Another example of broken healthcare insurance system

[Snicks]

I think universal healthcare could be done if it was done in increments and in a smart way. I think a sweeping bill like Obamacare was a huge mistake. Start with one segment. Emergency care. Address THAT. Get that RIGHT, then move on. And there has to be some coming to terms with REALITY that everyone cannot have everything they want whenever they want it . However no politicians will say that and there are powerful lobbies to ensure their special interest gets covered.

[disneysteve]

there has to be some coming to terms with REALITY that everyone cannot have everything they want whenever they want it .

That's certainly true, and is already true of existing health coverage. They cover some things and don't cover others. They have preferred providers. They have drug formularies. They have lower copays for in network and higher co-pays for out of network (if covered at all).

No insurance plan can cover everything, everywhere, for everyone.

[Snicks]

I mean America is a BIG country . And, yes other countries have done universal health care. England did so in the 1940s i believe. And, I think Canada is a bit more homogenous in their thinking. And, our country is loaded with lawyers and politicians and special interest groups. Certainly would be a huge challenge.

[disneysteve]

I mean America is a BIG country . And, yes other countries have done universal health care. England did so in the 1940s i believe. And, I think Canada is a bit more homogenous in their thinking. And, our country is loaded with lawyers and politicians and special interest groups. Certainly would be a huge challenge.

44 million Americans are on Medicare. 72 million Americans are on Medicaid. 10 million are on Tricare, the military plan. That's 126 million out of 328 million, so over 38% of us are already on a government insurance plan.

Roughly 20% of the population is 50-64 so if they drop the Medicare age to 50, you'd now have about 58% of folks on a government plan. Transitioning the other 40% wouldn't be as monumental a task as it might initially seem. Maybe they do it gradually over a decade, each year lowering the eligibility age by another 5 years so that after 10 years, the age will have dropped from 50 to 0 and everyone will be covered.

[jenn_jenn]

44 million Americans are on Medicare. 72 million Americans are on Medicaid. 10 million are on Tricare, the military plan. That's 126 million out of 328 million, so over 38% of us are already on a government insurance plan.

Roughly 20% of the population is 50-64 so if they drop the Medicare age to 50, you'd now have about 58% of folks on a government plan. Transitioning the other 40% wouldn't be as monumental a task as it might initially seem. Maybe they do it gradually over a decade, each year lowering the eligibility age by another 5 years so that after 10 years, the age will have dropped from 50 to 0 and everyone will be covered.

I’d expect as a doctor that you’d know how awful government insurance is.

I briefly worked in biotech for a healthcare services company and we closely monitored our Medicare, Medicaid, and Tricare numbers because their payment rate was so low. We specifically targeted healthcare providers based on their patient population and wouldn’t go on contract with providers who had too high of a patient population with these insurances. The company wouldn’t be in business if we didn’t because we *lost* money on their patients.

My fiancé is military. Most of the military families I know maintain their own private health insurance because TriCare is so bad. We’d have my fiancé on my health insurance if he was allowed to do so.

I wouldn’t point to the current government insurance as a successful model and certainly not something to transition more people onto.

ETA: I’m glad these insurance programs exist for people who qualify for/utilize them. They do a lot of good and provide healthcare for those that might not have other options. They certainly have their place. But to make it universal? Big nope.

[disneysteve]

I’m glad these insurance programs exist for people who qualify for/utilize them. They do a lot of good and provide healthcare for those that might not have other options. They certainly have their place. But to make it universal? Big nope.

Universal coverage doesn't have to be all or nothing. I don't think it should be and it isn't today either. There are a slew of Medicare supplement plans that help cover costs and care that isn't covered, or isn't fully covered, by Medicare itself. If you can afford to buy this additional coverage, you do. Medicaid also isn't a single plan. There are a variety of managed Medicaid plans, each having somewhat different coverage, different drug formularies, different provider networks, etc.

I'd love to see some type of basic universal coverage that at least ensures that folks can get routine preventative care (annual physical, mammogram, colonoscopy, etc.), treatment for typical acute and chronic conditions, emergency care, and some reasonable level of prescription medication coverage. It doesn't have to be fancy and cover everything but it should at least provide a basic level of coverage so that folks don't have to choose between filling their blood pressure and diabetes meds and putting food on their table. Then there can still be private coverage that you can purchase that goes above and beyond that with all of the bells and whistles that you want to pay for on your own.

[Like2Plan]

I really don't like medicare. But, I really, really don't like no medicare. So. DH signed up for medicare. Because he is still working and the primary insurance coverage comes from me (and I am retired), DH pays a higher premium for medicare part B (otherwise, if the primary ins came from DH we both could delay signing up for medicare part B while DH continues to work full time). You see, the basic premium for part B that everyone signs up for does not cover the cost of part B medicare--not by a long shot so, congress has to pitch in. And, as noted above Medicare does not cover the costs for care 100%.

So, you have to have more coverage. Which you have to pay for more health insurance. From my perspective--we pay the same premium we did before plus the medicare part B. When I turn 65, it will be 2 medicare part B premiums: one for him and one for me. Plus health insurance for that bit that is not covered.

There are some other features that are not ideal for medicare--firstly no matter which program you sign up for--it doesn't cover you if you are traveling overseas. If you sign up for a medicare advantage program, you might not be covered (except for emergencies) while you traveling in the US.

I haven't even touched on the myriad of confusing options there are with medicare. Prescription coverage, doughnut holes and so on.

[disneysteve]

doughnut holes

This has got to be the stupidest thing they ever came up with. We'll cover everything until you spend $2,500, but them we will pay 0% until you spend another $2,500, and then we'll start covering everything again. Whose idea was that? Why not just have a copay from day one or a 5% co-insurance and have the coverage be consistent from the first dollar you spend?

[Like2Plan]

This has got to be the stupidest thing they ever came up with. We'll cover everything until you spend $2,500, but them we will pay 0% until you spend another $2,500, and then we'll start covering everything again. Whose idea was that? Why not just have a copay from day one or a 5% co-insurance and have the coverage be consistent from the first dollar you spend?

I don't know what the answer is, but I can't tell you how much I despise co-insurance/co-pays. When I was growing up we had insurance, but we couldn't afford the co-pays. Yes--(growing up) we put off care because of it. So, it was rather useless insurance from my point of view. It did influence my employment choices and healthcare choices in adulthood.

Also, to bring up a different issue it is so frustrating because the prices at the pharmacy have gone up so much. Even 5% can add up to a lot. This is not related to medicare coverage, but the prescription coverage on my medical plan is so lame (and we have a secondary insurance) that we still end up paying $$ even for a cheap generic antibiotic. I suspect I could get it cheaper without insurance.

[disneysteve]

I don't know what the answer is, but I can't tell you how much I despise co-insurance/co-pays. When I was growing up we had insurance, but we couldn't afford the co-pays.

So many people don't understand that just because someone has health insurance still doesn't mean they can afford care. I worked for many years in a very poor area. A $15 or $20 copay was a huge barrier that stopped people from coming in for their appointments. And that was on top of the fact that they often needed to pay for transportation to get to the appointment.

Also, to bring up a different issue it is so frustrating because the prices at the pharmacy have gone up so much. Even 5% can add up to a lot. This is not related to medicare coverage, but the prescription coverage on my medical plan is so lame (and we have a secondary insurance) that we still end up paying $$ even for a cheap generic antibiotic. I suspect I could get it cheaper without insurance.

The cost of generic drugs has gone up something like 600% or more in the past 5-7 years. It's nuts. It's always good to check different pharmacies because prices can vary a lot. Check the price without insurance. And check the discount programs like GoodRx.com.

ETA: My mom saved over $100 on one of her meds by switching from one pharmacy to another and using the GoodRx program.

[Snicks]

So many people don't understand that just because someone has health insurance still doesn't mean they can afford care. I worked for many years in a very poor area. A $15 or $20 copay was a huge barrier that stopped people from coming in for their appointments. And that was on top of the fact that they often needed to pay for transportation to get to the appointment.


The cost of generic drugs has gone up something like 600% or more in the past 5-7 years. It's nuts. It's always good to check different pharmacies because prices can vary a lot. Check the price without insurance. And check the discount programs like GoodRx.com.

ETA: My mom saved over $100 on one of her meds by switching from one pharmacy to another and using the GoodRx program.

Exactly! Health INSURANCE is not the same thing as actual health CARE.

[amarowsky]

So many people don't understand that just because someone has health insurance still doesn't mean they can afford care. I worked for many years in a very poor area. A $15 or $20 copay was a huge barrier that stopped people from coming in for their appointments. And that was on top of the fact that they often needed to pay for transportation to get to the appointment.


The cost of generic drugs has gone up something like 600% or more in the past 5-7 years. It's nuts. It's always good to check different pharmacies because prices can vary a lot. Check the price without insurance. And check the discount programs like GoodRx.com.

ETA: My mom saved over $100 on one of her meds by switching from one pharmacy to another and using the GoodRx program.

The above helps to highlight the huge costs involved by making more transactions. Then you legally force people to use insurance companies (by penalty of x% tax) adding yet another round of transactions between 3 parties, 2 full degrees removed away from you physically receiving your care/service/Rx.

I get insurances can indemnify one's risk for some cases. But the fact that our system is now Coercing people to have to use insurance is so blatantly corporatism and exploitative. Insurance companies are a huge driver in skewing the prices, and effectively making what should be Clear Cost Cost and Price, turn into "sticker prices" at hospitals. That can be negotiated down like some cliche "slimy used car salesman". And think of the cost to EVERY SINGLE PERSON who ever gets health care, and has to dispute a cost, fee, or something hidden or not clearly explained. This adds countless thousands of hours to just be "less upset" when you scrape back some of your money. At no point in this entire exchange, is there a moment of joy, because you're typically just at the doctor to get back to base. ANd not to get "enhancements" or something you're looking foward to [generally speaking].

The removal of these extra transactions, and insurance acting only as "rent seeking behavior", will be a GREAT step in the right direction.

I was told of a charming anecdote about someone who was injured in France. They were traveling as tourist there. It was a minor injury, and when they were leaving to pay, they asked how much this service costed. The hospital staff replied, "I literally don't even have a way to accept your money. I.e no cash register or card swiper". <---- I know this could invite some exploitation, but i don't imagine it would amount to anything substantial.

[LivingAlmostLarge]

44 million Americans are on Medicare. 72 million Americans are on Medicaid. 10 million are on Tricare, the military plan. That's 126 million out of 328 million, so over 38% of us are already on a government insurance plan.

Roughly 20% of the population is 50-64 so if they drop the Medicare age to 50, you'd now have about 58% of folks on a government plan. Transitioning the other 40% wouldn't be as monumental a task as it might initially seem. Maybe they do it gradually over a decade, each year lowering the eligibility age by another 5 years so that after 10 years, the age will have dropped from 50 to 0 and everyone will be covered.

It's been suggested if you enrolled everyone on Medicare 0-18 and kept enrolling them and dropped the age to 50 we would be into completely disconnecting employment with medical care within a decade. There would only be a small group of people who would be covered by employer provided coverage. I mean really you can keep your children on your insurance until age 26? I see so many clients doing that and their "KIDS" are working full time and married!!! But they don't "check" if they kids are "students". No they just keep paying for the family plan.

Jennjenn and everyone else who doesn't want socialized single payer system, what system do you propose? The US has the worse outcomes for the most money and it's becoming more apparent now. We need to decouple insurance with employment. I"m hoping that the unemployment takes a toll and causes another look at expanding medicare for all.

Like i said my neighbor was riffed January 2020 from her job. She provided medical for her husband and 3 kids. Her husband is a contractor. He is still a contractor and they are on her medical until September 2020. Then they can buy cobra for $1500/month for family of 5. They are doing cobra because it's likely cheaper than anywhere else. So her husband works and is looking for a job with benefits. But he's not been able to land one. So he's been contracting.

In less than 6 months if he loses his job, which was a possibility and they are still praying he doesn't they might even consider going without insurance for them and medicaid for the kids.

[disneysteve]

It's been suggested if you enrolled everyone on Medicare 0-18 and kept enrolling them and dropped the age to 50 we would be into completely disconnecting employment with medical care within a decade. There would only be a small group of people who would be covered by employer provided coverage. I mean really you can keep your children on your insurance until age 26? I see so many clients doing that and their "KIDS" are working full time and married!!! But they don't "check" if they kids are "students". No they just keep paying for the family plan.

You don't have to be a student. I think that was the old rule when it was 23 but now it's just 26 no matter what. Our daughter is 24 and on our plan and I intend to keep her on it until she turns 26. Once she has to buy her own coverage it will be a lot more expensive (plus it almost certainly won't cover her therapy).

From hhs.gov:

Children can join or remain on a parent's plan even if they are:

• Married
• Not living with their parents
• Attending school
• Not financially dependent on their parents
• Eligible to enroll in their employer’s plan

[LivingAlmostLarge]

You don't have to be a student. I think that was the old rule when it was 23 but now it's just 26 no matter what. Our daughter is 24 and on our plan and I intend to keep her on it until she turns 26. Once she has to buy her own coverage it will be a lot more expensive (plus it almost certainly won't cover her therapy).

From hhs.gov:

Children can join or remain on a parent's plan even if they are:

• Married
• Not living with their parents
• Attending school
• Not financially dependent on their parents
• Eligible to enroll in their employer’s plan

So um how is being on your "parents" plan until 26? So if you have children before age 26 then your parents will support their grandchildren on their plan until 26 and the you keep grandchildren on until 26? I'm sorry but this is turning insane instead of a universal health care.