Why Do We Need To Reform Health Care?

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Re: Why Do We Need To Reform Health Care?

Post by ucantdoitdoggieSTyle2 »

BSmack wrote:In fact, I have no qualms about most companies making huge profits. It is when huge margins accompany huge rate increases for a service that literally can mean the difference between life and death for the entire public that I call bullshit.
And your beef with these rates hikes is with the insurance companies? :lol:

Do you know wtf an EOB is? Do you know the difference between the charged amount and allowed amount on an EOB? What happens to the difference in these two amounts, if anything? Do you really think the insurance companies have anything to do with the provider's chargemaster? Did you know that different docs charge different rates for the same fucking service and this amount is wholly determined by them... not Fireman's Orphan Insurance in Podunk, Minnesota?
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Re: Why Do We Need To Reform Health Care?

Post by ucantdoitdoggieSTyle2 »

Cuda wrote:BMonica wouldn't know a profit from a dog turd, and clearly you don't either

Insurance companies pay claims from profits made on the premiums that were taken in and invested in previous years, you dumb cocksucker- that's the ONLY fucking way they can do it. Otherwise, the first fucking time claims paid out exceeded premiums taken in, the insurance company would be out of fucking business.
Where are you getting your info from? The closest thing you could relate for paid claims on a financial statement (cash flow) as an expense under operating activities.

Furthermore, expenses are usually paid with cash... why do you hate journal entries so much? Show me the account named "income" that pays out expenses, you douche.

There's a whole lot of stupid up in this thread.
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Re: Why Do We Need To Reform Health Care?

Post by Cosmo Kramer »

ucantdoitdoggieSTyle2 wrote:
Cosmo Kramer wrote:I'm glad your HMO is working now, but you'll be singing another fucking tune when a member of your family gets REALLY sick and they start denying your claims. Mark my words "It will happen".

Bawahahahahah. Is that how this works?


You have this backwards. Insurance companies don't reject claims "out of spite" on the back end. There's this whole process called the eligibility check. No wait... it's cool. You'll love it. It's up to the provider to check with the payer to ensure eligibility/coverage before agreeing to see you. If they don't, then that's their problem. The smart ones (ya know, the ones that are actually still in business) usually check with the payer beforehand to see if they're going to paid for any tests and/or procedures they do. This goes to the heart of the whole referral process. Are you with me? If the payer says, "fuck you, you're not in our network" or "fuck you, i'm not paying for those breast implants"<-- j/k (definitely not covered by any HMO), then there's a pretty good chance the patient never even gets an appointment, nevermind an actual claim dropping and ultimately being denied. You dig? Do you know anything about managed care, specifically the whole health maintenance organization, or are you just guessing here? Furthermore, if you have a family and you actually decided to go the whole HMO route, then maybe you're just reaping what your cheap ass sowed.
No, you have it backwards because I work in a buisness that requires health insurance and they pay according to a little thing called "medical necessity" if you really need X kind of treatment or drugs and they are more expensive than Y, they will end up going with Y even if X is proven to work. Sorry Charlie nice try. It's a buisness they will fuck you coming and going.
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Re: Why Do We Need To Reform Health Care?

Post by Dr_Phibes »

tread carefully, Cosmo.

I get the feeling ucan't is going to wrap his paperweight with a form appendix 3945-B and throw it across his desk at you.
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Re: Why Do We Need To Reform Health Care?

Post by ucantdoitdoggieSTyle2 »

Cosmo Kramer wrote:No, you have it backwards because I work in a buisness that requires health insurance and they pay according to a little thing called "medical necessity" if you really need X kind of treatment or drugs and they are more expensive than Y, they will end up going with Y even if X is proven to work. Sorry Charlie nice try. It's a buisness they will fuck you coming and going.

How does this contradict my post? Didn't you know up front "Y" wasn't covered? How is that "denying" your claim? Do you even know what "denying a claim" means? They told you "Y" wasn't covered and then you're shocked when you have to pay for it yourself? Are you really this stupid?

HMO's are cheap. Do you cry like a bitch when you get into a car accident and have to pay a $1000 deductible because you're a cheap fuck who wanted to pay less for insurance? Newsflash, bitch, you get what you pay for. Don't like HMO's? Don't choose to have one, dumbfuck.
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Re: Why Do We Need To Reform Health Care?

Post by ucantdoitdoggieSTyle2 »

Dr_Phibes wrote:tread carefully, Cosmo.

I get the feeling ucan't is going to wrap his paperweight with a form appendix 3945-B and throw it across his desk at you.

Shouldn't get back to your malpractice?
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Re: Why Do We Need To Reform Health Care?

Post by PSUFAN »

What is this "paying claims" thing you mention?

--Insurance companies
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

BSmack wrote:You do realize that profits are what is left over AFTER overhead and claims are paid?
Yes. Though it seems to me you're left with sticking your head in the sand. Profits are invested. Investment income is earned. You must believe that the earned investment income is just stuffed in a mattress someplace or is just lining the pockets of some CEO. Premiums cannot and do not pay for claims. Period.
Nobody is disputing the right of a business to make a reasonable profit. In fact, I have no qualms about most companies making huge profits. It is when huge margins accompany huge rate increases for a service that literally can mean the difference between life and death for the entire public that I call bullshit.
No one gives a shit about what you think qualifies as a "reasonable" profit. Frankly, it's none of your business. And the level of profits earned never affect life and death.
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

Cosmo Kramer wrote:you have it backwards because I work in a buisness that requires health insurance and they pay according to a little thing called "medical necessity" if you really need X kind of treatment or drugs and they are more expensive than Y, they will end up going with Y even if X is proven to work. Sorry Charlie nice try. It's a buisness they will fuck you coming and going.
No, it's called paying on the policy. If the policy doesn't cover x kind of treatment or drug, why the fuck is the insurance provider obligated to pay for x kind of treatment or drug?

Answer: no obligation no matter your weak-assed bleating about evil insurance companies.
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Re: Why Do We Need To Reform Health Care?

Post by BSmack »

JMak wrote:No one gives a shit about what you think qualifies as a "reasonable" profit. Frankly, it's none of your business. And the level of profits earned never affect life and death.
Just STFU.

http://www.msnbc.msn.com/id/22357873/
Premiums cannot and do not pay for claims. Period.
So the insurance company just prints money to pay claims?
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

Moron, that link has nothing to do with your false claim that insurer profits are the tipping point between life and death.

I'm not sure why you people hate contracts.
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Re: Why Do We Need To Reform Health Care?

Post by BSmack »

JMak wrote:Moron, that link has nothing to do with your false claim that insurer profits are the tipping point between life and death.

I'm not sure why you people hate contracts.
When it comes to my health, I do not want a contract, I want a doctor. When it comes to my health, I want solutions, not contracts. What is so hard to understand about that?
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Re: Why Do We Need To Reform Health Care?

Post by ucantdoitdoggieSTyle2 »

BSmack wrote:When it comes to my health, I do not want a contract, I want a doctor. When it comes to my health, I want solutions, not contracts. What is so hard to understand about that?
then don't have any insurance whatsoever and you can pay the doctor/instution directly, instead of him/her/it submitting a claim to the payer for services rendered. just don't complain when you have to start footing 100% of the bill for an MRI or a hospital stay, mmmkay?
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Re: Why Do We Need To Reform Health Care?

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ucantdoitdoggieSTyle2 wrote:
BSmack wrote:When it comes to my health, I do not want a contract, I want a doctor. When it comes to my health, I want solutions, not contracts. What is so hard to understand about that?
then don't have any insurance whatsoever and you can pay the doctor/instution directly, instead of him/her/it submitting a claim to the payer for services rendered. just don't complain when you have to start footing 100% of the bill for an MRI or a hospital stay, mmmkay?
When I consider the money that I pay in premiums each year, it almost would be worth it. It certainly would be worth it for any non catastrophic care issues.

Of course maybe my premiums wouldn't be so high if they didn't send me a statement every single time they pay out.
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Re: Why Do We Need To Reform Health Care?

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BShitforbrains wrote: When I consider the money that I pay in premiums each year, it almost would be worth it. It certainly would be worth it for any non catastrophic care issues.

Of course maybe my premiums wouldn't be so high if they didn't send me a statement every single time they pay out.
There was a time- before politicians figured out they could buy votes by mandating coverage for every fucking possible condition (including pregnancy & children's coverage for men on the grounds that men get women pregnant) that you could get policies only for major medical and catastrophic care. That probably wouldn't sell these days even without all the coverage mandates because too many people have been conditioned to think that insurance means somebody else should pay the whole bill and they shouldn't have to pay anything out of their own pocket.
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Re: Why Do We Need To Reform Health Care?

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Cuda wrote: There was a time-that you could get policies only for major medical and catastrophic care. That probably wouldn't sell these days even without all the coverage mandates because too many people have been conditioned to think that insurance means somebody else should pay the whole bill and they shouldn't have to pay anything out of their own pocket.
I guess you haven't been paying much attention. There are plenty of plans with high deductibles and low(er) premiums available, with deductibles being paid out of an HSA, and they're becoming more and more popular. Basically the same thing you're complaining about not being available.
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Re: Why Do We Need To Reform Health Care?

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my old company experimented with the HSA & high deductible policy a few years ago- eventually had to ditch it and go back to something more conventional because none of the fucking employees would actually fund their HSA's like they were supposed to and then bitched and complained at having to cough up the money they were supposed to be putting in their HSA.

Perfectly good plan unless you think somebody else is supposed to pay from the first dollar.
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Re: Why Do We Need To Reform Health Care?

Post by LTS TRN 2 »

mvscal wrote:
Dinsdale wrote:QUICK! Name one thing the government does better than private industry...
Kill large numbers of people. Doesn't bode well for government run health care, though. Any idiot who thinks that government sponsored health care will be a sweet deal needs to spend a little time a VA hospital some day. They're fucking horrorshows.
Absolute bullshit! Some VA hospitals are understaffed, etc., but the one in S.F. is first rate with no complaints at all. Moreover, the typical scare stories about Japanese and Canadian health care are similar bullshit--by these same nut-job Libertarian Survivalist (racist hack) phonies like Avi.

Wake the fuck up! The American health care system is a huge racket and has been for a long time. One of the basic scams is for a patient to be shuttled about between a variety of doctors for all manner of expensive tests. The efforts of the huge pharmaceutical companies to stifle simple and cheap remedies by way of the Waiting For Godot FDA approval process is legendary. Moreover, the income of American doctors is as grossly out of whack as that of American CEOs. It's basically a twisted version of the Free Enterprise myth which would purport to legitimize and sanction such rapacious profiteering. And it's basically a crime.
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Re: Why Do We Need To Reform Health Care?

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LTS TRN 2 wrote: The American health care system is a huge racket and has been for a long time. One of the basic scams is for a patient to be shuttled about between a variety of doctors for all manner of expensive tests. The efforts of the huge pharmaceutical companies to stifle simple and cheap remedies by way of the Waiting For Godot FDA approval process is legendary. Moreover, the income of American doctors is as grossly out of whack as that of American CEOs. It's basically a twisted version of the Free Enterprise myth which would purport to legitimize and sanction such rapacious profiteering. And it's basically a crime.
What makes you qualified to comment about the VA or the health care industry in general? Now you are equating doctors pay to CEO's? You are a true whack job Nick. You don't know what the fuck you are talking about.
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Re: Why Do We Need To Reform Health Care?

Post by trev »

What is everyone's out of pocket cost for healthcare now? Who here doesn't currently have healthcare insurance? Right now, we have an HMO through my husbands job which he doesn't have to pay anything for. An office visit to the doc co pay is $30.00.

HMO's truly suck but will it be any better under a government plan?
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Re: Why Do We Need To Reform Health Care?

Post by Mikey »

Cuda wrote:my old company experimented with the HSA & high deductible policy a few years ago- eventually had to ditch it and go back to something more conventional because none of the fucking employees would actually fund their HSA's like they were supposed to and then bitched and complained at having to cough up the money they were supposed to be putting in their HSA.

Perfectly good plan unless you think somebody else is supposed to pay from the first dollar.
My company pre-funds the HSA with the deductible amount so, unless we charge something that's not covered as part of the deductible, the entire thing is covered. Pretty sweet deal, I guess, because if the HSA isn't drained it rolls over to next year and so on.
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Re: Why Do We Need To Reform Health Care?

Post by Lillian Vernon »

Moving Sale wrote:
Atomic Punk wrote: This is EVIDENCE that you didn't read the article Diego linked.
I never said I read it because I didn't read it. I also never commented to Diego and the only thing related to UHC that I did comment on was about its Constitutionality, which was dead on.
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

BSmack wrote:When I consider the money that I pay in premiums each year, it almost would be worth it. It certainly would be worth it for any non catastrophic care issues.

Of course maybe my premiums wouldn't be so high if they didn't send me a statement every single time they pay out.
Yeah, 'cuz premiums are high because the insurer notifies its subscribers when a benefit has been paid. Some of you people must sit on your brains for a living.

I mean, health insurance premiums are not, in any way whatsoever, affected my shall issue laws, mandatory coverage laws, or any of the other 1500+ state and federal health care regulations, right? No affect...right?

Come on, now. You people are smarter than this. You know, it's common sense, you know that when that the state of Michigan requires that every health insurance policy sold in the state must include coverage for diabetes maintenance equipment and supplies that that will result in an increase to all premiums. That's common sense. But you morons willingly suspend common sense to ignore facts like this.
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Re: Why Do We Need To Reform Health Care?

Post by ucantdoitdoggieSTyle2 »

JMak wrote:Yeah, 'cuz premiums are high because the insurer notifies its subscribers when a benefit has been paid. Some of you people must sit on your brains for a living.
Actually, that thing Bri was referring to is called an EOB (explanation of benefits) and it's sent to the patient/insured and any secondary payers (medicare/medicaid). In addition, it's not a notice of what's been paid, it's a notice of what they're going to pay. It may seem like overkill, but it's pretty important get everyone on the same page with regard to remittance. It actually speeds up the payment process because it cuts down on the number of denials.
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Re: Why Do We Need To Reform Health Care?

Post by Felix »

Papa Willie wrote:http://health.yahoo.com/news/afp/uspoli ... 04242.html

Looks like he's throwing in the towel for now. Yet another lie...

you can thank the Blue Dog Dems that are firmly on the insurance companies dole for quashing an August vote....by the time any health care "reform" bill gets to the floor for a full vote, it will be so watered down that it won't make one iota of difference...it will be "business as usual"
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Re: Why Do We Need To Reform Health Care?

Post by BSmack »

ucantdoitdoggieSTyle2 wrote:
JMak wrote:Yeah, 'cuz premiums are high because the insurer notifies its subscribers when a benefit has been paid. Some of you people must sit on your brains for a living.
Actually, that thing Bri was referring to is called an EOB (explanation of benefits) and it's sent to the patient/insured and any secondary payers (medicare/medicaid). In addition, it's not a notice of what's been paid, it's a notice of what they're going to pay. It may seem like overkill, but it's pretty important get everyone on the same page with regard to remittance. It actually speeds up the payment process because it cuts down on the number of denials.
Fair enough. But can they just email it to me?
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Re: Why Do We Need To Reform Health Care?

Post by ucantdoitdoggieSTyle2 »

BSmack wrote:Fair enough. But can they just email it to me?

That's a very good question. Perhaps you should ask ANSI regarding X12 transmissions of PHI.
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

ucantdoitdoggieSTyle2 wrote:
JMak wrote:Yeah, 'cuz premiums are high because the insurer notifies its subscribers when a benefit has been paid. Some of you people must sit on your brains for a living.
Actually, that thing Bri was referring to is called an EOB (explanation of benefits) and it's sent to the patient/insured and any secondary payers (medicare/medicaid). In addition, it's not a notice of what's been paid, it's a notice of what they're going to pay. It may seem like overkill, but it's pretty important get everyone on the same page with regard to remittance. It actually speeds up the payment process because it cuts down on the number of denials.
I know what they are, but thanks for the explanation. The EOB, though, ain't the cost lynchpin that Bri tried to suggest it was.
BSmack wrote:Fair enough. But can they just email it to me?
Have you asked them to? But even so, bfd! You're missing the point here...this EOB ain't driving up costs.
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

Felix wrote:you can thank the Blue Dog Dems that are firmly on the insurance companies dole for quashing an August vote....by the time any health care "reform" bill gets to the floor for a full vote, it will be so watered down that it won't make one iota of difference...it will be "business as usual"
Thank God! Status quo is eminently better than the monstrosity that Obamacare is.

First, Obama is a habitual liar now and we simply cannot trust anything out of his mouth regarding healthcare (or really anything else).

Second, it requires Americans to purchase a specific government-designed set of benefits, even if that package was more expensive or contained benefits that you didn't want; impose even more regulations on private insurers leading to higher premiums; extend government subsidies deep into the middle creating even more government dependency; impose huge new tax increases; and, most importantly, it would, inevitably lead to a national single-payer plan as employers dump employees from their benefit plans and individuals are priced out of the private insurance market leaving both groups to depend on Obamacare.

Third, Obamacare will increase costs, not reduce costs. No matter how many times Obama and his henchman attempt to coerce the CBO into generating more positive-looking reports about the cost of Obamacare, the fact remains that, at the very, very best, this comes out at revenue-neutral and that's with eliminating most of what Obama wants in this boondoggle and at worst, creates trillions in new costs.

Fuck you if you think this health care "reform" (ha!) is anything remotely close to good.
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Re: Why Do We Need To Reform Health Care?

Post by Felix »

JMak wrote:
it requires Americans to purchase a specific government-designed set of benefits, even if that package was more expensive or contained benefits that you didn't want
step back from being brainwashed by watching Faux News and do some research and you'll understand why this statement is not only blatantly false, but laughably ignorant....not to worry though, the insurance companies will continue to reap ungodly profits while your (or your employers) premiums will continue to rise, which of course you'll end up paying for one way or the other

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Re: Why Do We Need To Reform Health Care?

Post by Dinsdale »

Repeal the HMO Act of 1973, and watch insurance premiums plummet, since it removed most of the competition from the marketplace...


But wait, we don't do that. Less government is NEVER the answer to the Sheeple, nevermind the FACT it was more government intervention that caused the skyrocketing premiums to begins with.

Again, the ignorance of the Average Joe astounds me. Those who don't learn from history's mistakes are doomed to repeat them.


And I'll once again ask a question that none of the libs have ever been able to answer: By what right have you declared yourself worthy of seizing other peoples' money?

It ain't your cash, you fucking thieves. I've never been all that well-off financially by most standards, yet I never let it make me bitter to the point of legally-mandated theft of that which belongs to others.
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Re: Why Do We Need To Reform Health Care?

Post by Cuda »

Dinsdale wrote: Less government is NEVER the answer to the Sheeple,.
It sure as fuck is never the answer for the politicians.
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Re: Why Do We Need To Reform Health Care?

Post by Terry in Crapchester »

trev wrote:What is everyone's out of pocket cost for healthcare now? Who here doesn't currently have healthcare insurance? Right now, we have an HMO through my husbands job which he doesn't have to pay anything for. An office visit to the doc co pay is $30.00.
Since you asked . . .

We pay about $450/month for a family plan through my wife's employer (since I'm self-employed, a similar policy would cost me significantly more). I'm not sure what her employer pays, I believe they pay half the overall cost. Cost is deducted via payroll deduction.

Copay for a visit to the doctor's office is $20, except for my daughter, hers will be free until her 5th birthday next June. For prescription meds, copays fluctuate wildly, I've seen everything from $4 to $100.
HMO's truly suck . . .
Agreed.
. . . but will it be any better under a government plan?
Dunno, but you won't have to go to one if you don't want it.
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

BSmack wrote:
JMak wrote:Moron, that link has nothing to do with your false claim that insurer profits are the tipping point between life and death.

I'm not sure why you people hate contracts.
When it comes to my health, I do not want a contract, I want a doctor. When it comes to my health, I want solutions, not contracts. What is so hard to understand about that?
In other words, you don't want insurance. So pay as you go, bitch. Sounds like an easy decision. Why don't you make it?
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

Felix wrote:step back from being brainwashed by watching Faux News and do some research and you'll understand why this statement is not only blatantly false, but laughably ignorant....not to worry though, the insurance companies will continue to reap ungodly profits while your (or your employers) premiums will continue to rise, which of course you'll end up paying for one way or the other

everything's copasetic
I dont watch Fox news, idiot. I don't subscribe to cable or satellite. But it's clear that you have no legit response here. Please point out how my statement regarding a specific set of benefits in the govt plan is false. I won't hold my breath.

I have no problem with the insurance industry's profits...they're less than the banking sector, less than the IT sector, etc. Same reply I give when some know-nothing whines about Big Oil's profits.
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Re: Why Do We Need To Reform Health Care?

Post by BSmack »

JMak wrote:
BSmack wrote:When it comes to my health, I do not want a contract, I want a doctor. When it comes to my health, I want solutions, not contracts. What is so hard to understand about that?
In other words, you don't want insurance. So pay as you go, bitch. Sounds like an easy decision. Why don't you make it?
Wow, you really sold me with that. I think I'll take the chance I won't need major surgery next year and cancel my coverage. :meds:
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Re: Why Do We Need To Reform Health Care?

Post by JMak »

BSmack wrote:
JMak wrote:
BSmack wrote:When it comes to my health, I do not want a contract, I want a doctor. When it comes to my health, I want solutions, not contracts. What is so hard to understand about that?
In other words, you don't want insurance. So pay as you go, bitch. Sounds like an easy decision. Why don't you make it?
Wow, you really sold me with that. I think I'll take the chance I won't need major surgery next year and cancel my coverage. :meds:
Dumbass, you're the one who said you didn't want a contract, no? If you don't want a contract that necessarily means that you don't want insurance.

You fucking fool, you're the one who said he didn't want insurance. What was I supposed to sell you on?
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Re: Why Do We Need To Reform Health Care?

Post by ucantdoitdoggieSTyle2 »

JMak wrote:Dumbass, you're the one who said you didn't want a contract, no? If you don't want a contract that necessarily means that you don't want insurance.

Woah, woah, woah…. not so fast there, bro. All he said was… he wanted a doctor and solutions. He never said anything about paying for this stuff. It's supposed to be free... just like the milk, cookies, and pony rides The Messiah promised his minions.
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Re: Why Do We Need To Reform Health Care?

Post by OCmike »

Bsmack, how do you expect Barry's plan to be effectively monitored for fraud by ghetto PCPs? How does the gov't prove that Jose Garcia never came into the office if the doc says he had no ID to show proof of address or even identity? The doctor can make up a ficticiou appt for whatever he wants.

Level 5 office appt? - $125
Stitches to finger? - $350
Xray of hand (2 views) - $25

Not doing any of that shit and libs gladly paying for it? - priceless
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Re: Why Do We Need To Reform Health Care?

Post by LTS TRN 2 »

Atomic Punk wrote:
LTS TRN 2 wrote: The American health care system is a huge racket and has been for a long time. One of the basic scams is for a patient to be shuttled about between a variety of doctors for all manner of expensive tests. The efforts of the huge pharmaceutical companies to stifle simple and cheap remedies by way of the Waiting For Godot FDA approval process is legendary. Moreover, the income of American doctors is as grossly out of whack as that of American CEOs. It's basically a twisted version of the Free Enterprise myth which would purport to legitimize and sanction such rapacious profiteering. And it's basically a crime.
What makes you qualified to comment about the VA or the health care industry in general? Now you are equating doctors pay to CEO's? You are a true whack job Nick. You don't know what the fuck you are talking about.
Really, punk? read up, bitch, and I'll pound your ass some more if you dare stick your head out of your hole.

Doctors Reap Benefits By Doing Own Tests

By Shankar Vedantam
Washington Post Staff Writer
Friday, July 31, 2009

In August 2005, doctors at Urological Associates, a medical practice on the Iowa-Illinois border, ordered nine CT scans for patients covered by Wellmark Blue Cross and Blue Shield insurance. In September that year, they ordered eight. But then the numbers rose steeply. The urologists ordered 35 scans in October, 41 in November and 55 in December. Within seven months, they were ordering scans at a rate that had climbed more than 700 percent.

The increase came in the months after the urologists bought their own CT scanner, according to documents obtained by The Washington Post. Instead of referring patients to radiologists, the doctors started conducting their own imaging -- and drawing insurance reimbursements for each of those patients.


This is typical, and the shuttling of patients between doctors for more and more tests, etc., runs up the tab much higher. It's been going on for years.
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