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cldlhd

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People like to rave about US health care. In the US almost all companies require you to pay a part of their premium. The exception is usually federal or local governments and some unions provide no-premium or no-deductible coverage (very rare)For a typical family I have seen that portion be several hundred $$ a month. And then you generally have copays which (in many plans supporting Obomacare standards) usually means you pay 100% of the insurance negotiated cost up to a deductible and for me and my wife this year is is $1900 each this year. So when you think about it before insurance kicks in we have paid probably $2500 in premium and $3800 out of pocket each year. If we had kids it would be higher.

And we like to brag about your choice of doctor which is only partially true. Sure I can pick my doctor most times, but the lab or facility that does procedures may or may not be "in-network" and if they are not, those are higher and separate deductibles. Oh and call an Ambulance and most are not in network with any insurance carrier.

When I go to my doctor if I need blood work I need to go to a lab as the doctor's blood work people are with a company not in-network.

The people that brag about the US Health Insurance systems usually have not used it extensively.

That said when I had my OHS 2 years ago my total out of pocket was $5000 (not including premiums) after that everything else that year was $0. But think about it, to get to $5000 out of pocket I had to pay the first $1500 (that's years deductible) then 20% of the remaining bills until I paid $5000.

One of the main reasons I went to Cleveland Clinic was the excellent reputation, but the second benefit was they were a single biller facility. All doctors work for them, so I got one itemized bill. Most hospitals do not work that way. You get a bill from hospital, DR, anesthesia, etc. Heck my Colonoscopy last month has at least 4 bills I get (DR, anesthesia, the clinic and pathology). A very inefficient and wasteful systems.

ObomaCare costs are usually higher form similar coverage or cost less with less coverage. I have no clue how a young family with kids survives on minimum wage or even $50K a year.
I guess I'm one of those lucky union local government employees. When I had my surgery at U of Penn in 2015 I paid $0.
 

cldlhd

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I lived in the days when they could refuse coverage if you found out that you have high blood pressure, heart disease, or any other genetic defect. Not that long ago, I was a kid back in the 1970's and even back then it was hard to get coverage for those genetic defects. And then in the 1980's, if you had cancer, the hospital and life insurance would drop you like a hot potato. Then in 1990's things got changed under Clinton that no one could be refused health insurance for pre-existing health conditions. Nor could life insurance, who refused heart patients for many years, even after OPH. I would hate for that to be brought back. Sad. And many people died from their pre-existing conditions due to the lack of health insurance many years ago.
I thought the pre existing conditions changes happened when Obama was president under the ACA?
 

slipkid

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People like to rave about US health care.......(am snipping the rest to try to post a long rant)....

Comments from my own personal experience of what you said (which I agree with). Things that I think illustrate how effed up our healthcare system is here:

- When I had my heart attack, then was rushed to the nearby hospital by ambulance, had emergency OHS, AVR, double bypass, etc; my insurance plan at work (of which I was paying something like $3000 a year for in the first place through payroll deductions) had a $1600 (? I 4get exactly, either that or $1800) deductible which I had to pay b4 my insurance would cover a penny (then they pay 80% and I pay 20%). Then I had an "out of pocket" limit meaning once I reached that (I 4get exactly what it was but am thinking $3000? I 4get) the insurance paid 100%. Of course I paid that $1600 deductible out of my "pocket". But it didn't count towards my "out of pocket" expenditures. Many people don't understand that since they are paying it that really the "out of pocket": expense is your deductible PLUS what the insurance company calls the "out of pocket" expense.

- My hospital bill alone, not counting any of the bills for doctors, surgeons, the ambulance (a $2500 charge plus $56 dollars for gas, for a 4 minute ride btw), physical therapy, drugs, everything else, was $475,000! How many people actually have an extra half million dollars lying around? 1% of the entire population? I don't know anyone personally anyways. Of course the insurance co has "contracts" with the providers for every little thing so that $1500 box of kleenex or $800 bar of soap charged by the hospital got whittled down to $4 each, making my hospital bill "only" about $60,000, but still - who can afford an unexpected - or even expected - $60k bill??? Of course with insurance you yourself don't pay all that but....

- Luckily I had my heart attack in the end of April. I "only" had to lay out around $4600 for the medical costs themselves (except for some adventures with wrong billing that I had to fight) at which point afterwards everything was free for the next 8 months until the end of THAT YEAR so I could then get the various other followup treatments (cardio + physical therapy), many many tests and dr visits etc without having to pay more. But if I had been stricken say in the end of December my deductible and out of pocket etc would have all reset to 0 on January 1st!!!!! And I would not have even had been able to afford my next needed round of treatments/exams/etc!!!! That is nuts. Just total luck of the draw as far as what month I was stricken.

- While I was laid up in the hospital I asked for a pad of paper, pens, and a calculator. I then figured out how complicated it really is to determine what actual insurance plan to choose. For instance where I work there was at that time an option for a something like a $1200 deductible with $3000 out of pocket and 10% copay which cost X per month, a $1400 deductible with $3000 OOP and 20% copay which cost X-Y per month, and a $1600 deductible with $3000 OOP which cost X-Y-Z per month. To really figure out which plan makes most economic sense you need a crystal ball to know what your healthcare costs are going to work out to that year, or you can just say well I am not going to get sick at all so I'll go for the lowest cost plan (which actually is not the best bet), or even plug in the numbers from like I just had been hit with, and you then understand that the highest monthly cost plan is not even necessarily the best choice if you are going to be hit with huge healthcare bills, sometimes it makes more sense to bite the bullet & live with the higher deductible with the higher copay because you'll actually hit the OOP faster so you SAVE money in the long run when factoring in the lower monthly COST of that insurance etc. It's screwy and giving me a headache even trying to remember what I figured out, which was how fast on each plan I would have hit the OOP and how much I would be laying out in monthly plan costs. I ended up making some kind of matrix with guestimates for each overall as far as what differing health care bills for the next year would end up being. Not things that anyone tells you about to consider in making your choice of which plan to take (usually the only advice you are given is to chose the most costly plan with lower copay if you are afraid you might get big health bills that year or vice versa).

- While I was still in the hospital, think I had been transferred from ICU to cardio rehab floor only like a day earlier, still out of my mind with pain/weak/drugs/wired up all over the place etc I was paid a visit by the hospital administrator used car salesman who dangled a "discount" in front of me if I agreed to pay my deductible + out of pocket max to her right then. I told her that I needed to think about it. Then I asked her, even in my mental fog of pain & drugs post heartattack and surgery, wait a minute, as I understand it wouldn't my deductible, and also the out of pocket, be applied willy-nilly by my insurance company, in a process not yet determined, so wasn't it possible that the HOSPITAL BILL which she was trying to get me to pay up front wasn't even going to be BILLED to me FIRST in which case if I did pay her my deductible + full copay of $4600 now upfront (even keeping in mind her 5% discount or whatever it was) that I would be risking paying her something which in the end if the hospital bill was NOT processed first by my insurance I would then be OUT that $4600 I'd be giving HER PLUS be hit with $4600 of bills FROM SOMETHING ELSE, AND having to then bug the hospital to give me my $$$$$ back which they were not owed in the first place????

Now this is her JOB. She KNOWS the truth, what is REALLY going on, she handles this sort of thing hundreds of times a day, this is my first go round at this plus I am near death and in a fog. But what does she do. SHE LIES TO ME AND SAYS THAT THE HOSPITAL BILL OF COURSE WILL BE FIRST. So that I should take advantage of her discount offer and only pay her $4200 (or whatever it was) instead of the $4600 that I would be billed later. And then ramped up the pressure saying it was a one time offer but she would give me 24 hours to decide. Can you believe the nerve of that BITCH? I was too worn out/exhausted/not thinking clearly so the next day I paid her hoping to save that $400. But of course she was WRONG. The hospital bill took something like 6 MONTHS to get ironed out and negotiated with my insurance. I was hit with the $1600 deductible plus $900 of my out of pocket for the ambulance, then the other $2100 went to a bunch of Dr. bills. I called her on the phone every single day for a WEEK asking for my money back and she never returned a single call. I called the president/head administrator of the hospital and left messages and he never called me back. I wrote letters. I stopped by the admin office ("oh we're sorry he's out"). I did not get that $4600 back until several months AFTER the hospital bill was agreed upon by my insurance company plus another 3 months of phone calls to those assholes. I swear they do this ON PURPOSE to try to steal whatever $ they can. Some people die, or are too sick, or are too overwhelmed just trying to get well, deal with all of the virtually non-stop wrong bills that you end up having to fight and challenge and overlook the hospital ripoff part I just detailed. This is our great healthcare system we have though.

Sorry about that rant above but it got me boiling again. Other people I know were victimized similar ways. You need to have enough time, energy, intelligence, and sheer willpower to fight for yourself in light of all the crap that you get thrown at you if you dare to get sick.....

There was something else I wanted to say but got derailed with my hospital ripoff rant.....sorry
 

slipkid

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I thought the pre existing conditions changes happened when Obama was president under the ACA?
Yes, I caught that mistake & posted about that above as well. Under Clinton we got COBRA to allow us to continue our coverage for a limited time after losing a job under certain conditions but that had nothing to do with preventing insurers from excluding "applicants" with pre-existing conditions (that came from the ACA).
 

slipkid

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Also I don't believe Biden has come out for Medicare for all. That was Bernie Sanders position
Yes, I am afraid you are correct. Just like some republicans are called "rhinos" ("republican in name only") Biden is a "dino" ("democrat in name only"). I'm not going to elaborate on that since I don't want to get into politics...
 

MdaPA

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Under Clinton we got COBRA to allow us to continue our coverage for a limited time after losing a job
FWIW, COBRA (H.R.3128 - Consolidated Omnibus Budget Reconciliation Act) was passed in 1985 under Ronald Reagan, not Clinton. I know this as I worked on a computer system for an insurance company around that time and had to update it to meet the new COBRA requirements.

H.R.3128 - 99th Congress (1985-1986): Consolidated Omnibus Budget Reconciliation Act of 1985
 

cldlhd

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Yes, I am afraid you are correct. Just like some republicans are called "rhinos" ("republican in name only") Biden is a "dino" ("democrat in name only"). I'm not going to elaborate on that since I don't want to get into politics...
It's fine, we don't have to agree on everything. He's not perfect, nobody is but I prefer not to let the perfect be the enemy of the good. A Democrat to the far left would almost certainly lose swing States like Pennsylvania. So to me it was either a moderate Democrat or Trump
 

RAS

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FWIW, COBRA (H.R.3128 - Consolidated Omnibus Budget Reconciliation Act) was passed in 1985 under Ronald Reagan, not Clinton. I know this as I worked on a computer system for an insurance company around that time and had to update it to meet the new COBRA requirements.
Correct. COBRA preceded the Clinton admin. Under Clinton the Health Insurance Portability and Accountability Act of 1996 included privacy provisions for personal information associated with health care - which is what it is most known for under the acronym HIPAA and some limited protection in group health plans for pre-existing conditions. Employers could not deny coverage to an employee who for example acquired a significant illness while covered in a previous employer's plan, left that employer, went to a new employer and then applied for health insurance with the new employer. I don't believe it affected individual plans though.
 

cldlhd

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Yes, I am afraid you are correct. Just like some republicans are called "rhinos" ("republican in name only") Biden is a "dino" ("democrat in name only"). I'm not going to elaborate on that since I don't want to get into politics...
Just realized we are practically neighbors- I'm in Bucks county.
 

slipkid

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FWIW, COBRA (H.R.3128 - Consolidated Omnibus Budget Reconciliation Act) was passed in 1985 under Ronald Reagan, not Clinton. I know this as I worked on a computer system for an insurance company around that time and had to update it to meet the new COBRA requirements.

H.R.3128 - 99th Congress (1985-1986): Consolidated Omnibus Budget Reconciliation Act of 1985
Really? For some reason I remembered the Clinton administration taking credit for COBRA. Maybe they tweaked it in some way? Thanks for correcting me!
 

slipkid

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It's fine, we don't have to agree on everything. He's not perfect, nobody is but I prefer not to let the perfect be the enemy of the good. A Democrat to the far left would almost certainly lose swing States like Pennsylvania. So to me it was either a moderate Democrat or Trump
Yeah I hear ya. I never thought in a million years I would vote Joe Biden in for anything but faced with another 4 years of King Trump I felt compelled to vote for JB.
 

Keithl

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Yeah I hear ya. I never thought in a million years I would vote Joe Biden in for anything but faced with another 4 years of King Trump I felt compelled to vote for JB.
Not to start a Trump debate, but I am guessing he won't run 24 because I believe many moderate GOP after the "big lie" and Jan 6 will never vote for him and I don't think he wants to be embarrassed twice. My only concern is all the voter laws stacking the deck in the GOP favor. But then at this rate Corvid may help by reducing the GOP voter numbers ;) 😱:ROFLMAO:
 

Chuck C

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About 99.999% of fully vaccinated Americans have not had a deadly Covid-19 breakthrough case, CDC data shows


If you believe in math, it is not even debatable at this point. Get vaccinated and let's move past this difficult chapter.
 

tom in MO

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About 99.999% of fully vaccinated Americans have not had a deadly Covid-19 breakthrough case, CDC data shows


If you believe in math, it is not even debatable at this point. Get vaccinated and let's move past this difficult chapter.
It is always debatable. My coworker's 23yo son is twisted, uncommunicative and lives in a wheelchair due to one of those extremely rare bad reactions to a childhood vaccine. It's a tragedy that has formed their lives. I don't have the guts to ask her about whether or not she or her son are Covid vaccinated.
 

cldlhd

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Not to start a Trump debate, but I am guessing he won't run 24 because I believe many moderate GOP after the "big lie" and Jan 6 will never vote for him and I don't think he wants to be embarrassed twice. My only concern is all the voter laws stacking the deck in the GOP favor. But then at this rate Corvid may help by reducing the GOP voter numbers ;) 😱:ROFLMAO:
I wouldn't it be so sure about that. I think the vast majority of Republicans either agree with the big lie or they don't care. In other words they might know he really lost but they will vote for him anyway. He has an iron grip on the top of that party when it comes to the presidential race. Those who want to compete in the Republican primary, assuming he doesn't run, will be tripping all over themselves to be as stupid as possible just take a look at the governor of Florida these days. If Trump doesn't run any Republican who does and wants to win the nomination will wholeheartedly endorse the idea that Trump had its stolen from him or they will not be nominated. You are falling for a repeat of the thinking of 2016 that there aren't enough people who will vote for that buffoon but that is certainly not the case unfortunately. Personally I think he will run against simply because he can't stand the idea that he lost, he's raising a ton of money and a lot of States will have implemented voter suppression laws.
 

cldlhd

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It is always debatable. My coworker's 23yo son is twisted, uncommunicative and lives in a wheelchair due to one of those extremely rare bad reactions to a childhood vaccine. It's a tragedy that has formed their lives. I don't have the guts to ask her about whether or not she or her son are Covid vaccinated.
I can understand that but what are the specifics of the case? Is it certain it was a vaccine reaction?
 
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Keithl

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I wouldn't it be so sure about that. I think the vast majority of Republicans either agree with the big lie or they don't care. In other words they might know he really lost but they will vote for him anyway. He has an iron grip on the top of that party when it comes to the presidential race. Those who want to compete in the Republican primary, assuming he doesn't run, will be tripping all over themselves to be as stupid as possible just take a look at the governor of Florida these days. If Trump doesn't run any Republican who does and wants to win the nomination will wholeheartedly endorse the idea that Trump had its stolen from him or they will not be nominated. You are falling for a repeat of the thinking of 2016 that there aren't enough people who will vote for that buffoon but that is certainly not the case unfortunately. Personally I think he will run against simply because he can't stand the idea that he lost, he's raising a ton of money and a lot of States will have implemented voter suppression laws.

I guess the 22 mid-terms will be a good indicator. If the Trump endorsed candidates lose then maybe Trump fades away, if not i tend to agree with you. I just don't the irony that the people that love him are the people must screwed by him.
 

Chuck C

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Your coworker's situation does not justify new math. There is no question that the statistics are there to overwhelmingly support getting vaccinated for both 1) your individual self interest and 2) in the best interest of society.
Are there genuine medical exceptions? Of course. Not talking about that. Do some families have experiences that would make their decision not to vaccinate, due to fear not science, somewhat understandable? Perhaps. My oldest daughter had a real reaction to the MMR vaccine, and developed a condition known as ITP. This is a well documented side effect that occurs in 1/25,000 children from the MMR vaccine. With ITP the platelet count drops to life-threatening low levels. She developed bruises all over her body and we had to have her treated by a specialist who treats children with leukemia. Using drugs to raise the platelet count for such children, he was able to normalize her platelet count within about 4 weeks. Very scary time for us, as a bump to the head could have been fatal. Try keeping a hyper 2 year old from bumping her head for a month.
Would it have been understandable if my family developed an irrational fear of all vaccines from that experience? Perhaps. Would statistics be on my side to support this fear? No. Would it be debatable? No. At least not in the sense that there are two sides that have legitimate arguments. Unless you mean in the sense that everything is debatable, such as whether the Earth is round or flat.
 
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