[Butterfly201]

Originally Posted by dbussone

Now CF raises another very appropriate issue. The government (Feds and States) establish the rules for the Medicaid program. These include drugs, procedures, hospitalizations, and other regulations for care that are, and are NOT, covered. For example, my wife takes 2 expensive drugs for a chronic condition. Medicare partially pays for them. Medicaid would pay nothing for them.

We are fortunate that her out of pocket drug expense is limited by Medicare to approx $8000 per year. The two drugs retail for more than $76,000 per year. (That is 76 followed by 000.) Were she on Medicaid she would be responsible for the full cost - because neither drug is covered by Medicaid. Luckily there are some private programs that assist those who use expensive "orphan drugs."

My point is that docs and hospitals may not be the bad guys you think they are. Frequently their hands are tied by government regulations.

The important takeaway here is doctors and hospitals are bound by government and insurance. And as patients under Medicare or insurance plans so are we. Therefore if a doctor wants to give you a drug or procedure---insurance or Medicare has to approve it.
That simple. And THAT WRONG. Why this can't be changed I don't understand. And forget Obamacare-- it simply doesn't work and only incurs more problems and expenses on us all.
Even if we are not covered, we will end up paying in the long run.

[tuccillo]

I can't speak for Medicare but my premiums have increased 13% per year for the last 3 years for essentially the same plan. This is obviously not a sustainable trajectory.

Originally Posted by jblum315

My Medicare supplement payment jumped from $207 to $302. Whoa!

[KeepingItReal]

Originally Posted by CFrance

KeepingItReal, they are denying some forms of treatment that others not on Medicaid receive. Here is one example for Hep C drugs. Might be considered substandard care? I haven't read further about it; just offering it as a possibility.
"Medicaid Denial for Hep C Drugs Nearing 50% in Some States"

Medscape: Medscape Access

Link requires a password?

Originally Posted by dbussone

It is well documented, and has been for years, that Medicaid recipients do not receive the same level/quality of care as those having insurance and Medicare. The reasons would fill a week long seminar, but include:
1) a very few hospitals do not accept Medicaid
2) some physicians do not accept Medicaid
3) Medicaid is primarily a program for the poor:
a) the poor may have difficulty getting transportation to appointments
b) the poor may not have the ability to receive post procedural care from family members or
Their social network.
c) etc, etc, etc
4) many Medicaid plans require a minimal co-payment ($1-2)
5) many recipients prefer to use a hospital ER for their care since hospitals
MUST treat virtually any patient that shows up at its door. And ERs are open
24/7.
6) hospitals and physicians can wait for 6+ months to be paid
7) when a state believes it has paid enough for its Medicaid program in a year,
It simply stops paying. But the providers must continue caring for the patients.
8) Medicaid programs typically pay far less for care than it costs a physician or hospital
To provide it
6) etc, etc, etc

Your premises are not necessarily accurate and imply a negative connotation, while simplistically understating the issue. I worked in healthcare, hospitals specifically, for decades. 8 of those years were as CEO of a 3 hospital system which included the largest hospital in the state of Mississippi. We provided many services not available anywhere else in the state, and lost 10s of millions of dollars taking care of Medicaid patients. We didn't turn a patient away if they were in an emergent or urgent situation, or if we were the only system that could provide that service. We had transfer agreements with every other hospital in the state to be sure no patient was ever denied care.

And most other hospitals act the same way. I'll let GE discuss physicians in greater detail if he wishes.

So do Medicare patients also receive sub standard care compared to those paying with private insurance since Medicare pays less than insurance?

So why does anyone need Medicaid since they can get a subsidy through the ACA?

Why are we still spending hundreds of millions of tax money on Planned Parenthood and other women's medical clinics when everyone is supposed to have their own insurance through ACA ?

[KeepingItReal]

Originally Posted by dbussone

Your premises are not necessarily accurate and imply a negative connotation, while simplistically understating the issue. I worked in healthcare, hospitals specifically, for decades. 8 of those years were as CEO of a 3 hospital system which included the largest hospital in the state of Mississippi. We provided many services not available anywhere else in the state, and lost 10s of millions of dollars taking care of Medicaid patients. We didn't turn a patient away if they were in an emergent or urgent situation, or if we were the only system that could provide that service. We had transfer agreements with every other hospital in the state to be sure no patient was ever denied care.

And most other hospitals act the same way. I'll let GE discuss physicians in greater detail if he wishes.

Premises are totally accurate and the issue is not as complicated as it is usually made out to be.

So we know many and likely most or all procedures, services, and meds are priced out at many times their actual value to cover services provided to those that do not pay by those that do pay.

If hospitals can turn these people away to some other hospital why would they still need to charge the inflated costs ?

A recent ER visit at VRH of about 4 hours for my wife's kidney stone came to over $12,000.00. Over $5K was for a single MRI. Our insurance repriced it all and excluded some bogus claims that were thrown in and we ended up paying less than $1,200.00 total to settle it since we had not met our deductible. Are we saying the hospital lost nearly $11,000.00 on a United Health Care claim? Is the hospital saying they really provided $12,000.00 in services?

Why is this any different for the hospital than being reimbursed only $1,200.00 by Medicaid on a $!2,000.00 claim?

Does the hospital get to show they lost the other $11,000.00 because the patient was on Medicaid? If they are losing so many millions how are they still in business?

[golfing eagles]

Originally Posted by KeepingItReal

Link requires a password?




So do Medicare patients also receive sub standard care compared to those paying with private insurance since Medicare pays less than insurance?

So why does anyone need Medicaid since they can get a subsidy through the ACA?

Why are we still spending hundreds of millions of tax money on Planned Parenthood and other women's medical clinics when everyone is supposed to have their own insurance through ACA ?

I'll try to address this, although I can see where may be a reality gap to bridge. I don't know any physician who delivers "substandard" care on the basis of insurance or lack thereof. I really should have stated that the Medicaid SYSTEM is substandard. Unlike hospital ERs, physicians do not have to accept any insurance they choose not to, or for that matter, any patient they don't want, as long as it is not based on race/religion etc. In New York, there are very few private practices that accept Medicaid, and many now will not accept the combination of Medicare/Medicaid. This is simply a matter of economics. Let's say, for example, a 6 person internal medicine group in NY has office overhead of $3.4 million/year, which is reduced to 1.8 million by receipts from office labs and employed nurse practitioners,
and each physician has about 30 hours / week of office hours providing direct patient care, 48 weeks/year. This results in $208/ hour in overhead, or $52 for each 15 minute appointment. Since Medicaid pays $28 for that visit, no physician can afford any part of taking Medicaid patients. As a result, these patients are forced to go to Medicaid clinics and ERs (BTW, NY will pay a Medicaid clinic $134 for a 2 minute visit with a nurse to explain birth control pills). These clinics do the best they can, but are overwhelmed by sheer numbers. Also, the Medicaid population as a whole, are extremely unreliable, fail to show up to approx. 75% of appointments, and are generally non-compliant as well. I once calculated that NY could just buy super blue 0 deductible, 0 copay insurance for those who qualify for Medicaid and save 55% of their multi-billion expenditures---that's the effect bureaucracy has on your tax dollar.
Here in Florida, physicians in affluent areas such as Palm Beach and Naples have dropped out of MEDICARE --seniors are seen on a cash only basis. If you do not participate in Medicare, you are not bound by their rules or ridiculous paperwork
And lastly, Medicare does not really pay much less than private insurance, they all key off the Medicare rates for each CPT code. But they do require more paperwork which is a back end cost

Hope this helps you understand a bit

[dbussone]

Originally Posted by KeepingItReal

Premises are totally accurate and the issue is not as complicated as it is usually made out to be.

So we know many and likely most or all procedures, services, and meds are priced out at many times their actual value to cover services provided to those that do not pay by those that do pay.

If hospitals can turn these people away to some other hospital why would they still need to charge the inflated costs ?

A recent ER visit at VRH of about 4 hours for my wife's kidney stone came to over $12,000.00. Over $5K was for a single MRI. Our insurance repriced it all and excluded some bogus claims that were thrown in and we ended up paying less than $1,200.00 total to settle it since we had not met our deductible. Are we saying the hospital lost nearly $11,000.00 on a United Health Care claim? Is the hospital saying they really provided $12,000.00 in services?

Why is this any different for the hospital than being reimbursed only $1,200.00 by Medicaid on a $!2,000.00 claim?

Does the hospital get to show they lost the other $11,000.00 because the patient was on Medicaid? If they are losing so many millions how are they still in business?

Another seminar is needed, and your premise is still inaccurate. If I wrote a tome here about hospital pricing you most likely still wouldn't make sense of it - because the pricing system does not make sense, and hasn't since the 90's. In the '70's and 80's hospitals began increasing prices for several reasons: one was to help pay for patients who couldn't or wouldn't pay for their care. Another was for negotiation with payers.

This largely resulted from the creation of Medicare in in the late '60's. As we all know Medicare is a federal program and, from it's beginning, intended to pay only for the cost of care. Medicare has morphed numerous times over the years, but holds the upper hand because they don't negotiate over price - you take it or you leave it.

Then Medicaid came along and their model was to pay less than costs. So hospitals began increasing their retail price lists to have some more leverage over insurance companies when payment negotiations took place. Insurers gained more leverage over time and now pretty much tell hospitals what they will pay - take it or leave it.

So now hospitals have a retail price list that is unrelated to any payment or cost model. It would be like Chevrolet putting a $100k price on the sticker of a Nova, knowing customers will negotiate the price down to $20k, or be told by fleet buyers that they will only pay $15k for a Nova - take it or leave it.

[outlaw]

And a perspective from the street: All you can eat buffets used to be a good deal....until people started to abuse them, and tried to eat two meals worth of food. Now, buffets are overpriced for a "normal" appetite. Health care has the same problem. Everyone knows the person that has had one or two knee surgeries so that they could keep playing golf or tennis or pickleball. I was told by my orthopedic surgeon that I needed surgery on both knees. This was two or three years ago. Instead, I laid off activities that hurt my knees. Now I am probably 95% healed and I have resumed all my activities. I know smokers who have had a couple of bypasses. Still smoking; never exercising. Unless one has serious skin in the game ($$$$), healthcare will continue to be abused in this country. Try getting a knee replacement so you can continue playing your favorite sport in Canada or England. They'll see you in two years...maybe.

[dbussone]

Originally Posted by outlaw

And a perspective from the street: All you can eat buffets used to be a good deal....until people started to abuse them, and tried to eat two meals worth of food. Now, buffets are overpriced for a "normal" appetite. Health care has the same problem. Everyone knows the person that has had one or two knee surgeries so that they could keep playing golf or tennis or pickleball. I was told by my orthopedic surgeon that I needed surgery on both knees. This was two or three years ago. Instead, I laid off activities that hurt my knees. Now I am probably 95% healed and I have resumed all my activities. I know smokers who have had a couple of bypasses. Still smoking; never exercising. Unless one has serious skin in the game ($$$$), healthcare will continue to be abused in this country. Try getting a knee replacement so you can continue playing your favorite sport in Canada or England. They'll see you in two years...maybe.

Well said.

[golfing eagles]

Originally Posted by outlaw

And a perspective from the street: All you can eat buffets used to be a good deal....until people started to abuse them, and tried to eat two meals worth of food. Now, buffets are overpriced for a "normal" appetite. Health care has the same problem. Everyone knows the person that has had one or two knee surgeries so that they could keep playing golf or tennis or pickleball. I was told by my orthopedic surgeon that I needed surgery on both knees. This was two or three years ago. Instead, I laid off activities that hurt my knees. Now I am probably 95% healed and I have resumed all my activities. I know smokers who have had a couple of bypasses. Still smoking; never exercising. Unless one has serious skin in the game ($$$$), healthcare will continue to be abused in this country. Try getting a knee replacement so you can continue playing your favorite sport in Canada or England. They'll see you in two years...maybe.

And this is part of the problem with healthcare in America and why European style socialized medicine would not work here. We are used to 24 hr instant service, get whatever you want whenever you want internet shopping, and abhor lines and waits. This promotes both increased cost and fraud. Note again that foreign citizens that can afford it come here for healthcare, Americans don't go to Luxembourg. And yes, there are some morons who go to Thailand for plastic surgery, you can generally recognize them by some degree of disfigurement

[champion6]

Originally Posted by jblum315

My Medicare supplement payment jumped from $207 to $302. Whoa!

Let's get back on topic ... My Medicare supplement - AARP Supplemental Plan F - went from $173 to $175.

[golfing eagles]

Originally Posted by champion6

Let's get back on topic ... My Medicare supplement - AARP Supplemental Plan F - went from $173 to $175.

same for my wife

[Fredster]

My Mutual of Omaha plan F supplement went up about $157 to $169/month, but part was because of my age!
I had both my knees replaced, because of pain and discomfort, went as long as I could, had to give up long walks. Had the surgeries about 6 years apart. I really don't know of anyone that went through the procedures for convenience.

[debow]

Seriously. No one goes thru knee replacement for the convience of wanting to play golf. I Have had both knees replaced due to severe discomfort. Bone on bone is unbelievable pain.

[Fredster]

[QUOTE=debow;1165844]Seriously. No one goes thru knee replacement for the convience of wanting to play golf. I Have had both knees replaced due to severe discomfort. Bone on bone is unbelievable pain.[/QUOTE

Yes it is, even at night, and thank God for TKR surgery!

[jblum315]

Originally Posted by dbussone

Whose supplement do you have?

It is AARP Medicare Supplement Plan F. I've had the same plan for at least 10 years. It went up a few dollars but never like this