SparrowHawk
Veteran
- Nov 30, 2009
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Or within reach of the other 230 Million Americans, depends upon how you see the glass I guess.
UPMC is now out of network
- Thread starter Al Legheny
- Start date
Or within reach of the other 230 Million Americans, depends upon how you see the glass I guess.
CallawayGolf
Veteran
- Nov 13, 2009
- 1,920
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That is far from true given our nation's vast network of laws and regulations. It should be true that an employer and employee can define the terms of their relationship without government interference, but it certainly doesn't work that way today.
...
As are new luxury vehicles, and beachfront condos, super yachts, Gulfstream jets, and hundreds of thousands of other products and services that require people to actually have the money to pay for such things. Where do you get the notion that the nation owes people the things they claim to want or need? The only way to accomplish getting something for nothing is to steal it from somebody else (or have the government do it for you).
- Banned
- #18
Last time I checked a beach front condo or a luxury SUVs, dont save your life when your sick. And this country business' puts profits over people's living and being healthy.
I had a niece who had no insurance, she was 26 with a child and was diagnosed with thyroid cancer, the dr's would not see her unless she came up with $35,000. That is criminal.
I had a niece who had no insurance, she was 26 with a child and was diagnosed with thyroid cancer, the dr's would not see her unless she came up with $35,000. That is criminal.
SparrowHawk
Veteran
- Nov 30, 2009
- 7,824
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There were and are many ways for her to get treated in this country and not pay a dime. It takes some time and effort but it happens all the time. I have a friend the same age who is being treated for Hep C and it's not costing her a dime. While I'm sorry your niece had to experience that humility the facts are it;s not criminal. Bottom line apparently is that she is alive and has been treated so somebody somewhere made it happen.
BoeingBoy
Veteran
- Nov 9, 2003
- 16,512
- 5,865
- Banned
- #21
The unfortunate truth is that health care will be rationed for the foreseeable future, if not by who has insurance, can pay or get the money then by what is covered for whom. There isn't enough money to give everyone every procedure, done by the best doctors in the best facilities, that everyone wants. The U.S. rations primarily by who has insurance, the UK (and Canada increasingly) ration by limiting services available and waiting lists. Rationing is rationing - somebody wins and somebody loses. How the rationing is done merely picks different winners and losers.
Just look at the relatively inexpensive CLASS Act, part of Obama's overall health care plan. It was to provide a cash payment of no less than $50/day to defray the cost of primarily in-home assistence and IIRC the initial cost to get it set up and operating was $35 Billion, with it being self sustaining after that through payments by workers who joined the program before needing it. Last week it was announced that HHS couldn't find any way to make it self-sustaining so it wouldn't be implemented.
Jim
Just look at the relatively inexpensive CLASS Act, part of Obama's overall health care plan. It was to provide a cash payment of no less than $50/day to defray the cost of primarily in-home assistence and IIRC the initial cost to get it set up and operating was $35 Billion, with it being self sustaining after that through payments by workers who joined the program before needing it. Last week it was announced that HHS couldn't find any way to make it self-sustaining so it wouldn't be implemented.
Jim
ChockJockey
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- Dec 18, 2008
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This is how it should be. Listen, if people can't pull themselves up by their bootstraps, beg via fundraisers and further enslave themselves to debt, how are insurance company shareholders going to get any kind of appreciable dividend or their executives bonuses? I'm sure you understand; sick people are one thing, but a sick market is intolerable. And don't try to get the government involved, the private death panels we have now are far more efficient and cost-effective than any death panels the government could scheme up. If you can't get coverage you deserve to die, I mean, it's not as if I know you personally or anything. What's that? Health insurance is available to you but then you can't afford groceries? You're probably living an immoral lifestyle or have a personality disorder. More than likely you're just lazy.
It's a dream we call America; and it won't be fulfilled until you can't take a step in this land without increasing the wealth of another, the way it should be. Life (if you're profitable), Liberty (if you're wealthy), and the pursuit of happiness (as long as you keep spending). Just keep saying your prayers before bedtime, believe the headlines, clock in, clock out, don't cause any trouble; in the next life we'll all be dukes and duchesses, and have a laugh over it all in sunshine and lemonade. So long as your existence remains a net profit to it, the market will never ever let you down.
And remember to vote NoTA in 2012!
CallawayGolf
Veteran
- Nov 13, 2009
- 1,920
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So stealing is okay as long as it's for a good cause? The end justifies the means and all that, right? Is there no end to the generosity you want to use other peoples' money for? Does it have to be life threatening or are there other quality of life factors where stealing from others is also necessary? I tore my ACL a few years ago so I guess I should have asked my fellow Americans to pay for my surgery and physical therapy instead of covering the costs myself. Or does that injury not qualify under the 700UW health care plan funded by other people's money? Perhaps it would help you to know that I tore my ACL while skiing with a group of friends. One of those friends took a rough fall and looked to be unconscious from my vantage point down below. So, I decided to ski down to the lift and ask for the ski patrol to come help her out. Unfortunately for me, before I got down I took a nasty fall myself (skiing too fast and not paying attention to the terrain but looking for the fastest route down). I crashed and ended up with a seriously messed up knee. I see now that I should not have had to pay for my attempted good deed gone awry and just demanded that someone else cover the costs.
If people are not responsible for paying their own medical bills where does it end? In 2009 the total amount spent on health care in the US was $2.5 trillion which is more money than the entire economies (GDP) of every nation in the world except for China, Japan, Germany and France. On a per-person basis Americans spend 50% more on health care than Norway which has the second highest level of medical expenditures per citizen. Citizens of the United Kingdom spend less than half of what Americans spend per person, but I guess that is because they are cold--hearted, uncaring and don't mind having bad teeth.
Furthermore, half of all health care spending in the United States is paid by a federal program such as Medicare, Medicaid, and the Children's Health Insurance Program. So that amounts to approximately $1.25 trillion in federal health care spending against $2.2 trillion in total federal "revenues". Quick math would tell you that American tax dollars are now going to cover other people's medical services at the rate of 56%. The Congressional Budget Office has projections that will dramatically increase total health care spending over the next 20 plus years if the trends continue. Add in the Baby Boomer generation which are just now entering retirement and the problems will compound at even further unsustainable rates.
But not to worry about any of this, those 280,000 American families that make more than $1 million per year will gladly pick up the tab for this and all of the other social entitlement programs to make everyone happy. Getting out of bed and going to work each morning will be easy for them knowing that the federal government will allow them to keep a couple of percentage points of their full earning potential. "It's for the good of the country and my neighbors" they will say. I'm sure their only regret will be that they couldn't work harder and earn even more money that the federal government can then confiscate and give it to those who "need" to go to the emergency room when they are feeling a little bit under the weather. What a great country we live in, insolvent to the very core, but great nonetheless.
Reed Richards
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- Sep 2, 2009
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CallawayGolf
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More proof that third-party payers mask and insulate patients from the true costs of medical care. If people paid for their own services rather than looking to group coverage and third-party providers the US wouldn't be spending $2.5 trillion a year for medical care and rates wouldn't keep growing to cover the ever-expanding "needs" people have for care.
Here's an example for you. My best friend's dad had a bad heart all of his life (he learned about it in his twenties). Despite the weak heart, he still managed to be active and provide a good living for his family. he had to take regular breaks to give himself a rest or he would be in serious cardiac trouble. This was the nature of his life until he turned sixty. At that age he was no longer able to get past his weak and dying heart and he ended up living in the cardiac unit of the hospital for about a year. He was on a heart pump and needed regular medical care while he waited out his turn on the heart transplant list. Finally when he was likely days away from dying in the hospital according to the doctors, a transplant heart became available and he was rushed into surgery to receive his new heart. He has been living for more than ten years past the transplant and has a great quality of life. I personally love this man like a father and am very grateful that he was able to survive a life-threatening condition.
The problem with that story is that his lifetime medical insurance premiums were likely around $240,000 in today's dollars ($6,000 a year * 40 years) but the costs just in his final year leading up to the transplant were far in excess of his total lifetime contributions:
Average per day in hospital - $7,000*365 = $2,555,000
Average cost of transplant - $ 145,000
Total cost of transplant not including the years before and after his time in the hospital = $2,700,000. That means financially he only contributed about 9% of the total cost of his care. Where did the other $2,457,000 for that year come from? Obviously this came from the other members of his coverage group even though they didn't know him. Mathematically more than 400 people in his group had to receive no medical benefits in return for their insurance premiums in order for my friend's life to be saved (far more when you consider the full fifty years of him having a bad heart and not just the one year where he was waiting for a transplant). On an annual basis he only contributed less than 0.2% of his own medical costs.
I know this man and the love he has for his family. If he didn't belong to a group insurance program and was rather faced with bankrupting his family with a nearly $3 million medical bill in one year, he would never have permitted the procedure. He would certainly rather have died than to see his family suffer irreparable financial harm trying to keep him alive. By his own evaluation he would never have claimed that his life, at age sixty, was worth the price that was required to save it. His lifetime earnings may not have even been as high as this one medical event and objectively there was no way to accomplish this life-saving procedure except for the generosity of others. now he and I would likely have been fine with a fund being setup in his name and if enough people were willing to donate to save his life, I'm sure he would have gone through with it. Absent the safety net of group coverage, federal tax dollars, or generous donations it would have been logistically impossible to save his life through his own earning potential. And therein lies the problem: lifetime medical care can easily exceed the total lifetime earnings of an individual person and the only way to make up the difference is to force others to pay for someone else's care. Multiply this times 311 million Americans and we have a financial crisis of epic proportions. Just because we have the medical technology to provide care doesn't mean the nation has the financial resources to pay for all of the procedures and drugs and malpractice insurance that people may want or "need".
I can assure you that if I were faced with the same scenario that I wouldn't bankrupt my family to save my own life. I would evaluate each condition and the cost of the treatment and only purchase those procedures that I felt were necessary and beneficial to my entire family. We have lost that direct relationship of cost vs. benefit under these systems and we will never be able to sustain those kinds of costs if the expectation that there is no financial limit to the cost of saving a human life or to provide medical care for every single condition that people may face. Entitlements and socialism have already bankrupted this nation, we just haven't admitted it yet.
Travels2mch
Veteran
Actually this couldn't be the furthest from the truth. It has nothing to do with Obamacare........it has everything to do with the greed of UPMC and their unwillingness to negotiate with Highmark. Oh and they're also pissed off that Highmark just bought their competitor. It's OK for UPMC to be in the health insurance game but not for anyone else (in their eyes) now that the insurance company bought their competitor.
SparrowHawk
Veteran
- Nov 30, 2009
- 7,824
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Unwillingness to negotiate due to the uncertain future caused by the Back Bench Junior Senator posing as President and his Health Care scheme. No one knows what the future holds under Obamacare. So nobody is discounting to gain market share at a potential loss.
This is what happens when you allow Progressives who've never created a private sector job, had to make a payroll run the largest economy in the world.
Dont call me Shirley
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- Aug 20, 2002
- 3,270
- 306
Umm, isn't that the whole point of insurance? Shared risk pools? Please forgive me if I misunderstood your point.
Be Careful What You Wish For.
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- Dec 23, 2006
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Loyd's wasn't established for the likes of me or you but was "shared risk" none the less.
CallawayGolf
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- Nov 13, 2009
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Shared risk pools work out fine for home owners policies and auto insurance policies and the like where the insured rarely desires to actually have to make a claim. Most people don't want a fire to destroy their house and they don't want to get into a car accident. I think most people are quite happy to never make a claim in return for their premiums because the cost and inconvenience of having a loss is not worth what you might get back from the insurance policy to get back to normal. Those policies are a safety net and if someone burns down their own house or takes a sledge hammer to their own car they will be guilty of insurance fraud for trying to get other people to pay for their self-inflicted loss.
The same is not true for medical insurance and shared risk pools. People buy medical coverage expecting that they will get something of value in return for it. And unlike home or auto insurance, the maximum benefit that can be provided is not tightly defined. If my house is insured for $250,000 including all contents, then that is the maximum amount the shared risk pool is responsible to pay back in return if I suffer a loss. With medical coverage claims can easily total into the 10s or 100s or thousands of dollars and in some cases well into the millions of dollars.
Furthermore, cost disciplines are rarely on the minds of consumers when it comes to medical care. A Ford or Chevy level of quality isn't good enough; Americans want the best and they want perfection out of the service providers (skyrocketing malpractice insurance). They want the best technologies, the best drugs, the best doctors, and the best medical facilities that can be offered. It's easy to assume this attitude when you are only paying for a fraction of the total medical bills instead of the whole thing. Rarely will you find a patient calling around to different service providers trying to find out who has the best price or trying to negotiate with them for a better deal. That's the insurance company's job they will likely say and then they will become irate if the insurance company denies coverage, in part or in whole, for a desired service.
My point was with the third-party payers people stop being responsible consumers and rather transform into "money is no object" and "I only want the best" consumers which is a lifestyle that is typically reserved for the ultra-wealthy who could never spend all of their fortunes so why bother worrying over such a silly thing like price? And, like in the story I told, without a third-party people would unquestionably make different decisions about how much and how willing they are to go through a medical procedure if the money will come out of their own pockets. Mathematically speaking every life cannot be "worth" 3, 5, or 10 million dollars in medical treatments because there just isn't that much money available in the entire economy. But then Americans become outraged if an insurance company or the dreaded government "death panel" is forced to make life and death medical decisions for someone else. Those are decisions that are best left up to the individual or the family not a company or a government agency but third-party payers insulate individuals from making a tough decision on their own.
Medical Insurance rates on average will rise about 9% for 2012; they rose more than that in 2011 and it seems that the rates will just keep going up because the costs and demands for the best of the best will continue until people start making financial choices along with their medical choices. The forces that are driving private medical premiums up are also pushing our nation towards insolvency. Medicare/Medicaid are now the single largest federal expenditure on an annual basis and they are just getting started paying for the Baby Boomers. The total unfunded liability that America is on the hook for is over $100 trillion dollars according to the Federal Reserve. Since the Treasury takes in about $2.5 trillion in receipts each year, this represents 40 years of total tax revenues collected just to pay for our current unfunded Medicare/Medicaid promises. That doesn't include monies needed for defense, Social Security, welfare, food stamps, education, commerce, foreign aid, border security, and thousands of other federal commitments made each budget cycle. No, we are now 40-years in debt just to pay for these federal medical programs in addition to the the $15 trillion we already carry in national debt against a $15 trillion GDP. Unless serious reforms and program eliminations start to occur, the whole system and economy could be headed the way of Greece and our fall will be much harder than little old Greece.
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