Talk of The Villages Florida - Rentals, Entertainment & More
Talk of The Villages Florida - Rentals, Entertainment & More
#16
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As far as medical care was concerned, "big business" in the form of the insurance and pharmaceutical industries were given more control, taking it from the relationship between doctors and their patients. Soon an insurance clerk could tell a doctor what services he or she could--or could not--provide for patients. The focus became "the bottom line," less for the doctor and more for "big business." (I realize this is an ovesimplification.) As the well-paying jobs disappeared overseas (the jobs that invariably included health insurance coverage), the service businesses, which by their nature were nowhere near as profitable, did not offer health insurance coverage and created huge numbers of low-income workers, often at minimum wage or barely above, who now use hospital ERs for their medical care. One need only to refer to another thread about the long waits in ERs to understand this better. When Medicare Part D was created in the first decade of this century, I looked at it and saw it as a travesty for senior consumers and a boon to the insurance and pharmaceutical industries. The government at that time went so far as to pass a law prohibiting Americans from buying their prescription drugs far cheaper in Canada (or from Canadian sources). And why were they cheaper in Canada, especially that they were the identical drugs? Because Canada required the pharmaceutical companies to negotiate prices based on bulk purchase, while in the U.S. the full costs had to be borne by seniors, in order to maximize profits for the companies, and who had also to contend with deductibles and "doughnut holes" even as drug prices rose! Way back when, living in New York State, I had to have a radical surgery that was so serious that I had to be flown to another state for it to be done. My insurance company, Empire Blue Cross Blue Shield of New York State, covered about 20 percent of the cost, saying that that was their "reasonable and customary" payment for this surgery. Thankfully, NYS had a government that was supportive of its citizenry; I asked the NYS Insurance Department to demand of Empire how it had arrived at this "reasonable and customary" figure, since the surgery had never been performed in NYS! Thanks to this governmental agency's support, Empire was required to cover considerably more of its cost! And it has continued to worsen. I'm in the care of a doctor since he began practice, and he's ready to retire, so I know him well. First, I asked him why out of the clear blue he had "sold his soul" to some major medical holding corporation. His answer? "The way things are going, we have no power anymore at all; we can no longer decide what's best for our patients. The corporation, much as we dislike it, is what medical care has become." Second, he confided to me that he had dissuaded his daughter from going to medical school, which had been a lifelong dream of hers. However, she understood, seeing what her Dad was going through, and instead is now in her second year of veterinary school and is happy with this second choice. But this means the loss of someone who would likely have become an excellent physician. Sad. OK, I'm getting off my soap box.... |
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#17
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You have identified some of the fundamental inequalities which have been part and parcel of health care in the most prosperous nation on earth.
My glass is half full - but I do get frustrated when I read posts from folks who are certain the Affordable Care Act is not an improvement. Give it a chance. There will be tweaking. Just today the deadline for the small business insurance mandate was extended to 2015. I want to change insurance because my health situation has changed. I'm guaranteed I can do that. I'd woud have been turned down flat by every company in the past. Coverage will be extended to millions who otherwise end up in emergency rooms we pay for. The fraud investigation rules have changed and hundreds of millions have already been saved by catching crooks before they can raid the cookie jar. Etc, etc. etc. Give it a chance. |
#18
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You have identified some of the fundamental inequalities which have been part and parcel of health care in the most prosperous nation on earth. My glass is half full - but I do get frustrated when I read posts from folks who are certain the Affordable Care Act is not an improvement. Give it a chance. There will be tweaking. Just today the deadline for the small business insurance mandate was extended to 2015. I want to change insurance because my health situation has changed. I'm guaranteed I can do that. I'd woud have been turned down flat by every company in the past. Coverage will be extended to millions who otherwise end up in emergency rooms we pay for. The fraud investigation rules have changed and hundreds of millions have already been saved by catching crooks before they can raid the cookie jar. Etc, etc. etc. Give it a chance. |
#19
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You make three significant points that I have emphasized, the first and third in bold and the second underscored (just to differentiate them. 1. Look at the threads about people agonizing about which type of coverage to take; the new plan will eliminate the ability of insurance companies, who now control who gets covered and who doesn't, to reject someone based on past medical history. 2. I still find it hard to believe that there are those who object to nearly 50 million of our fellow citizens having easier access to health care than flooding our hospital's emergency rooms, which we all pay for over the long haul anyway. 3. The present level of fraud, which is outrageous, did not exist before the insurance industry controlled medical care. Some, yes, I'm sure, but nothing like now. My personal disappointment with the Affordable Health Care Act is that it did NOT eliminate the insurance industry from the equation, but that's the American system of lobbying.... But this act WILL be able to eliminate (hopefully) much of the fraud that is rampant in the present system. Yes, I agree: Give it a chance! P.S. When you wrote "I do get frustrated when I read posts from folks who are certain the Affordable Care Act is not an improvement," I suspect--though I could be wrong--and would be happy to be wrong--that these folks who object to the Affordable Health Care Act have reasons that are not directly related to health care itself.... Last edited by Quixote; 07-04-2013 at 07:00 PM. Reason: Adding P.S. |
#20
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I don't understand.
If "big business," "multinational corporations," "the bottom line," "extraordinary CEO salaries and benefits packages" are the problem, then why is United Healthcare--marketing its policies thru AARP and paying AARP commissions "like an insurance agent"--NOT a "Big Business" problem in the Medicare system people are grappling with here? "UnitedHealth Group Incorporated is a diversified managed health care company headquartered in Minnetonka, Minnesota, U.S. It is No. 17 on Fortune magazines top 500 companies in the United States. UnitedHealth Group offers a spectrum of products and services through two operating businesses: United Healthcare and Optum. Through its family of subsidiaries and divisions, UnitedHealth Group serves approximately 70 million individuals nationwide. In 2011, the company posted a net earnings of $5.142 billion. UnitedHealth Group is the parent of UnitedHealthcare, the largest single health carrier in the United States. It was created in 1977, as United HealthCare Corporation (it was renamed in 1998), but traces its origin to a firm it acquired in 1977, Charter Med Incorporated, which was founded in 1974. In 1979, it introduced the first network-based health plan for seniors. In 1984, it became a publicly traded company." ---------- Now, I don't have an MBA, and I'm not a CEO nor a CFO, but it sure looks to me like United Healthcare is "Big Business" and is surely focused on "the bottom line"......and its CEO gets "extraordinary salaries, benefits and stock options": "Stephen J. Hemsley (born 1952) has been CEO of UnitedHealth Group Inc since 2006. Before joining the company in 1997, he had a career at Arthur Andersen, where he was Managing Partner and Chief Financial Officer. According to bizjournals.com the country's highest-paid CEO, Stephen Hemsley, made $101.96 million in 2010. In 2011 he was named the highest paid CEO by Forbes following a large gain in the value of his stock ownership. In late 2011, Hemsley's most recent annual compensation was estimated by Forbes at $48.8 million." _____ AARP "Approximately seven million people have AARP branded health insurance, including drug coverage and Medigap, as of April 2007 and AARP earns more income from selling insurance to members than it does from membership dues. In 2008, AARP plans to begin offering several new health insurance products: an HMO for Medicare recipients, in partnership with UnitedHealth Group; and a PPO and "a high-deductible insurance policy that could be used with a health savings account" to people aged 50–64, in partnership with Aetna. AARP will likely become the largest source of health insurance for Medicare recipients, and AARP estimates the new products will increase its health insurance customers to 14 million by 2014. AARP is not an insurer and does not pay insurance claims. Instead, AARP allows its name to be used by insurance companies in the sale of insurance products, for which it is paid a commission like an insurance agent." ______ UnitedHealth Group - Wikipedia, the free encyclopedia Stephen J. Hemsley - Wikipedia, the free encyclopedia AARP - Wikipedia, the free encyclopedia |
#21
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Second, AARP and United HealthCare are taking advantage of the present structure of medical coverage in the U.S. Why shouldn't they? As I said, under ideal circumstances I would have preferred to see the huge insurance industry, which you've cited, out of health care, but lobbying certainly prevented this from happening. And third, if profit were the sole motivator behind AARP's and United HealthCare's involvement in Medicare Supplement and Part D Prescription Drug plans, why do seniors flock to them? Could it be because they have the lowest premiums? I'm not intimating that they're in business to be a "public service," but when I had a choice of identical plans some years ago, the premium for my Medicare Supplement plan was (and still is) about $100/month LESS than the identical plan offered by Mutual of Omaha, which was the plan sponsored by my former employer! In other words, although AARP/United HealthCare is indeed profitable, could they have been MORE profitable? Absolutely! Again I'm oversimplifying, but they could have made their premiums, say, $50 higher than other plans and still have had their same following, but they chose not to. Many years ago, stock market guru Peter Lynch, when asked how he came to select the stocks he did (and was incredibly successful at it), explained that while he did his homework, he also looked at everyday living and everyday products. As an example, he said that his wife used L'Eggs Panty Hose virtually on a daily basis, and this is how he became aware of the company. Other companies manufactured panty hose, but after investigating the "health" structure of the company that manufactured the product his wife used and was satisfied with what he found, he named it a company worth investing in based on practical, everyday experience. To my way of thinking, no matter what their profit margin is, saving me $100/month is pretty sensible on an everyday basis.... |
#22
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#23
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#24
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Interesting. I called both PCP abd Mid Fl Eye this morning. My followup end of the month (July) is still scheduled.
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Chicago, Cary, and Champaign, IL Winchester, IN Lancaster, OH Tampa, FL |
#25
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Last year when Mid Fl was dropped by PCP we were told that follow-up was accepted but not a new problem.
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#26
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Maybe that's what happened.
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Chicago, Cary, and Champaign, IL Winchester, IN Lancaster, OH Tampa, FL |
#27
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#28
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![]() Lange and Mid FL. both dropped PCP because they did not pay their bills. Lange did one of my husband's cataract surgeries and a week before the second surgery they called him and said they were in litigation with PCP for non payment. We called PCP and after a month they sent him to Mid Fl..he had the surgery and then when his follow up appt. was a week away, we received a letter stating that they no longer accepted PCP for the same reason.
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Shirleevee Staten Island, N.Y./The Villages |
#29
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#30
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If you had Preferred Care Partners...they'll be no longer in 2014. "IF" you want to go to the USF clinics here you will need the United Health Care policies...though they will see patients with other insurances if it's not an HMO or a PPO. I followed my practioner to USF and don't want to change physicians. Using UHC you will see docs within network. That list isn't public yet. IF I wasn't as picky as I'm being, I'd change to Freedom Health.
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