Military retirees medical cost going way up

[Lone_Gunman]

I live in a little town way away from any military, and almost every single provider in the area accepts Tricare.

I am a surgeon, and I take Tricare, but our group has strongly considered not taking it. It pays very poorly, on par with Georgia Medicaid. The surgeons in several other towns don't take it, and we get referrals from those towns simply because we take Tricare.

You should anticipate that fewer and fewer physicians will take Tricare, unless they start paying better.

 

[atomchaser]

Tricare has very low reimbursement rates. I work in the Military Medical System and there is a continuing exodus of network providers. Many want to provide services to the military but are losing money.

The third party payer system that we have in this country is a disaster. We need to allow the consumers to balance cost against need just like many other areas of our lives. I think catasrophic insurance is necessary, but the nickle and dime stuff is what makes it so expensive.

I read a quote the other day: If you think the price of health care is expensive now, just wait until it's free.

 

[CentralTexas]

If it happens we need to show up "carrying" in DC anc camp out.

Sadly, it would probably end like the "Bonus Army Rebellion".

CT

 

[Manedwolf]

IMHO Health Care costs are the sole responsibility of the individual. It is very nice when an employer will cover part of all of those costs for their employees, but its not something the emplyee should expect.

It is my sincere hope that one of these days, people will realize that, in the face of how much health care COSTS now, (heart surgery, $250k, can't pay, go ahead and die)...that people who think this way and vote this way might as well be a chicken voting for Colonel Sanders.

 

[Manedwolf]

Our health-care system is broken. The quality of care is excellent, but the management and administration thereof is barely functional. I know people on different ends of the spectrum point fingers in different directions over this, but the fact is that the whole thing is a mess.

There have been writings that even with all the advances in healthcare, the "Average" American now would have recieved better care in the 1950's and 1960's...simply because at that time, you could AFFORD a stay in the hospital, tests, and surgery.

Now, it would financially kill you.

 

[Manedwolf]

If people paid out of pocket for more of the costs and there was no such thing as a $10 co-pay then you would see the premiums seriously deflate.

The problem with that idea is that because of the inflated costs, you'd have to pay $250 for every office visit checkup, $200 for your prescription antibiotic if you needed one in some cases, etc...

Who among the middle class could just toss $400-$500 out the door when they get a case of pneumonia?

We'd see a return to 19th century self-remedies, quack and folk medicine, tonics and snake-oil in the worst way. And a lot more people dying of easily cureable illnesses in a way that looked like the third world.

 

[Kharn]

I think I know how to save money in the military.

1. Kill the Stryker program.
2. Upgrade our M113 APCs and use them instead of the stryker. (Talk to the Isralies on what to do, they have been upgrading their M113s for years.)

Stryker's already paid-for and deployed, no going back now. The FCS is on the horizon and much more capable than an M113 solution would be.

Kharn

 

[Waitone]

The situation will only get worse as the boomer wave begins splashing on the shore. We had a small window of opportunity to fix the medical mess we are in. Instead our elected idio. . . officials opted to make the situation worse. We are headed for a number of financial meltdowns; Medicare and social security leap to mind. Because of our unwillingness to deal with economic reality we will be faced with truly horrific decisions as a matter of government policy. The future is ugly.

 

[Malone LaVeigh]

...For one thing we don't have a "health care system" any more than we have a "home electronics system" or a "fast food system" or any other "system". We have a marketplace and one of the many things bought and sold in this marketplace are health care goods and services.

A "health care system" would be socialized medicine.

So I guess there's no such thing as an ecosystem, or a watershed drainage system.

Of course, we have a system, and it is partially a market-driven system. It is also highly influenced by governmental and corporate powers.

Secondly, we do have the best quality of medical care available anywhere in the world, but yes you have to pay for it ... until they start taxing us at 85% like much of Europe, or start forcing medical students into indentured servitude for the rest of their lives, you're going to have to pay for the health care goods and services you use.

So the bottom line is that a kid born into a poor family who needs an organ transplant can just die. Or depend on charity, I suppose. Nice if it happens.

Most of you out there would be appalled if all of the sudden farmers were to be enslaved and grocery stores forced to give away their products for free (or at least less than their cost) and food is more important than health care. Yet y'all get all bent out of shape when a doctor or drug manufacturer wants a market price for their products.

The market certainly has a place in an effective health-care system, but it's really more about what works. We don't have a free-market system in agriculture, either. "(F)orced to give away products for free" is a ridiculous straw man. On the contrary, farmers are subsidized, and damn few complain about it.

The problem is that in the Great Depression, farmers were plowing their crops under while people in rural areas and cities were starving. The free market failed.

You don't have to go far to find examples of how the markets fail in regard to health care, either.

The woeful lack of knowledge about economics that I see in this forum every day frightens the hell out of me ... I mean if an ostensibly more conservative/libertarian community doesn't realize how economics works and are clambering for the dismemberment of the free market in one area or the other, than I figure the Socialist police state must be just around the corner.

"Knowledge of economics" <> religious adherence to market outcomes.

 

[Malone LaVeigh]

Spot on. This exactly that way I view health insurance. I carry it for the big stuff (over $5k expense), and pay out of pocket for the routine items like check ups, dental exams and cosmetic things like orthodontic work.

... Yes we do have a free market in health care ... you are free to pay doctors directly for their services and not use HMOs, PPOs or any other form of health insurance. That is a free market.

The problem is you do not negotiate for your services in an unconstrained "free" market. It's distorted by cartel power on the selling and buying ends. The old bugaboos of the market systems.

If you don't have or use insurance, you actually pay more than the negotiated rates that the major carriers pay. You don't have their market power. I go through this every time I go to the dentist.

 

[Praxis]

The problem is you do not negotiate for your services in an unconstrained "free" market. It's distorted by cartel power on the selling and buying ends. The old bugaboos of the market systems.

If you don't have or use insurance, you actually pay more than the negotiated rates that the major carriers pay. You don't have their market power. I go through this every time I go to the dentist.

Malone is exactly right. My significant other has had some serious health problems over the past two years. At one point, she had some in-patient testing. The billing office forgot to include her insurance information and gave her an estimate of $1500 for one procedure. She reminded them about her insurance and suddenly the cost of the procedure (not what she owed, but what would be billed to the insurance company) fell to around $200-300. There is no level playing field in the health care industry. Those with little or no insurance often subsidize the cost of health care for those with insurance. It's like joining Costco or Sam's Club. You pay your fees and then get cheaper prices on items because the company (your insurance provider) is paying a bulk rate for goods and services.

 

[dolanp]

The problem with that idea is that because of the inflated costs, you'd have to pay $250 for every office visit checkup, $200 for your prescription antibiotic if you needed one in some cases, etc...

Who among the middle class could just toss $400-$500 out the door when they get a case of pneumonia?

We'd see a return to 19th century self-remedies, quack and folk medicine, tonics and snake-oil in the worst way. And a lot more people dying of easily cureable illnesses in a way that looked like the third world.

Yet they can toss out that amount per month on the insurance? The fact is that those prices are also inflated because doctors have to overcharge for their services since the insurance company negotiates it lower. Some doctors are going to no-insurance for those who choose to pay out of pocket and they charge less because they don't have to hire staff and deal with insurance overhead to get paid.

 

[Art Eatman]

"So the bottom line is that a kid born into a poor family who needs an organ transplant can just die. Or depend on charity, I suppose. Nice if it happens."

Fifty years ago, even a Rockefeller's kid was in the situation of "...can just die".

Fifty-five years ago this month, my grandmother died of a stomach tumor. Thirty-five years ago, my mother recovered nicely from surgery for a quite-similar tumor. Two years ago, I recovered quite well from a far more serious cancer.

It's not the quality of the medicine that's anywhere near being a problem. It's the never-to-be-ended inequity of an individual's financial circumstance. The money does not exist for everybody to have equal medical care.

Put it this way: More people in this country, whether from insurance or Medicare or Medicaid, have more access to basic medicine than anywhere else. Even advanced medicine, for many on Medicaid. You can't judge the system by the amount of private medical insurance coverage.

We're apparently going broke from our system, but a fullbore government program would merely have us going broker, quicker.

Art

 

[Malone LaVeigh]

It's not the quality of the medicine that's anywhere near being a problem. It's the never-to-be-ended inequity of an individual's financial circumstance. The money does not exist for everybody to have equal medical care.

Well, first of all, my statement you quoted doesn't say anything about quality of care. We all know medical science has advanced, "quality" in general is higher if you can afford it or have a good insurance plan. That was my point, under the approach that was proposed, if you are poor, you can just go die, higher quality health care notwithstanding. As to the second point, no one is saying that everybody should have equal care. There is a place for market forces, but if we want to have the best health care system we can, it will have to find some way to address the problems.

We wouldn't be talking about it if it worked.

Put it this way: More people in this country, whether from insurance or Medicare or Medicaid, have more access to basic medicine than anywhere else. Even advanced medicine, for many on Medicaid. You can't judge the system by the amount of private medical insurance coverage.

Sorry, but the first statement is not accurate. Unless you're talking gross numbers, in which case you might be right that "more people" have access. But a higher proportion of people in most European countries have access to very high quality health care than in this country. Even Cuba, for all the many many problems of that country, provides first-world health care to all of it's population. I agree with the last sentence.

We're apparently going broke from our system, but a fullbore government program would merely have us going broker, quicker.

Are you basing that on anything other than your prejudices?

 

[Lone_Gunman]

But a higher proportion of people in most European countries have access to very high quality health care than in this country.

Why do so many foreign elites choose to come to the USA for medical care then?

 

[Zundfolge]

The problem is you do not negotiate for your services in an unconstrained "free" market. It's distorted by cartel power on the selling and buying ends. The old bugaboos of the market systems.

If you don't have or use insurance, you actually pay more than the negotiated rates that the major carriers pay. You don't have their market power. I go through this every time I go to the dentist.

Then you must be a lousy negotiator.

I've spent most of my adult life with no form of health insurance (in fact I carry it now only because my wife insists on it). I've always gone to the doctor and before the evaluation of whatever ill I'm there for is discussed I tell him I'm paying out of pocket and would like to know what the terms are ... invariably I've paid less than other people I know who have gone to the same doctors for the same health issues (or more to the point I've paid less than their insurance companies did). One time I had to make arrangements to pay the doctor off in several payments, but I was still able to pay him (and it all cost me less than what a year's worth of insurance premiums would cost). All that applies to my dentist as well.


And I'm by no means wealthy ... I have never made more than $40k/yr (although I have a feeling that this year may be the year!). Back when I had the problem I described above I was making about $20k

Of course your retort is going to be that I'm somehow special or privileged or lucky or some other nonsense that requires you to take from me at gunpoint to pay for someone else who's not



Keep in mind that many doctors will accept less than what the insurance company will pay because you're going to pay them much faster and with much less paperwork than with the insurance company ... remind your dentist of this and maybe we'll see you get a better deal ... or better yet go find another dentist that will agree to better terms.

 

[benEzra]

If people paid out of pocket for more of the costs and there was no such thing as a $10 co-pay then you would see the premiums seriously deflate.

*We* are. In addition to our $700/month insurance premium, we shell out maybe $600 in medical expenses out of pocket. We paid maybe $15,000 out of pocket last year, and only stayed afloat thanks to the charity of family and friends. Now, we're a special case because our son is a special-needs kid, but the majority of our medical-related expenses insurance won't pay (non-covered stuff), or they'll pay 50% of the cost and we cough up the other 50%. Which is why I'm a bit jaded when the UAW throws an absolute fit that GM wants to raise their copay to $10 or $20 or whatever...

If I made a bit less per month, we'd qualify for Medicaid and SSI. As is, we don't (Medicaid and SSI are essentially fiction if you make enough to pay taxes...we learned that the hard way.)

The problem with that idea is that because of the inflated costs, you'd have to pay $250 for every office visit checkup, $200 for your prescription antibiotic if you needed one in some cases, etc...

Exactly. Been there, done that.

Also, once you've been treated for a particular disease, you often can't get insurance that will cover future episodes of that disease. Example, my son's heart condition. If insurance companies weren't required by NC law to cover preexisting conditions when you join a group health plan, the only people able to get insurance would be those who are healthy enough to not need it. Can't get an individual plan.

Who among the middle class could just toss $400-$500 out the door when they get a case of pneumonia?

We'd see a return to 19th century self-remedies, quack and folk medicine, tonics and snake-oil in the worst way. And a lot more people dying of easily cureable illnesses in a way that looked like the third world.

We're in that boat right now. After paying for the roof over our heads, food, electricity, and water, we spend practically all our disposable income paying for our son's medical care. Our vehicles are 19 and 13 years old, and the newer one (a Plymouth) is currently broken; I am fixing it myself b/c I can't afford to pay someone to do so. I haven't bought a new pair of glasses in ten years, though I badly need a pair. My wife needs some dental work, but we can't afford it, and the dentist wants payment up front. I've got a couple spots that probably put me at elevated risk of skin cancer, but I can't get them removed right now because I can't afford the deductible. I don't even have a primary care physician right now (haven't had one for ~3 years) because I can't afford the out-of-pocket costs; have to pay for my son's specialists instead. Good thing I'm pretty healthy.

If I took a job as a janitor instead, I'd qualify for Medicaid in 6 months, my son would qualify for SSI (he already does, except we're above the income limits), and we'd have free care for most of our needs, and access to all the doctors we have now...and I know one college-educated man who has done just that, for precisely that reason. But if we did, we couldn't afford some stuff that Medicaid won't cover, like nutritional formula (our son can't eat), and we'd go bankrupt and/or lose the house in the six months before Medicaid would kick in...and we'd have no insurance during that six-month period, either.

I understand the free-market-based arguments perfectly. I also know that the British NHS has problems with institutional coverups of medical malpractice (wouldn't want to make the government look bad, you know), and there is a strong tendency for doctors in a government-run system to develop the Doctor-Is-God complex. I don't know what the ideal solution to the current problem is. But the current approach IS in trouble.

 

[Malone LaVeigh]

Then you must be a lousy negotiator.

Etc.

Then I'm very happy for you that you obviously haven't had to contend with a serious illness. Last year my brother was dieing of lung cancer without insurance, and we went through all of that. Sure, we negotiated a lot of his bills down, quite significantly. I don't deny it can be done. But every time we went through a medical door it cost thousands of dollars. Courses of treatment were routinely in the tens of thousands. You can feel good and smug while you're healthy, but when you get older or if you get sick, you'll thank everything you believe in your wife made you get insurance.

Of course your retort is going to be that I'm somehow special or privileged or lucky or some other nonsense that requires you to take from me at gunpoint to pay for someone else who's not

That's right, stick'em up, Karnak.