[Pugchief]

Originally Posted by kingofbeer

My understanding is that the rate of pay for medical doctors in our area is low and that explains why doctors do not want to work here. I had a long conversation with someone in the medical field who works in Virginia because they are paid twice as much there.

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.

[OrangeBlossomBaby]

Originally Posted by Blueblaze

Obamacare didn't ruin medical care in America. It just drove the last nail in the coffin.

The road to ruin started in WW2 when the gooberment enacted wage and price controls when all the labor was off fighting a war. Business used the only tool in the toolshed to attract workers -- free hospitalization insurance. To this day, we remain the only country in the world where most people get their health insurance through their employer.

... Which meant that the moment someone retired, they lost their medical insurance, right at the moment when they needed it most. So the gooberment stuck a bandaid on it and created Medicare. Like all other medical insurance at the time, it only covered hospitalization.

Then, in the 80's the bright boys at Blue Cross came up with a brilliant scheme to sell everybody on the lunatic notion that we should buy insurance to cover ordinary doctor visits. It was like buying insurance for groceries, but like the rubes in any scam, we all bought into the idea of "free stuff" and joined an HMO.

...Which, in addition to driving the paperwork costs through the ceiling, caused doctors to notice the deep pockets of the insurance companies. Prices were adjusted accordingly, and now NOBODY could afford a doctor without a "healthcare" plan. For instance, the "well baby" appointments for my 1981 daughter prior to the invention of the HMO was $15. Once we were forced to join "Prucare", it still cost $15 -- but now the doctor billed Blue Cross another $100, which was equivalent to about $500 in the 80's.

"Heathcare" became so outrageously expensive that Bush expended Medicare to include doctors visits -- and started charging seniors the cost of a doctor's visit every month for the privilege.

Then, Obama noticed that the average "healthcare" policy in America was over $15,000, and about half the people in America couldn't afford it unless they worked for a fortune-500 company who could. So he nailed the last nail, and created Obamacare, to "insure" that every home in America was forced to pay at least $5000 a year (or a $500 fine) for a $10,000 deductible and a "network" of the worst doctors in America.

Now, everybody's gotten into the act. I just paid $3000 to a vet to remove a splinter from my dog's throat, because I don't carry pet "health" insurance. My Dentist just charged United $450 to clean my teeth and presented me with a $5000 "treatment plan" to replace a bridge that hasn't caused me a moment's problem in 40 years.

Boy, I can't wait for some moron to suggest that we need insurance for groceries in this high-inflation environment that our googerment created. How about you?

So what's your solution?

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

[Blueblaze]

Originally Posted by OrangeBlossomBaby

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.

[margaretmattson]

Originally Posted by Blueblaze

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.

[Viperguy]

Originally Posted by davephan

Medicare Advantage is really named incorrectly, it should be named Medicare Disadvantage. I’ve heard that 30% of all claims are routinely denied. If your doctor prescribes 12 treatments, they might only approve 8 treatments. You are also restricted to going to clinics that you probably wouldn’t have chosen on your own.

One of the worst things about Medicare Advantage is after one year of switching to Medicare Advantage, you have to medically qualify to switch back to Original Medicare. If you’re health declined, then you could be stuck with Medicare Advantage for life. The best option is to stay on Original Medicare with a good supplement.

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

[Blueblaze]

Originally Posted by margaretmattson

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.

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".

[tophcfa]

Originally Posted by Viperguy

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

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.

[Caymus]

Originally Posted by tophcfa

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.

[golfing eagles]

Originally Posted by Blueblaze

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".

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.

[kkingston57]

Originally Posted by GoRedSox!

Regarding the ACA, I don't think the costliest increase was the elimination of pre-existing conditions...because if the plans are affordable, many people will buy them and not have pre-existing conditions. But the elimination of the individual mandate ensured that the population on ACA plans were sicker and costlier individuals. If everyone was required to have a plan, the costs would be spread over more plans with healthier/younger people.

I know some people will say that the healthy are subsiding the unhealthy. While this may be true, none of us really knows when we may go from being healthy to not as healthy.

So much of the total medical spend in this country is for people in the final year of life. So no matter what, we all pay for that.

As for Florida, I believe that there is a math problem which manifests itself in several ways, and one of them is health care. There are so many people moving here and the growth has been so fast that medical care can't keep up with population growth. The same percentage of physicians would have to be moving here as the rest of the population, but I don't think physicians are as likely to give up a job or location they have been in as the rest of the population so this is one of several areas FL has to play catch up.

I am stating my opinion, not claiming to know it all or stating hard facts or statistics. As always and as my wife will happily verify, I could be wrong.

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.

[retiredguy123]

Originally Posted by Blueblaze

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.

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.

[kkingston57]

Originally Posted by ThirdOfFive

"If you build it, they will come".

This shortage is not just in The Villages but in Florida as a whole. Checking the data, no part of Florida has what could be called adequate physician care. The entire state has a shortage of primary physicians and specialty care physicians: no part of the state is expected to have adequate specialist care by 2035 with most of the state having at best 80%. Primary care physician availability outlook is a bit better, but only the southern tip of the state:: Miami, Ft. Lauderdale, etc. are expected to have 100% of adequate primary care physician coverage but this does not extend to the rest of the state. ("Florida’s physician shortage: It’s not just primary care and rural areas", Jarrod Fowler, MHA FMA, Florida Medical Association Website, April 21, 2022).

Why? Who really knows? A couple of things that we DO know however is that people with money and the wherewithal to relocate are fleeing their high-tax, high-crime states like deranged lemmings in search of friendlier surroundings, and for most, those "friendlier surroundings" happens to be spelled FLORIDA. According to data I've read Florida has FOUR TIMES the influx of new people than does the next state in the row, Texas (might be wrong about Texas). These folks are also taking their money, their toys, and most importantly their spending power with them. It has led to some monumental problems at both ends: influx AND outflux. My home state of Minnesota for example as a stable population if you're just counting heads, but the people with the money are the ones scurrying south. They're being replaced mainly by third-worlders, recent immigrants who are steered toward Minnesota by Federal authorities as well as migrant farmhands, in addition to the more-than-sizeable resident population currently on welfare. This is not new: as far back as 2004 there was an article in one of the Twin Cities publications that put a financial value to it and even then it was multiple billions leaving the state every year. Today, with the multiple COVID messes and economic upheaval I'm sure it is far worse.

Second (conjecture on my part) it is probably a lot harder for a doctor to leave his/her practice than it is for a couple of retirees to pack up and skedaddle. Took us maybe three months after we made the decision but we had no notices to give, interviews to arrange, etc. etc. I'm pretty sure that with all that money leaving, the people who were formerly PAID with that money will be leaving as well, just a lot more slowly.

I don't know. That whole COVID thing blindsided a lot of people and the influx of folks to Florida overall, not just TV, has been unprecedented and could not have been planned for. I'm sure the medical situation will improve; maybe not fast enough for some, but it will. After all the money is here.

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.

[kkingston57]

Originally Posted by GoRedSox!

The US Census Department's American Community Survey just came out, and Florida is, indeed, the top destination for domestic migration with over 740,000 people moving in. However, what is far less discussed is that almost 500,000 people moved out of Florida, and the state is one of the top outbound states as well as inbound. It's still a net domestic migration of about 250,000, but that is still a lot of people leaving. Interestingly, medical care is one of the primary reasons given for leaving, along with high cost of living and insurance premiums.

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

[retiredguy123]

Originally Posted by golfing eagles

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.

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

[kkingston57]

Originally Posted by OrangeBlossomBaby

So what's your solution?

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

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