huge topic:Americans keep getting fatter

[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.

[CA renter]

[quote=jpinpb][quote=CA renter]Maybe that’s because we don’t approach health from a holistic perspective, as the Europeans are more prone to do. That holistic approach tends to exist in a sytem where health — rather than profits — is the priority of the healthcare system.

After all, with a **for-profit** healthcare system, a sick population (with chronic conditions that need to be “treated” for life, no less) is precisely what they want.[/quote]

X2. But then we have our new national healthcare, which is insurance based. And this is why I have an issue w/it. They are in business solely to make money.[/quote]

Totally agree.

That’s why I’m as opposed to “Obamacare” as any red-blooded, Tea Party activist. I support a multi-tiered public/private healthcare system where everyone has basic “universal” coverage, and they can contract with private insurers and/or doctors if they want “upgraded” care.

[CA renter]

[quote=jpinpb][quote=CA renter]Maybe that’s because we don’t approach health from a holistic perspective, as the Europeans are more prone to do. That holistic approach tends to exist in a sytem where health — rather than profits — is the priority of the healthcare system.

After all, with a **for-profit** healthcare system, a sick population (with chronic conditions that need to be “treated” for life, no less) is precisely what they want.[/quote]

X2. But then we have our new national healthcare, which is insurance based. And this is why I have an issue w/it. They are in business solely to make money.[/quote]

Totally agree.

That’s why I’m as opposed to “Obamacare” as any red-blooded, Tea Party activist. I support a multi-tiered public/private healthcare system where everyone has basic “universal” coverage, and they can contract with private insurers and/or doctors if they want “upgraded” care.

[CA renter]

[quote=jpinpb][quote=CA renter]Maybe that’s because we don’t approach health from a holistic perspective, as the Europeans are more prone to do. That holistic approach tends to exist in a sytem where health — rather than profits — is the priority of the healthcare system.

After all, with a **for-profit** healthcare system, a sick population (with chronic conditions that need to be “treated” for life, no less) is precisely what they want.[/quote]

X2. But then we have our new national healthcare, which is insurance based. And this is why I have an issue w/it. They are in business solely to make money.[/quote]

Totally agree.

That’s why I’m as opposed to “Obamacare” as any red-blooded, Tea Party activist. I support a multi-tiered public/private healthcare system where everyone has basic “universal” coverage, and they can contract with private insurers and/or doctors if they want “upgraded” care.

[CA renter]

[quote=jpinpb][quote=CA renter]Maybe that’s because we don’t approach health from a holistic perspective, as the Europeans are more prone to do. That holistic approach tends to exist in a sytem where health — rather than profits — is the priority of the healthcare system.

After all, with a **for-profit** healthcare system, a sick population (with chronic conditions that need to be “treated” for life, no less) is precisely what they want.[/quote]

X2. But then we have our new national healthcare, which is insurance based. And this is why I have an issue w/it. They are in business solely to make money.[/quote]

Totally agree.

That’s why I’m as opposed to “Obamacare” as any red-blooded, Tea Party activist. I support a multi-tiered public/private healthcare system where everyone has basic “universal” coverage, and they can contract with private insurers and/or doctors if they want “upgraded” care.

[CA renter]

[quote=jpinpb][quote=CA renter]Maybe that’s because we don’t approach health from a holistic perspective, as the Europeans are more prone to do. That holistic approach tends to exist in a sytem where health — rather than profits — is the priority of the healthcare system.

After all, with a **for-profit** healthcare system, a sick population (with chronic conditions that need to be “treated” for life, no less) is precisely what they want.[/quote]

X2. But then we have our new national healthcare, which is insurance based. And this is why I have an issue w/it. They are in business solely to make money.[/quote]

Totally agree.

That’s why I’m as opposed to “Obamacare” as any red-blooded, Tea Party activist. I support a multi-tiered public/private healthcare system where everyone has basic “universal” coverage, and they can contract with private insurers and/or doctors if they want “upgraded” care.

[CA renter]

[quote=ocrenter][quote=bearishgurl]
Another hint: I’ve had co-workers and friends who have died due to misdiagnosis and/or too many hoops to jump through for care and not enough time on (or off) the books to play the waiting game. All were with “Kaiser” HMO.[/quote]

While I value your anecdotal comments, we have to put things into context.

One big issue is PPOs do not have direct control over their physicians. So if there is a bad outcome, or if there is a problem such as misdiagnosis, the word on the street would be “Dr. So-and-so did this to me! Dr. So-and-so is a bad doctor.” The word on the street would not be Anetna is a BAD insurance because it contracted with Dr. So-and-so.

But Kaiser is a HMO that hire their physicians. Therefore, if there is a bad outcome, then we have “Kaiser did this to me! Kaiser is a BAD HMO.”

So let’s think this through in real numbers.

Now Kaiser is the 800 lb gorilla in southern Cal, so out of say 12 million souls in SoCal, 1/4 are Kaiser members.

So that’s about 3 million.

Say Kaiser does a good job 95% of the time. That still leaves 150,000 anecdotal complaints out there. And these 150,000 will repeat that bad experience time and time again. And when these 150,000 report the events, they will not name this specific doctor that errored, it would be a blanket Kaiser problem.

Now let’s go back to Aetna. Let’s say in SoCal it has 1 million members. And its contracted providers does a good job also 95% of the time. Just by the numbers, we are now looking at 50,000 people going around complainting about their mistreatment. But because of the nature of the PPO structure, that 50,000 will likely blame the specific doctors that errored, not Aetna in general. Because there is no such thing as an “Aetna physician.”

There is always a personal story behind each and every anecdotal story. And they are important in their own ways. But we need to be careful when we try to apply anecdotal stories into the context of good vs bad care.

Overall, by numbers, per the US News and World Report, Kaiser SoCal scored a 84.1 out of 100, landing it #71 out of 239 health plans ranked.

But Aetna, and remember this is the same insurance giant that tried to raise rate by over 30% last year in Cali, scored 77.8 and landed #208 out of 239 health plans ranked.[/quote]

You are 100% right on this. Good post.

[CA renter]

[quote=ocrenter][quote=bearishgurl]
Another hint: I’ve had co-workers and friends who have died due to misdiagnosis and/or too many hoops to jump through for care and not enough time on (or off) the books to play the waiting game. All were with “Kaiser” HMO.[/quote]

While I value your anecdotal comments, we have to put things into context.

One big issue is PPOs do not have direct control over their physicians. So if there is a bad outcome, or if there is a problem such as misdiagnosis, the word on the street would be “Dr. So-and-so did this to me! Dr. So-and-so is a bad doctor.” The word on the street would not be Anetna is a BAD insurance because it contracted with Dr. So-and-so.

But Kaiser is a HMO that hire their physicians. Therefore, if there is a bad outcome, then we have “Kaiser did this to me! Kaiser is a BAD HMO.”

So let’s think this through in real numbers.

Now Kaiser is the 800 lb gorilla in southern Cal, so out of say 12 million souls in SoCal, 1/4 are Kaiser members.

So that’s about 3 million.

Say Kaiser does a good job 95% of the time. That still leaves 150,000 anecdotal complaints out there. And these 150,000 will repeat that bad experience time and time again. And when these 150,000 report the events, they will not name this specific doctor that errored, it would be a blanket Kaiser problem.

Now let’s go back to Aetna. Let’s say in SoCal it has 1 million members. And its contracted providers does a good job also 95% of the time. Just by the numbers, we are now looking at 50,000 people going around complainting about their mistreatment. But because of the nature of the PPO structure, that 50,000 will likely blame the specific doctors that errored, not Aetna in general. Because there is no such thing as an “Aetna physician.”

There is always a personal story behind each and every anecdotal story. And they are important in their own ways. But we need to be careful when we try to apply anecdotal stories into the context of good vs bad care.

Overall, by numbers, per the US News and World Report, Kaiser SoCal scored a 84.1 out of 100, landing it #71 out of 239 health plans ranked.

But Aetna, and remember this is the same insurance giant that tried to raise rate by over 30% last year in Cali, scored 77.8 and landed #208 out of 239 health plans ranked.[/quote]

You are 100% right on this. Good post.

[CA renter]

[quote=ocrenter][quote=bearishgurl]
Another hint: I’ve had co-workers and friends who have died due to misdiagnosis and/or too many hoops to jump through for care and not enough time on (or off) the books to play the waiting game. All were with “Kaiser” HMO.[/quote]

While I value your anecdotal comments, we have to put things into context.

One big issue is PPOs do not have direct control over their physicians. So if there is a bad outcome, or if there is a problem such as misdiagnosis, the word on the street would be “Dr. So-and-so did this to me! Dr. So-and-so is a bad doctor.” The word on the street would not be Anetna is a BAD insurance because it contracted with Dr. So-and-so.

But Kaiser is a HMO that hire their physicians. Therefore, if there is a bad outcome, then we have “Kaiser did this to me! Kaiser is a BAD HMO.”

So let’s think this through in real numbers.

Now Kaiser is the 800 lb gorilla in southern Cal, so out of say 12 million souls in SoCal, 1/4 are Kaiser members.

So that’s about 3 million.

Say Kaiser does a good job 95% of the time. That still leaves 150,000 anecdotal complaints out there. And these 150,000 will repeat that bad experience time and time again. And when these 150,000 report the events, they will not name this specific doctor that errored, it would be a blanket Kaiser problem.

Now let’s go back to Aetna. Let’s say in SoCal it has 1 million members. And its contracted providers does a good job also 95% of the time. Just by the numbers, we are now looking at 50,000 people going around complainting about their mistreatment. But because of the nature of the PPO structure, that 50,000 will likely blame the specific doctors that errored, not Aetna in general. Because there is no such thing as an “Aetna physician.”

There is always a personal story behind each and every anecdotal story. And they are important in their own ways. But we need to be careful when we try to apply anecdotal stories into the context of good vs bad care.

Overall, by numbers, per the US News and World Report, Kaiser SoCal scored a 84.1 out of 100, landing it #71 out of 239 health plans ranked.

But Aetna, and remember this is the same insurance giant that tried to raise rate by over 30% last year in Cali, scored 77.8 and landed #208 out of 239 health plans ranked.[/quote]

You are 100% right on this. Good post.

[CA renter]

[quote=ocrenter][quote=bearishgurl]
Another hint: I’ve had co-workers and friends who have died due to misdiagnosis and/or too many hoops to jump through for care and not enough time on (or off) the books to play the waiting game. All were with “Kaiser” HMO.[/quote]

While I value your anecdotal comments, we have to put things into context.

One big issue is PPOs do not have direct control over their physicians. So if there is a bad outcome, or if there is a problem such as misdiagnosis, the word on the street would be “Dr. So-and-so did this to me! Dr. So-and-so is a bad doctor.” The word on the street would not be Anetna is a BAD insurance because it contracted with Dr. So-and-so.

But Kaiser is a HMO that hire their physicians. Therefore, if there is a bad outcome, then we have “Kaiser did this to me! Kaiser is a BAD HMO.”

So let’s think this through in real numbers.

Now Kaiser is the 800 lb gorilla in southern Cal, so out of say 12 million souls in SoCal, 1/4 are Kaiser members.

So that’s about 3 million.

Say Kaiser does a good job 95% of the time. That still leaves 150,000 anecdotal complaints out there. And these 150,000 will repeat that bad experience time and time again. And when these 150,000 report the events, they will not name this specific doctor that errored, it would be a blanket Kaiser problem.

Now let’s go back to Aetna. Let’s say in SoCal it has 1 million members. And its contracted providers does a good job also 95% of the time. Just by the numbers, we are now looking at 50,000 people going around complainting about their mistreatment. But because of the nature of the PPO structure, that 50,000 will likely blame the specific doctors that errored, not Aetna in general. Because there is no such thing as an “Aetna physician.”

There is always a personal story behind each and every anecdotal story. And they are important in their own ways. But we need to be careful when we try to apply anecdotal stories into the context of good vs bad care.

Overall, by numbers, per the US News and World Report, Kaiser SoCal scored a 84.1 out of 100, landing it #71 out of 239 health plans ranked.

But Aetna, and remember this is the same insurance giant that tried to raise rate by over 30% last year in Cali, scored 77.8 and landed #208 out of 239 health plans ranked.[/quote]

You are 100% right on this. Good post.

[CA renter]

[quote=ocrenter][quote=bearishgurl]
Another hint: I’ve had co-workers and friends who have died due to misdiagnosis and/or too many hoops to jump through for care and not enough time on (or off) the books to play the waiting game. All were with “Kaiser” HMO.[/quote]

While I value your anecdotal comments, we have to put things into context.

One big issue is PPOs do not have direct control over their physicians. So if there is a bad outcome, or if there is a problem such as misdiagnosis, the word on the street would be “Dr. So-and-so did this to me! Dr. So-and-so is a bad doctor.” The word on the street would not be Anetna is a BAD insurance because it contracted with Dr. So-and-so.

But Kaiser is a HMO that hire their physicians. Therefore, if there is a bad outcome, then we have “Kaiser did this to me! Kaiser is a BAD HMO.”

So let’s think this through in real numbers.

Now Kaiser is the 800 lb gorilla in southern Cal, so out of say 12 million souls in SoCal, 1/4 are Kaiser members.

So that’s about 3 million.

Say Kaiser does a good job 95% of the time. That still leaves 150,000 anecdotal complaints out there. And these 150,000 will repeat that bad experience time and time again. And when these 150,000 report the events, they will not name this specific doctor that errored, it would be a blanket Kaiser problem.

Now let’s go back to Aetna. Let’s say in SoCal it has 1 million members. And its contracted providers does a good job also 95% of the time. Just by the numbers, we are now looking at 50,000 people going around complainting about their mistreatment. But because of the nature of the PPO structure, that 50,000 will likely blame the specific doctors that errored, not Aetna in general. Because there is no such thing as an “Aetna physician.”

There is always a personal story behind each and every anecdotal story. And they are important in their own ways. But we need to be careful when we try to apply anecdotal stories into the context of good vs bad care.

Overall, by numbers, per the US News and World Report, Kaiser SoCal scored a 84.1 out of 100, landing it #71 out of 239 health plans ranked.

But Aetna, and remember this is the same insurance giant that tried to raise rate by over 30% last year in Cali, scored 77.8 and landed #208 out of 239 health plans ranked.[/quote]

You are 100% right on this. Good post.

[CA renter]

Captcha,

Thanks for posting about your experience overseas. It’s always instructive to know how things work in different circumstances.

Based on your experience and knowledge, which system do you think functions better? Highly regulated or publicly owned for basic needs, with some capitalism for the “wants”…OR our sytem (which seems somewhat similar, but with a bit more privatization)?

[CA renter]

Captcha,

Thanks for posting about your experience overseas. It’s always instructive to know how things work in different circumstances.

Based on your experience and knowledge, which system do you think functions better? Highly regulated or publicly owned for basic needs, with some capitalism for the “wants”…OR our sytem (which seems somewhat similar, but with a bit more privatization)?

[CA renter]

Captcha,

Thanks for posting about your experience overseas. It’s always instructive to know how things work in different circumstances.

Based on your experience and knowledge, which system do you think functions better? Highly regulated or publicly owned for basic needs, with some capitalism for the “wants”…OR our sytem (which seems somewhat similar, but with a bit more privatization)?

[CA renter]

Captcha,

Thanks for posting about your experience overseas. It’s always instructive to know how things work in different circumstances.

Based on your experience and knowledge, which system do you think functions better? Highly regulated or publicly owned for basic needs, with some capitalism for the “wants”…OR our sytem (which seems somewhat similar, but with a bit more privatization)?

[Author]

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