NintendoAge

"Cadillac Plans

Roth — 2009-11-01T20:17:17 -05.00

Originally posted by: arch_8ngel

You may want to review what your insurance actually covers and at what price.

What is your deductible and coinsurance limit? I suspect you could be on the hook for upwards of at least $5k-$10k per person, per year.

I'm familiar with HMOs and PPOs and how they operate. Kaiser Permanente invented the HMO, literally. You get a cheaper rate through them, but you are sacrificing options. Personally, if I need specialized care, I want to be able to choose the best specialist without getting stuck dealing with second-rate doctors in the insurance providers network.

If good insurance was available to the general public for $186/month there wouldn't be a national debate on healthcare.

Here are all of the gritty details of the plan. It seems the plan that I am on isn't being offered directly any more. Here is what is currently offered and its details directly from their website

Cost per month: $160.86

Annuals Deductable: None

Maximum yearly benefits: None (In other words unlimited care regardless of the cost.)

Out of Pocket Expenses: $35.00 co-pay for doctors visits, $50.00 co-pay for specialists, $5 for generic prescriptions, $200 co-pay for ER visits, 30% co-pay for hospitalizations.

Maximum yearly out of pocket expensive: $3,000 for an individual (In others words you will pay no more than this amount regardless of expenses)

As you can see you are correct in stating that some out of pocket expense is possible. $3,000 a year can be a lot, although it is a lot better than being stuck with the entire bill. In addition you are limited to the Kaiser system for non-emergent care. While you may not have access to the best of the best, it is care I can afford. Please check out their website for a quote all they need is an email address.

I agree with you that if healthcare insurance was this affordable for the general population then health care wouldn't be an issue. This is one of the reasons that I mention Kaiser whenever I can, since they seem to have a good set-up.

"Cadillac Plans

Roth — 2009-11-01T16:27:21 -05.00

You may want to review what your insurance actually covers and at what price.

What is your deductible and coinsurance limit? I suspect you could be on the hook for upwards of at least $5k-$10k per person, per year.

I'm familiar with HMOs and PPOs and how they operate. Kaiser Permanente invented the HMO, literally. You get a cheaper rate through them, but you are sacrificing options. Personally, if I need specialized care, I want to be able to choose the best specialist without getting stuck dealing with second-rate doctors in the insurance providers network.

If good insurance was available to the general public for $186/month there wouldn't be a national debate on healthcare.

"Cadillac Plans

Roth — 2009-11-01T16:09:11 -05.00

Originally posted by: arch_8ngel

Originally posted by: Starwander

Originally posted by: arch_8ngel

^^^ What kind of coverage is a person getting for only $3600 per year?

Most policies I've ever heard of cost at least $8k/year, unsubsidized. A more realistic number is $10k-$12k per year.

Sure, people get $250/mo policies from their employer, but the employer is paying another $700-$1200 per month on top of that.

The coverage I have is all inclusive through Kaiser Permanente and it only costs $186 a month with $20 co-pays for doctor visits, $100 co-pay for ER visits and $500 co-pay for hospital admissions. No other deductibles apply. Just to clarify this isn't through a job either, it's the rate available to the general public that fit my demographics.

Kaiser Permanente is the original HMO. To get those rates you are SEVERELY restricted in what doctors or specialists you can see and be treated by.

Please do tell that to the over 1000 physicians I can choose from to see within the Kaiser system where I live. I can choose any primary care physician to be my primary physician. Furthermore I can see any specialist without the need for a referral.

If I need emergency treatment I can go to any hospital where I live for immediate care. Appointments, even with specialists are available within 2 weeks or sooner for non-emergent care.

The rates I am speaking off are available to everyone that fits my demographics, with few limitations on the care you will receive.

Edit:

Also to clarify if I did someday need care that Kaiser was unable to provide within their system, they would cover the cost of such care minus my co-pay.

"Cadillac Plans

Roth — 2009-11-01T15:36:45 -05.00

Originally posted by: Roth

I read someone's comment on a blog somewhere, and they said something about most hospitals being non-profit. I looked it up, and it seems like ~62% of hospitals are non-profit. Does anyone think that if there were more for-profit hospitals, there would be competition between these places and prices would be driven down? i.e. emergency room visits, surgeries, births, etc.?

Other than nights spent in the hospital, most of the expense is based on the physicians. They are NOT non-profit, even at a non-profit hospital.

"Cadillac Plans

Roth — 2009-11-01T15:35:41 -05.00

Originally posted by: Starwander

Kaiser Permanente is the original HMO. To get those rates you are SEVERELY restricted in what doctors or specialists you can see and be treated by.

"Cadillac Plans

Roth — 2009-11-01T13:51:13 -05.00

I dont think most hospitals are working in an environment where competition would drive down prices. For example, most people going to the emergency room, go to the nearest one. In many areas there arent really options on hospitals as there are really only one maybe two in a reasonable distance. Making more hospitals for profit, would drive up costs, as they would still have to pay their staff and other expenses at the same rates as other hospitals, yet they would need to somehow acquire more money to make a profit. Theoretically it is always possible for a non profit establishments to work with less money and at a lower cost, simply because there is no extra money needed at the top. You can cut off the cream. This isnt always true in practice, but it can be true in practice, if you have the right people in charge. There is nothing a for profit competitive hospital can do to reduce costs, that a non profit hospital cant do.

"Cadillac Plans

Roth — 2009-11-01T11:10:33 -05.00

I read someone's comment on a blog somewhere, and they said something about most hospitals being non-profit. I looked it up, and it seems like ~62% of hospitals are non-profit. Does anyone think that if there were more for-profit hospitals, there would be competition between these places and prices would be driven down? i.e. emergency room visits, surgeries, births, etc.?

"Cadillac Plans

Roth — 2009-11-01T10:35:21 -05.00

"Cadillac Plans

Roth — 2009-11-01T01:18:08 -05.00

I agree with Ross. Capitalism is great, but not when it comes to everything. I would like to consider health care would be included in with the basic care of your citizens. It shouldn't be any different then Fire, Rescue, Police, etc services. Could you imagine if everything were capitalist? "Oh no theres a fire on 34th St.!, Lets call for help!" "Hello fire department, can I help you? What?.. 34th? oh no.. im sorry 34th didnt pay this month. Couldnt afford the new rates, so we dropped them." Its basically the same thing. Why should your tax dollars rescue people from fires, if they cant give them preventive treatments for other early deaths? Why pick and choose where to save peoples lives? The best country in the world, theres no reason we cant take care of all our working citizens. Saving peoples lives, shouldn't be a competitive enterprise with profits driving the market. Were not talking stereos, tvs, cars, and real estate here. One day people will look back and think how evil it was to put peoples lives and health on the market driven by profit.

"Cadillac Plans

Roth — 2009-11-01T00:19:21 -05.00

You make some very valid points Uda. I have nothing against Capitolism at all, but like everything in life, there is a place for it. I personally do not feel that it has any place at all in healthcare. Sure, all of the advancements in medicine are great, but what good are they when only the richest of the rich can afford them and the insurance that will cover them? What good are they when your physician tells you it is what you need, and the insurance company denies the claim and you're stuck with hundreds of thousands of dollars in medical bills, that you can't afford?

The main argument I've heard against socialized medicine is, "I don't want to pay for all of these lazy ass people that don't work so they can be coverd..." The thing is, you already are paying for them whether it's through government funded programs, or through higher premiums because of the situations you mentioned earlier (people not paying bills, etc.). The people that would benefit most from this would be those that truly need, and (I feel) deserve it (those working at a crappy job that offers the worst of the worst coverage, self employed individuals, etc.) Yes it will obviously raise our taxes and we will be paying more for this, but cummon, is your money THAT important? Why wouldn't helping out someone truly in need be worth it? To ME, it is absolutely worth it. It would absolutely be worth it to know that no matter what, I'd be covered if something happened to me. It would be worth it to know that if I needed an expensive treatment, my insurance company couldn't turn me away for a "pre-existing condition."