Supreme Court Hearings on the Affordable Health Care Act (PT)

[ulthar]

Blue Cross Blue Shield refused to pay for a doctor's visit and subsequent testing I had a few years ago when I thought I was having a cardiac episode similar to something for which I have documented medical history (complete with hospitalization).

I left work early to go to the doctor, and he was sufficiently concerned/wanted to be thorough enough to send me to a specialist immediately for testing.  The specialist saw me and ran the tests.

BCBS refused to pay a single red cent of either visit.  Their reason?  "You should have gone to the ER."

#1.  It was not a true emergency if my history was to be a guide.  It was something to get checked first.  The ER was already slam packed with people getting their runny noses checked out, and the average wait time was about 6 hours.

#2.  The ER visit would likely have resulted in admission for further testing by the same specialist that saw me in his office...only with at least a day or two of "overnight observation" in the wards.

#3.  As such, the ER visit would have resulted in a bill probably up around 10 times what I ended up accruing by being seen in the two offices.

Brilliant.

I paid it out of pocket.

I'll never forgive them for this bit of lack of common sense.  Bean counters and bureaucrats should NEVER be involved in making health care decisions.

Your Mileage May Vary...

Oh, also, I was self employed so I paid my premiums to them out-of-pocket, which means they were making more off me than if I was getting it as a benefit from my employer (with his 'bulk rate discount').

[Flick James]

Blue Cross Blue Shield refused to pay for a doctor's visit and subsequent testing I had a few years ago when I thought I was having a cardiac episode similar to something for which I have documented medical history (complete with hospitalization).

I left work early to go to the doctor, and he was sufficiently concerned/wanted to be thorough enough to send me to a specialist immediately for testing.  The specialist saw me and ran the tests.

BCBS refused to pay a single red cent of either visit.  Their reason?  "You should have gone to the ER."

#1.  It was not a true emergency if my history was to be a guide.  It was something to get checked first.  The ER was already slam packed with people getting their runny noses checked out, and the average wait time was about 6 hours.

#2.  The ER visit would likely have resulted in admission for further testing by the same specialist that saw me in his office...only with at least a day or two of "overnight observation" in the wards.

#3.  As such, the ER visit would have resulted in a bill probably up around 10 times what I ended up accruing by being seen in the two offices.

Brilliant.

I paid it out of pocket.

I'll never forgive them for this bit of lack of common sense.  Bean counters and bureaucrats should NEVER be involved in making health care decisions.

Your Mileage May Vary...

Oh, also, I was self employed so I paid my premiums to them out-of-pocket, which means they were making more off me than if I was getting it as a benefit from my employer (with his 'bulk rate discount').

I'm sorry to hear that. I guess we've had night and day experiences.

[ulthar]

I'm sorry to hear that. I guess we've had night and day experiences.

I've had BCBS on and off for about three and a half decades, and this is the only (major) disappointment I've had with them.

Still, though...left a pretty bad taste.

[Frank81]

I'm sorry to hear that. I guess we've had night and day experiences.

I've had BCBS on and off for about three and a half decades, and this is the only (major) disappointment I've had with them.

Still, though...left a pretty bad taste.

It may be the old chicken and egg analogy. The insurance companies are getting worse cause of govt. mandate and intervention or were  they already bad and the Govt. needs to step in more cause they are  hurting people?   

[ulthar]

It may be the old chicken and egg analogy. The insurance companies are getting worse cause of govt. mandate and intervention or were  they already bad and the Govt. needs to step in more cause they are  hurting people?   

I cannot answer which is the chicken and which is the egg, but I will say this.

I remember the mid 1980's when HMO's were first hitting the scene in my neck of the woods.  It scared the crap out of me then as I could not imagine why anyone would allow their employer's chosen insurance company dictate which doctor to use.

I remember the HR person at the job I was starting singing the praises...I could choose Kaiser Permanente as an HMO or a "traditional" insurance which was JUST catastrophic hospitalization coverage.  I chose the latter, but the HR person was perplexed at my decision.

Fast Forward a few years and I was at another new job, and had some fun with another HR rep.  This one was telling me that under my plan, the one I was "forced" to take now, only certain ER's were "approved" for coverage.  I asked her if that meant if I was in a car wreck, unconscious and the EMT's brought me to a different hospital that the insurance would not pay.

She said, "That's right.  You HAVE to go to one of the approved ER's under ALL circumstances."

I don't think she had it quite right, but that's not my point.  My point is that she thought that was the rule and SHE WAS FINE WITH THAT.

Slippery slopes, and all that....

I also recall that Ted Kennedy was one of the movers and shakers behind getting those original HMO's like Kaiser pushed through as the "in thing," then later in his career he said they were the problem.  Now, he was not admitting his mistake but rather saying that they did not go far enough in "controlling" the administration of health care to the individual.

Scary, scary stuff.

What I want from "insurance" is just catastrophic coverage.  I'll pay for the runny nose treatment when I want it if I choose to get it.  The insurance and government involvement is destroying the ability of doctors to deliver quality care; at least that's what I hear from the doctor I live with who spends an insanely high percentage of her day not delivering true health care at all.

[tracy]

It may be the old chicken and egg analogy. The insurance companies are getting worse cause of govt. mandate and intervention or were  they already bad and the Govt. needs to step in more cause they are  hurting people?   

I cannot answer which is the chicken and which is the egg, but I will say this.

I remember the mid 1980's when HMO's were first hitting the scene in my neck of the woods.  It scared the crap out of me then as I could not imagine why anyone would allow their employer's chosen insurance company dictate which doctor to use.

I remember the HR person at the job I was starting singing the praises...I could choose Kaiser Permanente as an HMO or a "traditional" insurance which was JUST catastrophic hospitalization coverage.  I chose the latter, but the HR person was perplexed at my decision.

Fast Forward a few years and I was at another new job, and had some fun with another HR rep.  This one was telling me that under my plan, the one I was "forced" to take now, only certain ER's were "approved" for coverage.  I asked her if that meant if I was in a car wreck, unconscious and the EMT's brought me to a different hospital that the insurance would not pay.

She said, "That's right.  You HAVE to go to one of the approved ER's under ALL circumstances."

I don't think she had it quite right, but that's not my point.  My point is that she thought that was the rule and SHE WAS FINE WITH THAT.

Slippery slopes, and all that....

I also recall that Ted Kennedy was one of the movers and shakers behind getting those original HMO's like Kaiser pushed through as the "in thing," then later in his career he said they were the problem.  Now, he was not admitting his mistake but rather saying that they did not go far enough in "controlling" the administration of health care to the individual.

Scary, scary stuff.

What I want from "insurance" is just catastrophic coverage.  I'll pay for the runny nose treatment when I want it if I choose to get it.  The insurance and government involvement is destroying the ability of doctors to deliver quality care; at least that's what I hear from the doctor I live with who spends an insanely high percentage of her day not delivering true health care at all.

My Mom had some pretty bad experiences with an HMO back then. She was a retired government worker and was given Kaiser Permanente. She'd be waiting there for hours to see her doctor,even with an appointment. They insisted on giving her a medicine she was allergic to then tried to convince us she'd never gone into Anaphalactic Shock(SP?). The doctors got more and more hard to understand because their accents were so heavy....then the last two weren't even licensed to practice medicine in this country. Nedless to say,we were beyond relief when she got regular insurance.

[Jim H]

Reading the arguments, I basically feel like I'd need a multiple year long legal education to really have a true grasp of the issues.  I don't really like just admitting ignorance and moving on too often, but when it comes to supreme court legal decisions I often feel like this is what I have to do.  Looking to experts, they seem pretty divided actually, though I've noticed many apparently think it SHOULD be unconstitutional but don't think it WILL be ruled that way.  Found that interesting.

But in this case, that’s not what’s at issue. The issue appears to be that Americans are being required to purchase something from a commerical company. This means that here is a proposed government program that would actually be covered evenly by all the people, rather than paid for by the richest 1% for the use of the other 99%

Well, I will say the poor and semi-poor are having their healthcare payments heavily subsidized.  Where do you think THAT money is coming from?

But in large measure I agree.  Sometimes I feel like what we're doing now is the worst of both worlds.  We have a profit motivated healthcare system, and government forcing us to get it.  I kind of like what Germany does, where the majority of the health care companies do compete but are FORCED to be non-profit.  Seems like a good idea. 

I will say I think it's morally wrong to have a company where at times the best interests of the company lie in letting people die or in other cases getting inferior treatment.  It just isn't right.  It's clear to me we need significant government regulation of health care regardless of whether it is private or not - and we do have that, so hey. 

I don't really know where I'm going with this, just that I'm not seeing any real solutions to the problem here.  I don't know if Obamacare will work.  I do know I haven't seen any worthwhile serious overhauls proposed that would keep the system as private as it previously was.  Anyone have any?

[Zapranoth]

From an article in my local paper today:

"There are at least two ways to address this reality – which is, by the way, very much an issue involving interstate commerce, and hence a valid federal concern. One is to tax everyone – healthy and sick alike – and use the money raised to provide health coverage. That’s what Medicare and Medicaid do. The other is to require that everyone buy insurance, while aiding those for whom this is a financial hardship.

Are these fundamentally different approaches? Is requiring that people pay a tax that finances health coverage OK, while requiring that they purchase insurance is unconstitutional? It’s hard to see why – and it’s not just those of us without legal training who find the distinction strange. Here’s what Charles Fried – who was Ronald Reagan’s solicitor general – said in a recent interview with The Washington Post: “I’ve never understood why regulating by making people go buy something is somehow more intrusive than regulating by making them pay taxes and then giving it to them.”

Read more here: http://www.theolympian.com/2012/04/03/2055237/lumping-health-care-and-broccoli.html#storylink=cpy"

[ulthar]

From an article in my local paper today:

"There are at least two ways to address this reality – which is, by the way, very much an issue involving interstate commerce, and hence a valid federal concern. ..."

Holy Cow, what idiot wrote THAT article?

Classic false dichotomy.

I'm scratching my head how this has GOT to be defined as an Interstate Commerce issue.  The only thing I can come up with is that part of the problem with the insurance industry is that we cannot shop across state lines to find competing, yet desirable, policies.

The big problem with that sentence is that the writer seems to be asserting that health care itself is legitimately a federal issue which is pure crap.

No one can, or should, FORCE me to get any care I don't want.  If I have a condition x, and want to die from it in my home, that's MY choice, butt-hole, not yours.

This dirty little secret no one on either side of the aisle is really talking about is that to the average doctor providing 'front line care,' very little of their time is spent on the delivery of care that is really needed.

I know a doctor and she spends a TON of time doing the following: advising parents in common sense issues ("my kid won't eat his vegetables, what can I do?"), filling out stupid forms for the school system because THEY cannot trust the parents to decide to keep the child home with a fever, doing paperwork to keep the bean counters, lawyers, insurance companies and feds happy, including HIPAA stuff that is more far-reaching than any "biased media report" EVER said would be a consequence of THAT law.

She sometimes sees 500 patients a month, of which roughly half are "sick" patients.  Of the sick visits, she estimates maybe 5% are really sick and need to be seen by a doctor.

The costs of health are spiraling upward, out of control, because the issuance of care has become a commodity and no one knows the real value of the services anymore.  My tetnus shot no longer costs me two chickens; it's "sign here, and give me your policy number."

Neither taxation nor forced purchase is going to stop that.

[Jim H]

If I have a condition x, and want to die from it in my home, that's MY choice, butt-hole, not yours.

I was fairly shocked to find out recently sometimes that choice is, in fact, not yours.  I guess I shouldn't be, since suicide is illegal, but the idea of the government forcing me to live does rub me the wrong way.

Friend of mine's grandfather is in terrible health, wants to go home, but they can't afford hospice care.  They've basically said if he doesn't go into hospital rehab and does go home, they'll get a health inspection at the house which will not meet standards (they don't have any family members that can be a full-time care person, and their home is terribly suited for the care of someone who is bed ridden) - and that he'll eventually almost certainly get forced into a government care center.