Insurance is not the problem, it's the medical bills..

Ok a little back story first. My wife has had jaw pain for a few years now. (Insert wife joke here).
Not a constant pain it comes and goes. Her jaw also snaps loud enough that I can hear it. After a doctors visit and a referral to a jaw specialist she now has a treatment option. The doctor called it a splint that is supposed to align her lower jaw. 4-6 months wearing this thing should help.
Now the fun part,,,, the treatment will cost $3200. That's with a pay up front discount!
Our insurance will not cover this as it is considered cosmendic dental work. The splint does not straighten her teeth it only aligns her jaw, so how is that cosmendic?

Maybe our president and the rest of the frat boys in Washington should stop worrying whether or not we have insurance and do something about the cost of healthcare. A little piece of plastic should not cost over $3000. These prices are the problem, not insurance.

We are now forced to buy insurance that will not cover everything and I still have to pay the medical bills. The bills that are covered are ridiculously high and keep the premiums high. Listed below are a few examples of medical costs incurred by my immediate family.


Mother... 5 radiation treatments for cancer $80k (Medicare and supplement ins)
Father... $1000 per month medication for leukemia (veterans ins)
Daughter... $4200 for braces. ( yeah i paid for this one)


How much are you paying?

reply to post by Hoosierdaddy71

The root cause is medical school. There aren't enough seats. No competition in the market place. The supply -vs- demand thing.

The truth of it really is that no one wants to fix the problem.

reply to post by Hoosierdaddy71

My wife has had jaw pain for a few years now. (Insert wife joke here).

Ok, you asked for it.

Hit her hard on that side and break her jaw. Cosmetic turned injury in one swipe. Now they'll fix it for free.

Just kidding…

I say go for the cosmetic. Its only three grand, what the hell. She'll love you forever.

reply to post by Hoosierdaddy71

the treatment will cost $3200. That's with a pay up front discount!
Our insurance will not cover this as it is considered cosmendic dental work. The splint does not straighten her teeth it only aligns her jaw, so how is that cosmendic?

You realize it's the insurance company that determines what is and isn't covered right? So they are the ones saying it's cosmetic.

If I opted for surgery that I have to pay for for. I'd pay the $5000 rather than looking for "lowest bidder". "Vat, you naad eye sourgy? I give tu yuuu, cheap!"

By the way, plenty of countries with universal health care have lower cost per capita than the US (since US is at the top) which kind of shows what insurance companies can do to inflate rates. Just the manpower alone to negotiate with insurance companies is jacking your medical rates.

reply to post by Hoosierdaddy71

How much are you paying?

I'm on the borderline for a hearing aid. The hearing aid doctor told me they cost $3,200 and it's not covered by insurance. He let me try them out for a month. I had to bring them back twice because they stopped working. I told him, they weren't worth $3,200 and gave them back. I think the batteries are costly too! I told him I could buy three good lap top computers for the price of those small hearing aids. I told him I know they don't contain as much electronic components as a computer, so I couldn't justify paying that amount of money.

There is no way in hell, that those hearing aids should cost anywhere near $3,200. Manufacturers and pharmaceutical are taking us to the bank and causing the insurance rates to sky rocket. It seems like there's no competition and the price is set across the board no matter how cheap it costs to manufacture. They know a high percentage of people need these drugs and medical devices so they artificially keep the price high.

I've never understood why its so hard for some people to grasp the fact that insurance wouldn't be such a big deal if medical treatment in the US wasn't so damned expensive. Obamacare was doomed to fail just by the fact that it did little to nothing to address the rising (and ridiculous) cost of health care in this country.

I've got so many stories about insane medical costs. $300,000 for 9 months of cancer treatments, $2000 for heart surgery (that was really $4k because it had to be done twice), $500 for stitches. That's just the small bit that I can remember right now. All of that was what was paid to the hospitals, after copays and whatever insurance felt like paying that day. My family has had really good insurance for many years now thanks to my dad's job, so its not like we've been stuck with some bottom of the barrel plan that covers next to nothing.

reply to post by boncho


It is a number of issues, but yes, the prices are key....start with student loans, do you think it is a coincidence that tuition goes up every year right behind the increase in eligibility of a student for more loans? Why wouldn't a college or university price right below the availability of the stafford loans? Ensure you have bodies in the seats at a price that you know you can get......same with medical costs, hospitals know what an insurance company will pay, so why not charge at the highest rate possible? it is all just a great cause and effect, go to the medical school, of course costs are through the roof, because the students can easily attain the loans....promise, if the average med school student had to pay out of pocket or rely on private lending, the costs would drop quickly......

edit-look at the whole mess of this obamacare, do you think the premiums are going up, not because sick are added to the roster but because we now have to buy it or pay penalties......so either an insurance company gets another paying member or the government gets more funding....hmmm, sounds like a win/win for both parties.

reply to post by Hoosierdaddy71


I wish Mexico hadn't completely gone to the crapper safety wise. Most of my family always went there to get dental work from this dentist we knew. He was really good and really cheap.

Either way if I ever had an accident and needed dental work I'd take the chance and go back. No way to pay for it here.

My cousin got braces for 200 bucks over there.

I watched a show on netflix; I believe, that explained how
the more money that gets spent on health care actually
the more ill we become. Countries that have highest health
care budget also.have the people with the thickest medical
files.

When you dont have much money and there is no profit for
anyone to make selling you something they say will make you
better, then there tends to be less need for medical attention.

Moral of the story: The more you have, the more you spend

WeRpeons
reply to post by Hoosierdaddy71

 

How much are you paying?

I'm on the borderline for a hearing aid. The hearing aid doctor told me they cost $3,200 and it's not covered by insurance. He let me try them out for a month. I had to bring them back twice because they stopped working. I told him, they weren't worth $3,200 and gave them back. I think the batteries are costly too! I told him I could buy three good lap top computers for the price of those small hearing aids. I told him I know they don't contain as much electronic components as a computer, so I couldn't justify paying that amount of money.

There is no way in hell, that those hearing aids should cost anywhere near $3,200. Manufacturers and pharmaceutical are taking us to the bank and causing the insurance rates to sky rocket. It seems like there's no competition and the price is set across the board no matter how cheap it costs to manufacture. They know a high percentage of people need these drugs and medical devices so they artificially keep the price high.

Here's why it's $3,200 instead of $100. The average cost to get a device through FDA testing to be certified as a medical device is approximately $250 million. To recoup just those costs they have to sell almost 80,000 units. Oh that $250 million. If there's a new feature in the new model... yup another $250 mill gone.

If it's truly a $3200 peice of plastic then just get some measurements for one of the internet and buy a 3D printer so you can make your own. A 3D printer can save you lots when it comes to overpriced plastic doo-dads.

The problem IS insurance and the government. They both come between us and our medical providers, and both have far deeper pockets than we ever will. When both those players got involved, the impulse was to price services into their pockets because they could pay more and ever more.

Look at those medical markets where there is no insurance involvement - plastic surgery and Lasik. Both markets have been getting ever more affordable and they have no insurance or government involvement. Now, I'm not claiming they are cheap, but they are far less expensive than procedures done in the regular medical market and the prices for Lasik are far, far less than they are when the procedure first came out.

Here's my observation of the typical cost curve for a market when government gets involved:

1.) Some people can't afford a thing.
2.) Government gets involved to make it "affordable"
3.) Costs of the thing go up for all as the market prices to government pocket.
4.) More can't afford it.
5.) More start using government to afford the thing.
6.) Cycle repeats until no one can afford it without government.

We see this in health care and in the college tuition market. How many people are fortunate enough to afford college without some kind of loans from the government these days? Contrast that with how it used to be done before government assistance became a big thing.

See, in our market, businesses want profit. They will price higher and higher so long as someone pays. In this case, the insurance companies and the government will pay. Pretty soon, average folks couldn't pay anymore without being represented by either insurance or the government. Now, you have to one or the other as your middle man to get health care unless you're super rich because the market is priced into their pockets, not yours.

If we removed them from the system, the prices would have to correct and come down because they wouldn't have any business otherwise. The question would be how far they would come down. The thing with health care is that unlike material goods, it is a human skill. It will never be replicated by bots, so skilled practitioners will always command a good fee and be worth that good fee because there won't be a replacement for them.

reply to post by Hoosierdaddy71

Insurance is also an issue but the root problem of insurance hasnt been addressed, the monopoly structure and the inability for people to buy across state lines ie true competition.
But youre right, the real problem is the cost of health care.

The cause?

Government subsidies/intervention and the "Federal Reserve".

Why the Federal Reserves? Because as they inflate the monetary supply, they devalue the dollar, causing an increase in the price of everything.

Prior to the government getting involved in health care (via medicare and medicaid), prices were low and the quality was great.

Like every other sector which government subsidizes, student loans, housing, health care etc., costs skyrocket, quality drops and bubbles are created.

I was talking with a pharmaceutical rep who has been in the business over 10 years and he told me what sounds like a very plausible explanation.
He said for a person or company to get a medicine or medical apparatus to be allowed through the FDA they are given 17 years to create, test and get it through a review board from start to finish. He continued by saying, for example, that a medicine could take 10 years to finally pass through the FDA. That would only give the company 7 years to recoup any loss of revenue from developing and testing their product for that past 10 years plus earn a profit.
This is why everything cost through the roof because, according to him, after the 17 years has expired the medicine is allowed to be made generically by competitors.

In the end it all comes down to making lots of money over a short period of time.

Do you think those electric skooters people ride around on are really worth 5 grand? He'll no! But Medicare pays for them so CHA CHING! Everybody is getting bent over in this system and thats want I want the govt to dig in to. Only problem with that is the govt cant do anything right.

reply to post by ketsuko


Ketsuko, I think you're the closest to having it right and you did a nice concise job of explaining the major shortcomings of a convoluted and bloated system.

This video was an eye opener for me on a few things. It's all so screwed up; just makes me want to cry.

it's been pointed in other posts on why the costs continue to go up.
there are many reasons.
for example.
1-medical trials.
2-drug advertising on tv and magazines.
3-people going to the er for a regular doc visit.
4-people not paying current medial bills.

the list goes on and on.

but in saying that. i am currently pleased with the ACA. for the first time in years i have insurance. i was blackballed by all insurance companies i could access due to 2 previous bouts with cancer.

sure i have a high deductible. but i would rather pay 2000 a month than the 185k i paid for my heart attack.

My husband works for a union, they take 8 dollars per hour from his check for health insurance (they call it health and welfare on his check). This equals roughly 15 thousand a year for health insurance for me and my husband. The vision is not bad but the medical is a joke..god forbid you get sick and have to get seen by a doctor, the co pay is so high we never meet it so we always get billed for most of it. As of the first they are cutting the dental plan so we will have to pay 100 percent out of pocket. If he opts not to take the health insurance they still take the 8 dollars an hour but he will get a check once a year for two thousand dollars.......makes no sense to me at all..its just a huge crooked pyramid scheme!

health care will not be fixed until society is fixed, neither will most of our problems with corruption and greed. if anyone thinks this current society model we live in will somehow become better, they are just fooling themselves. our system is broken and it will continue to degrade until solvent.

ACA will not be fixed, health care will not get better, jobs are not coming back, unemployment will continue to rise, crime will continue to rise, white collar mostly, but blue collar will follow, taxes will continue to rise as well as corruption. nothing will be fixed until the entire system is replaced, so don't get your hopes up too soon. good news is i see promise on the other side, after the crash of this system.

reply to post by Hoosierdaddy71


Check out this story from today's New York Times:

As Hospital prices soar, A Single Stitch costs $500

The question is which came first - the chicken or the egg? Did the insurance industry and all of it's associated problems cause the hospitals to charge outrageous fees or did the outrageous fees cause the insurance industry to behave in almost criminal fashion with respect to who is/is not insured, the costs to insure, and all of the other shenanigans associated with that industry?

I think the answer may be more complicated than many people think.

Either way it stinks and is a completely unworkable "system" as it stands today...