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Obamacare healthcare insurance coverage for skiing? - Page 2

post #31 of 44
Quote:
Originally Posted by Coach13 View Post

Yep-we have private healthcare.

 

So do a lot of people who end up with major financial problems due to healthcare costs.

 

Originally Posted by Coach13 View Post

Anyone who wants the govt involved in their healthcare has never been to a DMV to see how good a job the govt does there.

 

I dunno, I got in and out with my new license in an hour last time I went, not so bad. But then maybe we should privatize the DMV, like the prisons, eh?

 

We have a friend, Colorado native, in his 60's, recently retired, having some health issues. We were visiting a couple months ago and he was raving about how great medicare was, how it simplified everything, paid for everything. So we asked "wouldn't something like that be great for everybody?", and he replied with an emphatic "NO! No socialized medicine!"

 

He watches a certain news channel a lot - Keep your GD government hands off my medicare!

 

I'm confused, don't know whether to laugh or cry.

post #32 of 44
Quote:
Originally Posted by Coach13 View Post
 
 
Yep-we have private healthcare.

Anyone who wants the govt involved in their healthcare has never been to a DMV to see how good a job the govt does there.

You are so right. I just signed up for Medicare. Hope the guvment doesn't come in and mess that up!!

 

(Medicare has far lower administrative costs than private insurance. Signing up took me 10 minutes on line and it was processed in 5 days. And anyone who thinks that private insurance does a great job has never had to fight for coverage with their private insurance company.) 

post #33 of 44
Quote:
Originally Posted by oldgoat View Post
 

You are so right. I just signed up for Medicare. Hope the guvment doesn't come in and mess that up!!

 

(Medicare has far lower administrative costs than private insurance. Signing up took me 10 minutes on line and it was processed in 5 days. And anyone who thinks that private insurance does a great job has never had to fight for coverage with their private insurance company.)

 

This is so much the truth (the private insurance fight- too young to have first hand experience with medicare).

 

I am a neurologically interesting person that happens to be predisposed to problems like epilepsy.  I have also had a LOT of concussions- NFL player style levels of concussions.

 

A few years ago, all of that coalesced into me having a migraine that lasted 4 months, with both audio and visual aura, along with a new icepick-stabbing pain in my temple that has now become the precursor aura that I get just before I have a good fun migraine.

 

I couldn't see well enough to read, was dizzy, nauseated to the point of vomiting, couldn't be in a lighted room, was completely unfunctional. I lost somewhere between 70-80 lbs. because I couldn't stand to eat and often couldn't keep it down anyways.

 

The first specialist I go to recommends an injection into the nerves causing the problem to deaden them for a few years- to give more standard prophylactic migraine meds a chance to take hold. Otherwise the drugs are useless because the nerves are pissed off pas the point of no return and never stop doing their thing.

 

But, my insurance just happens to be the only one of the major insurance companies that do not cover the procedure because the injected drug costed about $10,000. Instead, they called the treatment "experimental," which they get to do at their sole discretion no matter the amount of peer review studies validating the treatment. So despite the fact that I had tried every other method of treatment available, no dice.

 

I got a second and third opinion. All doctors concur that the other treatments have been ineffective, and this one is it. Meanwhile, I am out of work, racking up medical bills, and if I my employer had any other insurance company, this would be over.

 

I appealed the decision not to cover the drug. In my appeal, I explained we had attempted all other treatment methods covered with no success, and if the insurance company refused to cover the consensus treatment option, what did they see as the next thing to try in the way of treatment?

 

The response to the appeal was "Your appeal is denied, this treatment is experimental, we are not doctors and cannot give you medical advice as to treatment (although we can freely overrule your docs when it suits us), if you wish to contest this further your next step is to come out to California and sue us."

 

See, if the big, bad government is in control of health care, I can throw the bums out. I can find somebody to listen and make motions like they care, even if it is just to make members of the other party look bad. There is nothing I can do to compel a private company to do something they don't want to do if I can't get it to make economic sense for them. I can't even vote with my wallet, because I don't choose who my insurer is- my employer does, and I can't (at the time) get private insurance, because I have a pre-existing condition. I had no choice but to puke and bear it.

 

I graduated with "High Distinction" in economics.  Almost all of the economists I've met, and all but one of my professors were full on Libertarians and believed in the ability of the market to sort things out in almost all situations. Most of my professors would not accept the idea that highways should be public enterprises, and would instead argue that there is no reason we shouldn't allow the privatization of all roads for efficiency. These professors made Ron Paul look like Bernie Sanders.

 

The interesting part is that they would accept an argument that publicly funded health care was sensible- that no part of our current healthcare system came close enough to perfect competition to expect a competitive market would result from deregulation, and certain assumptions to perfect competition, notably perfect information, is probably not possible to even approach because doctors go to med school and we don't- the consumer will almost always have a significant, insurmountable, information deficit. In the existing US health scheme largely built off of employer-based health insurance, there are very few components of perfect competition that exist or could be reasonably expected to exist with changes to regulatory framework- you can't peel back regulatory layers in the healthcare market and expect costs to go down and insured to go up- you can only expect forms to make more money.

 

Finally, the problem with private health insurance in the argument these professors accepted is that the profit maximization of health care firms and overall public health do not align- health insurance firms make additional profit by limiting expenses- and those expenses are health services to make and keep people HEALTHY.  Health insurance companies are motivated to cull sick members from their insurance rolls, and denying expensive care to others, in many cases regardless of actual need of the individual trying to get the service. The typical feedback mechanism to this behavior is a loss of customers from poor service, but the person who receives the poor service is not the one that chose the firm- the employer did and the employer is motivated by their own profit maximization.

 

The argument became that our health system has become so screwed up, moving to publicly funded healthcare becomes an efficiency improvement- while at the same time also taking care of the moral problem of millions of uninsured people. Incidentally, this is also a conclusion that every other industrialized country in the world came to- which certainly does make America Exceptional in this regard.

 

So, this is an argument my ultra-libertarian, "the function of government is to provide for defense of the state and enforce property rights, AND NOTHING ELSE" econ professors accepted. I know this because these arguments made up my senior thesis- which was accepted, praised, and resulted in the "High Distinction" part added to my degree.

post #34 of 44
Quote:
Originally Posted by oldgoat View Post

You are so right. I just signed up for Medicare. Hope the guvment doesn't come in and mess that up!!

(Medicare has far lower administrative costs than private insurance. Signing up took me 10 minutes on line and it was processed in 5 days. And anyone who thinks that private insurance does a great job has never had to fight for coverage with their private insurance company.) 

My brother in law is now classified as disabled and in about 6 months will convert to medicare. I guess I'll learn 1st hand how it is by comparison. I sincerely hope it's at least a comparable experience.
post #35 of 44

As a critical care nurse in Denver, one thing people don't realize traveling to Colorado,is that a lot of our "typical" outdoor activities (skiing, mountain biking, rock climbing, river rafting) are considered high risk sports by a lot of insurance companies. More than once in my 20 year career, a patient's insurance company will not cover their medical bills due to the fact the injury occurred during one of those high risk sports. Make sure you check your coverage before coming out to play with us. 

post #36 of 44
Quote:
Originally Posted by SkiNurse View Post
 

As a critical care nurse in Denver, one thing people don't realize traveling to Colorado,is that a lot of our "typical" outdoor activities (skiing, mountain biking, rock climbing, river rafting) are considered high risk sports by a lot of insurance companies. More than once in my 20 year career, a patient's insurance company will not cover their medical bills due to the fact the injury occurred during one of those high risk sports. Make sure you check your coverage before coming out to play with us.

That shouldn't happen anymore with the ACA coverage provisions and requirements, but it always pays to verify.

post #37 of 44
When I hurt my knee, I was interviewed by some arm of the insurance company. You could tell they were trying to get someone else to pay the bill. They wanted to hear that someone cut you off or hit you so they could go after someone else.
post #38 of 44
Quote:
Originally Posted by crgildart View Post
 

US healthcare insurance companies bicker more about what treatment is covered and where instead of how and why the injury happened.  Being "out of network" as trekchick mentioned will allow them to charge you way more out of pocket for anything beyond the most basic emergency treatment.  One interesting thing that caught my attention is that antivenom for copperhead bites isn't covered by most insurance policies here and we have those snakes in this area. Some guy on the news said they almost had to pay $20,000 to get anti venom treatment.  The anti venom wasn't some experimental non FDA approved thing. 

 

http://time.com/2897/north-carolina-hospital-bill-snake-bite/

 

Sadly, it can be even worse...

 

 

http://www.reddit.com/r/pics/comments/3dngld/this_is_the_cost_of_a_rattlesnake_bite_in_america

post #39 of 44
Lot's of cases like your
Quote:
Originally Posted by Coach13 View Post

Yep-we have private healthcare.

Anyone who wants the govt involved in their healthcare has never been to a DMV to see how good a job the govt does there.

... Ever lived in a country that does single payer well? You might think differently if you have. Of course if we're convinced any gov't action is 'bad', we're bound to elect people that are likely to prove your the point.
post #40 of 44

I have a friend who was a nurse for 20+ years who now works in the adminstrative operation of the hospital. Although he's a contract worker, (so the hospital doesn't have to provide benefits, like healthcare), he effectively makes a six figure plus salary. His role is to interface between the hospital and the various insurance companies/entities to make sure the hospital gets paid, and to a lesser degree try and insure no one's taking up a bed that doesn't result in the hospital getting paid.

 

He's not really a "bad guy" in my humble estimation, more like a necessary evil with the current system, but regardless just one of myriad examples of middlemen that ultimately take a cut and cumulatively add to the overall expense of healthcare.

 

The whole thing is an unbelievable/sad joke of a mess. Read through the Reddit thread linked to above - as Mark points out there are a lot of places that are set up much more reasonably for the population as a whole.

 

Now, if you can afford a private "Cadillac" policy and all it provides, well then, yea, you're probably gonna be very happy with the current system.


Edited by jc-ski - 7/18/15 at 1:20pm
post #41 of 44
Quote:
Originally Posted by jc-ski View Post
 

I have a friend who was a nurse for 20+ years who now works in the adminstrative operation of the hospital. Although he's a contract worker, (so the hospital doesn't have to provide benefits, like healthcare), he effectively makes a six figure plus salary. His role is to interface between the hospital and the various insurance companies/entities to make sure the hospital gets paid, and to a lesser degree try and insure no one's taking up a bed that doesn't result in the hospital getting paid.

 

He's not really a "bad guy" in my humble estimation, more like a necessary evil with the current system, but regardless just one of myriad examples of middlemen that ultimately take a cut and cumulatively add to the overall expense of healthcare.

 

The whole thing is an unbelievable/sad joke of a mess. Read through the Reddit thread linked to above - as Mark points out there are a lot of places that are set up much more reasonably for the population as a whole.

 

Now, if you can afford a private "Cadillac" policy and all it provides, well then, yea, you're probably gonna be very happy with the current system.

He doesn't sound like a middleman to me. He sounds like yet another American employee, albeit a well paid one, misclassified as a contractor so the employer doesn't have to pay benefits or follow work rules, kind of like an Uber driver. If he's working for one hospital he's an employee although the corporations have paid politicians to pass laws to let them get away with this kind of thing. Most of the people getting screwed like this aren't making anywhere close to 6 figures.

post #42 of 44
... and another illustration of why having single payer insurance will be good for everyone. Administer it regionally, and you'd be good to go.
Edited by markojp - 7/20/15 at 12:12am
post #43 of 44
Quote:
Originally Posted by oldgoat View Post
 

He doesn't sound like a middleman to me. He sounds like yet another American employee, albeit a well paid one, misclassified as a contractor so the employer doesn't have to pay benefits or follow work rules, kind of like an Uber driver. If he's working for one hospital he's an employee although the corporations have paid politicians to pass laws to let them get away with this kind of thing. Most of the people getting screwed like this aren't making anywhere close to 6 figures.

 

I wouldn't disagree with that - he's a (relatively) lucky one. Plenty of examples all around the country of workers getting the short end of the stick. My main point was that it's just insane how many needless layers (including the role played by my friend) there are between the Doctor and the patient.

 

And as a result no shortage of healthcare horror stories...

 

http://ac360.blogs.cnn.com/2013/02/20/tonight-on-ac360-the-extraordinary-cost-of-getting-sick-in-america/

post #44 of 44

The primary layer between Dr. and patient in most hospitals is the number of patients each Dr. is assigned. Thus the need for auxiliary personnel and a layered approach to medicine (other than the highest end hospitals, where healthcare is actually amazing, if you can afford it). 

 

Anyone ever been to a public hospital in an urban area?......... All I can advise is that you not get into a car accident in an urban area near a public hospital.......... Beg, borrow, plead w/ the ambulance to take you to a private hospital (not including national urban trauma centers of course where emergency care is actually amazing if you are lucky enough.... to be wounded enough to be sent there!)


Edited by Yo Momma - 7/20/15 at 1:27pm
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