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      05-01-2019, 06:03 AM   #1
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Private insurance vs medicare for all

I'm looking for honest opinions on people's preference regarding medical insurance. I'm not sure if it is possible to separate this from politics and not go down the road of whether medical insurance is a right.

I imagine most of us here have private medical insurance, and with that comes the option of staying in network for a co-pay or going out of network and paying for it yourself. In most cases, unless you're really sick you will never meet the deductible for out of network.

I am very fortunate to have the ability to go to any doctor I choose regardless of whether he/she take my insurance. I will not choose a doctor, or change doctors due to who is in or out of network.

The thought of this choice being taken away from me is terrifying. It seems most of the Democrats that have thrown their hat in the race are for medicare for all. I try and tell myself that this won't be an issue. Even if a democrat wins 2020, they'll never get this through, it's a talking point/platform that will never be delivered. BUT, what if? Have any of the democrats here actually thought this through? Are you willing to have the government control your medical care and take away your choices so that everyone has medical coverage?

EDIT: Please correct me if my thought process is incorrect. I can still go to doctors of my choice but will there be less doctors to choose from?
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      05-01-2019, 06:52 AM   #2
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Originally Posted by cmyx6go View Post

EDIT: Please correct me if my thought process is incorrect. I can still go to doctors of my choice but will there be less doctors to choose from?
I dont know how the democrats plan their proposal or how it will be accepted/amended (if that happens), but I live in a country where having a basic medical insurance is mandatory, and where people who earn less (or nothing) get subsidized for that insurance. A basic insurance has an annual deductable (to stop people going to the doctor for the most trivial things, some people go to the doctor because they are bored...).

Extra coverage costs extra money

I can tell you that I can pretty much choose which doctor I want and which hostpital I want. To certain extent that's dependent on what insurance you choose.
I did a calculation once here on the forum to compare to the current US system and it showes that the total system in my country isnt more expensive than what you pay in the US.
So having a mandatory insurance doesnt have to be more expensive and you achieve that people who really cant pay it, can still go to a doctor.
If you dont make it mandatory, usually people who are really healty wont opt for an insurance. The insurance misses the income of those people and eventually that'll show in the annual premium you have to pay. Thats my view anyway: If I had a bad health, I'd be sure to get a health insurance. If my health was pristine, I'd maybe take the gamble.
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      05-01-2019, 06:55 AM   #3
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I don't understand this sentence
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Are you willing to have the government control your medical care and take away your choices so that everyone has medical coverage?
Why do you think this would be any different with "Medicare for all" vs current commercial health plans? Literally everyone in the country, regardless of medical insurance - Private, Medicare, HCR Exchange - currently has the ability to go to any doctor they want and pay full price for any services that doctor is willing to provide.
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      05-01-2019, 06:57 AM   #4
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People always say "go look at Sweden, Norway, do it like that!". They don't realize that Sweden and Norway are insanely healthy countries. People bike everywhere and their health problems are minimal.

We will GO BROKE. Look around you, we are surrounded by fat fucks. This will never work in America.

Government control is always sold as a new "freedom". If anyone has ever worked with the VA, the thought of government run healthcare will send shivers down your spine.
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      05-01-2019, 07:06 AM   #5
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Quote:
Originally Posted by CTSean View Post
I don't understand this sentence

Why do you think this would be any different with "Medicare for all" vs current commercial health plans? Literally everyone in the country, regardless of medical insurance - Private, Medicare, HCR Exchange - currently has the ability to go to any doctor they want and pay full price for any services that doctor is willing to provide.
I'm asking, I guess. I know I can do that now, but if things went the way of medicare for all, would that change?
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      05-01-2019, 07:11 AM   #6
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Originally Posted by DonaldPump View Post
If anyone has ever worked with the VA, the thought of government run healthcare will send shivers down your spine.
This is what has always amused me about these type or arguments - the government is shit at doing things - do you really want them managing your healthcare?
If you want something done in the least efficient and most complicated way possible - let the government do it. The preventative benefit component of HCR is a fantastic example - they took a relatively simple process for most insurance companies and turned it into something insanely complicated. The requirements for some services to qualify as preventative now are unbelievable. Those requirements put the responsibility on doctors' offices to make sure they bill just right to trigger that preventative benefit - otherwise stuff gets applied to the deductible.
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      05-01-2019, 07:13 AM   #7
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Originally Posted by cmyx6go View Post
I'm asking, I guess. I know I can do that now, but if things went the way of medicare for all, would that change?
Can't imagine it would - it doesn't work like that under current Medicare. No health plan can tell someone they can't have a service done - they can only say they won't cover it if it is done.
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      05-01-2019, 07:17 AM   #8
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Originally Posted by CTSean View Post
Can't imagine it would - it doesn't work like that under current Medicare. No health plan can tell someone they can't have a service done - they can only say they won't cover it if it is done.
Thank you. The question then becomes how much more in taxes will we have to pay to fund the program and after that will we still be in a financial position to afford our choices.
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      05-01-2019, 07:26 AM   #9
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Originally Posted by CTSean View Post
This is what has always amused me about these type or arguments - the government is shit at doing things - do you really want them managing your healthcare?
If you want something done in the least efficient and most complicated way possible - let the government do it. The preventative benefit component of HCR is a fantastic example - they took a relatively simple process for most insurance companies and turned it into something insanely complicated. The requirements for some services to qualify as preventative now are unbelievable. Those requirements put the responsibility on doctors' offices to make sure they bill just right to trigger that preventative benefit - otherwise stuff gets applied to the deductible.
You'll notice the people that constantly rail against private industry will never criticize government.

So somehow all the greedy capitalists are going to find a new heart when the government runs healthcare? Give me a break, they will find a new way to line their pockets through the creation/expansion of healthcare programs to justify taxing the citizenry into oblivion.

"Little 3 year old sally needs a sex-change, sorry taxpayers, 80%!"
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      05-01-2019, 07:27 AM   #10
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I have a high deductible plan and usually hit my individual and family deductibles well before the end of March each year. I choose my plan based on economics and because it gives me the best coverages for my needs. I am free to go anywhere for care, although in-network has 100% reimbursement (after deductible) and out-of-network is 90% or a copay, depending on service.

I view insurance as just that. I choose where to go for care and what care and medications to get, based on consultation with doctors. Insurance pays what it does and I pay the rest. That gives me the best care. Many doctors start to chose medications based on whether the insurance covers them; so far mine have been in the $hundreds so I tell them to choose based in efficacy, not cost. If I got into $thousands for medications (and there are several in that price range), I’d probably have to really think about it and have a deeper conversation with the physician.

I live in a small city with good everyday care, but for a heart condition I would go to Cleveland Clinic (closest really good center), for another condition I might go to another state/clinic. Not afraid to travel, not afraid to choose.

I know many people who view their insurance as dictating care; I think that is backwards.

All that said, I really dislike the one-provider system which I believe would turn into the VA for all here. I could get behind a good universal health insurance system, but they are problematic because cost determines coverage - and that gets decided by political appointees instead of patients and doctors (and companies negotiating coverages their employees will value). When I lived in Oregon (last century), they were wrestling with this issue in a new health plan; I haven’t followed how/if they resolved it.

Someone already mentioned weight; there are other risk factors like smoking, drug use, and high-risk activities that could result in higher medical costs. Should those be paid by an insurance-for-all pool, or should we each have some “skin in the game” as far as the costs of our care given the risks we take? And if we do, who gets to monitor that for us? I wouldn’t be a fan of government keeping tabs on my habits, hobbies and activities!
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      05-01-2019, 07:40 AM   #11
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Thank you. The question then becomes how much more in taxes will we have to pay to fund the program and after that will we still be in a financial position to afford our choices.
Pretty hard to say - a lot would depend on how private insurance contracted rates compare with Medicare schedules. I don't know for sure but my gut tells me private probably pays better since the contracts have to be agreed upon and if a provider doesn't like their fee schedule, they don't have to participate. Medicare rates are more like "this is all we're allowing, if you don't like it that's not our problem." which translates to "it may or may not be the insured's problem". it's similar to the concept of in vs out of network but a little different. It's conjecture, but Medicare for all could result in less providers actually accepting Medicare (meaning they accept Medicare's allowables) resulting in less providers available that will not balance bill a member for the cost above the medicare allowed.

This doens't even account for actual plan designs - will they be straight 80/20 plans or will there be different deductible and coinsurance amounts for providers accepting vs not accepting medicare rates?

Medicare for all is a nice 3 word chant - and lord knows the US loves a good 3 word chant nowadays - but the reality is way more complicated than the majority of Americans could ever hope to understand.
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      05-01-2019, 07:43 AM   #12
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Originally Posted by CTSean View Post
Pretty hard to say - a lot would depend on how private insurance contracted rates compare with Medicare schedules. I don't know for sure but my gut tells me private probably pays better since the contracts have to be agreed upon and if a provider doesn't like their fee schedule, they don't have to participate. Medicare rates are more like "this is all we're allowing, if you don't like it that's not our problem." which translates to "it may or may not be the insured's problem". it's similar to the concept of in vs out of network but a little different. It's conjecture, but Medicare for all could result in less providers actually accepting Medicare (meaning they accept Medicare's allowables) resulting in less providers available that will not balance bill a member for the cost above the medicare allowed.

This doens't even account for actual plan designs - will they be straight 80/20 plans or will there be different deductible and coinsurance amounts for providers accepting vs not accepting medicare rates?

Medicare for all is a nice 3 word chant - and lord knows the US loves a good 3 word chant nowadays - but the reality is way more complicated than the majority of Americans could ever hope to understand.
And, we canít assume that covered care will remain the same. Perhaps stints and balloons will be covered for heart care, but not bypasses? Maybe organ transplants are just too expensive? The plan overseers will have to determine specifically what is covered and what is not; to assume this will look like todayís insurance plans is naive.
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      05-01-2019, 07:48 AM   #13
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Quote:
Originally Posted by CTSean View Post
Pretty hard to say - a lot would depend on how private insurance contracted rates compare with Medicare schedules. I don't know for sure but my gut tells me private probably pays better since the contracts have to be agreed upon and if a provider doesn't like their fee schedule, they don't have to participate. Medicare rates are more like "this is all we're allowing, if you don't like it that's not our problem." which translates to "it may or may not be the insured's problem". it's similar to the concept of in vs out of network but a little different. It's conjecture, but Medicare for all could result in less providers actually accepting Medicare (meaning they accept Medicare's allowables) resulting in less providers available that will not balance bill a member for the cost above the medicare allowed.

This doens't even account for actual plan designs - will they be straight 80/20 plans or will there be different deductible and coinsurance amounts for providers accepting vs not accepting medicare rates?

Medicare for all is a nice 3 word chant - and lord knows the US loves a good 3 word chant nowadays - but the reality is way more complicated than the majority of Americans could ever hope to understand.
And this right here is what terrifies me. Will we lose our ability to choose and be in control of our own health care, be that the actual choice of providers or due to the cost.
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      05-01-2019, 08:12 AM   #14
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Originally Posted by cmyx6go View Post
And this right here is what terrifies me. Will we lose our ability to choose and be in control of our own health care, be that the actual choice of providers or due to the cost.
That's not really very different today - the difference is the medical necessity guidelines applied to whether a service is covered. Current private companies have guidelines that are equal or less conservative than Medicare. If they try to be more conservative than Medicare, they get sued by state DOIs (Department of Insurance). Medicare has the ability to set medical necessity guidelines to whatever they want and there's no bar to which they can be held accountable - they are the bar.

Now for the record, I'm not completely against the idea of gov't sponsored basic health insurance. What I'm against is the idea of "only" gov't sponsored health insurance. There's no reason we can't have private insurance and "Medicare for more". Obamacare attempted it, but I don't think it did so correctly. I know people will disagree - and they are welcome to - but IMO, a little bit of socialism isn't a bad thing - It's how we got interstate highways and GPS.
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      05-01-2019, 08:19 AM   #15
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I think there should be a program that provides basic medical care for everyone at a reasonable price, you can call it Medicare or whatever you want. Yes it will cost more money but I think it is the right thing to do.

One question of the above, why is this program or blame being put on Democrats? Trump (our Republican President) has also promised many times to do similar. So Democrats promise it and Trump promises the same.

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      05-01-2019, 08:23 AM   #16
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Quote:
Originally Posted by DonaldPump View Post
People always say "go look at Sweden, Norway, do it like that!". They don't realize that Sweden and Norway are insanely healthy countries. People bike everywhere and their health problems are minimal.
We will GO BROKE. Look around you, we are surrounded by fat fucks. This will never work in America.
Haha maybe you're right, the US is indeed not the most fit nation on average.

But Germany also has a mandatory health insurance system.
And Germans also arent that skinny with their beergarten and bradwurst culture.
They lead a pretty nice life if you know what I mean. Especially in the south.
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      05-01-2019, 08:27 AM   #17
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Originally Posted by David70 View Post
One question of the above, why is this program or blame being put on Democrats? Trump (our Republican President) has also promised many times to do similar. So Democrats promise is and Trump promises the same.

Trump -
One is lip service that I doubt anyone actually takes seriously, the other has already been proven back in 2008.
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      05-01-2019, 08:30 AM   #18
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if universal healthcare ran by the government is going to be a thing, it would have to be done completely different than Medicare, or it will fail miserably and bankrupt many in the process.

the problem with medicare, is that like mentioned, they pay what they pay and thats that. You get a procedure that the Hospital bills normal insurance 100k for but Medicare only pays $50k? Tough shit hospital, thats all you are getting. This leads to serious financial ramifications for the healthcare industry as a whole.

The other issue is they get to decide what is necessary. My parents recently retired, and with retirement, started looking at Medicare vs buying their own insurance. My dad has a bad knee that he wants to get replaced as well. Medicare would not cover his knee replacement because it wasnt "Medically Necessary" even though his DR and a second opinion DR both recommended it because it could improve his quality of life. They decided to pay for their own insurance (keeping the same coverage they had before they sold their business) and hes getting his knee replacement covered by insurance.

When you remove the private insurance companies from the equation, you dont get the option for what Medicare deems as "elective procedures". They literally do tell you what you can and cant do when it comes to your health. Sure, some will say "well you can still get the procedure, you just have to pay out of pocket" in an attempt to say you have a choice, but for many, they dont have the luxury of being able to afford said procedures.

If you trust the Government, who operates everything so inefficiently its annual budget is more than a trillion $ over what it makes, have at it i guess. But having family and friends that have worked at VA hospitals, i prefer to keep them as far away from my healthcare as possible.
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      05-01-2019, 08:31 AM   #19
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One is lip service that I doubt anyone actually takes seriously, the other has already been proven back in 2008.
I shouldn't vote for the one that is likely to do what they promise and instead vote for the one we know will promise what it takes to get elected and then never follow through?
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      05-01-2019, 08:51 AM   #20
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I shouldn't vote for the one that is likely to do what they promise and instead vote for the one we know will promise what it takes to get elected and then never follow through?
You lost me there, I'm not sure how "who should I vote for" became part of the discussion. You should vote for the person you believe will best serve the role for which they are running.
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      05-01-2019, 09:05 AM   #21
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Quote:
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I don't understand this sentence
Quote:
Are you willing to have the government control your medical care and take away your choices so that everyone has medical coverage?
Why do you think this would be any different with "Medicare for all" vs current commercial health plans? Literally everyone in the country, regardless of medical insurance - Private, Medicare, HCR Exchange - currently has the ability to go to any doctor they want and pay full price for any services that doctor is willing to provide.
Are there countries where this process has been instituted (single payor) where they do have freedom of choice?
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      05-01-2019, 09:09 AM   #22
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Are there countries where this process has been instituted (single payor) where they do have freedom of choice?
We would need our Canadian or British or German (or any other single payer country) friends to weigh in. I can guarantee though that, in the USA, there will never be legislation that says "You can't have an MRI, even if you're willing to pay for it out of your own pocket"
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