I was thinking about this when reading this thread.
When I hear people express opposition to health care reform, I’m not sure whether they are opposed to the very idea of health care reform, or instead, to the specific proposals that have been offered. I have pretty good insurance - Blue Cross - but am regularly surprised at how complicated it is to find if something is covered. And year after year it seems like copays and premiums continue to rise, and services continue to be dropped. Things were worse under HMOs I was previously in.
So I am just kind of curious, who is completely pleased with their health insurance coverage, thinking they get excellent value for their money, and are unable to identify any way that their insurance - or the manner in which health care is provided in the US - could be improved?
Second question - millions of Americans do not have health insurance. Are you fine with that? Is the best possible system for them to receive their health care in public clinics and emergency rooms? If not, do you have specific recommendations for how they can be given access to basic health care?
I’m not pleased with Kaiser medical. None of their doctors are people I’d have picked on my own. Some I simply avoid, because I’ve looked them up before getting an appointment. They have a bunch of chiropractors and herbalists and probably acupuncturists and phrenologists on staff. Who needs a quack with a certificate from that med school in Grenada?
Beats what I had when I was self-employed, which was crossed fingers. So I’m supposed to feel grateful. I’m still crossing my fingers.
I don’t have any problems with my health insurance itself, a United Health PPO. I can see whoever I want and they have never denied any treatment and I am not sure there is a good way for them to because it is a PPO and not an HMO. It is very expensive however. I personally pay about $700 a month for it since I got laid off and my former employer is still covering the other half. Still, it isn’t really possible for me to get a bad deal financially because me and my family tend to run up absurd medical expenses just due to bad luck and other things. I get the statements from them saying “THIS IS NOT A BILL” with many tens of thousands of charges that they had to pay out on our behalf and I never hear anything more about it.
I get decent coverage (in my opinion) because my wife works for a hospital and gets a Blue Cross HMO program through there. The insurance I had through my own job was pretty terrible and each time they changed it, they replaced it with something equally lousy.
I’m all for a public option. My wife’s hospital is choking on uninsured, low-income patients who use the emergency room as their basic care and then walk away form the bills.
All this, except I am a government employee and therefore get it for $60 a month. Needless to say, I love it and have no problem with it, but I’m one of those pesky outliers.
I was very happy with my coverage for many years. Most everything was paid, my share was manageable, and I never had to jump through crazy hoops and fill out and return the same stupid forms over and over again.
The insurance I’ve had for the last two years is pretty much a nightmare for me. The current company automatically rejects every one of my claims the first time, sends me the same form to fill out every time I get any kind of medical treatment or visit (asking about information that hasn’t changed and is very unlikely to change), and the people who work there all tell me different, contradictory things, most of which don’t make sense. I am an expensive patient, and like most businesses, they are trying to do what would be smart for them…stop doing business with me 'cause I cost way more than I pay in premiums.
The first insurance was Medicare. The current insurance is through a private company that I have referred to as “Untied” in previous threads.
It might be more informative to ask people if they have a lot of health claims, also, to see if there’s any correlation between satisfaction with insurance and number of claims.
BTW, I am making no general claims from all this; just relating my own experience.
Forgot to add: I pay WAY more in co-pays and uncovered expenses now than I did under Medicare. Sometimes I pay them even when I could mebbe get Untied to pay more, just because I want my doctors to get paid and I am unable to spend any more effort with Untied.
Is this typical expense, can anyone tell me? Since something like half of all households in this country make less than 50 something thousand per year, how is it even possible to think that the average American could afford to buy private insurance?
Seems like $700 per month per employee is quite a burden for businesses, too.
I am at heart a political/fiscal conservative, but I just don’t see that our current healthcare model could possibly work. It just doesn’t make sense.
no health ***insurance ***!= no access health care
If i don’t have health insurance, I’m not banned from scheduling an appointment for a flu shot, or from getting a broken arm set. It’s just that the clinic will bill me directly rather than my insurance company.
Heck, I can even buy prescription medicine from Walgreens without insurance.
I guess this gets to at least a portion of my personal dissatisfaction. I feel that I experience hassles and uncertainty even with respect to relatively routine and “inexpensive” (at least as far as health care procedures go) claims. If I were getting organ transplants or services that significantly exceeded my contributions, I’m sure I’d feel I was getting a great deal. Instead, my kid goes in to have a wart frozen off, and I have to paid as it is an elective cosmetic procedure. Or I have to bear the full freight of several hundred $ each to get my girls Guardasil injections, to reduce their chances of developing cervical cancer. Just a couple of minor examples.
I pay way less than $700/mo for coverage for my family of 5.
This is a very good point. I fear one of the problems with universal coverage is that recipients do not have to make cost-benefit decisions as to the amount of care they want. Instead, everyone thinks they are entitled to gold-plated service for the most minor ills.
Unfortunately, the flip side is that the current system may cause people to choose to forego preventative care, thereby creating greater costs down the line. Another issue - the costs of the same health care varies greatly for different people depending on whether they have insurance and, if they do, what type.
A complex issue indeed. And I am not a rabid supporter of all the proposals I have heard. I just am surprised when I hear people speak as tho our current system could not be improved upon.
My former employer was a major benefits administration outsourcing company so I always knew the real numbers off of the top of my head but it varies by plan and company. The total cost for a PPO family plan is about $1100 - $1300 a month with the employer picking up most of it. Figure a $350 a month employee contribution for a family plan. If you get laid off, you still get to keep your health plan under federal COBRA laws but you may have to pick up the full tab which is cost prohibitive for most people and may even exceed their mortgage which isn’t good for someone that just lost their job. Some companies subsidize that for a while but you still pay more than you were paying before.
That is for top of the line health insurance care however with few holds barred. There are much cheaper options like health savings accounts if you assume that you won’t have any major medical problems. HMO’s are a little less expensive but I never thought those were worth it unless you luck out on the right group of doctors.
For families like mine who have been unfortunate enough to have all kinds of incredibly expensive medical problems happen in a short time, it is the best deal in the world. You can have whatever you want, from whoever you want, whenever you want. That it why it is called “insurance” and not a savings account.
It’s very odd to see a first world country still link health care cover so closely to employment. It’s like Feudalism.
Another thing I don’t understand is how you think your employer pays for much of your cover when surely the financial reality is you get paid less because of the cover. It’s like being gratful for something you pay for.
The other thing I don’t get is why, with all the US networks having offices in London, why one of them hasn’t done a live link up with an NHS emergency department or hospital with interviews with patients and staff. That way all the political filtering and propaganda gets set aside and real people talk abut real experiences. That’s what you’d expect UK broadcasters to do in the reverse situation, anyway.
I guess the more parochially its set the better controlled is the debate.
I have a United Healtcare PPO plan through work. They have been extremely efficient for my admittedly paltry medical needs (OBGYN visits, two PCP visits for a nasty bronchitis that didn’t respond the first time to antibiotics). Additionally, when I was seeing a psychiatrist (long story, didn’t really need it), it was covered through an outside company. That was much, much less efficient, especially when it came to therapy (one therapist in two towns over 100K? Really?). But, in the end, it covered everything beautifully.
The one weird thing was when I had a cyst removed from my forehead. It was benign; in fact, the doctor said so when she took it out, because, really, it only took her a second’s look. She was even pretty damn sure beforehand. And yet, she said she had to send it out for biopsy, because otherwise it would be classified as cosmetic, and therefore not covered.
Yeah. A cyst the size of a dime in my forehead. Right.
Regardless, I have excellent health care coverage. I give them 20 bucks, and they fix it. And I think everyone else should, too, so I’m more than okay with reform.
That is a good point but the key factor is Group Health Insurance. People with serious medical conditions that can’t buy affordable insurance insurance on their own often have to find an employer that offers the same rates to everyone. It is a minor form of socialism because the 23 year old marathon runner subsidizes the 60 year old in need of a heart transplant but that is just the way things are set up in the U.S.
There is one level above a good PPO if you are willing to pay for it. It is called a Boutique Medical plan and costs about $3000 per year on top of your regular medical insurance. You always get preferential treatment including guaranteed same day appointments and physician contact on demand 24/7/365 plus preferential treatment for none life-threatening emergences . I have considered getting it myself but my own doctors are so competent that I usually get most of things anyway. You can easily get the the best medical care in the world in the U.S. if you are willing to pony up the cash for it.
I can’t say whether or not I’m pleased with my current insurance because I haven’t used it. I’m happy to not be running completely uninsured like I was in grad school (the insurance offered to grad students was so lousy I decided I was better off with the $40 a month for other things like food) but I’ve yet to use any of it since I got a job with insurance. On paper I’m happy with the insurance plan but since I’ve yet to use it I can’t really say anything.
Well, I have used my insurance for new glasses (I wore the same pair for about 5 years until I got new glasses a few months ago) but the bulk of that purchase was financed by my HSA option. I should really actually use my dental insurance and get my teeth looked at (something else that hasn’t been done in several years due to grad school) but I just keep not doing it.
I’m lucky in that I’m male, I’m 27, and I have no preexisting conditions. Honestly, if my current job did not offer insurance, I’d probably still be uninsured because I doubt that I’d be able to afford it.
It’s OK. I work for US county GOV, and it is slowly melting away. Premiums up every year co-pay and deductible up every year. Coverage is mostly the same, we just pay more for it.
What I don’t like is the complexity of the billing system. Every provider has a completly different way of handling things. Part of the big problem of the mess is the money we get charged just for managing the billing. It really needs to be standardized.
So far, I’m happy with the coverage my health insurance has provided. I have Golden Rule, which is a subsidiary of United Health. I’ve had the chance to test it this year to the tune of many thousands of dollars, and aside from a few tests done at out-of-network providers, they’ve covered everything with no hassles. That includes quite a few things that I’ve heard people have a lot of trouble getting covered.
The price, on the other hand, I’m not all that happy about. Currently I pay $5160/year for coverage for me and the hubby; once we hit our $3850 deductible in a year, it covers 100% of everything (doctor visits, prescriptions, lab tests, etc). So that works out to about $9K/year total, as we will meet our deductible every year from now on out.
Even that isn’t that bad, if it stayed there. We’re self-employed, so we don’t expect health care to be free, it’s part of our business expenses. But the yearly premiums have gone up about $1000/year for the two years we’ve had it; that’s a pretty crazy rate of increase. At some point, it will get unmanageable unless it evens out. And I have no hope that it really will even out without some sort of reform.
I called and asked them about the increases once, trying to find out how many times a year I can expect an increase. The answer? “Whenever we feel like it.” Great.
Oh, and because of medical problems, we’re stuck with it. We can’t shop around for another more reasonable plan, because I’m uninsurable with my current health issues. Which are very manageable and I have under control, but that means nothing to the health insurance underwriters.
I get confused with all the labels; socialism, capitalism, what appears to me to be a form of Feudalism.
They actually becomes slogans, invoking a kind of tribal loyalty. And somewhere in all that the practical issue of how best to provide decent health care for a population gets lost.
I really don’t understand why the masses aren’t embracing the opportunity to uncouple healthcare from employment, the rest of the developed world did it 50-100 years ago. In all that time not one of the 20 or so other developeed countries has voted to adopt a US style model - that must be a couple of hundred elections across 20 distinct cultures.