The road to Insurance Claims and Costs

[Spekkio]

Our healthcare system is completely bonkers. I am not sure what I’ll do when I’m old- after watching my parents and grandparents try to navigate things, moving to another country has crossed my mind.

That would be the worst time to opt out. The elderly are the largest beneficiaries of the pyramid scheme and no country is going to beat the specialty care you'd eventually need.

Moving to another country as you turn 66 would be like abandoning your TSP after contributing all your life.

 

[exNavyOffRec]

Are you referring to Tricare, VA, or Medicare?

The going reputation for Medicare among providers is that although it pays less, it's the easiest insurance to deal with for approvals. The government almost never challenges claims.

Tricare is supposedly the worst of both worlds, which is why almost no one takes it. And there isn't the largest cohort of healthcare consumers on it like Medicare.

Private insurance battles are slowly going away as they buy up providers and expand to regional networks. Private practices are an endangered species. The same people are getting a cut of the procedure and insurance payout, so the more the doc runs up the bill, the richer the C-suite gets. This is removing almost all cost reduction pressure from healthcare.

If you go to an UC clinic or ER and ask for the bottom line cash price to get seen for an acute illness, they wouldn't be able to tell you. That's a huge problem. That fear among the public is driving healthcare policy.

I have used both private and Tricare.

The few issues I have had with Tricare is when they changed who administered Tricare in the west region, that change over was an absolute mess and then my back issue. If I was to exclude those 2 issues I have been very happy with Tricare. My civilian health insurance which I have had 2 different ones have been a lot of delay where it seems they hope you will just give up.

I haven't dealt with VA healthcare but I have visited every VA Hospital in my state and talked to each director due to my past role with the VFW, in general the patients we talked to seemed happy with their care, most of the care is in house to minimize delays, there are shortcomings with community care and they are working on that. The one VA Hospital I visited that is the exception is Walla Walla, they basically triage and send about 90% of their patients out into the community.

 

[exNavyOffRec]

Lived in Australia for a few years.
I still think their system is far better than than ours.

Primary care lead times were a few days, so people get to issues much earlier than here.

When I saw the bills. Imaging tests like MRIs cost about a tenth what they do here. And the lead times were again, within a few days, not like a month plus which seems to be the norm I’ve heard/seen in multiple CONUS states.

Orthopedic surgery and other specialist wait times were within a week for initial consult.

They all pay for their Medicare through taxes, which is really just basic, preventative, and ER care. But most people have employer heath insurance that will pick up stuff their Medicare for all won’t like orthopedics.

I wouldn't mind living in Australia, except for the spiders, I really hate spiders.

 

[ea6bflyr]

I wouldn't mind living in Australia, except for the spiders, I really hate spiders.

Everything in Australia is trying to kill you….

 

[Flash]

I live close to Canada, I have many Canadian friends and they have no problems with minor medical issues, but when it comes to major ones several will come down to the US for specialized treatment or I have heard some go to Mexico, a friend's dad from several years ago moved to the US to practice medicine due to the state of the Canadian health care system and there were several others she knew as well. I also have had several candidates for roles I have hired for from Canada and one of the reasons they look at US jobs is to get healthcare in the US. CNBC did a report several years ago about the state of their healthcare in regards to specialized medicine the people they interviewed didn't have good experiences.

I have heard good things about Singapore, and my friends daughter lives in France with her husband, but I haven't asked her how she likes it.

Access to specialty care is an issue in the US as well if you live far from an urban center. Side effect of a fee for service system is that it's more lucrative to practice medicine in densely populated areas.

With a Canadian wife who's family all lives in Canada I've see both sides and can say both have big pluses and minuses. One thing to keep in mind is that the Canadian system is not a national one but is provincially based, with the richer provinces having more robust systems and the others less so.

My family has gotten outstanding care here in the US but that is primarily based on two things, good insurance that costs me ~5% of my pay (before co-pays and deductibles) and being located in an area (suburban/urban) with great access to plenty of primary and specialized care. Although we have good insurance we've still paid $10's of thousands for care over the last decade out of pocket with more to come. And even with the large number of providers and services in the DC area we've often had to wait weeks or even months in a few cases for routine or specialized care.

My wife's family in Canada have usually had good care in Canada, even with comparable or longer wait times to what we've had, and their outcomes have usually been as good as ours though they've had less experience with getting specialized care. The big exceptions being the specialized care that two of my family has received in the US that they likely would not have had in Canada with one being an experimental treatment at NIH and the other a developmental surgery at Johns Hopkins that is not widely practiced or approved by insurance yet even in the US.

A big thing hurting the Canadian system is the salary levels in Canada and cost of living, where Canadians across the board usually make quite a bit less in comparison to their American counterparts particularly if you are a white collar professional in addition to usually enduring a higher cost of living. My wife's family is from Vancouver and in a few weeks the last ones will have left due to the skyrocketing costs there, the highest in North America beating even NYC, Miami and San Francisco.

Finally a small anecdote about the French and American systems. I worked with the French liaison officer at JIATF-South years ago, a great guy with a very funny deadpan sense of humor, who's daughter broke her arm pretty good climbing a palm tree. Every time they had to go to the orthopedist they had to trek back and forth to Miami which is an all day trip from Key West. Apparently the ones (several) they saw sucked and he and his wife were considering moving her and kids back to France to get better care. Only one example of countless but to say he was unimpressed with American medical care is an understatement.

 

[number9]

I'm from Australia and the single-payer system (with a private option) has been around for decades, works fine, and no one goes bankrupt due to high medical bills. We are practically the only industrialized western country that can't seem to figure this out..

 

[Griz882]

I'm from Australia and the single-payer system (with a private option) has been around for decades, works fine, and no one goes bankrupt due to high medical bills. We are practically the only industrialized western country that can't seem to figure this out..

I applaud Australia’s willingness to tackle their health care, especially budget issues that are currently threatening to the system. But it clearly isn’t as easy to “figure out” as some imply.

'I'm sick of it': One in two Australians priced out of healthcare system

One in two Australians missed out on health care they needed last year mainly because they could not afford it, according to a new report by the peak healthcare consumers group.

www.abc.net.au

Macron to overhaul France's struggling health care system

French President Emmanuel Macron has announced an overhaul of France’s struggling health system, including new funding methods for doctors and hospitals, more hiring and other organizational changes.

apnews.com

Britons are beginning to admit it: Their beloved National Health Service is broken

“Free” healthcare costs a lot in personal time and taxpayer money.

reason.com

 

[exNavyOffRec]

I applaud Australia’s willingness to tackle their health care, especially budget issues that are currently threatening to the system. But it clearly isn’t as easy to “figure out” as some imply.

'I'm sick of it': One in two Australians priced out of healthcare system

One in two Australians missed out on health care they needed last year mainly because they could not afford it, according to a new report by the peak healthcare consumers group.

www.abc.net.au

Macron to overhaul France's struggling health care system

French President Emmanuel Macron has announced an overhaul of France’s struggling health system, including new funding methods for doctors and hospitals, more hiring and other organizational changes.

apnews.com

Britons are beginning to admit it: Their beloved National Health Service is broken

“Free” healthcare costs a lot in personal time and taxpayer money.

reason.com

It is starting to seem that no matter where you live there are issues, and no one really has it "figured out".