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Will fit/healthy/strong people be the new upper class??

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  • #31
    Originally posted by Neckhammer View Post
    Who is blaming a class? Not me. I believe I plainly blamed public education, shitty tv commercials, and the healthcare system itself. If not then thats just my inability to communicate things here I suppose. As to the last how do you know I wasnt?
    Your comment was that lack of money is a BS reason the poor are more unhealthy. My point is it's a huge factor. The system is largely to blame, but having far fewer resources makes it much harder.

    As to the trailer park comment - it's possible that you were born in one, but highly improbable, and therein is my point in regards to education and money.

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    • #32
      Hey NH - just read your latest posts. I am good - I was concerned that you just miiight have some issues conflating the system with its users, but I personally am assured: System sucks, people are not the system.

      Just as a PS, I once had a hospital admin tell me that the price diff you mention re abdominal CT and cash price/insurance reimbursement - get this: he told me that hospitals HAD to make up the difference somehow, because they couldn't cover cost with what the insurance companies pay...

      Off to watch that vid...
      Last edited by Crabbcakes; 06-09-2013, 05:42 PM.
      I have a mantra that I have spouted for years... "If I eat right, I feel right. If I feel right, I exercise right. If I exercise right, I think right. If I think right, I eat right..." Phil-SC

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      • #33
        Originally posted by Crabbcakes View Post
        Hey NH - just read your latest posts. I am good - I was concerned that you just miiight have some issues conflating the system with its users, but I personally am assured. Thanks.

        Off to watch that vid...
        Not at all. Like I said I'm just so sick with how things work. Really seems set up to kick ya while your down.

        Originally posted by quikky View Post
        Your comment was that lack of money is a BS reason the poor are more unhealthy. My point is it's a huge factor. The system is largely to blame, but having far fewer resources makes it much harder.

        As to the trailer park comment - it's possible that you were born in one, but highly improbable, and therein is my point in regards to education and money.
        Actually my comment was that the poor are not more unhealthy due to lack of medical care. I stated their lack of health was a function of not having access to the information necessary to maintain it and that using the system we have (symptom based, emergency room visits with preposterous rates for uninsured, and drugs out the wazzu) only compounds their problems. Hell, how many of these super healthy HG tribes had access to 21st century medicine? Thats my point. So if you are saying that the poor have fewer resources to access education about health we are in agreement. Teach a man to fish......

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        • #34
          Originally posted by Neckhammer View Post
          So if you are saying that the poor have fewer resources to access education about health we are in agreement.
          Indeed we are.

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          • #35
            Originally posted by Crabbcakes View Post
            Just as a PS, I once had a hospital admin tell me that the price diff you mention re abdominal CT and cash price/insurance reimbursement - get this: he told me that hospitals HAD to make up the difference somehow, because they couldn't cover cost with what the insurance companies pay...
            Pfft. What a load. They keep the rate that high so that the regional amount is inflated and they can get a better overall reimbursment rate from insurers. That they have to throw the uninsured under the bus to get that rate makes no difference to them. They are working the system.

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            • #36
              All and all I'm glad both of you made the posts you did so that I could clear up any misunderstanding regarding the first post

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              • #37
                That they have to throw the uninsured under the bus to get that rate makes no difference to them. They are working the system.
                They generally end up settling with the uninsured as well, after they scorch their credit. A good friend of mine does medical collections and it often ends up pennies on the dollar, still significant in the case of medical care.

                http://maggiesfeast.wordpress.com/
                Check out my blog. Hope to share lots of great recipes and ideas!

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                • #38
                  The cost of those settlements gets passed onto consumers who have traditional, employer-based insurance, via jacked up premiums. The hospitals charge a lot more money for procedures, such as CT scans, in an attempt to get a portion of what they are charging back from insurance reimbursement.

                  The poor have less access to preventive services, so don't get treatment that could prevent costlier treatments/surgeries in the long run, and get the majority of their basic care via emergency/urgent care facilities. The majority of health care utilization costs occur in poor populations in the south, from those who qualify for Medicaid. In that case (and it is very common for that population to be eligible for Medicaid), they have full coverage, often better than employer-based insurance, but don't utilize their benefits. They are still using the ER as a primary health care source and letting things get to a crisis point before thinking about their health, and with the poverty level you need to qualify, are often exacerbating their health conditions by eating absolute crap. 80% of utilization is driven by 20% of the population.

                  I work for the health care industry, doing IT data analysis in the quality management department for Medicaid plans. We are constantly trying to come up with interventions that drive that population into a consistent model of care that includes a PCP. Mailers, phone calls, in person visits by care mgmt staff happen year-round to try and get people in for routine screenings and appointments. You know why so much is spent doing that? Because even though health insurance companies are seen as being the bad guy (which they absolutely can be), they lose money hand over fist on those populations. Even though they have benefits, they aren't using them to stay healthy. Benefits are used once a health condition has deteriorated to the point where intensive, cost-heavy care is required. again, not by everyone, but the cost differential in preventive care versus crisis-level treatments, including inpatient admissions, surgeries etc. is so great that we do every thing we can to get members in the Medicaid population to use their benefits to get annual visits, immunizations, and other screenings. It's so much more expensive when people ignore their health.

                  And who bears the cost of inappropriate utilization stemming from people not putting in any effort to take care of themselves, even though they have the Medicaid benefits? Taxpayers. From our actual taxes used to support these programs, which are necessary, as well as rising premiums for our own insurance plans. I do think these programs are necessary, but it is frustrating to see benefits mis-used when I know plenty of people who would do anything to have health insurance and can't afford it or don't have a job that provides it, but still aren't poor enough to qualify for public assistance. Our whole health care system is a giant clusterfuck of mismanagement. It is so labyrinthine with all of the government dependencies and lobbying groups impacting policy-making, that it needs to be blown apart before it can be truly fixed. I fully believe the cost of our current health care system coupled with an aging, unhealthy population is going to drive the country into a dystopian hell in the next 25-50 years.
                  Last edited by Zanna; 06-12-2013, 06:52 AM.

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                  • #39
                    Originally posted by Zanna View Post
                    ...it needs to be blown apart before it can be truly fixed. I fully believe the cost of our current health care system coupled with an agin, unhealthy population is going to drive the country into a dystopian hell in the next 25-59 years.
                    I think actually it will just collapse under its own weight as insurance becomes so expensive that only the wealthy can afford it.

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                    • #40
                      Originally posted by eKatherine View Post
                      I think actually it will just collapse under its own weight as insurance becomes so expensive that only the wealthy can afford it.
                      That will only be allowed to get to a certain point. Insurance companies couldn't possibly maintain any profit margin based on contracting expensive services of the wealthy few. They need a large membership, preferably the straight commercial membership, where the majority of the insured are relatively healthy to make up for the costs incurred by the smaller group requiring ongoing disease management services. The big wrench in the works for this model, besides Americans getting financially raped for health care, is the slide towards poorer health experienced in greater numbers added to the Boomer populations aging out into retirement. It is simply going to cost more and more - it's not sustainable.

                      I had a conversation with a woman from Denmark a while back. She married an American and they have employer-based coverage provided by her husband. Her kid had to have a CT scan, which was billed at $4000. 80% is reimbursed through health insurance, once the deductible has been met. That's a hell of an out of pocket payment to make, on top of your monthly premiums. The same CT scan (same equipment, same procedure, same level of education and skill required by the administering clinician) costs $200 in Denmark. How the hell should that be possible? God, and don't get me started on prescription meds and how much more Americans pay for the same meds compared to the rest of the world. Not that there should be such a reliance on prescriptions to maintain health, but there are a lot necessary medications required for people with legitimate medical conditions (not the self-inflicted diseases acquired through unhealthy diet, lack of exercise). I think Big Pharm is way more evil than any of the other players in the health care arena.
                      Last edited by Zanna; 06-12-2013, 07:08 AM.

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                      • #41
                        We are constantly trying to come up with interventions that drive that population into a consistent model of care that includes a PCP.
                        I'm self insured with a large deductible.

                        If you want me to go in for check ups, don't mail me shit. Give me a price list. Let me call around to 5 doctors and get a price on a check up. Kind of like getting my car fixed.

                        I don't go in for check ups, because when I had employer health care, I went for a $25 visit. I saw the bill. It was something like $1300. To weigh me, take my health history, take my blood pressure, give me some allergy meds and inform me they were out of tetanus vaccine. So why the hell would I go in for a $1300 check up I could go do at WalGreens?

                        Medical providers need to be able to ballpark costs of services. I don't understand why they can't publish a list of "worst possible rates" for people. Planned Parenthood can give you estimates. I get my annual there. I know exactly how much I will pay BEFORE I commit.

                        I know that for me, not knowing whether the services will be $150 or $1500 is why I skip preventative care.

                        http://maggiesfeast.wordpress.com/
                        Check out my blog. Hope to share lots of great recipes and ideas!

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                        • #42
                          Being able to compare costs across different providers for services is supposed to be one of the benefits of having a health insurance exchange (like the system in MA), but that hasn't really happened. With my health insurance, they don't have much of a network in my state, so no one belongs the "preferred" group where I could check not only cost of services but quality ratings, i.e. how good a provider is at their job. So yeah, that sucks not having that information available. We get pushback from providers in trying to make this accessible to the public. No one likes having someone check up their work, and that's how they sometimes see efforts to make info on costs more transparent.

                          I agree with you on the mailings; I think they are a waste of money. The only thing I've seen that really seems effective are member incentives (yeah, paying members to go see a provider where they have full coverage already) and direct clinician interventions. Provider incentives can work too, but mailers don't. We get so much junk mail as a society that unless its a bill or personal correspond, I throw everything else in the trash without opening it. I expect everyone else to do the same lol.

                          Re: cost of an annual visit. I totally understand why you would get basic screenings done at Walgreens or Planned Parenthood. I've done the same. You're still seeking information on your health and are taking steps to take care of yourself. That's the difference; the population we are trying to reach (hundreds of thousands of people) have full coverage and still don't go in, even when they have conditions that require ongoing care.
                          Last edited by Zanna; 06-12-2013, 08:00 AM.

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                          • #43
                            I'm uninsured, and healthy. So basically I don't see a doctor. I hear some of the tests people have, and I'm like, what? A 48 year old woman having hot flashes goes to the doctor and he runs tests and tells her she's having hot flashes? And that cost what, $$$? No wonder I can't afford to see a doctor.

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                            • #44
                              the population we are trying to reach (hundreds of thousands of people) have full coverage and still don't go in, even when they have conditions that require ongoing care.
                              If you can't budget for it, then it's inaccessible. Period. Few people can handle an unexpected $1500 bill. To the providers, if you can't tell me what it will cost, and if your reputation is for wildly varying rates that don't make sense, no one is going to buy.

                              If my cleaning service charged me anywhere from $15 to $150 for cleaning my house but couldn't tell me how much it would be until they were done, I wouldn't have them come because I couldn't budget.

                              http://maggiesfeast.wordpress.com/
                              Check out my blog. Hope to share lots of great recipes and ideas!

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                              • #45
                                Even though Doug's video is from the vantage point of an ER physician the fact remains that you have no idea what medical procedures cost at the time of service when you involve a third party. You can get an estimate, or try to verify your coverage ahead of time. But you remember that little blurb at the end? The one that says "this is just some bullshit and if we told you the wrong info it isn't our fault even though we are the insurer. You very well may get stuck taking this in the backside." Yup they mean it! Again we come back to the fact that said provider would and does accept a much lower price than what they bill all because of the third party system. They inflate price so that they have better negotiating power to get what they actually feel the service is worth AFTER the preferred provider write-off.

                                And yes big pharma blows too.

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