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Thread: Not everyone has eye-popping deductibles: How one union kept medical bills in check

  1. #71
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    Re: Not everyone has eye-popping deductibles: How one union kept medical bills in check

    Quote Originally Posted by bave View Post
    So, you as a pretend physician, don't think you can see marked improvements in hypertension over 5 years? Right. Changing your diet and exercise you will see meaningful measurable results in a year.
    .


    You don;t get it. We are talking about preventative medicine and the costs and the benefits. So.. take a guy that has high blood pressure. Over TIME.. that high blood pressure is going to cause things like stroke, heart failure, liver failure, kidney failure.. and so on... VERY VERY Costly things.

    IF that fellow doesn't have access to healthcare.. because he has no healthcare insurance... and goes without knowing that he has high blood pressure.. or knows.. but can't afford the medications for it.. and goes say for year and years with high blood pressure... it will likely lead to all sorts of costly complications YEARS LATER. Maybe when he now has medicare.. and is getting surgery now for the results of decades of uncontrolled high blood pressure. Maybe heart surgery.. . or maybe he suffers a cva at 66.. the year after getting medicare. And now.. the costs of his care go up exponentially.. ..

    BUT.. if he had insurance when he developed the high blood pressure say in his 40's or 50's.. he goes to the doctor and they put him on a medication like a diuretic or an ACE inhibitor.. which is paid for by insurance.. so the patient is compliant... and now.. he avoids the costly CVA or surgery.
    So.. lets say the expense of the BP medication is about a 1.00 a day.. (midline between diuretics, ace inhibitors and beta blockers. That's 365 dollars a year.. for say 25 years..Thats 9,125.

    The average cost of a person with a cva for just hospitalization is roughly 20,000.

    So.. by getting the fellow his medication.. since he was 40 and controlling his blood pressure.. you save easy 10,000 and likely a lot more.

    THATS whats meant about preventative medicine by getting people access to insurance and healthcare...

    Wait...wait... but you have a five year study that shows...…… you don;t even understand what it shows....

    The study is clearly showing that people are being diagnosed and then non-compliant resulting in no improvements
    Yep...again SO WHAT? Again..the study is NOT showing that an uncontrolled diabetic has the exact same risk factors and likelihood of expensive complications as someone that is controlled with medication.

    See above.

    Right. So the person who is morbidly obese has no symptoms?
    Well first there is a difference between morbidly obese.. and being obese. A large section of our population is already obese.. and no they often don;t present with symptoms.

    And as far as morbidly obese folks... yeah.. there are a bunch of them that don;t present with any symptoms. They don't report that they are short of breath because they don;t do enough activity to make themselves short of breath. They may or may not have high blood pressure. it depends on many other factors. Sure..they may have joint pain.. but who doesn't. especially in your 30-40's or later. A lot of these folks are not suffering severe enough symptoms to even be concerned about their weight. WHICH by the way.. is one of the large reasons they are not compliant. They don;t see that much value in going through the expense and effort to lose weight. NOW.. if gastric bypass is a possibility... well then..maybe…

    Tell me.. did your study offer morbidly obese people gastric bypass? Did it then find NO RESULTS from weight loss with gastric bypass?

    I doubt it.

    Face it. you just don;t understand healthcare.. and thus.. you don't know what you are talking about.

  2. #72
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    Re: Not everyone has eye-popping deductibles: How one union kept medical bills in check

    Quote Originally Posted by jaeger19 View Post

    You don;t get it. We are talking about preventative medicine and the costs and the benefits. So.. take a guy that has high blood pressure. Over TIME.. that high blood pressure is going to cause things like stroke, heart failure, liver failure, kidney failure.. and so on... VERY VERY Costly things.

    IF that fellow doesn't have access to healthcare.. because he has no healthcare insurance... and goes without knowing that he has high blood pressure.. or knows.. but can't afford the medications for it.. and goes say for year and years with high blood pressure... it will likely lead to all sorts of costly complications YEARS LATER. Maybe when he now has medicare.. and is getting surgery now for the results of decades of uncontrolled high blood pressure. Maybe heart surgery.. . or maybe he suffers a cva at 66.. the year after getting medicare. And now.. the costs of his care go up exponentially.. ..
    And what you are not getting, as the Oregon study showed, that even with *unlimited free* healthcare, these patients didn't improve. They were non compliant, refused to follow instructions and did not improve. So, despite a lot more spending and delivered care their risk of cardiovascular event was unchanged. AKA: We pissed money away.

    Quote Originally Posted by jaeger19 View Post
    BUT.. if he had insurance when he developed the high blood pressure say in his 40's or 50's.. he goes to the doctor and they put him on a medication like a diuretic or an ACE inhibitor.. which is paid for by insurance.. so the patient is compliant... and now.. he avoids the costly CVA or surgery.
    So.. lets say the expense of the BP medication is about a 1.00 a day.. (midline between diuretics, ace inhibitors and beta blockers. That's 365 dollars a year.. for say 25 years..Thats 9,125.
    This is precisely what the Oregon study did. They gave you 100% free healthcare, high quality, unlimited and people still didn't improve. People didn't want to take their meds, change their diet, exercise, etc. They just preferred to walk around with a 160/120.

    Quote Originally Posted by jaeger19 View Post
    So.. by getting the fellow his medication.. since he was 40 and controlling his blood pressure.. you save easy 10,000 and likely a lot more.

    THATS whats meant about preventative medicine by getting people access to insurance and healthcare...
    Which is exactly what they did....

    Quote Originally Posted by jaeger19 View Post
    Wait...wait... but you have a five year study that shows...…… you don;t even understand what it shows....
    And showed no improvement.

    Quote Originally Posted by jaeger19 View Post
    Yep...again SO WHAT? Again..the study is NOT showing that an uncontrolled diabetic has the exact same risk factors and likelihood of expensive complications as someone that is controlled with medication.

    See above.
    What they are showing is that people with uncontrolled diabetes, hypertension, and various other chronic issues were not controlling them. That's the point. There is a certain percentage of the population who is just non-compliant period and thus the risk is unchanged. For instance, in the 5 year period they had no measurable improvement in severity and rate of obesity. So, for five years they couldn't get people to stop eating Big Macs and sitting on the couch. If you can't fix that in five years, what makes you think the 6th will be different?


    Quote Originally Posted by jaeger19 View Post
    Well first there is a difference between morbidly obese.. and being obese. A large section of our population is already obese.. and no they often don;t present with symptoms.
    And yet they still have a health risk.

    Quote Originally Posted by jaeger19 View Post
    And as far as morbidly obese folks... yeah.. there are a bunch of them that don;t present with any symptoms.
    Right. A BMI over 40 always has symptoms, always.

    Quote Originally Posted by jaeger19 View Post
    They don't report that they are short of breath because they don;t do enough activity to make themselves short of breath.
    BMI of 40 is out of breath walking into Walmart.

    Quote Originally Posted by jaeger19 View Post
    They may or may not have high blood pressure. it depends on many other factors. Sure..they may have joint pain.. but who doesn't.

  3. #73
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    Re: Not everyone has eye-popping deductibles: How one union kept medical bills in check

    Quote Originally Posted by bave View Post
    As yet again, you are making things up. That is not what pension spiking is.

    Pension spiking is when employees take additional measures to increase their final relevant years wages, or the average of them, in order to skew their pension formula. This is generally done by taking a years worth of vacation time, tons of overtime, secondary and ancillary duties, etc. This is how you get cops that make $250k in their final three years, because they are working 60 hours a week of overtime. For the entire last year, then taking 41 weeks of saved vacation time in December.
    ).
    Yawnn… because of course employers have no control over the vacation time that can be accrued before you have to take it.. have no control over overtime.. etc..
    OF course.. employers DO.. give monetary incentives for early retirement.. which spikes their earnings. But no..its all the overtime that employees force their employers to pay..

    You are so silly.

    Employee contributions are a fraction of the cost. T
    You don;t understand what I am talking about. My point has NOTHING to do with employee contributions..

    Lots of public employees..like teachers.. like firefighters.. give up what they COULD make in the private sector.. when it comes to wages.. FOR.. the benefits, especially retirement benefits of public employment.

    This also happens in the private sector as well. I know providers that work for non profit companies for salaries well below what other companies pay... simply because of the generous retirement package their current company offers. They basically are trading salary for benefits.

    Yea, false again.
    Nope completely true.

    Its a main reason that people go into teaching. And your calculation base on time is pretty much invalid. "well they only work 186 days a year"?

    So? The bottom line is that someone with good teaching skills and a college education.. (and many states require a masters degree or advanced classes at some point).. would make hundreds of thousands of dollars more during a lifetime of work. And one of the main reasons.. that despite this.. people are attracted to teaching is because of the benefits.. such as retirement benefits.
    As an aside.. I get so tired of hearing folks complain how easy teachers have it.. and then they complain about how crazy their weekend was because they had 15 kids over for a 3 hour birthday party.... Imagie having 30 kids 7 hours a day.. some of the who don;t want to be there.. and have to teach them something?

    Again, you are clueless. The bonuses you are talking about are generally known as DROP payments, and they are not included in pension calculations nor any definition of pension spiking
    They are for the teachers in our school district. Sorry..

    It's not employers, its governments.
    Governments are employers..

  4. #74
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    Re: Not everyone has eye-popping deductibles: How one union kept medical bills in check

    Quote Originally Posted by jaeger19 View Post
    So? The bottom line is that someone with good teaching skills and a college education.. (and many states require a masters degree or advanced classes at some point).. would make hundreds of thousands of dollars more during a lifetime of work. And one of the main reasons.. that despite this.. people are attracted to teaching is because of the benefits.. such as retirement benefits.
    As an aside.. I get so tired of hearing folks complain how easy teachers have it.. and then they complain about how crazy their weekend was because they had 15 kids over for a 3 hour birthday party.... Imagie having 30 kids 7 hours a day.. some of the who don;t want to be there.. and have to teach them something?
    Their "advanced education" is generally paid for by the district, is done over summers of free time, is a joke of a curriculum, and does little to improve their actual educational ability. All they are is a union negotiated way to get guaranteed raises at the taxpayer's expense. The idea that they would be paid more in the private sector is laughable. It is effectively a part time job, with no accountability or career risk, minimal educational/moat requirement to enter, and a disparate compensation level. This is why there is such a waiting list to become teachers in so many areas. It's a gravy job.

    Quote Originally Posted by jaeger19 View Post
    They are for the teachers in our school district. Sorry..
    Shows how much you know. Early retirement bonuses and separation bonuses, aka DROP payments, are prohibited from counting towards retirement benefits by ERISA (federal) law.

    Yet again, you pretend to be/know things on the internet. You're just a fraud man, stop flailing about. Don't you have a tertiary care center to be running between your multiple businesses?

  5. #75
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    Re: Not everyone has eye-popping deductibles: How one union kept medical bills in check

    QUOTE=bave;1071111814]And what you are not getting, as the Oregon study showed, that even with *unlimited free* healthcare, these patients didn't improve. T
    .
    [/QUOTE]
    No.. it didn't show that. Seriously.. do you think that a patient that came in.. and had headaches, dizziness and all sorts of issues and their blood pressure was 170/105. And was given a prescription for FREE blood pressure medicine... that person said... screw it.. I came to the doctor because I finally had health insurance and I feel terrible.. and I got a free visit with the doctor and got free medication that MAKES ME FEEL BETTER.... and SCREW THAT.. I would rather keep my high blood pressure and feel AWFUL.."?Crap no. That didn't happen.

    What happened in that study was that someone came in.. and had borderline high blood pressure. Not enough to medicate.. but still potentially harmful... and the doctor said "you need to get your blood pressure lower.. you need to eat better, stay away from alcohol, stop smoking, lose some weight and exercise regularly.. and the person walked out and went "screw that"... THATS what happened in that study.
    Whishkibble. Duh... Seeing the doctor for that really isn't a benefit for most people. You think most people NEED a DOCTOR to tell them... you are overweight.. you should stop smoking, eating Mcdonalds every day is bad for you and drinking a six pack every night isn't good either?.Come now. You don't understand the limitations of that study and what "free healthcare" was.

    ANYONE.. who thinks the value in having healthcare access for preventative medicine.. is in telling an obese person "you are fat.. you need to lose weight"... is a moron. They know they are fat.

    The value in preventative medicine in the case of access to healthcare.. is catching the guy that needs medication for their diabetes or highblood pressure, or catching an early cancer, or catching an infection that needs medication before it becomes an epidemic etc.

    Which is exactly what they did...
    No its not.

    What they are showing is that people with uncontrolled diabetes, hypertension, and various other chronic issues were not controlling them.
    And that's simply not the case. Think what you are saying man.. you are saying that people DON"T take high blood pressure medicine.. they DON"T take diabetic medication... the DON"T have gastric bypasses they don't take thyroid medication. .

    Think about that for a minute. You are saying that THERE IS NO MARKET FOR DIABETIC DRUGS, THERE IS NO MARKET FOR HIGH BLOOD PRESSURE MEDICATION.....

    IF that's the case.. gee man.. you please explain to me why there is a plethora of medications advertised on the television.. for medication that YOU SAY.. patients don't take.

    Think about that for more than a minute and get back to the group..

    For instance, in the 5 year period they had no measurable improvement in severity and rate of obesity.?
    Because it won't you ridiculous dude. Which is my point and what I have been explaining to you.. the value of preventative medicine.. in having people have access to healthcare is not..seeing the doctor for 5 years to be told "dude.. you are fat and you need to lose weight". THAT is not the value of getting people healthcare. Seeing the doctor for that ain;t going to improve CRAP.

    (If you want to improve those things. that.. starts with societal and cultural changes with the community, things like putting gym class back into school systems.. etc)..

    The value of having your population have access to healthcare.. is say.. catching the fellow with tuberculosis and getting him treatment. Its catching the diabetic that needs medication. Its vaccinating people for flu and other viruses like polio.. Its even in getting people gastric bypass surgery.. its in getting physical therapy for a shoulder injury before it needs surgery or the person becomes disabled.
    THAT is where you make your money back in preventative medicine.

  6. #76
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    Re: Not everyone has eye-popping deductibles: How one union kept medical bills in check

    And yet they still have a health risk.
    Yep.. and it will remain so until either they suffer symptoms bad enough that will spur them to change behavior, or those conditions be easily medicated or treated with surgery to relieve those symptoms. and OR.. community and other barriers are removed so that its easy for the person to comply.

    NONE of the above does anything to take away from the argument for universal healthcare as a way to decrease costs.

    NOW.. does this mean that having universal healthcare is going to end obesity, and smoking and vaping, and alcoholism or high blood pressure etc in this country? HECK NO.

    BUT.. is it going to reduce costs? HECK YES.. by catching and reducing some of those high cost conditions that CAN and WILL be controlled by interventions like medications and other interventions (as long as those interventions are covered by insurance and are affordable by the way).

    Right. A BMI over 40 always has symptoms, always.
    and not always enough to force someone to change.

    BMI of 40 is out of breath walking into Walmart.
    Not necessarily. Cripes.. I have patients with a BMI over 40 and they ski.

  7. #77
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    Re: Not everyone has eye-popping deductibles: How one union kept medical bills in check

    Quote Originally Posted by bave View Post
    Their "advanced education" is generally paid for by the district, is done over summers of free time, is a joke of a curriculum, and does little to improve their actual educational ability. s?
    Well lets see... not in my state its not. They have to pay for their advanced degrees like Masters degrees.. and it doesn't get paid for by the district. In fact.. in some districts it doesn't.

    And yes.. it does change their actual education ability. Nor is it generally a joke of a curriculum.

    The idea that they would be paid more in the private sector is laughable.
    NAh.. its not.. its absolutely correct.

    This is why there is such a waiting list to become teachers in so many areas
    Wrong again: The teacher shortage is real, large and growing, and worse than we thought: The first report in ‘The Perfect Storm in the Teacher Labor Market’ series | Economic Policy Institute

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