My Experience with ObamaCare

[WinniWoman]

OMG! I would go ballistic!! Just horrible! This is the state of healthcare today!

I work in radiology. We have the same issues with certain tests not being able to be performed in the same day. Well- they certainly COULD be performed on the same day, but the center would not be paid for the second test or would be paid a reduced rate depending on the test and body part.

This is so outrageous and patients and their doctors understandably become infuriated.

I'll tell you- you had more patience then I would have. The first hour and 15 minute wait I would have walked out.

As I posted on another thread- can you imagine the very elderly having to deal with all this nonsense?

 

[VegasBella]

I believe that a healthy citizenry and an educated citizenry will only make our country stronger. There are a few socialistic programs I believe we should adopt, and medicare for everyone and free education are two of them.

And before you jump all over me, I have no illusions that this is 'free'. There's a cost to everything. I just believe some things are worth the cost.

I agree.
The thing is, Obamacare is not medicare for everyone. It's a step in the right direction, I believe, but it's still too compromised by the giant insurance companies and drug companies.

My experience with Obamacare:
Our insurance payments went up, way way up. We used to have minimal coverage for catastrophic events and high deductible because we were/are pretty healthy. Obamacare does not allow that kind of coverage anymore so we have to have fuller coverage with lower deductibles.

The problems for us are that since we have to wait for insurance approval, everything takes more time and annoyance. Example, I used to be able to just walk in to a lab with a sheet of paper and just get a test done right away, paying cash. Now I have to wait a week for the paperwork to process, then make an appointment to get the lab test. It winds up taking a LOT more time and effort to get basic stuff done. More complicated things take way way way longer.

On top of that, I'm more restricted on what lab, what pharmacy, etc. Which adds to my frustration and time. But also, each time we renew our coverage my records get lost. This is just so annoying. My current insurance doesn't even show in my record some basic important stuff, like that I'm allergic to some medications. It's just scary that with all these changes so much gets lost.

If we had a actual socialized medicine then I probably wouldn't be restricted to which pharmacy or lab I had to use. I could just use whatever was closest or more convenient. They'd all get paid around the same. There would be more uniformity.

 

[AKE]

No one thinks that they are going to get sick and no-one is aware of how high the cost is of a simple visit to ER until it happens to them. Living in Canada we pay much higher taxes but have universal health care (better in some provinces than others) so the overall costs are the same. We also gripe about the costs and supposed abuse of the system. Before we had health care my parents paid for specialists at ludicrous rates (if I recall correctly my mom made $30/week and every visit that I made to the specialist cost $20!)... the public health clinics which we used to frequent only provided nurses to look at whatever you had - doctors were not available unless you were willing to pay and pay UPFRONT! (I still recall my mother telling me that when she was about to deliver me and went to the hospital, prepayment (and that was CASH ON THE SPOT) was required or she would have had me on the front lawn!) From what I have read, Obamacare is not perfect but it is a start.

 

[zinger1457]

Living in Canada we pay much higher taxes but have universal health care (better in some provinces than others) so the overall costs are the same.

Heath care expenditures per-capita is much less in Canada than the US, as it is for every other country when compared to the US.

 

[Brett]

Heath care expenditures per-capita is much less in Canada than the US, as it is for every other country when compared to the US.

right, that's part of the equation

 

[isisdave]

OMG! I would go ballistic!! Just horrible! This is the state of healthcare today!

I work in radiology. We have the same issues with certain tests not being able to be performed in the same day. Well- they certainly COULD be performed on the same day, but the center would not be paid for the second test or would be paid a reduced rate depending on the test and body part.

This is so outrageous and patients and their doctors understandable become infuriated.

I understand the idea here. If you go in for procedure X, some significant portion of the fee is overhead: it covers making the appointment, laundering the sheet on the scanner, etc. So if you also have procedure Y at the same time, and it's on the same machine, or uses the same anesthesia, etc., the cost to the provider is lower, and the reimbursement should be lower.

As usual, the devil is in the details. If the second procedure is reimbursed at 80%, that sounds OK. But 40% is more typical, and I think that's too low.

Before I was on Medicare, my dermatologist would do two moderate procedures at the same time. Now one has to wait 90 days to avoid him getting the "discounted" reimbursement. This could be "tuned up" but there is no advantage to the insurer/government to do so.

 

[geekette]

I would like to see an overhaul of the entire system. Makes no sense how they bill and what actually gets paid. Why not just have fair and reasonable rates that are paid by all? (Like back in the old days..)

It never worked that way. Mr Smith could pay with 2 chickens but Mrs Jones could only afford to pay with a 6 pk of cabbage.

Or do you mean the recent good ole days, where every place had a different chargemaster and depending on what facility and what insurance and what procedure, etc etc. ?

Fair and reasonable is now decided by insurance companies but patients can shop around.

 

[geekette]

I agree.
The thing is, Obamacare is not medicare for everyone. It's a step in the right direction, I believe, but it's still too compromised by the giant insurance companies and drug companies.

My experience with Obamacare:
Our insurance payments went up, way way up. We used to have minimal coverage for catastrophic events and high deductible because we were/are pretty healthy. Obamacare does not allow that kind of coverage anymore so we have to have fuller coverage with lower deductibles.

The problems for us are that since we have to wait for insurance approval, everything takes more time and annoyance. Example, I used to be able to just walk in to a lab with a sheet of paper and just get a test done right away, paying cash. Now I have to wait a week for the paperwork to process, then make an appointment to get the lab test. It winds up taking a LOT more time and effort to get basic stuff done. More complicated things take way way way longer.

On top of that, I'm more restricted on what lab, what pharmacy, etc. Which adds to my frustration and time. But also, each time we renew our coverage my records get lost. This is just so annoying. My current insurance doesn't even show in my record some basic important stuff, like that I'm allergic to some medications. It's just scary that with all these changes so much gets lost.

If we had a actual socialized medicine then I probably wouldn't be restricted to which pharmacy or lab I had to use. I could just use whatever was closest or more convenient. They'd all get paid around the same. There would be more uniformity.

You should be more scared if your insurance company does keep medical info on you, it's inappropriate for them to know or have that data!! Now if you said the doctor you've had for 20 years simply never wrote down that you are deathly allergic to Thing 2, that would be mind-blowingly bad.

Note that pretty much everyone has restrictions on physicians, provider networks, pharma, it's not unique to your plan. I have never had insurance that paid the same no matter where I went. Note that a person can receive services anywhere they want, it's really just a matter of who pays and how much.

Premiums and cost per procedure having been going up for a long time, I am in favor of removing the predatory insurance industry. We would save at least 10 million per CEO per year, money that could treat sick people.

 

[Patri]

Premiums and cost per procedure having been going up for a long time, I am in favor of removing the predatory insurance industry. We would save at least 10 million per CEO per year, money that could treat sick people.

No matter what changes occur, costs will never go down.

 

[geekette]

No matter what changes occur, costs will never go down.

The cost may indeed go down, but the price charged won't. That's true with any product or service. Business gains efficiency and isn't passing it along to the consumer.

Decreasing the rate of increase to us will help.

 

[cgeidl]

US costs are Highest

It is unbelievable to me that we receive so little for paying so much. In world studies it has been shown that the US pays even more than double for medical care that is no better than other modern countries. France is often shown as good as the US at less than half the cost.

 

["Roger"]

... France is often shown as good as the US at less than half the cost.

You are too generous toward the US. WHO ranks France as number one in terms of actual health outcomes while we are ranked in the '30's. We would actually rank even lower if it weren't for Medicare. For health care outcomes for senior citizens, we rank in the top 10.

I am not a fan of the US health care system, but this is what can be said for the other side. If you do have good health care insurance, the US is a good place to be. Healthcare is very uneven in the US while more evenly distributed in other countries. Rankings reflect overall averages, not how well you can come out if you are among the better off.

Also, much more is spent in the US than in other countries on quality of life issues that are not life threatening. While you might be able to live years without a heart bypass, you won't be playing golf. The various organizations that rate health care outcomes (WHO is just one, but its results are in line with others including our own CDC) don't factor in quality of life. (There have been attempts to come up with quality of life indexes, but this is very hard to do in that they tend to be very subjective. Also, people don't like death being equated with X years living.) The bottom line in this case is that quality of life is one thing that raises our costs over other countries.

I have been trying to stay out of this thread in that all the issues surrounding health care are incredibly complex. It is an Alice in Wonderland field. Even simple principles like competition reduces costs don't necessarily hold when it comes to the field of health care.

 

[Timeshare Von]

<<SNIPPED>> Even simple principles like competition reduces costs don't necessarily hold when it comes to the field of health care.

Correct because there is no such thing as a true open, competitive market.

Read the work of economist Michael C. Porter of Harvard to understand why this happens in the USA.

 

[MommaBear]

I am just glad I don't have to tell another person that they are going to die because they delayed care because they didn't have insurance. Death is inevitable, death from preventable issues in the 21st century is tragic.

We Americans are spoiled. Have an itch? Gotta see the doctor today. Have a sore throat? Go to the ED tonight and demand antibiotics for a virus. Smoke 2 packs a day for 40 years, get lung cancer and are angry because we cannot fix it. Exercise? Diet? Fugedaboudit, just take care of me because it's your job to make me better. True story: patient comes to ED for emergency MRI because she was going on a safari in Africa the next day and couldn't get a routine one before she left. No, she didn't get the MRI, but all our costs went up because of ED utilization.

It is also scary that I am now reimbursed based on how much my patients like me! Granted, if we have a good relationship you are more likely to follow my advice. However, it is also my job to say "no" No, you can no longer drive because you are a danger to yourself and others. No, I cannot order you a scooter because you do not feel like walking. No, I cannot say your tummy tuck is medically necessary.

I am also reimbursed in part in how well you take care of yourself. Moral dilemma. Do I continue to work to help you get your diabetes/CHF/high blood pressure under control or do I drop you as a patient because you haven't hit the targets and I just lost 2% of my salary?

Having lived and worked in New Brunswick, Canada we waited for care. Eight hours to be seen in the ED, once admitted might wait on a stretcher 3 to 5 days (yes, days) for a bed in a ward upstairs. Blood test on Friday, get the results in 10 days. Need to see a specialist? 6 weeks if you'd seen them before, six months if you hadn't. Need a tonsillectomy? You are on the OR schedule in 10 months. And that isn't even considering the tax rate!

No health system is perfect. If you want top drawer service and want the right to sue, you pay. If you want universal health care, service and resources are limited, but overall costs are lower and they come right out of your taxes.

And don't put me in charge! I would expect you to have taken Tylenol and/or Motrin before you are seen for muscle pain. I would expect you to put as much into your health care effort as I would: no smoking, all other things in moderation, exercise, use common sense, know basic first aid, take your meds, do your follow up blood work, accept that there are things we can help but not eliminate, and know that pain is part of life and after surgery or injury, you are going to have some pain, there is lots we can do for chronic pain but narcotics are not the only answer. And if narcotics are the answer, you are asking the wrong question.


Wow! Guess I was on a tear this morning. I have been in the medical field for forty years. I love what I do, consider it an honor and a privilege to go to work. I will care for you, support you, and hold your hand and cry with you when I share bad news. I will also tell you that the system is a mess and I hate being told what to prescribe based on your insurers, who, by the way, can change what medication they cover every 90 days without notice so when the receptionist sends me a request for a refill, I authorize the nurse to call it in, the pharmacist tries to get the payment Okayed only to find out it is no longer covered, so we have to start the whole telephone game over again.

We have a start in the right direction. Now, the process needs to be refined. I hope politics get put to the side and what the patient needs is at the center of the debate.

 

[taterhed]

I am just glad I don't have to tell another person that they are going to die because they delayed care because they didn't have insurance. Death is inevitable, death from preventable issues in the 21st century is tragic.....

.........We have a start in the right direction. Now, the process needs to be refined. I hope politics get put to the side and what the patient needs is at the center of the debate.

well said.

Amazing that the people making decisions for 'our' healthcare don't have to worry about healthcare or about paying for it....

Thanks for sharing what I feel is probably the heart of the matter.

 

[VegasBella]

I am just glad I don't have to tell another person that they are going to die because they delayed care because they didn't have insurance.

Well, actually you can still decline to get coverage. Or accidentally have a lapse. There's a fine that will deter some people, but we're still going to have uninsured people.