up right away. He's never admitted - but they consider it severe enough that he never has to wait more than a few minutes, either. Those are a bargain - only about $2k.

I'm certainly aware that people go to ERs frivilously. There are many reasons. One of the simplest is that in my area, if you do not already have a regular doctor, you have to wait 8-12 weeks to be seen. If you're on vacation here, that means if you need any medical care during your stay, you must go to our ER. Many doctors won't see you as a new patient if they don't take your insurance, even if you'll pay cash up front. Many low income people work long days, and not necessarily with access to a phone. They have limited ability to call in for an appointment and they cannot take a day off work to go. The doc might cost $70, but it might also cost them their job. The ER might cost $700 but they'll pay that off over time, because they'll still have a job. And many of them do pay - you might be surprised. It's the same as payday loans or rent-to-own furniture or any of the other horrible financial transactions that many poor people rely on.

Heaven forfend a doctor be open after 4pm, or on weekends.

poltroon

Apr. 4, 2008, 01:36 AM

Oh, you can get heart surgery if you live in a country with socialized medicine. You just have to wait a while. Sometimes six months. And you need to be young and "worth operating on", too. :no: Dialysis, too--assuming you're under the age of 65 and "deserving" of this expensive therapy. Too old, too sick, too many comorbidities? Sorry, move aside.

In the US, you're more likely get those surgeries if you're over 65. Here, if you're young and have been working, you're not worth bothering with. :(

Edited to add:
I've run across an inordinate number of 50-somethings lately who've had heart attacks (BTW, fit and skinny people too!), been told they need to reduce stress in their lives, and oh, you owe us $30K.

poltroon

Apr. 4, 2008, 01:48 AM

Yes, insurance companies would hate to have 43 million additional people on their coverage rolls. That makes perfect sense. :rolleyes:

Well, they wouldn't sell me or my daughter a policy. Missed out on thousands of dollars I would've forked over in an attempt to be responsible. Also pissed me off. ;)

I won the bet, kept my money.

When an insurance agent is telling you your best option is to bank the premium and then declare bankruptcy if anything really bad happens, you know something has gone terribly, terribly wrong. He also suggested that we consider an income cut to qualify our daughter for Healthy Families.

So what do they need (in terms of regulatory changes) to be willing to sell those 43 M people a policy?

The reason I didn't go for the pap smear wasn't just that I figured I would be unable to pay for any treatment, but also because I knew a positive result would make me uninsurable for life instead of 5 years. Since I expected the lapse would be temporary (ended up 2 years), I waited.

Ilex

Apr. 4, 2008, 06:55 AM

Huh?? Everyone in this country is able to get treatment, even the uninsured. Nobody is turned away from hospitals, ERs, offices. Yes, those people are billed for services rendered. Yes, it is a hassle and a pain in the butt. But health care IS available for everyone. Between 5-10% of my patients have NO INSURANCE at all. NONE. We still see them, do tests and procedures on them, with no holding back or second-best care because they have no insurance. And yes, of course I'm very well aware that my premiums and those who have insurance is paying for that. I haven't got a huge problem with that aspect, but as I said, it is hardly cut-and-dried or simple.

Hmmm...I'm not entirely sure if this is absolutely correct for all states/situations. I went to the Doctors office in October for what turned out to be muscle related tension (could not move my head at the time) fixed by steroids, flexerol & alternating cold/heat therapy. I paid for my office visit upfront. Then I paid for the treatment when I was through with the visit.

Four years ago ..... when I was knocked out cold leading an idiot horse. Same deal, we paid the doctor up front. And skipped the x-rays since those would have to have been paid up front as well.

Maybe if you go to the ER/hospital....they have to take you and give you some sort of care w/or w/out insurance? But in my experience they do not have to take you at the doctors office.

On a different note: our Doctor used to give us a discount because we did not have insurance and prior to no insurance we had a 5K deductible. He had to stop doing that cause the insurance company found out about that and told him to stop.

I recently looked into a plan that I thought I could afford. $106 bucks a month for me only ..... not hubby ..... I can buy a plan that will allow me to purchase the right to pay what the insurance company would pay doctor/hospital/diagnostics for said services. So I would actually be able to get the 40-60.

That really did not seem like a good deal. And the idiot on the phone was actually insulted that I had such a cavalier attitude toward my lack health care insurance. I'm anything but cavalier....but paying $3000 for an MRI instead of $5000 does not matter cause I don't have the money anyway.

As soon as I can afford health coverage I will get it. It's a top priority.

Or I could always have a kid.....according to the lady that I talked to at Basic Care adding a dependent would get said child insured through CHIP free of cost. And get hubby and I Basic Care at the reduced rate of $25 a month. Because we would be solidly in the 235% of Federal Poverty Level. We would possible qualify for public assistance as well, but that wasnt her department so she wasnt sure.

Thank God I have some morals......

sh6455

Apr. 4, 2008, 07:27 AM

camohn

Apr. 4, 2008, 07:37 AM

Moderator 1

Apr. 4, 2008, 07:54 AM

Please keep the healthcare discussion horse-related--how different folks in the horse business handle insuring themselves, etc., vs. a general discussion on the healthcare system.

Thanks!

EqLuvr

Apr. 4, 2008, 01:39 PM

I am ashamed and disgusted that an American Olympic Athlete will have catastrophic medical bills from an accident while competing that may bankrupt him.

I'm embarassed for my country, honestly. It makes me sick. It's just not right.

That Darren will have a long and hard road to recovery is bad enough, but to lose everything (potentially) when he has reached the highest levels of the equestrian sport is unconscionable.

Why doesn't the NYT writer write about that...?

With all the billions we are spending on the war in Iraq, why can't we have some funding/health care coverage for our Olympic athletes at least...?

Our health care system is FUBAR. You can all rant on after drinking the propaganda koolaid served up by big pharma and insurance... Until you are really sick and have a tangle with the health care system, you have NO FREAKING CLUE.

I lost a young friend to cancer two years ago (32) - the last chemo to save her life was not covered by her insurance company. It was $800,000.

What is wrong with this picture?

"Well, we could keep trying to save your life - do you have $800K...?"

It does not have to be like this. Other countries offer health care to their citizens as a basic right.

If the system changes, who loses? Big pharma and insurance. Follow the money trail.

I just think that we should be ashamed as a nation that one of our top Olympic equestrian athletes gets catastrophically injured and suffers financial ruin to boot.

At the very least, our country should provide some sort of health care coverage and financial support for our Olympic athletes.

Our health care system is jacked up. Anyone who's been really sick or had a loved one who was really sick knows it all too well.

My heart goes out to Darren...

PineTreeFarm

Apr. 4, 2008, 01:54 PM

At the very least, our country should provide some sort of health care coverage and financial support for our Olympic athletes.

I believe USOC does provide medical coverage for all team members but it doesn't start till after an individual is named to the team and training starts. It terminates at the end of the games or when you return home, not sure on that.

EqLuvr

Apr. 4, 2008, 02:02 PM

I think if you are Olympic-track or an Olympian, then you should get full health care coverage, an expense and travel budget, and some kind of living stipend.

Maybe start an Olympic-track group that helps people get to the Olympics... By the time you are officially chosen for the team, you have already made a significant financial investment and taken many physical risks....

I'm curious to know how many other U.S. Olympic equestrians would be in the same situation if a catastrophic injury occurred?

Blugal

Apr. 4, 2008, 02:12 PM

It does not have to be like this. Other countries offer health care to their citizens as a basic right...

At the very least, our country should provide some sort of health care coverage and financial support for our Olympic athletes.

I don't see why Olympic athletes should be excluded from bankrupting medical bills, but not Suzie Q horse groom. Suzie Q doesn't have the name recognition to have huge fundraisers with Robert Dover riding...

JER

Apr. 4, 2008, 02:15 PM

The one sure way to get free medical treatment in the US is to get arrested.:D

This applies to citizens and non-citizens alike. It is a truly egalitarian system. You'll get treated at a nice medical facility, usually same hospital you'd go to by choice but this way you get police chauffeurs as well.

That said, it would be very difficult to apply these principles to a riding accident. You don't usually have time to commit a crime and alert law enforcement in the moments before a fall. I suppose if one were to ride without pants, one could always be arrested on obscenities charges and therefore, get free treatment in the event of a fall.

poltroon

Apr. 4, 2008, 02:18 PM

In Texas during the 90's when Bush was governor, the state passed a law that a health insurance company could not deny you insurance if you were self employed and had at least 2 employees. For instance, my sister was self employed....no employees but was unable to obtain insurance due to her husband having been layed off from his job and she having a historical diagnosis of mitral valve prolapse which prevented her from getting heallth insurance. After this law was passes, she filed the incorporation papers (I think is was $25 with the state) , incorporated her company,put her husband on the payroll and now they have insurance. She went through an HMO, which only required her to show one years income tax as a corporation. Anyway, they have had excellent health care coverage for the last 10-12 years despite multiple medical problems. So, I don't know what state you are in but you might look into whether your state has this law. My sister was unaware of it until she heard something on the radio. Even her insurance agent for the home and auto was clueless about it.

In my state, you can be an employer group with as few as two, and they can be husband and wife if both work in the business. Also, my agent says that once a plan is started, it's easier to add and drop people despite the limits for a new plan as the business goes on its merry way.

Group policies are regulated entirely differently than individual policies in most states. In my state, you cannot be turned down for preexisting conditions on a group policy, and they can only increase the rate across the whole group for high risk by a certain amount. I believe anecdotally that claims when you're part of a group are handled better. If you can put together a group, it is a much better proposition.

So, that in mind, if I were an equine professional, I would seriously consider how I could adapt my business to include at least two workers. If all are owners, you don't have to do payroll, or you can go the payroll route if you want to have employees, such as a groom. You cannot add 1099 workers to your insurance policy.

You could:
- partner with another trainer you trust, and create a financial entity that can buy you health insurance
- hire an assistant trainer
- hire a groom
- think of other side interests you can combine with your business and hire someone based on that. Maybe you know another professional who needs health insurance, like a realtor. ;)

Incorporating is not necessary in all cases, but may make qualifying for that first policy a little easier.

It's a little out of the box, but it's a way to work around the problems in the system.

EqLuvr

Apr. 4, 2008, 02:20 PM

I don't see why Olympic athletes should be excluded from bankrupting medical bills, but not Suzie Q horse groom. Suzie Q doesn't have the name recognition to have huge fundraisers with Robert Dover riding...

She shouldn't be excluded from having health care coverage. Nobody should go without health care.

poltroon

Apr. 4, 2008, 02:21 PM

J Swan

Apr. 4, 2008, 04:19 PM

I too think that the NY Times writer should write about Darren's medical bills and Olympic dreams. If anything, it might help raise awareness of head injuries, help with the "wear a helmet" campaigns, (I realize he was wearing a helmet but many riders still don't), help raise money for his medical expenses, and showcase how horsemen come together in the midst of tragedy and help out one of their own.

Now there's a story worth writing.

I don't recall how much all these dues are - but maybe there is an opportunity for the powers that be to take a look at group coverage for equestrians. I know health insurance is a HUGE issue in the horse industry in general; from barn workers, to grooms, to working students, trainers, riders - you name it. While I have no doubt they don't want to be in the insurance business - it is very much a worthwhile thing to explore.

What I don't know is if the numbers of horsemen eligible (there has to be some sort of eligibility) justify doing it.

Around here - there are a lot of horsemen and women without insurance because single policies are horribly expensive. Some are on a spouse's policy, which is nice. But a lot of exercise riders and grooms and whatnot - they're among those stuck in the middle. No poor enough to get healthcare free, and not wealthy enough to be able to afford to pay for a policy.

Anyway - I know nothing good can come of this man's accident, except his complete recovery. But I would very much like to see a way that our governing bodies could look into ways that professionals, (and working students, grooms and such) could get group coverage.

That doesn't preclude financial devastation should the unthinkable happen. Thankfully, it's not that common. But all of us break bones, need basic care, need a cavity filled... and it could really be a boon.