huge topic:Americans keep getting fatter

[ocrenter]

Here’s the top 10 health care plans in America based on US News for Medicare patients.

# 1 Kaiser Foundation Health Plan of Colorado (HMO) Colorado
# 2 Fallon Community Health Plan (HMO) MA
# 3 Geisinger Health Plan (HMO) PA
# 4 Tufts Associated Health Maintenance Organization (HMO) MA
# 5 Capital Health Plan (HMO), FL
# 6 MVP Health Care (Rochester Area) (HMO)
# 7 Kaiser Foundation Health Plan of the Northwest (HMO) Oregon, Washington
# 8 Kaiser Foundation Health Plan of Southern California (HMO)
# 9 Kaiser Foundation Health Plan of the Northwest (Demonstation Project)
# 10 Capital District Physicians’ Health Plan (HMO) New York

Here’s the ranking for commercial plans:

# 1 Harvard Pilgrim Health Care (HMO/POS)
Maine, Massachusetts
# 2 Harvard Pilgrim Health Care of New England (HMO/POS)
New Hampshire
# 3 Tufts Associated Health Maintenance Organization (HMO/POS)
Massachusetts, Rhode Island
# 4 Grand Valley Health Plan (HMO)
Michigan
# 5 Capital Health Plan (HMO)
Florida
# 6 Geisinger Health Plan (HMO/POS)
Pennsylvania
# 7 Fallon Community Health Plan (HMO/POS)
Massachusetts
# 8 Health New England (HMO/POS)
Massachusetts
# 9 CIGNA HealthCare of New Hampshire (HMO/POS)
New Hampshire
# 10 Group Health Cooperative of South Central Wisconsin (HMO)

Here’s the top 10 plans in California:
Kaiser Foundation Health Plan of NorCal (HMO)
Kaiser Foundation Health Plan of SoCal (HMO)
Western Health Advantage (HMO)
Health Net of California (HMO/POS)
PacifiCare of California (HMO/POS)
Blue Shield of California (HMO/POS)
Anthem Blue Cross (HMO/POS)
CIGNA HealthCare of California (HMO/POS)
Aetna Health of California (HMO/POS)
Ventura County Health Care Plan (HMO)

*POS stans for point of service, or your classic PPO plans.

One reason why people do not like HMO is chances are the patient is not going to get what they think they want (and a lot of times they think they want something because of direct marketing by Big Pharma). But sometimes, actually most of the time, that is for the benefit of the patient. Afterall, if patients know best, then we don’t really need doctors.

[scaredyclassic]

i was only kidding about the justice system being the best in the world. actually, i have no idea whether it’s thebest in the world. it might be. who knows. it’s a big world. justice is a slippery concept. we were watching a youtube video about a nigerian village court where a theft accusation was being settled by elders with a vat of boiling oil in which the rightful party was supposed to not get burned. everyone semeed to beleive in it.. seemed to work for them. no one got hurt in the process. health, justice, these are local concepts. i don’t think it can be disputed that ourmedical system has some of the bitchingest toys int he world availabel to doctors, and some of the most interestingly complex insurance schemes in the world? but the best/ I don’t know. those people in nigeria with the boiing oil court looked pretty hale and hearty.

[scaredyclassic]

i was only kidding about the justice system being the best in the world. actually, i have no idea whether it’s thebest in the world. it might be. who knows. it’s a big world. justice is a slippery concept. we were watching a youtube video about a nigerian village court where a theft accusation was being settled by elders with a vat of boiling oil in which the rightful party was supposed to not get burned. everyone semeed to beleive in it.. seemed to work for them. no one got hurt in the process. health, justice, these are local concepts. i don’t think it can be disputed that ourmedical system has some of the bitchingest toys int he world availabel to doctors, and some of the most interestingly complex insurance schemes in the world? but the best/ I don’t know. those people in nigeria with the boiing oil court looked pretty hale and hearty.

[scaredyclassic]

i was only kidding about the justice system being the best in the world. actually, i have no idea whether it’s thebest in the world. it might be. who knows. it’s a big world. justice is a slippery concept. we were watching a youtube video about a nigerian village court where a theft accusation was being settled by elders with a vat of boiling oil in which the rightful party was supposed to not get burned. everyone semeed to beleive in it.. seemed to work for them. no one got hurt in the process. health, justice, these are local concepts. i don’t think it can be disputed that ourmedical system has some of the bitchingest toys int he world availabel to doctors, and some of the most interestingly complex insurance schemes in the world? but the best/ I don’t know. those people in nigeria with the boiing oil court looked pretty hale and hearty.

[scaredyclassic]

i was only kidding about the justice system being the best in the world. actually, i have no idea whether it’s thebest in the world. it might be. who knows. it’s a big world. justice is a slippery concept. we were watching a youtube video about a nigerian village court where a theft accusation was being settled by elders with a vat of boiling oil in which the rightful party was supposed to not get burned. everyone semeed to beleive in it.. seemed to work for them. no one got hurt in the process. health, justice, these are local concepts. i don’t think it can be disputed that ourmedical system has some of the bitchingest toys int he world availabel to doctors, and some of the most interestingly complex insurance schemes in the world? but the best/ I don’t know. those people in nigeria with the boiing oil court looked pretty hale and hearty.

[scaredyclassic]

i was only kidding about the justice system being the best in the world. actually, i have no idea whether it’s thebest in the world. it might be. who knows. it’s a big world. justice is a slippery concept. we were watching a youtube video about a nigerian village court where a theft accusation was being settled by elders with a vat of boiling oil in which the rightful party was supposed to not get burned. everyone semeed to beleive in it.. seemed to work for them. no one got hurt in the process. health, justice, these are local concepts. i don’t think it can be disputed that ourmedical system has some of the bitchingest toys int he world availabel to doctors, and some of the most interestingly complex insurance schemes in the world? but the best/ I don’t know. those people in nigeria with the boiing oil court looked pretty hale and hearty.

[bearishgurl]

[quote=ocrenter] . . . Here’s the top 10 plans in California:
Kaiser Foundation Health Plan of NorCal (HMO)
Kaiser Foundation Health Plan of SoCal (HMO)
Western Health Advantage (HMO)
Health Net of California (HMO/POS)
PacifiCare of California (HMO/POS)
Blue Shield of California (HMO/POS)
Anthem Blue Cross (HMO/POS)
CIGNA HealthCare of California (HMO/POS)
Aetna Health of California (HMO/POS)
Ventura County Health Care Plan (HMO)

*POS stans for point of service, or your classic PPO plans. . . [/quote]

I’d highly recommend Aetna Advantage PPO. I currently have a HDHP version of it but have also had low-deductible versions (when my premium was employer-paid). I’ve had two minor billing glitches which both got straightened out. Preventative care is 100% covered.

Hint: make sure you ask your dr to write your prescription for “generic,” (if avail) as brand-name drugs can be VERY pricey on this plan, depending on what it is.

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.

[bearishgurl]

[quote=ocrenter] . . . Here’s the top 10 plans in California:
Kaiser Foundation Health Plan of NorCal (HMO)
Kaiser Foundation Health Plan of SoCal (HMO)
Western Health Advantage (HMO)
Health Net of California (HMO/POS)
PacifiCare of California (HMO/POS)
Blue Shield of California (HMO/POS)
Anthem Blue Cross (HMO/POS)
CIGNA HealthCare of California (HMO/POS)
Aetna Health of California (HMO/POS)
Ventura County Health Care Plan (HMO)

*POS stans for point of service, or your classic PPO plans. . . [/quote]

I’d highly recommend Aetna Advantage PPO. I currently have a HDHP version of it but have also had low-deductible versions (when my premium was employer-paid). I’ve had two minor billing glitches which both got straightened out. Preventative care is 100% covered.

Hint: make sure you ask your dr to write your prescription for “generic,” (if avail) as brand-name drugs can be VERY pricey on this plan, depending on what it is.

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.

[bearishgurl]

[quote=ocrenter] . . . Here’s the top 10 plans in California:
Kaiser Foundation Health Plan of NorCal (HMO)
Kaiser Foundation Health Plan of SoCal (HMO)
Western Health Advantage (HMO)
Health Net of California (HMO/POS)
PacifiCare of California (HMO/POS)
Blue Shield of California (HMO/POS)
Anthem Blue Cross (HMO/POS)
CIGNA HealthCare of California (HMO/POS)
Aetna Health of California (HMO/POS)
Ventura County Health Care Plan (HMO)

*POS stans for point of service, or your classic PPO plans. . . [/quote]

I’d highly recommend Aetna Advantage PPO. I currently have a HDHP version of it but have also had low-deductible versions (when my premium was employer-paid). I’ve had two minor billing glitches which both got straightened out. Preventative care is 100% covered.

Hint: make sure you ask your dr to write your prescription for “generic,” (if avail) as brand-name drugs can be VERY pricey on this plan, depending on what it is.

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.

[bearishgurl]

[quote=ocrenter] . . . Here’s the top 10 plans in California:
Kaiser Foundation Health Plan of NorCal (HMO)
Kaiser Foundation Health Plan of SoCal (HMO)
Western Health Advantage (HMO)
Health Net of California (HMO/POS)
PacifiCare of California (HMO/POS)
Blue Shield of California (HMO/POS)
Anthem Blue Cross (HMO/POS)
CIGNA HealthCare of California (HMO/POS)
Aetna Health of California (HMO/POS)
Ventura County Health Care Plan (HMO)

*POS stans for point of service, or your classic PPO plans. . . [/quote]

I’d highly recommend Aetna Advantage PPO. I currently have a HDHP version of it but have also had low-deductible versions (when my premium was employer-paid). I’ve had two minor billing glitches which both got straightened out. Preventative care is 100% covered.

Hint: make sure you ask your dr to write your prescription for “generic,” (if avail) as brand-name drugs can be VERY pricey on this plan, depending on what it is.

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.

[bearishgurl]

[quote=ocrenter] . . . Here’s the top 10 plans in California:
Kaiser Foundation Health Plan of NorCal (HMO)
Kaiser Foundation Health Plan of SoCal (HMO)
Western Health Advantage (HMO)
Health Net of California (HMO/POS)
PacifiCare of California (HMO/POS)
Blue Shield of California (HMO/POS)
Anthem Blue Cross (HMO/POS)
CIGNA HealthCare of California (HMO/POS)
Aetna Health of California (HMO/POS)
Ventura County Health Care Plan (HMO)

*POS stans for point of service, or your classic PPO plans. . . [/quote]

I’d highly recommend Aetna Advantage PPO. I currently have a HDHP version of it but have also had low-deductible versions (when my premium was employer-paid). I’ve had two minor billing glitches which both got straightened out. Preventative care is 100% covered.

Hint: make sure you ask your dr to write your prescription for “generic,” (if avail) as brand-name drugs can be VERY pricey on this plan, depending on what it is.

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.

[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.

[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.

[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.

[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.

[Author]

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