Thread: rockzmom update

Hi everyone! Thank you so much for the well wishes and virtual chocolate, cookies and other assorted goodies!

I am back from my lovely vacation at Le Chateau Georgetown! A wonderful vacation spot indeed! Having your meals served to you in bed and people waiting on you hand and foot. It was too amazing, you just had to press a button and poof, someone was there to attend to you! Ah, how the rich folk live. I had a taste of the good life for a while. If only they had not disturbed my peaceful slumber so much, it would have been a slice of heaven.

Originally Posted by sperk

Originally Posted by MasterAdmin

Originally Posted by rockzmom

5. A pulse rate around 40 or below or bloood pressure of 80/50 is great for a world athlete, just not normal people.

Pulse rate below 40... Yea, what kind of a world athlete is that? The one at the slumber championship?

Glad to hear that your mom is finally fine!

Am I dating myself? Bjorn Borg was said to have had a standing pulse rate of 36.

I remember Bjorn (Billie Jean and Bobby Riggs too)... but maybe this one is more current....
Lance Armstong has a resting heart rate of 32-34 beats per minute (bpm) with a maximum heart rate of 201 bpm

Originally Posted by rockzmom

I remember Bjorn (Billie Jean and Bobby Riggs too)... but maybe this one is more current....
Lance Armstong has a resting heart rate of 32-34 beats per minute (bpm) with a maximum heart rate of 201 bpm

Go Lance go! Win that 8th tour ...doesn't look likely.

Originally Posted by sperk

Am I dating myself? Bjorn Borg was said to have had a standing pulse rate of 36.

I don't know who you are dating

Borg's physical conditioning was legendary as he could outlast most of his opponents under the most grueling conditions. Contrary to popular belief, however, this wasn't due to his exceptionally low resting heart rate, often reported to be near 35 beats per minute. In his introduction to Borg's autobiography My Life and Game, Eugene Scott relates that this myth arose from a medical exam the 18-year-old Borg once took for military service, where his pulse was recorded as 38. Scott goes on to reveal Borg's true pulse rate as "about 50 when he wakes up and around 60 in the afternoon." [21] Borg is credited with helping to develop the style of play that has come to dominate the game today.
http://en.wikipedia.org/wiki/Björn_Borg

Well I am a day late and a dollar short rockzmom. sorry ....sigh ....

However I am most glad that you are home from your lovely "vacation" in Le Chateau germantown. (hehee)

I sincerely hope that all is now well and that the doctors were able to figure out what the issue(s) were.

What a wonderful young woman you have as your daughter to post in your absence to give an update. True testament of a great mom!!!!

HUGS!!!!!!!!

C

So, a couple of you asked me in PMs about the cost of my 10 day "vacation" and if I had insurance and so on. As I just received what we call over here in the States an EOB (Explanation Of Benefits) I thought I would share it so that non-Americans might understand why our healthcare system is having such problems.

As of today, my insurance company has been billed a total of $43,536.70. And of that, it looks as if only $410.00 was for the doctor's fee, so there are probably going to be more bills coming. Now, from that $43k, the insurance is ONLY paying the hospital..... drum roll please... $5,795.57... Yes that is correct, $5,795.57. And I am paying $0.00. This is why we have a problem here in the States. The hospital that had me for 10 days and ran all kinds of tests including daily blood draws, x-rays and multiple scans...is getting 13% of what they asked for (I think I did that % correctly). How can they afford to stay in business?

So, why are they getting so little you might ask? It is because the hospital and my insuarnce company have "negotiated reimbursement rates." This means they have agreed upon the amount that they will receive for a service and under the insurance plan that I have, they cannot come after me for the difference, as long as I follow the "plan rules" and of course you know I follow those rules to the letter!

So, why would a hospital or doctor agree to such a low amount. Because they have no choice. A few years ago, one of my doctors group tried to boycott an insurance company to protest their practices of denying services and proper reimbursements. The practice lost a number of patients who could not switch insurance companies or afford not to be seen without insurance. The next year the practice had to crawl back to that insurance company and start using them again.

The insurance companies keeps making money and the doctors and patients lose out.

BTW tomorrow, President Obama is speaking at the University of Maryland about Health Care and we are going to go and try to get in. It is first come/first in. If we get in, I'll post my thoughts about it afterwards. While I have heard congressmen/women, governors, senators and so on speak before and even met them, I have yet to hear a president speak in person. Because of the life we lead, I am not easily impressed by “stars”; however, I have heard from others who have heard him speak in person that he is very impressive. We shall see and hear what he has to say.

This will be very interesting, as at least here in Germany no-one is able to even remotely understand how anyone could be against basic mandatory health insurance for everyone. We get the news that there are protests, we hear that protesters liken Obama to Hitler because he wants to improve health care, and we just don't get it. Background information like what you said about what the insurance actually pays is not available. To us it just looks as if the lunatics are taking over the asylum again.

Robin

Originally Posted by bitpicker

Background information like what you said about what the insurance actually pays is not available. To us it just looks as if the lunatics are taking over the asylum again.
Robin

I can give you a few more examples then...

Both of my girls had complete physicals last month. The cost was $90, the insurance paid $59.62.
One daughter also had two x-rays, cost $60.00, insurance paid $29.63.

dental...
Regular Adult check up with x-rays - $305.00, insurance paid $152.00
Regular Child check up with x-rays and fluoride, $221.00, insurance paid $104.00

Once again, because we followed all the plan rules, we had NO Co-Pay or costs for these services. Usually, we have to pay $15 for a regular doctor's visit and $25 for a specialist doctor visit. On dental, regular preventive visits are free. Any work like fillings, you have to pay a co-pay.

Now, we do pay bi-weekly premiums for our health, dental and perscription insurance.
The bi-weekly costs are:
$74.47 Medical
$39.52 Perscriptions
$20.26 Dental

Oh dear, rockzmom! How can people you have peace of mind and focus on recovery while the meter is ticking and they have to keep track of such complicated policies?
Are you worried about the costs, or quite confident you can stay on top of the situation?

I never paid a penny for healthcare and have no idea of the cost of the surgery that I've had.

The only complaint I have about healthcare here is that you sometimes have to wait a while for treatment, a month or so. In the English NHS (National Health Service) people may not enjoy sharing a room with a few other women. But the actual medical care in the UK is outstanding and you don't pay a penny regardless of how long you stay in hospital or what they do to you. Same in Sweden although Swedish hospitals are more comfortable.

I've actually had a private health insurance as a work benefit all the while I've been in Britain. But I don't really understand how to use it, so I had my recent surgery on the NHS regardless.

I suppose the benefits in the American system would be that doctors would take more interest in the patient since they are actually making money from him/her. The patient would be a customer and "always right". That would be a nice feeling. In Europe, the doctor knows he's "king" and can be a bit patronising. You can change doctor if you don't like the one you have though.

The dental care system that you are describing sounds pretty good though. That's subsidised here but not to the point that it's free.

I watched Sicko (brilliant, very funny) with some Scandinavian friends and we were laughing our heads off when the Michael Moore took the sick Americans to CUBA!! The poor woman finally got her medicine and started crying! I know he's a spinmeister prone to exaggerations, but it was still very touching...
Have you seen it?
[video:2erw6osx]http://www.youtube.com/watch?v=jDuVndy4qJc[/video:2erw6osx]

Originally Posted by rockzmom

Regular Adult check up with x-rays - $305.00, insurance paid $152.00
Regular Child check up with x-rays and fluoride, $221.00, insurance paid $104.00

OMFG! When I was forced to pass x-rays and fluoride check last year (processing papers for my current job), it cost me 200 rubles (about 7$) and I thought I was robbed (it's about twice less than amount of money I spend every day on gasoline for example). And you must pay only if you are healthy. If someone is sick it's free. Well, I was born in good old USSR and remember good health care for free, still can not get used than I must pay .

Originally Posted by Basil77

Well, I was born in good old USSR and remember good health care for free [...]

Well, you were lucky if you had gotten the "good" care. Fundamentally, you had very little choice, so it was really personally up to your physician to provide you with whatever care they cared. As to the fact it was free ... well, I will probably be called names here, but don't forget that back then the state basically owned everything and you might have potentially deserved much better pay for your work that you had received... So, eventually, it all levels up somehow: some things are more expensive or less expensive depending on the country.

Crocodile if you are in Canda as your profile says, then surely you know that it is possible for a country to provide citizens with free healthcare without the government owning everything and setting all salaries.

Originally Posted by Johanna

Crocodile if you are in Canda as your profile says, then surely you know that it is possible for a country to provide citizens with free healthcare without the government owning everything and setting all salaries.

True words. However, I personally know several people who went to the US to get their treatments, and I also know others (US citizens) who went through the long process of obtaining Canadian citizenship just to get some of the expensive treatment they couldn't in the US. It all depends on the type of treatment you need, how much money you have, and how much time you can wait. Do you think it's normal to wait 2-3 months to visit a specialist? He/she will see you for 5 minutes, send you to the tests (which would take another 2-3 weeks) and then you would have to wait another 2-3 months for the specialist to read the results. And after that, he/she would send you to another more detailed tests (they call it an algorithm) which takes another 2-3 weeks, and another 2-3 months to interpret the results and so forth. And after several such rounds, the algorithm would prescribe more expensive tests which are not covered by the government, so if you are still alive by then, just hang around with some more tylenol as your case falls right under some 5% of the cases with the "reason unknown". And all specialists would follow that algorithm like robots as they can not deviate even a little and apply their personal knowledge and experience, otherwise their practice is not covered by their malpractice insurance, etc. You see? There's no panacea. Sometimes, it's good to have a choice.

Yeah, the waiting time is the downside for sure.
Not all specialists have them, but enough so that people notice.

A couple of times I have managed to nag myself past them. or circumventing them. both in the UK and Sweden. But people who are sick should not have to nag, cheat or be intimidating.
The fact that the patient is also the customer is probably the strength of the US system.

But I still think the American system (if you can call it that) seems like a cruel system which is exploiting people when they are at their most vulnerable. But if that's what Americans prefer then I suppose it's their problem.

The solution to the problem with waiting time is to improve incentives for the specialists work more efficiently. Or simply have more specialists. Not to privatise. Luckily privatisation is not something that voters would ever accept in most of Europe, so it will not happen.

Originally Posted by Johanna

The fact that the patient is also the customer is probably the strength of the US system. [...]

But I still think the American system (if you can call it that) seems like a cruel system which is exploiting people when they are at their most vulnerable. But if that's what Americans prefer then I suppose it's their problem.

The solution to the problem with waiting time is to improve incentives for the specialists work more efficiently. Or simply have more specialists. Not to privatise. Luckily privatisation is not something that voters would ever accept in most of Europe, so it will not happen.

Well, Obama said in his Congressional speech it's a question of choice, and he is trying to offer more choice and press the insurance companies. I'm not in a position of objectively assess his claim, but for sure there's a bit more to it than just "if that's what Americans prefer then I suppose it's their problem."

Have you ever thought how would that be possible that the insurance companies do away with only partially compensating the medical costs in the US? For sure, all medical professionals would say they've been treated unfairly (money wise), but allow me to say that the US medical professionals (as well as the related technical/machinery production companies and their staff) enjoy relatively high profits and salaries if compared to their counterparts from the other countries. So, what really allows the insurance companies to "negotiate the costs down?" Perhaps the medical bills are designed to rip the customers off in the first place? Especially, as you said the customers "when they are at their most vulnerable". Or, perhaps, it's the opposite, and the medical bills are inflated just because the insurance would only cover them partially? I'm not sure it's easy to pull the simple answer right off the sleeve.

Now, let's think a bit about the privatization vs. the government management. Private companies seek to expend their profits and the governments are prone to inefficiencies and mismanagements. Which one is better? The conventional wisdom would say - neither. And the common sense would be: don't put all the eggs in one basket. Diversify. Try to have some of both. I'd say: have the basic needs covered by the government equally out of the taxes and allow people purchase private insurance on top of it for whoever find it important and can afford it. Sounds like a plan?

I don't especially want to get into a big argument here, but I'd like to raise a couple of counter points for people to think about.

First of all, numbers on EOBs tell us nothing about the health care system. If you and I agree to trade an item for $20 it doesn't matter what some piece piece if paper says is the "actual" value or amount billed or whatever. It's like if a car dealer says the MSRP (suggested retail price) of a car is $35000 but he can get you a "special deal" for only $32000. That first number is meaningless. The only important number is the second one--the amount changing hands.

As far as universal coverage, I really don't see why health care should be different than any other industry. Does the government mandate that everyone should be given clothing? Or food? Do we need universal plumbing insurance?

I don't mean that as a conclusive argument, but I wanted to give an example of the perspective of people who are opposed to radical changes in the US health care system. I'm all in favor of investigating what works well and what doesn't in other countries.

Originally Posted by paulb

Does the government mandate that everyone should be given clothing? Or food?

Hm.. and what about the social security?

Originally Posted by paulb

Do we need universal plumbing insurance?

I liked this one.
But you see, probably in some way we do have that. It's true you'd deal with the plumbing in your home yourself, but the home itself is plugged into the city plumbing system which is universally paid for by the city taxes. Isn't it?

Originally Posted by paulb

First of all, numbers on EOBs tell us nothing about the health care system. If you and I agree to trade an item for $20 it doesn't matter what some piece piece if paper says is the "actual" value or amount billed or whatever. It's like if a car dealer says the MSRP (suggested retail price) of a car is $35000 but he can get you a "special deal" for only $32000. That first number is meaningless. The only important number is the second one--the amount changing hands.

I agree; however, in the case of the hospital EOB, that is a VERY large difference and considering that it was a 10 day stay and I did mention that I had SEVERAL tests done while there, it does seem unreasonable the amount the hospital is actually getting at the end of the day from the insurance company.

Originally Posted by paulb

As far as universal coverage, I really don't see why health care should be different than any other industry. Does the government mandate that everyone should be given clothing? Or food? Do we need universal plumbing insurance?

Actually this is already happening. What about FARMS (Free and Reduced Meals) in the schools, that's free breakfast and lunch. In my girls school, EVERY child gets a free breakfast, every single one whether they are FARMS or not (yes, it is a public school). What about food stamps and WIC? As for utilities... there are funds available to pay for utilities in every state and the cooling centers when it is too hot and they also give away heaters and fans for free.

Maybe not plumbing insurance but there is National Flood Insurance.

So, in a way... our money is already being used for a number of programs.

The REAL problem is, who is getting these funds (or allowed to participate) and how are the programs being managed? And that is when tempers start to flare and the pitchforks come out.

I think many regular people would be turned around in this issue if they got to experience the other side.

E.g. a regular American person could experience being able to walk into the hospital, giving no information other than their name and age and get treated -- then leaving with the peace of mind that there'd be be absolutely no paperwork, bills or insurance hassle to worry about.

Also - staying in a very nice private hospital with gourmet food, a nicely decorated room and great food might get some public health supporters interested in the private option (if they could afford it). I have the impression that American doctors would be less likely to say "Mrs X, there is absolutely nothing wrong with you, just go home and rest..." This attitude in public health can be a problem because doctors do not want to refer to specialists unnecessarily. Occassionally there are scandals where somebody was told they were fine but in fact they had a serious condition and should have been referred to a specialist.