rapunzel
Beach Fanatic
Hey, hey, wait just a minute. I think you are assuming I am a conservative and are confusing what I have said things other people have posted. I never said the FDA controls are too strict. In fact, I believe the contrary. The FDA's budget is today underwritten by the very drug companies they regulate, and the current administration is appointing drug lobbyists to head the FDA. It is a horrible cluster*&^% and fuels the spiraling costs of drugs. It is a classic example of why I think a single payor, susceptible to lobbying and beholden to corporate interest, will neither improve the quality of healthcare nor decrease its costs.
In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA) and this act in conjunction with the Consolidated Omnibus Budget Reconciliation Act (COBRA) provide a safety net for anyone who has had healthcare coverage through an employer or an individual policy to continue that policy without being subject to medical underwriting or pre-existing condition exclusions provided they do not let a policy lapse for more than 90 days (or 30 days for ERISA and Individual policies). People who cannot get insurance at some point made an unfortunate decision that the COBRA or an individual policy was too expensive, and that is unfortunate. I don't mean to sound like a hard-a$$ -- it was unfortunate that I did not have a wind policy on my house in New Orleans and lost ten years' savings and investments. Sometimes people make bad financial decisions and they have to take responsibility.
As for not understanding how truly poor someone has to be to qualify for Medicaid, I have to laugh. I've had to assist so many people to sign up for Medicaid so that physicians and hospitals I've worked with could receive some sort of compensation. I have also had to help a lot of people apply for a special short-term Medicaid that many people can qualify for when they have an expensive ($18,000+) short term illness. Medicare is age-based, or kicks in with long-term disability. I don't want to pry, but did your grandmother not look into Medicare? Or was it that she required care in a long-term care facility? If someone is truly choosing between food and medicine, I am assuming that is because they have a condition for which there is no generic rx treatment available and are taking an expensive brand name medication. That proves my earlier point -- if everyone paid for their own drugs directly, would drug companies charge $200 for a thirty day supply? Or do the drug companies set the price at $200 because most people have insurance and will pay because a copay is a copay and there is no real competition? Regardless, if you know someone who is choosing between food and medicine please have them pm me and I will help them sign up for a prescription assistance program with the pharmaceutical company.
Your $200 premiums further illustrate my point about our system's problems. Let's say you are 28, and from the sounds of it healthy and rarely utilize healthcare. You are underwritten as a group with one hundred other women aged 25-29. Let's say one of those women gets breast cancer, and because of her young age has genetic testing ($3000) which shows she is positive for BRCA (a gene that causes breast cancer) and opts for a double mastectomy ($568 for the surgeon for pre-and post-op visits, surgery, writing a couple of letters to the insurance company for prior authorization for removal of non-diseased breast/ $14,598 for the hospital, two night stay on med/surg floor), chemotherapy ($1600 to the oncologist for customizing a treatment program based on the type of cancer and administering 12 rounds at an hour per round, $15,000 to $50,000 for the chemo drugs) and opt for breast reconstruction -- if she doesn't mind painful capsular contraction or the unnatural look of the cheaper implant option ($920 to the surgeon who must pay $250 - $400 for each implant, $10,400 to the hospital for outpatient surgery), and then $380 per month for estrogen receptor inhibiting drugs to protect her ovaries so that she can forego an oophrectomy and maybe preserve her fertility for a few more years. In this scenario, the insurance company is going to spend at least $85,646 (I've left out the costs of labs and diagnostic imaging because I don't know those off the top of my head), and underwriting predicts 1.54% incidence of catastrophic illness in this group. 40% of people in this group are on at least one maintenance drug like Allegra, Lunesta, Celexa at about $65,000, four will need outpatient surgery $48,000, and most will have a yearly exam with labs $6500. That is where your groups' $240,000 in premiums go. If you look at my example of the breast cancer patient, you will notice that only$2588 of the $85,646 is paid to the physicians who prescribe and manage the care. That is a real world example. I honestly believe that there is a way to get hospital and drug costs under control other than subjecting us all to a Medicare-like program which will diminish quality and slow innovation. Further, I don't trust the government who has orchestrated the kind of misallocation of resources outlined above to fix the problem.
The dollar amounts above are the amounts that would actually be paid, not the charges. The charges and the actual costs have nothing to do with each other, which is what makes it virtually impossible to navigate the world of healthcare without insurance. While your nurse practitioner's bill may have said the charge was $170, I promise you that was not what she accepted as payment or she's making about 3 to 4 times what a board certified physician would command in this market. If you have any financial obligation above and beyond a copay you will receive an explanation of benefits which will show what she was ultimately paid, what she wrote off, and the amount of your co-insurance. As an example, I got a bill today from a provider. The charges were $1945.00, the insurance company paid $345.00, I paid $155.00, and the provider wrote-off $1445.00. In my experience, that is pretty typical. You state that $35 and $4 isn't what an office visit and a prescription cost. Well, that my not be the advertised price, but that is what they cost. Wal-Mart has a $4 formulary and there is an acceptable treatment for the overwhelming majority of conditions on it. And you can look up 99212 (intermediate level office visit, established patient) at http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp?agree=yes&next=Accept for yourself. People without insurance just have to ask providers for the same discounts they give to the insurers, I've never met one who was not willing to do so. There are also free clinics and indigent care facilities available. There are many, many resources available to those who fall between that cracks.
As for the $80,000 boob jobs. The two men I worked for dedicated their practice to two procedures they developed called DIEP and GAP breast reconstructions for women who have had breast cancer. These procedures use a woman's own tissue without destroying her abdominal muscles or her latismus muscles to reconstruct natural looking breasts. Their patients breasts look and feel natural, do not develop painful and disfiguring scar tissue, and the women have far fewer psychological difficulties following their reconstructions. They are two of five surgeons performing these procedures in the world, and they are by far the best at it. They charge $80,000 but that is not what they are paid. They either lose money or operate for free on about 20% of their patients, they break even or make a very modest amount of money on 60-70% of cases, and make very good living off the other 20%. When I was hired, I was given the task of making sure they made as much money doing this world-class surgery as they would if they were popping implants in trophy wives all day. That was all that was asked of me. I did a bit better than that for them. They are world class surgeons, and deserve to make a good living. Frank Gehry is a world class architect, and deserves to make a good living as well.
Well lets not go getting our panties in a wad here. I am sure Punzy knows what the Medicare schedule is and who qualifies. Even though Skunk is a doc and Punzy is in industry, I have always found them to be objective and Skunky always looking for the least expensive route to treat someone which I find admiral.
I can certainly understand the 15 minutes with a doc. Between what my plan pays and my co-payment I often wonder how some of the stay in business. My doctor did it for a long time and eventually has gone to not even accepting insurance anymore.
But Punzy, where can someone go to a doctor for $35 who doesn't have insurance? In New York you can not even see a vet for that price.
In New York City, I think the relative value scale (RBRVS) is closer to $42.
Thanks for the kind words, Mango.
