Author Topic: What Do You Pay For Health Care?  (Read 909 times)

Shoe

What Do You Pay For Health Care?
« on: February 16, 2020, 09:23:09 AM »
I know some of you pay $0 for healthcare, others over a $1000 a month for so-so coverage. Now that I'm on Medicare I pay a total of $182 monthly for Medicare A&B including Part D (via a supplemental MedAdvantage Plan)--anyone who thinks Medicare is free is mistaken.

With my Medicare, a doctor visit co-pay is $15. Part D covers prescriptions. I have only one prescription at the moment and it retails for $160 but costs me $4.50 at check-out.

Anyone care to share what they're facing in healthcare costs? I'd like to get a better grip on true expenses. Google says the average is $400 a month (for a single person).
Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 

Alec Hutson

Re: What Do You Pay For Health Care?
« Reply #1 on: February 16, 2020, 11:05:09 AM »
I'm an American living in China and I pay 220 USD a month for pretty good international health insurance. Not the highest tier plan, but gives me piece of mind. When I had a bad ear infection last year and had to spend 3 days hooked up to a drip the total bill was over 5k USD (at an international hospital in Shanghai) and they paid all but 200 of that, I think.


To be honest, dealing with and paying for American health care is a big black check in the 'keep living abroad' category when I weigh the pros and cons of going back. I won't be eligible for America's socialized medicine programs for decades, so I'm really hoping someone wins this year who will finally drag America into the ranks of developed countries with some kind of public health care system.   

Alec Hutson
 
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twicebitten

Re: What Do You Pay For Health Care?
« Reply #2 on: February 16, 2020, 11:22:03 AM »
I haven't had health insurance since 2005. Google is my doctor. I find that most issues, if I ignore them, go away on their own. Others? Well, something is going to kill me, and if the cause of death is basically "Being an American," so be it.
 
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DrewMcGunn

Re: What Do You Pay For Health Care?
« Reply #3 on: February 16, 2020, 11:36:13 AM »
My last employer's healthcare plan was crap. It was a high deductible plan with a $5,000 year deductable. I think I paid around $150 a month for it. Fortunately, I didn't have to use it. But my boss, who had 4 kids was always having to use it. Of course, she and her husband owned the company.
My current employer's healthcare plan is much better. I pay around the same amount. It's still a high deductible plan, but it's set at $1400 per year. On top of that, my employer funds about 1/2 of the deductible by putting it onto an HSA card (health savings accounts are combined with high deductible plans to help bridge the funding gap on some employer plans).




Drew McGunn
 
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Shoe

Re: What Do You Pay For Health Care?
« Reply #4 on: February 16, 2020, 11:36:52 AM »
I haven't had health insurance since 2005.

Me too, until Medicare kicked in recently. I had no issues in those 14/15 years, fortunately. I saved about $75,000.
Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 
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Shoe

Re: What Do You Pay For Health Care?
« Reply #5 on: February 16, 2020, 11:58:01 AM »
I'm an American.

At 65 you'll get Medicare. Until then it sounds like you may qualify for Medicaid. Depending on the state it should cover all your needs until 65.
Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 

LilyBLily

Re: What Do You Pay For Health Care?
« Reply #6 on: February 16, 2020, 12:27:52 PM »
One thing worth mentioning to people who do a Schedule C. Healthcare premiums (not the out of pocket unreimbursed expenses) are 100% deductible as a business expense now even if they cover other family members. So a health plan with high premiums has the potential to reduce net profit and thus the amount of Social Security tax (FICA) to be paid. You could position yourself to get really good health insurance and despite the high premiums you'd end up on the positive side. This will only work if you make a profit on your business.

 
 
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Shoe

Re: What Do You Pay For Health Care?
« Reply #7 on: February 16, 2020, 01:17:15 PM »
Healthcare premiums

Would this include the $2184 I'm paying for Medicare?
Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 

DrewMcGunn

Re: What Do You Pay For Health Care?
« Reply #8 on: February 16, 2020, 01:21:14 PM »
Healthcare premiums

Would this include the $2184 I'm paying for Medicare?

IANAL or an accountant,... but this article is worth reading:
https://www.nolo.com/legal-encyclopedia/deducting-medicare-insurance-payments-if-you-are-self-employed.html
It does appear that you can claim those as a deduction.


Drew McGunn
 
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LilyBLily

Re: What Do You Pay For Health Care?
« Reply #9 on: February 16, 2020, 02:03:57 PM »
Yes, it includes your Medicare premiums, but I don't believe it would extend to the Medicare premiums for a spouse. (Worth checking, though.) However, to repeat, it does cover other healthcare premiums for family members. I bought a separate dental plan, for instance, and two of us are on it, and the whole thing is deductible.

The Nolo article is out of date. Depending on the tax software you use, you do deduct the healthcare premiums while entering your Schedule C data. Then it is carried as an adjustment to the 1040. If you're still doing a paper return (why?), you enter it on line 16 of Schedule 1, in Part II, Adjustments to income. which then goes to the 1040, line 8a.
 
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LilyBLily

Re: What Do You Pay For Health Care?
« Reply #10 on: February 17, 2020, 02:09:40 AM »
I'm an American.

At 65 you'll get Medicare. Until then it sounds like you may qualify for Medicaid. Depending on the state it should cover all your needs until 65.

I'm 56 and will not make it to 65. DES already denied my claim for disability because they don't recognize my condition and say I am able to work, in large part because a doctor on their payroll who saw me for five minutes also never bothered to understand my condition. It also didn't help that the neurosurgeon who was going to (temporarily) fix my primary spinal issue threw me under the bus after I canceled the surgery due my health insurance expiring.
I was lucky enough to use AHCCCS to cover my appendectomy in 2003 when we didn't have coverage, but they told me I'd never be able to use it again.

Medicaid was extended only in some states when the ACA came into being. In those states, your best bet is not to try for disability but just try for Medicaid through the ACA people, not the regular Medicaid people. Medicaid covers a lot of high-ticket items. (It is usually very sparse for restorative dental needs. And nobody covers hearing aids adequately; it's a hugely profitable, ripoff business.)

Also, if you were trying for federal disability, unless you use a lawyer to help you push it through, you'll be almost automatically denied the first time. The average wait time is up to three years to get it. If you can find a pro bono attorney (based on low income, there often is free legal aid available) to push your claim, try again. You have nothing to lose except time. The rule of thumb on obtaining such services is that you pay in time and paperwork instead of dollars.  grint

Bottom line is to keep trying. It's the same as for writing and publishing success: perseverance wins out.
 

AmHere

Re: What Do You Pay For Health Care?
« Reply #11 on: February 17, 2020, 02:17:58 AM »
TLDR; I think most people on corporate & individual plans, don't realize how much they will actually pay for health insurance/care. Everything is good as long as you are reasonably healthy, everything breaks loose when you have an emergency. 

Costs = premiums, deductible, copay, coinsurance, balance billing amount (Usually we can't figure out coinsurance accurately until we get an EOB let alone balance billing (unless you are lucky and live in a state that has made balance billing illegal) ).  EOB = Explanation of Benefits

Here is a comparison of what I had when I was at a large corporation vs what I currently have (I don't qualify for subsidies. Health insurance companies sell the same individual plans on healthcare.gov and directly through their website. If you don't get any subsidies, it doesn't matter where you get it from)

Note: Both plans are ACA compliant Medical only plans. Difference being corporate plan is an individual plan under company's group policy and the 2020 plan is individual plan on the marketplace. Vision and Dental costs are not listed below.

                                                    Corporate Plan (2017)              Current Plan (2020)
Type                                           Gold, HSA PPO,                          Bronze, HSA PPO,
                                               Individual in company policy         Individual in marketplace
Total Monthly Premium               $625                                         $452
My Monthly Premium                  $110                                         $452
Yearly Deductible                         $5500                                        $7650
CoPay                                            $0                                             $0   
In Network CoInsurance               20%                                          20%
Out of Network CoInsurance               40%                                          40%
Yearly OOP Maximum In Network           $24,000                                  $33,500
Yearly OOP Maximum Out of Network       $24,000                                  No Limit

OOP Maximum = Out of Pocket Maximum i.e. once policy holder has paid the amount listed in total of deductibles, copays, coinsurance for the year, 100% of the costs are paid by the insurance company.

Balance Billing = Out of network providers have no pre-arranged agreed upon rates with insurance company. Provider bills their rate, the insurance company pays whatever they want to pay - you are on the hook for the rest of the balance. Few states have laws in place to make Balance Billing illegal.
« Last Edit: February 17, 2020, 02:27:44 AM by AmHere »
 
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notthatamanda

Re: What Do You Pay For Health Care?
« Reply #12 on: February 17, 2020, 02:38:46 AM »
TLDR; I think most people on corporate & individual plans, don't realize how much they will actually pay for health insurance/care. Everything is good as long as you are reasonably healthy, everything breaks loose when you have an emergency. 

Costs = premiums, deductible, copay, coinsurance, balance billing amount (Usually we can't figure out coinsurance accurately until we get an EOB let alone balance billing (unless you are lucky and live in a state that has made balance billing illegal) ).  EOB = Explanation of Benefits

Here is a comparison of what I had when I was at a large corporation vs what I currently have (I don't qualify for subsidies. Health insurance companies sell the same individual plans on healthcare.gov and directly through their website. If you don't get any subsidies, it doesn't matter where you get it from)

Note: Both plans are ACA compliant Medical only plans. Difference being corporate plan is an individual plan under company's group policy and the 2020 plan is individual plan on the marketplace. Vision and Dental costs are not listed below.

                                                    Corporate Plan (2017)              Current Plan (2020)
Type                                           Gold, HSA PPO,                          Bronze, HSA PPO,
                                               Individual in company policy         Individual in marketplace
Total Monthly Premium               $625                                         $452
My Monthly Premium                  $110                                         $452
Yearly Deductible                         $5500                                        $7650
CoPay                                            $0                                             $0   
In Network CoInsurance               20%                                          20%
Out of Network CoInsurance               40%                                          40%
Yearly OOP Maximum In Network           $24,000                                  $33,500
Yearly OOP Maximum Out of Network       $24,000                                  No Limit

OOP Maximum = Out of Pocket Maximum i.e. once policy holder has paid the amount listed in total of deductibles, copays, coinsurance for the year, 100% of the costs are paid by the insurance company.

Balance Billing = Out of network providers have no pre-arranged agreed upon rates with insurance company. Provider bills their rate, the insurance company pays whatever they want to pay - you are on the hook for the rest of the balance. Few states have laws in place to make Balance Billing illegal.
My guess is insurance companies won't offer these plans in states where they would be on the hook for some or all of the balance billing money. I would like to check though. Would you PM me the name of your plan, I'd like to check. Totally understand if you don't want to.
 

AmHere

Re: What Do You Pay For Health Care?
« Reply #13 on: February 17, 2020, 03:05:29 AM »

My guess is insurance companies won't offer these plans in states where they would be on the hook for some or all of the balance billing money. I would like to check though. Would you PM me the name of your plan, I'd like to check. Totally understand if you don't want to.

Balance Billing is done by the provider and not the insurance companies. As far as the insurance company is concerned, they have no contract with the provider and the provider is out of network and they pay whatever their rate is and they are not on the hook for the rest of the money. This balance is between the provider and the policy holder.

Here is an article that explains this better:
https://www.ncsl.org/blog/2017/07/12/states-tackling-balance-billing-issue.aspx
 

LilyBLily

Re: What Do You Pay For Health Care?
« Reply #14 on: February 17, 2020, 06:25:23 AM »
Quote

I know a lot of people don't bother trying to help themselves before they seek help from others, but that is not the case with me. I have always been the one offering help rather than the one seeking it. If I ask for advice or help it's because I've already exhausted every avenue known to me.
I applied. I spoke with a disability attorney who told me I had no case because of the lack of physician recognition and my condition being too rare. I sought help with an advocacy group for my condition. I had a neurosurgeon conclude I was not able to work without spinal surgery until I had to cancel the surgery and he suddenly proclaimed me fit to work. I had a formal letter from my personal doctor which they wouldn't accept. Most doctors I spoke with had never head of it, including the quack they assigned to assess me, and I can't afford to see another, independent doctor.
Do you really believe I lack perseverance when I've been able to write, format, create art for, and publish six books even though the simple act of sitting uptight is extremely painful and exhausting for me? See my profile image?  I was on my knees in front of our library because I couldn't stand unaided long enough to have the photo taken. That's why it looks like I'm in pain.

Not knocking your efforts, and I'm sorry that you are in such pain. Disability is harder to get than Medicaid--although, depending on your state, not so. Mine is so full of people whose bodies have been destroyed by factory work that I regularly see people who do get disability from the federal government. But the only ones who get it fast have been helped by the company they used to work for, which destroyed them. Disability income is not a lot of money; it's poverty-level income, but it comes with free health care, and that's why I also recommended trying Medicaid through the ACA. We got nowhere with regular Medicaid slugs, but in less than one hour we got Medicaid arranged via the ACA. However, there still was endless paperwork, over and over. Endless. Explaining to people with secure government jobs the nature of random income never seemed to work, either; one had to go to their supervisors and explain over and over that $1,000 gig income this month does not mean anything for next month because it is not employment.

Anyway, despite all the betrayals, it's probably worth your time to seek Medicaid if your state extended the qualifying income levels.   


 

Shoe

Re: What Do You Pay For Health Care?
« Reply #15 on: February 17, 2020, 06:31:11 AM »
Sunday Sidetrack: I did a little Googling on a typical spread of American family's monthly expenses:

Daycare: $300 - 800
Cell Phone: $50 - 200
Mortgage: $1030 - 1492 (Average rent=$1025)
Internet: $35 - $75
Food: $300 - 800
Streaming: $24 - 50
Utilities: $75 - 200
Gas: $50 - 200
Health Insurance: $445 - 1500+ (family of four)
Car Payments: $393 - 550
Car Insurance: $86 - $148

Add lattes, fast food, dining out, dry cleaning, clothes, gifts and a dozen things I'm missing.

Millennials should be pissed. It's possible it's tough for most to live single and nearly a necessity to couple-up. But having children too? A near impossibility for a fair share of the population (which won't stop them).


Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 

Luke Everhart

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Re: What Do You Pay For Health Care?
« Reply #16 on: February 17, 2020, 02:24:05 PM »
I assume the question is actually for what self-employed authors are paying? That's not me but...

Currently mine is covered by an employer.
But if it wasn't, because I'm a single guy who is extremely healthy with no medical issues and so therefore shoulders a disproportionate share of the cost of those who actually use healthcare, under the ACA an 80/20 co-pay with a $5000 annual deductible would cost me $1100 per month?! So... I'd be $18200 in the hole in one year to get 80% of costs covered. The fork?!?!
The ACA is a redistribution of costs that subverts the actuarial model insurance is based on, not an actual cost reduction.

Were I to go self-employed I'd join one of the Christian cost-sharing programs like Medi-Share because conventional insurance has been destroyed in the US except for those in the high risk pool.
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Alec Hutson

Re: What Do You Pay For Health Care?
« Reply #17 on: February 17, 2020, 02:46:28 PM »
I assume the question is actually for what self-employed authors are paying? That's not me but...

Currently mine is covered by an employer.
But if it wasn't, because I'm a single guy who is extremely healthy with no medical issues and so therefore shoulders a disproportionate share of the cost of those who actually use healthcare, under the ACA an 80/20 co-pay with a $5000 annual deductible would cost me $1100 per month?! So... I'd be $18200 in the hole in one year to get 80% of costs covered. The fork?!?!
The ACA is a redistribution of costs that subverts the actuarial model insurance is based on, not an actual cost reduction.

Were I to go self-employed I'd join one of the Christian cost-sharing programs like Medi-Share because conventional insurance has been destroyed in the US except for those in the high risk pool.

The Slack self-published writing group I'm a part of talks a lot about health care, and I think the cost you're talking about would be a little high based on what they say unless you're in a state where the ACA has been horribly mismanaged (which happens, sometimes intentionally). One of them is a 29 year old healthy male in MA and he pays something like 600 a month. According to this article, the average monthly premium for a self-employed individual was 400 USD in 2017. That seems on the low side, but 1100 for a healthy, young, single male I think is on the high side.

https://www.ehealthinsurance.com/resources/individual-and-family/self-employed-health-insurance

The ACA is a flawed system, certainly, but health care in America was a horrible mess long before it came about, and in certain states it has improved things.

Alec Hutson
 

dgcasey

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Re: What Do You Pay For Health Care?
« Reply #18 on: February 17, 2020, 02:57:39 PM »
Not knocking your efforts, and I'm sorry that you are in such pain. Disability is harder to get than Medicaid--although, depending on your state, not so.

And yet, I got disability from SS on my first try, without the aid of a lawyer. Went onto the SS website, looked up the procedure and started. It took four or five months before they sent me a letter saying I was scheduled for a doctor's visit and when I went in for that visit, he was understanding and helpful. He filed his report and it took another couple of months or so before I got a letter from SS saying I had been approved and would start receiving the payments starting the next month. They also said I would receive a check for the amount of the disability payments going back to the date I applied. which worked out to about six months of payments. So it can be done without a lawyer. You just have to know how to follow directions and be patient.

Anyway, that was about four years ago and I've been able to see doctors on a regular basis and they put me on Medicare a couple of years ago. Oh, and I turn 62 next month, so you don't have to wait until you're 65 to get these benefits.
I will not forget one line of this, not one day. I will always remember when the Doctor was me.
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dgcasey

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Re: What Do You Pay For Health Care?
« Reply #19 on: February 17, 2020, 03:02:00 PM »
The ACA is a flawed system, certainly, but health care in America was a horrible mess long before it came about, and in certain states it has improved things.

Health care is not a mess in the US. It's just expensive, sometimes a lot more expensive than it should be.
I will not forget one line of this, not one day. I will always remember when the Doctor was me.
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I'm the Doctor by the way, what's your name? Rose. Nice to meet you, Rose. Run for your life!
 

Luke Everhart

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Re: What Do You Pay For Health Care?
« Reply #20 on: February 17, 2020, 03:05:02 PM »
I assume the question is actually for what self-employed authors are paying? That's not me but...

Currently mine is covered by an employer.
But if it wasn't, because I'm a single guy who is extremely healthy with no medical issues and so therefore shoulders a disproportionate share of the cost of those who actually use healthcare, under the ACA an 80/20 co-pay with a $5000 annual deductible would cost me $1100 per month?! So... I'd be $18200 in the hole in one year to get 80% of costs covered. The fork?!?!
The ACA is a redistribution of costs that subverts the actuarial model insurance is based on, not an actual cost reduction.

Were I to go self-employed I'd join one of the Christian cost-sharing programs like Medi-Share because conventional insurance has been destroyed in the US except for those in the high risk pool.

The Slack self-published writing group I'm a part of talks a lot about health care, and I think the cost you're talking about would be a little high based on what they say unless you're in a state where the ACA has been horribly mismanaged (which happens, sometimes intentionally). One of them is a 29 year old healthy male in MA and he pays something like 600 a month. ...

Massachusetts vs Texas I guess. I got the figure from the healthcare.gov 'marketplace by state' section as a hypothetical.

If the ACA had been more than political graft in the service of the insurance industry, ensuring that virtually every conceivable service had to be covered in even the minimum insurance plan (bronze plans under ACA are more comprehensive than 80ish% of all private plans that existed pre-ACA), then more demo-appropriate, limited options would be available which would dramatically reduce cost to many. But, again, it's a redistribution of both risk and cost that contravenes the basic actuarial risk model of insurance. Obgyn, psych care, etc shouldn't be mandatory in plans sold to demos not in need, or even capable of being in need, of those services.
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Alec Hutson

Re: What Do You Pay For Health Care?
« Reply #21 on: February 17, 2020, 03:11:10 PM »
The ACA is a flawed system, certainly, but health care in America was a horrible mess long before it came about, and in certain states it has improved things.

Health care is not a mess in the US. It's just expensive, sometimes a lot more expensive than it should be.

Well, I mean, Americans pay far more per capita than any other developed country for far less comprehensive coverage and worse results. That's because we prioritize industry profits over the actual well being of those that use the system. That seems like a mess in my book

You can see some of the stats here:

https://www.pgpf.org/blog/2019/07/how-does-the-us-healthcare-system-compare-to-other-countries

"In 2018, the U.S. spent about $10,600 per person on healthcare — the highest healthcare costs per capita across the OECD. For comparison, Switzerland was the second highest-spending country with about $7,300 in healthcare costs per capita, while the average for wealthy OECD countries, excluding the United States, was only $5,300 per person. Such comparisons indicate that the U.S. spends a disproportionate amount on healthcare."

...

"There are many possible factors for why healthcare prices in the U.S. are higher than other countries, ranging from the consolidation of hospitals — leading to a lack of competition — to the inefficiencies and administrative waste that derive from the complexity of the U.S. healthcare system. In fact, the U.S. spends over $800 per person on administrative costs — nearly five times more than the average of other wealthy countries and significantly more than we spend on preventive or long-term healthcare."

...

"Prices, therefore, appear to be the main driver of the cost difference between the U.S. and other wealthy countries. In fact, prices in the U.S. tend to be higher regardless of utilization rates."

...

"America’s health outcomes are not any better than those in other developed countries. The U.S. actually performs worse in some common health metrics like life expectancy, infant mortality, and unmanaged diabetes."
« Last Edit: February 17, 2020, 03:18:32 PM by Alec Hutson »

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Luke Everhart

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Re: What Do You Pay For Health Care?
« Reply #22 on: February 17, 2020, 03:24:47 PM »
The ACA is a flawed system, certainly, but health care in America was a horrible mess long before it came about, and in certain states it has improved things.

Health care is not a mess in the US. It's just expensive, sometimes a lot more expensive than it should be.

Well, I mean, Americans pay far more per capita than any other developed country for far less comprehensive coverage and worse results. That's because we prioritize industry profits over the actual well being of those that use the system. That seems like a mess in my book

It's a mess, yes. But the other side of the equation is that the US and its corporations are also responsible for 95% of the world's research and development of new pharmaceuticals and new medical technologies every year, an average that has been the case for decades. And industry profits, however excessive, are less of a burden on consumer costs than the absurdly monumental cost imposed by the FDA in the world's longest, most expensive drug approval process.
Cost to develop a new drug through the FDA approval process is estimated at an average of $2.6 billion per a report by the Tufts Center for the Study of Drug Development and published in the Journal of Health Economics and that cost is assumed despite an actual approval rate of only 12% after entering clinical development (same study).
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R H Auslander

Re: What Do You Pay For Health Care?
« Reply #23 on: February 17, 2020, 03:41:55 PM »
Health care for both of us is free and good. At least in this berg medicine costs are regulated and pharmacies are checked almost weekly for price and service. We don't have ambulance chasing lawyers here so 'optional' health care and services and medicine costs are low. I'm on 3 different heart meds (don't get your hopes up, I'll be around for a whlie yet) and the monthly cost is roughly ten bucks. In this berg all meds are manufactured in Russian Federation or Germany, nothing else is allowed. While the health care is free, depending on your financial status the medicines are not, but the threshold for City Government to pick up the costs is low.

Care in this berg is quite good, and doctors, both for us two legs and the dogs, do make home visits. Hospital #4 is but five minutes from our house if needed, and I have some old wounds that do from time to time kick up, witness four weeks ago when a left over tiny piece of metal in my left arm seems to have waited 6 years before deciding to start an infection. It was less than three hours from the time of 'well, mayhap I should see the sawbones about this glowing red hot arm' to the good Tovarich Doktor cutting in to the problem.

However, when one gets off the beaten path, care availability can drop a bit.
 

Rinelle

Re: What Do You Pay For Health Care?
« Reply #24 on: February 17, 2020, 04:36:25 PM »
I pay about $40 a month for ‘extras’ care, which includes dentists, glasses, and non-subsidised prescriptions. Get free doctors and hospital care.

I love living in Australia!
 

Shoe

Re: What Do You Pay For Health Care?
« Reply #25 on: February 18, 2020, 02:03:40 PM »
Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 

LilyBLily

Re: What Do You Pay For Health Care?
« Reply #26 on: February 18, 2020, 02:43:34 PM »
The premium for my spouse's silver plan with Blue Cross--the kind that allows visiting whatever doctor one wishes to--is $1,400 a month. The Advance Premium Credit (from the federal government) pays $1,000 of it as long as our income is below a certain dollar limit for the year. You can bet I do some very careful math to make sure that happens.

When I got sick in London during WorldCon a few years ago, my cabfare to the hospital cost 12 pounds, whereas the medical care, including prescription medicine, cost nothing. I understand that there can be long waiting periods for people with non-emergency health needs, and there are other negatives. Still, not having to go bankrupt because I got a disease would be a real plus. And not having to fear financial ruin alongside physical ruin would mean a major reduction in stress for all Americans. If that means higher taxes, I'm willing to pay them.
 

dgcasey

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Re: What Do You Pay For Health Care?
« Reply #27 on: February 18, 2020, 02:55:51 PM »
I will not forget one line of this, not one day. I will always remember when the Doctor was me.
"The Tales of Garlan" title="The Tales of Garlan"
"Into The Wishing Well" title="Into The Wishing Well"
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I'm the Doctor by the way, what's your name? Rose. Nice to meet you, Rose. Run for your life!
 

Shoe

Re: What Do You Pay For Health Care?
« Reply #28 on: February 18, 2020, 03:02:00 PM »



And now, for the counterpoint ...

If you'd watch the Oliver video, you'd know what you posted was by no means a counterpoint. It was rightwing propaganda.
Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 

dgcasey

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Re: What Do You Pay For Health Care?
« Reply #29 on: February 18, 2020, 04:13:06 PM »
And now, for the counterpoint ...

If you'd watch the Oliver video, you'd know what you posted was by no means a counterpoint. It was rightwing propaganda.

Showing you didn't bother to watch the Crowder video. And yes, I did watch the John Oliver video. He's been a hack for years and will be a hack for the foreseeable future.
I will not forget one line of this, not one day. I will always remember when the Doctor was me.
"The Tales of Garlan" title="The Tales of Garlan"
"Into The Wishing Well" title="Into The Wishing Well"
Dave's Amazon Author page | DGlennCasey.com | TheDailyPainter.com
I'm the Doctor by the way, what's your name? Rose. Nice to meet you, Rose. Run for your life!
 

Alec Hutson

Re: What Do You Pay For Health Care?
« Reply #30 on: February 18, 2020, 04:36:25 PM »
I watched it. That guy is an idiot. He doesn't even begin to engage with the actual reasons for cost reduction and relies on his dismissive, sneering attitude that resonates with right wing sheep.

One example: One of the reasons total health care costs would be projected to go down under a medicare for all type system is the decrease in paperwork and administrative bloat. There are layers upon layers of middlemen between Americans and their healthcare right now, which of course leads to substantial administrative costs. Removing these private insurance company layers will reduce overall costs, full stop. That's the reason why every other developed country spends far, far less per capita on administrative healthcare costs (like 200, as opposed to 800 per American). But instead of actually engaging with this argument he sneeringly dismisses it by claiming 'reduce paperwork? The federal government reduce paperwork? Ha!' Raw red meat to his base, ignoring the actual argument to strum those gubmint hating bones in his listener's bodies.

Pathetic. 
« Last Edit: February 18, 2020, 04:42:44 PM by Alec Hutson »

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Re: What Do You Pay For Health Care?
« Reply #31 on: February 18, 2020, 04:50:46 PM »
I watched it. That guy is an idiot. He doesn't even begin to engage with the actual reasons for cost reduction and relies on his dismissive, sneering attitude that resonates with right wing sheep.

One example: One of the reasons total health care costs would be projected to go down under a medicare for all type system is the decrease in paperwork and administrative bloat. There are layers upon layers of middlemen between Americans and their healthcare right now, which of course leads to substantial administrative costs. Removing these private insurance company layers will reduce overall costs, full stop. That's the reason why every other developed country spends far, far less per capita on administrative healthcare costs (like 200, as opposed to 800 per American). But instead of actually engaging with this argument he sneeringly dismisses it by claiming 'reduce paperwork? The federal government reduce paperwork? Ha!' Raw red meat to his base, ignoring the actual argument to strum those gubmint hating bones in his listener's bodies.

Pathetic.

Anyone that believes that the paperwork load will go down if the government takes over the entire healthcare system is .... well ... there's no helping you.
I will not forget one line of this, not one day. I will always remember when the Doctor was me.
"The Tales of Garlan" title="The Tales of Garlan"
"Into The Wishing Well" title="Into The Wishing Well"
Dave's Amazon Author page | DGlennCasey.com | TheDailyPainter.com
I'm the Doctor by the way, what's your name? Rose. Nice to meet you, Rose. Run for your life!
 
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Alec Hutson

Re: What Do You Pay For Health Care?
« Reply #32 on: February 18, 2020, 05:16:10 PM »
Quote

Anyone that believes that the paperwork load will go down if the government takes over the entire healthcare system is .... well ... there's no helping you.

And you prove my point. Rather than address the actual arguments, you resort to broad statements without any evidence. Government health programs like Medicare are significantly more cost-effective than private insurance right now. From Health Affairs:

https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/

"According to CMS, for common benefits, Medicare spending rose by an average of 4.3 percent each year between 1997 and 2009, while private insurance premiums grew at a rate of 6.5 percent per year."

And why, you might ask?

"According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue."

And before you cry 'get your government hands off my medicare!'  - yes, indeed, Medicare is a government program. Eliminating middle men reduces costs - hey, have you met this cool new thing called self-publishing? In it, we eliminate the middlemen (traditional publishers) and are able to make a sweet living income from far fewer units sold! Cool, huh?
« Last Edit: February 18, 2020, 05:21:10 PM by Alec Hutson »

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LilyBLily

Re: What Do You Pay For Health Care?
« Reply #33 on: February 18, 2020, 11:29:52 PM »
Doctors have complained bitterly to me about the immense hassle and cost of dealing with the insurance companies. The typical medical practice has one or more employees who deal with this full time. (Look at all those people behind the glass windows. What are they doing? They aren't delivering medical care, that's for sure.) A common training course offered to people looking for part-time or work-from-home employment is to become medical coders. Those people look up the codes and apply them to any medical visit or procedure. Codes change all the time, and insurance companies commonly reject a large number of medical claims from doctors--not just from you or me.

Doctors have employees who spend all day filing and re-filing the claims and navigating their way through an immense sea of paperwork. But who pays for those extra employees--people who provide no direct patient services? You and me, with ever increasing bills, either from the doctors directly or from the insurance companies.

And let's not get started on the gouging big pharma does with meds. The profits are immense despite the costs of getting a new drug through the FDA. Yet many people die because they can't afford the meds that are priced absurdly high. Do you eat this week, or take this pill? That's what it comes down to for too many people.
 
It doesn't have to be this way. The U.S. could actually learn something from how other countries handle medical care instead of being pigheaded.
 

The Masked Scrivener

Re: What Do You Pay For Health Care?
« Reply #34 on: February 18, 2020, 11:56:44 PM »
It doesn't have to be this way. The U.S. could actually learn something from how other countries handle medical care instead of being pigheaded.

Except the US has learned from other countries and that is why we don't want a government monopoly of our health care services.

The real problem with the US health care system is over insurance. Americans go to doctors for every little thing when they are insured for it. This causes the cost of insurance to go up. Then you have to factor in over regulation by the government and you find that doctors have to perform unnecessary tests to appease bureaucrats. Now add in malpractice insurance to protect doctors from over zealous lawyers and you have a $1,500 aspirin for a headache (complete exaggeration).

Every countries healthcare system has problems. Always has, always will. It is my opinion that the safest answer is to allow me to make my own decisions and not be forced to pay for something I don't want under penalty of going to jail.

I don't have health insurance and my family has never wanted for health care. I am also living at just under the national average income level, until my next book series takes off :), so not rich by any measure. I just find clinic doctors will treat you for a lot lower cost when you pay cash than the premiums I would pay for insurance.

With that said, I've also been paying into medicare my entire adult life and will be more than happy to take what I paid for when I hit 65-67. Again, hopefully my writing takes off to the point I wont rely on it.
 

Alec Hutson

Re: What Do You Pay For Health Care?
« Reply #35 on: February 19, 2020, 12:16:45 AM »
Quote

Except the US has learned from other countries and that is why we don't want a government monopoly of our health care services.


Have you ever discussed health care with someone from another developed world country?

I've lived abroad for 15 years in a major world city that's a crossroad for expats and have discussed health care with dozens if not hundreds of folks who come from developed countries, all of which have some form of universal health care. Canadians, Brits, South Koreans, Japanese, Germans . . . I have never - never - found one of them who expressed the desire to trade their health care system for the one in America. Sure, they might have gripes about their health care system, but they are absolutely horrified when conversation turns to how our system operates. They are aghast, every time, at the barbarity of taking a basic human need like health and making the overriding concern the amount of profit corporations can extract.   

Alec Hutson
 

DrewMcGunn

Re: What Do You Pay For Health Care?
« Reply #36 on: February 19, 2020, 12:55:36 AM »
Doctors have complained bitterly to me about the immense hassle and cost of dealing with the insurance companies. The typical medical practice has one or more employees who deal with this full time. (Look at all those people behind the glass windows. What are they doing? They aren't delivering medical care, that's for sure.) A common training course offered to people looking for part-time or work-from-home employment is to become medical coders. Those people look up the codes and apply them to any medical visit or procedure. Codes change all the time, and insurance companies commonly reject a large number of medical claims from doctors--not just from you or me.

Doctors have employees who spend all day filing and re-filing the claims and navigating their way through an immense sea of paperwork. But who pays for those extra employees--people who provide no direct patient services? You and me, with ever increasing bills, either from the doctors directly or from the insurance companies.

And let's not get started on the gouging big pharma does with meds. The profits are immense despite the costs of getting a new drug through the FDA. Yet many people die because they can't afford the meds that are priced absurdly high. Do you eat this week, or take this pill? That's what it comes down to for too many people.
 
It doesn't have to be this way. The U.S. could actually learn something from how other countries handle medical care instead of being pigheaded.

But, Lily, let's talk about big pharma. One thing that irritates me regarding pharmaceuticals is that most of us don't really understand how or why we in the US pay so much. Now, for the record, my views on whether we should ask the government to negotiate drug prices has evolved and I've decided that I think the trade-offs are worth it, at least for me and my family.
I'm loathed to link to the left's version of Breitbart, but surprisingly, Vox did have a rather even-handed explanation about why drugs are priced so much higher in the US.

https://www.vox.com/science-and-health/2016/11/30/12945756/prescription-drug-prices-explained

There's a direct trade-off between innovation and access. The US has access to every drug approved by the FDA (Food & Drug Administration for non-US readers). That's not the case in much of the rest of the world, because national agencies determine and negotiate which drugs and at what prices they'll approve. Sometimes, they'll decide the benefit to cost isn't there and they'll deny even to negotiate the price - that drug is simply not available. An example of that in the UK is aimovig, a drug that treats chronic migraine sufferers. NICE decided to take a pass. They felt the benefits didn't line up with the costs.

If we changed our model in the US, it's silly to think that investors won't change their behavior. If drugs become less profitable, less money will flow into their research and development. To think otherwise is economic illiteracy.

Before we change the model, we really ought to ask ourselves, what would be the global effect if the US started negotiating drug prices. Right now, global pharmaceutical companies can and do negotiate drug prices in the rest of the world that are oftentimes below the cost of the drug (and yes, I'm counting the cost of R&D in that equation), because the pharmaceutical company knows they will recoup their R&D budget in the US market. All they need to do in the rest of the world is make more than the production cost (which may exclude R&D).

But what if that changed? What if the US negotiated prices with the pharmaceutical companies? First, we'd get cheaper drugs. Second, globally, drug manufacturing would become less profitable. Then, R&D budgets would fall. And the pace of new drugs entering the global marketplace would slow, as there would be fewer investors willing to risk their investment in a lower profit industry. This might have the effect of changing drug manufacturers' behaviors when it comes to negotiating prices in places like the UK and Australia. Today, pharma knows they'll clean up in the US market. If that changes, then they have less incentive to allow a drug to sell in the international marketplace below certain price points. Maybe other countries would pony up more money for drugs their people need, maybe they wouldn't.

While I'm uncertain if the over-all benefits outweigh the costs of changing the US model, it would work for me and my family as I suspect it would benefit millions of other families in the US. And if it comes with a reduction in new drugs entering the market or if it adversely affects other marketplaces outside the US, I'm ok with that.


Drew McGunn
 

dgcasey

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Re: What Do You Pay For Health Care?
« Reply #37 on: February 19, 2020, 01:10:50 AM »
Sure, they might have gripes about their health care system, but they are absolutely horrified when conversation turns to how our system operates.

And I wonder why that is? I wonder if it's because ex-pats will tell them some things that just aren't true? I wonder if they are being told embellished "horror" stories just to try to make the US look bad? I'm guessing that's quite a bit of it. We've heard the same horror stories here in the US, about other countries and I'm sure some of what we hear is just a bunch of hot air, but there is probably lot of truth to it. Like ungodly long wait times in Canada just to see a doctor and then being denied when the doctor suggests some procedure.

I remember seeing a clip on YT a while ago, of Jim Carrey going on about how the Canadian healthcare system is so great, about how he's never had to wait when he needs to see a doctor. Oh really? I wonder why that is. Is it because he's Jim Freakin' Carrey? I wonder if Joe Blow, who drives a delivery truck forty hours a weeks, gets the same treatment when he needs to see a doctor?

Everyone has their anecdotal stories about the "horrors" of the healthcare system. I mean, my God, I had to wait almost an hour a couple of weeks ago when I went in for my semi-annual check up with my doctor. I mean, the nerve of the guy to keep me waiting that long! And don't even get me started about going into the lab and getting blood work without an appointment and having to wait twenty minutes before being called back.

For all its faults, I'll take the US healthcare system over any other in the world right now. And yes, I've lived in other countries during my lifetime. The US system has problems, but it's better than any other system out there. If it wasn't there wouldn't be people flying in from all over the world to get their healthcare needs taken care of. There wouldn't be people driving down from Canada on a daily basis to see American doctors. There wouldn't be people crawling under the fences, trying to get to this country and partake of the services we have here.
I will not forget one line of this, not one day. I will always remember when the Doctor was me.
"The Tales of Garlan" title="The Tales of Garlan"
"Into The Wishing Well" title="Into The Wishing Well"
Dave's Amazon Author page | DGlennCasey.com | TheDailyPainter.com
I'm the Doctor by the way, what's your name? Rose. Nice to meet you, Rose. Run for your life!
 

The Masked Scrivener

Re: What Do You Pay For Health Care?
« Reply #38 on: February 19, 2020, 02:18:03 AM »
They are aghast, every time, at the barbarity of taking a basic human need like health and making the overriding concern the amount of profit corporations can extract.

Are they as angst at corporations making profit from food production? Food is an even more basic human need.

Sorry, anecdotal testimony is meaningless. It ignores the complexity of the topic. Frankly, we are not going to agree nor are we capable of solving the issue. I will continue to push away government intervention in favor of individual freedom. You do what you have to, I only ask you don't force me with the threat of violence to support your decisions.
 

Shoe

Re: What Do You Pay For Health Care?
« Reply #39 on: February 19, 2020, 02:41:05 AM »
What if the US negotiated prices with the pharmaceutical companies? First, we'd get cheaper drugs. Second, globally, drug manufacturing would become less profitable. Then, R&D budgets would fall.

I think it actually works the other way around. Broadly speaking, earning loads off of ten products reduces the incentive (urgency) to create more products. When those ten products begin earning less, there's an incentive to create more products to restore revenue/profits, despite their development costs.
Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 

Shoe

Re: What Do You Pay For Health Care?
« Reply #40 on: February 19, 2020, 02:57:11 AM »

Except the US has learned from other countries and that is why we don't want a government monopoly of our health care services.

I doubt this is true. What country with universal healthcare would they point to as an example? Can you name one?

Quote
The real problem with the US health care system is over insurance. Americans go to doctors for every little thing when they are insured for it. This causes the cost of insurance to go up.

There are several layers there but the truth lies elsewhere--if everyone was insured and got the care they needed when they needed it, the costs of healthcare would go down dramatically.
Martin Luther King: "Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."
 

DrewMcGunn

Re: What Do You Pay For Health Care?
« Reply #41 on: February 19, 2020, 03:01:13 AM »
What if the US negotiated prices with the pharmaceutical companies? First, we'd get cheaper drugs. Second, globally, drug manufacturing would become less profitable. Then, R&D budgets would fall.

I think it actually works the other way around. Broadly speaking, earning loads off of ten products reduces the incentive (urgency) to create more products. When those ten products begin earning less, there's an incentive to create more products to restore revenue/profits, despite their development costs.
I'm not an expert, but if the government negotiates the price, the incentive to create more products may not be there, because the profit may not be there. Not like in the current environment.

Any way you slice it though, it would be an interesting experiment if the US would start negotiating drug prices.


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dgcasey

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Re: What Do You Pay For Health Care?
« Reply #42 on: February 19, 2020, 06:13:06 AM »
Are they as angst at corporations making profit from food production? Food is an even more basic human need.

That was one of the things Crowder got on about in his little rant. He showed the healthcare sector brought in $100 billion in profits in 2018. Then he showed that Apple had brought in profits to equal almost 60% of that. Just one tech company brought in over half what the entire healthcare sector brought in. Where's the outrage over Apple's overpriced smartphones?
I will not forget one line of this, not one day. I will always remember when the Doctor was me.
"The Tales of Garlan" title="The Tales of Garlan"
"Into The Wishing Well" title="Into The Wishing Well"
Dave's Amazon Author page | DGlennCasey.com | TheDailyPainter.com
I'm the Doctor by the way, what's your name? Rose. Nice to meet you, Rose. Run for your life!
 

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Re: What Do You Pay For Health Care?
« Reply #43 on: February 19, 2020, 07:54:42 AM »
Are they as angst at corporations making profit from food production? Food is an even more basic human need.

That was one of the things Crowder got on about in his little rant. He showed the healthcare sector brought in $100 billion in profits in 2018. Then he showed that Apple had brought in profits to equal almost 60% of that. Just one tech company brought in over half what the entire healthcare sector brought in. Where's the outrage over Apple's overpriced smartphones?
Because your life is unlikely to depend on possessing an Apple smartphone. Your life might depend on the quality of healthcare you can receive.


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Re: What Do You Pay For Health Care?
« Reply #44 on: February 19, 2020, 08:06:27 AM »
What if the US negotiated prices with the pharmaceutical companies? First, we'd get cheaper drugs. Second, globally, drug manufacturing would become less profitable. Then, R&D budgets would fall.

I think it actually works the other way around. Broadly speaking, earning loads off of ten products reduces the incentive (urgency) to create more products. When those ten products begin earning less, there's an incentive to create more products to restore revenue/profits, despite their development costs.
I'm not an expert, but if the government negotiates the price, the incentive to create more products may not be there, because the profit may not be there. Not like in the current environment.

Any way you slice it though, it would be an interesting experiment if the US would start negotiating drug prices.
Your argument is sound, but there is one way to short-circuit that connection between research funds and profit margins--government-financed research.

Big Pharma can do as it pleases in part because it doesn't face as much outside competition. If it chooses not to research treatments for a particular medical problem, right now philanthropic efforts aren't able to fill the gap. But if Big Pharma knew that the government would start developing drugs and potentially make them available for a very low cost? Big Pharma would race to develop those drugs first, even if their profit margin was lower.

Big Pharma has long been able to set its own priorities, often with detrimental results. For instance, in the beginning, BP spent more of its research funds on cures. Gradually, the emphasis shifted more and more to treatment. It's not that treatment isn't important, but the reason for the shift was that treatment is more profitable than cure. Why cure diabetes when you can keep selling people insulin and other drugs? The long-term profits are far greater.

But if someone else appeared to be working toward a cure? I bet Big Pharma would come up with one in record time to salvage what it could.


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Re: What Do You Pay For Health Care?
« Reply #45 on: February 19, 2020, 08:27:28 AM »
Fun facts about healthcare:

US is not #1 in patient satisfaction https://www.beckershospitalreview.com/quality/where-does-the-us-rank-internationally-in-patient-satisfaction.html
Sweden 92.37%
Finland 91.92%
Norway 90.75%
US  89.33%

I won't deny that the US actually has the best standard of care--for those who can afford it. That's why foreign heads of state so often end up here. But access to medical care is uneven at best. The three countries that beat us in satisfaction also have socialized medicine. Hmm...

Healthcare in the US is also far more expensive than in comparable countries. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-average-wealthy-countries-spend-half-much-per-person-health-u-s-spends
US average cost per capita is $10,224. Average for economically comparable countries is $5,280. Also, US costs are growing faster than those in other countries.

So, let's see, we provide more expensive care at a lower rate of patient satisfaction than some of our single-payer healthcare rivals. Explain to me again why our system is so wonderful?

That said, Masked Scrivener has a point about being forced to have medical insurance, and I can also see the argument for people happy with their current health care. That's why I'm more of an advocate for Medicare for everyone who wants it rather than Medicare for all, at least in the short-term. Two things to keep in mind, though. First, people can experience sudden changes in health status that may make them regret not having insurance. I've seen this happen. Second, the people who opt not to be insured will tend to be the healthy ones (duh!) which makes insurance costs proportionately higher for everybody else.

It's also worth noting, in response to someone's earlier comment about people being denied the prescribed treatment, that that is hardly unique to government-run system--but at least the government-run variety is not motivated by profit. Private insurance companies have been notorious for that for years and will continue to be. For example, a friend of mine was diagnosed with peritoneal mesothelioma. That's an extremely rare condition for which there is only one treatment that produces results. Ordinary chemo doesn't do a thing. Initial insurance company response: denied on the basis the process was experimental. (It's been used for years, and its effectiveness is supported by research.) My friend eventually won on appeal, but it took months, and literally whole working days for him and his wife to pour through medical journals for more information, something a lot of people couldn't have done. He's still with us, but a lot of people caught in that trap could have ended up dead.


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