OT: Health Care Hell

[Ralph]

My wife recently had a total knee replacement. And I'm not suggesting it's anything like a frozen shoulder treatment. But am just offering some info how our Medicare system treated us. We have a Medicare Advantage Plan from United Healthcare. A Dow Jones Industrial stock that makes billions of dollars each quarter profit. And it wraps around regular Medicare and is also a supplement including Schedule D (drugs). And we pay a good bit for this.

As I drove out of the parking lot with my wife....got a call from in house PT to schedule first visit. Had two weeks of that, incision inspection, staples out, etc. No co payment as I recall. Then she began out patient PT at a PT facility for about 4 weeks, and then then 4 more as ordered by her surgeon. $20 co payment for each outpatient PT facility visit. I am also under the impression she could have received as many PT facility visits as the Doctor ordered....maybe at some point would have required a Medicare review.

Just mentioned this as a report on how excellent out Medicare system is for us old folks (thanks current workers)....and you younger folks would be fortunate to have this as an option. it also includes a program called Silver Sneakers…which is accepted at out local Planet Fitness Gym, so we go free, and can use all the equipment any time we wish. Maybe your wife could find a local gym where they have the equipment to duplicate the work done by the PT.

[dgauthier]

Originally Posted by mdeth1313

(...) I'm ready to vote for anyone who wants to get rid of for-profit health insurance.

Sorry to hear about your wife. As far as your vote is concerned: you nailed it.

I was born in Canada, and now live in the U.S. I can tell you this: the Health Insurance industry in the U.S. must be killed. Your Health Care industry is fine, it's the Health Insurance s.o.b's that trade human life for money that have to go.

Medicare for all rules. It's so good if you don't implement it here, it will be the deciding factor that sends me back to Canada when I retire.

Try it, you'll like it. You want it? Vote!

[buddybikes]

My wife is about to enter Medicare and scares crap out of us with confusion supplements.

Can't their be a simple - I want a platinum plan and will pay x surcharge.

When I reach there is will be a total minefield. Type1 diabetes on insulin pump, bg sensor that auto corrects my bg, plus plethora of meds.

[soulspinner]

Went through something like this after hip surgery. Called the responsible parties after missing 2 doc follow ups and lawyered up. The threat got my coverage back after several weeks without.....in 2 days.

[DaveS]

Originally Posted by Mr. Pink

Are there certain treatments that require another human to manipulate you?.

Yes, you hit the nail on the head - there are certain treatments that you can’t perform yourself and where the “fix” isn’t just a progression through strengthening, proprioception, and ROM exercises. A few examples include frozen shoulder, removing adhesions (e.g from an Achilles rupture repair...which I’m living through now!), oncology-related things like a Axillary web syndrome, etc.

PT has changed a lot over the last decade or two.

I will admit, that as soon as I get to the exercise progression portion of PT I start doing it myself at home, but there is significant value to the other treatment modalities that require an expert (IMHO)



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[sitzmark]

Originally Posted by steveandbarb1

I got 60 visits with my former insurance (BCBS MA) and now changed insurances so will see how it goes. I need lot manual manipulation due to my back surgeries.

Was my wife’s experience with the BCBS MA plan we have as well. Broken shoulder (humerus separated at surgical neck) from a bike fall. Basically broke the “ball” off the end of her arm bone - - collision with an unleashed dog.

BCBS covered 2x/week PT from Sept - April when Ortho surgeon concluded further PT would not yield greater benefit. Ending range of motion is 95%. We paid $20 copays. There are different BCBS plan options. Ours has some perks for staying in network, but does allow choice for any properly licensed medical provider - an advanced PPO program. Her Ortho and PT were not in network providers.

Similarly, when I tore my Achilles my PT (2x/wk) was progress dependent, which concluded with 90+% ROM.

Before getting too far into any legal expenses, the OP should confirm the coverages outlined in the BCBS plan subscribed to.

[oldpotatoe]

Originally Posted by HenryA

Nope, Medicare is just as f'd. I get enough paperwork from a simple doc visit that may cost as much as the benefit provided. But I do think that the health care insurance industry is a huge scam.

Disagree....been on Medicare for 4 years, wife too. Numerous eye surgeries(cataracts), sinus surgeries, 2 ER visits for me(a PE and AFIB), back ablation for wife..ALL were not only seamless with regards to Medicare but ALL resulted in statements, where at the bottom,
"what you Owe"..being zero.
ONLY hiccup was getting a shingles shot series..medicare doesn't cover that for free..

My Medicare coverage was as seamless as my coverage when on Tricare(retired USN) and nearly as seamless as when I was active duty..

What 'costs as much'..to you?

[mj_michigan]

I think that BCBS of Michigan (my insurer) is non-profit. They are just OK, not great, but I am not sure how much better things could get with a (governmental) single payer Obviously, it could be cheeper if the government subsidizes it. I believe that, currently, privately insured patients subsidize Medicare ones -- that is, between me and my insurer, we pay more for the same service than a Medicare patient.

In the single-payer system in my native country, medical care is not denied, it is rationed through long waiting lines. Hence, many people who can afford it go to a parallel cash-only private network of doctors and clinics. I assume this is how the future would look like here, if a single-payer system is implemented.

[oldpotatoe]

Originally Posted by mj_michigan

I think that BCBS of Michigan (my insurer) is non-profit. They are just OK, not great, but I am not sure how much better things could get with a (governmental) single payer Obviously, it could be cheeper if the government subsidizes it. I believe that, currently, privately insured patients subsidize Medicare ones -- that is, between me and my insurer, we pay more for the same service than a Medicare patient.

In the single-payer system in my native country, medical care is not denied, it is rationed through long waiting lines. Hence, many people who can afford it go to a parallel cash-only private network of doctors and clinics. I assume this is how the future would look like here, if a single-payer system is implemented.

"Non Profit", 'Not for Profit'..may be BUT the money spent isn't consistent with actual costs.

I spent 5 days in the hospital after getting smacked by a car...After the initial ER, back stabilized with a back brace..next 4.5 days was just observation..NO procedures other than trips to radiology...

I got to see the bill..5 days, $60,000...ER visit alone...about 45 minutes, $15,000 of that.

I had an MRI about 4 years prior to that for my shoulder..a mistake(didn't see that it was ordered by a MD)..I got the bill..$5500....30 minutes in the MRI and the MRI machine was busy everyday, all day...

ONLY way for single payer to happen is a tax increase. EVEN IF, the total money spent per year would be LESS, with 'medicare for all'...the TEA partiers would howl, wince and whine.

[sitzmark]

There are issues with healthcare for sure. The answers are not simple - especially with diametrically opposing forces working against each other.

We were in Vancouver late last year for the Whistler fondo. While waiting to pick up the key for our condo, a man sauntered out of his condo to smoke a cigarette on the street. Don't recall how, but we ended up taking about healthcare when he found out were were from the States. Rather than unleash on him, my sister-in-law who is a primary care physician in WA walked away. She has a couple of CA patients who see her across the boarder.

SIL hates her job and is preparing to retire early. The sooner the better - she's had enough. She's the #1 ranked physical in her group practice based on customer surveys. The group practice has operated in a couple different iterations over the past 10 years ... now part of Kaiser. For the last 10 years she's suffered continuous reprimands from the management team for spending more than the allotted 15 minutes with a patient. Her position is that she will spend whatever is the appropriate amount of time for the medical condition presented. She spends long hours after clinic closing to research patient issues, validate course of care, and complete paperwork. She's considered private practice, but billing/compensation nightmares and malpractice insurance makes the effort and personal financial risk not worth the return. Net income she'd do better in a job that has far less responsibility and stress.

A couple of other physicians in the group were known to step in with patients for a brief consultation, prescribe medication and call it a day. Eventually those physicians were released from employment with the clinic. Some of these patients were reassigned to my SIL when the physicians departed. She refused to continue prescribing unwarranted medication - especially pain medication - which resulted in some very unpleasant interactions with patients.

A lot of medical professionals are no more pleased with the "system" than the general public. Lots of abuse of the system, by everyone, everywhere you look. Costs are out of control and efforts to control it have negative consequences for someone. Politicians and political "tribes" talking past one another are not going to solve the problem(s).

[Ralph]

I'm generally against our Government doing more than it needs to do but....

in 2019....United Healthcare (one of the Dow stocks) had revenues of $242 billion. it also had pretax profit of $18 billion. A 7.5% profit margin (before taxes).

I also think Medicare is run just as efficiently, or more so, than United Healthcare. And Medicare would know how to put to good use that $18 billion in profit with patients....instead of paying it out to us investors.

That's mainly why I'm in favor of offering a Medicare option to younger worker. It could be priced properly as to risk (more than the subsidized amount the over 65 crowd pays), and it still could be cheaper than their "for profit" or "not for profit" (after building all those new fancy hospitals on big campuses) hospitals without raising taxes to every tax payer.

Switching everyone to a Medicare type single payer health plan for all Americans would require a substantial change in our tax code....elimination of most health care deductions etc.....something maybe hard to get passed. But offering Medicare (by another name probably) as an option to younger workers at a 7-8% savings (United healthcare profit margin) over "for profit" Health insurance options is doable without much or any tax code change.

[mj_michigan]

Originally Posted by oldpotatoe

ONLY way for single payer to happen is a tax increase. EVEN IF, the total money spent per year would be LESS, with 'medicare for all'...the TEA partiers would howl, wince and whine.

I agree with all these points. My only point above was that, if medicare-for-all passes, middle class and above taxpayers should expect to pay higher taxes, get less effective coverage, and have to pay for some services outside of the system.

[unterhausen]

our employer switched to a narrow network and increased the cost, so I'm not sure that medicare is any worse than that. Narrow networks are a real headache and should be significantly cheaper than a broad network Turned out okay for us, because our family doc is still seeing us -- for now. The change led him to sell his practice. You can see signs the system is crumbling and that was only delayed a bit by the ACA. Pennsylvania only expanded medicaid fairly recently, and the delay did a lot of damage to rural hospitals.

[zap]

Originally Posted by thwart

That says a lot right there... of course the military likely doesn't have the cost constraints that any single payer plan (a la Medicare) would have to include to avoid blowing up the national budget. But still... there's gotta be a better way.

Good buddy up in D.C. has tricare...military. According to my buddy nobody decent accepts tricare so he is on his wife's private insurance plan and uses that.

[2LeftCleats]

Don't believe it's true that it will be more costly--as a nation--to have Medicare for all. True, taxes would increase, but other out of pocket expenses would go down: medical insurance deduction from paychecks, deductibles, copays. In the end, I think it may be a wash, and without the infrastructural costs of for-profit companies, it could be cheaper.

Offering a public option, such as Medicare, is fraught with challenges. It seems sensible on the surface, and the thinking goes that such a program would shine above the rest, people would eventually flock to it and the for profit industry would die a slow death. This underestimates the deviousness of that industry. The so-called cherry picking and lemon dropping that occurs now, would accelerate and the public option would end up with the unhealthiest population. Costs would be concentrated in that segment and it would implode, giving the insurance companies the ability to argue that government-run care is too costly. Then the whole concept would be taken off the table for yet another generation. To guard against such mischief would require an expensive bureaucracy to prevent cheating and undermining the system.

Obviously, a big change to Medicare for All would be seismic and cause lots of turmoil initially, including displacement of insurance industry workers. Perhaps we should consider a gradual phasing in. Start by adding those currently in the Marketplace plans or uninsured. Consider adding Medicaid and take that expense off state budgets, so they could use the money for, say, education. Gradually lower the age from 65. These proposals also come with potential problems, but our current healthcare system, while working well for some, is expensive and bloated and unsustainable.

The other issue is cost control. Simply changing to a different payment system won't necessarily cause care to be cheaper. There's lots of unneeded care and a centralized system would make it easier to manage data, find trends, move money to things most pressing, and eliminate practices that aren't helpful or harmful.