Thread: Trading with a sane president...

Medicare, as an organization, cares not at all about profits, therefore they have no reason to cut corners on patient care.

Not sure I can agree with that. My parents are on Medicare, and there are certain medications that they won't cover. Why would they do that?

Originally Posted by Dave K

Your points are all well and good. But I"m just pointing out what many are afraid of, at least in the U.S. When our health care is in the hands of the barely trusted government, people just get nervous.

Plenty of reasons to not trust the government. However I still have clear running water that won't kill me,
the roads are "maintained".. When I dial 911 they answer the phone and even show up.

There are things I trust less than the government.. Like rabid dogs.. A fart on May 6th.. Medium rare
chicken.. A toddler that says "don't worry, my hands are clean", A guy named Guido that says "trust me"..

And after all that... There is big business in general.. The ones that would screw their grandmother
for a nickel..

Then there are dentists that say "This won't hurt"..

And then there are insurance companies.. They are all niceny nice when you are paying them...
But the shit surely hits the fan the second they have to pay out a penny.


I think its all bull shit anyways.. The insurance companies customers are the people that aren't
really old and expensive to care for yet, the people that have enough money to pay for insurance, and the
people that are healthy enough to work to afford insurance..

The government already takes care of all the shitty customers.. The old, the poor, the sick.
Taking care of the same stuff for the people that can actually afford it and are least likely to
get sick should be a piece of cake.

Originally Posted by Dave K

Not sure I can agree with that. My parents are on Medicare, and there are certain medications that they won't cover. Why would they do that?

Well, they certainly don't make a profit, that's for sure.

As for your parents drugs, I don't know the circumstances. What I do know is that both Medicare authorized drug plans as well as every private insurance company have a formulary or list of drugs that are approved for prescription. This list of drugs is called the "formulary". There are many reasons a drug might not be on the formulary. It might be an experimental drug or it may simply be too expensive or it is being prescribed off-label and they substitute a different drug instead.

What your parents can do is appeal the decision not to cover their drugs. I have had to do that personally three times in the last year. In every case my doctor explained why the drug prescribed was the only drug that would give the desired result. In all three cases my appeal was approved and I got the drug. This procedure is called "prior authorization" or PA for short.

Medicare, you see, does not itself provide any drugs. In order to receive prescription drugs under Medicare, one purchases a private market prescription drug plan. These are the same companies that provide drugs for the private market. So, really, there's very little difference between Medicare and private insurance when it comes to prescription drugs. They work exactly the same way.

If your parents are not getting the drugs they want get them to enlist the aid of their doctors in completing the prior authorization procedure. If they are still denied there are appeal rights that go further still if they are Medicare patients.

Squire

Sent Using Tapatalk - Cherokee Nation of Oklahoma, Tahlequah OK

Originally Posted by OldSquier

Well, they certainly don't make a profit, that's for sure.

As for your parents drugs, I don't know the circumstances. What I do know is that both Medicare authorized drug plans as well as every private insurance company have a formulary or list of drugs that are approved for prescription. This list of drugs is called the "formulary". There are many reasons a drug might not be on the formulary. It might be an experimental drug or it may simply be too expensive or it is being prescribed off-label and they substitute a different drug instead.

What your parents can do is appeal the decision not to cover their drugs. I have had to do that personally three times in the last year. In every case my doctor explained why the drug prescribed was the only drug that would give the desired result. In all three cases my appeal was approved and I got the drug. This procedure is called "prior authorization" or PA for short.

Medicare, you see, does not itself provide any drugs. In order to receive prescription drugs under Medicare, one purchases a private market prescription drug plan. These are the same companies that provide drugs for the private market. So, really, there's very little difference between Medicare and private insurance when it comes to prescription drugs. They work exactly the same way.

If your parents are not getting the drugs they want get them to enlist the aid of their doctors in completing the prior authorization procedure. If they are still denied there are appeal rights that go further still if they are Medicare patients.

Squire

Sent Using Tapatalk - Cherokee Nation of Oklahoma, Tahlequah OK

Well, they did figure it out, by doing exactly what you said, it's just that my point was, that if some drugs are too expensive, they won't cover them, which is exactly why insurance companies deny certain drugs, despite whether they're in it for profit or not. Under an NHS, not sure if those appeals or PA's will work the same as they do under medicare. Depends how our government would set things up, which is another scary thought. I don't know what the answer is. At times I think an NHS would be the way to go, just so we don't have to fork out these monthly premiums and pay these high deductibles.

Originally Posted by Dave K

Well, they did figure it out, by doing exactly what you said, it's just that my point was, that if some drugs are too expensive, they won't cover them, which is exactly why insurance companies deny certain drugs, despite whether they're in it for profit or not. Under an NHS, not sure if those appeals or PA's will work the same as they do under medicare. Depends how our government would set things up, which is another scary thought. I don't know what the answer is. At times I think an NHS would be the way to go, just so we don't have to fork out these monthly premiums and pay these high deductibles.

Yes , I see your point. I think you're right - the availability of drugs not ordinarily on a formulary would hinge on how they set the system up. At the least, I'm guessing that there will be certain classes of drugs that will require review before they are dispensed. This isn't necessarily a reduction of benefits, it's more a double-check against the prescription of drugs without sufficient reason.

Course, there is also the fact that nothing is perfect. We don't want "perfection" to become the enemy of "good".

Squire

Sent Using Tapatalk - Cherokee Nation of Oklahoma, Tahlequah OK

Originally Posted by Dave K

Again, great point, but can't the same be said by replacing "insurance companies" with "government"?

I honestly don't know how often I have to keep repeating this.

Healthcare isn't and shouldn't be "run" by government. The only thing a government should be responsible for is FUNDING healthcare. Who in their right mind would want changing political majorities and parties running healthcare?

I'm going to start a new thread and the title will probably be something like "Healthcare - American style" and try and stay out of it unless asked a direct question

Originally Posted by Gordon B. Clarke

...I'm going to start a new thread and the title will probably be something like "Healthcare - American style" and try and stay out of it unless asked a direct question

Awesome, I'm sure the entire forum is waiting with bated breathe for your next "America sucks, Denmark is better" troll thread.

It will be the thread of threads, I'm sure.

Originally Posted by Gewehr 98

Awesome, I'm sure the entire forum is waiting with bated breathe for your next "America sucks, Denmark is better" troll thread.

It will be the thread of threads, I'm sure.

Judge for yourself. IT'S POSTED Denmark isn't mentioned.

I'm sure you'll find a way to fuck it up.

Originally Posted by Gordon B. Clarke

I honestly don't know how often I have to keep repeating this.

Healthcare isn't and shouldn't be "run" by government. The only thing a government should be responsible for is FUNDING healthcare. Who in their right mind would want changing political majorities and parties running healthcare?

I'm going to start a new thread and the title will probably be something like "Healthcare - American style" and try and stay out of it unless asked a direct question

Well, even though that might be the better way, will our government set it up that way? As power hungry as they are, probably not. They'd end up wanting as much control as possible, would be my guess.

Opinions vary about the "efficiency" of Medicare. The lower payment rate compared to private insurers is used as "proof" of the superiority.

The alternative view is that Medicare, using the power of government, underpays the cost of care and the providers bill the difference to private insurers and those who pay for their own care. Medicare instituted the concept of fee for service, which many critics claim has caused health care costs to skyrocket thanks to "a la carte" billing practice.

If you look at the change in how care delivery has changed since the 1960s you can see several drivers of costs, including restriction on supply, government subsidies of service, and consolidation of both insurers and providers in an escalating "arms race". The general public has been the losers and like a frog being boiled starting with cold water have not noticed the change until it became a crisis over the last couple decades.

Originally Posted by gustafson

no not really

concierge medicine, medicine for the wealthy, and healthy

That may be how it started...but in this program they have made healthcare affordable for all by paying direct into a pool then take what you need. Doctors and staff push for bargain cost on drugs and procedures so its a one stop affordable healthcare shop. I am not sure how it could be scaled up...but I find it a very interesting alternative.

It would be great if doctors got a bit more, hospitals got a bit more and we as consumers paid a bit less.

Originally Posted by gustafson

A sizeable portion?

your personal contribution is 6.2 percent

it was never to be set aside in a fund, ever

SS has never run dry, ever

so everything in your post is a lie

no, no gov't program is without flaws, but most of them work as intended.

VA hospitals? A travesty, but how would vets be with zero care, as Republicans wish it, well, they would be dead, what is the wait time on that?

This whole right wing bs that somehow private industry runs things better, is just that. BS

Only 6.2%. 6.2% is a sizable amount to remove from my wage...also matched by employer, which is really removed from my wage...so 12.4%

In any case its money removed from my wage.

I say it was set aside...no its not locked in a vault...but the system is flawed and borrowed upon. It is almost a Ponzi scheme being it is not sustainable in present form.

Is that a lie...no, don't think so.

VA- A travesty no doubt. Our men and women who served should receive the best care possible, period.
Republicans and Democrats have both been in office, both in the majority and neither have fixed the problem. They both do a great job pointing fingers...and at the end of the day the Vets are a minority that will not help a Dem or Republican get into office or line their pockets so lip service is paid and little gets done.
Both parties wrong.

Trump said he would take this on...I sincerely hope he does carry though on that promise. Call him whatever, I hope he does more then offer lip service.

Originally Posted by SIM

Only 6.2%. 6.2% is a sizable amount to remove from my wage...also matched by employer, which is really removed from my wage...so 12.4%

In any case its money removed from my wage.

I say it was set aside...no its not locked in a vault...but the system is flawed and borrowed upon. It is almost a Ponzi scheme being it is not sustainable in present form.

Is that a lie...no, don't think so.

I think if the Gov't calls it a "fund", then you can too.

It's 7.65% if you count medicare, 15.3% if you're self-employed.

For me, that's very significant.

It is a Ponzi scheme.

SSI went upside-down in 2011. That's when it began to pay out more than it takes in each year. The ~$4 Trillion in the "trust fund" has, as you noted, already been spent. Those treasuries have to be redeemed from general funds, meaning the money has to come from taxes.

That $4 Tn will be exhausted in 13 years, at which point SSI benefits have to be reduced by 30%.

That surplus was from the 1986 tax reforms that Reagan implemented. FICA taxes were raised, and the retirement age was pushed back. It was supposed to make the program actuarially solvent for 75 years. Instead we got 45 years if we're lucky.

SSI needs to be reworked again, but we all know how the dems will cry and moan at any attempt.