Seriously What the F!@#$% is wrong with cost of Healthcare in this Country?

[zx10guy]

I'm in the situation where so far I have close to the best medical plan I have had in my life. I pay $145 (soon to be $75 when I get the ex off the plan) a month for full family coverage. Doesn't matter how many dependents I have on the plan. This monthly cost includes dental and vision. Yearly individual deductibles are $250. The plan is a PPO. The only other plan I have had which was better was a long time ago where it was also a PPO but the yearly cost was $1. Yes, you read that right. The explanation was that the company couldn't give away free health insurance due to IRS rules so they had to charge the employees something....$1. I don't remember if that included vision and dental. I seem to recall it didn't, but still very good.

The issue I'm going to face in a couple of years is what my current employer is going to do if the "Cadillac plan penalty" of the ACA is going to kick in. My employer has structured things to provide a very good benefit for those that are employees. Yet we have the Feds telling us we're not allowed to have this type of benefit anymore. Yet, these same politicians will still enjoy their "Cadillac" plans. So I don't know if my employer will suck up the tax penalties associated with having the current benefits in place or if it'll be passed on to the employees in higher premiums or a change in the plan benefits. This is an example of a benefit which has nothing to do with public funding being affected by public policy.

[zx10guy]

Originally Posted by BeastieBombRacing

I would lose my fucking shit every time.

And from what I've seen, you're not allowed to have copies of your own reports and scan images. I don't know if that is true or not. But that's the impression I got from the Canadian forum members.

[Salty Dog]

Originally Posted by zx10guy

I don't know anything first hand about the Canadian healthcare system. But because of my medical situation, I have been active on the various cancer support forums. There are some people that fall into the situation you've mentioned that are in Canada. They live in a rural area and have to drive hours in to the nearest cancer treatment centers. With various things that is just life, they've had challenges with the whole logistics whether it be scans to actual treatment.

One thing I'm stunned about is the limit on access to your own information under the Canadian system. What I mean by this are lab results and scans. When you deal with cancer, you learn about this thing called scanxiety. It's the anxiety one feels just before going in for scans and the painful wait after for the results. From what I've seen, Canadians have to wait till they see their doctor before they know the results. Sometimes this is only a few days but can be as bad as a couple of weeks based on what I've seen on the forums. This would drive me nuts. For me, I have been able to get my scan images right after I finish the scan procedure and have been able to get the official radiology report later that day.

So healthcare is administered at the provincial level, Ontario has spend billions the last few years implementing "e-health"....I've not accessed my profile but I think there is or it's planned to allow you to log in and see results and view your records.

[zx10guy]

Originally Posted by Salty Dog

So healthcare is administered at the provincial level, Ontario has spend billions the last few years implementing "e-health"....I've not accessed my profile but I think there is or it's planned to allow you to log in and see results and view your records.

This would be a step in the right direction. But from my US view point, the promise of collaboration and single access to all of your medical records has been and still is a pipe dream. Even though I have portal logins to see various things, it's still not complete. An example is my oncologist's portal. I can see some basic information and it's where I have to go for my blood work results. But I can't see the radiology reports nor scan images that are part of my file. If I didn't get copies of these from the radiology office, I would be totally in the dark. And notice that I said portal logins. I have one for my GP. I have one for my GI doc. I have one for my oncologist. I have one for one of the labs I had my blood work done in the past. They're all independent systems. My GP has access to the local hospital's medical records system. But I don't think my oncologist does. It's a total mess.

[pennsiveguy]

Originally Posted by ///M///

The point is not about copay but more about what they bill for a frickin’ service. I can’t even comprehend it sometimes because it makes no sense. Here is an example and I’ll just talk about one of the line items because the rest will likely blow your mind....when I had my motorcycle accident, they put in a claim for $1400 for oral medication in the 1.5 day hospital stay. Just to be clear, the oral medication just involved a nurse handing me meds to swallow. $1400 for the three times she had to do that. Chew on that for a bit. Lol!

When I was in Italy during the European delivery I caught a bug and fell ill suddenly. The ER trip, seeing a doc and a course of antibiotics (no insurance) came out to 38 euros.

Last year in Switzerland my 4 year old daughter fell ill in Lauterbrunnen. Went to the local hospital where they did xrays and complete bloodwork along with medicines. Bill was 125 euros and by European standards that’s high that’s because it’s Switzerland. Compare that to here if I needed walk in doc visit, bloodwork, xrays, prescription drugs and following. Easy 4-5k.

I fucking hate the healthcare cost and hate more how the ridiculous cost is normalized in our society.

The problem stems from the 3rd-party payer model. If you had some minor procedure - like having a mole cut off - and they handed you a $5000 bill that you had to pay out-of-pocket, on the spot, you'd laugh your ass off and tell them to go fuck themselves, right? "BWAAAHHAAAHHAAA! Yeah, I'm thinking more like $200. That's my final offer. Take the $200 or put the mole back on." Never happens that way, though.

But the insurance company doesn't care. They pay the horribly inflated prices, and then jack up your premiums to cover them. They leave themselves a "cut" and always seek to maximize that cut, at the expense of you and the health care providers. Whomever they can get the money out, or deny paying, the easiest and cheapest, that's who they'll put the screws to.

That, and the big health care companies are horribly bloated and loaded down with administrative overhead. They hire another "EVP of Synergistic Optics" every few months, and raise premiums to cover it.

[infinitekidM2C]

You won't find many people siding with the health insurance industry lol.

Just a little tidbit. I have found, on many occasions, that not going through your insurance, and negotiating a cash price for the visit can often be less than using insurance and AFTER your insurance pays it's part. So my experience has been that yes, it can often be more expensive to actually use your damn insurance due to how they bill (and yes i have PPO).

[TheWatchGuy]

What is your deductible and max out of pocket? If you hit or are close, you wont have many more healthcare related expenses for the rest of the year and while the 1st couple bills may seem bad, the rest wont.

My wife had pretty intense emergency surgery a few years back. We had a high deductible plan at the time ($0 premiums through her employer - a hospital), and end up paying ~6k out of pocket for it. The overall bill for the surgery + week in hospital was ~$115k. However, there was a cash option for ~10-15% of that, or a payment plant for about a quarter of it, for if we didnt have insurance. However, when she had to have a follow up surgery later, we paid a massive $0 bill since wed already hit our out of pocket max.

The following year, same deal. Another follow up surgery that we hit our max out of pocket ($3k since we figured shed need another surgery and went with a lower deductible/out of pocket max plan - $100/month premiums through her employe) and then she had another surgery and i had a surgery for just small copays (< $200 total tops).

Yes, healthcare costs are high, but a lot of that has to do with how litigious we are in America. Over half of physicians will get sued once in their career and someone has to pay for that. And in America, we dont have caps on damages. For example, Canada has a 350k cap and UK has a 400k cap. Lawsuits in America routinely surpass 1mill. You also have the added costs of the uninsured and underinsured that someone has to foot the bill for. In our case, its the facilities and the insurance companies, which in turn goes to those who actual pay (us). In other countries, its the government, which in turn is those who pay taxes (again us).

To add, i would gladly pay what i do to have access to DRs and procedures when i want/need. My parents recently sold their business in the healthcare industry, and decided to try out medicare. After my Dad getting his knee surgeries denied because they were not "necessary" and not life threatening, they went back to private insurance and he had both covered by insurance.

[TheWatchGuy]

Originally Posted by infinitekidM2C

You won't find many people siding with the health insurance industry lol.

Just a little tidbit. I have found, on many occasions, that not going through your insurance, and negotiating a cash price for the visit can often be less than using insurance and AFTER your insurance pays it's part. So my experience has been that yes, it can often be more expensive to actually use your damn insurance due to how they bill (and yes i have PPO).

this works if you dont expect other expenses throughout the year, but hitting those deductibles and max out of pockets save you a lot

[AlpineWhite_SJ]

Originally Posted by zx10guy

This would be a step in the right direction. But from my US view point, the promise of collaboration and single access to all of your medical records has been and still is a pipe dream. Even though I have portal logins to see various things, it's still not complete. An example is my oncologist's portal. I can see some basic information and it's where I have to go for my blood work results. But I can't see the radiology reports nor scan images that are part of my file. If I didn't get copies of these from the radiology office, I would be totally in the dark. And notice that I said portal logins. I have one for my GP. I have one for my GI doc. I have one for my oncologist. I have one for one of the labs I had my blood work done in the past. They're all independent systems. My GP has access to the local hospital's medical records system. But I don't think my oncologist does. It's a total mess.

It's also very basic info - I usually try and get image files for radiology and it's like pulling teeth just to get the low resolution files that play in a viewer. I want the full resolution files because my Dad's a radiologist and can consult on a second opinion but half the time it takes multiple attempts just to get what I'm asking for.

[TheWatchGuy]

Originally Posted by AlpineWhite_SJ

It's also very basic info - I usually try and get image files for radiology and it's like pulling teeth just to get the low resolution files that play in a viewer. I want the full resolution files because my Dad's a radiologist and can consult on a second opinion but half the time it takes multiple attempts just to get what I'm asking for.

ive found that if you specify upfront you want copies of your images, its much easier for you to get them than after the fact.

my parents always did this when my dad had cancer and made it much easier getting them and being able to take to friends/family for 2nd opinions.

[AlpineWhite_SJ]

Originally Posted by TheWatchGuy

ive found that if you specify upfront you want copies of your images, its much easier for you to get them than after the fact.

my parents always did this when my dad had cancer and made it much easier getting them and being able to take to friends/family for 2nd opinions.

Tried and it's still hit or miss. We start every imaging appointment stating we want full res files of the images.

[zx10guy]

Originally Posted by AlpineWhite_SJ

It's also very basic info - I usually try and get image files for radiology and it's like pulling teeth just to get the low resolution files that play in a viewer. I want the full resolution files because my Dad's a radiologist and can consult on a second opinion but half the time it takes multiple attempts just to get what I'm asking for.

Originally Posted by TheWatchGuy

ive found that if you specify upfront you want copies of your images, its much easier for you to get them than after the fact.

my parents always did this when my dad had cancer and made it much easier getting them and being able to take to friends/family for 2nd opinions.

This is what I do always after a scan. I ask for a copy of the images to be burned onto a CD before I leave the office. Not that I'm a radiologist but it helps for me to look through the scan images myself before I get my hands on the radiology report. My previous oncologist would go through my scans with me and point out different things he's looking for/at. It provided me some basics as to what seems to be out of the ordinary as I have all my previous scan images on CD. This is what radiologists would do anyways....compare your previous scan with the current one to look for any changes. PET scans are easy to read. Depending on the view, that glowing red spot or dark black spot is something active that the PET scan picked up. Depending on the location, it's either normal or abnormal. The included viewer software on the CD will even tell you the measured SUV of that area.

I have all the reports and CDs precisely for situations where I want a second opinion. It came in handy when I had NIH/NCI review some of my scans.

[AlpineWhite_SJ]

Originally Posted by zx10guy

This is what I do always after a scan. I ask for a copy of the images to be burned onto a CD before I leave the office. Not that I'm a radiologist but it helps for me to look through the scan images myself before I get my hands on the radiology report. My previous oncologist would go through my scans with me and point out different things he's looking for/at. It provided me some basics as to what seems to be out of the ordinary as I have all my previous scan images on CD. This is what radiologists would do anyways....compare your previous scan with the current one to look for any changes. PET scans are easy to read. Depending on the view, that glowing red spot or dark black spot is something active that the PET scan picked up. Depending on the location, it's either normal or abnormal. The included viewer software on the CD will even tell you the measured SUV of that area.

I have all the reports and CDs precisely for situations where I want a second opinion. It came in handy when I had NIH/NCI review some of my scans.

Sounds like they're a bit more helpful given the seriousness of the illness. But for regular broken bone or MRIs for non-cancer situations it's unnecessarily difficult sometimes.

[Hawkeye]

Originally Posted by AntF32

I'm happy to pay my N.I contributions, it gives me comfort that should i need emergency healthcare I'm not going to be hit with ridicules costs afterwards or having to prove i can afford treatment.

My wife has had been undergoing treatment for Stage 3 cancer for coming up to two years now, all covered under our healthcare.

I would rather pay a lot less and put the difference into a personal account in case I need it for something. That way I can earn interest on my money and spend it on something else if I don't need care.

The issue with the US isn't the cost, it's people who are not smart enough to put away an emergency fund even though they know full well that emergencies can be expensive. If you don't know this by now you have had your head in the ground for way too long.

[Hawkeye]

Originally Posted by infinitekidM2C

You won't find many people siding with the health insurance industry lol.

Just a little tidbit. I have found, on many occasions, that not going through your insurance, and negotiating a cash price for the visit can often be less than using insurance and AFTER your insurance pays it's part. So my experience has been that yes, it can often be more expensive to actually use your damn insurance due to how they bill (and yes i have PPO).

Just so you realize, it is not the insurance companies asking the hospital to jack up the price so they can pay more. The hospitals jack up the price on their own so that they can squeeze more money out of the insurance companies. That is the reason you see ridiculous charges and bills and can negotiate the prices down. I am astounded at how many people think it's the insurance companies fault (unless you are blaming them for not telling the hospital to take a hike and provide a more reasonable bill).

[Run Silent]

Originally Posted by ///M///

Am aware of that but it's not twice. This what people don't get here in this country that they are effectively paying closer to the same tax others pay in countries like Germany, Netherlands, Switzerland, etc where healthcare is covered when you add in the premium and deductible you are paying for insurance every year. Let's say my effective federal Tax rate is 30%. Now add in the monthly premium I am paying towards insurance every year to cover my family and that's another 8-10% easy. And if I am using the insurance that year add another 2-3% that goes towards meeting the deductible. Where does that get me? Well into the 40% plus of my salary.

I would rather pay 40% in taxes every year knowing that my health is covered no matter what than have to worry about plans every year, deductibles, coinsurance and all that crap.

The problem here is that everyone does not want to contribute to the system. It's all me, me, me. The young say I don't need to see a doc so why should I pay towards medical, others feel they are healthy so why pay? But guess what, everyone starts to get old and needs medical help at some point.

That can't be right. I get chemo injections almost monthly and I am in a pretty high tax bracket.

My ETR last year was around 18% and my total annual OOP medical costs typically run around $6k per year. I don't know anyone who has an ETR in America that is 30%. You either calculated that wrong or you have the worst accountant ever in world history.

I understand you are upset, but your numbers don't add up. Something isn't right here.

[zx10guy]

Originally Posted by Hawkeye

I would rather pay a lot less and put the difference into a personal account in case I need it for something. That way I can earn interest on my money and spend it on something else if I don't need care.

The issue with the US isn't the cost, it's people who are not smart enough to put away an emergency fund even though they know full well that emergencies can be expensive. If you don't know this by now you have had your head in the ground for way too long.

Until you get hit with a serious illness and no matter how much money you sock away, it isn't going to keep you out of financial ruin.

I felt the same way you did and thankfully I woke up and opted for the higher tier insurance coverage just before I got hit with cancer. I didn't have any of the risk factors which would indicate I would have any serious illness. No family history either. Had I not opted for the higher tier insurance when I had to get treatment...twice....I would be in a world of hurt financially. Would I have been able to survive it had I not paid for the extra coverage? Most probably. But that's because I had a job which I had flexibility in working and not be placed on disability. Plus my job paid well. I would venture to say the vast majority of people in this country don't have it as good as I have it.

[///M///]

Originally Posted by Run Silent

That can't be right. I get chemo injections almost monthly and I am in a pretty high tax bracket.

My ETR last year was around 18% and my total annual OOP medical costs typically run around $6k per year. I don't know anyone who has an ETR in America that is 30%. You either calculated that wrong or you have the worst accountant ever in world history.

I understand you are upset, but your numbers don't add up. Something isn't right here.

You are right. I made a mistake. On the phone so won’t go about retyping actual numbers but my point still was that I’d rather get medical taken out of taxes than having to worry about plans and crazy medical expenses every year. The charges that hospitals bill make no logical sense. The whole system doesn’t make sense. I didn’t think much of al this in my twenties when I was single and barely saw the doc but now I’m my 40’s, married with kids one starts to realize how crazy it really is. I have a employee backed plan and end up paying around $6500 per year for the kids and me. Can’t add my wife because my insurance won’t allow it since she has access to medical through her employer. So I all, off the top of my head we are paying around $9k in premium every year. Add the 4.5K deductible on top of that it’s more like $14k per year. With the toddlers we end up having multiple doc visits through the year and although we almost never meet the deductible we still end up close to 3-4K out of pocket.

I lived in the Netherlands for work for a bit and although taxes were higher we as a family never had to worry about medical and childcare. That’s a huge load off the head. But I guess to each their own. Personally I preferred that over the craziness here.

[Rmtt]

Originally Posted by zx10guy

I'm in the situation where so far I have close to the best medical plan I have had in my life. I pay $145 (soon to be $75 when I get the ex off the plan) a month for full family coverage. Doesn't matter how many dependents I have on the plan. This monthly cost includes dental and vision. Yearly individual deductibles are $250. The plan is a PPO. The only other plan I have had which was better was a long time ago where it was also a PPO but the yearly cost was $1. Yes, you read that right. The explanation was that the company couldn't give away free health insurance due to IRS rules so they had to charge the employees something....$1. I don't remember if that included vision and dental. I seem to recall it didn't, but still very good.

The issue I'm going to face in a couple of years is what my current employer is going to do if the "Cadillac plan penalty" of the ACA is going to kick in. My employer has structured things to provide a very good benefit for those that are employees. Yet we have the Feds telling us we're not allowed to have this type of benefit anymore. Yet, these same politicians will still enjoy their "Cadillac" plans. So I don't know if my employer will suck up the tax penalties associated with having the current benefits in place or if it'll be passed on to the employees in higher premiums or a change in the plan benefits. This is an example of a benefit which has nothing to do with public funding being affected by public policy.

My insurance is similiar to yours. Plus as mentioned, I have a Dr who will change billing codes.

I work for a private individual, and he's always provided this type of coverage since I started with him in 2006.

I hope he continues to be generous as I know he is probably paying a lot of his own money to afford his employees that type of plan.

[zx10guy]

Originally Posted by AlpineWhite_SJ

Sounds like they're a bit more helpful given the seriousness of the illness. But for regular broken bone or MRIs for non-cancer situations it's unnecessarily difficult sometimes.

I don't think that's the case or at least in my area it seems not to be. I had to go to the ER shortly after I had surgery for my first cancer. I had massive pain on my left side which I thought was complications from the surgery. The docs there pumped me full of pain killers because I was doubled over. After a CT scan, the docs found out what was causing the pain. Kidney stone. I looked through my stack of CDs and found the CD with my scan images from that visit.

I think you just have to be persistent on getting a copy while you're there. I haven't had to ask for copies after some time has passed other than the radiology office I use now. Last year I thought I misplaced one of the CDs for a scan I had done. When I was at the office for a check up scan months later, I asked for another copy and was provided one on the spot.

[yco]

thats why every time i go to US, im keeping on eye on every step i make additionally for not hurting myself somehow.. any connection with "health" can make me unhealthy easily there..

[infinitekidM2C]

Originally Posted by Hawkeye

Just so you realize, it is not the insurance companies asking the hospital to jack up the price so they can pay more. The hospitals jack up the price on their own so that they can squeeze more money out of the insurance companies. That is the reason you see ridiculous charges and bills and can negotiate the prices down. I am astounded at how many people think it's the insurance companies fault (unless you are blaming them for not telling the hospital to take a hike and provide a more reasonable bill).

Oh i get it doc. I mean if anything it shows that the docs and hospitals can be pretty reasonable if you say "hey how much cash"? They give you quite a good deal sometimes.