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RE: so what does US private healthcare cost? - 11/23/2008 7:00:20 AM   
Maya2001


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From: Woodstock ONT,CANADA
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quote:

ORIGINAL: NuevaVida


quote:

ORIGINAL: variation30

I don't know anybody who has no coverage at all. I don't think I've even heard any family/friends/friends' family ever having trouble with insurance. And I'm situated firmly in the middle class. I think only 15% of our population in the US is without health coverage. that doesn't seem too egregious to me.



Some interesting facts:
(from the National Coalition on Healthcare)


Who are the uninsured?

• Nearly 47 million Americans, or 16 percent of the population, were without health insurance in 2005, the latest government data available.1
• The number of uninsured rose 2.2 million between 2005 and 2006 and has increased by almost 9 million people since 2000.1
• The large majority of the uninsured (80 percent) are native or naturalized citizens.2
• The increase in the number of uninsured in 2006 was focused among working age adults. The percentage of working adults (18 to 64) who had no health coverage climbed from 19.7 percent in 2005 to 20.2 percent in 2006.1 Nearly 1.3 million full-time workers lost their health insurance in 2006.
• Nearly 90 million people - about one-third of the population below the age of 65 spent a portion of either 2006 or 2007 without health coverage.3
• Over 8 in 10 uninsured people come from working families - almost 70 percent from families with one or more full-time workers and 11 percent from families with part-time workers.2
• The percentage of people (workers and dependents) with employment-based health insurance has dropped from 70 percent in 1987 to 59 percent in 2006. This is the lowest level of employment-based insurance coverage in more than a decade.4, 5
• In 2005, nearly 15 percent of employees had no employer-sponsored health coverage available to them, either through their own job or through a family member.6
• In 2006, 37.7 million workers were uninsured because not all businesses offer health benefits, not all workers qualify for coverage and many employees cannot afford their share of the health insurance premium even when coverage is at their fingertips.1
• The number of uninsured children in 2006 was 8.7 million - or 11.7 percent of all children in the U.S.1 The number of children who are uninsured increased by nearly 610,000 in 2006, the second year that the number of uninsured children increased.
• Young adults (18-to-24 years old) remained the least likely of any age group to have health insurance in 2005 - 29.3 percent of this group did not have health insurance.1
• The percentage and the number of uninsured Hispanics increased to 34.1 percent and 15.3 million in 2006.1
• Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more.1 A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.




it explains why countries that have existing National Healthcare Systems are fighting to keep privatization out of the country ...in Canada we have a non profit healthcare insurance ..so there is no middle man so to speak pushing up the costs  like in a privatized system and that is why  it can also support those who may not be working for one reason or another...it also explains why US corporations  open companies in Canada or other countries that do have NHS as it lowers their operating costs.

and  the facts also spell out further problems  as the economic down turn worsens..companies that are fighting to survive are going to stop offering benefits,  there will be a growing number of unemployed... as a result the insurance companies who have lost a number of accounts will  start charging more  for existing accounts to maintain their profit margins   so what is 15% in 2007   could be 30% or more by 2010 and those that do have private insurance will be paying far more ... also in the US doctors end up billing the private insurance companies more ..because more time needs to be spent on paper work having to deal with so many different plans..so it increases actual health care costs and takes away the doctors time with patients and forces them to hire extra staff

Most of the delays many in the US  fear  ..related to stories about care ..is not so much related to having a NHS  but due to the Ontario government who stepped in and decided to put a cap on doctor wages which caused many doctors to become disgruntled and close offices here to move to the US or take an early retirement .. and after a while many who went to the US did return when they realized they are not going to make more money there and that  the insurance systems there was a greater pain in the ass  than anything they faced here.....because of the numbers of doctors that chose to retire early or moved ..it created major problems at the time.... but now things are back to normal and with the addition of Nurse Practicioners ( a registered nurse who goes back to school for additional training and  is just a step under a doctor and can make diagnosises and can prescribed most medications though for some more complicated health issues must consult or refer the patient to a doctor)  the system is now even better than it has ever been.  The number and types of testing I have undergone in the last 6 weeks with 3  new serious illnesses diagnosed in that time and the speed at which I have been referred and am getting into specialists has been amazing and even if I do need to wait a couple of  weeks or more to get into a specialist of my own ..I am provided with back up of the ER specialists to phone  if I have any problems or concerns  until I get in  so I am not left stranded.   When it came to a referral for my rheumatoid arithritis .....I told the doctor that I wanted to be referred  to a research hospital that specializes in the treatment of rheumatic and auto immune diseases so that I could have the latest and most up to date  service possible he could have referred me to a  doctor more local but had no problems with referring me to my choice as long as I okay with travelling farther to get there..which to me travelling 2 hours to get to one of the worlds best treatment facilities I felt was worth it ...
So even in a country with a national healthcare service were I live in a rural area I have some control of my healthcare and can request being  referred to the best services available outside of my local area as long as I am willing to absorb the costs of travelling ther...so it does not mean you have to settle for sub standard care.

In the US ..putting in place a NHS will cost far less than in Canada because of a higher population density  for the land mass so to maintain the same quality of service would cost possibly a third in taxes as what Canadians pay and since you are paying for a for profit insurance currently.... means if you switch to one  non profit healthcare insurance  the cost will be far less and every individual can have access to healthcare and more of your corporations would keep work in the US because it will become less costly to operate and that would help stimulate the economy bigtime


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RE: so what does US private healthcare cost? - 11/23/2008 10:29:12 AM   
NuevaVida


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quote:

ORIGINAL: Maya2001

it explains why countries that have existing National Healthcare Systems are fighting to keep privatization out of the country ...in Canada we have a non profit healthcare insurance ..so there is no middle man so to speak pushing up the costs  like in a privatized system and that is why  it can also support those who may not be working for one reason or another...it also explains why US corporations  open companies in Canada or other countries that do have NHS as it lowers their operating costs.


In my recent visit to Canada, I was shocked at how much goods and services were taxed. Even recreation was taxed. I asked why? "To pay for the NHS." I understand (but don't know for sure) that employment tax is higher, too. "To pay for the NHS."

My preference is to know my costs up front - this is what I will pay on a monthly basis - rather than being nickled & dimed every time I turn around. That's how I felt while there. It is also my understanding that the "middle man" in an NHS is the government system. Now that's a group of people I'd rather not be in charge of my health care.

quote:


and  the facts also spell out further problems  as the economic down turn worsens..companies that are fighting to survive are going to stop offering benefits,  there will be a growing number of unemployed... as a result the insurance companies who have lost a number of accounts will  start charging more  for existing accounts to maintain their profit margins   so what is 15% in 2007   could be 30% or more by 2010 and those that do have private insurance will be paying far more ... also in the US doctors end up billing the private insurance companies more ..because more time needs to be spent on paper work having to deal with so many different plans..so it increases actual health care costs and takes away the doctors time with patients and forces them to hire extra staff


Well that would be illegal. Companies over a certain number of employees are required to offer benefits. People who are unemployed as a result of a layoff are offered COBRA benefits (legal requirement to be offered). Yes, it's more expensive, but like Aileen said, it's a matter of priority. I give up other luxuries in life to pay for my insurance until my new employer insurance kicks in.

Outside of COBRA there is private insurance that people can apply for, which is much cheaper. That said, you can easily be rejected for it if you don't meet their criteria (which is why COBRA is so much more expensive - it's guaranteed).

quote:


So even in a country with a national healthcare service were I live in a rural area I have some control of my healthcare and can request being  referred to the best services available outside of my local area as long as I am willing to absorb the costs of travelling ther...so it does not mean you have to settle for sub standard care.

But not everyone has the option of traveling.

My mind keeps going to my uncle in Spain (who has an NSH), who was very ill with stomach and esophageal cancer. The hospital would not pay for his prolonged treatment and surgery because the survival rate of such a surgery was not high enough to warrant the expense. So he & his partner sold their business, sold a house, and gathered most of their savings, and paid for his surgery through a private practice - came to something like $300,000. Had they not done that, he'd have died that year, rather than 5 years later.

A friend's aunt was rejected for care in Canada for the same reason. That kind of stuff scares the crap out of me, to be honest. Once you have the government deciding who gets treated and who doesn't, based on a national statistic, well, that's not a society I prefer to live in.

I believe Seattle tried a state-wide managed care plan about 15 years ago. It became a plan of rationed health care, based on funds available and people who needed care. Scary stuff. But I don't live there - maybe someone who does can shed some light on that, and let me know if I'm wrong about that.

quote:


In the US ..putting in place a NHS will cost far less than in Canada because of a higher population density  for the land mass so to maintain the same quality of service would cost possibly a third in taxes as what Canadians pay and since you are paying for a for profit insurance currently.... means if you switch to one  non profit healthcare insurance  the cost will be far less and every individual can have access to healthcare and more of your corporations would keep work in the US because it will become less costly to operate and that would help stimulate the economy bigtime


But if most of the US citizens are covered through employers, why do we want to drop that coverage - and the ability to see who we want, when we want - to have our taxes raised and our services lowered? Personally, I don't.

While I'm in agreement that our health system needs a serious review, I am not convinced that handing it over to the same entity that runs our schools, our social security, and all the other mismanaged programs, is the way to go.

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RE: so what does US private healthcare cost? - 11/23/2008 11:08:39 AM   
meatcleaver


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quote:

ORIGINAL: NuevaVida


quote:

ORIGINAL: Maya2001

it explains why countries that have existing National Healthcare Systems are fighting to keep privatization out of the country ...in Canada we have a non profit healthcare insurance ..so there is no middle man so to speak pushing up the costs  like in a privatized system and that is why  it can also support those who may not be working for one reason or another...it also explains why US corporations  open companies in Canada or other countries that do have NHS as it lowers their operating costs.


In my recent visit to Canada, I was shocked at how much goods and services were taxed. Even recreation was taxed. I asked why? "To pay for the NHS." I understand (but don't know for sure) that employment tax is higher, too. "To pay for the NHS."



Canada spends 10% of its GDP on Healthcare, the USA 16%. While 70% of the cost of Canadian healthcare is made direct by the taxpayer, only 45% of US healthcare is met direct by the taxpayer. So Americans pay far more than Canadians, they just pay it out of their own pockets. But that is not news, everyone knows Americans pay more for their healthcare than anyone else in the developed world. The reason, private company profits.

< Message edited by meatcleaver -- 11/23/2008 11:09:24 AM >

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RE: so what does US private healthcare cost? - 11/23/2008 11:12:55 AM   
MidMichCowboy


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Status: offline 		The United States spends more per person and more as a percentage of GDP, yet we rank lower than almost all industrialized countries in amount and quality of heath care. That is a sad situation.

Non profit health insurance companies have an operating cost of 24 to 26 percent of the total premiums collected, while wastefully government agencies (Medicare and Medicaid) have operation costs of 2 to 3 percent.

Capitalism does not solve all problems. Government is not always wastefully and privatization is not always cheaper and better.

We need to re-examine what is the best way to provide health care in this country.

If we can reduce the cost burden on individuals, business and government, we can free up our country for true entrepreneurship.

We don't have to make money on everything.

http://www.commonwealthfund.org/chartcartcharts/chartcartcharts_show.htm?doc_id=727155

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RE: so what does US private healthcare cost? - 11/23/2008 11:53:08 AM   
moonvine


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Status: offline 		I'm unemployed and can't afford health care.  If I get sick, I'm just hosed.

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RE: so what does US private healthcare cost? - 11/23/2008 12:36:47 PM   
BlackPhx


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Joined: 11/8/2006
Status: offline 		Variation...actually the health insurance you were covered under is Government sponsored, it is only nominally Private, since your Mother was a Teacher. As it is government sponsored it is offered in the same pools and premiums as the rest of the state governments health insurance that includes, police officers, firemen, administrators, corrections, parks and maintenance people, and so on. The risk is spread across a much wider base than you would have working in the average company and the government itself regulates just how much can be charged as a premium absorbing the lions share of the premium. There are usually 2-6 different policies to choose from . In other words..We the tax payers are paying for most of the insurance that you the family member of a teacher was covered under, just the same as we contribute to the teachers salaries and student insurance as well as liability insurance for schools.

Rising health insurance costs and consistently devastating cuts in the  education budgets are making it harder for the Board of Education to meet the rising costs of insurance for teachers, and health insurance for teachers is no longer a guarantee; teachers in counties across the nation are searching for affordable health insurance.  Teachers across America are faced with the dilemma of either surrendering a higher wage to keep their health insurance or taking the higher wages and agreeing to pay larger percentage of health costs. Either way, educators are facing financial issues. As it is, we lose teachers yearly to the Private sector for jobs as cost of living raises are not keeping up with the cost of living, lending to classroom overcrowding and our children are suffering. The number of young people who are going into teaching is dropping year by year.

Money for School budgets except for Private Schools are taken from State taxes and subsidized by the Federal government. The pool that Teachers fall into under Medical Insurance covers the entire state and is contracted for and administered by the Board of Education. The majority of 4 year colleges have Student Health Services available that is included in the tuition and supplemental insurance available.
My husband just opted for a High Deductible plan in conjunction with an HSA. The reason, the other plans offered, while lower in Deductible, had much HIGHER premiums and covered less than we could spend the HSA on.

The last couple of years his employer has covered only 400$ of his insurance a month  and even with his contribution of 200$ a month the deductible was so high he ended up Paying for every office visit and benefited only in the prescriptions. None of the policies until now have offered dental or vision with this company.Basically the Insurance companies were paid money and never paid out anything for medical care..only prescriptions and those were few. A Net profit of 90% on my husband..I was not covered.
My coverage which is a Medicare Advantage Plan will this year cost me my medicare premium $96.40 a month, 69$ a month more in premium from me for a total of $165.40 a month out of an Disability income of 800$ leaving $634.60 a month to cover co-pays. I will  pay according to the following schedule:
10$ Primary and $25 Specialist,
$75 for any MRI's, CT's, PET scans, nuclear testing etc (thyroid, etc),
$150 ambulance and ER visit if needed (try driving with a  full blow asthma attack)
$250 a day for 1-5 day hospital stay,
$300 per out patient surgery,
15% on durable medical equipment and
$2-$40 per prescription unless it is a tier 4 drug then it is 33%,
eye exams are covered but not glasses and dental cleanings up to $60 (not likely to be found) but not treatments.

Gods forbid any of this has to be done outside of my county as I will bear the cost and then have to submit the bills and hope they pay something towards it.

Oh and lets not forget the Gap..after $2700 is reached in my prescriptions (easy to do when you have chronic health problems) I get to pay 100% of drugs on the tier 3-4 formulary and they will cover tier 1 & 2 until I reach $4,350 at which point they will cover the rest. Yes they will count any money paid my my husband through the HSA for prescriptions including glasses and durable equipment supplies to reach that initial gap. 
I am one of the fortunate ones..many of the Elderly reach the Medicare Gap halfway through the year. IF they are lucky their doctors will prescribe a double dose pill so they can split them and stretch their prescription dollar. 
I worked, in fact I was a workaholic. I worked to the point I broke my health and I am now trying to gain skills that will allow me to grow a business I can do from home. I am scared however that once I can get off disability, I won't be able to afford health care or even GET IT. When I first left my ex husbands health coverage, I tried to get private insurance, this was before the Medicare Advantage Plans became a mandate. They all but laughed in my face. I suspect it will be the same if I can get my business going.

Health insurance coverage in this country needs a serious overhaul. If they can take money in while the employee struggles to pay the high deductibles and never makes it to where the company pays anything. If the elderly have to choose between home, food, utilities and health. If employers ae dropping coverage right and left because the premiums are too high..then something has to give, something has to be done.

poenkitten


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RE: so what does US private healthcare cost? - 11/23/2008 12:44:01 PM   
LadyEllen


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quote:

ORIGINAL: moonvine

I'm unemployed and can't afford health care.  If I get sick, I'm just hosed.


well, indeed this is what amazes me about the hostility towards an NHS for the US - aside from a very few, those with private coverage seem to be one or two months away from being in the same situation should their job suddenly vanish and they be unable to get another - which is by no means a rare occurrence from what I've read here even for the highly qualified, more so for the less qualified and more so in a declining economy.

Yes, there are delays in our NHS - but you can get treatment, regardless of ability to pay. Yes, there is rationing, but then there is rationing in the US system too - its just done by a different method (ie we dont cover that). And it doesnt matter how sick you are or disabled or whatever, youre covered, simple as that. And if you happen to have the money and the wish to do so, you can get private cover too for very low cost (assuming youre healthy), to skip the queues etc. It just seems like a no-brainer to me, and then there are the public health spin offs that come from it too.

I would guess that for less than the private premia paid today, the whole nation could be covered by an NHS for the US, not just those paying the premia. Private coverage to skip the queue would then be much cheaper too, since the bulk of treatment is being provided by the NHS, so those paying premia now could have the NHS and private coverage for the same cost as their current premia.

E

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RE: so what does US private healthcare cost? - 11/23/2008 12:53:16 PM   
moonvine


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quote:

ORIGINAL: variation30

quote:

ORIGINAL: LadyEllen

My conclusion so far is that some are getting royally screwed over, some are doing OK and some are doing very well indeed, nothwithstanding the millions that have no cover at all.

E


I don't know anybody who has no coverage at all. I don't think I've even heard any family/friends/friends' family ever having trouble with insurance. And I'm situated firmly in the middle class. I think only 15% of our population in the US is without health coverage. that doesn't seem too egregious to me.



Hi, nice to meet you.  I'm moonvine.  I have no coverage at all.  My best friend was laid off from her job earlier this year, and now works 2 full time jobs and makes less than I do on unemployment (she's a medical transcriptionist and gets paid 8 cents a line), she has no coverage at all.  One of the doms who is currently considering me does not have coverage.  Fortunately we all live close enough to Mexico that we could potentially get there and get some sort of heatlh care we could actually afford.

To the OP, I fear the amount of ones who are getting screwed over will continue to increase.  People are getting laid off from jobs with insurance and taking jobs with none, if they can find jobs at all. 

There was a good Frontline on this:  http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Apparently we're #37 amongst industrialized countries in terms of health care.  Not sure why this is something people are proud of. 

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RE: so what does US private healthcare cost? - 11/23/2008 12:53:41 PM   
Raechard


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Status: offline 		The main problem with the NHS from my perspective is some things which are vital to survival like cancer screening are part of the same budget as other things which aren’t such as IVF treatment. Sometimes I think priorities are set wrong and it should only be about basic health care and not extended to cover lifestyle needs.

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RE: so what does US private healthcare cost? - 11/23/2008 1:00:01 PM   
meatcleaver


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quote:

ORIGINAL: Raechard

The main problem with the NHS from my perspective is some things which are vital to survival like cancer screening are part of the same budget as other things which aren’t such as IVF treatment. Sometimes I think priorities are set wrong and it should only be about basic health care and not extended to cover lifestyle needs.


So? Are you being denied screening?

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RE: so what does US private healthcare cost? - 11/23/2008 1:01:16 PM   
LadyEllen


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Status: offline 		I'd agree to an extent Raechard - but it isnt as simple as such a division might suggest.

For instance, is my SRS a medical need or a lifestyle choice? If its the first then there is no reason for the budget being used as an excuse for my treatment to be denied - and given that my condition is recognised as a medical one by way of psychiatry/ psychology and I might commit suicide otherwise..... (the leading cause of death for transsexuals). If its the second then what the hell is it even under consideration for in the budget in the first place so as to be cut?

As things are there isnt the money for my SRS. Personally this is disappointing, but then in reality I could pay for it because I work (most in my position dont, because no one will give them a decent job). In the wider picture though, do I think SRS is more important, as important or less important than some kid getting treated for cancer? Its a no-brainer - treat the kid.

E

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RE: so what does US private healthcare cost? - 11/23/2008 2:04:03 PM   
Vendaval


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RE: so what does US private healthcare cost? - 11/26/2008 1:26:19 PM   
Raechard


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quote:

ORIGINAL: meatcleaver
So? Are you being denied screening?

No one gets denied obviously but by the time they got their appointment things may have moved on significantly. It's the difference in terms of how often people are screened. This should be decided on a statistical basis rather than a budgetary one.
 
In fairness a better argument is keeping specialist disciplines in the NHS, I can agree with IVF funding on that basis.


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Profile   Post #: 53
RE: so what does US private healthcare cost? - 11/26/2008 1:41:49 PM   
Raechard


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quote:

ORIGINAL: LadyEllen
For instance, is my SRS a medical need or a lifestyle choice? If its the first then there is no reason for the budget being used as an excuse for my treatment to be denied - and given that my condition is recognised as a medical one by way of psychiatry/ psychology and I might commit suicide otherwise..... (the leading cause of death for transsexuals). If its the second then what the hell is it even under consideration for in the budget in the first place so as to be cut?


That's a tricky issue Ellen I find myself agreeing the NHS should provide this, although the same argument would entitle an insecure woman to new body parts. I think somewhere a line has to be drawn in terms of what is the basic care the NHS can give, there are limits there has to be. Some things will always be a personal endeavour and in the mean time it's treat the symptoms i.e. the depression not having the treatment causes.


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RE: so what does US private healthcare cost? - 11/26/2008 2:05:49 PM   
BlackPhx


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quote:

ORIGINAL: NuevaVida

My mind keeps going to my uncle in Spain (who has an NSH), who was very ill with stomach and esophageal cancer. The hospital would not pay for his prolonged treatment and surgery because the survival rate of such a surgery was not high enough to warrant the expense. So he & his partner sold their business, sold a house, and gathered most of their savings, and paid for his surgery through a private practice - came to something like $300,000. Had they not done that, he'd have died that year, rather than 5 years later.

A friend's aunt was rejected for care in Canada for the same reason. That kind of stuff scares the crap out of me, to be honest. Once you have the government deciding who gets treated and who doesn't, based on a national statistic, well, that's not a society I prefer to live in.



Even with private health care this happens Nueva, more often than people like to think. Getting approvals ( if they are needed) is a battle and a half, starting with the non medical clerk saying no and having to have things pass up the line. Even then, once an approval is given, the company may renege on the payments, leaving the patient no recourse but to battle it out in court, while struggling to pay something toward it and protect their credit. People have been driven into bankruptcy even though they had GOOD insurance..or so they thought. This does not stop the Insurance company from dropping them like  hot potatoes and then comes the fun of trying to find another insurance company. Worse comes along when you reach your lifetime cap.

Mental health is rarely covered for unlimited sessions, even though it may be needed.. Dental, unless you are paying a high premium for it, rarely factors in though gum disease is proven to be a factor in heart ailments. Vision can break the bank. Cancer treatments have left people sans homes, and yet..after you have exhausted your health plan, even if you are Cleared..counted as in remission you aren't going to get insured again without high premiums and a fight for several years. Shriner Hospitals are the only hope for many kids and they can't treat them all, but insurance companies watch the bottom line and sick kids and people ain't profitable.

poenkitten

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Profile   Post #: 55
RE: so what does US private healthcare cost? - 11/26/2008 5:52:10 PM   
Maya2001


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From: Woodstock ONT,CANADA
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quote:

A friend's aunt was rejected for care in Canada for the same reason. That kind of stuff scares the crap out of me, to be honest. Once you have the government deciding who gets treated and who doesn't, based on a national statistic, well, that's not a society I prefer to live in.


Was you friend aunt a resident?  was she willing to follow government guidelines for precedures?  or did she simply say that because she did not want the family to know she chose not to have the treatment?..because they do force you to go thru if you don't want ...but it is available if you are willing and wanting ..even to the nth degree.    What I am asking are you sure of the actual facts??? Because it sure is not what I am seeing knowing other that have fought and lost and going thru the battle myself, 



I am rural..... I am almost 50 , I have lung cancer,  my odds of surviving beyond 5  years probably is 1 in 30 if in stage 1 or 2  - stages 3 to 5  is 3 years to a few months  ... certain procedures  tests have specific guidelines and is not based on your odds of surviving   eg  a PET scan requires a biopsy first before the goverment will pay for  the PET scan  to show that cancer is existing already  and is use to see if it has mestasized .....but as long as you follow procedure you can have(just the chemical  injection not the scan itself ..costs $5000) . .... I am not denied healthcare  even when the odds are bad .  the decision to have  surgery, chemo therapy and radiation all lies with me    ... I can choose to have or choose not to , I can pick and choose or take all  the options that are recommended thru staging  for prolonging my life .. I have chosen to fight if there is a semi  chance of beating   ..so all the doors are open to me ..they are not being closed because the odds are poor .....the testing  alone for the last 3 months that i have had and have yet to go thru is probably running around $40,000 to $50,000 since I have 2 other medical conditions recently diagnosed  as well that I am under care for  ..  I have 4 doctors(thoracic  surgeon, cardiologist, rheumatogist, family doctor) working together sharing  information doing whatever testing on their end that is needed to try to get me thru this

I know one person who was my sons age who had cancer that mestasized ....and he chose to continue fighting   and it was battle after battle  spreading to  all major organs and brain ..his odds were extremely poor due how agressive the cancer was  but as long as he  was willing and wanted to fight the  health care system had to  continue to paying for his care ..his parents remained supportive but they had secretly hoped  he would have quit fighting long before he did .. as he spent most of his last 2 years in the hospital having surgery after surgery lost his bladder, bowels, prostate gland, half his intestines, spleen, parts of his lung, liver, kidneys , chemo and radiation treatments ..stem cell transplants...so even with an extremely aggressive cancer with really no odds of beating  they continue to pay as long as he was  willing/wanting  to endure.   If mine proves to be agressive and mestasized I would be looking at options only to give me the most quality time rather than quantity.

I know others who had went thru extensive treatments for agressive mestasized  cancers and lost..but the choice was left in their hands the government did not deny them. 

and another example of a goverment guidelines ..routine mammographs  will be covered once you turn 50 ..but the government allows exceptions  for eg if a lump is found of there is a family history of cancer...   which is what  I  needed have documented to have earlier mammagrams and started around 45 years old... at the time I did not have a reason to be checked  for eg like a lump,   it was something I simply asked the doctor about .because I do have family history of cancer and had  ovarian cancer myself when I was 23 so wanted them for peace of mind. 

some of the policies are in place to ensure  services are not wasted unnecessarily

yes our taxes our higher but remember we have a   larger land mass that must have medical services even in very low populated of the north that are serviced mostly by air ambulance   due to the remoteness and lack of roads or because of weather  ... yet we have a 1/10 of the population of the US to support these medical services and hospitals and most of  Canada population is located along the great lakes and St Lawrence river or US border  which leaves the rest of the country lowly populated but they  also require full service/equipped  hospitals even though  they will not get the usage but they have to be there to service those people living in the remote areas   ....so the tax burden is high because we do not have the population to support the number of hospitals needed to cover our land mass .. this is why I said if  the US went to a non profit insurance  you would be paying far far  less in taxes than we do 




_____________________________

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(in reply to NuevaVida)
Profile   Post #: 56
RE: so what does US private healthcare cost? - 11/29/2008 10:31:37 PM   
NuevaVida


Posts: 6707
Joined: 8/5/2008
Status: offline
quote:

ORIGINAL: BlackPhx

Even with private health care this happens Nueva, more often than people like to think. Getting approvals ( if they are needed) is a battle and a half, starting with the non medical clerk saying no and having to have things pass up the line. Even then, once an approval is given, the company may renege on the payments, leaving the patient no recourse but to battle it out in court, while struggling to pay something toward it and protect their credit. People have been driven into bankruptcy even though they had GOOD insurance..or so they thought. This does not stop the Insurance company from dropping them like  hot potatoes and then comes the fun of trying to find another insurance company. Worse comes along when you reach your lifetime cap.

Mental health is rarely covered for unlimited sessions, even though it may be needed.. Dental, unless you are paying a high premium for it, rarely factors in though gum disease is proven to be a factor in heart ailments. Vision can break the bank. Cancer treatments have left people sans homes, and yet..after you have exhausted your health plan, even if you are Cleared..counted as in remission you aren't going to get insured again without high premiums and a fight for several years. Shriner Hospitals are the only hope for many kids and they can't treat them all, but insurance companies watch the bottom line and sick kids and people ain't profitable.

poenkitten



Hi kitten,

I have a PPO plan, which I pay a high premium for, and have not had an issue with getting approvals. My only issue has been getting off COBRA and onto a private independent plan, since I've been rejected due to past medical issues. When my insurance from my current job kicks in, this will not be the case. Pre-existing conditions does not apply when getting insurance from an employer.

I have flat out NOT paid some medical bills and while they sent me to collections, eventually they wrote it off as "bad debt" and none of those claims has ever shown on my credit, which I watch regularly.

I am fortunate that I have not come close to any maximum levels. Those I know who have had cancer (which, unfortunately, has been many) have not had issues with their insurance maxing out or not paying the hospital bills. I understand there are costs that insurance doesn't cover, but one can usually be put on a payment plan to pay those back.

I'm honestly not sure how vision breaks the bank. I pay cash for my contact lenses and the balance of what my insurance company pays for glasses. Without insurance, it still wouldn't be more than a few hundred dollars a year.

I understand medical care can indeed be expensive, but I'm still not convinced the government will run it better.

_____________________________

Live Simply. Love Generously. Care Deeply. Speak Kindly.



(in reply to BlackPhx)
Profile   Post #: 57
RE: so what does US private healthcare cost? - 11/29/2008 10:35:51 PM   
NuevaVida


Posts: 6707
Joined: 8/5/2008
Status: offline
quote:

ORIGINAL: Maya2001

quote:

A friend's aunt was rejected for care in Canada for the same reason. That kind of stuff scares the crap out of me, to be honest. Once you have the government deciding who gets treated and who doesn't, based on a national statistic, well, that's not a society I prefer to live in.


Was you friend aunt a resident?  was she willing to follow government guidelines for precedures?  or did she simply say that because she did not want the family to know she chose not to have the treatment?..because they do force you to go thru if you don't want ...but it is available if you are willing and wanting ..even to the nth degree.    What I am asking are you sure of the actual facts??? Because it sure is not what I am seeing knowing other that have fought and lost and going thru the battle myself, 

Yes, she was born and raised in Canada. She wanted treatment for her ailment and came to the states (dual citizenship) to receive it. But I do not know all of the facts of her situation. I'll ask her the next time I talk to her, because I'm curious now.


quote:


yes our taxes our higher but remember we have a   larger land mass that must have medical services even in very low populated of the north that are serviced mostly by air ambulance   due to the remoteness and lack of roads or because of weather  ... yet we have a 1/10 of the population of the US to support these medical services and hospitals and most of  Canada population is located along the great lakes and St Lawrence river or US border  which leaves the rest of the country lowly populated but they  also require full service/equipped  hospitals even though  they will not get the usage but they have to be there to service those people living in the remote areas   ....so the tax burden is high because we do not have the population to support the number of hospitals needed to cover our land mass .. this is why I said if  the US went to a non profit insurance  you would be paying far far  less in taxes than we do 





I am genuinely sorry for your medical state, and truly wish you the best. The US healthcare system does indeed need revamping, but I remain unconvinced that a government run system is in our best interest. I honestly don't know what the solution is, but I fear trading in one bad system for a worse one.

_____________________________

Live Simply. Love Generously. Care Deeply. Speak Kindly.



(in reply to Maya2001)
Profile   Post #: 58
RE: so what does US private healthcare cost? - 11/30/2008 7:30:57 AM   
BlackPhx


Posts: 3432
Joined: 11/8/2006
Status: offline 		I would have to say you are among the Lucky ones Nueva..I know more than a few who have had to file Medical bankruptcy. One was an ex dominant of mine who was in a motorcycle accident before I met him... the time spent in the hospital, sepsis, prosthesis, PT and other ancillary expenses were not completely covered by his insurance, auto coverage and the other persons insurance. His co pays and limitations even with all of the insurances kicking in left him thousands in the red, and he ended up losing his job as he could no longer perform it and was out so long. But he isn't the only one...http://blogs.wsj.com/health/2007/11/29/even-with-insurance-hospital-stay-can-cost-a-million/ is an example of what can happen as Insurances cap out. http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/06/22/MNGB87A0J71.DTL is another article regarding HMO's who deny medically necessary health care and your limitations on suing them. Some of this has slowly been changed over the years, state by state, but it is far from a problem solvedh
n
I have diabetic retinopathy. I had cataracts. Before the cataracts were removed, due to their placement I was unable to drive as under certain conditions I could not SEE an F-350 and in fact didn't one morning until just before I hit it. I had BCBS with vision and dental coverage and it was one of their top of the line coverages due to the company my ex was working for, and I also had medicare as I am disabled. Neither would cover cataract surgery until I lost almost 50 % of my vision. Of course by that point I had to have some drive me where ever I needed to go and BCBS was outta there. They were no longer my secondary insurance..Medicare is always primary, and what they DON'T pay ( I am still trying to figure out their math) is phenomenal..you can only hope any secondary insurance will pick it up. Once the cataracts reached that certain point they replaced the lenses of my eyes. Yes both of them and while my co-pay was only $100 per eye that is a lot when your income is limited. The Logic of waiting until the cataracts were so bad that your life is badly impacted eludes me. When I was diagnosed I had a 25% vision loss already. Since they replace the lens completely and cataracts do not resolve on their own, why the wait?

As I said I have diabetic retinopathy http://www.nei.nih.gov/health/diabetic/retinopathy.asp Intermittently my vision blurs so that I cannot read until the blood is reabsorbed or I have to angle and tilt my head to have clear vision. Eventually it may become bad enough that they will treat it with more than just eye exams to track it. Currently my right eye is the worst one and I am back in glasses instead of just having them for reading. I fight to keep my blood sugars under control but, the disease is progressive and anytime I am ill even on tight BG control my sugars will spike. Since the only coverage I have medically now is a Medicare Advantage plan..my vision problems will have to wait until they reach the badly deteriorated stage before it is handled. I am scared to death of going blind. But medicare (Advantage plans are Privatized Medicare Administration (read as insurance companies and HMO's))  is penny wise and pound foolish, instead of dealing when a problem is small..they wait for catastrophic which invariable costs more to correct if it can be. Of course by that point, you can be blind, deaf, have complications that will require MORE medications, home health care, hospitalizations etc.

For the millions of people on Medicare there is a 2700$ cap on their drug plan. When you reach 2700$ then you are under a second tier where you pay 100% of the cost until you accumulate 4500$ in payments (starting again at 1$), at that point you become eligible for catastrophic drug coverage and they once again pick up paying a large percentage of the cost. To those who are elderly or disabled and living on a limited budget, that middle point is very hard to pay for and can often mean they have to make a choice between medications and food or other necessities of life. that initial cap can be reached extremely quickly under some conditions..Cancer drugs can max that out in a week. But what happens if you don't have the money to cover the Gap? Many on Social security or disability are living UNDER the poverty line. Something has got to give. A friend of my M-I-L has leukemia, her chemo and drugs are eating up her savings at a rate of nearly $6k a month. She did everything right, saved for retirement, banked money against job loss, kept her bills within her means, and now because she is ill she is looking at losing everything she worked her entire life for just trying to keep up with her medical costs. She will soon file for Disability and medicare and that will take a year to kick in AFTER she gets disability. She is still struggling to work to stave off that point, but her job at the Space Port is going away.  She has excellent coverage right now and she is STILL paying out of pocket $$$$ and that will vanish with her job. She has already maxed several benefits under her health insurance trying to survive.

Something needs to give in this country. Medical costs are out of line $25 for an aspirin is not unheard of..Doctors charging for reading the wrong chart, Insurance companies that insist on waiting until a condition becomes chronic or catastrophic, drugs that never make it to generic or cause more problems than they treat (read your side effect inserts) are breaking the backs of the people who are paying them for coverage. I am still paying the price of drug side effects. Long ago and far away they wanted to give me Methotrexate a cancer drug to wean me off of a year of steroids (prednisolone) prescribed to treat highly brittle asthma. The steroid had it's own side effects of suppressing my adrenal gland, triggering a genetic predisposition to diabetes and a few other joys in my life.  The Methotrexate was experimental at the time for steroid withdrawal. The possible side effects can include anemia, neutropenia, increased risk of bruising, nausea and vomiting, dermatitis and diarrhea. A small percentage of patients develop hepatitis, and there is an increased risk of pulmonary fibrosis.The higher doses of methotrexate often used in cancer chemotherapy can cause toxic effects to the rapidly-dividing cells of bone marrow and gastrointestinal mucosa. The resulting myelosuppression and mucositis are often prevented (termed Leucovorin "rescue"- as this is the folic acid based drug used). I would have had to have monthly liver tests, blood tests, etc to insure that none of the side effects occurred.  I said HELL NO. The result, I kicked the steroid cold turkey and my sons spent 3 months helping me move a body that had turned to stone to the bathroom and back to the bed. It had suppressed my own corticosteroid production among the other side effects.

Something has to give..Private Insurance is out of control and out of reach for far too many people.

poenkitten

(in reply to NuevaVida)
Profile   Post #: 59
RE: so what does US private healthcare cost? - 11/30/2008 10:20:08 AM   
NuevaVida


Posts: 6707
Joined: 8/5/2008
Status: offline 		Hi again, kitten,

You are right - I have been very fortunate and, as a result, am probably very naive in my awareness of the issues out there. My dad left my mom with a great pension and health coverage, so she isn't experiencing the medicare issues I so often hear about from others.

I do understand when one's coverage is limited they can absolutely find themselves in financial crisis. And I find that to be a travesty. I was just complaining a few weeks ago about the ridiculous cost of my COBRA coverage ($540/month) and saying I was going to cancel it since I can not afford it at all. A week later I had an accident which has rendered me temporarily immobile, so thank heaven I had not cancelled my coverage!! But as I sit here I have no idea what (if any) my bill for the home healthcare I'm receiving will be. I have a feeling I may have a battle ahead of me about it.

For the record, I hate HMOs and chose the higher cost plan of a PPO as it allowed more flexibility in care. HMOs are a form of "managed care" which makes its money by preventing patients from visiting doctors and hospitals. The idea behind it was to keep patients healthy by preventive care, but I think what ended up happening was patients were prevented from getting any care at all - preventive or otherwise.

I'll continue to agree that our system needs an overhaul. I just haven't seen a solution I'm comfortable endorsing. Having lost faith in my government's ability to manage programs, the idea of them managing my healthcare is scary to me.

Thank you for enlightening me with the information you provided. I admit my knowledge is very limited, and I'm appreciative of those taking the time to educate those like me.

_____________________________

Live Simply. Love Generously. Care Deeply. Speak Kindly.



(in reply to BlackPhx)
Profile   Post #: 60
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