(08-10-2015 04:13 PM)dfarr Wrote:  

(08-10-2015 03:10 PM)Tom in Lazybrook Wrote:  

(08-10-2015 03:06 PM)dfarr Wrote:  

(08-10-2015 03:02 PM)Tom in Lazybrook Wrote:  

(08-07-2015 11:24 AM)BatonRougeEscapee Wrote:  Maybe everyone that goes to a publicly funded college, or a private college using government subsidized loans should have their income artificially lowered in perpetuity. Why single out those money grubbing ******* doctors.

Actually, if you take government subsidies, you should serve the public.

No problem with that.

The issue with medicine is that many in the medical field don't recognize that we are subsidizing the f*ck out of them. And then they decide to not serve the public.

We already have socialized medicine. Socialism for the health corporations. And no, that doesn't translate into lower costs, more coverage, or better service. Just higher profits concentrated in a small circle of persons.

If a person pays off the loan, be it from the government or a private bank, then he doesn't own the debtor anything.

I'd be interested to learn how the government is subsidizing my office.

Pay off the loan AND the subsidized portion of that loan, AND the subsidized portion of the loan used to build the hosptial you hold admitting privileges at. AND the subsidized portion of the loan used to build the medical school (above what you paid in tuition). AND the subsidized portion of the loan or grant used to pay for the hospital you went to for your residency. And you can pay all of that back to the present value to the taxpayer.

At that point, the taxpayers will not have subsidized your education, your practice, or your workplace.

Oh, so you're one of those who believes that everything that you use that the government played a part in paying for is therefor government subsidized? One of the "you didn't build that" folks who thanks the government for everything. Gotcha.

Actually, the GOP health care plan (which is to hand everything to the insurance companies, pharma, and big hospital corps) screws over a lot of doctors too.

But what galls me is that people who took in many cases millions of dollars in subsidies don't recognize how they got where they are and doesn't expect any ACCOUNTABILITY by the recipients of that largesse towards those that paid for those subsidies.

But since this form of welfare (benefits without accountability) goes towards well off persons, conservatives treat it differently.

The amount of implied subsidy given to virtually all doctors is massively larger than for other professions. This isn't making some third derivative argument about roads and the interstate commerce clause...but an argument pointing to much more direct and individually identifiable benefits that accrued to a very small group of persons and that cannot be accessed by many others in society.

Want the subsidy..be accountable. Not greedy.

---

But yes, government helps rich people too. There's nothing wrong with that, so long as society, in an equitable manner, sees benefit from that government help. Otherwise its 'just big government, picking winners and losers'. See two can play that 'meme' game.

(08-10-2015 04:20 PM)Tom in Lazybrook Wrote:  

(08-10-2015 04:13 PM)dfarr Wrote:  

(08-10-2015 03:10 PM)Tom in Lazybrook Wrote:  

(08-10-2015 03:06 PM)dfarr Wrote:  

(08-10-2015 03:02 PM)Tom in Lazybrook Wrote:  Actually, if you take government subsidies, you should serve the public.

No problem with that.

The issue with medicine is that many in the medical field don't recognize that we are subsidizing the f*ck out of them. And then they decide to not serve the public.

We already have socialized medicine. Socialism for the health corporations. And no, that doesn't translate into lower costs, more coverage, or better service. Just higher profits concentrated in a small circle of persons.

If a person pays off the loan, be it from the government or a private bank, then he doesn't own the debtor anything.

I'd be interested to learn how the government is subsidizing my office.

Pay off the loan AND the subsidized portion of that loan, AND the subsidized portion of the loan used to build the hosptial you hold admitting privileges at. AND the subsidized portion of the loan used to build the medical school (above what you paid in tuition). AND the subsidized portion of the loan or grant used to pay for the hospital you went to for your residency. And you can pay all of that back to the present value to the taxpayer.

At that point, the taxpayers will not have subsidized your education, your practice, or your workplace.

Oh, so you're one of those who believes that everything that you use that the government played a part in paying for is therefor government subsidized? One of the "you didn't build that" folks who thanks the government for everything. Gotcha.

Actually, the GOP health care plan (which is to hand everything to the insurance companies, pharma, and big hospital corps) screws over a lot of doctors too.

But what galls me is that people who took in many cases millions of dollars in subsidies don't recognize how they got where they are and doesn't expect any ACCOUNTABILITY by the recipients of that largesse towards those that paid for those subsidies.

But since this form of welfare (benefits without accountability) goes towards well off persons, conservatives treat it differently.

The amount of implied subsidy given to virtually all doctors is massively larger than for other professions. This isn't making some third derivative argument about roads and the interstate commerce clause...but an argument pointing to much more direct and individually identifiable benefits that accrued to a very small group of persons and that cannot be accessed by many others in society.

Want the subsidy..be accountable. Not greedy.

---

But yes, government helps rich people too. There's nothing wrong with that, so long as society, in an equitable manner, sees benefit from that government help. Otherwise its 'just big government, picking winners and losers'. See two can play that 'meme' game.

Since you have no clue about health insurance, I'm sure you're equally as clueless about the education and training of health care professionals, so I'll just save myself the effort and say that I disagree with you.

(08-10-2015 03:07 PM)Tom in Lazybrook Wrote:  

(08-10-2015 01:18 PM)hoopfan Wrote:  I have a question for Tom.

have you tried to buy a new PPO policy from any other carrier?

I've got a few people working on that. Right now, there aren't any PPO plans for sale in Texas other than BCBS Gold PPO.

There is one other "PPO" that really isn't a PPO.

Basically every person that has assets to protect, has preexisting conditions, or who is at risk due to genetic/environmental factors ended up on the BCBS PPO last year as it was the only plan available that covered anything. And as the plan was very expensive, only those that really really really needed it purchased it. So basically, this plan, by its very nature was going to collect all of the 'costs' of Texas health care. And most of the 'revenues' will be in the premiums for the other BCBS plans.

So BCBS Texas has decided to not pay the 'costs' and the state will allow them to retain the 'revenues'. Great for the Lear Jet salesman, but not for the people of Texas

Wait.

So you want to continue to get the benefits from premiums that were paid in the past? Those are these "revenues", but you aren't paying any longer, whether you wish to or not. The "costs" being current medical expenses that are no longer covered?

Am I reading that right?

Guess what? Yea, that's how this works. Including the TWO group policies I've had cancelled in successive years, each time with the notice of "Due to provisions in the ACA..."

You wanted it, you got it!

It's the rest of us that got screwed in the process.

(08-10-2015 05:43 PM)JMUDunk Wrote:  

(08-10-2015 03:07 PM)Tom in Lazybrook Wrote:  

(08-10-2015 01:18 PM)hoopfan Wrote:  I have a question for Tom.

have you tried to buy a new PPO policy from any other carrier?

I've got a few people working on that. Right now, there aren't any PPO plans for sale in Texas other than BCBS Gold PPO.

There is one other "PPO" that really isn't a PPO.

Basically every person that has assets to protect, has preexisting conditions, or who is at risk due to genetic/environmental factors ended up on the BCBS PPO last year as it was the only plan available that covered anything. And as the plan was very expensive, only those that really really really needed it purchased it. So basically, this plan, by its very nature was going to collect all of the 'costs' of Texas health care. And most of the 'revenues' will be in the premiums for the other BCBS plans.

So BCBS Texas has decided to not pay the 'costs' and the state will allow them to retain the 'revenues'. Great for the Lear Jet salesman, but not for the people of Texas

Wait.

So you want to continue to get the benefits from premiums that were paid in the past? Those are these "revenues", but you aren't paying any longer, whether you wish to or not. The "costs" being current medical expenses that are no longer covered?

Am I reading that right?

Guess what? Yea, that's how this works. Including the TWO group policies I've had cancelled in successive years, each time with the notice of "Due to provisions in the ACA..."

You wanted it, you got it!

It's the rest of us that got screwed in the process.

Tom was ok with all of that up until he got screwed.

It's at best a zero sum game. There are winners and losers. Tom thought he was a winner, and he was happy. Now he finds out he's a loser and he's all butthurt about it.

(08-10-2015 06:18 PM)Owl 69/70/75 Wrote:  It's at best a zero sum game. There are winners and losers. Tom thought he was a winner, and he was happy. Now he finds out he's a loser and he's all butthurt about it.

Actually, Texas will be the loser because they won't regulate the insurance companies properly.

If Texas wants to go after its entrepreneurs and small business owners, while no one else does, they're welcome to drive innovation out of state.

(08-10-2015 09:44 PM)Tom in Lazybrook Wrote:  

(08-10-2015 06:18 PM)Owl 69/70/75 Wrote:  It's at best a zero sum game. There are winners and losers. Tom thought he was a winner, and he was happy. Now he finds out he's a loser and he's all butthurt about it.

Actually, Texas will be the loser because they won't regulate the insurance companies properly.

So, you agree Obamacare should be killed and the states should get back to running their own insurance plans?

Or would being able to buy insurance across state lines work for you?

Because, right now, you dont have a Texas problem. You have an Obamanation problem.

(08-10-2015 03:07 PM)Tom in Lazybrook Wrote:  

(08-10-2015 01:18 PM)hoopfan Wrote:  I have a question for Tom.

have you tried to buy a new PPO policy from any other carrier?

I've got a few people working on that. Right now, there aren't any PPO plans for sale in Texas other than BCBS Gold PPO.

There is one other "PPO" that really isn't a PPO.

Basically every person that has assets to protect, has preexisting conditions, or who is at risk due to genetic/environmental factors ended up on the BCBS PPO last year as it was the only plan available that covered anything. And as the plan was very expensive, only those that really really really needed it purchased it. So basically, this plan, by its very nature was going to collect all of the 'costs' of Texas health care. And most of the 'revenues' will be in the premiums for the other BCBS plans.

So BCBS Texas has decided to not pay the 'costs' and the state will allow them to retain the 'revenues'. Great for the Lear Jet salesman, but not for the people of Texas

i heard that Humana is offering a PPO plan.
Humana has apparently merged with Aetna in Texas and is writing PPO's.

This is why Obamacare means that I will probably never retire. I don't want to take my chances without and employer-provided health care plan. And I spend $300/year to maintain guaranteed admission to a hospital of my choice outside the US. That's how confident I am of the future of our health care system.

(08-10-2015 04:28 PM)dfarr Wrote:  Since you have no clue about health insurance, I'm sure you're equally as clueless about the education and training of health care professionals, so I'll just save myself the effort and say that I disagree with you.

Smart move.

The biggest problem is that Tom doesn't understand that the 'government' model for care, doubled down with the ACA is an HMO.. an Accountable Care Organization with bundled payments where the entire group is paid to deliver to a constituency, regardless of how much care is actually needed.

He wants Fee For Service (a PPO) but he also wants socialized medicine which is NOT Fee For Service and he supports the ACA which makes the economics for FFS worse and causes companies to re-evalute.

(08-10-2015 06:18 PM)Owl 69/70/75 Wrote:  It's at best a zero sum game. There are winners and losers. Tom thought he was a winner, and he was happy. Now he finds out he's a loser and he's all butthurt about it.

Yep. Actually he's still a winner because his PECs no longer work against him, he's just not getting EVERYTHING he wants (choose your doctor, despite Obama assuring us he could).

(08-10-2015 09:44 PM)Tom in Lazybrook Wrote:  Actually, Texas will be the loser because they won't regulate the insurance companies properly.

If Texas wants to go after its entrepreneurs and small business owners, while no one else does, they're welcome to drive innovation out of state.

Yeah... because ALL entrepreneurs and small business owners have significant existing medical needs and DEMAND to be able to see doctors of their choice, despite the fact that about 70% of the rest of the country doesn't get to do that either. None of them are young and relatively healthy and willing to see 'participating' doctors.

As far as regulation goes... If you think the state is doing it wrong, then file a federal lawsuit. You seem to claim to have numbers and resources... and I'm sure the Democrats in the state and across the nation would love to push Republicans out. I'm sure you won't do that though.

(08-11-2015 10:15 AM)hoopfan Wrote:  i heard that Humana is offering a PPO plan.
Humana has apparently merged with Aetna in Texas and is writing PPO's.

Tom admits there already is one... but he doesn't like it.
Then there's this other one that is also a PPO, but he doesn't think it is... because he doesn't know what one is.
and of course, if there is money to be made on a product in a market, SOMEONE (maybe even BCBS) will try and create a product to exploit it.... but by definition that will have to either charge more, somehow get more low users or somehow exclude more heavier users. Simple economics.

It seems likely that one of the reasons Tom doesn't like those other PPOs is that they work economically by cutting some of the extras. I think it entirely possible that BCBS will close this plan, forcing people to move to other plans... often HMOs due to cost... and then they will open a functionally similar plan with different economics.... more like those other plans that Tom doesn't like. I might also add that it seems obvious that Tom's doctors don't like those plans either.

Maybe Tom and his entrepreneur buddies should consider forming a mutual health insurance company. I mean seriously, that is the obvious solution. There are apparently a ton of these people with resources.

I'm being dead serious, Tom. There's a business model right there. If all it takes is BCBS not to make extraordinary salaries and profits to make this work, then form a mutual company.

(07-30-2015 01:29 PM)Kronke Wrote:  Blue Cross/Blue Shield lost $400 million last year on their PPO product, and have decided to no longer offer it in 2016.

http://www.expressnews.com/business/heal...408174.php

That wouldn't be that big of a deal, except they were they were the only company that offered a PPO in Texas.

Imagine you're a current BC/BS PPO policyholder that is undergoing cancer treatment at MD Anderson. Your new insurance options for 2016 are BC/BS's Advantage HMO, Aetna, Humana, and United Health Care. Great, it appears you have a lot of options. That is, until you look to see which plans MD Anderson accepts.

From MD Anderson's website:
http://www.mdanderson.org/patient-and-ca...plans.html

Quote:Note: MD Anderson is not a participating provider for the Aetna Texas Marketplace plans.

Note: MD Anderson is not a participating provider for the Blue Advantage HMO Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the Humana HMO X Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the UHC Texas Marketplace plans.

Turns out, I was 100% correct.

http://www.houstonchronicle.com/business...603232.php

Oh, and the *new* product that BC/BS came up with is an HMO that will pay for out of network services at 50% coinsurance, with no out of pocket maximum. So, you theoretically could use MD Anderson if you had to, just be ready to hand them a check for 50% of a trillion dollars, so you might as well just declare bankruptcy, which was supposed to be the #1 SELLING POINT OF OBAMACARE.

"..no one should face financial ruin over their health."

(11-02-2015 11:15 AM)Kronke Wrote:  Oh, and the *new* product that BC/BS came up with is an HMO that will pay for out of network services at 50% coinsurance, with no out of pocket maximum. So, you theoretically could use MD Anderson if you had to, just be ready to hand them a check for 50% of a trillion dollars, so you might as well just declare bankruptcy, which was supposed to be the #1 SELLING POINT OF OBAMACARE.

"..no one should face financial ruin over their health."

The problem is that BCBS put everyone who actually uses health care into one PPO, then 'surprise' that PPO "loses" money. Not really, BCBS makes millions on its other plans. The people in the PPO represent the 'expense' of coverage.

This is on the state of Texas.

They could

1) Require that insurance companies offer the same policies to all, regardless of employment status. If you offer it to Shell, you have to offer it to everyone.

2) Require that all public hospitals (of which MD Anderson is) accept at least one lifetime max insurance plan available to every single Texan.

But they won't. For the exact same reason that poor Texans can't get health insurance at all. Because the Texas GOP wants to destroy health care in the state so they can get $$$$ and they can try and blame it on Obama.

Every plan is going to have loopholes that need to be fixed. But Texas' GOP wants to kill people in an attempt to harm affordable health care.

----

Alternatively, I expect all of our 'religious' charity hospitals to take up the slack. If they're really religious charity hospitals...LOL.

-----

There is a way around it for cancer patients at MD Anderson. Its not optimal, and might not last as a window, but as of right now, one does exist. I don't think the insurance companies or MD Anderson know about it.

-----

You guys laugh all you want. But this isn't the beginning of the end of Obamacare, but the beginning of the end of capitalism in our health care system.

All the Dems have to do is to put forth a plan to fix it. Which they will. And the GOP, AGAIN, will just try to frustrate people's healthcare and put forth no reasonable solutions other than "if you aren't super rich, just die already. Please deposit all of your assets at the front door of a health care CEO on your way to death."

---

By the way any Houston folks want my view on which of these ****** plans works best IMHO, PM me.

(08-11-2015 11:03 AM)Hambone10 Wrote:  He wants Fee For Service (a PPO) but he also wants socialized medicine which is NOT Fee For Service and he supports the ACA which makes the economics for FFS worse and causes companies to re-evalute.

This is what the left never seems to understand about any issue. You change the rules, and people re-evaluate. So you never get the results you expected.

You raise taxes, people move jobs offshore.
You cut reimbursement to health care providers, people decide to do something else instead of providing health care.
You increase welfare payments to single mothers, more fathers decide to run away.

None of these things should be a surprise. Some take longer to manifest themselves than others.

To me, just the idea that you get penalized monetarily is against the law. To FORCE people to sign up for obamacare is totalitarism. I'm puzzled why Leftist were so against the Selective Service when obamacare isn't any different but they love obamacare. You didn't register for the draft you were liable, you don't register for obamacare you're liable. Same-same as the Thais used to say.

(11-02-2015 01:13 PM)Owl 69/70/75 Wrote:  

(08-11-2015 11:03 AM)Hambone10 Wrote:  He wants Fee For Service (a PPO) but he also wants socialized medicine which is NOT Fee For Service and he supports the ACA which makes the economics for FFS worse and causes companies to re-evalute.

This is what the left never seems to understand about any issue. You change the rules, and people re-evaluate. So you never get the results you expected.

You raise taxes, people move jobs offshore.
You cut reimbursement to health care providers, people decide to do something else instead of providing health care.
You increase welfare payments to single mothers, more fathers decide to run away.

None of these things should be a surprise. Some take longer to manifest themselves than others.

XACLY!

it's hardly an enigma.....