OT: COVID-19 Megathread III (Please limit all COVID discussion to this thread)

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adsfan

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May 31, 2008
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We have the most expensive health care system in the world and we have 400,000 dead so far!

This country needs to make lots more changes to fix things.

Our state legislature in Wisconsin met at the request of the governor about the current insurance problem and for the second time they adjourned within one minute.

Meanwhile, a lady who drove up for a COVID-19 test was charged $3100. That isn't a typo.

Cases and deaths are going up here, again.

With 5,600-plus COVID-19 deaths, Wisconsin Republicans propose getting rid of mask mandate
 
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Adz

Eudora Wannabe
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The lady I was telling you about had been off the ventilator for 70+ hours this morning. I hope she has continued to be off of it but I haven't seen any other updates. Definitely a good sign, though.

Insurance companies put too much money in legislators' pockets, either directly or indirectly. It may be too late at this point but PACs and such really ought to have been monitored better to cut down on such conflicts of interest. I don't know what you do at this point. Even if it's legislated out, there are ways around the rules.

I have heard of high billings for tests, but my daughter and my sister have both been tested multiple times and it was free (to them--obviously someone paid). So what is the difference? Going out of area? Having it done at a doctor's office instead of where it's offered by the health department? One would think that a provider would caution the person receiving the test but maybe they get a big chunk of it. My sister had it done at one of the Doc in a Box facilities, Care something. She's had at least 3, and none cost her a penny. Not sure about where my daughter had hers done, but she's had 2 or 3, as well.
 
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triggrman

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Insurance companies aren’t the reason stuff cost so much, that’s in the providers. Insurance companies are actually capped on how much they can make, they have to give money back if they make too much. No restrictions on providers. That $3100 was billed to the insurance company from the provider. It actually included an $1800 facility fee, it was a drive up test, at a pop up tent.
 

triggrman

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We have the most expensive health care system in the world and we have 400,000 dead so far!

This country needs to make lots more changes to fix things.

Our state legislature in Wisconsin met at the request of the governor about the current insurance problem and for the second time they adjourned within one minute.

Meanwhile, a lady who drove up for a COVID-19 test was charged $3100. That isn't a typo.

Cases and deaths are going up here, again.

With 5,600-plus COVID-19 deaths, Wisconsin Republicans propose getting rid of mask mandate
Cases are actually going down there and the RT rate is at 91 which is good. 2500 test is way down from December numbers
 

adsfan

#164303
May 31, 2008
12,621
3,665
Milwaukee
Insurance companies aren’t the reason stuff cost so much, that’s in the providers. Insurance companies are actually capped on how much they can make, they have to give money back if they make too much. No restrictions on providers. That $3100 was billed to the insurance company from the provider. It actually included an $1800 facility fee, it was a drive up test, at a pop up tent.


There is a lack of coverage due to people being unemployed or being part time where they used to be full time and now they have reduced health benefits or none. I know at least one person who was "furloughed". In plain English, she has a job, she just isn't an active employee, so she has limited or no health care coverage until she is recalled, which can be up to 3 years. She just came back for 2 weeks for some special project, then she is back on furlough again.

We have something called Badger Care, which is like a state Medicare for the working poor and indigent. Our state legislature just pooped on those people rather than extending benefits or adding more money to cover more residents. Maybe we need a state referendum that 2 years from now the state legislatures get paid $1 a year and have zero health benefits! I would gather signatures for that.

So that one lady has to pay the cost of the entire tent? I say that is price gouging and the responsible party should be fined heavily, perhaps $5,000, to help put them out of business.
 
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triggrman

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Those insurance companies aren’t issuing the furlough, her company is, they can continue her insurance they just choose not too. That’s not the fault of the insurance company, that’s her company, they choose not to pay her insurance.

I agree on the price gauge for the facility fee. It’s ridiculous. AHCA or ACA or Obamacare, did some good things with preexisting conditions, but did not address the true problem, over pricing by medical providers and pharmaceutical companies.

Why cap the profits if the insurance companies and then not address the price gauging
 

Armourboy

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Jan 20, 2014
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Those insurance companies aren’t issuing the furlough, her company is, they can continue her insurance they just choose not too. That’s not the fault of the insurance company, that’s her company, they choose not to pay her insurance.

I agree on the price gauge for the facility fee. It’s ridiculous. AHCA or ACA or Obamacare, did some good things with preexisting conditions, but did not address the true problem, over pricing by medical providers and pharmaceutical companies.

Why cap the profits if the insurance companies and then not address the price gauging
Well that's what happens when you pass something to figure out what is in it. If you don't know what it actually is how do you know what it's going to really accomplish?
 
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adsfan

#164303
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Cases are actually going down there and the RT rate is at 91 which is good. 2500 test is way down from December numbers

Yes, our 7 day death average is down to 40 from 48 (Jan 16, 135 deaths) or 52 (Jan 21, 55 deaths). On Jan 15th, the 7 day average was 34, with 42 deaths. We need just one cluster in the state and it will zoom back up, perhaps to 53 (Jan 22, 49 deaths).

The Wisconsin state positivity rate averaged over 21% last week. That doesn't sound good.

Here is the most ridiculous link that I have ever seen for the non-red data above:

wisconsin covid 19 deaths - Google Search
 

PredsV82

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Insurance companies aren’t the reason stuff cost so much, that’s in the providers. Insurance companies are actually capped on how much they can make, they have to give money back if they make too much. No restrictions on providers. That $3100 was billed to the insurance company from the provider. It actually included an $1800 facility fee, it was a drive up test, at a pop up tent.

Actually (not in this case, obviously) the insurers dictate the prices in a really screwed up mechanism. For a given service, insurers agree to pay a percentage of the providers charge. The insurers want to make it look like they get providers to give a discount to them. But in reality it's just like these mall jewelers that always claim everything is 70% off. They just raise the "price" 70% then figure in the "discount". Insurers tell a provider they will pay 50 dollars for a certain service but only if the provider charges 120 dollars so it can look like the insurer got a hell of a deal.

It's really screwed up.
 

hockey diva

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Insurance companies are all about the bottom line, profits. Even supposedly non profit BCBS makes a buttload of money every year. For profits are concerned with impressing Wall Street. Others costs are billers, claim processors, along with all the minimum wage CSRs whose main job is to say no.

The ACA was a 1000 page doorstop with a few good things and a lot of crap.
 

Adz

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Insurance companies aren’t the reason stuff cost so much, that’s in the providers. Insurance companies are actually capped on how much they can make, they have to give money back if they make too much. No restrictions on providers. That $3100 was billed to the insurance company from the provider. It actually included an $1800 facility fee, it was a drive up test, at a pop up tent.
Yes and no. They negotiate the prices together and then point fingers, but it's all intermingled. Patients want private hospital rooms, not wards or even semi-private rooms. We want restaurant quality not hospital food and maternity suites with furniture and soft lights. So providers have those things that cost more money but don't really affect "care" at all. We want the latest research, cancer treatments and machinery, not a GP who will tell us "you shouldn't have smoked, bozo--here's some pain pills," because we want to smoke AND live. Between patient wants, technology, personnel of many types, and things we don't even know to add in, the providers have high costs. Insurers will pay some of it, not all. They negotiate to an acceptable level for both. Do we want to go back to wards and let them serve tepid jello and mush in order to lower costs? No. It's as much on us as it is the insurance companies and the providers--no one is blameless nor should anyone shoulder all of it. But there is a reason that insurance companies are sponsoring arenas and athletic events and have huge buildings. They're not living hand to mouth, I can tell you that.

It is excessive for the $1800 facility fee but that may have been a price negotiated with the government. And SHE is having to pay all that? She needs to negotiate with their business office (and maybe sue her employer for payment if she's furloughed and not unemployed. Not sure on her rights there.) I pulled the paperwork on my flu shot. There was a "total charge" listed of $492.56. Of this I paid $0 since it was covered by BCBST. BCBST paid $139.47. Pathology got $55.90 of that. So that seems fairly reasonable to me. And yes, Volde, I had figured the "discount" out. Ha! I've also found that going around insurance for prescriptions ends up costing me about 1/4 the price as insurance out of pocket costs.
 
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lstcyr

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The ACA was a 1000 page doorstop with a few good things and a lot of crap.

ACA was a document that was structured to get past the people who were opposing it so hard. It's not what the people who drafted it wanted but it was what they thought a certain group of people would tolerate. It did some good things but has been fiercely opposed for the last decade by a group of people who don't want regular people to have decent medical coverage.
 
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Armourboy

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ACA was a document that was structured to get past the people who were opposing it so hard. It's not what the people who drafted it wanted but it was what they thought a certain group of people would tolerate. It did some good things but has been fiercely opposed for the last decade by a group of people who don't want regular people to have decent medical coverage.
All I know is prior to it my insurance rates were going up roughly 4% a year, out of pocket costs were next to nothing, and it paid for dang near everything. The year after it passed its never seen less than a 15% increase with an average of about 21%. My out of pocket costs went through the roof and the actual coverage is pretty sorry.

So there is a pretty dang good reason people oppose it.
 

lstcyr

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All I know is prior to it my insurance rates were going up roughly 4% a year, out of pocket costs were next to nothing, and it paid for dang near everything. The year after it passed its never seen less than a 15% increase with an average of about 21%. My out of pocket costs went through the roof and the actual coverage is pretty sorry.

So there is a pretty dang good reason people oppose it.

Others had a different experience including the millions who were covered for the first time. As for your experience, if you were part of a company, then the ACA did not necessarily affect your premiums the same way, that would be your company's situation. In my corporation, at the time, premiums went up and coverage went down but that was a decision made by the executives and not a result of the ACA. Your situation could have been similar.
 

Armourboy

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Others had a different experience including the millions who were covered for the first time. As for your experience, if you were part of a company, then the ACA did not necessarily affect your premiums the same way, that would be your company's situation. In my corporation, at the time, premiums went up and coverage went down but that was a decision made by the executives and not a result of the ACA. Your situation could have been similar.
Sure they made that decision, but when a company is punished for offering too good of coverage at lower than expected rates your plan still sucks.

No one gives a damn about the millions of others when it makes their own situation worse.
 
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lstcyr

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Sure they made that decision, but when a company is punished for offering too good of coverage at lower than expected rates your plan still sucks.

No one gives a damn about the millions of others when it makes their own situation worse.
Guess they're not really Christians then are they?
 
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triggrman

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Guess they're not really Christians then are they?
I'm not here to judge how good of Christian someone is, I sin too much for that, and you know that whole, judge not lest ye be judged thing.

I just know the ACA is as thick as a phone book and has contradictions throughout. The only good thing I know that's come out of it is the preexisting condition inclusion. Seems like we killed a fly with a sledgehammer on a glass top table. But what do I know. I guess I should be thankful. My wife is works in healtcare insurance, she's need now more than ever, because most people don't know what's going on......
 

adsfan

#164303
May 31, 2008
12,621
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Sure they made that decision, but when a company is punished for offering too good of coverage at lower than expected rates your plan still sucks.

No one gives a damn about the millions of others when it makes their own situation worse.

My company had a "Cadillac Plan" according to the Obama administration. We lost a benefit or two, but the cost has been fairly flat over the last 5 years.
 

Adz

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All I know is prior to it my insurance rates were going up roughly 4% a year, out of pocket costs were next to nothing, and it paid for dang near everything. The year after it passed its never seen less than a 15% increase with an average of about 21%. My out of pocket costs went through the roof and the actual coverage is pretty sorry.

So there is a pretty dang good reason people oppose it.
The portion of the ACA designed to give people who are self employed or otherwise unable to be on group plans a way to join one is a good feature. I've compared the numbers and they are very close to what I see proposed to our group for similar plans. Had they left it at that and used another bill to address problems with group insurance would have, in hindsight, been a better way to go.

I've contracted the insurances for our company for around 25 years. We had some "proposed" 30-40% increases and one 60% increase to plans long before Obama took office. Most years it was 15-30%. After ACA they've been steady at 8 - 25% IF they offer the same plan. My employees never see this because I spend July -August poring through spreadsheets trying to find something we can all afford with similar features. Many years the decent policy I found the year before is "discontinued" and the substitute plan is much higher. They can't raise the prices over x% for your current plan--but they can discontinue your plan. All my employees see is "you will pay this much more and you will get this much less" but they have no idea what those things would have been. Without adjustments on my end, we have, in 25 years, never seen 4% increases over identical plans.

ACA mandates really added to the overall cost of premiums, though, far more than I realized. My son has a "non ACA" plan since they're legal now. It's $25 copay and reasonable deductibles. He doesn't need colonoscopies, well child care, prostrate exams etc, so it works for him. It was $200+ less than what he had originally gotten on the exchange-- but exchange premium is about what we would pay for someone his age through our company. And that's considerably lower than what you'd pay for individual insurance. It went up $10 between age 29 and age 30, still an 8% increase.

Also, I agree that companies shouldn't have been penalized for offering the best insurance. Maybe if only certain executives got it and the rest got $20000 deductible plans. But yeah, that was a puzzler to me.
 
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Armourboy

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Jan 20, 2014
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The portion of the ACA designed to give people who are self employed or otherwise unable to be on group plans a way to join one is a good feature. I've compared the numbers and they are very close to what I see proposed to our group for similar plans. Had they left it at that and used another bill to address problems with group insurance would have, in hindsight, been a better way to go.

I've contracted the insurances for our company for around 25 years. We had some "proposed" 30-40% increases and one 60% increase to plans long before Obama took office. Most years it was 15-30%. After ACA they've been steady at 8 - 25% IF they offer the same plan. My employees never see this because I spend July -August poring through spreadsheets trying to find something we can all afford with similar features. Many years the decent policy I found the year before is "discontinued" and the substitute plan is much higher. They can't raise the prices over x% for your current plan--but they can discontinue your plan. All my employees see is "you will pay this much more and you will get this much less" but they have no idea what those things would have been. Without adjustments on my end, we have, in 25 years, never seen 4% increases over identical plans.

ACA mandates really added to the overall cost of premiums, though, far more than I realized. My son has a "non ACA" plan since they're legal now. It's $25 copay and reasonable deductibles. He doesn't need colonoscopies, well child care, prostrate exams etc, so it works for him. It was $200+ less than what he had originally gotten on the exchange-- but exchange premium is about what we would pay for someone his age through our company. And that's considerably lower than what you'd pay for individual insurance. It went up $10 between age 29 and age 30, still an 8% increase.

Also, I agree that companies shouldn't have been penalized for offering the best insurance. Maybe if only certain executives got it and the rest got $20000 deductible plans. But yeah, that was a puzzler to me.
Well I worked for a very large company at the time so what they were able to negotiate wouldn't be the same as many businesses would be. It was one of their big selling points to work for them so they had an entire team dedicated to controlling costs. The way they viewed it if our costs were less that meant theirs was too so it was in everyone's best interest. I kept track of the numbers over the years so when it jumped I started asking questions.

The tax on the cadillac plans was silly and never made any sense at all. It was literally the government telling businesses and employees that their coverage was too good and cost too little. Something that should have been praised ended up being destroyed.
 
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PredsV82

Rest easy, 303, and thank you.
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ACA was a document that was structured to get past the people who were opposing it so hard. It's not what the people who drafted it wanted but it was what they thought a certain group of people would tolerate. It did some good things but has been fiercely opposed for the last decade by a group of people who don't want regular people to have decent medical coverage.

The biggest benefit of the ACA as far as coverage goes has been medicaid expansion to allow working/underemployed/ lower income adults to have insurance. These are people who previoisly had no coverage their entire life and previously let themselves get gravely ill before seeking care.

But the ACA also screwed the lower middle class by making them purchase a plan that, due to mandated coverage of preexisting conditions, would become very expensive once the government stopped subsidizing those plans.

We eventually have to get to a public option that's available for everyone and is means tested, with the option for those who want it to purchase private insurance
 
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Legionnaire11

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The ACA is imperfect for several reasons. But I also think a lot of complaints about it have more to do with how individual employers chose to react to it.

Where I worked at the time that it was passed, the company cut almost everyone's hours to below 30 so that they didn't have to offer them insurance. That's an awful thing to do, but it's not something to blame the ACA on, it was the company that chose to do that.
 
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FossilFndr

RIP Steve
Jan 18, 2014
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The ACA saved my life, I own a small farm and had no insurance at all. I was not fortunate enough to have a business paying for most of my health care insurance as a benefit. I always had to pay 100% of all health care costs. Fortunately I got affordable access to a policy through the ACA. I had un-diagnosed developing condition(s) that would certainly have taken my life if I did not have access and ability to pay for some high dollar medications including Cosentyx that retail cost is about $4500 a monthly dose plus Trulicity for type 2 diabetes @ over $900 a month. Trust me a small farmer could not afford that level of base monthly med costs.


Glad that the Tennessee Rt number is now so low, one problem with Cosentyx is that it is a IL-17 inhibitor that reduces the effectiveness of vaccines including the COVID vaccine.

upload_2021-1-26_9-58-1.png
 
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