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  1. #101
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    Oct. 18, 2008
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    Deschapelles, Haiti
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    Quote Originally Posted by katarine View Post
    We don't have enough family practice/general practitioners. The money is in the specialties, so that's where the bulk of the doctors went, into specialties.

    I work for a multi-facility ambulatory care facility. Our business model currently is to see a fee-for-service patient on their first visit for $155.00. Follow ups are $55. On a given day one of our two-doc shops will see 140+ patients between 8-6. Most are insured, many are not.

    Think about that volume: 140 patients, two doctors, 10 hour day. 7 days a week.

    Now open the doors to everyone being 'covered'.

    We cannot find enough doctors to hire to meet demand.

    They don't exist.
    Agree with you on the PCP vs specialist balance.

    But I in turn have two PCP parents who ran private practices, and I'm doing Admin for a public health system. Even our reference hospital docs aren't seeng 70 patients per day because not everyone needs the doc. My folks were using nurse practitioners back in the 80s to see the patients who needed care, but care a nurse could provide. Our system here is more basic than what the US should be able to do, but we still get loads of quite adequate care done with nurses and even some auxiliaries. There are MANY things that families can't handle on their own, but that nurses can handle very well. Especially when so many common things can be managed off a starter protocol, and don't need adaption if the patient responds well.

    We probably will need more PCPs but I don't think the problem is as dire as you suggest if we train and use nurses and other appropriate staff efficiently.
    Last edited by HorsesinHaiti; Nov. 8, 2012 at 07:11 AM. Reason: quote messed up
    HAS provides hospital care to 340,000 people in Haiti's Artibonite Valley 24/7/365/earthquake/cholera/whatever.
    www.hashaiti.org blog:http://hashaiti.org/blog



  2. #102
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    Apr. 17, 2002
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    between the barn and the pond
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    BES, I've been in clinic management and physician practice management for years. I've heard it straight from the source, from their mouths to my ears.

    Is it true for all docs? No, of course it isn't.

    But there is a real shortage of FP docs. That much is true.
    Last edited by katarine; Nov. 8, 2012 at 08:24 AM.


    1 members found this post helpful.

  3. #103
    Join Date
    May. 11, 2004
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    2,355

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    Mmmm someone mentioned security of electronic records.. handled by the govt. are you serious... really.
    Ask someone about the electronic records of tricare/champus being breeched in the not so distant past... I was lucky enouch to have mine breeched yeah lucky for me the majority of mine was sent to the records depot in St Louis so wat was breeched was juust a small file but it was enough fr Tri Care to send me a bt load ofpaper wark that had toe filled out, for me to run credit report to make sure no one had taken my idenity( someone had oh what a nighmare)..
    Timely payments on what... medical bills.. where.. by the govt... seriously.. what planet are you from...as they want to use Tricare as their modle.. Will your dr be happy waiting for he payment aprox 6mth to a year? And in one case that I know of and there maybe more 91/2 yrs with out harrasing the person.. doubt it.The drs did not with the one person who kept on Tricare to pay the bill.
    As for Drs liking Obamacare.. I stand to lose my onocolgist,neurogist, neurosrugon, and my Internal med. So basically all my Drs. they came to this country from countries that have social med to get away form it. While obamacare it the moment isnt socal med. they fear it will turn into it. And when it does that is when they will leave the med. field.
    Friend of bar .ka


    2 members found this post helpful.

  4. #104
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    Nov. 5, 2000
    Posts
    9,305

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    Not talking about people who "have horses". But people who willingly choose to work in a profession or industry with a high risk of physical injury owe it to themselves, and their families , and medical care providers, AND the taxpapers, to have some sort of health coverage. Even if they don't get injured ON THE JOB, they are still working in a high risk field and SHOULD have coverage just in case, which CAN be used for non job-related incidents.

    Premiums for younger folks are usually not too onerous, esp. if it is a high deductible plan. For instance, in my area, a 24 y/o non-smoking female can obtain a plan with a $3500 deductible for under $100/month - deductible is waived for first 3 office visits with $30 co-pay, afterwards the deductible kicks in with a 30% co-pay. There are other plans with even lower monthly premiums (several under $55/month), and no co-pay, but they have higher deductibles.

    As someone said at one point, you are basically gambling that you will not get sick or injured, but if you work with horses - esp. if it is your JOB to work with horses - you WILL get hurt at some point, so it is really just common sense to have some kind of health plan. Yes, you may have to pay the deductible, but health care isn't free - medical care providers spend a LOT of money getting their educations, and hospitals and clinics spend millions on high end diagnostic equipment, infrastructure, personnel, etc.

    Even with our three separate health plans and $1500/month premiums, we have a $2600 annual deductible and 20% co-pay on one plan, a $10,000 annual deductible on another plan that covers only costs over $10,000 not covered by our primary plan (i.e., we have to pay $10,000 "out of pocket" in order for this plan to kick in), and a $15,000 deductible "per condition" on the third plan (with 3 year cap), but the deductible is based on the total cost of care (not how much we pay out of pocket). I've been in the ER three times in the past 10 months (two strokes and a head injury resulting from a fall), had three CTs, three CTAs, two MRIs, plus X-rays, ECGs, EKGs, etc., tons of blood work, plus had two hospital stays of 9-10 days, and the cost of my care over the past year has exceeded $100,000. Even though we have fussed and fumed every month about paying those premiums, we are now glad we gave up other things in life - including my dream of owning my own farm - so we could have health care coverage. We felt we owed that to each other, and to our families.


    1 members found this post helpful.

  5. #105
    Join Date
    Aug. 25, 2007
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    8,497

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    Quote Originally Posted by lilitiger2 View Post
    Here, let me help. Because THEY CANNOT AFFORD IT. Good, hard working folks cannot afford to pay $1500/mo in healthcare! Its not a matter of "willingly" didn't get health insurance, it is a matter of finding an affordable option! Affordable, meaning, can eat, and pay rent/mortgage and put fuel in the car. And you most certainly ARE paying for their health care! As others have pointed out, a whole lot! And it will be more and more if there are not significant changes.
    Are you familiar Dr. Zorba Paster? He's got a pretty good show on NPR (run here on Sunday a.m.).

    He's generally pretty left wing on political issues but on medical stuff he's pretty much down the line. A while back he noted that the average American, in their lifetime, will spend $475,000 on health care. 80% of this will spent in the last two years of life. This is the economic reality of health care.

    If you divide that $475,000 by 50 (an average working life) you get $9500/annum (or $791.66/mo.). THAT'S how much each of us must plan for under current conditions. If you were to assume that costs could be cut 20% (an assumption that is highly questionable) you've still got to come up with $633.33/mo. if you're going to pay your own way.

    Scary, yes?

    Need this all be in cash? No, we buy insurance and pay a certain amount and the company invests that against the day (maybe decades down the road) when they will actually pay out that 80%. I'm not enough of a mathematician (or actuary) to do that sort of number. I'm sure it's significantly less than $791.66.

    For the government paid persons the government must allocate an annual sum (as is done with Social Security) or let it be a "line item" (as is done with DoD Retirees). In either case real money is involved.

    Extend this these numbers to the 35 million people who, in 2014, will become eligible for taxpayer paid health care and you're looking at $332,500,000,000/annum. Remember that, as with individuals, this is an obligation that must be funded, not the actual payout in any given year. There will be some offsets against it, such as ER care that will not be rendered because a patient seeks private physician care vice an ER visit. But even that number is "fuzzy" because we keep ERs open 24/7 to deal with emergencies. If not one patient presents we still have substantial costs just to keep the doors open (salaries, utilities, expendables (meds go out of date if not used), depreciation, etc. So it seems to me that a lot of the math used to calculate "offsets" and then claim overall savings is very fuzzy indeed (and may even fall into the category of "voodoo math").

    Obamacare imposed on the people of the U.S. the largest tax increase in the history of the Republic. Maybe it is a good idea and maybe it's the wolf at the door. Frankly, I don't think anybody knows. The Bill was passed in a "lame duck" session of Congress in the waning days of the Democratic majority in both Houses of Congress. I fear that we are about to learn the truth of the old adage "act in haste; repent in leisure."

    G.
    Mangalarga Marchador: Uma Raça, Uma Paixão


    3 members found this post helpful.

  6. #106
    Join Date
    Jan. 4, 2007
    Location
    TX
    Posts
    40,104

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    Quote Originally Posted by Guilherme View Post
    Are you familiar Dr. Zorba Paster? He's got a pretty good show on NPR (run here on Sunday a.m.).

    He's generally pretty left wing on political issues but on medical stuff he's pretty much down the line. A while back he noted that the average American, in their lifetime, will spend $475,000 on health care. 80% of this will spent in the last two years of life. This is the economic reality of health care.

    If you divide that $475,000 by 50 (an average working life) you get $9500/annum (or $791.66/mo.). THAT'S how much each of us must plan for under current conditions. If you were to assume that costs could be cut 20% (an assumption that is highly questionable) you've still got to come up with $633.33/mo. if you're going to pay your own way.

    Scary, yes?

    Need this all be in cash? No, we buy insurance and pay a certain amount and the company invests that against the day (maybe decades down the road) when they will actually pay out that 80%. I'm not enough of a mathematician (or actuary) to do that sort of number. I'm sure it's significantly less than $791.66.

    For the government paid persons the government must allocate an annual sum (as is done with Social Security) or let it be a "line item" (as is done with DoD Retirees). In either case real money is involved.

    Extend this these numbers to the 35 million people who, in 2014, will become eligible for taxpayer paid health care and you're looking at $332,500,000,000/annum. Remember that, as with individuals, this is an obligation that must be funded, not the actual payout in any given year. There will be some offsets against it, such as ER care that will not be rendered because a patient seeks private physician care vice an ER visit. But even that number is "fuzzy" because we keep ERs open 24/7 to deal with emergencies. If not one patient presents we still have substantial costs just to keep the doors open (salaries, utilities, expendables (meds go out of date if not used), depreciation, etc. So it seems to me that a lot of the math used to calculate "offsets" and then claim overall savings is very fuzzy indeed (and may even fall into the category of "voodoo math").

    Obamacare imposed on the people of the U.S. the largest tax increase in the history of the Republic. Maybe it is a good idea and maybe it's the wolf at the door. Frankly, I don't think anybody knows. The Bill was passed in a "lame duck" session of Congress in the waning days of the Democratic majority in both Houses of Congress. I fear that we are about to learn the truth of the old adage "act in haste; repent in leisure."

    G.
    The stories how Obamacare is affecting health care in the news here are increasing.
    Yesterday about doctors hard to find, more are quitting.
    Medicare patients can't find doctors that will accept them in greater and greater numbers.

    Those were becoming chronic problems, now made acute by Obamacare.
    We are in for a rough ride, will see how this will play out.



  7. #107
    Join Date
    Mar. 31, 2006
    Posts
    273

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    I think we have the best healthcare available in the world. It's paying for it that's so out of wack.
    I don't have the answer, but I will share my experience. We do have insurance through my husband's company, but it is getting more and more difficult to afford to provide it to our employees. In order to do so, we have had to pick and choose various coverage options.
    Our daughter required her wisdom teeth out. No big deal, all of the others had theirs out too. Loaded her up in the car and off to the oral surgeon. But to my surprise, no longer had coverage for that procedure. Sooooo, I called my dentist and friends for oral dr. references and called around to them and was shocked at the difference in their pricing for "cash" patients. With a good reference, I selected a fine surgeon, teeth came out, paid the bill and all is good.
    But it made me aware that if we had the opportunity to shop around for services, perhaps we would see the difference in costs. I bet if insurance was allowed to go across state lines, it would open up some serious competition. I don't know what the solution is, but I have never personally experienced anything that the government does well and without red tape.


    3 members found this post helpful.

  8. #108
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    Aug. 18, 2004
    Posts
    1,321

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    Now that CMS' 2013 Physician Fee Schedule (PFS) is out, I'm looking at a 33% cut in reimbursement for my most common (about 85% of my practice) procedure. Joy.

    I do agree with the others that Obamacare, while imperfect, is a step in the right direction, but I really don't see how docs are going to stay afloat with these continued cuts in reimbursement.



  9. #109
    Join Date
    Jan. 4, 2007
    Location
    TX
    Posts
    40,104

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    Quote Originally Posted by ser42 View Post
    Now that CMS' 2013 Physician Fee Schedule (PFS) is out, I'm looking at a 33% cut in reimbursement for my most common (about 85% of my practice) procedure. Joy.

    I do agree with the others that Obamacare, while imperfect, is a step in the right direction, but I really don't see how docs are going to stay afloat with these continued cuts in reimbursement.
    Well, that is the idea, you will have to become a salaried employee of the government, as they are in other countries with socialized medicine.
    Welcome to a new brave world.


    1 members found this post helpful.

  10. #110
    Join Date
    Jan. 17, 2008
    Location
    Dutchess County, New York
    Posts
    4,036

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    ser42 -- to follow on from your point, if we are going to cut doctors' reimbursements I think we have to continue to reform the system and cut some of their costs as well (so, reform the malpractice area, student loans, etc). That is why I also agree with you that Obamacare is flawed, though a step in the right direction. A better overhaul of the system would have overhauled much more.

    Bellaluna, my husband is in charge of picking the insurer (or should I say administrator) for his employer (his employer is self-insured) and he also talks about shopping around. Shopping around for wisdom teeth removal is one thing, however if you have colon cancer or some other life threatening condition -- are you going to go for the cheapest doctor, or the one you think is the best? Picking based on price only goes so far in the medical arena, in my opinion.


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  11. #111
    Join Date
    Oct. 8, 2002
    Location
    Maryland
    Posts
    9,413

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    Quote Originally Posted by BellaLuna View Post
    I think we have the best healthcare available in the world.

    By what measure? My understanding is that we lag behind many other countries - we have a high rate of infant mortality, for instance (especially concerning since we pay more for health care than just about any other country on earth). Some numbers:

    http://www.reuters.com/article/2012/...85R0XN20120628

    What about this is "the best health care in the world?"

    According to WHO rankings, France is the place to go if you value health (best care, spends much less than we do on it, too)
    "smile a lot can let us ride happy,it is good thing"

    My CANTER blog.


    1 members found this post helpful.

  12. #112
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    Aug. 18, 2004
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    1,321

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    Quote Originally Posted by caffeinated View Post
    By what measure? My understanding is that we lag behind many other countries - we have a high rate of infant mortality, for instance (especially concerning since we pay more for health care than just about any other country on earth). Some numbers:

    http://www.reuters.com/article/2012/...85R0XN20120628

    What about this is "the best health care in the world?"

    According to WHO rankings, France is the place to go if you value health (best care, spends much less than we do on it, too)
    This is true. The infant mortality rate in this country is abysmal, and I think some of it has to do with sandsarita's post (the OB/Gyn who posted above). There are so many uninsured that don't get prenatal care, and it's such a set-up for bad outcome.

    Keep in mind though, that Americans are overweight and smoke. The French have lots of red wine
    Last edited by ser42; Nov. 8, 2012 at 11:37 AM. Reason: Brain fart- referred to wrong poster


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  13. #113
    Join Date
    Apr. 23, 1999
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    Rosehill, TX
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    6,996

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    Quote Originally Posted by HorsePlayyy View Post
    My boyfriend works as a surgical assist. He, as well as nearly all of the doctors, are against Obamacare. Many doctors have already refused or turned away people on medicare and I believe more and more are going to do so. What is the federal government going to do about that? Likely force physicians to take anyone on medicare. And how is that okay, taking away the rights of the doctors who worked hard to earn their position?.......
    United HealthCare pays at medicare rate + 10% as do other large insurance companies -- guess that 10% makes all the difference?
    Nothing says "I love you" like a tractor. (Clydejumper)

    The reports states, “Elizabeth reported that she accidently put down this pony, ........, at the show.”



  14. #114
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    Jun. 12, 2009
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    934

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    I for one do not understand medicare. I'm suppose to sign up for it. Right now, I don't need it. My husband isn't retiring and he has good employer sponsored ins. So since I don't need it, why am I punished if I don't sign up for it within a certain time interval? This has been going on with medicare for eons.
    What's the purpose except to waste taxpayer dollars. The govt should be encouraging people to delay retirement and medicare for as long as possible just like they do for SS. Makes no sense to me.



  15. #115
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    Oct. 25, 2012
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    3,920

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    Quote Originally Posted by two sticks View Post
    Yes Bluey, of course I'm kidding, just specifically so you think I'm absurd!

    The worst purveyors of this is the Pharma industry. If you are a Pharma company that relies on people buying your medication, does it make more business sense to treat them and resolve the issue, or to give them a for-life prescription so that they pay into your pocket every 30 or 90 days for the rest of their lives?

    If health care is a for profit industry - the profit is not being made off of healthy people.
    Yes it is. Because Big Pharma has managed to redefine "health" to a completely unnatural standard, where you're expected to slide exultantly into your grave at age 110 with the same joints, same BP, same prostate, heck, the same freakin' HAIR COLOR you had at 17! Anything less than that, including toenail fungus, normal aging and bad moods, is not "Wellness" and must therefore be medicated. This syndrome was begun, with intent, by Merck in Germany in the 1920's. The idea was that much more $$ was to be made by selling meds to the entire population than only to the sick.

    Further reading: the book Selling Sickness. available on amazon


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  16. #116
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    Apr. 28, 2008
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    7,235

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    There are also a growing number of doctors who don't take insurance. You have to submit everything on your own, which I imagine is a huge pain. When I was in DC finding a good pediatrician in my Bethesda area that actually TOOK insurance was not easy.

    And docs that you pay a large lump sum to be a client. My grandparents do this and are happy as clams with the results as they get super-fast, thorough service and lots of attention.



  17. #117
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    Apr. 17, 2002
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    between the barn and the pond
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    Quote Originally Posted by pezk View Post
    I for one do not understand medicare. I'm suppose to sign up for it. Right now, I don't need it. My husband isn't retiring and he has good employer sponsored ins. So since I don't need it, why am I punished if I don't sign up for it within a certain time interval? This has been going on with medicare for eons.
    What's the purpose except to waste taxpayer dollars. The govt should be encouraging people to delay retirement and medicare for as long as possible just like they do for SS. Makes no sense to me.
    If he drops dead tomorrow and you sign up later than you 'should' have, you will regret not doing it sooner.



  18. #118
    Join Date
    Feb. 25, 2012
    Location
    Montana
    Posts
    2,250

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    Quote Originally Posted by Guilherme View Post
    Are you familiar Dr. Zorba Paster? He's got a pretty good show on NPR (run here on Sunday a.m.).

    He's generally pretty left wing on political issues but on medical stuff he's pretty much down the line. A while back he noted that the average American, in their lifetime, will spend $475,000 on health care. 80% of this will spent in the last two years of life. This is the economic reality of health care.

    If you divide that $475,000 by 50 (an average working life) you get $9500/annum (or $791.66/mo.). THAT'S how much each of us must plan for under current conditions. If you were to assume that costs could be cut 20% (an assumption that is highly questionable) you've still got to come up with $633.33/mo. if you're going to pay your own way.

    Scary, yes?

    Need this all be in cash? No, we buy insurance and pay a certain amount and the company invests that against the day (maybe decades down the road) when they will actually pay out that 80%. I'm not enough of a mathematician (or actuary) to do that sort of number. I'm sure it's significantly less than $791.66.

    For the government paid persons the government must allocate an annual sum (as is done with Social Security) or let it be a "line item" (as is done with DoD Retirees). In either case real money is involved.

    Extend this these numbers to the 35 million people who, in 2014, will become eligible for taxpayer paid health care and you're looking at $332,500,000,000/annum. Remember that, as with individuals, this is an obligation that must be funded, not the actual payout in any given year. There will be some offsets against it, such as ER care that will not be rendered because a patient seeks private physician care vice an ER visit. But even that number is "fuzzy" because we keep ERs open 24/7 to deal with emergencies. If not one patient presents we still have substantial costs just to keep the doors open (salaries, utilities, expendables (meds go out of date if not used), depreciation, etc. So it seems to me that a lot of the math used to calculate "offsets" and then claim overall savings is very fuzzy indeed (and may eve n fall into the category of "voodoo math").

    Obamacare imposed on the people of the U.S. the largest tax increase in the history of the Republic. Maybe it is a good idea and maybe it's the wolf at the door. Frankly, I don't think anybody knows. The Bill was passed in a "lame duck" session of Congress in the waning days of the Democratic majority in both Houses of Congress. I fear that we are about to learn the truth of the old adage "act in haste; repent in leisure."

    G.
    Actually G I don't necessarily disagree with a lot of what you say as far as numbers (and my health insurance premiums were in the $600/mo neighborhood and climbing each month, seriously so those numbers are not far off) but I will say that number is NOT affordable to many people, who are working full time jobs, not sitting home getting stoned, then driving their 50k truck to play with their horses. And these people, insurance or not, ARE health care consumers! They WILL show up at ERS and clinics and so forth, and those clinics are going to do their damndest to get paid, somehow, which is where you (I presume) and me and others with insurance come in. So, one way or another, we are certainly paying, and will continue to pay more and more as more people can't afford it but use it nonetheless. I suppose we could just have docs and hospitals turn away anyone with no insurance but that is not going to happen.

    Its all well and good to talk about "Responsibility" (you were not, in your post but others have) but we are not talking about "irresponsible people", for the most part. And this, I think, will cripple us as a country one way or another.

    So, I do think something has to change. I agree that gettign up to speed with this is going to take some time, and likely failures along the way (hello, UK). But I do think it is a good direction.

    And, FWIW, as far as GETTING paid, Medicare, Medicaid, Tricare, CHampus-no problems, you will (or I have) definitely get the money. United Health Care?????? Ha Ha Ha! No, can't go after the client but they can take 4-5-6 months easily, with lots of hour long phone calls, to get a billing issue resolved. Will take gov't over that any day! Just my experience!


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  19. #119
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    Feb. 25, 2012
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    Montana
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    I do realize that this does present the conflict for many, the idea that "we should get what we deserve" (God forbid!!!!!). That if someone has been drinking, and develops liver problems, its kindof their "fault", or smokers with lung problems, oveweight people with diabetes. Lifestyle related health problems are huge, HUGE in our country (all I know about) and we (many) dislike somehow "rewarding" what looks like bad behavior, without necessarily looking at our OWN choices, some high risk in certain areas, and how much responsibiltiy we assign. Should we help someone who falls off a ladder, if maybe they were hurried an didn't place it properly? What about an accident victim who feel asleep? Its very hard to determine the level of responsibility we think is "fair" and the health care debate does seem to highlight the "let 'em eat cake" idea (putting all the emphasis on choice rather than on circumstance and biology) and I suppose there are others who would say none of us should ever have to take responsibilty for anything.

    Not to mention, as happened to someone I loved, that if you fall seriously, can't work, ill, you will take a hit financially f you are not working. And eventually, you wil not be able to pay for your insurance, cobra or not. And you will lose it. And you will not be able to get anything else. And then, things get very very grim, and not because you are lazy, irresponsible, insensitive or don't feel you "owe it" to your family.



  20. #120
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    Mar. 24, 2004
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    Pottstown, PA (East Coventry)
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    I for one do not understand medicare. I'm suppose to sign up for it. Right now, I don't need it. My husband isn't retiring and he has good employer sponsored ins. So since I don't need it, why am I punished if I don't sign up for it within a certain time interval? This has been going on with medicare for eons.
    What's the purpose except to waste taxpayer dollars. The govt should be encouraging people to delay retirement and medicare for as long as possible just like they do for SS. Makes no sense to me.

    Except that you will be enrolled and paying a monthly premium and not receiving much by way of Medicare benefits. If your husband is actively working and your are covered under his insurance then Medicare is secondary to his insurance. For the most part his insurance will pay more than the Medicare allowed amount. If that happens the Medicare payment will be $0. Medicare will generally only pay if there is something Medicare covers and your primary insurance does not cover.
    They are trying to start getting some of your premiums into the system without having to pay out. What they don't want to happen is to be getting no premium from you from age 65 to 68 then have you get really sick, so your husband retires and now you enroll and Medicare is primary. They want and need your premiums for when you are 65-68 years old and healthy or the other insurance is covering your costs. Medicare is like any other insurance- a risk pool.
    I believe that you can wait to enroll in Medicare but your premiums if you enroll late will be higher and your opportunities to enroll are limited. Medicare enrollment is not my forte, I know more about once a person is enrolled and the interplay of Medicare and other insurance.
    In summary, if you enroll before you retire or before your spouse retires and either of you have Medicare it is a win for Medicare. Medicare gets your premiums but has little to none that they have to pay out for you as the other insurance is primary.
    Last edited by SonnysMom; Nov. 8, 2012 at 12:04 PM. Reason: Forgot the quote
    Oh, well, clearly you're not thoroughly indoctrinated to COTH yet, because finger pointing and drawing conclusions are the cornerstones of this great online community. (Tidy Rabbit)


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    Last Post: Aug. 5, 2009, 10:14 PM

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