BOHICA! Just looked at the 2013 Health Benefits Comparisons

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jimntx

Veteran
Jun 28, 2003
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Dallas, TX
www.usaviation.com
jimntx I do not know if a law exist baring the government from negotiating with pharmaceutical companies. I would like to see proof of that claim. To my knowledge government has always gone with the lowest bidder. Second most of pharmaceutical purchases are made either through private individuals or private entities (insurance companies). I think (my opinion) it is more likely that insurance itself is responsible for this mess we are in. Health Care corporations (pharmaceuticals, hospitals, medical device manufactures) see insurance as a nice big pool of money to exploit. Health Care was not always so outrageously priced.

Will this do?

From a casual selection from multiple Google references...


"In 2003, Congress and President Bush enacted the "Medicare Prescription Drug, Improvement and Modernization Act," which established a prescription drug program for Medicare. That legislation expressly prohibited Medicare from negotiating drug prices with pharmaceutical companies."

On more than one occasion in the past 4 years, the Obama administration has attempted to repeal that prohibition. The insurance company and pharmaceutical company lobbies have made sure that the legislation to repeal has never even gotten out of committee in the Republican-controlled House of Representatives.
 

xmarlin

Member
Dec 12, 2007
70
11
All plans at DL just saw significant premium increases, and large jumps in both coinsurance max & deductibles. For the plan that is most comparable to the "top of the line" plan you noted, the premium is actually the same ($247), with a $3450 (DL pays the first $1500) deductible, and $6k for coinsurance max.

I'm not sure why so many Americans are okay with paying more & more each year for less & less coverage...


Because they buy into the "free-market" will lower health care costs argument put out by the right and sponsored by the health care industry?
 

WorldTraveler

Corn Field
Dec 5, 2003
21,709
10,721
Just to emphasize again, heatlhcare is not a free market industry because the consumers who pay the bill do not make the buying decisions.

The inability to negotiate prices for products and services is also not consistent with the principles of a free market.

Insurance companies have had to become the bad guys in cost control and have had to pass that role of being bad guy onto companies who buy their coverage because those who spend health care dollars - largely doctors - have not done enough to control health care costs which have more than doubled in the past 10 years in the US.
 
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jimntx

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Jun 28, 2003
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Dallas, TX
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Well, there's also the proliferation of very expensive diagnostic equipment in multiple doctor's offices instead of a single machine in a centrally-located clinic/hospital where patients could be referred for the test.

Case in point..
Almost 15 years ago, when I still lived in Houston I had a treadmill stress test in my primary care physician's office. He didn't like the results and referred me to a cardiologist connected with Texas Heart Institute in the Texas Medical Center near downtown Houston. He sent me to the THI for a thalium stress test. This is a specialized ekg in which they also inject a dye into the veins and the machine not only measures all the usual EKG type stuff, it also takes movin' pitchers of the dye moving through the veins and arteries. Nothing conclusive was determined.

Two or three years later my doctor referred me to another cardiologist (same reason). This guy had a thalium stress test machine in his offices. Now, this is not a compact little "hide it in the corner when not in use" size machine, and it costs several hundred thousand dollars. That cardiologist told me I was positive for major blockage in the front AND the back of the heart and we needed to do an angiogram immediately. I told him that I ran 4-8 miles/day with no problems. He gave me the long lecture on silent ischemia and reminded me that Jim Fixx (one of the early running gurus) had dropped dead of a heart attack while running.

So, I checked into the heart clinic at Methodist Hospital in Houston one morning at 7am, had the angiogram, and was out of there by 12 noon to the tune of $5000 (I was self-employed and did not have insurance at the time.) The cardiologist told me that he saw no sign of any blockage of any kind any where. And, that evidently I give what is called a false positive on EKG tests. His final advice to me was "I recommend you stay off treadmills when there are wires attached to you."

To this day, I wonder if that thalium stress test really indicated blockages, or he just needed to pay for that behemoth of a machine.
 

777 fixer

Veteran
Jul 21, 2004
4,792
912
I decided the best way to deal with the health care increase along with everything else was to switch employers.
 
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Jacobin777

Senior
Jul 12, 2011
282
158
West of the Atlantic
Ok, so your snarky comment was totally unnecessary because it is a given that individual policies are more expensive than group insurance. What you pay vs. what we pay is apples and oranges. However, our group insurance is more expensive than it ought to be. Our employer has chosen to pay substantially less for each employee than they have paid in the past. I know. I know. AMR is in bankruptcy. A bankruptcy where they went into bankruptcy with $5 billion in the bank.

Nothing snarky. At the end of the day, I pay multiples of what you pay for health insurance. You should consider yourself lucky as that is a "work perk" you get which I can't get.

To this day, I wonder if that thalium stress test really indicated blockages, or he just needed to pay for that behemoth of a machine.

While I'm not questioning what happened to you, most (as in 99% or whatever) cardiologists are stick to the various laws, are very ethical & use their knowledge, experience and judgmement to give their best diagnosis and treatments . The law comes down very hard on physicians who are abusing their position.
 

silverbird007

Senior
Aug 1, 2012
266
304
MIA
The Democrats were already in a position where they controlled all 3 houses. What did they accomplish? Would it have been any different if Republicans controlled all 3 houses? I doubt it.

The only real thing the government accomplished during President Obama's presidency was passing Obamacare.

The main problem with Obamacare is the cost. How are we going to pay for it? We are already going more and more into debt every day. Obamacare does nothing to reign in out of control medical cost. Obamacare does nothing to increase the number of doctors. In fact the only thing it accomplishes is employing more IRS agents which are paid through..........taxes.

This story shows what the REAL problem is with our health care system.

Arizona Hospital's $80,000 Bill Stings Worse Than Scorpion Venom
  • An Arizona woman was shocked when her brush with a scorpion led to a stinging $83,046 hospital bill.
    Marcie Edmonds, 52, called the poison control center an hour after a bark scorpion stung her in the stomach while she was opening a box of air conditioner filters. She experienced mild tingling, throat tightness, darting eyes, muscle spams, and difficulty breathing, ABCNews.com confirmed.
    As a typical illness from the venom progresses from numbness and tingling to uncontrolled muscle movements, it can resemble a seizure, aid Dr. Steven Curry, the Director of Medical Toxicology at the Banner Good Samaratin Medical Center. The muscle spasms spread to the chest and cause respiratory problems, which can be life-threatening – especially in children, Curry said.
    The poison control center advised Edmonds to go to a hospital, so she went to Chandler Regional Medical Center, where doctors administered two vials of a relatively new anti-venom called Anascorp which was approved by the Federal Drug Administration last August and is distributed to hospitals for about $3,800 per vial, toxicologists say.
    Edmonds left the hospital after a three hour stay, but the bill that arrived several weeks later came out to $83,046, or $39,652 per Anascorp vial, ABCNews.com confirmed. 10 times what the hospital paid for each vial.
    "Everyone I talk to says, 'You've got to be kidding,' " Edmonds said to the Arizona Republic.
    Chandler Regional Medical Center released a statement apologizing for Edmond's treatment costs, explaining that they are working to adjust the high "out-of-network" bill she received for the anti-venom.
    "In addition, we are also currently reviewing our pricing of this expensive specialty medication," the statement said.
    Anascorp had been administered for free to about 2,000 scorpion sting patients during a 10-year clinical trial in the United States before to last year, said Dr. Keith Boesen, the director of the Arizona Poison and Drug Information Center.
    The drug is made from horse antibodies and comes from Mexico, where it costs about $100 per dose, according to Kaiser Health News. Boesen explained that this is because about 10,000 people are treated with the drug there each year, bringing down costs.
    In the United States, however, there is only one scorpion that has the potential to be lethal in humans: the bark scorpion. And it's mostly found in Arizona and its neighboring states. The number of people treated with Anascorp each year is much smaller in the U.S.
    "It's only given to 200 people," he said, explaining that the small number of drug recipients have to share the costs of the lengthy clinical trial.
    So far this year, the Banner Good Samaritan Poison and Drug Information Center, which handles poison control for Phoenix, has had 5,414 calls for scorpion stings. No deaths have been reported in more than three years, according to Good Samaritan spokeswoman Rebecca Armendariz.
    Although Edmonds' experience was scary, toxicologists are most worried about children under 6 years old. The smaller or younger a child is, the more likely it is that the venom will have a life-threatening effect on that child because the scorpion releases the same amount of venom regardless of its target's body mass.
    "A scorpion sting that would just affect my leg would affect an entire child's body," Boesen said.
    It's those children that are most often prescribed the expensive anti-venom because it's often cheaper than spending two days in the intensive care unit on a ventilator, which is often the alternative, said Dr. Richard Clark, who directs the toxicology department at the University of California San Diego.
    "The only way to justify spending that on an anti-venom is that 99 percent of the time it costs less than a day in the ICU," he said.
So, in Mexico Anascorp cost $100.00 dollars. Here in the United States it cost $39,652.00. Does anybody else see a problem here? This is where we need Health Care Reform.

Please note where I highlighted the green text with the purple numbers. The excuse for the ridiculous price is that the United States has far fewer incidents of scorpion stings per year than Mexico treated with Anascorp. They throw that 200 doses number up there to make you think they only have 200 incidents per year. When in fact they had 5414 (for one city mind you Phoenix). They are purposely giving that specific medication to very few people to justify keeping the price artifically high. So apparantly having HALF the incidents of Mexico (again these are only the cases that Phoenix handled) justifies a $39,552.00 price increase. Get freaking real.

BTW what were/are the Republicans plan to fix this?
 

Veritas

Veteran
Aug 19, 2002
882
148
www.usaviation.com
Does anyone have any idea what's the difference in benefits between tiers I, II and III of the Value Plan? Is it just the list of providers? If so, is it possible to find out who the providers are for the various tiers before the enrollment period opens?

We are trying to decide between AMR's and my employer's health insurance plans; my open enrollment period closes before my spouse' starts.