Stick it to the HMO's

[Marg's Man]

Reading all the fun and games people have with HMO's makes me glad of our (far from perfect) system in Australia.


Your stories make me wonder how true this item from the Non Sequitur comic might be:
Non Sequitur Comic Strip, January 09, 2012 on GoComics.com

Marg's Man

 

[TeDo]

Boy, do you have a GREAT understanding of our situation!! Thanks for the chuckle.

 

[Marguerite]

I finally saw it too. Love it! We've learned from reading all your posts, about the sort of problems you have.

Our health system here used to be private companies. Perhaps we had fewer problems, medication was generally dealt with by government subsidy and not by insurance companies. Then in the mid-70s we got out first national government-based health insurance. Some doctors went hog-wild and started billing everyone who walked in the door, and their families and friends. Now we have it much better monitored (another government agency which acts a bit like the HMOs, but because it's government it's answerable to the people). Doctors who abuse the system get their licence pulled.

Our private insurance companies no longer had to cover basic doctor visits or tests. They now only cover hospital-related expenses. Some of them cover wellness programs (such as paying for exercise classes or running shoes). We don't have a public dental or optical system (although you can get an optometrist to check your eyes under the government health system) so private health insurance helps there. But there's always extra to pay, with the private insurance.

With private insurance, we also used to have the "pre-existing condition" escape clause that they would try to use. But we also have had health industry ombudsmen whose job it is to "keep the bast**ds honest" (a common Aussie political phrase; one party had it as their permanent campaign slogan). So even before we had our current government-based health insurance, we never had the HMO problems you guys have. I just can't understand how they can get away with it. I really can't. But clearly, they do.

The US is supposed to be perhaps the most affluent country in the world with the highest living standard. But in reality - I think you've got politicians who claim this, kidding themselves (and you). If you crunch the numbers, US is not as healthy as it seems.

Marg

 

[TeDo]

Our current president wanted a law about everyone having to have insurance of some kind. Many here (in the US) couldn't afford it and/or made too much for the government programs so went without. The outrage over national government-run healthcare is uncanny. So many people are against it but then I hear you talk about how well it works and it makes me wonder.

The private companies are making big bucks and EVERY decision is based on the bottom dollar (getting more for less....or nothing). There are things that many of our kids are going to need such as various therapies, assistance, etc that have "life-time limits". That is insane in some cases.

 

[InsaneCdn]

TeDo... Canada is public health care. Its... still about dollars, unfortunately. The distribution is more "fair"... everybody has the same insurance. Anybody can show up at ER with a heart attack, and gets the same care (at least in theory...). But... 2 year waits for knee surgery (they are working on shortening...), specialists the US takes for granted are not available here or not available for the broad range of services (neuropsychologist). Someone's daughter on the board needed to see a PCP and it was going to be $100 or so... for us? free. Reg PCP, or walk-in clinic... no diff. In a public system, too much goes to "management" - salaries and such - whereas in a private system, those funds go to "profit"... Its just a different set of problems. No big win anywhere - pluses and minuses, not enough reason to move somewhere else.

 

[flutterby]

In the private system those monies still go to executives in forms of extravagant bonuses. They talk about profit and shareholders, which is a joke because in a lot of cases the biggest shareholders are the executives themselves.

The Affordable Healthcare Act will still require the mandate, but that doesn't take effect until 2014. That's the part being challenged. It also does away with pre-existing condition clauses and now health insurance companies have to spend 80% of premiums on healthcare. The insurance companies don't like that one and have tried to get exceptions, but have been denied.

 

[muttmeister]

I saw a good quote the other day: "The United States is the only first world country where people are afraid of their medical bills"

Even if you have good insurance, which many of us cannot afford, what with caps and copays and all of the other nonsense, if you have a major illness you may very well be looking at bankruptcy.

I have some insurance but not much. The last time I went to the doctor was nearly 10 years ago. I can't even afford an office call. HOpefully, I'll live for one more year and then I can be on MediCare but if the people running for office get their way, we won't have that either. My mother has been on it for years and, by paying an additional 250 per month for private insurance on top of the Medicare, she has good coverage but they are talking of outlawing that so you still have to pay 20% out of pocket. I guess that would get rid of a lot of old people who would die from lack of care and make more money to use for the other ones.
Our medical system is a mess. We have, arguably, the best medical knowledge and technology in the world, but unless you're one of the fat cats, you can't access it.

 

[Star*]

That would be hillarious if it were not true.

I can think of SEVERAL acryonyms for H.M.O. after having not received it's ghastly care......that better suit those letters.

Oddly enought it was an HMO that wanted to do my hysterectomy so HMO became Hide My Ovaries. Made me think they were all for sterilization.......kinda Himlerish.

 

[Star*]

Mutt - DF has medicare - and they get a cost of living increase this year right?

WRONG.......that little bit of an increase put him OVER the limit to have Medicaid pick up the additional amounts they usually do and NOW the bills he's facing from Cataract and double knee replacement are going to put us past the poor farm, and right into the funny farm.

 

[muttmeister]

star - social security got a cost of living increase this year.
I suppose it depends on what mediCARE you're signed up for but there really aren't any limits on your income for that - but there are for medicAID.

I find the whole Medicare thing completely confusing and I have to get signed up before next December so I'm going to have to do some studying. All I REALLY know is that with my mother's (she's 97 and been on it for years) she pays so much a month to Medicare which then pays 80% of what she has done no matter how much money she has. Then she pays and additional $250 per month to Blue Cross Blue Shield and they pick up the other 20%. She's had numerous procedures over the years and I think the biggest bill she's ever had to actually pay out of pocket for anything has been around $5. Of course, she also had to have a policy with Humana for drug coverage.

I'm relatively young, have an IQ over 140, and a Master's Degree and I don't understand it at all. How is somebody who's really old and confused supposed to figure it out. I think they make it as confusing as possible so it's just that much easier for them to skrew you.