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  1. #31
    Ken Nadvornick's Avatar
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    Quote Originally Posted by BrianShaw View Post
    In general I agree, but having had the unfortunate opportunity to spend about 6 days (over the past month) in emergency rooms and urgent care facilities and hospital rooms... the number of uninsured who receive services is quite astounding. I'd guess 33% of everyone there... and I live in an somewhat affluent part of Los Angeles. The uninsured are asked to apply for a grant, and if they do not qualify... then they will get stuck with a bill. I'll bet most default one way or another since there is likely no way to ever pay it off. But at least they get serviced and not turned away.
    They get "serviced" only to the point of stabilization. That's the law. Then they get booted unless they have insurance. Or sufficient personal means.

    Emergency care is hideously expensive. Orders of magnitude more costly than simple access to a primary care provider for preventative maintenance. But they do not have access to that level. So when their kids get sick, they do what they have to do. As would any parent. And because they have only been stabilized, they'll be be back again very shortly to be restabilized—if they haven't died before then.

    It's an upside down system. Sniffles are being treated at regional trauma centers. And don't think for a minute that those unpaid costs are not being met. Look at your hospital invoice. See that line for ibuprofen tablets (Advil) at $80 per tablet? The insurance companies pay for that. That means you and me and employers paying indirectly through outrageous premiums.

    My wife recently had a two night stay at a hospital for a broken elbow that required surgery. The room charge alone, nothing else, was $57,800. For two nights. That's the Motel-6 charge only. No doctor costs. No medical test charges. No rehabilitation. Just the room. Or half of the room, since it was shared.

    And we still have people saying that the current system is just fine. No need to change a thing.

    Lunacy...

    Ken
    Last edited by Ken Nadvornick; 10-11-2012 at 05:12 PM. Click to view previous post history. Reason: Spelling...
    "They are the proof that something was there and no longer is. Like a stain. And the stillness of them is boggling. You can turn away but when you come back they’ll still be there looking at you."

    — Diane Arbus, March 15, 1971, in response to a request for a brief statement about photographs

  2. #32

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    Quote Originally Posted by Pioneer View Post
    Please read this with a certain amount of healthy skepticism because I am sure there are better ideas out there than my own simple ones.
    I don't know too many "normal working people" who would disagree with your simple and straight-forward approach. I thought there already were government protections on defined-benefit pensions. But now I'm learning that there are protected parts of the defined benefits, and parts they can weasel out of. And even the protected parts aren't fully protected it seems.

  3. #33

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    Quote Originally Posted by Ken Nadvornick View Post
    And we still have people saying that the current system is just fine. No need to change a thing.

    Lunacy...
    Lunacy is right. But I hate to admit... I haven't a clue how to make things better. I went to college, got a good job, make more money than God himself... yet I'm struggling... and only to be insulted at the grocery store when I'm buying ground meat of questionable origins and seeing steaks getting paid with government food cards (formerly "food stamps"). I'm not bitter, but I sure am frustrated... about health care, about job security, about getting the short end of every stick. Yet I'm blessed to be int he status I am becuase I know there are many,many who are not. What's worse... I don't think I trust ANY of the folks who say they think they know the way to a better life for all (or most. or many. or even just a few more).

  4. #34

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    Oh.. sorry about that. What I meant is: good luck to the folks at Kodak.

  5. #35

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    Quote Originally Posted by Steve Smith View Post
    Yes... If you consider rated 37th in the world by the World Health Organisation to mean best!

    I don't know of anyone who has travelled from here to the US for health care.


    Steve.
    That stat is unmitigated nonsense. The US as THE BEST health care technology in the world PERIOD. We do NOT have the healthiest people due to lack of access, hideous lifestyles, etc. But when it comes to doctor's, nurses, hospitals, and technology, no one even comes close.

  6. #36

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    Quote Originally Posted by Ken Nadvornick View Post
    They get "serviced" only to the point of stabilization. That's the law. Then they get booted unless they have insurance. Or sufficient personal means.

    Emergency care is hideously expensive. Orders of magnitude more costly than simple access to a primary care provider for preventative maintenance. But they do not have access to that level. So when their kids get sick, they do what they have to do. As would any parent. And because they have only been stabilized, they'll be be back again very shortly to be restabilized—if they haven't died before then.

    It's an upside down system. Sniffles are being treated at regional trauma centers. And don't think for a minute that those unpaid costs are not being met. Look at your hospital invoice. See that line for ibuprofen tablets (Advil) at $80 per tablet? The insurance companies pay for that. That means you and me and employers paying indirectly through outrageous premiums.

    My wife recently had a two night stay at a hospital for a broken elbow that required surgery. The room charge alone, nothing else, was $57,800. For two nights. That's the Motel-6 charge only. No doctor costs. No medical test charges. No rehabilitation. Just the room. Or half of the room, since it was shared.

    And we still have people saying that the current system is just fine. No need to change a thing.

    Lunacy...

    Ken
    My daughter was born with an emergency C-section. I brought my wife into the ER as she was in MASSIVE pain. The ER treatment, the C-section and all other exploratory surgery and recovery costs totaled 40,000 dollars. This is in Chicago, a very expensive city.

    You were ripped off big time.

  7. #37

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    OK, I'll succumb to temptation and lay everything out once again for non-US members, even though this entire thread flirts heavily with APUG's ban on politics outside the soapbox.

    First, pensions. If a US corporation offers a defined-benefit pension (one where a certain number of dollars per month will be provided at retirement, usually based on a formula that includes age, wages and years of service), it must pay premiums to the Pension Benefit Guarantee Corporation (PBGC). Employees' pensions are referred to as "vested benefits," with vesting sometimes happening after a several year delay and sometimes happening immediately after each year of service. That is, the employee is entitled to those pension payments regardless of whether the employer discontinues the pension plan or not. In return for employer premiums and meeting a minimum plan funding level by the employer, PBGC will continue payment of a retiree's pension benefits in the event the employer goes bankrupt. There are some limitations, based on how old a retiree is at time of company bankruptcy and how large their monthly benefit was, but a substantial portion -- many times all -- of the monthly pension check continues to be delivered, from the PBGC rather than the former employer's plan.

    Next, medical benefits. There may be a small number of exceptions that actually pre-fund and vest this coverage, but most US private sector employers who "promise" retiree medical make very clear, through regular disclosures during employees' working years, that said medical coverage is not a vested benefit and is subject to discontinuation or modification at the employer's whim at any time. Most employees don't bother to read the mandated disclosures; even those who do usually fail to grasp their meaning. Note that almost everyone in the US is eligible for Medicare coverage at age 65. It does require a monthly contribution, carries a deductible and doesn't cover everything, but is infinitely better than the situation those under 65 find themselves in -- i.e. no coverage outside employment or prohibitively expensive individual insurance policies. This is scheduled to change with the phased implementation of the Affordable Care Act


    but, even after all Affordable Care Act provisions take effect, Medicare remains a much less expensive option for those who qualify. There are private supplemental insurance plans available for those who wish to mitigate the risk of Medicare's deductible and co-pays.

    In summary, the important points are:
    • Pensions, when offered, are guaranteed vested benefits
    • Retiree medical benefits are provided at employers' whims


    I should point out that private sector defined benefit pension plans are going the way of the dinosaur in the US. Most companies have ended them completely for new employees and many are placing a "hard freeze" on their plans for even long-term current employees. That is to say, "your monthly pension benefit is frozen based on your salary and length of service today; no matter how many more years you work from this point on it won't increase." Also, the number of private sector employers who even "promise" retiree medical coverage is rapidly approaching zero. In the case of my former employer, probably the country's largest exporter, there wasn't much need for me to speculate. It terminated all such coverage, including for then-current retirees, in 1994. Medical insurance expenses had to be part of my retirement planning for a long, long time.

    One last thing. Some will undoubtedly pile on now to complain about public-sector employees who continue to receive defined-benefit pensions and retiree medical coverage. My preemptive response is: why not work toward requiring those benefits for private-sector employees rather than dragging public-sector workers down too? Why not recognize the reality that employer/employee relationships are inherently adversarial and once again support labor organization rather than working/voting against public sector unions who never lost sight of the fact? Why let "divide and conquer" succeed?

  8. #38

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    Thanks Sal.

  9. #39

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    Quote Originally Posted by BrianShaw View Post
    Thanks Sal.
    You're welcome Brian. Even though my career was spent in engineering, managers up through the VP level frequently referred to me as "HR" with a wink when questions arose on these matters. For some reason I always paid close attention to the details; real HR people occasionally visited my office for consultations.

  10. #40
    Ken Nadvornick's Avatar
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    Quote Originally Posted by RattyMouse View Post
    My daughter was born with an emergency C-section. I brought my wife into the ER as she was in MASSIVE pain. The ER treatment, the C-section and all other exploratory surgery and recovery costs totaled 40,000 dollars. This is in Chicago, a very expensive city.

    You were ripped off big time.
    The total overall cost for that broken elbow, including eventual rehabilitation, came to just over $100,000. It did include entry into the system via emergency trauma care.

    Payable costs between providers and insurance companies are tightly negotiated and controlled. Generally, providers bill at one level, but agree to accept negotiated fee settlements that limit out-of-pocket costs to the insured at a much lower level. So you actually pay the costs via higher insurance premiums and not direct provider reimbursement. Our out-of-pocket was about $4,000. That was a 96% reduction for us. Not too bad. However, to cover the shortfall my employer's cost of his employee's medical insurance premiums are insanely high. This limits his ability to expand and hire.

    And because insured patients pay so little out-of-pocket—and uninsured patients almost nothing—there is no visibility of the problem. And no incentive, when feasibile, to shop around for lower costs. It's always somebody else's (the insurance company's) money, so why worry? Except that the insurance companies get that money from us.

    It's not a ripoff. In the absence of reform, this is how the system has evolved and works. We deny access to millions, thus forcing them into the most expensive levels of emergency care possible, then spread that unneccesary extra expense to those who do have insurance via insurance company premium structures. In other words, we all pay far more than is necessary to get much lower levels of care (stabilization only) than are actually required.

    Something has got to change before we bankrupt this entire country.

    Ken
    "They are the proof that something was there and no longer is. Like a stain. And the stillness of them is boggling. You can turn away but when you come back they’ll still be there looking at you."

    — Diane Arbus, March 15, 1971, in response to a request for a brief statement about photographs

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