Medicare Advantage is great for people who rarely get sick. But remember - if you are a Medicare Advantage participant- YOU ARE NO LONGER A BENEFICIARY OF THE MEDICARE HEALTH PLAN. If you break a hip or have some other incident in which you need swing bed services - don't count on your plan covering the cost. It isn't in there. There also isn't a secondary insurance option. It'll have to come out of your pocket.

One more thing - remember our government pays PRIVATE insurance companies to manage Medicare Advantage. These companys are making money off this sytem - if they weren't they wouldn't be in this business. Insurance companies are in business to make money! So it may cost you less in premiums, but it is costing the "system" more and again, an insurance company is profiting from our taxes.

Ah, but some will have you thinking change is much scarier than the status quo.

I have Kaiser Medicare Advantage--they are a non profit.  This Democratic plan will take away my coverage that I worked for all of my life.  I should not have to pay for dead beats that want the government to pay for all their mistakes.  (multiple children that they can't pay for)  Obama told the school children to be responsible---he should tell adults to be responsible for their decisions also.

You are fortunate to have Kaiser Medicare. My father-in-law was not so fortunate. He enrolled in a Medicare Advantage plan because he thought it provided him better coverage than Medicare. He paid dearly for that decision. Last year he died after being forced to leave the hospital too soon and being placed in a subpar nursing home. We complained after finding him numerous times when we visited, left to suffer after falling out of bed at this nursing home but were told that nothing could be done because that was the only nursing home with beds available on the list of nursing homes that the Medicare Advantage plan would pay for. The Medicare Advantage plan was only interested in maximizing their profits and not in properly caring for a sick elderly man. He died needlessly because of their greed!

You know... it just amazes me sometimes. Some people would believe the rumors, the inaccuracies, the LIES that those who are against any health care fix will spread, rather than believe President Obama when he directly addresses these rumors as just plain NOT TRUE. Is there a lack of understanding the English language?

there is absolutely NO doubt that, if left unchecked our current system of health care will implode in the not too distant future. The system needs a fix, and needs it now. Our President is trying to accomplish this monumental task, with or without the input of the Party of NO. The ignorant outburst by one Repug at the speech earlier this week, only demonstrates the fact that Republicans reject anything and everything our President says, not to mention any Democrat who is working for the public good with health care reform. I am convinced that this goes much further than a Republican unwillingness to work together, compromise, and face a very difficult issue. They are STILL crying like babies.... spoiled rotten babies at that, because they didnt win the election. They will sit in the corner, sulk, and hold their breath till they turn blue, before allowing themselves to get involved in a constructive, productive discussion on what this new health care bill will look like. That being the case, STOP being babies... put constructive ideas on the table to be discussed. Republicans in Washington.... either you are part of the solution, OR you are part of the problem in getting to a new health care system. Personally, I think you're part of the latter, rather than the former.

Grow up, be responsible adults, and be part of the solution or just get out of the way.

I love it when I actually see an intelligent response in this forum-thank you. It takes a certain amount of intelligence to see the big picture, be able to think for your self, and be able to distinguish fact from fiction. Oh, I forgot. If one is intelligent, then they are an "elitist".

LEP- the repubs have offered two such bills, excellent in my sight. And again, let the Dems quit crying- EVEN if we wanted to we couldn't do a thing to stop health care- you have the house, the senate-with 60 votes- and the WH- do whatever you want to do, and don't piss and moan when we tell the truth- DO WHATEVER YOU WANT- we will all see you at the 2010 elections

right on go fins!!!

Lep1230: I hear you . . . Itemizing your complaints re: Republicans. I am amazed at your ability to so clearly elucidate the behavior of the Democrats over the entire span of G.W. Bush's two terms. I am, and will remain an Independent.

Absolutely need insurance reform, this mess is the unintended consequence of moving health insurance from the free market to the corporations we work for. BUT the idea that we are going to save money by paying doctors less is absurd- and that is the only thing this bill does.

Steph,

BUT the idea that we are going to save money by paying doctors less is absurd- and that is the only thing this bill does.

Oh, really! I think they should have only taken a day or so to get it written if that is the case. They have a panel of doctors also helping them write this bill. How do you think that is going over with them?

You know, your exaggeration doesn't make exactly add to your credibility.

BTW...The insurance companies already pay doctors pennies on the dollar. It is wrong and also needs to change.

TL- not sure what the exaggeration is the bills do nothing except pay less. There is absolutely not one thing in the bill that will reduce costs. The bills all are a boondoggle for insurance companies by requiring people to buy policies. There is nothing that reduces costs, just payment. Reducing cost means outlawing smoking, obesity and couch potato behaior. Reducing cost requires outlawing alcoholism, speeding, drinking and driving. It is our behavior that costs us so much, not our doctors

Dear Waterdog

So your telling me that the $20,881.00 bill that my insurance company paid on my behalf to my local hospital is their fault? I was in the hospital less then 24 hours, omitted at the ER at 5:00pm for my appendix, at 10:00pm I was in the OR, woke up in recovery around midnight, in my room by 1:00AM was ready for discharge at noon the next day, duty nurse waited tell 2:00pm, when I started to complain she said she wanted to wait tell the next shift came on so they would have to discharge me. I was up and walking the floor by 9:00 AM, the charge just for my room was $549.00, now my wife and I by no means are rich, this past year I have taken a deep cut in pay, a reflection of the economy (paid on commission) but I have in years past stayed in some pretty nice hotels that didn't even come close to $500.00, this charge wasn't for any Nursing staff, just my room and board. I am not a fan of the insurance company's, I think they are they biggest shyster's out there, along with banks, but in reflecting on my bill I think my local hospital could make their pricing......less inflated.

lilred...I have heard that the hospital's bills are so inflated because those of us that are insured or do pay are paying for the unisured or those patients that didn't pay their bills?

How true is this? Someone in the medical profession/billing help me out here. If this is true, those that are SO scared that they will be paying for someone else's healthcare...you have been doing so for a very long time.

The cost of the room did include your nursing care, and often other respiratory and aide care. These services are not charged fee for service like pharmaceutical and Physical Therapy. The charges are for a 24 hour period, and staying til the next shift would not increase your bill. I do not have insurance, and when I had a knee scope I negotiated a cash price, it was about 1/3 the price. There is no professional courtesy any more.

Cost shifting, TL, is illegal. However, it happens all the time.

I would like to see them run a story on the root cause of the cost of health care (something the democrats refuse to comment on and the media doesn't cover when a Republican brings it up). Liability lawyers and frivolous lawsuits cost insurance companies BILLIONS. Some lawsuits are warranted like removing the wrong body part in an amputation or something like that, but we all know people who would sue at the drop of a hat.

Make it where if the jury of peers rules unanimously that it is a frivolous lawsuit, the plaintiff is guilty of attempted grand theft or insurance fraud and responsible for any damages or slander to the defendant.

I firmly believe that a HUGE part of the cost in medical care is all of the unnecessary duplication in billing. My son just broke his arm last Friday. Now I will get a bill from the hospital for the ER, a bill from the Trauma Dr., a bill from the radiologist, a bill from the Orthopedic group, a bill from the anesthesiologist, a bill from the respiratory tech, and a bill from th hospital pharmacy. SOMEONE EXPLAIN TO ME why I don't get one bill for all of these services listed from the hospital billing department. Then when I pay that... They can pay everyone else who just happend to be working there that particular day.

When I take my car to get it fixed I don't get separate bills from the Service writer, the dealership, the parts department, the mechanic, the waste disposal company, the guy theat mops the floor and the guy that drove me home... I get one stinking bill.

Maybe if there weren't 100 people involved in shoving billing paperwork around between all the medical providers and insurance companies they could reduce the cost of healthcare!

If the cost of the romm included the nursing staff and care, then why was there a seperate charge for RN services, which I could only conclude being the nursing staff. On top of that, they charged me for a blood panel, type and match I believe is the correct terminology, I told them I was 0+, they stated that they have to do this, yet they ask a person if there allergic too any drugs and for their past medical history. Taking a persons word for it, why could they take my word for what blood type I am. They also charged me for $43.50 to check my blood sugar, I'm a diabetic, my own fault eatting too much MC'ds, they wouldn't allow my meds in the hospital, and I had my meter with me at the time and could have done this myself.

Flyover- You are right, BUT legally (read federal regulation) all physician services have to be billed separately, and I agree that this is a huge expense. Hospitals are not allowed to employ docs.

The issues you bring up are interesting. If there were separate charges for RN sevices I would insist on those being explained, and documentation that the services were rendered. The T&C is absolutely necessary. We cannot take your word because of laws and regulations. In Fact, if your T&C were done at one hospital, and you were transferred to me I would have to repeat the T&C before giving blood. Now, you can question why they did a T&C for an appendectomy. I do them every day and don't do a T&C. The allergies we have no way to test for, because believe me we would. Most people do not know their histories or even their medications!! I have had people have reactions to meds and then say- oh yeah I'm allergic to that.

That is SO true, Flyover! It is nearly impossible for anyone that is not familiar with medical billing/coding to understand those things. I think the codes are submitted by doctors offices, and I read just a week or two ago on MSNBC that bills are wrong 80% of the time according to Candy Butcher, CEO of the Medical Billing Advocates of America. Maybe the story is still somewhere on MSNBC. The story was about a guy named Scott Fedyshyn and his experience with a bill he fought back on.

The article cited double-billing, typos, upselling, and outright fraud as the common causes of bill discrepancies.

There is a cottage industry of billers who review bills for insurance and individuals and there are errors on about 80% of bills. Most of these are not substantial, but money is money. I had the occassion to work with a doctor who would place a one in front of whatever appropriate anesthesia units were on a bill. If they ddn't notice, and paid the bill, great! If they did oh dear it was a clerical error- he was a jerk. I reported him to CMS- nothing happened.

Sometimes I dont think the hospital staff understands the codes. My wife went in for blood work and insurance wouldnt pay for it because it was coded wrong. I didnt find out about it until I saw it as a collections on my credit report. By then I had already changed jobs and insurance cos. Never could get them to pay.

That is one of the favorite ploys- if you don't submit a 'true bill' within a certain time they don't have to pay. They send bills back for spelling errors!

Allen...do you REALLY want to know what the "root cause" is ?? The "root cause", as you put it, is people's lack of personal responsibility for their own health. It's the gov'ts failure to make laws which protect the health of American citizens from the tobacco industry, the alcohol industry and the BIGGEST culprit of all ... the FOOD INDUSTRY. It lies in the fact that Americans have become some of the LAZIEST, UNINFORMED, LACADAZICAL, IGNORANT people on the planet. We have brought around our own demise by letting these industries lie to and deceive us and because we're too damned lazy to cook for ourselves, think for ourselves, learn about proper nutrition, teach our children about proper nutrition, DEMAND proper nutrition and make the effort to CONSUME food that is healthy and nutritious. REAL FOOD does NOT come in a box/can/bottle. REAL FOOD does not have 101 ingredients with chemical names which cannot be pronounced. REAL FOOD is not created in a laboratory by "scientific nutritionists". We need to stay away from entirely or exhibit great moderation when indulging in vices such as alcohol and tobacco and avoid drug use altogether.

The gov't is at fault for not protecting us from industries that have HIJACKED the food and created a multi-gazillion dollar industry that creates "franken-foodstuffs" to replace REAL FOOD which destroys our health with chemicals, preservatives, carcinogens, toxins, GMO ingredients, artificial colors/flavors/ingredients, hydrogenated oils & trans fats, etc.. The gov't does not mandate that our children receive education in basic home economics and nutrition courses in our schools like it did years ago. Nor does it require our schools provide physical education to keep our children in healthy physical shape, as it did years ago. They don't even make sure that schools and other institutions provide NUTRITIOUS meals in their cafeterias !!!!

I know it's not ever probable that alcohol and tobacco will ever be banned. At least the gov't finally got the BALLS to regulate the tobacco industry and hopefully the same will come of the alcohol industry. There are always those ignorant dependent souls that need their self-destructive detrimental vices. But.... THOSE people actively contribute to their own poor health and they SHOULD be penalized for it, as should those who consume foods that are known to be health risks. Yep.. they should either be taxed or charged MUCH more for their healthcare. PERSONAL RESPONSIBILITY is the key. Those who ARE responsible and practice PREVENTATIVE health care by eating right, avoiding alcohol, tobacco, drugs, etc should be REWARDED and the Gov't needs to step in and regulate these industries, starting by eliminating lobbyists, special interest groups and by forcing them to eliminate harmful ingredients from our food supply... or FAUX food supply as it currently stands.

We can't rely on the gov't though... we have to rely on OURSELVES but the Gov't should clearly provide incentives to do so. THIS is the only real solution to soaring health care costs. Preventive healthcare and nutritional education and penalizing those who refuse to take responsibility by making their burden THEIR burden, not ours.

Let me add too that the Gov't needs to STOP subsidizing giant mega-corporations and Big Pharma and go back to subsidizing small farmers and small businesses that promote healthy lifestyles and produce quality, healthful products and to promote and educate people about alternative health care and natural ways to take care of ourselves which would reduce health care costs by billions of dollars AND keep more money in our own pockets. Natural health care and prevention is extremely economical and safe and most non-lifethreatening issues can be practiced without the need for doctors, hospitals, insurance companies, etc.

absolutely gemini!!

Though you do need to know what you are doing. I cared for a woman who took ginko, vitamin E garlic and several othe supplements-long story short many of her supplemens "thinned the blood" leading to a problem clotting. She fell in her driveway, had bleeding into her spine and had to delay emergency surgery for transfusion so her sugery was safe- KNOW the supplements you take- take them wisely- and tell your doctors!!

Thank you all for an excellent discussion.

Gemini, Here is a seeded link to an opinion piece that I found in the New York Times earlier this week. http://leonahardware.newsvine.com/_news/2009/09/10/3246609-big-food-vs-big-insurance

The government absolutely should not be subsidizing Big Ag they should be looking out for the smaller, more health savy vegetable farmer.

The insurance companies who rob the American people are 21st Century "Slave Masters". They own the very lives of the American people. FDR spoke about this--they are the "new tyrants". Freedom now. Public Option now to save us from the "New Tyrants". The new "Slave Masters".

To doctorsteph, Re: T&C: This happens to be something I know about as I work in healthcare.  There are several sub-types of blood beyond ABO+-. In order to make sure that you will not have a reaction to the blood that you are recieving, they mix some of your blood with some of the blood that you will be recieving to make sure that no reaction occurs. This is for YOUR safety, and if they did not do it and you did have a reaction, then you could (and probably should) sue the hospital for negligence.

If you paid for the check ups out of your pocket- the way you would pay for an oild change or tune up- you wouldn't drive up the costs. Not you personally, but multiply this over the whole population. Insurance is to prevent catastrophy- NOT every expense. We need insurance reform, but we have to use it wisely too. HEALTH CARE COSTS MONEY. we seem to have forgotten that.

Sounds like you need to reform you family not the medical system....

Why should we all change because you had nasty siblings?

One of the issues that must be addressed is the INSURANCE INDUSTRY and their ability to cherry pick whom they cover. Force them to offer reasonable coverage to all and it drops the risk-pool.

I don't care how much the Insurance carriers whine, they ARE able to adjust and can handle the cost vs. their outrageous profits. PROFIT is not a dirty word, but the way it garnered is obscene.

Also....reality of life. Premiums WILL go up as you get older.

Example: Husband & I owned the Company, it paid my medical. At age 55, a Divorce gave me $$ but husband got the business. I was now an EX employee. I was also unable to continue working, thus NO new employer/insurance.

I went onto COBRA and my premium (PPO) went to $500. a month. 18 months later, I had to find private coverage, cholesterol level gave me a virtually un-insurable status. The Insurance plan I had been on for years REFUSED to cover me any more.

Found another one, lesser coverage; premium was $600 a month. By the time I hit 65, my monthly premium was at $925. a month. Same policy, carrier.

However, during that 10 year interval, I had 3 surgeries and the costs of them exceeded the total premium I had paid. So - overall it was a plus, although I don't know of many people who would have had the means to pay the annual premiums for 10 years.

I was lucky....so many are NOT.

dear big- you have a very clear vision of the course of what happened. You were fortunate, and I am glad. We still need reform for the insurance costs.

No- there is no way to self insure. The reasons have to do with the disproportionate share of sik people the plan would attract, and the fact that people use HCI for every expense.

When it comes to the public option we need an honest debate on what checks will be put in place to prevent it from driving out all private competition.

First - The Public Option cannot be subsidized by the government in any way. If it is the only affordable plan for sick people, all the sick people will flock to it. This will result in either increased premiums (which wouldn't make it affordable) or would require government subsidies. It cannot be allowed to take government subsidies because private insurance isn't subsidized, thus it would drive private insurance out of business.

Second - The Public Option must negotiate its own reimbursement rates. It must reimburse doctors at a competitive rate. It cannot use Medicare reimbursement rates, unless those same reimbursement rates are extended to all private insurance providers (again because it will drive private insurance out of business.)

Third - Enrollment in the public option must be limited. If the public option grows too large, it reduces competition and creates the very problem it is designed to eliminate (lack of competition.)

Unfortunately these issues have not been addressed, in fact they have all been said to be opposite. Everyone can enroll in the Public Option, the Public Option will reimburse healthcare providers below market rates (but still 5% higher than Medicare.) The only thing that is ambiguous is how much the government will ultimately subsidize the plan to keep it "affordable."

All of the President's platitudes that the Public Option will not become a Single Payer system are completely meaningless as the bills are currently written.

Absolutely James, Prez is on vid saying this is the best way to get single payer which he prefers. So is Barny Frank

That is what makes me scratch my head. I don't hear anybody talking about a single-payer, which would fix our problems and be less complicated than a public option. And let's face it, with talk of death panels and other BS rhetoric that most idiots believe, we need the most simple solution for the simple people to understand. That way there is no "confusion". FIX THE PROBLEMS WITH MEDICARE AND GIVE IT TO EVERYBODY. SCREW PRIVATE INSURANCE COMPANIES IF THEY GO OUT OF BUSINESS, THEY ARE THE REAL DEATH PANELS.

No, they don't realize this. They not interested in hearing the facts, but are hearing and spreading the "tall tales" like wildfire. Buying into the scare tactics, angry about something that doesn't exist, and shooting themselves in the foot at the same time.

I think even those inventing the "tall tales" about health insurance are probably a little surprised at how little fact-checking people are willing to do before spreading the garbage.

Sorry to burst your rumor ridden bubble, but all the bills contain a provision to reduce medicare and medicaid payments. That means more doctors and hospitals ( nurses and therapists) will stop accepting this "insurance" so there will be reduced choice, reduced availabilty, and ultimately less care. Many hospitals are closing their Emergency rooms in favor of Life support units- the VA did this ages ago to shift emergency costs to the private sector.

Steph, The bill is not signed. Don't get your nickers all balled up.
What page is this information on? I would like to check it. Also, if your information proves to be true after fact-checking, since they are trying get rid of programs that don't work and replace them with more effective programs, have you checked to see what they are replacing it with?

How very small of you.

If checking facts and not exaggerating is "very small" to you, then yes, I am very, very small.

Seems like Truthlover was asking a legitimate question--why the snide remark?

when someone refers to knickers- and mis spells it to boot, it is offensive. Leading with that instead of the question was what I was referring to . I would have to know which BILL you want to know about before I can send you to a page, as you well know. You say you are about facts, but you are about name calling.

Yes, let's distract from the real subject and talk about typos. I am sure you have never made one.

Anyway, I am not going to stoop to your level. I simply have not been able to read the entire piece of legislation...and in fact, some of our politicians have not either. Have you? I would like to be responsible about what I am saying, so when someone speaks about or publishes information, I like to be responsible and check the facts before I proceed with spreading it as fact. Too much fiction spreading around and I am not going to contribute to it.

How small of me.

By the way, I am human and will make typos as everyone does. Since you are perfect, feel free to point them out for me so you can continue to avoid the facts.

Sorry...forgot to ask Steph, what name did I call you?

I think there are strange things going on in your head, because anyone can see that I did no such thing.

You don't know what you are talking about, and you disparage me.

"knickers" isn't that a reference to underwear? and "mis spell" is a misspelling. lol Stop arguing over trivial things. Stick to the topic...sheesh!

I'd say that anyone who wants the government out of their life won't accept Medicare coverage and will not accept their social security check, in which case just send the funds to me and I will make good use of the money.

There seem to be quite a few people who DO NOT realize that Medicare is government run insurance. I have no idea who they think pays for it.

Who told you that they don't realize this? The right has been using the failing Social Security and Medicare as examples of why this plan will fail for MONTHS. I think you've been spoonfed misinformation by the left only designed to drive a wedge in between the parties so you won't listen to what the other half of the country wants. Really, if you honestly believe this, your media source is too liberal because what I just stated is MAJOR news on other media outlets.

glorida dear, i pay for my medicare now and paid into it before i was eligible, the good news for me is one day you'll be my age.

peggy, and what about those of us who are paying now and in the future, but won't get s*** when we're your age - or are you a typical old person who doesn't care about future generations

gk yes i care about future generations, and no i'm not an OLD person, i still pay my taxes. and by the way gk i was paying for the generation before me as you are. if you have a problem with that talk to your government if you believe that you'll get a straight anwser! by the way, i have children and a grandchild, if you want to complain, suggest to our wonderful washington reps about their frivoulous stimilous package, cap and crap and the porkulous!!! and gwb is no longer pres. and while you're at it ask you're congress why they're lineing their pockets at the expense of ALL of us.

One of the greatest misconceptions is that people on SSI or social security don't pay taxes- and if you think you can survive on that forget it. My Dad has Naval ret, hosp retirement and ssi and I still have to supplement. They have 3 different insurance carriers and they really well covered. But get hit with a 4000 dollar tax bill, and it blows your mind. Wasn't the ssi a tax I paid, you want to tax military retirement?? WTH??

It's funny how Medicare is a social insurance program at some times and therefore an "entitlement", and at others it is a welfare program run by the government.

Only in the Health care reform debate do you find Liberals calling Medicare a welfare program. It suits their purpose of being able to rob one program to pay for a new one and still look fiscally responsible. At all other times it is an "Entitlement" that they have "paid into."

According to President Obama's speech earlier this week "Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan." The only waste that can easily be eliminated from Medicare and Medicaid is how much they pay for the health care of those covered by the program (that is a cut in benefits for those of you not paying attention.) Otherwise the "waste" and "inefficiency" would have been eliminated ages ago because it is such a perfect program, right?

It is also funny how quickly ignorant liberals propose that conservatives should opt out of the benefits of Medicare and Social Security, but do not offer the option of opting out of the TAXES THAT PAY FOR THESE PROGRAMS. I would gladly opt out of these programs if I could ALSO opt out of the 15.3% (12.4% for Social Security and 2.9% for Medicare) TAX on every cent of my income.

Go back to school, go on medicaid.

sure doc send me a check. i guess working all my life means nothing to you.oh and paying taxes and paying for house car and health ins. give it back to me

There is a program for people displaced from work to be re-educated. I was not being flippant- truly these programs are funded in the stimulus bill, please use it. Then, your family would be eligible for medicaid, and may be eligible now. You can call your congressional rep for the particulars.

why do you think i need to be re-educated ive been in the auto industry for 40 years .i have pre-existing conditions that wont allow me to get the same or equivalant health care that I already overpay for.its going to take along time to find another job. my retirement is in the property i own besides my house that i coud loose due to [hopefully not] some up comeing health issue for me my wife and son . we are at that age things start to happen.

In your first comment you asked what you should do. In this economy, education is currency. Unfortunately, manufacturing is shrinking as you have found out. I was trying to be helpful, those programs are there. If you are eligible to retire- God Bless you and enjoy it.

thank you , but retirement wont be for years . someone has to pay the bills now unemployment and other programs probably wont either . now if healthcare dosnt change for the working class we are in big trouble .but we need to look at are past to see how we got to this .this is america and the insurance companys have turned into the mafia

I am no fan of the insurance companies, and I do think we need reform. Unfortunately the "reforms" are all about decreasing payments to doctors which will decrease access.

iam in the autobody industry. insurance allready did that to us. a good docter should make a real good living . but maybe theres a better answer . its not done yet

That was absolutely unconstitutional

There was no Supreme Court ruling that it was unconstitutional...we should send it to them for a ruling now that Sotomayor is on the bench.

Do you need the supreme court to tell you that a program the President withdrew so quckly was unconstitutional??

Not for me, but an actual SC ruling would help keep it from being repackaged and trotted out again and again...

True!!

They do not profit from denying care, though they and medicare and medicaid routinely deny PAYMENT ( yes there is a difference) That said, we need insurance reform.

OK, I can see you are about semantics.

Denying payment is not the same thing as denying care if a person cannot afford $50k for treatment?? Before providing expensive treatments, doctors don't make sure they are going to get paid??

Please don't be so very nasty- it isn't necessary. The problem we have is that this is how insurance companies get away with this. I agree we need insurance reform, including med mal insurance reform, but making me out to be chicken little or ignorant only alienates someone who probably agrees with 80% of what you want. By alienating people like me you lose ground.

And by the way. NO DOCTOR will stop treating a patient because they won't get paid. We can't- we would lose our license and/or our ability to participate in medicare/medicaid. HOSPITALS, pharmacies and manufacturers are allowed to do this.

Maybe I need to change doctors since mine either wants my insurance up front, or he wants some sort of pre-payment. I guess that is just my doctor. See, I learned something new.

I don't understand why you are so defensive when I ask you legitimate questions since you are in the health care industry.

The doctor is allowed to " expect payment at the time of service" but they should not require payment up front, unless there has been an issue with your payments before. There is generally an initial paperwork that has to do with payment, and initially there may be a payment required. Once the relationship is established however they are ethically bound to treat you or sever their relationship with you legally.

Steph,

Wow! I like you when you are civil:-) I appreciate the answer, and I think someone else that reads your answer may learn something.

Please re-read my posts...I did not call you any names, so I don't know why you said that. I also mentioned "coverage, not "care". It is OK...I realize you may have just been upset because I didn't agree with your first statement that the ONLY thing the bill does is pay doctors less. Hope you can see now that I just want the facts and if someone can tell me exactly where it is in the bill I would love to get it that way.

Now, about those other questions....

Peace to you.

And by the way. NO DOCTOR will stop treating a patient because they won't get paid. We can't- we would lose our license and/or our ability to participate in medicare/medicaid. HOSPITALS, pharmacies and manufacturers are allowed to do this.

Doctorsteph, so what field of medicine do you practice? I have a pre-existing injury related to military service. Denied by the VA countless times, they state that the nature of my injury was not do or aggravated by my time in uniform. Kind of funny considering I was on morning Physical Training, something I don't think I would have been doing at the time if I weren't a Marine. Have asked numerous Doctors to fix my knee, they state its only arthritis and I don't need surgery, which totally contradicts what was done twenty years ago at the time of my injury.

I have to pay my DR immediately when I walk into the office, and it's a co-payment. If I don't make the co-payment, I don't get to see the DR.

Who do I sue?

THANKS!

Your copayment is a contract between you and the INSURANCE company. We cannot bill insurance if we have not collected the copay- it happens all the time with surgery and anesthesia- whoever files the first bill has to collect the copay- it is a mess. You can't sue anybody, because it is in your policy, which you tacitly accepted when you accepted coverage.

I am not sure what to think about your knee, lilred. It is true that knees get arthritis. It is also true that government denies care as much as other insurance entities. I suggest you request the help of your congressional rep- constituent service is their job. They are your best bet in dealing with Tri-care or the VA

Went that route, after dooing numerous, favors for my Congressman. I work in the auto industry and he collects old cars.(not a salesman, but better I sell Parts) and he stated that he couldn't help me. Which is power for the course since the last letter I sent him, his response was the exact form letter one of my wifes employees recieved. Didn't even address my concerns at all. The How will we pay for this, Who will be covered and How will this effect me, my wife and our employers. Really think Washington doesn't care and just doesn't get it anymore.

If you are in ND, you could seek care at one of the Catholic hospitals. Otherwise you can move to Tarrant County Texas where we have one of the best integrated health systems in the country and you would be eligible from day one. You could also seek care at a medical school. Good Luck

drsteph, I am a 48 yr-old Disabled Female in SD, (just south of ND) and yep, we've got the Avera Presentation Hospitals/University Providers {sic Catholic Hosp.} and they have this totally unintelligible 'new' billing practice! They have several "specialty clinics/hospitals" of which the billing is now magically? split 50/50? So, I get bills from the clinic I was treated at, AND the 'Avera Entity" itself? I'm still trying to wrap my brain around it all! Did I mention I am DISABLED? Ergo, on Medicare; which is another cluster..; And yep, I DO have the 127 page book Medicare & You; 2009! Great for...Insomnia??? I am STILL clueless on my 'required' co-pay, with just the parts A&B! Any thoughts? I'm currently struggling to get MEDICALLY NECESSARY Oral Surgery, due to concommitant dentition nastiness and a prominent Coronary Condition. Yep, they'll shell out Thousands for me to get a Pacemaker, but not the $1,800 for the pre-denture surgery, at a Surgical Center! (Yes, my Disability Back-Pay went on account to the Dentist, and Dentures have been molded and ready to go since 4/09!!) $7,000!! out of pocket, and these folks won't even SCHEDULE the Surgery until... the Cow jumps over the Moon??? How about "Mandatory LIFE Insurance", since that is where I am headed, if this silliness doesn't get resolved!

This is a particular issue, and I feel for you. Where I work we regularly have to do the extractions, because we have a dental residency for oral surgery- but we don't have a heart surgeon if soemthing happens- they do the heart surgery elsewhere. This will sound like a broken record but call your congressman. This is a winnable fight, we see it all the time. Incidentally, you paid 7k out of pocket because dentists refused to be part of medicare/medicaid. I have treated so many people for an abcessed tooth that I cannot do anything about, and dentists have no obligation to treat. I give ABX and pain meds but it won't go away without a dentist.

Doctorsteph wrote: "NO DOCTOR will stop treating a patient because they won't get paid."

That is an out and out LIE. 10 yrs ago I was in an automobile accident and was under the care of a neurologist. When my policy limit was reached he REFUSED to continue my care and also tried to SUE me to collect already given care that my policy didn't cover. So peddle your "crock of s*h*i*t elsewhere. That doctor's refusal to continue with my healthcare resulted in my having 2 strokes, which by that time were not covered by ANY insurance because I was "uninsurable" because of pre-existing conditions.

On another note.... I was in another auto accident 2 1/2 yrs ago. The only insurance I had was my auto MedPay plan which I paid EXTRA for to increase the coverage to $15K after what happened last time. Only THIS time... no hospital, specialist, specialized clinic or treatment facility would even ACCEPT this insurance. They wanted regular insurance like BC/BS, Aetna, etc or CASH.

I was injured, out of work, have been deemed "uninsurable" for the last 10 yrs. Where the hell was I coming up w/$250-$400 for an INITIAL CONSULTATION? And what about lab tests, x-rays, mri's , Rx's, etc ?? The only ones who would accept this "insurance" were chiropractors, accupuncturists and a handful of drs who were desperate for patients but who had no expertise in any of the fields I required... neurology, psychology, orthopedic surgery, dental reconstruction surgery. Because I was unable to obtain the care I desparately needed I lost my personal injury lawsuit because I "obviously wasn't injured, otherwise I would have received continual care/treatment ". The woman who hit me and destroyed my mental and physical health to the point where I have lost the ability to make a living, in which I lost my home business, my regular job, ruined my credit, used up ALL of my savings which I had put away for years to open a new business and renovate my house/property etc , walked away scott-free. I live in constant severe pain with back, hip and neck injuries, have been diagnosed w/PTSD , severe anxiety and Mild Traumatic Brain Injury and I have NO way to receive treatment, meds or any kind of care. I was turned down for Medicaid and told to apply for SSDI.

If I had been allowed the right to healthcare coverage WAY back when NONE of this would have ever happened. So instead I am forced to suffer or get emergency care when I need it. I have over $7000 in bills from 2 trips to the ER this year...not for non-emergency care either. Once for a severe bleeding problem as the result of ovarian cysts and once for impaling my hand in the middle of the night where I could have possibly had nerve and tendon damage.

My only alternative now ?? Bankruptcy.

You have been treated badly. The doctor had no right to sever your relationship for payment and had an ethical responsibility to find another doctor. You can report him to the medical board and he will be sanctioned which can impact his ability to get priveleges. He may even be suspended for a time. PLEASE do this, it will cost you nothing, and will make the market a better place. I would be happy to put you in touch with a great atty to sue the woman who did this to you. THAT is what needs to happen. The doctors may be lacking in their ethics and compassion, but that driver needs to pay.

Absolutely, it is part of the bill, it is part of the way they plan to control costs.

Which Bill are you refering to? The one the House is doing the Senate, the gang of Six or what the President outlined last night when he addressed both houses?

The Prez didn't offer a bill. He reiterated what he wants in a bill. The Pay for Performance quality project which is in all the house bills, will decide what medications and what treatments you can get. As for the wait time, docs will opt out of medicaid and medicare and PubO because it isn't worth the reimbursment. Doesn't cover our costs.

You mean the President hasn't offered up a bill, funny thought that is what he did last night? For months he has stated I want Health Care Reform, but hasn't said what he wanted in the bill left it up to those in Congress. Last night he spelled out what he wanted in the Bill, hmmmm may be I am watching the wrong news channel, wish John Stewart would get back from vacation then I could really catch up on the news.

Prez was very exact that these are things he wants but that he is willing to negotiate in good faith- well kind of- Nothing was new, he has said these things all along.

A bill is a document that can be read, debated, voted on, and signed into law. The President offered up no such document. He simply gave a vague speech about principals and goals.

amy the republicans have offered bills, i guess you just are not listening.

Peggy,

The Republicans have offered nothing, except a few dozen amendments, (most of which were accepted). That is the basis of the problem, they are opposed to the Democrat plan, but have steadfastly refused to put forward any kind of alternative proposal.

Cricketer that is NOT TRUE- Both Paul Ryan in the house, and John Cornyn in the senate have submitted bills. Many have been engaged and offering amendments.

Lies, all lies. Not insuring the uninsured keeps the costs high! I don't mind if my taxes go up if it means that my loved ones who don't have health insurance can get health insurance. You're the one that needs the reality check! This isn't a political issue, it's a human issue. If you don't support government health care, then drop yourself from Medicare/Medicaid!

Sorry Nat you are misinformed. IN FACT 15 million of the 'uninsured' are illegals and will never buy coverage because they send money home, they depend on our charity systems for coverage. 15 million are young healthy people who have decided not to buy insurance because they don't need the plans offered, and the bare bones policies aren't offered. This group also takes nothing- or very little- out of the system. So what is being proposed is a HUGE tax increase on the young healthy population.

Doctor Steph,

I have patiently read your comments so far, however, although you strive to present yourself as some "voice of reason", it is pretty clear where your agenda lies. While it is true that many of the uninsured are illegal, even when they are exclude, the number of uninsured is still in excess of 30M. Also, since these people are EXPLICITLY excluded from the bills which are doing the rounds, I dont see how this is relevent to the current discussion. I would also guess that there are also a percentage of young people who "choose" not to buy insurance, however your statement that they "take nothing - or very little - out of the system", has no actual basis in fact. Just sit in an emergency room and count them.

Your fixation seems to be that "doctors will be paid less"! Is this something that I should lose sleep over??? I dont see many doctors in the soup kitchens, or in the shelters.

While I am not a doctor, (although I do have a PhD), I make a good salary, I pay my taxes, and I have good insurance. I am however, cognisant of the fact that I could lose it all at the drop of a hat.

I am actually quite astonished at the complacency of the many people who think that they are "safe", and that their insurance has them covered. I guess they must be independently wealthy, and not have to worry about possible future scenarios.

Frankly, I think that investing 5% of my taxes in providing healthcare for the less fortunate would be vastly superior to the current situation where my tax dollars are handed out in buckets to the military war machine so that they can continue to flex their muscles in countries which had no possiblitity of standing up to them in the first place. Or handed out to the greedy hands of the insurance company stockholders who expand their wealth on the backs of the poor and the sick.

A little known fact is that among countries which dont provide a public, or govenment run health system, America is the only "civilized" country which allows heath insurance to be run for profit. There is something a little uncomfortable about a system which determines how much healthcare you can have, and how much you should pay, but at the same time, has a vested interest (i.e. profit motive) in ensuring that they charge you as much as they can get away with, and give you back as little as possible.

VERY,VERY WELL SAID.THANK YOU.

Another voice of reason.It's time for the silent majority to stop being silent letting the vocal minority run things.

I am concerned that docs will be paid less because they are going to retire in droves and reduce the access to quality care. IF I really believed that every American could pay a 5% tax that would be fiercely protected for providing care that would be one thing, but as soon as it gets to DC they use the money for whatever they want, then they have no money- kind of like now. All the other countries do have a for profit insurance option, we in America already have a public option. I agree with your observation about insurance- it is little more that legalized gambling. You pay in so it will be there if you need it, and insurance is betting you won't get it- it is a scam!! Primarily because the rules are very amorphous. With clarity and regulation it can work.

the 45 million stat includes 15 million illegals who use medicare, medicaid and afdc every day in this country, they do not pay taxes except some sales tax, they are generally paid in cash. There is another 15 million ( like me) who "self insure" we don't have insurance cuz we don't want to pay ridiculous prices for what we do not need or want. I need a policy that will cover emergency and catastrophic care only- I won't let the insurance tell me what doc to go to!! I know too much ;( The whole argument is how do we serve the folks like me a policy they want and can afford, how do we cover the middle 15 million primarily the working poor, and how do we rienforce our border with Mexico to stop the influx of illegals?

Well if you were a Republican you'd say too bad for you but I'm not willing to pay for it. They want insurance for themselves and coffins for everyone else.

This is truly dispicable. I am sorry for your boyfriend, and I want him to be able to have coverage. But how did he get to where he is?? This may not be true in his case, but the statistics say that he was in an automobile accident. That is what we have to deal with every day- the cold hard FACTS not the vitriole from people like Amy. Most of us favor insurance reform, including Medical Malpractice Insurance reform.

Wow!!!! doctorsteph You are a cold hearted selfish a$$!!!!! Let see he is 21. I'll tell ya what he did. He was born you moron! I hope you really are a doctor and can come up with some perfect genes for your offspring!

I would say the government needs to implement tort reform, not give away free healtcare to your boyfriend. I am guessing he wouldn't want it for free either if he is any kind of man. I feel for you and will keep you in my thoughts. I hope things work out for you, check with Medicaid, I have a friend that has no insurance and had to have back surgery. He actually had to move from Texas where it would have taken over 2 years to get seen, because of illegal aliens waiting in front of him, to Colorado where it took 9 months and he got his surgery. So check the gov't programs already in place, there should be something for him there.

anon- thanx for bringing the usual level of liberal discourse. I was speaking statistically, and you know that. My point is we all have to be responsible for the choices we make. Being born with defects can be an issue, but most of those epople are covered by medicaid from the outset, and are transitioned to SSI and medicare as they age. Don't throw mud when you don't know what you are talking about. Nat, I agree with MSNBC- check into medicaid, but there is also a good chance for SSI and medicare.

not true Nat-1329760, do a little more research, is his father covered thru his employer? If so he may be able to go to his hr or benefits dept at his work and discuss special options. Plus, check into disabled and/or overaged dependents coverage on the plan. And never be afraid to call and speak to customer service about the benefits and special situations. If there isn't anything on his dad's plan, maybe he should be on a different insurance plan because there are good ones out there that DO cover overaged dependents in specific situations. I know health insurance companies, I do, however also, support reform in health care, don't get me wrong.

thats most of people not epople, just want to point that out since you jumped on someone else for a typo.

true dat, but that wasn't what I jumped on.

Hi Nat - I would pay no attention to Dr. Steph.

"Being born with defects can be an issue, but most of those epople are covered by medicaid from the outset, and are transitioned to SSI and medicare as they age."

There are those of us who are born with genetic defects that impact us through constant doctor and hospital visits to keep us as healthy as possible but we don't qualify for special services. We try very hard to lead as "normal" a life as possible. That becomes impossible as the lack of available medical insurance because of a pre-existing condition PUSHES us into further disease and disability.

Dr. Steph has apparently been one of the fortunate souls that doesn't have to deal with these problems. However, as I've aged, I've found that I don't know anyone in my age cohort (50's) who has had perfect health and would qualify to get private medical insurance. We've all had some type of health issues. Dr. Steph will also fall into this category as she goes through the natural aging process. Karma isn't instantaneous but can evolve over time. There is a price to be paid for discounting the suffering of your fellow human beings. Your boyfriend has a great deal to teach the world about patience and the power of suffering. He may touch more people with his disability than the Dr. Steph's of this world and ultimately, looking back, may be the true teacher.

I'm sorry you have had a hard life, but I speak from experience. My sister had birth and genetic defects. I didn't just read about it I lived it all the way through her death. I am your age cohort. I have lost a sister to diabetes, a brother to alcoholism, and my mother is having a massive surgery today for breast cancer. Speaking the truth isn't popular, but t doesn't change the facts. I feel the suffering of each of my patients, my friends and neighbors. CARING is not the same as giving medical care or speaking of how to manage a complex medical, economic and human problem

Caring, in a civilized society, must be the CORE of medical care and how to manage complex problems evolving from medical, economic, and human issues. I, and a few others who post here, don't hear that from you. What we hear is that those of us with disabilities, through no fault of our own, are disposable. Eugenics is what I, and probably others, hear.

I'm sorry you hear that, nothing could be farther from the truth. Is it possible that you are so jaded by what has happened to you and how you have been treated that you think everyone feels disdain toward you?? That will not change with Obamacare. In fact, this administration DOES NOT care, they just want a program big enough to raise taxes. When they had the chance to give us a stimulus to help joblessnessness, to protect unemployment-what did they do?? They gave money to study the fieldmouse. LOOK carefully at who says they care about you and who has dedicated their lives to caring about you.

Dr. Steph, I've been treated very well in my lifetime and I'm not jaded. I'm fairly realistic about western biomedical concepts and have degrees in medical anthroplogy. But I've had more hope of help with the Obama administration than I ever did during the Bush administration. I worked in the capital and listened to everything that the R. administration said about those that died during Katrina (60% elderly and disabled). Reprehensible and uncaring. Please don't take your cues about caring for others from that group. It makes most of us sick to our stomachs.

I will never visit any doctor for the rest of my life with stephen or stephanie in their name thanks to DOCTORSTEPH!!!!

PLEASE put this back. And in fact we need to force people to accept death, and pull the plug. I watch families crushed watching patients die by degrees and wasting money.

Dr. Steph, I would never want you as my doctor. You sound heartless to me as I read your comments.

My patients love me, and I am far from heartless, we are talking in broad generalities about policies, and we better talk about the down side or we will fail!! I have had to watch horrible suffering by may patients and their families because people do not understand that we play God when we put people ON ventilators, NOT when we take them off.

If you support reform then get your representatives back at the table instead of just saying NO NO NO

Paul Ryan & John Cornyn both have very excellent proposals, but this president has a do it my way approach.

Amy---newsflash..I am not a republican....so not sure what you mean by "your representatives" In fact I notice every comment you make on here is republicans this republicans that...I am a moderate..I am from Missouri.. the Show Me State..where we have a Dem and a Rep in the senate. I voted for both of them. So perhaps "your" representatives need to listen? People that say dems this and reps that are part of the problem..quit with the blame game and make a sensible argument.

excellent point!! again, it really isn't the republicans at all. Even if Rs wanted to torpedoe health care reform, they can't do it.

You are the only dr. I have ever heard of that has so much time that they can blog all day on a Thursday.

My mom is in hospital having double mastectomy for BrCA- this keeps me busy while she was in surg, and now in RADS

I would be completely embarrased if my 5 year old didn't have the impulse control to keep from hollering out while someone else speaks. Shows how childish you for thinking such a thing is appropriate.

Amy, So the British house of commons is childish?

Just heard factcheck.org on NPR as well as another non-partisan organization state that the president was telling the truth when he said illegals would not be covered. In fact, they played the the quote from Sean Hannity where the rumor started. Guess what, Sean Hannity is not non-partisan! He does not qualify as a fact-check!

Whether you like it or not Amy- there are alot of people who said FINALLY when Joe Wilson spoke out. The illegal aliens will continue to be covered, just like they are now, there is no provision to remove this. No there is no improvement in their coverage under these bills. The President has said he supports care for illegals.

Kristina if you are correct that would be great. Because it is my understanding they are covered under Medicaid, so maybe there would be significant savings there. But what kind of id will have to be shown to provide coverage? A social security card and birth certificate?

Since some of you do not believe that I'm right just start reading that 1017 page bill and if you can find anything that says that Illegal's are not covered as will, as abortions. Then you can let me know about it. I do have the 1017 page and I have been reading on and so far have not one items says that are not covered. In fact there are at lease 115 reason for this bill not to pass. There will be rationing if this passes. There are number items that you have no control on your healthcare.

Paul- they are not allowed to cover the illegals under the public option in 3200- The illegals are covered under medicaid, and will continue to be.

Apparently, the other 3 congressional bills make NO statement as to the eligibility of public option except to say that immigrants will be eligible despite their legality

doctorsteph - You just proved my point. Unless there is clear language that prohibit the illegals they will be covered

http://www.opencongress.org/articles/view/1210-Read-the-Bill-Illegal-Immigrants-Are-NOT-Covered

Paul MN...is this what you are looking for? You have to read all the way down to section 246 in HR3200.

Site is www.opencongress.org check it out for the facts. Let me know what you think.

I agree that there is regulation needed to balance the needs and rights of share holders, but I still trust a private system with government watchdogs more than government.

I agree. Nowadays, corporations are greedy and will stop at nothing to make more money in their pockets. Just look at credit card companies. They bleed customers to death. Look at telecommunication companies (mobile phones), they are all greedy. In other countries when you receive calls you don't get charged, here in the US it is a double whammy, they charge the caller and the receiver.

Let the government take over. I don't care just get these greedy corporations out of my way.

fdj just look at the congress lineing their pockets!