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K9Buck

Single-payer healthcare opinion

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Desertrat56
On 2/21/2020 at 11:13 AM, DieChecker said:

I can imagine MOST healthcare providers deciding to opt out and thus sending bills to people.

You know that won't work because doctors cannot opt out of a system that pays to bill people who can't pay.  That is just some crazy notion that they would "opt out".  Those doctors would have no patients to charge. 

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odas

Got a question. Why don't you guys ask the UM members from countries that have the tax payer insurance? How does it work for them?

Here, in Canada, I do not even notice what they take out from my pay. All I know that myself and two of my kids had surgeries for which I only payed taxi or my own parking ticket.

Every three months I go to my regular checks and pay nothing. 

Emergancy, if it really bad you are in front of the line refardles rich or poor. Otherwise it can be a longer wait.

I could not even immagine how it is that you have to pay thousands of dollars just to have a broken pinki finger fixed. 

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DieChecker
27 minutes ago, Desertrat56 said:

You know that won't work because doctors cannot opt out of a system that pays to bill people who can't pay.  That is just some crazy notion that they would "opt out".  Those doctors would have no patients to charge. 

Why couldnt they opt out? They're not government workers! 

Did you read what I quoted in my post? People unable to pay, on Medicare, are being billed by doctors right now. It happens. Not often, but I don't see why doctors, who had just had their practice destroyed, wouldn't opt for the way to get the most money.

They could set up a practice and not accept Medicare insurance. They'd just bill you. If the doctor in question is the only cardiologist in your area, you either pay him, or you go 200 miles to the next one.

Unless the government makes all healthcare workers Federal Employees, they will not be able to control them.

Plastic surgery is an example where this is true. Its entirely elective, and almost no insurance covers it. Yet it is a thriving business.

Another example is reproductive technologies. Artificial insemination, and other fertility treatments are often not covered. Yet they're used by millions.

It's all academic though, since the Congress is not going to let a hugely lobbied industry be turned upside down.

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DieChecker
35 minutes ago, odas said:

.

I could not even immagine how it is that you have to pay thousands of dollars just to have a broken pinki finger fixed. 

It's mostly greed I think. Greed from the insurance companies, so they cost so much. Greed from the healthcare employees who make twice, or three times, what a Canadian of the same profession makes. Greed of the drug, and supply, companies, which supply the hospitals and prescriptions. Greed of those who have complications and sue for a hundred times their real damages...

Greed.

I could support a single payer system, as it would remove almost all the incentive of greed, but I realize that the politicians (greed) arent going to let that happen. 

The best we can do, I think, is allow Medicare to include those who have no insurance, and can't afford it. No one will mind adding people who were previously outside the system. All the sacred cows will still remain.

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Desertrat56
1 minute ago, DieChecker said:

Why couldnt they opt out? They're not government workers! 

Did you read what I quoted in my post? People unable to pay, on Medicare, are being billed by doctors right now. It happens. Not often, but I don't see why doctors, who had just had their practice destroyed, wouldn't opt for the way to get the most money.

They could set up a practice and not accept Medicare insurance. They'd just bill you. If the doctor in question is the only cardiologist in your area, you either pay him, or you go 200 miles to the next one.

Unless the government makes all healthcare workers Federal Employees, they will not be able to control them.

Plastic surgery is an example where this is true. Its entirely elective, and almost no insurance covers it. Yet it is a thriving business.

Another example is reproductive technologies. Artificial insemination, and other fertility treatments are often not covered. Yet they're used by millions.

It's all academic though, since the Congress is not going to let a hugely lobbied industry be turned upside down.

There are doctors who only accept certain insurances.  And any doctor who bills a medicare patient can only bill for the 20% that Medicare does not pay and if the patient can't pay the amount gets written off.  If it is sent to a collection agency the patient still has processes in place to defray the costs if they are unable to pay.  And any doctor who bills a medicare patient over the allowed amount set by Medicare will be forced to write the amount and can get in trouble and loose all medicare patients. 

Usually before a procedure is done the doctor's staff verifies how much the patient's insurance will pay and lets the patient know how much they will be responsible for so that the patient can go elsewhere.  Often the private insurance companies will allow certain procedures and amounts on paper but refuse to pay them after the fact.  Major surgeries are required to have a pre authorization from the insurance company.  The stories you are telling have information missing or are misleading somehow.  The system we have is broken and needs to be fixed but it is the Private Insurers that have broken it, not the feds programs.

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Desertrat56
9 minutes ago, DieChecker said:

Why couldnt they opt out? They're not government workers! 

Did you read what I quoted in my post? People unable to pay, on Medicare, are being billed by doctors right now. It happens. Not often, but I don't see why doctors, who had just had their practice destroyed, wouldn't opt for the way to get the most money.

They could set up a practice and not accept Medicare insurance. They'd just bill you. If the doctor in question is the only cardiologist in your area, you either pay him, or you go 200 miles to the next one.

Unless the government makes all healthcare workers Federal Employees, they will not be able to control them.

Plastic surgery is an example where this is true. Its entirely elective, and almost no insurance covers it. Yet it is a thriving business.

Another example is reproductive technologies. Artificial insemination, and other fertility treatments are often not covered. Yet they're used by millions.

It's all academic though, since the Congress is not going to let a hugely lobbied industry be turned upside down.

The point is that if people can't afford it, they will not go to a doctor that works outside the system.  If a doctor "opts out" of single payer, who is going to go to them?  Only people who have a lot of  money, and even those people will not go to them if they have access to "free" healthcare.  Why would they?

Of course fertility treatments are not covered!  How stupid would that be?  I know insurance companies will pay for one artificial insemination after years of proof that the patient cannot get pregnant any other way and proof from the doctors that it actually will work on the patient.  I worked with someone who got the insurance company to pay 10,000.00 of the 15,000 it cost in the 80's but if the couple wanted a second child they had to adopt or save up for it.  I know it costs a lot less nowadays, but still, I don't see any reason that you want insurance to pay for artificial insemination when there are people with insurance that can't afford the copay to buy their medicines that the insurance company helps cause to be so expensive based on their contracts with pharmacies to pay 25.00 for a 10.00 drug, and in the contract it stipulates the pharmacist cannot sell it for less to non insured patients.  Ask a walgreens or CVS pharmacist about that .

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odas
33 minutes ago, DieChecker said:

It's mostly greed I think. Greed from the insurance companies, so they cost so much. Greed from the healthcare employees who make twice, or three times, what a Canadian of the same profession makes. Greed of the drug, and supply, companies, which supply the hospitals and prescriptions. Greed of those who have complications and sue for a hundred times their real damages...

Greed.

I could support a single payer system, as it would remove almost all the incentive of greed, but I realize that the politicians (greed) arent going to let that happen. 

The best we can do, I think, is allow Medicare to include those who have no insurance, and can't afford it. No one will mind adding people who were previously outside the system. All the sacred cows will still remain.

Our Doctors in Canada make a minimum of 200K. I can olny dream about that and hope we never have to opt out of our current health care system. Not perfect but still awsome.

And, it makes me feel good that my money can help someone less fortunate.

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DieChecker
11 hours ago, Desertrat56 said:

There are doctors who only accept certain insurances.  And any doctor who bills a medicare patient can only bill for the 20% that Medicare does not pay and if the patient can't pay the amount gets written off.  If it is sent to a collection agency the patient still has processes in place to defray the costs if they are unable to pay.  And any doctor who bills a medicare patient over the allowed amount set by Medicare will be forced to write the amount and can get in trouble and loose all medicare patients. 

Usually before a procedure is done the doctor's staff verifies how much the patient's insurance will pay and lets the patient know how much they will be responsible for so that the patient can go elsewhere.  Often the private insurance companies will allow certain procedures and amounts on paper but refuse to pay them after the fact.  Major surgeries are required to have a pre authorization from the insurance company.  The stories you are telling have information missing or are misleading somehow.  The system we have is broken and needs to be fixed but it is the Private Insurers that have broken it, not the feds programs.

Thank you. You've explained it better then you previously did.

And it seems you are agreeing it does happen. If it is allowed under Medicare for All, why would doctors not attempt to get paid more?

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DieChecker
11 hours ago, Desertrat56 said:

The point is that if people can't afford it, they will not go to a doctor that works outside the system.  If a doctor "opts out" of single payer, who is going to go to them?  Only people who have a lot of  money, and even those people will not go to them if they have access to "free" healthcare.  Why would they?

Of course fertility treatments are not covered!  How stupid would that be?  I know insurance companies will pay for one artificial insemination after years of proof that the patient cannot get pregnant any other way and proof from the doctors that it actually will work on the patient.  I worked with someone who got the insurance company to pay 10,000.00 of the 15,000 it cost in the 80's but if the couple wanted a second child they had to adopt or save up for it.  I know it costs a lot less nowadays, but still, I don't see any reason that you want insurance to pay for artificial insemination when there are people with insurance that can't afford the copay to buy their medicines that the insurance company helps cause to be so expensive based on their contracts with pharmacies to pay 25.00 for a 10.00 drug, and in the contract it stipulates the pharmacist cannot sell it for less to non insured patients.  Ask a walgreens or CVS pharmacist about that .

Wasnt it you that said in some areas theres no other choice. Pepple will either go with the doctor that's there, and pay for it, or they'll have to drive 200 miles.

You're asking why would the insurance pay for fertility, when theres people with no medixation?

If a medical practice goes outside Medicare, the people will have to pay themselves, right? And they can charge what they want. Why would doctors want to take Medicare patients, when if they refuse them, and theres no choice, the patients are going to come to them anyway?

I realize that's a big gamble, but if, say, a medical union backed the idea...

Point being, just socializing insurance without socializing medicine, combined with US profitability expectations, is going to mean no one is happy.

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DieChecker
11 hours ago, odas said:

Our Doctors in Canada make a minimum of 200K. I can olny dream about that and hope we never have to opt out of our current health care system. Not perfect but still awsome.

And, it makes me feel good that my money can help someone less fortunate.

I'm glad you like it. I've heard good and bad.

https://en.m.wikipedia.org/wiki/Comparison_of_the_healthcare_systems_in_Canada_and_the_United_States#Wait_times

The one thing I've heard about Canada is wait times. Going to a specialist, bone, cancer, whatever... averages about 19 weeks, while it is 26 days in the US.

So there is some give and take. I'd not mind socialized insurance, but I already have great insurance, so it just doesnt impress me.

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and then
On 2/6/2020 at 12:18 PM, Tatetopa said:

If you don't have insurance, you have to come up with the $6k yourself.

Not exactly true for indigents.  ANYONE who shows up at an ER, by LAW, has to be seen.  That's one of the reasons care is so expensive.  Those who continually claim that illegals can't get services like healthcare or education are either ignorant or complicit.

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Setton
18 hours ago, DieChecker said:

Did you read what I quoted in my post? People unable to pay, on Medicare, are being billed by doctors right now. It happens. Not often, but I don't see why doctors, who had just had their practice destroyed, wouldn't opt for the way to get the most money

Some probably would. The majority, however, wouldn't be good enough to attract a sustainable number of patients. 

That's what we have here. Everyone has access to good healthcare for free at the point of access. Then there are some truly excellent doctors who take private patients. They usually also give a certain number of hours to the NHS to help in their specialisms. 

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aztek
19 hours ago, DieChecker said:

Why couldnt they opt out? They're not government workers! 

 

of course they could, and do,  really good doctors who have a month wait as a rule do not accept medicaid, or medicare

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Desertrat56
8 hours ago, DieChecker said:

Thank you. You've explained it better then you previously did.

And it seems you are agreeing it does happen. If it is allowed under Medicare for All, why would doctors not attempt to get paid more?

Because they would loose their ability to charge the feds for anything.  If they are found to consistently bill patients over what is allowed they loose that privileged of being a medicare provider.  And if it looks like some kind of fraud, which has happened, they loose their license to practice medicine.

If you were on a free plan, guaranteed to be free, and you got a bill would you pay it?  Most people would complain to the insurance carrier (the feds in this scenario). 

Edited by Desertrat56
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Desertrat56
8 hours ago, DieChecker said:

Wasnt it you that said in some areas theres no other choice. Pepple will either go with the doctor that's there, and pay for it, or they'll have to drive 200 miles.

You're asking why would the insurance pay for fertility, when theres people with no medixation?

If a medical practice goes outside Medicare, the people will have to pay themselves, right? And they can charge what they want. Why would doctors want to take Medicare patients, when if they refuse them, and theres no choice, the patients are going to come to them anyway?

I realize that's a big gamble, but if, say, a medical union backed the idea...

Point being, just socializing insurance without socializing medicine, combined with US profitability expectations, is going to mean no one is happy.

I know a lot of people who can't drive 200  miles and would choose not to go to a doctor.  I think you are twisting my meaning.  I was talking about currently there are already a lot of places in the U.S. that don't have doctors or don't have enough doctors and using the driving 200  miles as an example, not addressing whether people will go to a doctor or not.  If they have to pay and don't have the money they don't go.  What is so hard for you to understand about that?

And doctors don't bill people who can't pay.  They may try, but what's the point if the people can't pay.   I remember a conversation I overheard of my friend's mother talking to the cardiolgist in El Paso after she got home from the hospital.  She was on medicare and medicaid and still got a bill that happened to be the amount medicare said was over the limit of what could be charged.  She told them "I only have social security to live on and you think I am going to give you more money?  Medicare paid you, and that's what you agreed to accept."  That is the truth of it, contracts are signed by the doctors with Medicare that they will abide by the charges allowed and not charge medicare patients more than allowed.

And most doctors sign similar contracts with other private insurance companies.  Pharmacies sign contracts with insurance companies as well.  The pharmacy contracts are a little different.

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Doug1029

About health care:

Wednesday, February 26, 2020:  Hospital admissions have reached 80,000.  We might make it to 90,000 by the end of the week, but not the predicted 100,000.  Deaths are at 2700.

 

The disease has escaped containment in Italy, Japan and South Korea.  Containment is holding in Iraq, Iran and the USA.  Uncertain about other countries.

 

Rush Limbaugh claims Covid19 is no worse than the common cold and is nothing but a Democrat plot to bring down Trump.

The NYSE has fallen by 1900 points in the last week in response to worriers about Covid19.

Trump says that those infected in the US are getting better and that we have the situation well in hand; he has asked for $2 billion to fight the epidemic.

Trump complains that he wasn't asked for permission to bring infected patients from a cruise ship to the US.  There is nothing in the law that requires presidential permission.  The cruise ship patients are now in quarantine at the University of Nebraska.

 

Epidemiologists say it is a matter of days to weeks before Covid19 escapes confinement in the US.

Doug

 

Edited by Doug1029
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DieChecker
2 hours ago, Desertrat56 said:

 

If you were on a free plan, guaranteed to be free, and you got a bill would you pay it?  

I would if I had knowingly gone to that doctor and previously agreed to paying it. Same as with fertility treatments, or cosmetic surgery, that were elective. 

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Desertrat56
6 minutes ago, DieChecker said:

I would if I had knowingly gone to that doctor and previously agreed to paying it. Same as with fertility treatments, or cosmetic surgery, that were elective. 

Right, if you had KNOWINGLY agreed.  So you have been talking about oranges while everyone else has been talking about apples.  You never qualified your point with that before.  It makes a big difference in the conversation. 

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Tatetopa
10 hours ago, and then said:

Not exactly true for indigents.  ANYONE who shows up at an ER, by LAW, has to be seen.  That's one of the reasons care is so expensive.  Those who continually claim that illegals can't get services like healthcare or education are either ignorant or complicit.

Right you are. I don't think it was the case when I was a kid except in county hospitals , but I think it did change during Reagan's terms didn't it?

A visit to the ER is just the ticket for a gunshot wound, stab wound, or car wreck.   It is probably not so good for malnutrition,diabetes, hypertension, a tooth  abscess or any condition that need  more than one visit.

I guess I wasn't thinking about illegal aliens getting medical treatment or going to school, just American citizens on the low end of the income scale.  Especially children who don't get to choose their parents, but suffer with their parent's choices.

 

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DieChecker
1 minute ago, Desertrat56 said:

Right, if you had KNOWINGLY agreed.  So you have been talking about oranges while everyone else has been talking about apples.  You never qualified your point with that before.  It makes a big difference in the conversation. 

OMG... So you believe people will walk into private practices, accept healthcare, and have no idea it's not free? Why do you think I kept using fertility, and cosmetic surgery, as examples?

I'd agree if there is universal insurance and people go to see a doctor, and theres no mention of out of network, then it should be free. If it is For Profit, then it should say so immediately when you first consult with them.

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Setton
1 hour ago, Doug1029 said:

Trump says that those infected in the US are getting better and that we have the situation well in hand; he has asked for $2 billion to fight the epidemic

He also thinks Traumatic Brain Injury is a 'headache' and something you can lie to the public about. 

I wouldn't put too much weight on his medical credentials or honesty. 

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Desertrat56
8 minutes ago, DieChecker said:

OMG... So you believe people will walk into private practices, accept healthcare, and have no idea it's not free? Why do you think I kept using fertility, and cosmetic surgery, as examples?

I'd agree if there is universal insurance and people go to see a doctor, and theres no mention of out of network, then it should be free. If it is For Profit, then it should say so immediately when you first consult with them.

Like I said you are not talking about the same thing the rest of us are. 

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Doug1029
12 minutes ago, Setton said:

He also thinks Traumatic Brain Injury is a 'headache' and something you can lie to the public about. 

I wouldn't put too much weight on his medical credentials or honesty. 

I'm only reporting what he says.  One thing, though:  this type of advice in lieu of effective action will get people killed.  Same with Limbaugh's comments.

I hear the lawyers warming up in the wings.

Doug

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Setton
3 minutes ago, Doug1029 said:

I'm only reporting what he says.  

Oh, I know. Just thought it a good opportunity to highlight for anyone who might see your quote and take it at face value. 

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aztek
1 hour ago, DieChecker said:

OMG... So you believe people will walk into private practices, accept healthcare, and have no idea it's not free? Why do you think I kept using fertility, and cosmetic surgery, as examples?

I'd agree if there is universal insurance and people go to see a doctor, and theres no mention of out of network, then it should be free. If it is For Profit, then it should say so immediately when you first consult with them.

all doctors here are for profit,  even when they take medicaid,  but their office will never tell you complete price, they may tell you price on their procedure, but they also send samples to a lab, or give you a referral to imaging office, they may be out of network, they will bill you later, but your doctor office has no clue how much they charge, and what other doctor will review your test results, and whether or not those doctors are in network, cuz many offices do not want raw test result they want a report,  this will not change no matter who pays, private ins, or gvvmnt. 

all those promises of free healthcare are blatant lies  anyone who has a slightest idea what is involved , and half a brain to process it, knows it,  

Edited by aztek
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