Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[moltenmetal]

Contrary to davefitz's assertion, if you travel outside Canada deliberately to jump the local queue, you can't claim any of that money back from the public system. You want to short-circuit the queue for a hip or knee replacement or "liberation therapy" for MS, then YOU pay the whole shot. Here, the queue is determined by the nature of the therapy (i.e. "liberation therapy" is not covered because there is no conclusive evidence that it is effective), and your medical need as determined by doctors.

Medical tourism exists, for sure. But as cheap as hospitals can be in India etc., it's not a major cost saver for the system right now. The vast majority of healthcare needs are met by the local publicly-insured system.

Where the local system saves plenty of dollars and also keeps wait lists shorter is by providing the opportunity for people to get tests (primarily) done faster if they choose to travel to a MRI machine across the border. In that case you pay the travel but the public system pays for the test. Sometimes they pay for the travel too, if the local machines are clogged and there's a medical emergency requiring a test ASAP. The public system doesn't therefore have to build spare MRI capacity so it can sit idle most of the time so it's there to provide fast access during peak demand periods, i.e. the public system is taking advantage of the excesses of the US system to be efficient and keep its own costs low. Having a neighbour who spends an extra 7% of GDP on excess capacity that sits idle most of the time, definitely has its benefits!

BTW for every person going south of the border for a MRI, there are probably two retiree Americans going north of the border to load up on low price pharmaceuticals which are low price precisely BECAUSE the public system here negotiated bulk purchase pricing for us collectively from the pharma companies. So that border goes both ways, folks.

I forgot to mention the obvious- my friends who run the mobile medical imaging business are in the US. Here they would likely not have a business at all, or it would be a niche private business at most.

 

[IRstuff]

Part of the reason US medical costs are so high is that the uninsured go to county hospital emergency rooms that are required to treat them regardless of insurance, thereby jacking up the cost of what might be a routine visit to a family doctor into a emergency room visit that's about 5x higher in cost. There are additional side effects of this system:
> Because of the lack of insurance, these people wait until their illness get so bad that that they have to go to the ER
> Which further jacks up the cost of what might have been a trivial thing to treat at an earlier time
> This delay in treatment has the potential of getting other people sick, who may, or may not, have insurance. In either case, more people get sick than is necessary
> The additional demand on ER resources means that critically ill patients wind up competing with those that shouldn't have had to go to the ER for those resources
> This further means that county ERs have to have additional staffing to treat all the extra patients

And, we pay for all of that through property or other taxes. In effect, we are creating a single payer system with a guaranteed poor outcome, because we pay for those services at ER rates, and have to spend even more because the patients are sicker than they could have been had they had insurance.

The bottom line is that those that have insurance are still paying for the uninsured, and the rates that we pay are higher because non-county hospitals are likewise building in operating margin to cover the non-paying patients. My son stayed in the hospital for 2 days for pneumonia and the "bill" as $10k, which is an insane amount of money.

TTFN
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[CELinOttawa]

Molten: Depends and varies province by province. While I lived in NZ I was covered by OHIP (Ontario) for three years... Newfoundland refunds US treatments up to their local payment rate AND treats all dental up to the age of 18 (excluding orthodontics).

 

[davefitz]

The post starts with a statement that TBONEBANJO pays annually $12,500 USD + deductables for a family's health insurance. That sounds normal . If a family, or a single mom, happens to be earning less than $40K per annum ( so-called "working poor") or is unemployed , certainly they will not be able to afford such health insurance, and may even qualify for Medicare/Medicaid. Unfortunately, in most of the US it is nearly impossible to find a doctor to accept a new patient whose payment method is Medicaid/ medicare. As a direct result of this issue, many less fortunate persons who cannot afford insurance also cannot get prompt attention from a doctor unless they use the ER room. The belated realization of this conundrum seems to be the rationale for Obamacare.

I have a cabin just south of the US-Canada border, and a few years ago (2005) found an elderly man hitch-hiking on the side of the road. I asked him where he was expecting to go, and he indicated he just crossed the border from Canada, and needed to get to the US hospital in Bellingham, Washington state ( 30 miles away). When I asked him why he doesn't use the Canadian facilities in Abbotsford or Vancouver, he replied" I am 70 yrs old , and they found I have brain tumor , and that they can schedule the operation in Canada after a 2 yr waiting period . There is no way I will survive 2 yrs with this tumor, so I will have it removed in Bellingham , where they will backcharge Canada Health".

"Whom the gods would destroy, they first make mad "

 

[moltenmetal]

Obviously must vary province by province. Here in Ontario, if you are sick outside of your home province, you get enough care to get you stable enough to transport home, and even that coverage is limited. CELinOttawa, your experience was from a different era...Medical services obtained out of province in Canada, much less out of country, must be pre-approved or there'll be no payment from OHIP for you!

http://www.health.gov.on.ca/en/public/publications/ohip/travel.aspx

 

[Tunalover]

Where is all the money going in the US? Who is benefiting most from the procedure-by-procedure, test-by-test medicine being dispensed? Where's all that money going? Obviously the healthcare providers and the insurance companies! I took my son into the dermatologist for his severe acne and to have a wart removed. The PA (not an MD) concluded he needed Accutane and then used a liquid nitrogen gun to freeze the wart. Total time = 20min. Our cost = $180 US (and that's with the insurance company discount). That's $540/hr for someone who isn't even an MD! I called the insurance company and they said that they have agreed to reimburse PAs at the same rate as MDs! Obviously the insurance companies and healthcare providers are in cahoots to milk the consumer of as much of his cash as possible!


Tunalover

 

[IRstuff]

"Obviously the healthcare providers and the insurance companies!"

Please distinguish between family doctors, surgeons, and hospitals. My wife is the former, and spends about ~20 minutes per patient doing charts, for which there is there no billable, yet, the billables must cover her time spent, so she sees fewer patients. That means that she spends about 10 hrs a week just doing charts, and only 30 hours seeing patients. Refills, referrals, medical excuse forms, etc., are also not billable, and must also be accounted for in the actual revenue stream, as are the MAs answering the phones, and doing the routine stuff. So, for those that can pay with PPO, the rates have to cover this. Medicare is generally very skimpy, and she basically loses money seeing those patients, so she declines to see those.

TTFN
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[Tunalover]

IRStuff-
Not so much the hospitals as the doctors. The hospitals have so many other tasks that aren't billable plus they have to somehow stay afloat in spite of the many uninsured/under-insured clogging the ERs. Granted the doctors have costs to bear besides a PA providing 20min of services, but there is no excuse for a rate of $540/hr for someone who isn't even an MD.


Tunalover

 

[CELinOttawa]

Looks like you're right Molten... Times have changed. Also, while Newfoundland still reimburses for out of Province and Country, their coverage for Dental has dropped to 12 years of age and under, this *with* a co-pay. Given the amount of financial hardship in that province, such a co-pay would likely be denying coverage to the majority. Sigh/Tear.

 

[KENAT]

tunalover, you realize the PA isn't getting that $540/hr an hour in his check right? That $540/hr includes a whole bunch of overhead be it paying for the building, the equipment in the building, the receptionist, the billing person, the one that weighs you on the way in, liability insurance, taxes, the supervising physicians cut ... Plus, given that there was probably some time spent before or after your visit on updating the charts etc. then even $540 may not be an accurate number for the time the provider spent on your sons visit.

Don't get me wrong, I happen to think that MD or not $540/hr seems excessive for the actual services you received but you make it sound the like the PA is pocketing the cash.

Posting guidelines faq731-376

http://eng-tips.com/market.cfm?

(probably not aimed specifically at you)
What is Engineering anyway: faq1088-1484​

 

[BiPolarMoment]

FWIW $400-500/hr is the market rate for surgeon consulting/time (e.g. product development).

[Source: I work in medical devices.]

 

[cranky108]

No matter what happens the wealthy will always be able to get good medical care. The question is what is wealthy? Do you drag the middle class into the class of the wealthy, or the class of the poor? Which makes more since? Healthy middle class or sick middle class?

The problem of the poor will always be a problem, that will only increase as the cost of living or the definition of poor keeps growing.

If you need a resource of doctors, all you need to do is look at the number of doctors doing nose and face jobs for people who diden't take care of there skin in the first place. You don't see many of these doctors doing charity work, or performing procedures for medicare.

Another resource of doctors that don't do much charity work is the ones next to the pot shops that issue medical pot cards (Making pot legal might reduce the number of these, but I don't wish to discuss it here).

The bottom line is money talks, and there are far too few free clinics, and the wait time of several hours is needed to keep the greedy out.

 

[IRstuff]

"Granted the doctors have costs to bear besides a PA providing 20min of services, but there is no excuse for a rate of $540/hr for someone who isn't even an MD."

All PAs, NPs, and MAs are technically under the direct supervision of the doctor who signs off on the charts and who pays for the liability insurance, and who is the one that gets sued if things go south. They get less than the 4 yrs of medical training, and ZERO residency training, and they're "ready" to do things that doctors are supposed to do. The risk and work content is still the same. The charts still need to be done or checked, by the doctor, as are any followups or telephone calls, etc. That's all part of the overhead of running the business, and specialists, like dermatologists, are billed out at higher rates than family doctors.

TTFN
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[urgross]

Two of the largest health care networks in the US are "socialized" medicine, if you count the DoD as one single health care provider network, and the VA as a separate. The USPHS could be added on top of that, as they have considerble amount of facilities availability and funding, as well as medical officers. Doesn't matter if your rich or poor, just as long as you can make it through the door. VA bene. Most recently, my father-in-law, whom lived in a rural area, needed extensive, intensive medical care. He called me from another state to help him transfer to the VA system. He, my mother-in-law, and I could all tell you once you get in the door, the care is first rate. Of course, you do have to be a Vet. A lot of motivation was shown from people wanting to treat our Vets with the respect, courtesy and best treatment possible, so not all motivation is financial.

 

[JohnRBaker]

And let's not forget Medicare, at least Parts A, B and D (but not including supplementals which are sold by private insurance companies). Also Medicaid in many states is a pure single-payer system. With an aging population (more people living past 65 when Medicare kicks in) as well as programs like the VA and the DoD, a larger percentage of Americans are already, or will soon be, getting their healthcare under a single-payer scheme. It would not be that big of a shift if the entire country were moved to something like the proposed 'Medicare Part E' since we're almost half-way there already. And if you want to look at it from purely taxpayer's point of view, we're even closer:

http://www.pnhp.org/resources/60-pe...dy-publicly-financed-enough-to-cover-everyone

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[Tunalover]

KENAT-
Of course I realize that the PA doesn't get that rate! The rate goes to the practice who probably pays the PA a $50-$70k annual salary or the least they can pay to get the PA to do the job, whatever that is.




Tunalover

 

[glass99]

Engineering school: Efficiency is the only thing which matters -> Result = Trans Atlantic Flight.

Medical school: The patient's wellbeing at any cost.-> Result = my HMO.

Solution: Let engineers run hospitals.

 

[JohnRBaker]

Your comment about HMO's is an interesting one as we just started to get the information that we will need when our open enrollment starts for choosing next year's benefit options. The first thing we were told was that the company was dropping all HMO options, as they state that they've simply priced themselves out of consideration. We will now have three basic plans to choose from, two high-deductable, lower payroll cost plans with a couple of different ways to set aside a combination of employee contributed tax-exempt dollars and company contributed taxable dollars to help offset the higher deductibles. The 3rd plan is a traditional PPO with smaller deductibles but higher payroll costs, with a smaller health care saving account funded only with tax-exempt dollars from the employee. Note that the deductibles and co-pays for the PPO will be going up from last year as well as the what will be taken from our payroll to pay for medical insurance (we won't learn what that will be until the open enrollment actually opens in a few weeks).

My wife and I are currently covered by the PPO plan and I'm assuming that we will continue with the PPO for next year, which will be my last before I retire and we move to Medicare starting in 2016 (I'll be 68 by then and my wife will be close to 70).

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[cranky108]

Another way to reduce costs is like what my company does, they have there own pharmacy, and clinic. No free loaders there.

And it just might come to pass that companies will have there own medical staff so they can avoid the free loader fees of the current medical system.

 

[Tunalover]

My wife, and RN, works for a health insurance company and our coverage has a lot to be desired: family deductible=$3400, max out of pocket for family=$6500, 20% copays after deductible is met. One would think that someone who works for a health insurance company would get stellar insurance, but NOOO!



Tunalover