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ObamaCare Discuss The Real Problem With America's Healthcare System at the General Forum; Originally Posted by GottaGo When I was first diagnosed with Type 1 diabetes, I made several inquires about paying cash ...

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Old 02-22-2020, 08:55 PM
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Default Re: The Real Problem With America's Healthcare System

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Originally Posted by GottaGo View Post
When I was first diagnosed with Type 1 diabetes, I made several inquires about paying cash for the insulin. $136 (?) I believe it was for a bottle of Novalog. That was 14 years ago. Now, I believe it is up to $400+. I've posted several articles on here regarding Big Pharma and their scalping.

The latest game of Big Pharma is to 'subsidize' their own prices so people can afford their meds... my test strips went from $65 (not on my insurance's preferred formulary) a month to $35 when I had contacted my new insulin pump company and complained about the cost of the strips needed for the proprietary meter linked with their pump. They reached out to the test strip company and *ding* I was subsidized.

So, was I truly subsidized on the back of other consumers, or did the test strip company reduce their profit margin to keep a user 'hooked'? I can (and do) use an inexpensive non-linked meter that takes test strips I already have, and can get for a fraction of the cost.

Games Big Pharma plays, and will continue to do so as long as they are guaranteed customers.
Price increases for insulin are due to a number of factors not just greedy manufacturers exploiting sick patients. The insulin most often prescribed today is far different and more costly to manufacture than the traditional variety. Doctors are reluctant to prescribe the older varieties of insulin although there is evidence it works as well. There are 3 major companies that dominate the insulin market. They use tactics like applying for new patents for minor improvements to discourage generics.
But the biggest contributor to keeping the market closed to generics is government regulation.
Here is an article that goes into more detail.

https://www.statnews.com/2019/02/19/...o-is-to-blame/
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Old 04-06-2020, 11:51 AM
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Default Re: The Real Problem With America's Healthcare System

It is certainly true that when a third party pays the bills--or most of them, anyway--it may lead to an overuse of the medical system.

But both Medicare and most private healthcare insurance truncate the submitted charges--and quite considerably. (For instance, the submitted charges may be, oh, say, $1,000; and the negotiated amount just $300. This is fairly typical.)

Of that, Medicare--and many private healthcare insurers--pay 80 percent. (My own insurance pays 85 percent.)

So I am not sure that most people would profit by abolishing insurance (especially if they have PPOs).
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Old Yesterday, 07:04 AM
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Default Re: The Real Problem With America's Healthcare System

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It is certainly true that when a third party pays the bills--or most of them, anyway--it may lead to an overuse of the medical system.

But both Medicare and most private healthcare insurance truncate the submitted charges--and quite considerably. (For instance, the submitted charges may be, oh, say, $1,000; and the negotiated amount just $300. This is fairly typical.)

Of that, Medicare--and many private healthcare insurers--pay 80 percent. (My own insurance pays 85 percent.)

So I am not sure that most people would profit by abolishing insurance (especially if they have PPOs).
I don't believe the answer to this is to abolish insurance. There are things that insurers could do to encourage consumers to seek out lower cost options when possible. The could also steer people to hospitals and doctors that are open about their pricing for medical procedures. They could also work with the medical community to eliminate unnecessary paperwork and other processes that add undue costs to the model.

But the point of the article would be to encourage all parties to stay informed about the true drivers of the rising costs in HC. If people begin to understand that while people believe they are getting something for free, in the end, they and the rest of us are all paying for it with increased premiums and HC costs in general.
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Old Yesterday, 07:28 AM
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Default Re: The Real Problem With America's Healthcare System

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Price increases for insulin are due to a number of factors not just greedy manufacturers exploiting sick patients. The insulin most often prescribed today is far different and more costly to manufacture than the traditional variety. Doctors are reluctant to prescribe the older varieties of insulin although there is evidence it works as well. There are 3 major companies that dominate the insulin market. They use tactics like applying for new patents for minor improvements to discourage generics.
But the biggest contributor to keeping the market closed to generics is government regulation.
Here is an article that goes into more detail.

https://www.statnews.com/2019/02/19/...o-is-to-blame/
I've been on Humalog or Novolog since day one. The prices I quoted were for the same product.

Analog insulin has not changed in any demonstrable way in 14 years. Animal based insulin is still available, and extremely inexpensive, but it is also not as reliable or stable as analog in it's actions.

While certain overhead costs of manufacturing any pharmaceutical have increased, they are not comparable with the price increases, IF they pharmaceutical is even produced in the US where the regulations are more stringent.
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Old Yesterday, 07:38 AM
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Default Re: The Real Problem With America's Healthcare System

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Originally Posted by pjohns View Post
It is certainly true that when a third party pays the bills--or most of them, anyway--it may lead to an overuse of the medical system.

But both Medicare and most private healthcare insurance truncate the submitted charges--and quite considerably. (For instance, the submitted charges may be, oh, say, $1,000; and the negotiated amount just $300. This is fairly typical.)

Of that, Medicare--and many private healthcare insurers--pay 80 percent. (My own insurance pays 85 percent.)

So I am not sure that most people would profit by abolishing insurance (especially if they have PPOs).
If you stop and consider that if the prices are so greatly reduced and the provider is willing to accept the reduced price, then they aren't losing money. The prices for the services are over inflated when submitted to the insurance company in the first place, and the negotiated price paid to the provider is usually very close to what it should have been in the first place, with a little added for the overhead at the insurance company.

Where insurance is beneficial is for major needs... accident, injury, catastrophic illness. But the PPACA made sure to eliminate that option (which it now allows, but ONLY for those under 35 I believe) so everyone would be forced to be covered for things they didn't want nor need, so the premiums could be jacked (sort of like accessories if buying a new car) and the insurance companies profit margin would increase.

I pay cash for as much as I can, and save money doing so, even though I have insurance. Chiropractor: Insurance co-pay $60 (specialist) cash price $45 (it just went up from $40 where it had been for a good 10 years) or a basic Dr office visit $20, copay $25. Xrays $150 or worse, a 3 set back xray, $50 cash.

Insurance is not the end all, if people would just wake up to it. It is a method of payment, nothing more.
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Old Yesterday, 11:38 AM
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Default Re: The Real Problem With America's Healthcare System

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Originally Posted by GottaGo View Post
If you stop and consider that if the prices are so greatly reduced and the provider is willing to accept the reduced price, then they aren't losing money. The prices for the services are over inflated when submitted to the insurance company in the first place, and the negotiated price paid to the provider is usually very close to what it should have been in the first place, with a little added for the overhead at the insurance company.

Where insurance is beneficial is for major needs... accident, injury, catastrophic illness. But the PPACA made sure to eliminate that option (which it now allows, but ONLY for those under 35 I believe) so everyone would be forced to be covered for things they didn't want nor need, so the premiums could be jacked (sort of like accessories if buying a new car) and the insurance companies profit margin would increase.

I pay cash for as much as I can, and save money doing so, even though I have insurance. Chiropractor: Insurance co-pay $60 (specialist) cash price $45 (it just went up from $40 where it had been for a good 10 years) or a basic Dr office visit $20, copay $25. Xrays $150 or worse, a 3 set back xray, $50 cash.

Insurance is not the end all, if people would just wake up to it. It is a method of payment, nothing more.
Very valid points.

I remember growing up, whenever I had gotten injured to the point of requiring stitches (I was quite active as a kid and had to be sewn up a number of times), my mother would take me to the family doctor. In and out for $15 - $20. No insurance, no excessive paperwork just a visit, a few stitches and I was back outside trying to rip them out again.

However, if anyone ever had anything major that required a trip to the hospital, we had the insurance for it. And I'm sure it came with a deductible, but I have no memory of my parents ever fretting about it.

Yes, if we could go back to that model, I believe that we could greatly reduce the HC costs in this country. That and some tort reform to bring the legal community under control.
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Old Yesterday, 12:49 PM
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Default Re: The Real Problem With America's Healthcare System

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Originally Posted by GetAClue View Post
[Healthcare insurers] could also steer people to hospitals and doctors that are open about their pricing for medical procedures.
Good point.

But PPOs typically do steer their policyholders toward certain hospitals and doctors. (Mine, for instance, pays just 60 percent of the submitted charges, as concerning doctors' fees, if one goes out of network; but it pays 85 percent of the negotiated charges if one stays within the network. As regarding hospitals, it pays 100 percent of the hospital bill--of course, doctors' bills are separate--if one stays in network; but, again, only 60 percent of the submitted charges if one goes out of network.)

As you point out, however, pricing should be transparent; there should be no add-on charges. (Consumer Reports has crusaded against this sort of thing--and for good reason, I believe.)
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Old Yesterday, 05:00 PM
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Default Re: The Real Problem With America's Healthcare System

Originally, health insurance paid to the individual, not the healthcare provider.
To make this clear, I go to doctor and get bill for $300.00. I am responsible to the doctor for the bill. I send a copy to the insurance company and they reimburse me for the part they cover. This is still a third party pay, but the consumer feels the bite first and has incentive to keep the pocketbook pain level down.
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Old Yesterday, 08:35 PM
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Default Re: The Real Problem With America's Healthcare System

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Originally Posted by FrancSevin View Post
Well, in case you didn't notice at the time, the healthcare program known as Obamacare assured that the insurance industry was secure and well-paid. The Affordable Health Care Act was not about health care. It was about Insurance.
yes, people have pretty much realized Obama was republican lite.
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Old Yesterday, 08:38 PM
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Default Re: The Real Problem With America's Healthcare System

read up on what countries' citizens pay for health care.
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We’re seeing this on multiple fronts. The aforementioned failure to ramp up testing, and the ongoing failure to get needed testing equipment to desperate governors, is compounded by Trump’s insistence on claiming that no such testing failure exists — or ever has.
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