huge topic:Americans keep getting fatter

[all]

[quote=sdrealtor]Thanx captcha.
I’m wondering what country you are from.

Its an intersting perspective which speaks to the differences between the US and other countries. Here our best and brightest typically become doctors because it is generally regarded as the top of mountain careerwise. I wonder if it is second tier in other countries because as a doctor you have to play on the local stage whereas engineers get to play on a global stage which gives the access to the US.[/quote]

Western part of the former Yugoslavia, which is often mistaken for a Soviet-controlled country. Fairly boring until ’90s. Unlike ‘those’ countries we did not need a permit to exit the country or visa to enter any European country other than France, commerce was fairly liberal and pop-culture shaped by Hollywood and French movies.

However, most of the industries and services were not state owned, but heavily regulated. You would have to go into commerce, manufacturing or agriculture to run a private business – education, health, energy, etc… were ‘publicly owned’. And if an industry is regulated the ratio between the lowest and the highest salary worked as equalizer for salaries between professions. A physician cannot make 10x what college professor makes if the highest salary cannot be more than seven times larger than what janitors make. So, a college degree would almost guarantee an equivalent of a middle-class life – a housing unit, a vehicle, summer and winter vacation trips, vacation house in the area, etc.

Desirability of occupations and professions change once you reduce the disparity in the compensations. A physician is always and everywhere held in high regard, but the job really sucks and the school is not easy. You are always around people who are ill or dying, cutting parts and draining stuff. And while in school you have to memorize a lot of information and there is little room for creativity. Engineering is less stress and more creativity.

When I went to school access to the US was not part of the equation. Poor and uneducated were more interested in finding work in wealthier European countries. Professionals were mostly happy with what they had.

[sdrealtor]

Thanks for sharing that and welcome to American whenever you arrived.

[sdrealtor]

Thanks for sharing that and welcome to American whenever you arrived.

[sdrealtor]

Thanks for sharing that and welcome to American whenever you arrived.

[sdrealtor]

Thanks for sharing that and welcome to American whenever you arrived.

[sdrealtor]

Thanks for sharing that and welcome to American whenever you arrived.

[ocrenter]

[quote=bearishgurl]

ocrenter, you hit upon the problem right there. I guess I should have intimated that the business model of the typical HMO (such as Kaiser) was to blame for patient-runaround.[/quote]

but the PPO business model will bankrupt us.

[quote=bearishgurl]
If I want to see a particular specialist, I can just make an appt with him/her (in or out of “network”). If I am a cancer patient and want to participate in a clinical trial at the MD Anderson Cancer Center in TX or a specialized treatment program that is only being offered at the Mayo Clinic in MN, I can do that and Aetna will cooperate acc to the terms of my coverage, no problem. If the providers happen to be “out of network,” I’ll just have more co-insurance responsibility. HOWEVER, there are many thousands of Aetna providers across the nation. [/quote]

The freedom of choice CREATES a huge cost burden for the society at large.

For example, let’s assume someone is having chest pain. In an HMO world that someone is seen by the primary. The primary physician makes the determination whether this is cardiac chest pain that requires further evaluation or whether this is say… heart burn. Let’s say 10 people that show up with chest pain all go to the primary, perhaps only 3 really sound likely to be heart, and perhaps only 1 really has a heart condition. But point is 3 gets referred to cardiology and work up is focused on the 3 that have symptoms and family history and risk factors that warrant further evaluation.

But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.

[ocrenter]

[quote=bearishgurl]

ocrenter, you hit upon the problem right there. I guess I should have intimated that the business model of the typical HMO (such as Kaiser) was to blame for patient-runaround.[/quote]

but the PPO business model will bankrupt us.

[quote=bearishgurl]
If I want to see a particular specialist, I can just make an appt with him/her (in or out of “network”). If I am a cancer patient and want to participate in a clinical trial at the MD Anderson Cancer Center in TX or a specialized treatment program that is only being offered at the Mayo Clinic in MN, I can do that and Aetna will cooperate acc to the terms of my coverage, no problem. If the providers happen to be “out of network,” I’ll just have more co-insurance responsibility. HOWEVER, there are many thousands of Aetna providers across the nation. [/quote]

The freedom of choice CREATES a huge cost burden for the society at large.

For example, let’s assume someone is having chest pain. In an HMO world that someone is seen by the primary. The primary physician makes the determination whether this is cardiac chest pain that requires further evaluation or whether this is say… heart burn. Let’s say 10 people that show up with chest pain all go to the primary, perhaps only 3 really sound likely to be heart, and perhaps only 1 really has a heart condition. But point is 3 gets referred to cardiology and work up is focused on the 3 that have symptoms and family history and risk factors that warrant further evaluation.

But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.

[ocrenter]

[quote=bearishgurl]

ocrenter, you hit upon the problem right there. I guess I should have intimated that the business model of the typical HMO (such as Kaiser) was to blame for patient-runaround.[/quote]

but the PPO business model will bankrupt us.

[quote=bearishgurl]
If I want to see a particular specialist, I can just make an appt with him/her (in or out of “network”). If I am a cancer patient and want to participate in a clinical trial at the MD Anderson Cancer Center in TX or a specialized treatment program that is only being offered at the Mayo Clinic in MN, I can do that and Aetna will cooperate acc to the terms of my coverage, no problem. If the providers happen to be “out of network,” I’ll just have more co-insurance responsibility. HOWEVER, there are many thousands of Aetna providers across the nation. [/quote]

The freedom of choice CREATES a huge cost burden for the society at large.

For example, let’s assume someone is having chest pain. In an HMO world that someone is seen by the primary. The primary physician makes the determination whether this is cardiac chest pain that requires further evaluation or whether this is say… heart burn. Let’s say 10 people that show up with chest pain all go to the primary, perhaps only 3 really sound likely to be heart, and perhaps only 1 really has a heart condition. But point is 3 gets referred to cardiology and work up is focused on the 3 that have symptoms and family history and risk factors that warrant further evaluation.

But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.

[ocrenter]

[quote=bearishgurl]

ocrenter, you hit upon the problem right there. I guess I should have intimated that the business model of the typical HMO (such as Kaiser) was to blame for patient-runaround.[/quote]

but the PPO business model will bankrupt us.

[quote=bearishgurl]
If I want to see a particular specialist, I can just make an appt with him/her (in or out of “network”). If I am a cancer patient and want to participate in a clinical trial at the MD Anderson Cancer Center in TX or a specialized treatment program that is only being offered at the Mayo Clinic in MN, I can do that and Aetna will cooperate acc to the terms of my coverage, no problem. If the providers happen to be “out of network,” I’ll just have more co-insurance responsibility. HOWEVER, there are many thousands of Aetna providers across the nation. [/quote]

The freedom of choice CREATES a huge cost burden for the society at large.

For example, let’s assume someone is having chest pain. In an HMO world that someone is seen by the primary. The primary physician makes the determination whether this is cardiac chest pain that requires further evaluation or whether this is say… heart burn. Let’s say 10 people that show up with chest pain all go to the primary, perhaps only 3 really sound likely to be heart, and perhaps only 1 really has a heart condition. But point is 3 gets referred to cardiology and work up is focused on the 3 that have symptoms and family history and risk factors that warrant further evaluation.

But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.

[ocrenter]

[quote=bearishgurl]

ocrenter, you hit upon the problem right there. I guess I should have intimated that the business model of the typical HMO (such as Kaiser) was to blame for patient-runaround.[/quote]

but the PPO business model will bankrupt us.

[quote=bearishgurl]
If I want to see a particular specialist, I can just make an appt with him/her (in or out of “network”). If I am a cancer patient and want to participate in a clinical trial at the MD Anderson Cancer Center in TX or a specialized treatment program that is only being offered at the Mayo Clinic in MN, I can do that and Aetna will cooperate acc to the terms of my coverage, no problem. If the providers happen to be “out of network,” I’ll just have more co-insurance responsibility. HOWEVER, there are many thousands of Aetna providers across the nation. [/quote]

The freedom of choice CREATES a huge cost burden for the society at large.

For example, let’s assume someone is having chest pain. In an HMO world that someone is seen by the primary. The primary physician makes the determination whether this is cardiac chest pain that requires further evaluation or whether this is say… heart burn. Let’s say 10 people that show up with chest pain all go to the primary, perhaps only 3 really sound likely to be heart, and perhaps only 1 really has a heart condition. But point is 3 gets referred to cardiology and work up is focused on the 3 that have symptoms and family history and risk factors that warrant further evaluation.

But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.

[bearishgurl]

[quote=ocrenter] . . . But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.[/quote]

ocrenter, how do you surmise that “everyone pays” the PPO bills of those who have “choice” in their healthcare decisions?

First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!

The reality is, if this patient had spent little to no healthcare costs towards their $5000 deductible in that calendar year, the full cost of all those supposedly “unnecessary” tests will come out of that patient/insured’s pocket, NOT the insurer’s or taxpayers!

An HMO member can just pay $15 each (or whatever the current “co-pay” amount is), to every practitioner they see and get seen into oblivion (or as much as their “system” will allow). They will pay zero for x-rays and tests that a ($15) practitioner (who already examined them) ORDERED. The purpose of the “gatekeeper PCP” in an HMO is to keep all their member-repeat patients with “chronic hangnails” from “working the system” for no reason. Unfortunately, the truly sick often fall through the cracks with this “business model.”

I maintain that when routine healthcare comes out of a patient’s pocket, not only do they tend to take better care of themselves, they don’t visit a doctor just for the h@ll of it.

Think about this, ocrenter.

[bearishgurl]

[quote=ocrenter] . . . But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.[/quote]

ocrenter, how do you surmise that “everyone pays” the PPO bills of those who have “choice” in their healthcare decisions?

First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!

The reality is, if this patient had spent little to no healthcare costs towards their $5000 deductible in that calendar year, the full cost of all those supposedly “unnecessary” tests will come out of that patient/insured’s pocket, NOT the insurer’s or taxpayers!

An HMO member can just pay $15 each (or whatever the current “co-pay” amount is), to every practitioner they see and get seen into oblivion (or as much as their “system” will allow). They will pay zero for x-rays and tests that a ($15) practitioner (who already examined them) ORDERED. The purpose of the “gatekeeper PCP” in an HMO is to keep all their member-repeat patients with “chronic hangnails” from “working the system” for no reason. Unfortunately, the truly sick often fall through the cracks with this “business model.”

I maintain that when routine healthcare comes out of a patient’s pocket, not only do they tend to take better care of themselves, they don’t visit a doctor just for the h@ll of it.

Think about this, ocrenter.

[bearishgurl]

[quote=ocrenter] . . . But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.[/quote]

ocrenter, how do you surmise that “everyone pays” the PPO bills of those who have “choice” in their healthcare decisions?

First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!

The reality is, if this patient had spent little to no healthcare costs towards their $5000 deductible in that calendar year, the full cost of all those supposedly “unnecessary” tests will come out of that patient/insured’s pocket, NOT the insurer’s or taxpayers!

An HMO member can just pay $15 each (or whatever the current “co-pay” amount is), to every practitioner they see and get seen into oblivion (or as much as their “system” will allow). They will pay zero for x-rays and tests that a ($15) practitioner (who already examined them) ORDERED. The purpose of the “gatekeeper PCP” in an HMO is to keep all their member-repeat patients with “chronic hangnails” from “working the system” for no reason. Unfortunately, the truly sick often fall through the cracks with this “business model.”

I maintain that when routine healthcare comes out of a patient’s pocket, not only do they tend to take better care of themselves, they don’t visit a doctor just for the h@ll of it.

Think about this, ocrenter.

[bearishgurl]

[quote=ocrenter] . . . But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.

So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.

So granted you get what you think you want, but ultimately everyone loses.[/quote]

ocrenter, how do you surmise that “everyone pays” the PPO bills of those who have “choice” in their healthcare decisions?

First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!

The reality is, if this patient had spent little to no healthcare costs towards their $5000 deductible in that calendar year, the full cost of all those supposedly “unnecessary” tests will come out of that patient/insured’s pocket, NOT the insurer’s or taxpayers!

An HMO member can just pay $15 each (or whatever the current “co-pay” amount is), to every practitioner they see and get seen into oblivion (or as much as their “system” will allow). They will pay zero for x-rays and tests that a ($15) practitioner (who already examined them) ORDERED. The purpose of the “gatekeeper PCP” in an HMO is to keep all their member-repeat patients with “chronic hangnails” from “working the system” for no reason. Unfortunately, the truly sick often fall through the cracks with this “business model.”

I maintain that when routine healthcare comes out of a patient’s pocket, not only do they tend to take better care of themselves, they don’t visit a doctor just for the h@ll of it.

Think about this, ocrenter.

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