redbears
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Post by redbears on Jul 25, 2019 7:43:07 GMT -6
Can we talk about this for a minute. I only really know what I heard in the first debates. I want everyone to have a Medicare option, but I personally am not comfortable with the idea of losing our employee healthcare. I want the option for either. Is Biden the only one who supports this?
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jkjacq
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Post by jkjacq on Jul 25, 2019 8:15:08 GMT -6
I'm curious why losing employer sponsored healthcare is not a good option?
The arguments I've heard so far arent compelling to me. As an employee I have no choice if my employer chooses to change my plan, raise my deductible, my copay, change networks, or raise my premium, and I'll lose it when I leave, because its not easily portable or affordable as COBRA. Unless you have union benefits, the typical employer plan isn't the best option for the average person. RX benefits change midyear with little to no notice.
The employer portion of my benefits are considered my salary. They are very much a golden handcuff.
And I'm not bashing my coverage. We have fairly good medical/dental/vision at my employer, but coverage has changed twice in the 3 years since my company was bought.
I'm very much in support of universal/MFA plans. There is no reason we can fund a 20 year war in this country and not afford to cover medical necessities in this country. As for coverage, moving to MFA all doctors would be 'in network' so that takes the network out of the equation.
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redbears
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Post by redbears on Jul 25, 2019 8:20:04 GMT -6
My husband works for the city, so we have a lot of choices when it comes to which plan we want to use. It just makes me really nervous thinking about how all these changes would impact us. To me, it seems simpler to just add Medicare as an option instead of forcing me into a change I don’t want.
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Post by wickedcandy on Jul 25, 2019 8:21:32 GMT -6
I'm not sure if it's the same idea as Universal Health care in Canada, but I'll explain how ours works..
For us, all dr visits, ER/Urgent care, are covered, through our taxes, so are hospital stays, medical surgeries (ie my d&c, my spinal surgery, things like that) We still have private insurance benefits that are offered from employers or you can buy, that cover dental, eye care, prescriptions, things like Chiropractors, massage therapy etc, and upgrade to semi private or private hospital rooms.. Yes sometimes the wait times are long for certain specialists or surgeries (knee replacements etc) but at least people aren't going bankrupt... And if you are on dialysis or chronic illness, you have coverage.. It's not perfect, but at least I can go to the ER knowing that I'm not going to end up with a 100k bill
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jkjacq
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Post by jkjacq on Jul 25, 2019 8:28:31 GMT -6
My husband works for the city, so we have a lot of choices when it comes to which plan we want to use. It just makes me really nervous thinking about how all these changes would impact us. To me, it seems simpler to just add Medicare as an option instead of forcing me into a change I don’t want. I dont think it would be one sweeping change. It can't be.
But done in steps, such as covering newborns starting in 2023 thru life and then as children age off their parents plans as well as those who qualify due to their age or necessity, is a feasible solution
And would give those who aren't completely opposed but apprehensive a glimpse into how it would work.
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Post by blurnette989 on Jul 25, 2019 8:48:23 GMT -6
Also lots of countries with national healthcare have combined systems. In Portugal there is the national healthcare, the military also has its own healthcare system (in order to be effective worldwide), and you can buy private healthcare on top of whatever else you have.
The other big thing is that the government negotiates with hospital groups, pharmaceutical companies and med device manufacturers, so costs are hella lower. This part is also extremely important for people to realize. Because maybe yes over time you'd lose some coverage but it is OK because nothing costs what people in the US think it costs.
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kitchen
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Post by kitchen on Jul 25, 2019 8:52:54 GMT -6
jkjacq , I can't speak for redbears concern but I have selfish concerns about losing employer insurance. My experience is that my daughter is eligible for Medicaid but if we used it as her primary insurance instead of secondary we would end up on mega wait lists, with no providers who take Medicaid, and just generally have a much harder time getting care for her. I assume the key answer to this concern is that under a Medicare for all system the negotiated rates would be high enough that doctors wouldn't have to limit the number of patients with public insurance and therapists would be able to make a living seeing patients with public insurance. I absolutely worry about my daughter's entire childhood of medically indicated therapy needs getting lost in the shuffle of a transition to a new system. Doesn't stop me from supporting it because I know it's the correct solution for everyone, but I fall back on knowing we are in a position of privilege and can pay OOP when we really need to. I can imagine people without that option would be in a tough spot. "Just trust us, it will be better" is so hard.
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jkjacq
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Post by jkjacq on Jul 25, 2019 9:05:56 GMT -6
kitchen, valid concerns Again I dont think it can be a sweeping change. Like you wake up Jan 1, 2022 and EVERYBODY has Medicare. The ACA was implemented over years, the insurance industry complained the whole way but they adapted. If the majority of people moved to a universal plan, the medical community will have no choice but to follow, drs, therapists, etc because thats where the money is going to go. The bigger issues I see are less people going into healthcare because it won't be as profitable and its expensive to go to medical school. We need to find a balance somewhere. And oversight and implementation. The Medicare framework is already in place nationally but I could see an influx of people causing big problems and the CMS would probably need to be overhauled and adjusted as well.
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dc2london
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Post by dc2london on Jul 25, 2019 9:08:35 GMT -6
She hasn't done a good job of talking about it in the debates or town halls but Kamala's healthcare plan is along the lines of the Canadian or UK systems wherein coverage for continuous and incidental health care is entirely included in the national health plan and many/most people have additional employer sponsored or private plans for supplemental care. Personally, as it stands right now, I think that's the best option.
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Post by mandmpie on Jul 25, 2019 9:09:43 GMT -6
Can we talk about this for a minute. I only really know what I heard in the first debates. I want everyone to have a Medicare option, but I personally am not comfortable with the idea of losing our employee healthcare. I want the option for either. Is Biden the only one who supports this? Pete Buttigieg also supports this.
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Minerva
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Post by Minerva on Jul 25, 2019 9:21:59 GMT -6
She hasn't done a good job of talking about it in the debates or town halls but Kamala's healthcare plan is along the lines of the Canadian or UK systems wherein coverage for continuous and incidental health care is entirely included in the national health plan and many/most people have additional employer sponsored or private plans for supplemental care. Personally, as it stands right now, I think that's the best option. This style of plan would definitely be my preferred option. I would like to be able to purchase supplemental private insurance to have additional access to things like more coverage for PT, OT, ST, psychiatrists, etc... for my SN child. And to avoid shared hospital rooms and long waitlists as much as possible. But having a safety net of comprehensive healthcare for people without the means to afford private coverage should be the first priority.
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athn64
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Post by athn64 on Jul 25, 2019 11:06:00 GMT -6
She hasn't done a good job of talking about it in the debates or town halls but Kamala's healthcare plan is along the lines of the Canadian or UK systems wherein coverage for continuous and incidental health care is entirely included in the national health plan and many/most people have additional employer sponsored or private plans for supplemental care. Personally, as it stands right now, I think that's the best option. This is also my preference for a system
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jaygee
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Post by jaygee on Jul 25, 2019 12:46:52 GMT -6
Hi!
I am a huge supporter of Medicare for all. Even though a headline on one of my industry email briefs said the CBO estimated $200B in losses for hospitals under the plan and I work for a hospital.
I do think private insurance has to be part of the system as a supplement. I just don’t see how it couldn’t - mostly based on our culture and economy. People here don’t like to wait. We don’t like to share resources, so private supplemental insurance will give people options if say their wait for a Medicare provider doesn’t meet their needs. (Although even with private insurance now people can wait months for a top specialist, but I digress).
I think it’s the right thing to do for people. Every provider takes Medicare. If they don’t, you probably don’t want to see them because they have been barred from the Medicare program due to fraud or poor quality. (I’m excluding very niche concierge type medical providers, but those don’t usually take private insurance either). Medicare makes life so much easier for patients. So much less stress and chance for denied care. I swear if you gave people a trial of Medicare for a year, they would never look back. Is it perfect? No, but with more people on it, we can make changes to make it better. And Medicare does improve with feedback. It’s actually one of the things our government runs best (same with VA coverage - there is a huge access to care issue there that still needs work, but the care and actual coverage is fantastic)
Medicare has very easy to follow, well laid out rules and regulations for what they cover and what the payment will be. People know in advance what is covered and what isn’t. Providers don’t need to jump through hoops to obtain authorizations or notify Medicare of admissions like we do with private insurance as long as we follow their guidelines. When Medicare wants to do something new with payments they test it out and work with providers to get feedback. Private insurance just comes up with a new policy to get out of paying us, sends us a letter, and doesn’t listen when we complain.
It will reduce cost in healthcare. Drastically.. I am sitting in an office of probably 300 people right now that represents just one part of our billing and collection functions. Under Medicare for all you would probably need 100 people to do the same work. Now, what could those people do? So many possibilities exist in healthcare alone - patient care, case managers, preventative care initiatives, compiling date for research studies are just a few examples.
Yes, it will be lost revenue for hospitals. Medicare pays well but we do make up for our losses on Medicaid and some of our Medicare services by how much we get paid by private insurance. But with the reduced costs, I don’t think this is as big of a deal as it seems. Plus they could finally gives us our 2% sequestration cuts back and that would help. Also, having more predictable income will help. We are constantly watching our payer mix now because any percentage skew towards Medicaid and away from private insurance makes a huge swing in our revenue. Under Medicare for all we would be able to more accurately forecast revenue.
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jkjacq
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Post by jkjacq on Jul 25, 2019 12:50:54 GMT -6
jaygee, I was hoping you'd be here with the billing side. I knew I couldn't do it justice like you just did.
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jaygee
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Post by jaygee on Jul 25, 2019 13:00:03 GMT -6
kitchen, valid concerns Again I dont think it can be a sweeping change. Like you wake up Jan 1, 2022 and EVERYBODY has Medicare. The ACA was implemented over years, the insurance industry complained the whole way but they adapted. If the majority of people moved to a universal plan, the medical community will have no choice but to follow, drs, therapists, etc because thats where the money is going to go. The bigger issues I see are less people going into healthcare because it won't be as profitable and its expensive to go to medical school. We need to find a balance somewhere. And oversight and implementation. The Medicare framework is already in place nationally but I could see an influx of people causing big problems and the CMS would probably need to be overhauled and adjusted as well. Your last point is very valid. Medicare doesn’t deal with whole swaths of the population right now - they have payment rates for delivering a baby, but they don’t have a population who does that, so they don’t have the data to really assess if the payment is reasonable. Same with NICU services or basically anything that elderly people don’t get. So there would be a lot of heavy lifting to do to update their coverage guidelines and payment rates. This whole thing if it happens will be a huge transition for the industry and citizens. Exchange plans and ACA was a large transition that we are still working through (it’s been successful but it’s been a lot of work and adjustments). This will be even more. I feel like a candidate would go far on transparency around that. A lot of the fears / opposition I hear from people who believe healthcare is a right but are nervous of this system/proposal could be addressed with some talk about transition. The only candidate I’ve heard address that too much is Gillibrand. I wish they would say “I know you’re afraid of this or this happening, here’s what my vision is and even though it’s going to be a change, here’s why I think you’ll end up better off than you are today”
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jaygee
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Post by jaygee on Jul 25, 2019 13:01:17 GMT -6
jaygee, I was hoping you'd be here with the billing side. I knew I couldn't do it justice like you just did. I could talk for hours. Secretly I just want M4A so I can retire and focus full time on dog rescue. 🤣
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jkjacq
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Post by jkjacq on Jul 25, 2019 13:11:32 GMT -6
jaygee , I was hoping you'd be here with the billing side. I knew I couldn't do it justice like you just did. I could talk for hours. Secretly I just want M4A so I can retire and focus full time on dog rescue. 🤣 I worked for a TPA for a couple of years. I love talking insurance
I think most of the country has been, brainwashed for lack of a better word, to think private insurance is the only way medical care can be successful. Thats due in a large part to part of your premiums paying lobbying groups to keep that narrative alive. Add in mistrust of the government to do whats right and its a mess.
When someone was complaining about the individual mandate and not wanting to pay for someone 'who is just going to take advantage of them and not work'. I kept telling them, you realize you are already paying for them. Do you really think that a hospital isn't going to pass a loss on to the people who DO pay? And if more people are paying into a system then YOUR premium goes down because there is more money to pay claims. I had to damn near bust out actuarial tables.
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jaygee
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Post by jaygee on Jul 25, 2019 13:57:55 GMT -6
Also, think of the freedom a system like Medicare for All creates and the positive impact it would have on our economy. So many people stay in jobs they hate or are overqualified for just to keep their medical coverage. If people could freely change jobs or leave jobs to start companies without worrying about their health care coverage, it would be great. Yes, there are a ton of other obstacles to changing jobs and starting a business, but health care coverage shouldn’t be one of them. It made sense for health care to be tied to employment when people got a job and stayed with the company for their whole career, but now that’s not how the economy works. A lot of people don’t realize that what sucks about their health care coverage is what their employer is choosing when they set up benefit packages. If something is not covered (like infertility treatments) it’s because the employer choose not to offer it in the benefit package - probably to save money.
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AmyG
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Post by AmyG on Jul 25, 2019 15:01:49 GMT -6
Seems a compromise might be to just lower the age Medicare covers every x number of years the age for medicare drops by x number. Like if you can take early retirement at 62, you should be able to get Medicare at 62. so start there, then in a couple years drop to 60 then 55. It would be a start maybe?
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Post by Uncaripswife on Jul 25, 2019 15:40:51 GMT -6
My husband works for the city, so we have a lot of choices when it comes to which plan we want to use. It just makes me really nervous thinking about how all these changes would impact us. To me, it seems simpler to just add Medicare as an option instead of forcing me into a change I don’t want. For employees who aren't unionized (and that's most people in the US), being forced into a health plan change they don't want is always a possibility. A private sector employer can decide tomorrow to change or completely cancel it's health plan, with no advance warning, and there's nothing they can do about it. So, for most, switching to Medicare for All wouldn't be any worse. In fact, it would remove that uncertainty and anxiety for them.
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Post by Uncaripswife on Jul 25, 2019 15:44:45 GMT -6
I'm not sure if it's the same idea as Universal Health care in Canada, but I'll explain how ours works.. For us, all dr visits, ER/Urgent care, are covered, through our taxes, so are hospital stays, medical surgeries (ie my d&c, my spinal surgery, things like that) We still have private insurance benefits that are offered from employers or you can buy, that cover dental, eye care, prescriptions, things like Chiropractors, massage therapy etc, and upgrade to semi private or private hospital rooms.. Yes sometimes the wait times are long for certain specialists or surgeries (knee replacements etc) but at least people aren't going bankrupt... And if you are on dialysis or chronic illness, you have coverage.. It's not perfect, but at least I can go to the ER knowing that I'm not going to end up with a 100k bill Re waiting for care. I have available to me what is widely considered some of the best health care coverage in the US. MH's doctor ordered an MRI in early June. He finally got it on Tuesday. The delay was caused by the health plan's utilization review. So anyone who alleges that waiting for care in the US doesn't already happen is kidding themselves.
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Post by Uncaripswife on Jul 25, 2019 15:55:33 GMT -6
Also, think of the freedom a system like Medicare for All creates and the positive impact it would have on our economy. So many people stay in jobs they hate or are overqualified for just to keep their medical coverage. If people could freely change jobs or leave jobs to start companies without worrying about their health care coverage, it would be great. Yes, there are a ton of other obstacles to changing jobs and starting a business, but health care coverage shouldn’t be one of them. It made sense for health care to be tied to employment when people got a job and stayed with the company for their whole career, but now that’s not how the economy works. A lot of people don’t realize that what sucks about their health care coverage is what their employer is choosing when they set up benefit packages. If something is not covered (like infertility treatments) it’s because the employer choose not to offer it in the benefit package - probably to save money. This. Yes. And I get that people are nervous about change, and as mentioned above the insurance lobby makes sure people stay afraid. But the employer coverage most people have could change tomorrow. They just don't realize it. That's what people should REALLY be afraid of. Also, having to offer health coverage is tough for mid sized employers and horrible for small employers. It's expensive, they don't understand what they're buying, and they don't understand the significant obligations that come along with offering employee health coverage. If the gop hadn't undermined the ACA every small employer in this country would be free from the burden of health benefits, and they'd be grateful for it.
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athn64
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Post by athn64 on Jul 25, 2019 15:57:30 GMT -6
I'm not sure if it's the same idea as Universal Health care in Canada, but I'll explain how ours works.. For us, all dr visits, ER/Urgent care, are covered, through our taxes, so are hospital stays, medical surgeries (ie my d&c, my spinal surgery, things like that) We still have private insurance benefits that are offered from employers or you can buy, that cover dental, eye care, prescriptions, things like Chiropractors, massage therapy etc, and upgrade to semi private or private hospital rooms.. Yes sometimes the wait times are long for certain specialists or surgeries (knee replacements etc) but at least people aren't going bankrupt... And if you are on dialysis or chronic illness, you have coverage.. It's not perfect, but at least I can go to the ER knowing that I'm not going to end up with a 100k bill Re waiting for care. I have available to me what is widely considered some of the best health care coverage in the US. MH's doctor ordered an MRI in early June. He finally got it on Tuesday. The delay was caused by the health plan's utilization review. So anyone who alleges that waiting for care in the US doesn't already happen is kidding themselves. I have to call 3 months in advanced to see DD2's allergist. It took us 6 months to get in initially. So yeah, we have to wait. And if I want to see my primary and not one of her Nurse practitioners, it's at least a month wait. I don't really see it getting worse
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Post by Uncaripswife on Jul 25, 2019 15:59:05 GMT -6
One more thing before I step off my soapbox.
Most people like their employer's health plan because they are relatively healthy and aren't submitting especially high claims or aren't getting unusual medical care.
Once people get really sick, they find out if they're one of the lucky ones that really does have good coverage... or are they going to be looking at the choice to forego care or fall into medical bankruptcy.
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jaygee
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Post by jaygee on Jul 25, 2019 20:35:29 GMT -6
I'm not sure if it's the same idea as Universal Health care in Canada, but I'll explain how ours works.. For us, all dr visits, ER/Urgent care, are covered, through our taxes, so are hospital stays, medical surgeries (ie my d&c, my spinal surgery, things like that) We still have private insurance benefits that are offered from employers or you can buy, that cover dental, eye care, prescriptions, things like Chiropractors, massage therapy etc, and upgrade to semi private or private hospital rooms.. Yes sometimes the wait times are long for certain specialists or surgeries (knee replacements etc) but at least people aren't going bankrupt... And if you are on dialysis or chronic illness, you have coverage.. It's not perfect, but at least I can go to the ER knowing that I'm not going to end up with a 100k bill Re waiting for care. I have available to me what is widely considered some of the best health care coverage in the US. MH's doctor ordered an MRI in early June. He finally got it on Tuesday. The delay was caused by the health plan's utilization review. So anyone who alleges that waiting for care in the US doesn't already happen is kidding themselves. This is my experience too but I don’t know how much is because I work for a top teaching system, so people really want to get in. Some specialties are so tough to get into. Some book 6 months out. It’s really challenging because we can’t start the authorization process until 30-60 days before the appointment and if it gets denied someone was waiting for 4 months for an appointment and then told they aren’t covered. Or they get the appointment covered but the insurance won’t pay for the treatment recommended by the specialist and they have to start over with a different provider. It’s not common but when it happens, it’s a huge mess for the patient and their family and the providers get pissed too. But under Medicare you would right at the time you make the appointment what is covered and what is not.
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jaygee
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Post by jaygee on Jul 25, 2019 20:38:58 GMT -6
One more thing before I step off my soapbox. Most people like their employer's health plan because they are relatively healthy and aren't submitting especially high claims or aren't getting unusual medical care. Once people get really sick, they find out if they're one of the lucky ones that really does have good coverage... or are they going to be looking at the choice to forego care or fall into medical bankruptcy. 🙌🏼🙌🏼🙌🏼 Preach sister.
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Post by oreobitsy on Jul 25, 2019 22:19:37 GMT -6
One more thing before I step off my soapbox. Most people like their employer's health plan because they are relatively healthy and aren't submitting especially high claims or aren't getting unusual medical care. Once people get really sick, they find out if they're one of the lucky ones that really does have good coverage... or are they going to be looking at the choice to forego care or fall into medical bankruptcy. As I read this thread, I am just in awe and so grateful to have your great minds helping explain why Medicare for All and universal healthcare is a good idea. Imagine me as Wayne or Garth, being not worthy to you all. And amen to Uncaripswife's post. I was hanging out, enjoying being a first-time parent to a cute kid, and then bam. He got leukemia. I quickly found out what type of coverage we had, what options we had, and even hung out career-wise until things settled down and we felt we could handle it. It happens to so many people for so many different health needs. We need to have better ways to help everyone deal with that uncertainty. Healthcare should not be tied to employment.
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jaygee
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Post by jaygee on Jul 25, 2019 23:05:01 GMT -6
oreobitsy I’m so sorry you had to deal with all that. It all happens so fast. And something we talk a lot about at my health system is that taking care of the patient physically is only part of the story - we have to treat them well mentally and financially as well. We may save their lives and leave them in bankruptcy and that’s not an outcome anyone wants. It’s hard under the current system and patients and their families have to be financial experts to navigate it all. Even happened in my own family this week. My husband was trying to coordinate care for a family member and even with my industry knowledge he was struggling to figure it all out. A better system would be to relieve the financial burden as much as can and allow the patient to focus on their treatment and getting care.
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dc2london
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Post by dc2london on Jul 26, 2019 7:20:26 GMT -6
jaygee are you suggesting that outcomes improve and costs decrease when the overarching goal isn't profiting off of sick people? My gosh!
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Post by oreobitsy on Jul 26, 2019 7:31:45 GMT -6
jaygee, thanks. We are done now and enjoying life without treatment.
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