That's bc the cost of living in VA is much higher than in central FL. The rate of reimbursement in PPOs even varies between the central business district of a large city (where the rent is high and you have to pay staff more) and the distant suburbs of that same city.

So what's your solution?

And why is it so difficult for you to spell the word government?

The solution is the same one that was working pretty well 30 years ago when a doctor's visit was $15 and if you had insurance to pay for it, you had to file for it.

In other words, CAPITALISM.

The solution is for Americans to wake up from their fantasy that "free stuff" exists, that gooberment is the solution to every problem, and that the gooberment's money comes from somewhere other than their own pocket. It would also be a big help if people weren't so stupid as to believe that insurance can possibly work to pay for every day expenses rather than catastrophes.

On the day that stupid people quit being stupid, here's how I would unwind the current farce.

1. Add the cost of employer medical benefits to employee income and tax it at the same rate, to end the idiotic link between employment and insurance that the gooberment created.

2. Outlaw as insurance fraud the scam of selling insurance policies for ordinary, everyday expenses, such as doctor visits, car repairs, roof replacements, and groceries.

3. Make it illegal for a practitioner of any sort to deal directly with an insurance company. Require the insured to file their claims AND PAY THE BILLS, to restore their interest in containing the costs.

3. Disband the doctor's union (AMA) to defeat their primary purpose, which is to limit the number of practitioners (the same as any union). Or at least, forbid them from engaging in that practice. Create a federal agency to monitor and publish the complaints and outcomes, to enable the market to remove incompetent doctors.

4. Require all medical facilities and practitioners to publish a complete list of their rates and fees, easily accessible to all patients.

5. Prohibit lawyers from advertising. Pass meaningful tort reform that limits punitive damages and requires plaintiff to pay the cost of frivolous claims.

6. Overhaul the Patent Office. Restore patents to 7 years, as originally intended, and prevent it from allowing patents on new uses for an old drug, or other such ruses for artificially increasing the monopoly period for new discoveries.

7. Overhaul the FDA. Eliminate the FDA's ability to ban anything. It should merely test and publish results, and should be required to complete that testing within one year. Prescriptions should be advisory, not mandatory, as they are in most other countries. You should not need buy a doctor's permission every 6 months for your asthma medicine.

9. End Obamacare, Medicare, and Medicaid. Pay back with interest the money that was confiscated from retirees for Medicare over their working lives, so they can use that money to purchase their own catastrophic major medical insurance on the open market.

10. In order to reduce the cost of becoming a doctor, prohibit any educational institution that receives federal funding from raising their tuitions and fees beyond the federally-published inflation rate.

And, by the way, I'll quit spelling it that way when it goes back to governing instead of goobering.

Most of your solutions, I agree with. However, by law, medical help cannot be denied to anyone. I have been told those who have insurance pay for the costs of those who cannot afford it. Another issue are patients who need long term or extensive care. I believe it is much more complicated than any of us can understand.

Is this true? Qualify? How? I was under the impression that I can go back to original anytime in open season. Tell me more.

Requiring a doctor to provide medical help to someone who can't pay is an unconstitutional confiscation of private property. The fact that a law exists does not make that law constitutional or even right. Charity must be voluntary or it corrodes the humanity of both the recipient and provider, not to mention the society that confiscated the means to provide it. Theft does not become moral just because it's "legal".

There is nothing complicated about reality. Reality only becomes "complicated" when it is in conflict with your notion of "how things oughta be".

You can not be denied Medigap (original Medicare Supplement Plan) when you turn 65 and sign up for Medicare based on preexisting conditions. Medigap costs more per month than Advantage plans, but provides way better catastrophic coverage if you have serious and expensive health issues. With most good Medigap plans, you pay a higher monthly premium, but after that you are only required to pay a small annual deductible (about $250) and 100% of everything else is covered (except prescriptions (part D,), hearing, vision, and dental). If you originally sign up for an Advantage plan because you are healthy, and don’t anticipate any significant health expenses, then you can be medically underwritten for preexisting conditions if you want to later switch to a Medigap plan.

Think about it, if there was no medical underwriting for switching, everyone who is healthy would sign up for an Advantage plan to save money. As people age and begin to develop expensive health issues they would simply switch to a Medigap supplemental plan to again save money. That’s not how insurance is designed to work, it’s to cover catastrophic costs. Allowing people to switch, without medical underwriting, would drive up the price of supplemental plans ridiculously high.

Plus, with Medigap, there is no network. You can see any doctor in the USA that accepts original Medicare without a referral. They should rename Medigap, “Snowbird insurance”. Birds don’t need to be worried about being out of network regardless of which of their homes they are currently at. Somehow, which I can’t understand, the Villages Health has managed to only accept Advantage plans. The only way I can figure how they get away with that is that they don’t accept original Medicare (parts A & B). This practice is extremely rare, and is shady at best for a region that theoretically caters to the best interest of senior citizens!

People need to be very careful about properly planning for the long term when turning 65 and not simply think about what their monthly premiums will be immediately. Deciding to go the Advantage plan route, versus a Medigap supplemental plan, can have negative long term financial implications as health needs change over time. There are several very well written books available that go into great detail about the Medicare decision tree one must navigate and how to maximize one’s benefits as well as minimize their risks. I highly recommend anyone nearing the age of Medicare eligibility read a couple of these books and very carefully consider the long term implications of their initial enrollment decision. Hope this helps.

I think I remember the SHINE person tell me that in Massachusetts you can switch without underwriting. That could help some snowbirds.

Almost. A private medical practice does not have to accept anyone as a patient, as long as it is not on the basis of race, religion, sex ,etc. On the other hand, a public facility such as an ER or urgent care facility is bound by COBRA 1987 regulations. They must see any patient, regardless of ability to pay, and can only transfer them to another facility if "stable". The paperwork is Draconian and the penalty for violations even more Draconian.

Well reasoned rationale. In addition, I bet statistics will show that Floridians seek more medical care than the average populace due to fact that there are more older patients in Florida.

I would add that the patient should always be required to make a copay for any medical treatment, to encourage competition among medical providers. Under the current system, patients don't care how much the treatment costs when it is covered 100 percent by insurance.

The problem is happening now and getting worse. It does appear that nobody wants to address it now so that it does not get worse. Not every professional person wants to move to hot, central, minimal culture central Florida. People moving here come mostly for 1 reason, lower costs of living.

Most of those moving out are coming from the real higher cost of living areas of Florida, near the coast. We moved out 3 years ago along with many other S. Floridians

Don't those rules only apply to public facilities that accept Medicare?

Had the same ?. Only alternative I could think of was a single payer system, which is used by 99% of the developed world.