Auto service and medicine

[labman]

Well the bills are still trickling in from my stent installation last month. A couple of threads here lately have left me wondering if the whole medical thing is much like the sheep that take their car to the stealership when the owners' manual says and nod yes to all the service writer's questions. Is it a good idea anytime to allow the provider to decide what is done? The country is going broke paying for our medical care. I hope we can skirt the question of how we should pay for it and avoid one more thread locked for politics.

Of course paying for it is central to my question. It is like the thread here where the kid could buy what ever oil he wanted to at Walmart on his dad's credit card. Any real reason not to do 3K/3 month with M1 and a Mobil or TG filter? So it is for many with good insurance plans. But somebody pays for that.

Now I think most of us in the real world look for ways to get the job done right using as little resources as needed to do it right. After all, how many times has it been posted here that a certain filter is the best bang for the buck? Should the medical establishment be completely exempt from such pressures?

Part of this is thinking about returning to cardiac rehab on Monday. I didn't have a heart attack. I have frequently done vigorous activity without chest pain or other symptoms. My service interval came up late last year and I had a bad UOA, er I mean high blood pressure and cholesterol. My doctor also seemed disturbed that a 66 year old wasn't on any prescriptions. (Yes Virginia, the prescribing doctor does get a cut of the outrageous prescription prices and maybe even the referring one.) So it was off to the shop, I mean heart specialist for more tests. After the stent, I was told I needed rehab. When I asked why, I was told my insurance would pay for it. I haven't been told what the goal is, what I should accomplish, or anything else. Maybe it is just an Italian tune up. Why don't I just stay home and take care of some jobs such as getting the natural gas line run for my generator?

Forbes magazine is pushing health saving accounts. You, or somebody else, fund it with pre tax dollars. You own the account and are free to spend it on the medical care you think you need, medical, dental, eye care, even hearing aids usually not covered otherwise. The idea is if you are spending your own money, maybe it will bring some discipline ship to the current lots more where that came from.

 

[tomcat27]

I agree - the last time I was in the e-room, I knew what was wrong with me - yet they insisted on running unneccesary tests. probably just to cover their tail. I even have medical training - used to be a licensed paramedic. It was refreshing to have a coworker explain how he negotiated through the testing that was done on his wife - eliminating needless tests - but getting alot of resistance from the hospital

 

[AdRock]

So many people these days are sue happy. Hospitals are paranoid about covering their butt. So they run all kinds of tests. If I had the liability that they do I would probably do the same thing.

 

[labman]

Yes, malpractice suits add to the problems. Yet, I feel the stunt of doing a catheterization and then when I had the suspected blockage, having to haul me to a different hospital for the stent added to the risk as well as the expense. Why did they start something they knew there was a good chance they couldn't finish there?

 

[ddrumman2004]

My brother-in-law,age 52, had a mild heart attack and had to have 3 stents put in his chest and was home the same day....no rehab ever mentioned.

That could be due to the fact that he is on state Medicaid and has no kind of insurance.

 

[Gary Allan]

Quote:
Forbes magazine is pushing health saving accounts. You, or somebody else, fund it with pre tax dollars. You own the account and are free to spend it on the medical care you think you need, medical, dental, eye care, even hearing aids usually not covered otherwise. The idea is if you are spending your own money, maybe it will bring some discipline ship to the current lots more where that came from.


No it won't do anything to lower the cost of medicine.

I pay copays for services. These were to take care of all the documentation and clerical issues associated with physicians services. It was designed to isolate those costs and liberate the physician/facility fee structure.

All it ended up doing is growing to the point where you're now paying $300/hour for your physician PLUS $100/hour for them billing your insurance.

It would be like your local township or borough announcing a "shift" from 100% property taxes toward earned income taxes. They would eventually be dual taxes and the maximum that they could manage.

With savings accounts the (non) market would just adjust to soak that up too. What Forbes left out is that the patient would be the one determining what the appropriate value was delivered for their medical savings $$$. That's still in the home court of doctors, lawyers, and accountants. They all determine what they deserve or can get access to.

I cannot afford to use my wife's insurance. I'm sure that I should ..even if I adjust for the "service writer" she devil that calls herself a doctor and minimize her sector and self serving nonsense.

 

[labman]

Originally Posted By: ddrumman2004
My brother-in-law,age 52, had a mild heart attack and had to have 3 stents put in his chest and was home the same day....no rehab ever mentioned.

That could be due to the fact that he is on state Medicaid and has no kind of insurance.


Or could it be the hospital hasn't bought a bunch of treadmills and stationary bicycles? Medicaid likely would pay for it if prescribed.

 

[labman]

That is part of the beauty of the health savings account. You get the bill and write a check. No administrative overhead.

 

[Gary Allan]

Originally Posted By: labman
That is part of the beauty of the health savings account. You get the bill and write a check. No administrative overhead.


I must be ignorant of the Forbes conceptual plan. I imagine it will go like this.

First year:

Bill $5000
Insurance (of whatever kind) $4500
Balance to be paid by the end user to pay with whatever means available be it sheltered medical savings account of just out of the same pocket not sheltered.

Second year for same services:

Bill $7500
Insurance of all kinds: $4000
Balance to be paid by the end user by whatever means available.

Third year for same services:

Bill $9300
Insurance of any and all kinds $3000
Balance to be paid by end user by any means.

..or is this Forbes conceptual plan going to allow your medical needs to always fall into whatever the maximum that you'll be allowed to sequester for medical needs?

Somehow I don't think so. The sector will just be enabled to reach even higher to assure that this engineered money falls into their hands.

To control/reduce costs you need to dismantle the insurance industry. Without that captive audience paying all the bills, they cannot continue to remain non-competitive with each other.

 

[crinkles]

my vasectomy is going to cost $300 at the GP down the road.

Medicare gives me back $115.

He said the majority of his costs are his malpractice ensurance fees.

More than the net cost to me of $185 is insurance so that if i sued him because i lost my "function" if he messes it up!.

Edit: it is more expensive for my labrador to get sterilised at the vets, than it is for me to get the nick...

 

[Shannow]

crinkles, he's tugging you chain (no pun intended).

They petitioned for tort reform years ago to reduce the costs of their insuraces.

Now you need to be 15% permanently disabled (and down there doesn't count) for you to get anything.

Lady with a set of scissors left in her during surgery is entitled to get them out gratis...that's all.

I know people who have seen manslaughter on the operating table, and the doctors get away scott free, often without any questions being asked.

 

[kb01]

Originally Posted By: labman


Forbes magazine is pushing health saving accounts. You, or somebody else, fund it with pre tax dollars. You own the account and are free to spend it on the medical care you think you need, medical, dental, eye care, even hearing aids usually not covered otherwise. The idea is if you are spending your own money, maybe it will bring some discipline ship to the current lots more where that came from.


I have a HSA and am very happy with it. They came out of the health care reform of 2003 & 2004.

The IRS has a list of items that you can use your funds on (it's a very generous list and includes things like OTC drugs, prenatal vitamins, etc.). I try to maximize my contributions, as (once you reach a certain threshold) it can be invested tax free in mutual funds and can eventually be rolled over into an IRA.

The ultimate flaw in HSAs, is that when it comes down to it, the HDHP plans they are coupled with have the same problems as traditional PPO/HMOs. There's no way to know how much, in advance, a medical procedure is going to cost, as providers don't give estimates. You also just pay whatever the standard BC/[censored] negotiated rate is. The only real difference between a HDHP and a PPO/HMO is that instead of dealing with copays, out-of-pocket maximums, etc. is that you pay 100% of costs for everything until you hit your deductible.

 

[kb01]

Originally Posted By: labman
That is part of the beauty of the health savings account. You get the bill and write a check. No administrative overhead.


That's not how HSA plans work. An HSA/HDHP has all of the overhead of a traditional PPO or HMO.

By law, to have an HSA you must also have a HDHP (high deductible health plan) associated with it. When you see a doctor, it's handled like regular insurance. The provider sends a bill to the insurer; the insurer responds to the provider stating the negotiated rate and tells the provider to bill the patient directly. The doctor then sends you a bill with the reduced, negotiated rate. You finally write a check that pays the provider from your HSA. It works like this until you hit your deductible and then your insurer pays 100%.

I think you're thinking of a Health Spending Account aka "Cafeteria Plan", which can be used w/out an associated insurance plan. But the HUGE downside of those is that you forfeit any unused funds at the end of the year.

 

[eljefino]

So there are two radically differently working accounts with the same "HSA" initials? Lovely.

 

[kb01]

Originally Posted By: eljefino
So there are two radically differently working accounts with the same "HSA" initials? Lovely.


Yeah, that sounds about right for the government.

And to further complicate things, if you have a Health Savings Account, you can't have a Health Spending Account too. This can turn into a pain for those with kids, as childcare can be paid for via a spending account but not a savings account.

 

[CivicFan]

You can discourage health care spending by high deductible plans that come with HSA-s but it may result in foregoing necessary care and multiplied health care costs in the future. for example, you may choose to ignore a health issue because it is going to cost you money and delay seeking care in the hopes of the condition disappearing. But it usually does not disappear - health issues have this nasty tendency to get worse.

Generally, it's easier and cheaper to cure a condition when it's new rather than wait until it becomes a major issue. For an illustration, think of cancer - while stage 1 or 2 cancers can be treated, stage 3 or 4 usually result in very short life expectancy and delay of death with high cost chemotherapy, radiation therapy and surgery.


As a rule of thumb, preventative health care such as regular exams and such are far cheaper than treating a condition. High deductible schemes like high co-pays and co-insurance discourage this kind of care and in the long run are far more costly. The hope these private insurers have is that the enrolee will somehow reach the age for Medicare and then will be the government's problem, not theirs.

 

[Vikas]

Car insurance, home insurance works because not all cars get totaled or get in to accidents over their life. Same is true with the houses.

On the other hand, if you are talking about over the hill population (say above age of 50), they all are going to get sick and would need the medical care which unfortunately costs quite a lot in this country. For example, a heart surgery might be pushing half million dollar total. If we are going to pay for our own medical, not many people have half million dollars in their checking account *EVEN* if it was pre-taxed Now, if that heart surgery can be done under $5000, I am all for the Forbes plan.

- Vikas

 

[kb01]

Originally Posted By: CivicFan
You can discourage health care spending by high deductible plans that come with HSA-s but it may result in foregoing necessary care and multiplied health care costs in the future. for example, you may choose to ignore a health issue because it is going to cost you money and delay seeking care in the hopes of the condition disappearing. But it usually does not disappear - health issues have this nasty tendency to get worse.


I'm not sure if it's the case with all plans but with mine (Bluecross), the insurer will pay for preventative care regardless of the deductible.

But you're absolutely correct that it's easy for people to forgo care when they're paying out of pocket. For an HSA/HDHP to work effectively, you really need a year or two without getting sick or injured. Once you get a few thousand saved up in an HSA, a few $80 doctor visits are painless financially, especially when you factor in how much you're saving vs. a PPO. Unfortunately, I have several coworkers who just pocket the difference and grossly underfund their HSAs.