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<p>Same thing.</p>
<p>Baby out with the bath water? You talking additives and engineering? Or the nutritional recs?</p>
<p>Please reread my post. It’s pretty clear.</p>
<p>Honestly not seeing it, BC.
There’s a lot of work to cure diseases, we are well ahead of where we were. I don’t get the Ag comment. </p>
<p>I’d build a network of clinics for first-level services, nothing fancy, cheap to operate, cheap to visit. Send all the “runny noses” there, folks who need a bp check or want to make sure something isn’t more serious. In my early walk-in clinic experiences in CA, you paid $35 out of pocket. I don’t recall insurance taken or all the complications based on who had what policies, etc. If it’s in a needy area, where more patients cannot pay, build a support system, as many free clinics have today. Make it happen.</p>
<p>If you come down with a dread disease, we have to decide, as a nation, if we want to cover that, how much, and be willing to share those costs. Not sharing means Fred pays more for his cancer treatment, Mary’s post-delivery complications are her problem.</p>
<p>There’s a lot of emotion in all this. We want quick visits, sure treatment plans, low cost.</p>
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<p>Hangout on the diet and exercise thread or read through it. The evidence is there. The main problem is the emphasis on low-fat diets.</p>
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<p>This is similar to what we have in our neighborhood. It’s somewhat bigger than a clinic but much smaller than a medical center and tiny compared to a hospital. I think that there are three or four doctors and some PAs and NPs. They do some lab services on-site. I have found it easy to get appointments with the PAs and NPs. I’m not particularly concerned that we usually don’t get a doctor when we go there.</p>
<p>I’d still go with trying to provide first-aid training to everyone. Our company will provide it if you agree to be a first-responder in the office. My previous company paid for my training many years ago.</p>
<p>Does anyone know how open enrollment will work within the exchanges - or in the private/group market after ACA implementation?</p>
<p>Here’s the thing. I’ve balanced the premium/deductible/OOP figures in such a way that they work best for our family right now. No one has a long term condition, no one has expensive ongoing needs. As a member of a group plan we have the option to change - without any requalification - every open enrollment period.</p>
<p>Now, if one of us were to develop a serious and costly issue I’d switch us to a high premium, 100% coverage, no deductible plan at next open enrollment. The numbers work differently under different family/health scenarios.</p>
<p>So, why not enroll in a basic Bronze plan…the lowest premiums possible. THEN if you get sick - move over to the Platinum. This is one huge benefit of removing pre-existing condition clauses for everyone.</p>
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<p>THAT! If you don’t change your oil, put on new tires, make sure your coolant level is correct and subsequently your engine blows up…well…it’s cause and effect. Your car insurance doesn’t cover it. You have to be willing to cover your own maintenance.</p>
<p>One way to control costs would be to limit charges for any medications/treatments given in the US to the lowest charged by the same pharm/medical company in any other part of the world. Why in blazes should US company A spend a gagillion dollars developing miracle drug B, sell it to US customers for astronomical prices and then conversely sell it to a third world nation for ‘humanitarian’ reasons for pennies a day?</p>
<p>Original OP here 
We have contacted another insurance agency (used them previously) and they are researching and getting together a list of some other possible health insurance policies for our business. We’ve contacted our accountant and he said that many of the other small businesses he works for have been moving over to the high deductible HSA insurance programs. The more we look into it, the more it seems that this may be the best way for us to go.</p>
<p>Although H has provided 100% of health insurance for our two full time employees in the past, he is leaning towards scaling back. He’s considering the high deductible medical insurance and simply informing the employees about their option to open up the HSA on their own (he’s not gong to fund it). Enough is enough. The costs are too much and continue to rise at ridiculous amounts.</p>
<p>We’ll know more by the end of the week when we get a new set of choices from this second insurance broker and compare them to the set of choices from the first broker.</p>
<p>I’m all for that med suggestions, dietz. Got three months worth of my meds in Costa Rica for about $40. While my meds in the US don’t cost as much as music’s (yet), they’re astronomical.</p>
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<p>The idea is that you sell things to people at a price where it is a value to them. Valuation might be different for every person. You can see this in airline pricing where they try to figure out what you will pay for something.</p>
<p>There are huge margins on some products because we perceive them as a great value - and this may have no relationship to the actual cost of production.</p>
<p>Musicmom, sorry to read you have UC. </p>
<p>NYSmile good luck.
My old firm paid for 100 percent of the employee’s healthcare until it was decided that it was too expensive. </p>
<p>Hayden, I like your post. </p>
<p>I am sure there are many reasons why this country doesnt have universal single payer healthcare.</p>
<p>Many posters in this thread probably dont really want universal single payer healthcare. They are happy with their healthcare. Many people are happy with their healthcare.</p>
<p>I can also think of 2 more reasons…EB and JL.</p>
<p>There is a free clinic in our area that is completely run on donations and treats the runny noses and similar maladies. </p>
<p>They are BOOKED. You can’t get in for months. </p>
<p>I agree, if you had one that ran on $20-$35 a visit, it might alleviate some of the stress in other areas.</p>
<p>Agree with you, BCEagle on both cures and nutrition.</p>
<p>Here’s an idea - stop putting sugar/high fructose corn syrup in EVERYTHING. I don’t need sugar in my bread. I don’t need sugar in half the things I buy off the shelf. And if I want to add some sweet, I can add some sweet.</p>
<p>Foreign exchange students that come here from affluent families in other well developed countries, even if they’re involved in physical activities similar to those at home start packing on the pounds. Why do you think that is?</p>
<p>We had one buddy from Italy and one from Sweden, and I told them both, just stop drinking sodas, go back to water, and eat fresh foods like you would at home. Watch your bread, because we add sugar here…weight fell right off.</p>
<p>I’m late to this discussion but some economists have proposed reference pricing. Insurance would pay 100 percent for only the lowest priced provider of a procedure in your area. You would have to pay out of pocket the difference for high priced providers. This would slow the growth of premium costs and drive down procedure prices as patients flocked to lower cost providers. Of course this, and other schemes such as negotiated prices between all the providers and all the insurers, requires transparency in pricing. If hospitals and doctors were required to post their prices, that alone would be a good start.</p>
<p>Re moving services out of doctors offices. Many larger employers are being to provide their own medical care services for well care and uncomplicated sick care. And time was when i wanted my flu shot I’d have to make an appointment with my doctor wait for an hour with sick people coughing on me and pay for an office visit. Now I go to Walgreens. </p>
<p>One reason young and healthy insureds are experiencing a rating shock is that before the ACA, their premiums were based on their current actuarial status not their lifetime projected costs. As they aged and got sick they could be denied coverage, experience high premium increases, or be kicked into a high risk pool. Now, higher current rates are a kind of insurance against a much bigger rating shock later. </p>
<p>Uwe Reinhardt on this, a bit wonkish [‘Premium</a> Shock’ and ‘Premium Joy’ Under the Affordable Care Act - NYTimes.com](<a href=“http://economix.blogs.nytimes.com/2013/06/21/premium-shock-and-premium-joy-under-the-affordable-care-act/]'Premium”>'Premium Shock' and 'Premium Joy' Under the Affordable Care Act - The New York Times)</p>
<p>RE: BCEagle and medication pricing…</p>
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<p>I’m sure the AID’s victim in the US places as much value on their life as the AID’s victim in say Africa. However, the US victim may not be able to afford the huge monthly OOP cost…while the African victim gets it for ‘free’ and the drug company sells it to the foreign aid services for pennies.</p>
<p>An excellent personal example: I use RetinA…arguably a ‘vanity’ medication. I’ve used it for 25 years now. It costs about $100/tube in the US. It runs about $18/tube for TWICE the size in Mexico. WHY! Do kids with Acne ( or vain middle aged women) in Mexico place less value on their issues? </p>
<p>So, each year I purchase enough of the stuff for myself and my two, still acne prone younguns’, for about $400. I figure I’d be paying about 3K in the US. That is a huge difference…about weeks worth of a reasonable vacation.</p>
<p>I’m pretty sure there are incentives for undercutting pricing in 3rd world countries.</p>
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<p>The motive of a business is to make a profit so that is what they try to do.</p>
<p>It’s not that different from the business of college - you try to extract as much money as you can from everyone that you can along with attracting candidates that you would like in your class. If someone can’t afford something, the drug companies say: “come and talk to us and maybe we can work something out”. Similar to buying a car too. Someone has to pay for R&D and production costs + profits.</p>
<p>I don’t want to edge this closer to political and end the thread, but it seems like the last bunch of pages here–trying to come up with a workable alternative, are re-inventing the wheel, since there are so many working models around the world we could adopt/adapt.</p>
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<p>Of course, in many cases a good deal of the R&D is subsidized by the federal government in the first place.</p>
<p>I won’t be boohooing for big pharma until they stop advertising drugs on TV, especially drugs that work no better that aspirin. How much do they spend on advertising that stuff? </p>
<p>The safest and most effective drug for T2 diabetes is metformin, and it costs about $8 per month at RiteAid. It is by definition a generic, because it has been around forever. So big pharma constantly tries to come up with new drugs that are NOT generic, often something else mixed with metformin. Those drugs–which expose T2s to dangerous lows–cost $60 per month and up. (Mostly up.) You will search long and hard before you find a study in which T2 diabetics control their blood glucose with low carb diet and exercise, and possibly metformin. No one in that category is EVER studied. Studies are routinely conducted on people who are obese and have over HBA1C’s of 8.2 and up, and the attempt to force that down by loading them up with drugs. A decrease to 7.9 is celebrated. In contrast, when I was diagnosed I brought my HBA1C from 9 to 5.1 in 6 months–just about “normal”–with a low carb diet, exercise, and metformin. Big agriculture pushes grains, they fund the ADA, as do the drug makers who stand to gain if people fail to control their HBA1C by the cheapest and most effective methods, and people fall for it because it is easier to pop a pill and keep on eating those “healthy whole grains” in quantities that makes all the big players rich. Not to mention their lobbyists. And kills diabetics.</p>
<p>The fact that some clinics are booked would have to be resolved. </p>
<p>Some pricing can be seen in the Healthcare Blue Book. I think the complaint is that it’s rolled, like Medicare, not itemized. But it gives an idea. I looked at the gall baldder surgery someone mentioned, outpatient, from 5k (OK) to 6k (N. CA, Boston.) Averages, but a start.</p>
<p>At the exact moment I was ready to enroll in my new plan, my super healthy dau had a condition detected on a routine physical. Hence the echo. If this is nothing, fine, I could have put her on the cheapest plan, workable deductible. If it is worse, she could simply need meds- or major surgery. It underscores how difficult these choices are. A major consideration for me was the cap. But, family plans aren’t always simple math. And you have to dig deep to understand. (A colonoscopy is 20% after deductible. Sheesh, so what’s a colonoscopy cost? In the end, it turned out the routine procedure we get every x years, is free, as a preventative. Double sheesh.) Her echo may be covered, if the doc coded it as routine related to the annual. Or not. ?</p>
<p>The reason I’m less inclined to point one finger at ACA or docs or whatever, is really because I see how miserably interconnected so many issues are. The big insurers are for-profit. Regulations mandate this and allow them to get away with that. State pricing can be affected by buddy relationships or even other legit considerations. Some states have little competition among insurers. Med research is expensive and depends on that guy or that team having an idea to pursue and getting sufficient funding to proceed. Existing diagnostic equipment is expensive to produce and obtain. Insurers don’t want statistically unproven tests run, at a cost, if they can’t be justified. Some docs know how to work around that. Some consideration also has to go to the patient’s age and overall condition. It goes on. If you have ever read a hospital’s annual report, you see what adds to what. It’s interesting when the medical ethics line up against the costs.</p>
<p>BC, I am up on the low-fat and carb controversies, with regard to cardiac, diabetes, obesity. This was coming. Look at the butter-no butter-butter changes. Docs are not omnipotent, med sci only knows what it knows- and clearly, over time, continues to question and evolve.</p>
<p>Moderator’s note:</p>
<p>In order for me to keep this within TOS without having to resort to shutting it down as unworkable, please stay within the parameters that are workable.</p>
<ol>
<li> What is allowed by law at the moment.</li>
<li> What are things people can do to make it workable for them.</li>
<li> What are scenarios that may develop because of the law that we need to anticipate.</li>
</ol>
<p>This is a thread essentially to help your fellow member navigate the complexity. </p>
<p>Coulda, shoulda, worked in Canada, the law does not work, the law needs to change - these are the kind of messages that will be removed as having no relevance to this discussion.</p>