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Veteran Advisor

Re: BA head for the storm celler

it's overcast out, humid and I can smell rain this morning, had about 10 hundreds so far, but heat advisory this afternoon, chance of

thunderstorms, some severe, later today.


This post will take me a bit to get to the end, but hold on, I think it will perhaps show where I am coming from


as far as healthcare, seems we have two different numbers, one that people talk about, how they went to the hospital and the $20 pill and

the huge numbers..........then there is the real numbers, what insurance companys pay and what you can usually get the hospital

to cut it down to if self pay.


this website basicly tells you what the insurance companys pay, and what is "fair", in other words, if self pay, what they should come

down to, there is also a link to a company that if you are self pay, they will "go to bat" for you, cut your bills down, but they get a

10% fee for, if they cut your bill by $1000, they get $100


you next option could be to go with med-share type program......mixed opinion on these...first, no guarantee it will be paid (in my book that's

the biggest problem)....also most have low cost caps, ie, maybe 100k max per year.  also most pre-existing not covered, same with

medication.  only 2 use electronic systems....the biggest one of this is called "media partners"........they process the claims, and also

have discount agreements with many hospitals/doctors......this single thing, has a huge impact on the size of the bills, and so much

easier for the person, you just hand them the plastic card, and away it goes, with the others, you have to explain it all them them, and



here Is something for you to look at, and some names that you can research yourself


ok, now onto the big one....ACA.

I want to say that I am a supporter of i'm not saying that there are some things in it that I think should be changed that I feel

would lower costs......i'm not going to go into who wrote it, or any of that, I want to talk about the item itself.........if you are aginst it for only

one reason, that Obama did it, just don't even talk about it, frankly that has no impact on how the plan works or coverage, it's just something

to yell about, if that's your problem, go outside and start in, and maybe the neighbors will call the cops and they will get you some help.


first, let's examine the plan........before you send a man to the electric review the let's review the facts.


first....there are some basic things that must be covered.....this is one of the main reasons that some plans were cancelled...some policys

available before maybe had limits, and etc..........

first, there can be no upper limits........I've seen policys with $100,000, and $1,000,000, this plan has no limits........

second, you can not rate or refuse due to pre-existing conditions....this has always been a problem.......for years I was unable to get insurance

due to diabetes, and it was well yes of course I would be in favor of this part of the program........

as someones concern of the cost of cost for the last year was approx. $700 my cost, with the insurance co not paying

anything........I get my lantus thru a company program, I can order my pill thru rxoutreach, and that gives you a 6 month supply of most

generics for $20 (anyone can get theirs there, and very high income limit, something like 75,000 for 2, NET)

I have labs run 4 times a year.........cbc, a1c, metabolic profile, lipid profile.  I also get an inhaler per year, and also a box of albuterol for

my nebulizer to use as needed......I battle diabetes, arthritis, osestoarthritis, asmatha, a severe back problem due to age and a defect

I was born with, thrombocytopenia that is stable, and a possible neurological disease that needs to be further investigaged, but

not wanting to do so, due to the possibilities........


if you look at


it will give the basics, and then you can look in specific what it covers for men, women and children.

lastly, there is a cap of 130% on premium for the older you get.......basicly if you are older, the max your premium would

be is no more than 130% of a 30 year old..........for us "old farts", that's also a good point in the plan, I like.


frankly.....the ACA does provide good coverage.......many things covered, and if you have a severe threat to your life, it frankly

is very good.


but it is expensive.


I have asked both of my reps, to ask CBO, to break down the cost of the major parts of the ACA, the 10 essentials, the pre-existing,

the age help us identify the most costly aspects of the me that is can you modify it, if you don't

know the costs ??

neither has responded.


to me, this is the key........I think we can make some modifications here, that could save costs.

to me, the most easy, and perhaps save quite a bit of money is how the 10 essential coverages are paid for.

if you read it, it says "free", that means insurance co paid for it.........we could can it over to maybe a copay or have it

go thru the deductible system.........i'll give a prime example.  last year I had a colonscopy screening.......I wasn't having

problems, but had family members that did, so doc said it wouldn't hurt.......well we got in and did find some things, but

it was early, and due to the number of them, I have to do it every 3 years, or if have pain or problems, even earlier.

at any rate, the bills came in, and the "insurance billing cost was close to about $2500...I paid 0 for it....yes that made

me happy, but I also understand that is an expense, and if there would have been a copay, or run thru the

insurance, it would have cost me more, by the time of the deduction, etc, etc

that is one the expensive items on the list, there are others, such as some injections, and etc........

I guess my biggest suggestion, is to either create a copay, or run it thru the insurance, rather than "free".

I think that that single change would make a significant cost savings, and help lower premims.


as far as controlling healthcare cost........that's almost impossible.........and yet it already is done.


the insurance companys tell the hospitals and doctors how much they will pay....they have no control over this, other than to  say

yes or that basicly is a cost control measure right there.

also consider.......rural hospitals can not compeate  with the metro hospitals.........say you have a ct scanner.......the rural hospital might

use it once or twice a the metro, it is booked up every day.........there is no way you can say, ok a scan will be $200.

yes, the metro could live with it, but not the rural.


really, this whole healthcare issue is a rural vs metro issue..........just look at it......most of the older people are in the rural, that

usually require more care....and not many young people around, since they went to the big city to chase their dreams.

second, the healthcare cost.....the local hospital...due to the low volume, their prices must be higher to cover expenses.


how can you fix the rural/metro gap ???   there is really not much you can do, it's just fixed costs.


ok, that should keep you busy for a while.


Senior Advisor

Re: BA head for the storm celler

I didn't say the diabetic chose to be so. And define reasonable.



"If a person stayed healthy and uninsured their entire adult lives up to age 59, as a new insured, should they now pay the same premium as one who stay healthy and insured their entire adult lives up to age 59?"



Yes. They should.


Senior Advisor

Re: BA head for the storm celler

Not really disagreeing with anyone, 3020, just sharing/discussing/learning.  On the "reasonable", assuming this is about premium discounts/surcharges -- kind of like crop insurance has "cups" and "caps" for annual changes APH, there could be annual limits on how much individual health insurance premiums can go up or down based on an individual's experience/claims.  I threw in the 59 year-old, previously insured/uninsured example question for this reason -- the one who has been insured forever has paid into the system for many years with no return other than peace of mind, while the uninsured one has no historical investment in the system -- shouldn't the one with the favorable insurance claim history receive some sort of discount compared to the one with no insurance history?  Kind of like crop insurance might start you out at a county average APH, then your actual experience builds in over time until your APH reflects your own history, again still subject to "cups" and "caps", etc.  Again, just thinking out loud.

Senior Advisor

Re: BA head for the storm celler

No, I disagree with you and here is why. Maybe he didn't pay in but he also never present any sort of a risk to the insurance company. For that he should not be penalized.


As far as caps. Some one who has bad health should pay more for health care than some one who is healthy. The health person may face other challenges the unhealthy person never does.

Senior Advisor

Re: BA head for the storm celler

So, example again using the 59 year-olds, one previously uninsured and no history, and one fully insured and paid premiums for 37 years with a healthy history and no prior claims -- assume both have the same insurance policy and premium and both have been in good health -- now, assume both of them have same sudden medical problem and the insurance company shells out $100,000 for each of them during the year --


- should both still have the same premium for the next year?

- should either/both of their premiums increase?

- and, if so, how much should the premiums increase?

- are you of the opinion there be no limit on the percentage increase from one year to the next?

- what if one of those 59 year-olds is you?  same opinion?

Senior Advisor

Re: BA head for the storm celler

I think a better question is why do we hire insurance companies to pay our medical bills. Let the market decide who pays how much. Nothing in your example will help to lower health care cost. All it does is decides who is responsible for the bill.

Veteran Advisor

Re: BA head for the storm celler

well I must have given BA too many things to do at FB HQ......


3020.....I must say I have a hard time following your logic......why do we have insurance company pay our medical bills......because we

have paid a premium to insure us from an expensive medical incident....if you don't want to protect yourself for such an event, you

don't have too


but the idea, "let the free market decide "  and nothing here would lower medical costs........


I don't understand how the free market will change are now allowed to go to any doctor or hospital you want, no

law aginst the case of insurance, they may or may not be in network........if no insurance, remember you are paying it all

so you can go where you want........but I doubt if any doctor nor hospital is going to change their prices due to "free market".


in most communities, you only have 1 hospital......there is no competition..........or you can say no free market......well the

truth is, the cost is so high to operate a hospital, nobody would build another one in a community....there would not be enough

business for both, and both go down the tubes, then you are left with nothing......the free market doesn't always work.


I have of yet not seen anyone present a way to lower premiums or the hollering point, lower medical costs............

first you holler get the gov out of our lives.......then you turn around you want lower medical costs, and the only way you will

get that done is more gov intervention, forcing the medical field to charge lower prices..........


as I have said, there is cost control so to speak.......the insurance co tells your local hospital and doctor how much they will

pay.....that's it, you either join the network or you don't.


so the idea pointing to the hospitals and doctors charging such high prices and etc....think about that......I know several

people in the medical industry, and yes, there are many procedures that they don't make much on, but according to your

free market model, you would just say "don't do it unless you make money on it" the medical field, that is not

always possible.


so, you are bleeding like a want to go around to all the area ER's and shop for the lowest price ??


be my guest.


not saying some medical stuff does not have huge mark ups.....the medical device manufactures do make good money, such as

those who make joints, nerve stimulators, pacemakers, etc.........and also the ones that make the neat stuff, such as the

kits they put stents in the heart, or the similar things they use to fix AA's than rather than have to cut you open, same with

the new devices they use for clot blockage in the brain or a brain bleed.......these are amazing things, and it's actually

kind of slick to see them work......but look out when the bill comes.


so, if you can figure out how to make all these costs go down, or how to make a hospital run cheaper, let me know, i'll

pass it on.


Senior Advisor

Re: BA head for the storm celler

Insurance is a multi billion dollar industry that soaks up health care dollars but provides no cures. Their only task is to pay the bill.