Elephants and Jackasses...

When shit goes south in the health/injury department I soon am reminded of what is possibly the best thing about living here. I think about how my daughter spent her first two months in 24/7 intensive care (plus one more week in NN care) and it cost a total of about $22 when it was all done (if you don’t include the highway robbery that is parking at St. Joseph’s hospital). Imagine how many digits that would have cost without coverage. I’d be poor until my death if we didn’t have what we have here.

 

No, it isn't. Sorry, I have to call bullshit. There is no healthcare plan in this country that blanket covers EVERYTHING at costs over $3k. That doesn't exist.

 

Makes sense. Us going to a hospital in their country makes us dread in the way that they would having to go to a hospital while in Mexico.

 

I never had to pay that, my jobs always covered it. But they don't charge that anymore anyways.

 

A lot of people up here take for granted that we never even have to think about a nightmare like that.

 

Yep, that's a $3k out of pocket max health insurance plan alright. Just one small caveat. Hardly anything that's actually expensive counts towards your out of pocket limit. They tell you on the first page (I assume because they are required by law) that you should be aware there are all kinds of services that don't count towards your deductible or out of pocket max, and that the plan is riddled with pre-authorization clauses - insurance speak for "Fuck you, we decided we're not letting you get that treatment. Also, if you ever receive medical services without getting our approval first we reserve the right not to pay any of it." Explained quite clearly here.

I have doubts those vetoes trend in the direction of what's in your best interest.

On the second page it tells you that all specialists visits, including those in-networks, will always come with a copay and never count towards your deductible. How useful do you really expect an emergency out of pocket limit plan to be if specialists don't count towards your limit? Who do you think provides emergency treatment for life threatening ailments like cancer and heart attacks? It's not the general practitioner.

Following this it outlines what you can expect with this insurance plan in an emergency situation. If you have to go to the ER you are automatically slapped with a $250 copay, and a 20% coinsurance for the ambulance. On average you're paying $450 just to get in the door, of which none is part of your out of pocket limit. Then, if you need treatment from a specialist, which you almost certainly will if your life is truly at risk, that also doesn't count towards your out of pocket limit. Oh, and double everything after the first day if your situation is severe enough you can't immediately be transferred to an in-network provider. Once you eventually get there your plan provides you with the privilege of haggling with your insurance company for pre-authorization every time you need treatment. If you need medication, that also doesn't count towards your out of pocket limit. To get anything out of the insurance plan for medication may require pre-authorization. If you're lucky enough to get approved those drugs better work fast, motherfucker. After 30-90 days, depending on the medication and assuming you get authorization what little help this plan does provide gets cut off.

It goes on and on. Take this however you want. I can promise that if this is what resembles your plan then the insurance plan you think you have and the insurance plan you actually have are very different things. There's no deep mystery as to why you are paying such a low premium for such a low out of pocket plan. Sorry, it's not because you're young and healthy.

 

EDIT: DOUBLE POST

 

Okay guys, how would we actually get the medical industry to bring down their prices here, though?

I know that people say that the government would have more "bargaining power," but have you ever seen what the government pays for things?
They're like a drunken roughneck on payday.

Also, if they did nut-up and tell the medical industry that they're going to have to take huge losses because they've been price-gouging for years, the medical industry is going to cry that the mean old government is going to put them in the poor-house, and probably try to challenge it on some sort of legal grounds.

I want M4A - or at least cheaper healthcare - more than anyone, but I can't see how that will actually get accomplished in this country, because our current system is so crooked.
It's not because we can't afford decent healthcare for all citizens, it's because the medical industry is so greedy.
Even if we cut budget in other places, I don't like the idea of those scum-fucks getting rich by price-gouging people who are already over a barrel.

They never should have been able to make profits off of healthcare to begin with.

 

I'm certainly not going to pretend to know the surefire path for getting there, but I think it at least starts with overturning citizens united, and mandating that federal elections be publicly funded. I don't see how we ever get anywhere on improving healthcare with a system that essentially amounts to legalized bribery.

 

Nearly half of psychiatrists in the United States don't take insurance. Not "they don't take Medicare/Medicaid because it's shitty government insurance," they don't take any insurance. You pay out of pocket and deal with your insurer on your own.

 

Saw a fantastic political bumper sticker today. “Any Mature Adult 2020”

 

Yes, yes they do. This is literally the function of the government. We vote for representatives based on two principles when it comes to taxation. One, these representatives will spend our taxes on matters we deem important. Two, the people we vote in ultimately control the rate in which the government collects taxes.

So how good is that hedge against catastrophe, really? Let's assume you take out a health insurance policy with an 80/20 coinsurance provision (which is most high deductible health plans like yours). The maximum deductible in 2020 for a single person is $6750, with a $6750 out-of-pocket maximum. In my state of Washington, this plan costs roughly $300 a month.

Unfortunately, you slipped and broke your ass in the shower and now require surgery that costs $40,000. Luckily, a friend of yours was able to decipher your tortured screams on the phone that you needed to go to a hospital, so they drove you to the ER instead of taking an ambulance that your plan probably doesn't cover.

Up until now, you've been pretty lucky, so you haven't needed to go to the hospital. This also means that you haven't met your deductible, so you have to pay the first $6,750 of the bill. After meeting your $6,750 deductible, you are then only responsible for 20% of the remaining $33,250, or $6650. Your insurance company will cover 80%, the remaining balance. The good news is that you've hit your out of pocket maximum, so when you slip and break your ass again, you won't have a deductible to worry about. Just the 20% of that $40,000 surgery.

So to recap, the total cost out of pocket cost of just surgery, is going to be $13,350. This does not include the cost of the hospital stay itself, the anesthesia for the surgery, no follow up care and no prescriptions to deal with the pain of recovering from having your ass cut open and reassembled, or antibiotics to prevent your ass from rotting from the inside out. You may still have to pay co-pays in addition to the 20% co-insurance payment for each physical therapy session so you can relearn how to walk.

With a M4A plan, you won't be paying a health insurance company $300 a month so they can throw you the equivalent of a Cheerio as a lifeline in the event of an emergency. You'd probably be paying more in taxes, but you also would never have to worry about an unexpected five figure medical debt that will require that you eat ramen and live in a shack in a shitty neighborhood for a few years so you can pay it off.

It's not a matter of if you'll be faced with a large, unexpected medical cost, but when. I won't even get into the societal positives of everybody having healthcare, but suffice it to say, a world in which everybody is healthy makes a fuckton of economic prosperity possible.

 

Obama's 'government healthcare' was specifically designed to appease insurance companies who didn't want the public option he campaigned on. You pay your premiums to them, not the government. There are some glaring failures written into that bill involving cost controls and risk pools, and how that offsets with the benefit of expanding American coverage is probably a worthwhile expansion, but using it as an example of why government healthcare can't work doesn't make much sense.

 

Why does a transfer necessitate shutting them out?