OT: Preparing for National Health Plan

[OldLincoln]

With most sincere apologies to those who have inadequate or no insurance currently. Many of us are fortunate enough to have medical insurance such as Medicare. After hearing our President state that he intends the plan to save Medicare costs by providing good but less expensive care, I started musing what form that might take with regard to CPAP treatment.

My thought first focused on low-hanging-fruit like replacement supplies. It would be easy to extend replacement schedules and limit selections to lower tiered products. Then machine lease/purchase which could become a shared cost like some are now with a buy out provision at the end of 13 months giving you the choice of buying your machine or continuing rent payments to Medicare. Then of course raise the threshold for diagnosis of SA. Say from 5 AHI to 10. Also require home diagnosis and titration such as Kaiser does now where I live.

While I'm fortunate to already have the diagnosis and "paid off" my lease/purchase, I thought about the supplies I get and have decided to get all I can per the schedule and save them for the coming dark days. I'm reminded of my wife freaking over the new millennium buy buying case after case of water and stacking them in the garage. I hope my concerns are equally as foolish but I fear it won't be given the rob Peter to pay Paul mentality of the current administration.

I am in no way disparaging this administration. Their decision has been made to do the health care plan and I can't imagine the layers of details they have to work though to pull it off. While not what I might suggest, they have their work cut out for them. I only pray that whatever they come up with will provide health care to those without and fill in gaps otherwise.

[twokatmew]

Then of course raise the threshold for diagnosis of SA. Say from 5 AHI to 10.

It's one thing to promote cost sharing and decreasing the frequency of obtaining supplies. But ... to raise the threshold for a diagnosis and thus deny access to treatment at all? That's just penny-wise and pound foolish, not to mention diminishing the quality of life for those in that 5-10 AHI range.

[jdm2857]

The big savings should come by improving primary care, catching problems early when costs are lower and health benefits are greater and avoiding more expensive care for problems diagnosed later. And by getting primary care out of emergency care facilities. The cost savings by providing one mask per year instead of two is bupkes in the big picture.

[6PtStar]

Could it be that I am just to old and already have to many things wrong with me to have all those expensive things done to me to keep me alive. I have just not learned that I need to go on and die so there will be enough money for those that are not as wore out as I am can get the care they need to go on being productive!! One way to save money.

Jerry

[Goofproof]

It all comes down to one thing, expect the government to take care of you, or expect to be responsible for your own path in life, and make your own way in life.

The second way isn't easy, it requires work and making hard choices, even a little of doing without. Let the Jones go their way, we all don't have to keep up with them, we only need to take care of our families, of which we should control when and the conditions of when we want to start one. Jim

[jdm2857]

Jim --

That sounds really good. Until you look at the specifics.

Most people can't even think about paying the ripoff rates the medical establishment charges those without insurance. And even insurance costs are going up 25 to 30% per year. And then the policies are written in such a way, and the companies operate in such a way that one never knows what a service is going to cost until after it is rendered.

So unless you make a very, very good salary, or work for one of the dwindling number of companies that provide good insurance plans, your wonderful suggestion doesn't really fly.

[OldLincoln]

I worked for 24 years in the Ma Bell system and am absolutely blessed by a wonderful medical plan in retirement. However, I took an early retirement to avoid relocating when my headquarters moved to Sacramento. My last job offered medical which I didn't take and when the economy forced them to downsize by 50% I saw the impact on other layoffs with families.

I recall the trips to emergency with our son in the middle of the night when he was gasping for air and shuddered at the thought of what would I do without my insurance. My adult son works for a small business and has 3 children. We know of all the times he has made the emergency run and the threat is very real if his company should shut down. You can cut back in a lot of areas like home hair cuts and generic foods, etc., but all those savings won't equal just one visit to ER.

When facing this kind of situation, I cannot be totally against some kind of solution, I just strongly disagree with the direction this one is heading.

[Goofproof]

Jim --

That sounds really good. Until you look at the specifics.

Most people can't even think about paying the ripoff rates the medical establishment charges those without insurance. And even insurance costs are going up 25 to 30% per year. And then the policies are written in such a way, and the companies operate in such a way that one never knows what a service is going to cost until after it is rendered.

So unless you make a very, very good salary, or work for one of the dwindling number of companies that provide good insurance plans, your wonderful suggestion doesn't really fly.

I made my job choices based on good insurance, we took less pay and retirement benefits, to secure better health care. My job choices led to more health damage than if I had taken other paths, for my family I had to go that route. I guess that's why I drive 30 year old cars, but have good health care. Many times our problems are the result of making poor choices all through life.

Maybe we could have paid more attention in school, had less fun out of life, took easier ways out to earn a living. Maybe not wasted our money on things that weren't important. The Ant and the Grasshopper Story comes into mind. I never cared if the Jones House was Bigger and his cars newer, mine are paid for, or I walked..... Jim

[SaltLakeJan]

Old Lincoln

I get nervous when I think about pending health care changes . . I joined the Medicare ranks last December. I was not pleased that I had to pay more for medical tests and drugs than I did under my previous health insurance. I do have a supplemental policy, but the medicare restrictions apply to what my other ins. will pay.

I worked for a University and had a good health plan. They paid 25% of all of all prescription drugs. As soon as Medicare started Part D, the University dropped that portion of their coverage for retirees. Drugs cost me about 35% more on Part D, than what I paid under the University plan.

Does that follow that asa there is a Govt sponsored health plan, that employeers will drop their employee retiree health plans . . . My experience is that they will, and we will be stuck with even more restrictions and cost increases.

Jan

[roster]

........Most people can't even think about paying the ripoff rates the medical establishment charges those without insurance. .....

Where do you get this idea? The medical practices I deal with have lower rates for those without insurance.

I had a follow-up colonoscopy this year and despite having insurance, I paid cash because it was considerably less than my deductibles and much less than what the insurance company and I would have paid together.

All you have to do is ask, "What is the rate without insurance?"

[jdm2857]

My experience has been just the opposite. Once, a national lab chain billed me instead of my insurance company. They wanted $440. When it was finally settled the insurance company paid $120 for the tests. And the insurance companies in NJ have negotiated rates with hospitals that are way lower than the rates they charge individuals.

You may have found a sympathetic doctor who gives a break to the uninsured but the system is rigged against anyone without insurance.

[roster]

My experience has been just the opposite. Once, a national lab chain billed me instead of my insurance company. They wanted $440. When it was finally settled the insurance company paid $120 for the tests. .......

I will bet that they were billing you the rate for the insurance company. You have to ask for the no-insurance rate up front.

These companies are used to billing high to the insurance companies then receiving the much lower insurance company negotiated rate in payment and writing off the difference.

I just saw a poster here say his insurance company was billed $3100 by the DME for a vanilla CPAP machine. I guarantee you the insurance company did not pay that much.

[jdm2857]

When I was pricing sleep studies (I was uninsured at the time) four hospitals quoted me rates from $3000 to $5000. All understood that I was going to pay out of pocket. I was unemployed at the time. The only alternative that they could suggest was NJ's charity care program. But since that program counts retirement funds as assets, I would have to liquidate my entire 401K to qualify.

One sleep doc did say he would cut his visit fee to $75, which was very nice. But the hospitals wanted their fee or no service.

I can't believe that the insurance companies pay those rates.

[PST]

When I was pricing sleep studies (I was uninsured at the time) four hospitals quoted me rates from $3000 to $5000. All understood that I was going to pay out of pocket. I was unemployed at the time. The only alternative that they could suggest was NJ's charity care program. But since that program counts retirement funds as assets, I would have to liquidate my entire 401K to qualify.

One sleep doc did say he would cut his visit fee to $75, which was very nice. But the hospitals wanted their fee or no service.

I can't believe that the insurance companies pay those rates.

No, they don't. They negotiate discounts. Hospitals and other providers compete for their business. They bring volume, and they pay more quickly and reliably than self-payers, on average. I'm looking at the bill for my sleep study. It was a split study, with diagnosis and titration studies on the same night (which is pretty common). The bill is $2,370, the discount is $1,285, leaving a net fee of $1,085 (still nothing to sneeze at). I paid $10 and the insurance company paid $1,075.

One of the many things that is broken about the current system, in my humble opinion, is that anyone without insurance is charged so much more than the big insurance companies (including Medicare, Medicaid, Tricare, and other exisiting government program).

[Julie]

I'm not sure how anything I say will be received, as I'm not in the U.S. but Canada, but I must say that just listening to all those stories reminds me again of how awful, how barbaric in a way it must be to live like that, afraid to be sick, not knowing if you'll be on the street one day because you can't pay the fees to keep yourself alive (who the heck do you think you are anyway wanting to live?) and always having to compare notes on different companies and treatment, etc., trying to finagle some way of coming out in one piece.

It's been so long for us here (50 yrs) that we've forgotten what it meant to pay for medical care. Maybe there are times we have to wait longer than some of you for certain things, but at least we do get them, and pay nothing. And one thing made me crazy on TV this week - I think it may have been a political ad showing a supposed Canadian saying our gov't decides how long people live... SO NOT TRUE!! If there is any question at any time regarding using heroic treatment in a certain instance, possibly with regard to a patient so old physically that the treatment would simply be ineffective, then the doctors and family get together (and the patient, of course, if they're capable) and come to whatever the best resolution is for the patient's welfare.

I've worked in big hospitals here all my life and watched doctors struggle with such decisions, but only from the point of view of what's best for the patient, and never, ever does money come into it, and NEVER, EVER does the government have anything whatsoever to do with it (they're completely unaware - never have had a thing to say regarding anyone's treatment for any reason). The only conflict I've ever seen (and I've been privy to plenty in all kinds of situations) between anyone is between doctors who have different 'takes' on the best way to go for given patients, as do any doctors all over the world. Our 'medicare' is administered by each province, who set out parameters in terms of how much money is available and then issue codes for every conceivable service that can be rendered, and the doctors just fill in the codes and send in their 'bills' monthly for reimbursement. And no services are turned down, except possibly in the case of something which has somehow not made it onto the forms (possibly being new) then there can be some discussion about it, but the services have already BEEN given to the patients, so if there's a question of money being available or not, then the hospitals, or possibly even the doctors will be 'shorted', but that's all!

There are a few guidelines regarding experimental services and/or 'catastrophic' medication, and those can create dissension, but each one is addressed individually, and one way or another gets dealt with. Yes, there are a very few and far between things (like those) that can fall through the cracks until resolved, and there are wealthy people who may choose to get certain procedures carried out either by a very few private clinics (and those are being looked at for suitability within the system), or even in the U.S., but the vast majority of us receive perfectly good and very up-to-date treatment 24/7/365 without any of it ever being questioned or any of us ever being untreated because of money (I also include insurance in there of course).