KirtFalcon Posted July 14, 2019 Share Posted July 14, 2019 (edited) 2 hours ago, btex said: If the GOP is all about the government not being in the healthcare industry why not just strike down ACA and move on? We both know the reason. I do not recall a year where my insurance cost did not increase. Years ago I listened as a BCBS rep told us it was increasing because so many people were uninsured and those who were were covering the cost. Hence why we had $200 Tylenol in the hospital. I heard this year after year. Then 2 years before ACA ( and I am no fan of ACA) we saw big jumps, supposedly because of the coming ACA. Then with ACA it increased and reps told us it had to increase because so many more people were now insured. Ok so it increases because people are not insured and then it increases because people are insured........... Now Atena has left the ACA market, and my insurance increased. This time around the rep told us it was they were leaving the ACA market.................WHAT?????!!!!! Now I have looked for all those companies who went bankrupt due to ACA but I cant find them. I investigated all these companies losing money, yet I saw hundreds of millions in bonuses. Kind of like the owner of the Marlins when he claimed he was losing money yet he was just making sure his paycheck caused a loss. Neither side wants this fixed because EACH side is getting money from them. It is claimed that free market will fix it, but we had it and it didnt. Why is it that one Dr charges $20 for a service and another $50 yet you dont know until the service is done? There has to be a better way. I am open to suggestions on a fix, but I would like to see some detail. This is TRS rates. Most district cover about $300 (smaller districts left). For the WORST insurance it is 1400 for a family and 722 for employee and children. That plan is nothing more than paying for a catastrophic incident. The BEST plan is 2400 and 1300. There are other plans available in certain areas.   So a teacher who makes 50K for the WORST plan covering their children it is around 17% of their pay, for the best plan it is 31%. The system is BROKEN https://www.trs.texas.gov/Pages/healthcare_trsactivecare_rates.aspx  It would have been except for RINOs like McCain, Susan Collins, etc. .... and a Supreme Court justice that decided to make new law from the bench ... Edited July 14, 2019 by KirtFalcon yo mama 1 Link to comment Share on other sites More sharing options...
KirtFalcon Posted July 14, 2019 Share Posted July 14, 2019 5 hours ago, btex said: So what are you in favor of? just end it and let the system we have continue? Obamacare should be totally repealed and market based common sense reforms to encourage competition to bring down costs should be implemented ... allow medical insurance policies be marketed and sold across state lines ... get the federal government out of it except for Medicare and Medicaid ... free market reforms!!!! ... Link to comment Share on other sites More sharing options...
CENTEXFAN Posted July 14, 2019 Share Posted July 14, 2019 11 minutes ago, KirtFalcon said: Obamacare should be totally repealed and market based common sense reforms to encourage competition to bring down costs should be implemented ... allow medical insurance policies be marketed and sold across state lines ... get the federal government out of it except for Medicare and Medicaid ... free market reforms!!!! ... Who would cover people with pre-existing conditions with your plan ? Answer : Nobody would cover them, or they make them pay an unreasonable monthly premiums. Either way no insurance for pre-existing conditions. Profit over your healthcare.  Link to comment Share on other sites More sharing options...
KirtFalcon Posted July 15, 2019 Share Posted July 15, 2019 (edited) 13 minutes ago, CENTEXFAN said: Who would cover people with pre-existing conditions with your plan ? Answer : Nobody would cover them, or they make them pay an unreasonable monthly premiums. Either way no insurance for pre-existing conditions. Profit over your healthcare.  Both sides have stated that preexisting conditions and keeping kids on parents plan until 26 would be covered in any reform bill, President Trump supports both ... dimwits and media keep lying about it with their "fake news" talking points. The thing about preexisting conditions is that it's no longer insurance at that point so premiums would naturally increase ... of course dimwits and libtards expect insurance companies to operate at a loss ... do the dimwits expect any other companies to operate at a loss? No ... but that's the libtard mentality ...  Edited July 15, 2019 by KirtFalcon yo mama Link to comment Share on other sites More sharing options...
KirtFalcon Posted July 15, 2019 Share Posted July 15, 2019 11 minutes ago, btex said: Ok I can agree with the state line part, I agree with the repeal. I do not believe the free market idea will cause cost to go down. We had that for a very long time and yet cost increased. What do you do when insurance says cost are rising because so many are uninsured? Maybe you have the answer with common sense reforms which is an area for discussion. No, we haven't had free market reforms ... that's the best way to control costs ... there were and still are tons of regulations that restrict tru free market reforms ... get rid of these burdensome regulations and watch competition drive down costs ... States should step up and handle the people that fall through the cracks ... the feds need to stay out of it ... Link to comment Share on other sites More sharing options...
CENTEXFAN Posted July 15, 2019 Share Posted July 15, 2019 15 minutes ago, KirtFalcon said:  The thing about preexisting conditions is that it's no longer insurance at that point so premiums would naturally increase ... of course dimwits and libtards expect insurance companies to operate at a loss ... do the dimwits expect any other companies to operate at a loss? No ... but that's the libtard mentality ...  Good luck passing that , and getting elected. Most people know people who has pre-existing conditions. Four of my kids have pre-existing conditions just for the fact they were in foster care at one time before adoption. They are more acceptable to mental issues according to the insurance agencies.  Link to comment Share on other sites More sharing options...
CENTEXFAN Posted July 15, 2019 Share Posted July 15, 2019 4 minutes ago, btex said:  Would you agree that 17% of your pay to cover yourself and your children is just way out of line? More than that , if you have to pay co-pays for injuries and medicine. Kids will be kids.  Most expensive phrase; " WATCH THIS " ! Link to comment Share on other sites More sharing options...
DAWG91 Posted July 15, 2019 Share Posted July 15, 2019 2 hours ago, CENTEXFAN said: Good luck passing that , and getting elected. Most people know people who has pre-existing conditions. Four of my kids have pre-existing conditions just for the fact they were in foster care at one time before adoption. They are more acceptable to mental issues according to the insurance agencies.  I'm no expert on health insurance which is why I'm mostly steering clear of the debate apart from the general principle that the federal government was not designed to micromanage it's citizens lives in such a manner. My only comment on your post is the "good luck passing that and getting elected" portion of your statement.  Call me naive,  but isn't that how we got into this mess to begin with?  Nobody wants to make the tough choices and getting elected and re-elected is all that matters.  This applies to BOTH PARTIES. Link to comment Share on other sites More sharing options...
KirtFalcon Posted July 15, 2019 Share Posted July 15, 2019 12 hours ago, btex said: Ok I am trying to follow you but I just dont see where selling across state lines will drive cost down. BCBS is in many states, while it is not one large company the cost are pretty much the same state to state. Can you be more specific on the regulations? What I see is that since 1990 my insurance has had a steady increase and the companies sure are not going out of business. I guess what I am trying to say is I dont believe that competition will cause cost to decrease. I believe that is a line the industry says so that when we move that direction we have 5-8 years of them saying it is coming and then we end up right back to where we are now. Would you agree that 17% of your pay to cover yourself and your children is just way out of line? Honestly, you must not know much about health insurance. First of all, BCBS is not a company, it's an association ... BCBS of Texas, BCBS of Illinois, BCBS of Montana, BCBS of Oklahoma, and BCBS of New Mexico all make up a company called HEALTH CARE SERVICE CORPORATION ... HCSC is a non-profit and is the largest customer-owned healthcare insurance company in America and the 4th largest overall in America ... if you google HCSC.com there is a lot of basic information there that explains how healthcare insurance works. What most people don't realize is that all insurance plans are not alike. It's like the difference between a Yugo and a Lamborghini ... the premium rate you pay depends mostly on the plan your employer has chosen, the services and procedures your employer wants covered, the cost of those services and procedures and the number of people in your benefit group plan or the number of covered employees. Some companies want only minimal basic Yugo coverage and some companies want very expensive Lamborghini plans ... that, along with the operating costs for HCSC determine your premium ... HCSC makes little more than operating costs ... it's all extremely complicated as you will find if you go and read all about it in HCSC.com ... there is a ton of red tape that drive up the costs, not to mention the rising costs of goods and services that the insurance companies do not control, yet get the blame for when premiums rise .... no company can survive operating at a loss, not even HCSC ... Link to comment Share on other sites More sharing options...
BarryLaverty Posted July 15, 2019 Share Posted July 15, 2019 Looks like poor HCSC is doing just fine. https://healthcare.dmagazine.com/2019/03/15/blue-cross-blue-shield-of-texas-parent-company-more-than-tripled-profits-to-4-1b-in-2018/ 1 Link to comment Share on other sites More sharing options...
Coach Rab Posted July 15, 2019 Share Posted July 15, 2019 On 7/14/2019 at 9:45 AM, btex said: https://thehill.com/policy/healthcare/452894-republicans-make-u-turn-on-health-care I find it disturbing that something the GOP has been trying to end since it started has zero plan for what to do. GOP doesnt just want to say ACA is done find your own because they would lose elections, yet how do you go this long without a plan to replace it? Trump's plan was to end the AHA and let health insurance go back to the insurers as it was intended... Republicans axed that idea and talked him into a "Republican plan" which basically pissed everyone off.... so it easily failed. Link to comment Share on other sites More sharing options...
KirtFalcon Posted July 15, 2019 Share Posted July 15, 2019 3 hours ago, BarryLaverty said: Looks like poor HCSC is doing just fine. https://healthcare.dmagazine.com/2019/03/15/blue-cross-blue-shield-of-texas-parent-company-more-than-tripled-profits-to-4-1b-in-2018/ Like I said, HCSC is the largest consumer owned healthcare company in America and the fourth largest overall. The "profits" look massive when taken as a dollar amount. In reality that large figure only amounts to a 2-3 % net profit. Looking at the dollar amount alone distorts the true story. Their profits are mostly absorbed back into the company, not paid out to shareholders like for profit large companies like Exxon or U.S. Steel, etc. ... Link to comment Share on other sites More sharing options...
KirtFalcon Posted July 15, 2019 Share Posted July 15, 2019 40 minutes ago, MavGrad99 said: Trump's plan was to end the AHA and let health insurance go back to the insurers as it was intended... Republicans axed that idea and talked him into a "Republican plan" which basically #### everyone off.... so it easily failed. RINOs led by McCain, Susan Collins, Murkowski and others blocked the full repeal of Obamacare... after they voted numerous times before Trump was elected to repeal Obamacare ... they all ran on repealing and replacing the ACA ... tru storie ... Link to comment Share on other sites More sharing options...
KirtFalcon Posted July 15, 2019 Share Posted July 15, 2019 21 minutes ago, btex said: Kirt no I don’t know a lot about insurance companies. I do know that dealing with them as they attempt to cheat people is a huge pain I have had to deal with. I know the cost have risen while the benefit has decreased. Blaming everything on insurance companies is not the answer. I am not saying they are as innocent as Snow White, but a lot of the time the blame should be directed elsewhere. BCBS has to deal with a lot of fraudulent claims and outrageous costs for services and procedures charged by hospitals and healthcare providers ... yet the insurance companies are made out to be the bad guys ... i worked for BCBS for almost 16 years mostly in the engineering dept as a facilities manager but I saw enough to understand a lot of what the insurance companies get blamed for isn't always in their control ... Link to comment Share on other sites More sharing options...
DAWG91 Posted July 15, 2019 Share Posted July 15, 2019 I suspect,  and have no proof of this,  that the real villain in all of this are the drug manufacturers.  I'm seeing numerous reports here and there about the great breakthrough's they've had in fighting cancer,  but I don't think for a second there will ever be a cure. Instead,  there will be drugs available to help manage it so that people can live longer.  Living patients = big $$$ while dead and cured patients = $0.  But that's just my opinion.  I hate being so cynical and would love to be proven wrong. But there's something we all need to realize.  Eventually, we all die.  I work in the healthcare industry and love that I help people stay alive but it's people's vanity and thirst for immortality that led me to join the healthcare profession.  People want to live forever and I'm making a pretty good living because of that. Link to comment Share on other sites More sharing options...
KirtFalcon Posted July 15, 2019 Share Posted July 15, 2019 1 hour ago, btex said: No I dont think EVERYTHING is due to insurance, I have also in the past mentioned pharma and the whole healthcare industry. Insurance does get a lot of blame because it is mostly who people deal with directly. While you site examples of fraud what about examples of insurance companies trying to slow pay or deny payment? BCBS, my oldest was born and was not breathing, he was rushed to NICU. He was kept in it for about 30 hours. He ended up fine. BCBS denied payment on the ICU claiming it was an unneeded service. Cost was around 25K. We went through the proper channels, letters from doctors and nurses etc. This went on for awhile, whole time the hospital is calling us about 5 times a day. I was a 20 year old kid and had no idea what was going on. My parents had their lawyer look at the whole thing and he noticed we were about a month away from BCBS not having to pay anything due to the time. He makes one call, talks about state board of insurance and with in a few days it is all paid. Now go away from the personal aspect, how many times have we seen insurance companies in the news for denying or failing to pay? How many court cases? How about insurance companies claiming they are losing money then you find out they paid out 100s of millions in bonus money. Sorry but while the individual agent might be a great person the company as a whole is 100% focused on making money and could careless about the actual people. The main reason claims are denied is that the specific service, procedure, or drug isn't covered by a particular employers plan. Doctors and medical facilities many times don't coordinate with insurance companies before they provide a procedure or service. I don't know the background or reason your particular issues claims were denied, but the majority of these denials are for things not covered by a particular healthcare plan ... like I said before, there are huge differences between HC plans and they are based on negotiated coverages by the employer and the insurance company ... I know that may sound cold and cruel but it comes down to policy holders getting what is covered by their plan ... if the insurance companies had to cover everything under the sun, regardless of cost, they would go bankrupt in a hurry. Think about it this way ... if I bought a car with a 36 month warranty and didn't buy the extended warranty .... after 4 years the motor blows up ... the car company isn't going to replace the motor because it isn't covered ... I know health insurance is personal and life and death in many cases but the business concept is the same as the car thing I described. Requiring unlimited healthcare claims that are over and above a plan's specific coverage would bankrupt the insurance company.  Now, if we went to a government run universal HC system can you imagine the magnitude of the problems like yours that would arise? Talk about limited services and rationing of coverage. Do you think the government beauocrats are going to cover everything doctors and hospitals want to provide? Just food for thought ... Link to comment Share on other sites More sharing options...
TheNameIsDalton Posted July 15, 2019 Share Posted July 15, 2019 Healthcare has some issues. Â We need to get big pharma under control. Â Link to comment Share on other sites More sharing options...
CENTEXFAN Posted July 15, 2019 Share Posted July 15, 2019 41 minutes ago, KirtFalcon said: The main reason claims are denied is that the specific service, procedure, or drug isn't covered by a particular employers plan. Doctors and medical facilities many times don't coordinate with insurance companies before they provide a procedure or service. I don't know the background or reason your particular issues claims were denied, but the majority of these denials are for things not covered by a particular healthcare plan ... like I said before, there are huge differences between HC plans and they are based on negotiated coverages by the employer and the insurance company ... I know that may sound cold and cruel but it comes down to policy holders getting what is covered by their plan ... if the insurance companies had to cover everything under the sun, regardless of cost, they would go bankrupt in a hurry. Think about it this way ... if I bought a car with a 36 month warranty and didn't buy the extended warranty .... after 4 years the motor blows up ... the car company isn't going to replace the motor because it isn't covered ... I know health insurance is personal and life and death in many cases but the business concept is the same as the car thing I described. Requiring unlimited healthcare claims that are over and above a plan's specific coverage would bankrupt the insurance company.  Now, if we went to a government run universal HC system can you imagine the magnitude of the problems like yours that would arise? Talk about limited services and rationing of coverage. Do you think the government beauocrats are going to cover everything doctors and hospitals want to provide? Just food for thought ... So you admit even with health insurance you are not getting the BEST treatment. You are only getting what your health care provider can afford. Yeeesh only in America. Time for the doctor to decide the best plan of action, and the insurance company has no say so.  Link to comment Share on other sites More sharing options...
DAWG91 Posted July 16, 2019 Share Posted July 16, 2019 @btex i guess you owe hitler a big thanks then, since he's the one who imposed universal health care in germany. Link to comment Share on other sites More sharing options...
Coach Rab Posted July 16, 2019 Share Posted July 16, 2019 4 hours ago, btex said: Kirt no I don’t know a lot about insurance companies. I do know that dealing with them as they attempt to cheat people is a huge pain I have had to deal with. I know the cost have risen while the benefit has decreased. The rise and fall of insurance started with AHA... it forced premiums to rise.  Link to comment Share on other sites More sharing options...
DAWG91 Posted July 16, 2019 Share Posted July 16, 2019 Most things go up in cost year after year. Â Why should medical care be any different? Link to comment Share on other sites More sharing options...
CENTEXFAN Posted July 16, 2019 Share Posted July 16, 2019 You know what a Democrat is. He or she was yesterdays Republican who ended up in the Emergency Room and got the bill. Link to comment Share on other sites More sharing options...
DAWG91 Posted July 16, 2019 Share Posted July 16, 2019 (edited) 4 minutes ago, CENTEXFAN said: You know what a Democrat is. He or she was yesterdays Republican who ended up in the Emergency Room and got the bill.  8 minutes ago, btex said: Ok what is an appropriate cost increase? Ours has been increasing at WAY above wage increases. This is a fact, so if the cost increase is going much faster than wages how can a person pay for it? teachers received a state mandated pay increase for the first time since 2009, my district was a 5% increase. All these increases did was pay for the rise in health insurance. I don't know but this I do,  the more involved in the "solution" that DC is,  the more screwed up it's going to be.  I mean lol,  they couldn't even get a website set up and running with a billion dollars.  That's saying something. Edited July 16, 2019 by DAWG91 Link to comment Share on other sites More sharing options...
CENTEXFAN Posted July 16, 2019 Share Posted July 16, 2019 6 minutes ago, DAWG91 said:  they couldn't even get a website set up and running with a billion dollars.  That's saying something. Apple iPhone had a glitch when it first came out. The Model-T had glitches when it first came out. So I guess under your reasoning they should have just scrapped the whole idea.  Link to comment Share on other sites More sharing options...
Coach Rab Posted July 16, 2019 Share Posted July 16, 2019 1 hour ago, btex said: That is actually not accurate. You are on TRS I believe and you know our cost we’re rising since 1998. I am not sure if you attended the meetings but I was there when bcbs said it was going up due to uninsured. I was there when they said it was due to aca when they said it was because so many more were being insured and I was there last year when they dodged the question when asked if it would decrease since Aetna was off aca. Yes you can use other industries to back what you are saying but that doesn’t explain TRS. my wife works for HUMANA... I can tell you the jump in premiums and drop in coverage was due largely to AHA taking effect within her company. Link to comment Share on other sites More sharing options...
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