I hate the Un-affordable Obama Care

[rotor]

he medical profession is exempted from monopoly and restraint of trade laws. The whole system is a government facilitated rip-off. Unless that changes, yep, only the rich well be able to afford healthcare and those who are on the government tab will not be treated for certain conditions because it costs too much. Already happening in the UK.

Break it down for me. Locally, there are probably 50 or more "family practice" doctors. I'd say that's a reasonable level of competition.
However, they don't compete.... I can't really can't shop around due to insurance.

It seems like there's a real problem with the insurance implementation. If I walk into a family practice doctor, no insurance, but able to pay, I'm likely to spend $200-$250 for a few minutes of that doctors time.
With insurance, the payment to the doctor drops to about 60% of that - say $120 or so... Even though having insurance costs the doctor much more to process than having cash.
My out of pocket with insurance? Maybe $20 or so... Not counting the $750 or so that my employer and I are spending every month for that coverage.

It just seems very backwards to me. Dental care is the same way.

However, I can go down to Mexico and for some procedures where the standard of care and technology are on par, I may pay 75-85% less than the prevailing cash rate...

I don't claim to have a solution, I'm just claiming that the only thing worse than Obamacare would be allowing the status-quo for another 2 decades. And I might be wrong on that - both may implode.

Go to Mexico then for your care. No malpractice insurance, disposable instruments used multiple times, medicine that may be counterfeit from China, and we all know that the legal system and police will protect you from anything illegal. Have you been smoking that funny stuff?

The problem with the American medical system is the government. Pricing is done by the government with everything in relation to what Medicare pays. Almost every insurance policy pays a doctor on the basis of Medicare. Doctors fees are about 8% of the cost of getting sick. The hospitals are where you get ripped off big time. But worry not because with Obamacare you will probably not end up seeing a doctor. Your "health care provider" will now be a nurse or less. I still like the system that I use for my pets, I pay for care on the spot at a reasonable rate and the vet doesn't have to spend a million dollars just to computerize his records so that the government will know if my dog prefers critters of the same or opposite sex. On Oct 1, 2014 ICD10 will hit every doctor's office. The new required coding system ordered by Medicare. Cost to a solo practice will be between $80,000 to $220,000 and will not in anyway benefit the doctor or patient but will allow the government to spy on you with even greater ease. Look for many senior doctors to post their retirement notices in your local paper close to that date.

[mojo84]

I wish more people were better informed as to what goes on.

As far as shopping around, people that have large deductibles tend to shop around and save money in the long run. Those that have small deductibles and copays just accept whatever the providers charge. CMS has a huge influence on reimbursements. However, I've had clients shop around for an MRI andtge prices ranged from just a few hundred dollars to well over $2000.

We need to be good prudent consumers regardless the product or service. At the end of the day, we are going to psy one way or another.

[cb1000rider]

Go to Mexico then for your care. No malpractice insurance, disposable instruments used multiple times, medicine that may be counterfeit from China, and we all know that the legal system and police will protect you from anything illegal. Have you been smoking that funny stuff?

Rotor, not all of Mexico is like that. Medical tourism is a huge industry and there are places that have very high standards of care... I shouldn't just limit it to Mexico, especially with what is going on over there now. I wouldn't travel for state of the art cancer treatment, but for many things, especially for retirees - medical tourism is a viable option.

No malpractice insurance is part of what makes the pricing more reasonable. Malpractice insurance is part of the problem here. Yes, it's not without risk, but you can do your homework. I think the medical tourism industry illustrates that healthcare can be provided in a quality manner at a much more reasonable price point.

The problem with the American medical system is the government. Pricing is done by the government with everything in relation to what Medicare pays. Almost every insurance policy pays a doctor on the basis of Medicare. Doctors fees are about 8% of the cost of getting sick. The hospitals are where you get ripped off big time. But worry not because with Obamacare you will probably not end up seeing a doctor. Your "health care provider" will now be a nurse or less. I still like the system that I use for my pets, I pay for care on the spot at a reasonable rate and the vet doesn't have to spend a million dollars just to computerize his records so that the government will know if my dog prefers critters of the same or opposite sex. On Oct 1, 2014 ICD10 will hit every doctor's office. The new required coding system ordered by Medicare. Cost to a solo practice will be between $80,000 to $220,000 and will not in anyway benefit the doctor or patient but will allow the government to spy on you with even greater ease. Look for many senior doctors to post their retirement notices in your local paper close to that date.

So there are no advantages to electronic medical records? And the government requires them simply so they can better spy on the sheep? That's where you start to lose me. We complain about inefficiencies in government, especially medical care, but we've got offices still submitting on paper... Maybe I'm too young, but I can't imagine doing my taxes on actual paper.

Yea, it's expensive, but costs will come down. Anything that is new and requires technology is expensive, but over the long haul, what are the costs of keeping and processing paper records over decades? I understand why it might push older practices towards retirement.

Personally, I've got no problem seeing a nurse for care if that nurse is well qualified for dealing with the situation. I've known quite a few experienced nurses to be much better than younger doctors. I'd like to see nurses expanded where appropriate, it could help bring in the cost of care.

And you're right.. I complain about the cash price of a doctor. The cash price of a hospital is way worse...

[mojo84]

Most medical tourism is not to Mexico for the more serious procedures. Dental and bariatric surgery and cheap drugs are what people go to Mexico for usually.

[rotor]

cb1000rider, Almost all doctors submit their claims electronically. The only practices that don't are in areas that are in the hinetrlands with no internet access and they are given an exemption. Research ICD10 yourself to see why the government needs to know if you are attacked by a turtle. They are data-mining the population. Questions about your sexual preferences, etc are all required info now. The claim is that it is for your health. And they also claim that registration of firearms is to protect you. Believe what you want.
As far as computers, I am very much in favor of them. In a bank though it is not the bank president that inputs all the data it is the peons at the front end that do that. In a doctors office it is the most highly skilled person doing the input, which takes away time from seeing sick people unless he can afford to hire a scribe (my hospital ER did this as the docs couldn't see the patients and input everything-more cost to you of course). Electronic health records are very expensive to maintain and input, tremendously time consuming and frustrating for the user. For the company that sells the stuff it is the pot of gold at the end of the rainbow.
Finally, there are places to go outside the US that do provide good medical care at reasonable prices. I was impressed with Costa Rica but NOT MEXICO. Again, with all of the counterfeit meds, I no longer trust what they sell in Mexico or Canada to be real. We have seen anti-cancer meds that were phony introduced into the US. There are people without scruples that will do anything for money.

[cb1000rider]

I think that the entire "fake meds" issue is just a bunch of fear-mongering by politicians who are funded by drug companies. It's just like "gun free zones' - it makes parents feel good, but has no actual impact on safety. The issue isn't safety. It's income.

You can easily solve the fake medications problem simply by buying from legitimate sources. Or if more "proof" is necessary, implementing a means of quality control and inspection. Drug companies don't want us shopping around, it's not in their best interest.. And it's things like this that drive up healthcare costs for everyone.

[VMI77]

he medical profession is exempted from monopoly and restraint of trade laws. The whole system is a government facilitated rip-off. Unless that changes, yep, only the rich well be able to afford healthcare and those who are on the government tab will not be treated for certain conditions because it costs too much. Already happening in the UK.

Break it down for me. Locally, there are probably 50 or more "family practice" doctors. I'd say that's a reasonable level of competition.

However, they don't compete.... I can't really can't shop around due to insurance.

It seems like there's a real problem with the insurance implementation.
If I walk into a family practice doctor, no insurance, but able to pay, I'm likely to spend $200-$250 for a few minutes of that doctors time.
With insurance, the payment to the doctor drops to about 60% of that - say $120 or so... Even though having insurance costs the doctor much more to process than having cash.
My out of pocket with insurance? Maybe $20 or so... Not counting the $750 or so that my employer and I are spending every month for that coverage.

It just seems very backwards to me. Dental care is the same way.

However, I can go down to Mexico and for some procedures where the standard of care and technology are on par, I may pay 75-85% less than the prevailing cash rate...

I don't claim to have a solution, I'm just claiming that the only thing worse than Obamacare would be allowing the status-quo for another 2 decades. And I might be wrong on that - both may implode.

It's not a Dem/Rep issue, it's an oligarch against the rest of us issue. As far as costs go, quick example. A few months ago my son woke up in the emergency room after being knocked unconscious. They charged him $26,000 for an MRI. I had an MRI done for $1500, which was too much itself, as I know people who've gotten them for $500 cash. I don't have the energy to write an essay, but here are some examples for consideration:

http://market-ticker.org/akcs-www?post=228851

I had some other links but apparently they don't work.....so just work backwards through the blog and you will see where he gives numerous of examples of the medical scam.

[cb1000rider]

At the root of this is political sponsorships with big payoffs and legislation. They're probably the oligarchs of which you speak. I'm sure it wasn't intended to become what it is today, but it's now a monster. Obamacare doesn't address it, it just forced everyone into the monster with the end goal of having the healthy subsidize the sick and old.

As long as political PACs can write massive checks and hide their donors, nothing is going to change.

[philip964]

There is a real need for insurance for people who can't get insurance. I have two friends who through no fault of theirs ended up with chronic diseases and no insurance.

That said. Seems the baby was thrown out with the bath water.

So far no changes for me, other than a new 75 dollar a month described by my insurance carrier as a tax.

I was going to loose my insurance in October, then there was going to be a problem, but then surprise, don't know why but now the are saying two more years before I loose my insurance. Obama kicking the can down the road, who knows.

But my big question, I currently pay about $3000 a year to the Harris County Hospital District in property taxes. So will this end, as there will no longer be needy people without health insurance? Thus no need for charity care.

Inquiring minds want to know.

[Crossfire]

I just got a phone call from my doctors office. I have a little "procedure" scheduled in a few weeks, and they wanted to let me know that my part, based on my insurance coverage, would be $450.

OK, but I lost my job, and my coverage has terminated. So, I asked what the cost would be if I paid cash. She worked through the numbers and said, "cash payment - no insurance - $358."

WHAT??? So, tell me again - why do I need insurance???

[rotor]

I just got a phone call from my doctors office. I have a little "procedure" scheduled in a few weeks, and they wanted to let me know that my part, based on my insurance coverage, would be $450.

OK, but I lost my job, and my coverage has terminated. So, I asked what the cost would be if I paid cash. She worked through the numbers and said, "cash payment - no insurance - $358."

WHAT??? So, tell me again - why do I need insurance???

Again, doctors fees are pretty much set by the government and contracts with insurance companies are set by what the government fee is. When you have no insurance and the doctor has no hastle or expense dealing with insurance ( which he can not legally charge you less than the insurance contract as by definition that is insurance fraud and punishable with jail time) he can bargain with you and charge what he wants. Knowing your circumstances he can give you a break or whatever. I personally like the cash price listed at the door and bargain with the doc will almost always work. Money received today is better than money received in 90 days (maybe).

[cb1000rider]

I've never seen what you've experienced. The only time I've seen a doctor's visit be at a reasonable cash rate was for a flight exam where they only accept cash.
Every other procedure - especially dental procedures and emergency visits, the listed rate was far far above what the "negotiated" rate was with my insurance company.
And yes, you can absolutely negotiate down (up front) with smaller offices if you're paying cash, but often the rate for people who can pay for it, especially if they need it now - emergency/urgent care.. Rates are just crazy.

[Beiruty]

There are clinics/doctor office that only accept cash and no insurance whatsoever. Doctor Visit is is just $35 and the only way to know about those clinic is when your PCP kick you out as you do not have insurance. Yep doctor visit and it is just $35. Lab works are also heavily discounted. Legit doctors and regular clinic like any other out there.
Who most visit such clinics? illegal immigrants.

[G26ster]

If there's someone here that is knowledgeable in State health law, I have one for you. I am in a Medicare Advantage HMO. This means I must deal with the PCPs and specialists in my network. I wanted to get a second opinion from a noted specialist at UT Southwestern in Dallas (UT Southwestern does not accept my insurance). I told them I would pay cash. I was informed that Texas state law prohibits them from accepting cash from a patient who has health insurance, even if they do not accept that insurance. Any one ever heard of this?

[Beiruty]

UT SW should accept medicare patients.