Anyone agree that we 50-65 year olds need insurance too?

[diana543]

I seldom hear anyone, except the presidential candidates who speak of universal healthcare, talk about those MILLIONS of us who have fallen through the cracks - age 50-65 - who cannot get insurance because of a prior illness. I’ve been turned down for a personal policy & my husband’s group policy premium (for me) is so high we cannot afford it! I need healthcare now but am treated very rudely & in some cases obnoxiously, when asked if I have insurance when trying to make a doctor appointment & have to say “no”. A new patient must wait 4 months to see the doctor so in the meantime, if that patient has an emergency situation, he/she must go to an extremely high-priced (even more than regular clinics charge) to get care at ERs or a walk-in clinic. I am a productive member of society but am treated as though I’m pond scum. With all the talk about this country being Christian, I am not seeing it! I have been a Catholic all my life & love my church. But when are we all going to wake up & do something about this moral dilemma called “healthcare in America”. When is it going to be more important to help people in time of need than to line the pockets of the medical profession (including insurance companies). I sometimes feel its too late for me.

 

[Neil_Anthony]

I seldom hear anyone, except the presidential candidates who speak of universal healthcare, talk about those MILLIONS of us who have fallen through the cracks - age 50-65 - who cannot get insurance because of a prior illness. I’ve been turned down for a personal policy & my husband’s group policy premium (for me) is so high we cannot afford it! I need healthcare now but am treated very rudely & in some cases obnoxiously, when asked if I have insurance when trying to make a doctor appointment & have to say “no”. A new patient must wait 4 months to see the doctor so in the meantime, if that patient has an emergency situation, he/she must go to an extremely high-priced (even more than regular clinics charge) to get care at ERs or a walk-in clinic. I am a productive member of society but am treated as though I’m pond scum. With all the talk about this country being Christian, I am not seeing it! I have been a Catholic all my life & love my church. But when are we all going to wake up & do something about this moral dilemma called “healthcare in America”. When is it going to be more important to help people in time of need than to line the pockets of the medical profession (including insurance companies). I sometimes feel its too late for me.

Yes, the biggest reason to have public health care is that insurance companies will drop you like a hot potato if you get sick. The whole reason for health insurance is to BE THERE when you’re sick.

 

[Swan]

Yes, the biggest reason to have public health care is that insurance companies will drop you like a hot potato if you get sick. The whole reason for health insurance is to BE THERE when you’re sick.

Exactly. It’s kind of like needing to get a loan - it’s much easier to get one if you don’t really need the money.

The problem is that the insurance companies are getting rich while folks like us go without health care. I’ll be 50 in Oct. and have rheumatoid arthritis and bipolar disorder. Right now I don’t have insurance at all and I get no treatment at all. I make too much to get free care and too little to be able to pay for insurance.

 

[quasimodo]

people need health care not health insurance. Where I come from everyone has health care whether or not they are insured. It isn’t perfect but it works well enough.

socialized medicine is not the answer we need but it is probably the answer we are likely to get. -(and you are right, it will be largely because of the heavy-handed-patient-be-damned attitudes of the insurers.) We will all suffer for it and the elderly and imperfect babies will be early victims of socialized medicine…

 

[JimG]

I was able to carry over my company healthcare into retirement, but that is a rather fortunate situation.

My sister’s husband died a year ago. She was carried on his employer policy. When he died, she was still covered but only as a COBRA plan. That meant she had to pay the full cost plus 10%, something over $1000/mo. (When it was withheld from his salary, it was about $300.)

I told her that paying $12,000 / year sounded outrageous. Finally got her off COBRA and onto an individual plan, but individual plans are still more expensive than group plans, plus they are medically underwritten, so they can exclude all her pre-existing conditions. (And the individual plan is carred by the same company that carried her husband’s group plan. So now she is covered by the same carrier, only paying more and assuming more risk.)

She has another few years to wait before she’ll be eligible for Medicare. At that time, all the plans will be willing to take her on at a lower cost, since they will then be secondary.

 

[diana543]

I am in the same boat where my husband makes too much to get any kind of assistance but not enough to pay the exorbitant insurance premiums. What really angers me is the people who treat us as though we trying to get a “hand-out” instead of paying our fair share. I’m more than willing to pay “my fair share”. However, the cost of a regular office visit is so “through the roof” that those who don’t have insurance are excluded from even preventive care. I just **keep praying **that I will never, ever, need extensive medical care or hospitalization because I find it revolting that a person’s home can be taken away just so he/she can remain alive! Don’t we have a Constitution in this country anymore? Do we not all have the same rights? :banghead:

 

[JimG]

Some hospitals actually charge the uninsured more for the same services. Insurance companies will negotiate fees, but individuals can’t.

And there are some physicians offices who are starting a new trend of accepting no insurance whatsoever. Their idea is that by getting completely out of the insurance mix, their office costs drop dramatically, they spend more time with patients. Some post price lists.

 

[diana543]

Some hospitals actually charge the uninsured more for the same services. Insurance companies will negotiate fees, but individuals can’t.

And there are some physicians offices who are starting a new trend of accepting no insurance whatsoever. Their idea is that by getting completely out of the insurance mix, their office costs drop dramatically, they spend more time with patients. Some post price lists.

You’re right about some hospitals charging the uninsured more (sometimes up to 50% more from what I’ve read from reputable sources). In addition to that, they also charge for items never given to the patient or for treatments never rendered, which is why everyone must always get detailed copies of their hospital bills. I had no idea, however, that in some physician’s offices they are accepting no insurance at all! What a great concept Maybe things are a’changin’ little by little! Thanks for the info

 

[Swan]

When I had insurance it paid my rheumatologist about $100 per office visit. When I lost my insurance and asked what she charged she told me each visit was $175! Needless to say, I haven’t been back. And should I get insurance again, I’ll find a new doctor. I went to her for a decade and she couldn’t charge me the same as she got from the insurance company???

 

[Schluns]

As an Oncology nurse, I really do feel for you. I work day to day with “tweeners” like you: Cant afford insurance/under insured and don’t qualify for Mediaid or Medicare.
I realize that our healthcare system is broken, but do not feel that socialized or Government medicine is the answer either, especially after researching medicine practices in Canada & the UK.

I don’t know what the answer is so will step out of this conversation now, but I pray for those in your position and hope that soon, our country will be able to come up with an acceptable alternative.

 

[Ridgerunner]

You’re right about some hospitals charging the uninsured more (sometimes up to 50% more from what I’ve read from reputable sources). In addition to that, they also charge for items never given to the patient or for treatments never rendered, which is why everyone must always get detailed copies of their hospital bills. I had no idea, however, that in some physician’s offices they are accepting no insurance at all! What a great concept Maybe things are a’changin’ little by little! Thanks for the info

Sometimes it’s more than 50%. The whole system is bogus. I used to negotiate provider plans for a large company, and I always got discounts from Medicare rate, which, itself, is supposed to be a 40% discount from “reasonable and necessary” charges. Providers make out quite well on Medicare rate, and “reasonable and necessary” is supposedly the reasonable retail cost. But it’s not. It’s an artificially high rate created so the Medicare and Medicaid “discounts” actually result in profitable rates. The uninsured are the only ones who pay “reasonable and necessary” rates. Insurance companies and self-insured large companies sure don’t.

But there’s another wrinkle. Medicare allows providers to build their costs (with some limitations) into “reasonable and necessary”, so the grandiose building projects, high executive and specialist salaries are, in effect, paid by the government. There is almost no incentive against “gold plating” everything. That’s part of the reason every clinic everywhere has to have the latest equipment, even if it sits idle most of the time. The government will pay for it, so what the h—. To add to it, Medicare and Medicaid pay private insurance companies to manage their claims, adding further to the cost which, of course, makes “reasonable and necessary” go up.

Then there’s yet another wrinkle. One of the reasons corporations get low rates is the “well worker effect”. In many jobs, you can’t continue working if you are really sick, particularly if you run out of FMLA. Then you’re terminated and COBRA is all you have. If you can’t pay that, then you’re dropped.

Weirdly, relative salaries of general practitioners has been stagnant. They get nowhere near what we usually think they do when they work for a big healthcare outfit. The recent proliferation of NPs and PAs suggests that GPs are in for an even rougher time in the future. Of course, they have huge insurance costs because of malpractice suits, and that gets added into “reasonable and necessary” too.

Also strangely, many healthcare giants are actually run by, or heavily influenced by the super-specialists who are supposedly just “staff”. They are at the peak of the pyramid, and make enormous salaries. They are, by the way, the ones with whom I used to negotiate rates most of the time.

I’m no longer in that business, but a friend of mine who is recently told me he got a 70% discount from “reasonable and necessary” on MRIs, CTs, etc. Now, if the medical groups can make money at a 70% discount, it really is outrageous to charge “reasonable and necessary” to some uninsured person. But they do because the system, particularly Medicare, essentially forces them to do it.

I have come to believe government isn’t the answer to healthcare. It’s a big part of the problem. But I can’t imagine how it will ever get reformed. I don’t think, though, that throwing more federal money into that “greed machine” is the answer.

 

[Ridgerunner]

Oh, almost forgot. Emergency rooms lose money in bucketsfull; chiefly because, by law, they have to treat people who come in whether they can pay or not, and whether the situation encountered is an emergency or not, and also have to have sufficient staff, equipment, etc, available to handle “peak loads”. All of that is also built into “reasonable and necessary”.

I’m in the same pickle as the OP, age-wise. “True” group policies are not individually underwritten. Most small companies, though, do not have “true” group policies, and the participants are, indeed, individually underwritten. But then, “true” group policies are usually available only for large companies whose insurers also benefit the most from the “well worker effect”.

 

[puzzleannie]

I seldom hear anyone, except the presidential candidates who speak of universal healthcare, talk about those MILLIONS of us who have fallen through the cracks - age 50-65 - who cannot get insurance because of a prior illness. I’ve been turned down for a personal policy & my husband’s group policy premium (for me) is so high we cannot afford it! I need healthcare now but am treated very rudely & in some

absolutely
I am supposed to be on disability but have to work to get insurance, since my self-employed husband cannot buy it for me at any price. just forget about SSI approving disability for someone who has to retire younger than 65, aint gonna happen, and if they give it to you one year, they take it away the next and you have to fight all over again.

not saying it is the government’s job to give me insurance, but am pointing out if they did not let the insurance co’s get the upper hand in deciding who gets health care in this country we would not be in this fix. will probably have to get a passport since it is a dead cert if I lose this job I will be going over the border for medical care, like so many of my comadres.

i find it hard to believe that fees charged for medical procedures and Rx actually reflect true cost, when the same can be had from licensed doctors 6 miles away for 20% or less charged on this side of the border.

If I get an MRI here, even with BX, and after negotiating (haggling) for a reduction, I will still pay more out of pocket (even if I have already met my deductible) than paying for the same MRI, same machine, same board certified radiologist to read it, on the others side of the border on my own.

 

[JimG]

There is a booming medical tourism business wherein Americans and Europeans travel to Asian countries for surgery. The hospitals and the physicians are excellent, and the prices are so reasonable that people pay by check or credit card.

As for universal coverage, I’ll paraphrase Dr. Doug Farrago: You can’t have universal and comprehensive. Choose one. Universal means rationing. Comprehensive means higher costs.

Personally, I think insurance ought to be mainly for catastrophic coverage. Think of what you pay over the course of a year for health insurance premiums. That amount could go down if we paid for most routine medical costs out of pocket, using insurance only for the high ticket items.

Over the course of a lifetime, I would guess that most people pay far more for health insurance than they ever receive in benefits.

 

[Ridgerunner]

Personally, I think insurance ought to be mainly for catastrophic coverage. Think of what you pay over the course of a year for health insurance premiums. That amount could go down if we paid for most routine medical costs out of pocket, using insurance only for the high ticket items.

QUOTE]

Unfortunately, in most places you can’t buy catastrophic coverage only, because the law prevents it. Deductibles are “capped” by state law or regulation, and an insurance company cannot sell you a product that is not allowed in your state. Also, under federal law, you can’t “discriminate” among employees when it comes to benefits. So, for example, the higher paid employees, who might be more able to pay for “routine” care themselves, can’t have larger deductibles than any other employees. So, it makes it pointless for a company to decide to fund “medical savings accounts” for employees based on income (which they must be to be tax deductible), since the insurance coverage has to be the same for everyone.

Medical savings accounts are a wonderful idea. But there is little incentive for employers to offer them as a benefit.

Health care costs are so distorted by governmental action at all levels that it’s no wonder they are out of control. The system is badly in need of reform, not just money.

 

[KathleenElsie]

When I had insurance it paid my rheumatologist about $100 per office visit. When I lost my insurance and asked what she charged she told me each visit was $175! Needless to say, I haven’t been back. And should I get insurance again, I’ll find a new doctor. I went to her for a decade and she couldn’t charge me the same as she got from the insurance company???

Sadly she may not have been able to charge you the lesser fee without being sued by the insurance companies. The charges across the board must be the same for everyone. What the laws also allow is for discounts must also then be offered to insurance and governmental agencies. The higher the “cost” charged to “everyone” them more the Dr is reimbursed by the government and insurance agencies. If your Dr got caught charging you the government/insurance amount then their payment from said government/insurance agency would go down to maybe $50. The Dr can’t win. (I know of Drs that don’t even charge those that are uninsured so they don’t get involved in the trap of how much)

 

[Listener]

I agree that health care in this country is a complete disaster. I am in my early 60’s and not eligible for Medicare yet. I’m lucky that I do have insurance, but here’s what gets me. The insurance pays the doctor at a discounted rate whereas an individual would have to pay the full price! For example, the doctor sends a bill for $150. The insurance says that they will allow $100, and the doctor has agreed to accept that to be in the “network.” It pays $85 out of the $100, and I have to pay the remaining $15 in addition to a copay. Just think! A person without insurance has to pay the full $150! Is this fair? I don’t think so. I think that when it comes to insurance, people are treated like car insurance companies treat people who wreck their cars. Too many wrecks, and your insurance is cancelled.

Call me radical, but I believe that the answer is to gradually get everybody in the country into Medicare, even if the deductible has to be huge. This would allow insurance companies to keep doing their thing, but Medicare would be responsible for the more catastrophic costs. Maybe this would prevent the insurance companies from refusing to insure people for pre-existing conditions.

Other countries insure everyone, and it works. The cost is lower. I will vote for whatever presidential candidate that has a decent plan for universal health care.

 

[Ridgerunner]

Other countries insure everyone, and it works. The cost is lower. I will vote for whatever presidential candidate that has a decent plan for universal health care.

Neither does, of course. Nor does either candidate have a plan to reform the healthcare system. One step in the right direction would be to require that all third party payers pay the same, and that uninsureds be charged no more than the third party payers. At least then the system could be analyzed. Right now it’s a crazy quilt of inconsistent “discounts” that no one could truly unravel. Another step in the right direction might be to disallow Medicare reimbursement for needlessly duplicative facilities.

 

[Ridgerunner]

To my above comment, I might add that oftentimes healthcare providers do not even know what discounts they have bargained for. I have many times seen them rebill at greater discounts just because a third party payer told them that’s the deal they have.

 

[KathleenElsie]

I agree that health care in this country is a complete disaster. I am in my early 60’s and not eligible for Medicare yet. I’m lucky that I do have insurance, but here’s what gets me. The insurance pays the doctor at a discounted rate whereas an individual would have to pay the full price! For example, the doctor sends a bill for $150. The insurance says that they will allow $100, and the doctor has agreed to accept that to be in the “network.” It pays $85 out of the $100, and I have to pay the remaining $15 in addition to a copay. Just think! A person without insurance has to pay the full $150! Is this fair? I don’t think so. I think that when it comes to insurance, people are treated like car insurance companies treat people who wreck their cars. Too many wrecks, and your insurance is cancelled.

Call me radical, but I believe that the answer is to gradually get everybody in the country into Medicare, even if the deductible has to be huge. This would allow insurance companies to keep doing their thing, but Medicare would be responsible for the more catastrophic costs. Maybe this would prevent the insurance companies from refusing to insure people for pre-existing conditions.

Other countries insure everyone, and it works. at 50 to 75% tax rates for many The cost is lower. I will vote for whatever presidential candidate that has a decent plan for universal health care.

I am not someone that never uses drs. I have asthma, arthritis, melanoma and am just getting old LOL. But, I don’t want anyone to go bankrupt for my medical care that includes the me, my children, grandchildren and the government. And I sure don’t want my grandchildren to have to pay 50% or more of their income to pay for it and other social “needs”.

Ways other countries cut costs in their wonderful healthcare systems are:

rationing anything other then the most routine procedures.

x-rays ok today

MRIs three to four month wait

minor out patient surgery ok

in-hospital surgery waits up to one year (many die waiting)

euthanasia or as it is called “death with dignity” provided for even mental health reasons and in some countries even for children. Just look at the Oregon health plan that has been in the news lately for a closer example.

Our USA system is sick and we need to fix it. This does not mean throwing it out with the bath water. All I want is to have affordable care and insurance for all not free. Free health care comes at a high cost and is defiantly not free.

One way to cut costs for many would be to not cover doctor visits and routine things and go back to the extraordinary costs insurance. It was at one time called hospitalization insurance. This allowed people not to worry about loosing their homes and savings while still being responsible for their own basic care.