Dental Insurance

CTL, while you have a point about the need of insurance, still:

1) DR P is correct about prevention. I think 2 largest medical expenses are end of life (that you wrote about) and chronic diseases – many of the latter are lifestyle-based.

2) you should notice a seeming paradox – a well-off person like you can not afford medical care. Someone is paying for it, right? Is it that the most filthy-rich pay so much taxes that they pay for insurance for all of us, including you? Probably, not (at least according to people claiming that rich are not paying their share). The other option is that your own taxes are paying for it. Say, you earn modest $300K/year (in current year money) for last 40 years. So, you paid income tax $80K*40 = $3.2mln i just federal taxes. This is not counting 3% medicare tax, $400K, FICA 15% = $1.8 mln, + social security + cap gains + CT tax + medical insurance that you were paying … It is way possible that if the government were to give you a modest discount on your generous donations, you would be able to afford your own healthcare. Instead, government made you (somewhat) poor and then comes to help you.

“As I mentioned earlier, they cannot raise premiums at their whim and 80% or 85% of premiums must go to providers, any additional premiums collected are returned.”

Percentage alone isnt everything

The Ceo’s and Presidents of insurance companies get paid multiple millions of dollars At one Point Mark Bertoloni received almost 28 million dollars in one year. while running a company that denies claims that could have saved lives. That year I had spent months trying to get a CT scan approved for a patient wit ha suspicious lesion. Renal cell carcinoma is essentially curable if caught early enough before it spreads. by the time it was approved it had spread. (Admittedly there is no way to know for sure if it spread during that delay). The patient is dead now. the few thousand dollars his company should have spent in timely error is a rounding error in his salary. This is but one story I have dozens my colleagues have more.

The truth is I don’t fault him or the company. that is their job they profit by denying healthcare that is there entire business model. I fault the business model.

“As far as the story you mentioned is concerned- I hope that’s the exception and not the norm”
Thanks for reading it.
What I was most outraged about whas the physician who just rubber stamps what nurse had previously denied. what is the poitn of having a physician reviewer if he isnt actually reviewing it?

You say you hope its the exception . It is a lot of exceptions close enough to being the norm . It is their business model . Yes they have t pay 85% that still leaves millions and million and millions for their top executives .

Haven’t had ACA in about 5 years as I aged out. It gave me the savings benefit of a huge statewide group not the income based subsidy. It also had better benefits for same level plan from same carrier I had before ACA.
Connecticut did/does a much better job with ACA and our state exchange than most other states. Should the federal program cease due to court challenges or Congressional whim the Connecticut program will continue independently.
This afternoon a neighbor came by with some questions about tax forms for short term disability (he is having a knee replacement). I reviewed his situation, explained how to fill out the forms and then looked at his health insurance plans. We determined he would save more than 30% buying his coverage through the exchange than the small group from his employer. Since he recently had another child, I pointed out it was a qualifying life changing event and he could change his insurance despite being outside the annual enrollment period. We did it all on line. Not only will he save on his monthly cost, but his out of pocket for the surgery (all in) will be reduced by about $1000.
This was just a friendly chat with a neighbor, not billable client work. When Mrs. CTL died, his teens were here every day during shiva, setting up chairs, taking out garbage, parking visitors cars, etc. They are not Jewish but understand small town neighbors help neighbors without being asked.

@ubiquitin

“Percentage alone isnt everything”
That’s definitely correct, there are many, many more metrics that can be used to quantify data. However, given that CMS uses a percentage it’s the most appropriate metric to quantify this data.

“The Ceo’s and Presidents of insurance companies get paid multiple millions of dollars”
That’s correct again. There aren’t too many people on the planet that can accomplish what CEOs of large companies accomplish and those that can do it and are willing to give up their personal lives can command whatever salary they want. If you don’t like it start your own company and pay the CEO $150,000, let’s see what kind of CEO you get and how long the company remains afloat.

“At one Point Mark Bertoloni received almost 28 million dollars in one year. while running a company that denies claims that could have saved lives.”
This is morally wrong but he’s a businessman and makes business decisions. Had he approved all of the claims that were denied the company would either have gone out of business or had to raise premiums much higher than the competition and then gone out of business the next year. It’s wrong, I agree- but that’s how it needs to be in order for it to work.

“What I was most outraged about whas the physician who just rubber stamps what nurse had previously denied. what is the poitn of having a physician reviewer if he isnt actually reviewing it?”
That was totally appalling- physicians shouldn’t be businessmen, they should forget about money and do what it takes to make the patient as healthy as possible.

“It is their business model . Yes they have t pay 85% that still leaves millions and million and millions for their top executives .”

The 15% doesn’t only go to executives, it goes to all employees, marketing, real estate, IT, employee benefits and many other expenses. The top executives do get millions but the company wouldn’t function without them.

Dr P

The bottom line is I don;t think free market could or should be in charge of healthcare

We have touched on many reasons here are a few:
1) Healthcare is largely not driven by supply and demand
2) The information asymmetry is close to insurmountable
3) When its an emergency you cant exactly price shop
4) Having a business decide who lives and who dies Is as you said “wrong, I agree”

So If not the private sector who should run it?
t o that I say it should be the government.

The response to that is one of two things:

A – Thats not the government’s role
B- A government run system wopuldnt work

To A I reply hear, I disagree but if you dont view it as the governments role. You favor “limited government” therefore havign a business run it even if it doesnt work because of the reaosns outlined above but “that’s how it needs to be ” I hear completely. disagree, but hear (though be prepared to explain why you give the government other roles like paying for education, roads defense etc I’m not saying you cant provide a difference you just need one)

To B my reply is well Private sector doesn’t work either. so lets make the government system work .

“4) Having a business decide who lives and who dies Is as you said “wrong, I agree””

Ubiq,

So it’s better for the government to decide “who lives and who dies”?

Ubiq,

“That year I had spent months trying to get a CT scan approved for a patient wit ha suspicious lesion. Renal cell carcinoma is essentially curable if caught early enough before it spreads. by the time it was approved it had spread.”

This is very unfortunate as early detection is crucial and delays may increase complications and reduce the effectiveness of treatment. They had the following alternative options.

a. Go to the ED, and have the ED provider convinced that their symptoms require an urgent scan.

b. Explain to them the importance of the study, and why it is time sensitive, and see if they can lay out the costs (roughly 500 when paid out of pocket) and hopefully be reimbursed at a later time.
(I assume that being that they had private insurance, they had some sort of income that made the not eligible for government-funded healthcare insurance).

c. Could have used ultrasound as an alternative diagnostic tool to detect a mass, and use that as an objective means for declaring the CT Scan study urgent or emergent.

I for sure will not tell you how to practice and I am sure that you do your best to prioritize the needs of your patients, but one needs to navigate the system to the benefit of their patients.

2scents

Tried
a. didn’t work He had no symptoms.
IVe since hinted to patients to exaggerate their symptoms, Its easy to get a CT scan in ED, though I hope you appreciate the absurdity of this suggestion, Lie, commit insurance fraud to get Health care you have paid for already

b. It was more than 500, and no they didn’t have that much lying around. Though perhaps I should have pushed harder. Renal cell carcinoma does not tend to Grow quickly I was optomistic that they would eventually agree to pay for the scan (as they did). Maybe I should have told him to just pay and figth later to get reimbursed. I doubt it would have changed anything (as I mentioned earleir) but it is something I think about

C. Ultrasound was equivocal

CA
no its better for doctors and/or the patients to decide

DrP
“We seem to agree that CEOs make lots of money in their positions and that high paid CEOs are needed for the health insurance companies to function.”
disagree completely

” We also agree that (as unfortunate as it may be) CEOs (and companies) need to either be aggressive in denying claims (lawfully or unlawfully) to keep premiums down or they’ll either go bankrupt or put out of business by the competition. (It’s wrong, I know, but that’s the only way it can function.) ”

Agree but while you view that as a feature. To me hat is a bug. In other words yes That is the way it has to be to function this way. My reply is: It cant be that way there fore it shouldnt function this way. we need a new system. Period.

” We finally seem to agree that a physician should be doing everything for the best interest of a patient and setting aside how his / her decision will affect the bottom line of the company.”
Not sure that was ever in dispute. Though this seems to contradict your previous statement “…CEOs (and companies) need to either be aggressive in denying claims…”

“What we seem to disagree on is who should be running the healthcare in this country.”

Yes becasue of what yyou addmitted was “as unfortunate as it may be” If it is unfortunate, change it! It doesnt HAVE to be this way. We chose this.

“Despite all the problems going on with corporations running healthcare as a business I still think it’s the lesser of the two evils. Just because there are decisions that are being made that are morally wrong doesn’t mean the alternative is better.”

YES! that is where we disagree. As I said from one of my first posts

Ubiq,

“IVe since hinted to patients to exaggerate their symptoms, Its easy to get a CT scan in ED, though I hope you appreciate the absurdity of this suggestion, Lie, commit insurance fraud to get Health care you have paid for already’

– Its the way the system is set up, if the provider believes that this is an urgent matter, they can send the pt for the scan. I doubt that this would be considered insurance fraud.

In fact, PCPs send pts frequently to the ED for quicker and more convenient management. Despite the fact that at times these pts can adequately be managed outpatient.

CEO payments are not _the_ problem. US companies are large, it is a bog company. Most companies in fully private businesses without government payments choose to pay CEO high salaries so that there is a person in charge who spends 24/7 trying to make the company successful.

It is an empirical question which system is better. As mentioned, do we think that public schools are run better than private/charter/etc? Ask people on medicaid and medicare – are these systems better than private insurances (other than possible subsidies).

There was always a difference between how rich and poor were treated, but recent generations acquired unprecedented knowledge that allows channeling resources into improving human condition, including health.

Maybe we did not fully absorbed this into our world view. If we do value human life, maybe it is worth spending even more than we spend now in supporting medical treatments and public health instead of buying faster cars, larger homes, and fancy vacations. So, maybe health spending should be 50-70% of the GDP instead of mere 15%?

ubiq,

There needs to be some mechanism that will filter out unnecessary or excessive medicine.

@ubiquitin

“I say denying healthcare is a non starter if thats the only way it can function,”
It’s too late for that- health insurance companies have already been started, are going strong and are here to stay.

“then we need a different way. Period If that means Insurance will no longer be the lucrative field it is (one that MADE money during a pandemic!!!)”
Sounds good to me, go find another way- one that’ll work though. Just because something isn’t functioning 100% doesn’t mean that you get rid of it for something that has a 0% chance of succeeding.

“and instead we a need a non-for profit system or Government run Ok so be it.”
The government tried that already with the COOPs (part of the ACA). Each state was supposed to have one, they were supposed to be not for profit and the CEOs (or any employee) couldn’t make too much money. The government pumped billions of Dollars into them and they practically all failed within a few years (causing the providers to lose hundreds of millions of Dollars in unpaid claims and causing the policy holders to lose thousands of Dollars each in high deductibles that had to be restarted mid-year).

“But denying healthcare a patient and or doctor* deems neccesary is a non-starter for me”
Again, just because the system isn’t functioning 100% of the time for 100% of the people- doesn’t mean that you get rid of it for something that has no chance of working.

“disagree completely”
It would help if you would let me know what part of my comment you’re disagreeing on.

Do you disagree that CEOs make lots of money in their positions?
I’ve never researched this but I think the salaries of CEOs in publicly traded companies is available online.

Do you disagree that high paid CEOs are needed for health insurance companies to function?
Again, take a look at the failure of the COOPs where CEOs weren’t allowed to make too much money.

If you think it’s possible, go ahead and start a company that pays all claims- let’s see how long it lasts.

“Agree but while you view that as a feature. To me hat is a bug. In other words yes That is the way it has to be to function this way. My reply is: It cant be that way there fore it shouldnt function this way. we need a new system. Period.”
It’s an unfortunate feature- If companies just approve every claim they’re going to go out of business as premiums weren’t priced based on that. If they raise the premiums to be able to afford to pay all claims- the policy holders will just switch to a company that doesn’t pay all claims. You’re correct that it shouldn’t be that way but, again, just because there’s problems with a system doesn’t mean that you throw it out for a system that’s guaranteed to fail.

“Yes becasue of what yyou addmitted was “as unfortunate as it may be” If it is unfortunate, change it! It doesnt HAVE to be this way. We chose this.”
Again- just because a system is unfortunately not working 100% doesn’t necessarily mean that there is a way to fix it or that changing the system will be better. It doesn’t necessarily even mean that it’s the design of the system that’s flawed- the system could also be harmed by people who aren’t even part of it but are still bringing it down.

“YES! that is where we disagree. As I said from one of my first posts”
Finally! We agree on what we disagree on. As I mentioned in an earlier post- in order for a government run healthcare to work in this country the inhabitants need to start taking more responsibility for themselves- and we’re decades away from this and heading full speed in the wrong direction. Were the government to take over it would turn into an epic disaster probably the same size as the public-school calamity. Taxes will go up; the system will barely work for anyone and those who are serious about their healthcare are going to have to buy their own insurance (above what they’re already paying in their increased taxes).

I strongly feel that a system that’s working, but not for 100% of the people, shouldn’t be thrown out for a system that is guaranteed to fail catastrophically. Apparently, you disagree.

To sum up

Yes for a healthcare company to profit they have to deny healthcare. people need to suffer/die/go bankrupt. There is no other way.

(you said this to me a few times as if I didnt get taht, I get it that is EXACTLY the problem with outr current system. IT CANNOT work for everyone)

The only way to have it work for everyone is for the government to step in.

There are 2 reasons I can think of why someone would oppsoe this
1) Dont think it would work
2) don;t think governemtn should be involved even if would work.

1- I don’t fully get. so make it work. It works for Medicare it works in other countries. It works for dialysis patients expand it to cancer expand the age for medicare.
2 I hear thats where we disagree

(note this is what I said from my early post to you THIS is the point of argument

“If you maintain that it isn’t the Government’s job to get involved whether you worked out and saved (Mr A.) or didn’t (Mr. B) I understand that. I disagree (as to most people Even Trump running as a Republican promised to provide “the best healthcare plan” and Medicare is wildly popular )”

the rest eg do healthcare CEO’s make too much is fluff)

“(I’m not familiar with kidney dialysis but does Mediare actually pay for all their expenses?)”

Yes!!!

IT is the one disease if a person gets it they automatically get government funded health insurance (after a waiting period)

Can thank Nixon ofr that of all people.

” Why aren’t you going to defend it [ACA]? If the government failed catastrophically at the ACA, why do you think they’re going to succeed at something that’s going to be much larger?… The last time they tried this (i.e. the ACA), they failed miserably.”

I’m not defending ACA because that is not my proposal. A single payer system was proposed but quickly shot down.

“I’m in the first category (as well as probably every sane person in the country who currently has health insurance)”

That hasn’t been my experience.
Most people I talk to who have had a medical expense (Cancer treatment denied, procedure denied both in the past week) do not think this is working. They are sane people, but whereas you “sympathize with them and wish something can be done” I know that something can be done

You remind me of the Onion article that runs after every mass shooting “”‘No Way to Prevent This’, Says Only Nation Where This Regularly Happens”

I can hear it:
“No way to fix this says only country where medical bills is leading cause of bankruptcy” !
And “we have the best healthcare system in the world says the country with highest healthcare expenditure and lowest life expectancy of (almost) any western country”

@ubiquitin

“I’m not defending ACA because that is not my proposal. A single payer system was proposed but quickly shot down.”

You’re going to have to defend the ACA if you’re insisting that the government can come up with a single player system that’ll work after they failed miserably on something of a much smaller scale.

“That hasn’t been my experience.
Most people I talk to who have had a medical expense (Cancer treatment denied, procedure denied both in the past week) do not think this is working. They are sane people, but whereas you “sympathize with them and wish something can be done” I know that something can be done”

There are exceptions- I agree, that’s why I used the word “probably”- to exclude people who, for extreme circumstances, would not be in that category. Please explain though why any sane person (not in an extreme situation) would want to pay more for a lower quality healthcare system?

“You remind me of the Onion article that runs after every mass shooting “”‘No Way to Prevent This’, Says Only Nation Where This Regularly Happens””

The reason why we’re the only nation where this regularly happens is because we’re the only nation where it’s ingrained in people’s culture that life (their own or others) has little to no value. Change that culture and the number of mass shootings will go down.

“I can hear it:
“No way to fix this says only country where medical bills is leading cause of bankruptcy” !
And “we have the best healthcare system in the world says the country with highest healthcare expenditure and lowest life expectancy of (almost) any western country””

Sure there’s a way to fix this. Change the culture of people and teach them the value of life at a young age. Look at all the unhealthy lifestyles that people have- get them to make healthier choices from when they’re young and the healthcare expenditure will go down and the life expectancy will go up. Instead, we have people like you putting the blame in the wrong place. Once people start taking responsibility for themselves- then a single player system can be a viable option. Until then- it’s going to crash and we’re all going to be worse off.

At this point I’m getting pretty frustrated with this discussion. I respond to practically everything that you write (no matter how many times you repeat the same thing in different words) and you don’t respond to many of the strong points that I make. The points that you do respond to, you don’t bring up any claim to back it up.

I’m happy to continue this conversation if you can answer my questions straight to the point. If not, it was a pleasure discussing this with you but I’m done.

1. You mentioned that health insurance companies don’t need high paid CEOs to function. I brought you many examples of non-public companies run by low paid CEOs that failed miserably (the ACA COOPS). Can you show me (or explain how it’s possible) a health insurance company (public or private) that functions with a low paid CEO?

2. I opined that until people learn to take responsibility for themselves a single payer healthcare system will turn into a calamity the size of the public school system where those who want quality healthcare will have to pay for their own insurance above the extra taxes they are already paying to fund the single payer system. Can you please explain why you disagree with that?

@ubiquitin

“I dont understand this.
I support one idea, why do I “have to” defend a different idea ?”

As I’ve said before but you never adequately answered (a strong point that you ignored)- you’re advocating for the US Government, who failed miserably at the ACA, to be in charge of a single payer system. You need to explain why you think the same US Government could successfully run something of a much larger magnitude.

“I am advocating paying less for a higher quality system.”

That was former President Obama’s claim with the ACA- the typical family will save $2,500 per year in healthcare- and we all saw that it wasn’t the case. I understand that you’re advocating for that (and I wish it were possible) but you haven’t explained how we’re going to end up paying less (where the money is going to come from) or how the quality is going to go up.

Would you mind explaining how you think it’s going to work?

“By any Benchmark the US pays MORE for healthcare. By most benchmarks we have worse outcomes.”

I’ve said this point before and you haven’t addressed is so I’m going to repeat again- this is mostly due to the irresponsible culture here of people not caring about their health or taking responsibility for their wellbeing.

“Same for healthcare. “Hey it works for me who cares about those it doesnt work for, that is just a necessary evil” (almost a verbatim quote)”

Where’s this coming from? You can’t ask people who are struggling to make their own health care payments (already so overpriced due to the people who refuse to responsibly of their health) to care more about someone else’s health than they care about their own. (Again- I’m referring to those who are fully capable of taking care of themselves but refuse to, not people sick with illnesses that they didn’t bring upon themselves.)

“As I said (20 times?) I don’t think health insurance should be a for profit industry. So while you keep repeating this point over and over. It has absolutely nothing to do with the subject at hand .”

You’ve said that health insurance companies don’t need to be run by high paid CEOs- did you mean to say that for health insurance companies to work they need high paid CEOs but health insurance companies shouldn’t exist at all? You still haven’t explained how a company will survive with a low paid CEO.

“Ok so CEO wont be filthy rich. I’m fine with using that extra $$$ to approve more cancer treatments.”

Then the CEO will resign and become a high paid CEO elsewhere. I agree that they’re greedy but we need them to run our corporations which provide employment to millions of people making a modest salary and provide goods and services to hundreds of millions of people. Go ahead and replace them with well-meaning but low paid CEOs and watch how fast everything will fall apart and make things worse for everyone.

“You say there is no CEO of a healthcare company that gets a reasonable salary. Yes I know, THAT is the problem The problem IS that health insurance IS a for profit venture. Yes Its hard to find a reasonably paid CEO, that is EXACTLY the problem. Have I really not said this ????”

I didn’t write that there isn’t one (I’m not saying that there is, I have no idea one way or the other). I just asked if you could explain how it could work without one. Until a not-for profit system can be designed we need for profit companies which come along with high paid CEOs. I mentioned how practically every single COOP (not for profits that received Billions of Dollars and had low paid CEOs) failed.

“But if you insist as far as I can tell Chiquita Brooks-Lasure the head of CMS (center for medicare and medicaid services) makes $249,723.”

CMS isn’t a private company- it’s a government agency. From the ridiculous dealings I had with them (while working in the ACA) and the sheer incompetence of the people working there all I can say is that a typical company that acted like that would be out of business within a year. The president of the US also makes a mere fraction of what these CEOs make- but again- no company could survive with him at the helm.

“In contrast Cigna CEO David Cordani took home more than $91 million in 2021 thats more than 364 times as much!!! put another way, he made her salary every single day of the year minus his birthday.”

Obviously the shareholders and board which determines his compensation felt that that’s what he’s worth. If you feel that he’s overpaid start a mutual, not-for-profit company that’s owned by the policy holders, become the low paid CEO, pay all claims, charge lower premiums and if you can stay in business you can put them out of business- that’ll show them.

“As I said over a month ago (February 2, 2023 5:35 pm) that is a technicality. If you want to increase taxes on smoking /sugary drinks etc to encourage good behavior. sure I can get on board. You want some sort of mandatory exercise program, I’m a bit squeamish but ok if thats what it takes I’m in”

You may have said that over a month ago but it still doesn’t respond to my strong point that a single payer system CAN NOT work until people start taking more responsibility for their health. Can you please respond to that directly?

“My apologies I missed all of your “strong points”
Do you mind repeating them”

Sure- here’s one of them.

I mentioned a few times that a single payer system will turn into a calamity the size of the public school disaster. Some school systems pay in the $30,000 range per student yet don’t have a single student that is proficient in math ot English. All this while the teachers (some of them who have no business being around children but are protected by the powerful unions) are bringing in huge salaries. After paying for all this in taxes, families that want their kids to get an education are forced to send their kids to private schools at an additional expense.

With a single payer free health care for all, you’re going to have people who don’t take care of their (or their kids’) health, don’t follow doctors directions and end up costing the system billions of Dollars in unnecessary expenses while clogging up doctors’ offices, hospitals and emergency rooms. What’s going to end up happening is that those of us who care about our health and currently have insurance are going to have to pay more in taxes for a single payer system while having to take out private insurance all over again if we want quality health care.

“There were no points in this last post that were strong nor that I didn’t previously reply to”

Uh- there was- the comparison to the public school that I just repeated again. Please explain why it’ll be different

Can you break up the super long posts into shorter ones? Or send more coffee over to Mods HQ?

@ubiquitin

“Medicare works”

Ok, here’s another important point of mine that you ignored. I mentioned earlier that Medicare is generally for people aged 65 and older. People that age grew up in a different era where they took more responsibility for their health. Once you start including the younger generations the costs will spiral out of control.

“here other countries manage. I see no reason why the US can’t manage soemthing similar.”

Again, it’s the culture ingrained nowadays in the US that life and health are practically worthless.

“The fact that something else was tried has nothing to do with this .”

To me it does- it proves that the US Government has no clue how to manage healthcare for those under 65.

“Sure
No premiums. taxes go up. Government pays for health costs.
Easy peasy
Same as medicare just for everybody”

That’s easier said than done. It’s like saying you can fit five elephants in a Volkswagen by putting two in the front and three in the back.

“I am nto sure what there is to address. But I’ll repeat it again so encourage people to care about their health.”

That’s not my problem and I have no idea how to go about doing it- it’s a horrible culture that they’ve been brought up in- if you’re trying to get a single payer system to work you need to first figure out how get people to take responsibility for their own health. That’s the first step.

“for the 21st? Time they shouldn’t survive. that is my plan.
How on earth are you still not getting this?”

You made it clear that you don’t like health insurance companies, you’ve made it clear that you don’t like it that CEOs make so much, you’ve made it clear that you don’t think companies need high paid CEOs to survive and you’ve made it clear that health insurance companies should be not-for profits with low paid CEOs- I don’t believe you’ve said that they should all be closed down.

“Take one day’s worth of the Ceo’s salary use it to pay my neighbor’s cancer treatment for 2 years (10,000 a month), the ceo will barely notice the missing money its not even a rounding wrror. And neighbor gets to live a few more years . I know I know “no sane person” would expect insurance company to shell out money just to gain few years (The rep practically told him that too) . and leshitascha I can’t blame them they have to make profit.”

The massive salaries that the CEOs make can not pay for all the claims that are denied (it’s not only your neighbor whose claims are getting denied). This is a problem with a for profit company (the health of the insureds should come first but the wallets of the shareholders have a higher priority) and I’d be all for a single payer system if there’s a chance that it’ll work.

“This is incorrect Medicare is very popular.
and by far the easiest company to deal with.”

Of course it’s easy to get them to give out other people’s money- those weren’t the issues I was having with them. One issue I was having with them was when I needed a response from a certain person regarding a report I needed to submit that was already overdue. She (and her supervisors) ignored my repeated calls, voicemails and emails for over a month. When I learned that she was hosting a webinar I joined and during the Q & A at the end I asked my question. She gave me the wrong answer and when I pointed it out based on guidance published by CMS she said she would look into it and get back to me. Despite numerous attempts to contact her (and her supervisors) I never heard back from them.

“what ? Seriously, What?”

What part don’t you understand- that a CEOs salary is based on his / her performance determined by the board or my idea what you could do if it bothers you?

“Again?
Sure. so encourage people to take more responsibility. You got me. I’m in.”

Yes, Again- until this issue is resolved a single payer system will not work.

“Sure.
firstly Medicare works so no reason to compare to ecucation which is less similar.”

As mentioned previously, Medicare works because it’s for a more responsible part of the population. Education is less similar but similar enough in that it’s failing because the people that it serves don’t take responsibility for themselves or their kids.

When I used to take my kids to the doctor for an ear infection I would make sure to follow the doctors directions and pick up the medication right away- aside from not wanting my kids to be in pain I didn’t want to have to pay the copayments for follow up visits. For people who don’t care about their kids (i.e. the ones who send them to public school, have no idea that their kid is failing every single subject and barely ever shows up to class) and aren’t concerned with a copayment- what incentive is there to follow the doctors recommendations? This attitude is one of the things that is going to break the system.

“Second all the government will be doing is paying the bills.”

If they keep paying all the bills (with no cost to the patient) what’s going to discourage someone with a paper cut from going to the emergency room, taking up a bed, wasting precious resources and having the government pay hundreds or thousands of Dollars- instead of them just going to Duane Reade and spending a few Dollars to get a box of Band-Aids? Eventually they’re going to have to do some denial of claims and then it’s going to be the government that decides who’s going to live and who’s going to die? Does it make you happier that it’s the government deciding and not some rich, greedy CEO?

“And I’m not sure how you think private medical insurance makes sure their clients are listening to doctors any more than Medicare does.”

That’s what copayments and deductibles are for- to discourage unnecessary follow-ups and encouraging the patient to follow the doctors directions. Besides- when people pay for things with their own money (i.e. health insurance premiums and private education) they tend to value it more.

” I mentioned earlier that Medicare is generally for people aged 65 and older. People that age grew up in a different era where they took more responsibility for their health. Once you start including the younger generations the costs will spiral out of control.”

I dont think its an important point. I know young people careful about their health and old people that ignore it.
This is your go to for every example
elderly, Europeans All super careful about their health. dialysis patients, oh I guess they are too. You made an assertion, with out much to back it up
And no it wont spiral out of control. young people use much much less health dollars than those > 65

“I don’t believe you’ve said that they should all be closed down.”
I don’t think you are reading my posts
Here are some verbatim quotes of mine

” I don’t think health insurance should be a for profit industry.”
and
“Yes for a healthcare company to profit they have to deny healthcare. people need to suffer/die/go bankrupt. There is no other way.(you said this to me a few times as if I didnt get taht, I get it that is EXACTLY the problem with outr current system. IT CANNOT work for everyone)
The only way to have it work for everyone is for the government to step in”
and
“The truth is I don’t fault him or the company. that is their job they profit by denying healthcare that is there entire business model. I fault the business model.”
and
“You say it is a business. Yes I get that I don’t blame him. But I think it SHOULDN’T Be a business that is PRECISLEY my point. As I’ve been saying from the beginning. Business leads to morally wrong decisions and outcomes (as you agree). Healthcare as a business doesn’t work.”

I don’t understand how you could have missed all these

“The massive salaries that the CEOs make can not pay for all the claims that are denied ”
Lets take one a t a time. Lets start with him, he’s a really nice guy

“What part don’t you understand-”

I don’t understand why you keep repeatign this. Yes I know the WHY the ceo makes money. I know how. I dont think he should. I don’t think healthcare should be a for profit industry.
Your response to that has been “well the CEO deserves the profit”. He only deserves the high salary if you think healthcare should be a for profit industry. yes in a for profit healthcare world he desrves high slary. He helped guide thousands of denials! he shortned so man ylives saving the company millions. He definitely deserves his salary. But this is a premise I completely reject (again and again and again)

“As mentioned previously, Medicare works because it’s for a more responsible part of the population”
Yes you mentioned that. I dont think you have any real data to bck that up.
And again i’ll bet the extra expense incurred by the young population that ignores there health is much less than the expenses incurred by the elderly that don’t.

“When I used to take my kids to the doctor for an ear infection I would make sure to follow the doctors directions and pick up the medication right away-”
you get a gold star!
Some of my patients do some don’t I see no correlation based on their insurance

“If they keep paying all the bills (with no cost to the patient) what’s going to discourage someone with a paper cut from going to the emergency room,”
The uninsured already do that . Providing them insurance would ease the pressure on emergency rooms, they can now go to their regular doctor

Dr. Pepper,

“you’re advocating for the US Government, who failed miserably at the ACA, to be in charge of a single payer system. You need to explain why you think the same US Government could successfully run something of a much larger magnitude.”

So the US Government does not “run” the ACA. The ACA is a conglomeration of laws that primarily expanded eligibility for Medicaid, forbade insurance companies from denying coverage based on pre-existing conditions, and mandated individuals to have medical insurance coverage. You might be thinking of the disastrous rollout of the online individual insurance marketplaces. Agreed that was truly bad. The blame can be spread around (some states set up their own awful exchanges, others relied on the Federal Government’s), but it was a failure to coordinate resources, share knowledge, and test systems before going live. A slight limmud zechus is that these state and Federal agencies had not put something together like that before, whereas Medicare has been a humming beast for decades.

“I mentioned a few times that a single payer system will turn into a calamity the size of the public school disaster.”

Public schools are not a single payer entity. The majority of their governance comes from the local and state levels of government.

“All this while the teachers (some of them who have no business being around children but are protected by the powerful unions) are bringing in huge salaries.”

I’d hate to see what you consider a meager salary.

“With a single payer free health care for all, you’re going to have people who don’t take care of their (or their kids’) health, don’t follow doctors directions and end up costing the system billions of Dollars in unnecessary expenses while clogging up doctors’ offices, hospitals and emergency rooms.”

…

“As mentioned previously, Medicare works because it’s for a more responsible part of the population”

So blaming the citizenry for the sorry state of affairs may feel good (politicians used to not dare try it, but now they love to so long as they can tar their targets with the opposite political affiliation), but it’s just simply not true. Health care expenditures are higher for young children, then drop quite low through early adulthood (with higher expenses for childbearing women), and then increase along an exponential curve once you get older. Per HHS statistics, your superior responsible adults aged 65+ accrue an annual average of more than $11,000 per year, vs. near $3000 per year for the horrible no good rotten 18-44 age group (which even includes most of those childbearing women getting harassed into expensive hospital interventions).

@ubiquitin

Ok, you got me there. I wasn’t reading your posts carefully and I apologize. I believe I misunderstood a comment of yours that health insurance companies shouldn’t be run by high paid CEOs, I took that to mean that you felt that they should be run by low paid CEOs and not that you felt that they should be shut down altogether. I was fixated on that point and my posts reflect that.

I’d still like to continue our discussion if you don’t mind. And again, I apologize for any frustration I may have caused you.

א גוטין חודש

Avi

Dr. Pepper, I’m not an expert on this issue, but is the public school systems in suburbia as bad as those in the major cities? I somehow got the impression that often well to do parents move to towns known to have decent to good (or better) public schools that are in another league compared to major cities.

AND
I f I may add to the last point
Even if you are right that medicare for all won’t work becasue people who don’t take care of their health will abuse the system
OK so support Medicare for all who do take care of their health (or at least try) . Exclude smokers, require exercise , I said a few times if thts what it would take to get you on board I’m in

In that case do we agree?

ubiquitin,

“OK so support Medicare for all who do take care of their health (or at least try) . Exclude smokers, require exercise , I said a few times if thts what it would take to get you on board I’m in

In that case do we agree?”

Aaand there’s the coercion. Nope, I don’t agree. Medicare for all should be Medicare for all. Pay the healthcare costs and let the citizenry live their lives.

@ujm
I’m not sure if my previous post went through as I got an error message- so here it is again. Apologies if it’s a duplicate.

I’m not either an expert but based on discussions I had with a former supervisor who lived in the outskirts or Queens or on Long Island I believe that it’s true.

He said that the district raised property taxes sky high (with the blessings of the residents) to keep the riff raff from moving in and used the extra money to create public schools that are on par with the most prestigious private schools.