Something positive for a change

[Uncle Al]

Abbreviations create a mind twist

Everyone here as been referring to Universal Health Care as UHC.
Every time I read that, I think of my personal insurance company
of United Health Care. Had this employer provided insurance
company since I retired in 2007.

Now, come January 1st, the program is changing to a Managed Care
provider. It will take over for Medicare parts A, B and D. It is
"supposed" to cover 'D' prescriptions, but time will tell. Humana and
United Health Care are the two 'WORST' payers to providers that I've
encountered.

I agree that Insurance Companies, in general, are a big PITA
But what do we do without them

Oh - Wait - Our local news program had a special about Medical
Insurance. A single lady had insurance but was in an auto accident
which caused her to be hospitalized. She received her bill and was
confused as to why she was having to pay $1,400.00 for the service.
She asked them(the hospital) if they billed her insurance for this.
They told her that they(the hospital) didn't know she had insurance.
She gave them the insurance information, and thought that would be
the end of it. A month later she received a hospital bill for $2,500.00
upon which she called to find out WHY the bill is higher instead of
lower, with her insurance.

She was told that the hospital has two billing scales. One for patients
who have insurance, and one for patients who don't have insurance.
The charges on her 'NEW' bill were 100-150% higher per item. She wanted
to know WHY, to which they(the hospital) responded that the higher
charges off-set the costs for patients who don't have insurance.

To me, this is a good example of how everyone "works the system".
It's quite unfair to the population that hospitals, and doctors, have
to resort to this kind of behavior to get paid for services rendered,
because of unscrupulous tactics by, so-called, health insurance companies.

Uncle Al

[moonshadow]

To me, this is a good example of how everyone "works the system".
It's quite unfair to the population that hospitals, and doctors, have
to resort to this kind of behavior to get paid for services rendered,
because of unscrupulous tactics by, so-called, health insurance companies.

Hehe.... yeah.. someone outta do something about that...

[Faldaguy]

by Uncle Al » Tue Nov 24, 2020 1:44 pm
To me, this is a good example of how everyone "works the system".
It's quite unfair to the population that hospitals, and doctors, have
to resort to this kind of behavior to get paid for services rendered,
because of unscrupulous tactics by, so-called, health insurance companies.

Isn't this a delightful insight. Sadly it has not been a secret, nor is it new. The examples abound: Many years back I was given a prescription for a CPAP machine, from the 'preferred' provider it would cost $1600.00; but I could get the identical new item online for $400.00. I asked the our insurance provider if I could get it there instead -- save us both some money. They said sure, but the co-insurance portion for me would change using an non-preferred provider so it would cost me more that way. So even though we could have both save a bundle -- the system was designed to pad the pockets of those in the game.

Another great example for those of us Ex-pats from the States that have Medicare -- we have to pay our premiums, it is deducted without choice from our Social Security -- BUT, we cannot use it outside of the US. So, thousands of US ex-pats (mostly retired) living in many countries around the world that have excellent health care at much lower rates than the US, end up flying back to the US for any major procedure, thus Medicare incurs a much higher payout to US providers, than if they had just helped out with the lower costs outside the borders. But then the system was not designed to help the insured -- but to feed the medical industry in the US (guess who pulled those strings.)

Sorry, your observation and my tantrum are "not part of the something positive for a change". And as to "free" -- the old line: "There ain't no free lunch" is ever more true. If you get it 'free' mostly likely you or somebody paid double or more in hidden costs.

[moonshadow]

Sorry, your observation and my tantrum are "not part of the something positive for a change". And as to "free" -- the old line: "There ain't no free lunch" is ever more true. If you get it 'free' mostly likely you or somebody paid double or more in hidden costs.

Not true, poverty is so bad in my locale, there are entire counties that give all the children in the school system free lunches.... among other government freebies (just for having children you can't afford....)

Considering the political leanings of Tennessee and Appalachia, the irony is striking... and admittedly, somewhat irritating.

I literally had a woman tell me the other day "I ain't no communist or sssssocialst, but I desperately need another stimulus check..."

My face.... squarely in my palm....

Let's translate this to REDNECK ENGLISH...

"I WANT THE GOVERNMENT TO WORK FOR ME AND NOBODY ELSE".

'bout sums it up....

Country boys 1980: "if you can't feed 'em, don't breed 'em"

Country boys 2020: "knocked up again babe? Hell yeah! Git another two grand back on taxes, and a few hundred more on food stamps!"

[crfriend]

I literally had a woman tell me the other day "I ain't no communist or sssssocialst, but I desperately need another stimulus check..."

Let's translate this to REDNECK ENGLISH...
"I WANT THE GOVERNMENT TO WORK FOR ME AND NOBODY ELSE".

The point here is that the government is supposed to work towards the common good -- the "General Welfare" -- of the society as a whole NOT one tiny sliver of it that controls most of the wealth. So, your conversation, in that context, reflects someone who believes that her government has failed her -- and it has. In spades. And has been doing so for four bloody decades.

No offence, sir, but your translation was just a bit off.

Country boys 1980: "if you can't feed 'em, don't breed 'em"

That sums it up nicely, and note that the birth rate did not slacken amongst the general population then. Not enough folks understood what was going on.

Country boys 2020: "knocked up again babe? Hell yeah! Git another two grand back on taxes, and a few hundred more on food stamps!"

Nor has it now, but the Country Boys are catering to the far right in the assertion.

[john62]

Two years ago started to use an insulin pump, cost $9500.00, the health insurer paid the full cost all that was needed was a letter from the Endocrinologist.

John

[moonshadow]

I literally had a woman tell me the other day "I ain't no communist or sssssocialst, but I desperately need another stimulus check..."

Let's translate this to REDNECK ENGLISH...
"I WANT THE GOVERNMENT TO WORK FOR ME AND NOBODY ELSE".

The point here is that the government is supposed to work towards the common good -- the "General Welfare" -- of the society as a whole NOT one tiny sliver of it that controls most of the wealth. So, your conversation, in that context, reflects someone who believes that her government has failed her -- and it has. In spades. And has been doing so for four bloody decades.

The point that irritates me, is the fact these issues will never be resolved. The process of wrestling capital (and the means of production that capital provides) out of the hands of the elite and placing it in the hands of society is the textbook definition of socialism.... and let's face it... that ain't gonna happen... Americans are just too damned brainwashed..

But honestly, I don't object to the hard-core capitalist, what grinds my gears is the blatant hypocrisy that has gripped this land... Okay... the Appalachian citizen wants to the the "poster child capitalist"? Fine.... hand over that social security check, hand over that Medicare card (assuming the subject is 65 or older), for those of us younger... hand over that union card, hand over that EBT card, stop complaining about roads not being cleared of snow and pot holes repaired, take the child OUT of public school and enroll the kid in a private school with NO tax funded vouchers., pay back the money one SAVES every time one visits the grocery store and buys a can of beans or a loaf of bread due to agriculture subsidies, big on coal? Let's not forget the subsidies and tax breaks to the coal and oil industry... shut out the lights... or pay three times as much... the list goes on and on...

I mean for God's sake Tennessee is HOME to the Tennessee Valley Authority!- Probably the most SOCIALIST program in the entire United States! WTF is wrong with these people? Why can they not see what side their bread is buttered on??

I'm just so fed up with the bullsh!t hypocrisy...

[moonshadow]

Speaking of which (the TVA), many have probably heard this before, what I would argue is one of the unofficial anthems of the south...

Nevertheless, the lyrics are striking, and a reminder of what we can accomplish when we pull our heads out of our own asses and work together....

https://youtu.be/lHdXQAQHjd8

Check out this Wikipedia article:

https://en.m.wikipedia.org/wiki/Tenness ... _Authority

During the 1920s and the 1930s Great Depression years, Americans began to support the idea of public ownership of utilities, particularly hydroelectric power facilities. ... Many believed privately owned power companies were charging too much for power, did not employ fair operating practices, and were subject to abuse by their owners (utility holding companies), at the expense of consumers.

During his presidential campaign, Franklin D. Roosevelt said that private utilities had "selfish purposes" and said, "Never shall the federal government part with its sovereignty or with its control of its power resources while I'm president of the United States." The private sector practice of forming utility holding companies had resulted in their controlling 94 percent of generation by 1921, and they were essentially unregulated. In an effort to change this, Congress and Roosevelt enacted the Public Utility Holding Company Act of 1935

In 1920 Senator George Norris (R-Nebraska) blocked a proposal from industrialist Henry Ford to build a private dam and utility to modernize the valley. Norris deeply distrusted privately owned utility companies, which controlled 94% of power generation in 1921. He gained passage of the Muscle Shoals Bill, to build a federal dam in the valley, but it was vetoed as socialistic by President Herbert Hoover in 1931

Now today Tennesseans love them some TVA, it's the pride of the state! Yet enacting similar measures with regards to our health care is a bridge too far!?!

If the TVA was being introduced for the first time today in 2020, the citizens of the state would fight it tooth and nail and INSIST on privately owned electrical utilities.... They'd laugh the very notion right out of the Nashville capitol building....

[Faldaguy]

by moonshadow » Tue Nov 24, 2020 5:52 pm

Faldaguy wrote: ↑Tue Nov 24, 2020 5:13 pm
Sorry, your observation and my tantrum are "not part of the something positive for a change". And as to "free" -- the old line: "There ain't no free lunch" is ever more true. If you get it 'free' mostly likely you or somebody paid double or more in hidden costs.

Not true, poverty is so bad in my locale, there are entire counties that give all the children in the school system free lunches.... among other government freebies (just for having children you can't afford....)

Moon, a "free lunch" program may indeed by eaten without direct charge to the diner; the same as you can have your 'free lunch' at Costco (or at least could, pre-covid) from all the food samples handed out. BUT, we both know neither of those is truly FREE in that the subsidy comes from somewhere, and most likely you are paying for them indirectly in Ag supports; taxes for the schools; higher prices at the market.... they ain't free. That does not mean they are not a good idea. I'm inclined to think the free lunch program at schools is a great idea with multiple benefits -- to the extent it may actually do more good than harm and save us money that would otherwise be spent on health, educational, and social consequences of kids being nutritionally deprived. In that respect, I'd go so far as to suggest "free education, right through University ultimately pays real benefits to a society -- but "free" it ain't.

I do share your frustration with the lack of understanding so many have as to what constitutes socialism, or a bunch of our isms -- and that so many that squawk about the horrors of the various isms are first in line to take advantage of them -- hypocrisy (maybe), just ignorance (more likely) -- having taken their courses in civics and government from the likes of Fox "news" -- maybe 'new' truths -- like "alternate" facts? Sorry, off - theme here....but none of it is truly free, even if it is sometimes good.

[Gusto10]

However, if you stop to look at health insurance in general, it is fundamentally
flawed. Private companies take your money and then pay it out for health care.
Along the way, they must use some of your money (premiums) to cover their costs.
This makes less money available to pay those medical costs.

This applies to any form of insurance though, that's not what makes health insurance special.

The issue with health insurance is that (a) everyone is going to use it at some point, (b) at the moment of use you generally don't have the time to think about your options and (c) the costs are barely related at all to your income or wealth. So whereas for example home-insurance you're talking about the pooling of risk (most people never have their house burn down), for health-insurance you're more talking about smoothing out the payments over your lifetime. It's a redistribution problem.

The only way you can get insurance companies to work efficiently is stiff competition. This should be easy since insurance companies fundamentally don't actually offer different services. Yet somehow this doesn't work in the US? I guess the US the bundling of health insurance with employment means that it doesn't happen?

Here we have insurance companies but the government has put them in a special role. Namely, because they basically all offer exactly the same product, there's quite a bit of competition. So the only way for them make more money is get health providers to charge less. The insurance company can't refuse treatment, they have to pay out for anything an authorised health provider bills. All they can do is try to get the prices down.

Whether it's working is up for debate. Health costs keep going up, but the baby-boomers keep getting older and using more health services. We don't get to do alternative timelines so we don't know if it would have been worse otherwise. The issue is not so much that procedures are too expensive, the insurance companies got that under control. But whether people are get unnecessary procedures, that's quite a bit harder and not something the insurance companies can easily fix.

As for UHC in the US, I wonder if such a large change could happen. I'm generally more of an evolution rather than revolution person. The ACA was a good start, taking smaller steps that way seems more likely to work.

@Rode Kater: The sytem in the Netherlands is 50% paid via the taxes, 50% paid by premium and a deductable of 385 euro's. Exception: immigrants whom 's visa are pending, they pay no deductible and premiums are compensated. Same with students. Till a few years ago the emploeyer would contribute also. So the monimum premium is including the tax share almost 3000 euro's per annum.

[rode_kater]

So the monimum premium is including the tax share almost 3000 euro's per annum.

Right, but that's average. People who earn little pay less (and get a rebate on the insurance) and rich people pay more.

My point is the insurance companies play a role is keeping prices down. And that that's done by saying that they cannot refuse payment and stiff competition. The fact that a large chunk of the money comes from income tax is to make the system more progressive.

[crfriend]

My point is the insurance companies play a role is keeping prices down.

That, I suspect, is highly dependent on locale and local laws.

Germany, I am given to understand, has an "individual mandate" for folks to purchase health "insurance" (making it effectively a tax), but specifically prohibits for profit "insurance" companies from participating in that arena. If that was the case in the US, I could have supported Romneycare. However, in the United States, it's all for profit, and the interests of the "insurance" companies runs counter to that of the population who are looking for care. Unfortunately, through propaganda and manipulation of language, "insurance" is now equated with "care" which is 180 degrees out of phase with reality.