New Teaching Contract

[Veronica]

Most of the teachers at my school are really excited about our new contract. We're all getting a 3% raise and our average class sizes have been lowered slightly. But I am miffed about the benefits. I don't take the district health benefits and I receive about a third of what the district pays for a single person's health coverage as compensation. This new contract increases the amount the district will pay monthly for a single by $50, two party gets a $100 increase and a family gets a $200 while my compensation is staying the same. Apparently the amounts teachers have to pay for health insurance are ridiculous; we must be in the highest risk pool. Beginning 1/1 the district is picking up $845 a month for a single and $1200 for a family and teachers still have to pay a substantial amount of pocket.

I dislike the inequity; choosing to have children entitles you to more compensation? However, the amount required to cover them seems insanely high to me as well. BTW I chose the word entitled because that's the way it's presented in the lunchroom at work. :D

Veronica

[Irulan]

Welcome to the world of what people pay for health insurance. We haven't had employee sponsored benefits in over 8 years. Those rates look about right for what we'd have to pay for a standard lower deductible 80/20 plan that covers all the bases.

[Veronica]

According the lunchroom talk (basically gossip) families are still paying an additional $400 or $500. $1600 - $1700 a month for insurance is normal? Why do people have children? Good grief they're expensive! :p

Veronica

[Veronica]

Oh and for the record I don't care about the raise. :rolleyes: I would have liked to see the word average taken out of class size and a hard limit of 28 students to a class. The contract now states an average of 30 instead of 32, which means there will still be classes with 32 - 34 students in them. That word average can do amazing things.

Veronica

[Irulan]

1600 - $1700 a month for insurance is normal?

As someone who pays out of pocket, yes. Now, I don't know what kind of plans these are. I live in a state where I am pretty sure insurance costs less, and if you want a "cadillac" plan, one that covers just about everything, (mental health, prescriptions, pregnancy and maybe some vision) with minimal copays, low deductible, and a low maximum out of pocket,with a reputable company such as Blue Cross, Premera, yes, that is what you'll pay for TWO people. Most people seem to want those kind of plans, $20 office visits, $5 prescriptions, etc....again, I don't know what kinds of plans you are offered. I just know that as a consumer that pays out of pocket for all of my health insurance, there's no way I could afford the full costs of those kinds of plans.So I don't have one like that. I'm pretty savvy as I've been buying our families insurance for a long time, and know what's out there from decent companies on the market, at least in my state. My belief is that if you get any employer buy in on health insurance you should count yourself lucky. I'm not trying to bum you out - i know there are certain expectations with union contracts and all that, but for the rest of us, the realities can be quite different.

[Blueberry]

I dislike the inequity; choosing to have children entitles you to more compensation? However, the amount required to cover them seems insanely high to me as well. BTW I chose the word entitled because that's the way it's presented in the lunchroom at work. :D

Veronica

+1000.

Health insurance is incredibly expensive, and (at least in my state) has increased astronomically in the last few months with no relief in sight. As far as the risk rating of teachers....you have told us about their eating and exercise habits;)

[Veronica]

+1000.

As far as the risk rating of teachers....you have told us about their eating and exercise habits;)


True... snickering, snorting....:D

Veronica

[OakLeaf]

According the lunchroom talk (basically gossip) families are still paying an additional $400 or $500. $1600 - $1700 a month for insurance is normal? Why do people have children? Good grief they're expensive! :p

Veronica

$1600 a month for single coverage for a female without a maternity rider is a bargain. Welcome to the real world. And wait until you hit 40.

Maybe in California they're not allowed to discriminate on the basis of sex? Even so, single coverage for males is over 70% of what females pay in "my" world.

[thekarens]

I work for a major insurance company and as an employee my deductible is $3400 with an out of pocket of $7500. I don't go to the doc unless it's very serious.

My son sees a psychiatrist once a month and a counselor once a week. The psychiatrist is covered, but it comes out of my pocket because I never hit the deductible. The counselor is not covered and that's $100 a visit (that's the discounted rate.)

Health insurance pretty much sucks no matter how you look at it,

[Irulan]

I work for a major insurance company and as an employee my deductible is $3400 with an out of pocket of $7500. I don't go to the doc unless it's very serious.

My son sees a psychiatrist once a month and a counselor once a week. The psychiatrist is covered, but it comes out of my pocket because I never hit the deductible. The counselor is not covered and that's $100 a visit (that's the discounted rate.)

Health insurance pretty much sucks no matter how you look at it,

Do you have a HSA with that plan?

[goldfinch]

I am retired without retiree health benefits. I also am not insurable so I am on the Minnesota risk pool, that can charge 5 to 25% more than equivalent insurance for a person in good health. It is one of the least expensive pools in the United States with some of the best coverage. I pay roughly $500 a month for an 80/20 in network plan, with a $5000 deductible. The drug deductible is part of the $5000 but is only $2000. I am not remembering off the top of my head what is my maximum out of pocket but it isn't bad.

My husband pays the same.

Even though we do not usually hit the deductible we have the advantage of negotiated lower prices. For example, I pay roughly $50 for a prescription that would be close to $500 if I had no insurance.

I am lucky to be a Minnesota resident and am lucky to have enough money to pay these prices. There are many states I cannot live in because there are no affordable options for me or no options at all. Some state risk pools are a total joke. High prices. Limitations on how much they will pay for a specific condition. Yearly limits. Low lifetime limits. Etc. Other states have risk pools that are closed or non-existant and the only way you can buy insurance if uninsurable is if you have HIPAA rights, coming off of a group plan. Or, you get on the new federal plan for the uninsured but you have to be uninsured for six months to do so.

(I would not call a plan a "Cadillac" plan if it covers prescriptions. Prescriptions can bankrupt a person. Look at chemo therapy drugs. I also don't consider mental health "Cadillac." Health is health. Mental health is not less worthy than physical health.)

[Irulan]

To clarify, what I meant by "Cadillac Plans" was this
-very low copay ($5-20) per visit
-low deductible (not multi thousand dollar)
--low out of pocket maximum (less than about 1k)
-full availability of prescriptions (no exclusions) for a reasonable cost
And of course coverage for everything. These plans, out of pocket, are very expensive. Anyone remember the days when plans like these were what most people got from their employers?

There are plenty of plans out there that "cover" many things, but as many of us have pointed out, the coverage has to be applied to huge deductibles, huge out of pocket maximum, and sometimes exclusions. Mental health care and prescriptions are usually the first things removed from plans to reduce the cost.

[malkin]

A couple years ago my employer switched us from a $0 deductible plan to a $3000 deductible/HSA and told us that we would now be 'empowered' in our health care decision making.

[thekarens]

Do you have a HSA with that plan?

Yes, I do and I put all I can afford on it, which is about 2k a year. Saves a little being pre tax.

[Crankin]

Yes, insurance for teachers is outrageously expensive. I had it through my employer in AZ, for just me, because, back then, it was free. I was also covered by my DH's plan, once he graduated college and had a professional job.
That said, once I moved here, I never took the school district insurance. It was outrageously expensive, although it did cover pretty much the same things my plan covered through DH's work.
We pay 294.00 a month for what Irulan called Cadillac coverage (Blue Cross PPO). My employer offers the same plan, for twice the cost to the employees. No deductibles, no referrals needed, and it includes vision care. Our dental insurance is another 44.00 a month. He works for a successful company, but I also think the risk pool has something to do with this. The average age of the employees is young and they are mostly healthy. That said, our insurance paid 100% of DH's stents and angioplasty, as well as paying 18K for an experimental procedure that DS had to cure his Raynauds, back in 2003. They also paid for all of my second opinions at Brigham and Women's back in 2007.
It's a sad fact of life that there is this inequity, but, on the other hand, my clients, who have Mass Health, also have access to most of the same benefits I have. When my older son first graduated, he bought his own insurance, through our health care connector (part of the universal care bill here) that helps working people without benefits find insurance. He paid about 200.00 a month.

[Pax]

Holy crap, I've got it made and didn't realize it! I pay $52 a month for an HMO with $20 office visits, $10/$26/$45 prescription co-pays, and a $200 fee if I use the emergency room.

[Irulan]

Um, yeah. And you were wondering why people are talking about the cost of health care?

[Crankin]

I know I'm lucky. In addition to the above, we have unlimited mental health benefits and prescriptions are 20.00, 30.00 or 50.00. ER visits are 200.00, but that just went up from 50.00.
Our task will be to find similar coverage when DH stops working. We will be able to afford to pay a good amount, but we are more concerned with the continuity of coverage. DH takes 4 prescriptions, and even though he is incredibly healthy since his surgery, he cannot stop taking them. My Prolia is also covered, but I did have to go through some weird mail order pharmacy that Blue Cross insists I use, where incredibly stupid people with really thick regional accents constantly barrage me with phone calls. I now have it arranged that they call my doctor directly to deal with shipping the injection to her.

[Jen12]

Well, as a substitute teacher, I don't get benefits at all, so I pay out of pocket for my insurance.
The system is preposterous. I was looking into dental and you can't really get individual dental insurance. You have to be on a group plan to get some type of coverage. It needs an overhaul system-wide. Teachers aren't the only people getting the short end of the stick.

[girlontheroad]

I am self employed and got to learn all this last year when my cobra coverage ran out. Crankin one thing that saved me was that my state requires if you can't get coverage elsewhere which I couldn't because of pure existing conditions at the time, and you are just coming off an employers plan the company has to offer you one to two plans that are comparable to your previous coverage. The key is not to let it lapse. That allowed me to have similar coverage when other options were not available to me. It currently costs me $1200 a month but the benefits are good. A very nice person told me about this requirement on the phone when they told me they couldn't cover me or I would have been in trouble. The thing that floors me about insurance is the difference in negotiated costs it gives you. I just had major surgery that the hospital charged $60,000 for and which they accepted about 7,000 for with the negotiated rates. Had I not had insurance I would owe the whole $60,000. As opposed to my max out of pocket of $6000. And that was just the hospital bill. My insurance premiums more than paid for themselves this year even with the increase but the whole thing seems like a scam when you look at what gets paid. And I realize how fortunate I am to be able to pay the premiums.

[Crankin]

Well, our situation isn't really related to Cobra; more retirement that may occur before one or both of us are eligible for Medicare and various Medicare supplements. In all reality, we are pretty sure we can work out a deal with the company to continue the benefits, if we pay a larger portion and DH would be willing to stay on in a consultant role. The company doesn't have very many employees in their fifties (all younger), and the CEO is the same age as my DH and he can't fathom why people stop working.

[OakLeaf]

You know what's most distressing to me about this thread?

The expressed and implied resentment toward others who have barely adequate coverage.

What Irulan described as "Cadillac" coverage (a metaphor that was devised to set working stiffs against each other) is barely adequate. It's more like a Nissan Versa with 100,000 miles on it. It'll get most people where they need to go most of the time, but if you put any serious demands on it, you'll find it isn't enough.

Take my coverage, just for example. By today's standards, it's good coverage. I might consider a higher deductible lower coverage plan if it were available to me, but because I have a couple of minor but chronic pre-existing condition, I'm stuck with the conversion plan that I transferred from COBRA in the early 1990s. I'm not insurable on the open market, and I'm not eligible for open enrollment unless I go uninsured for six months, and I'm not ready to take that risk. I'm aware that I'm very lucky to be able to afford EITHER my insurance premiums OR the medical care I need, so go ahead and resent me for my good luck. But I want to illustrate what so-called "Cadillac" coverage really is.

Just take physical therapy - something lots of us have been through and many more will need. My plan gives me 20 sessions. That's plenty for someone who's working out a bit of plantar fasciitis or a back strain. Have a stroke or get in a serious accident? Not so much. Remember that so-called "out of pocket maximums" apply only to benefits that are covered in the first place. So, if you need months of physical therapy, after the first 20 sessions they're all out of your pocket. My deductible is $500, my out of pocket maximum is $2000, and I wound up paying over $10,000 out of pocket last year ... yep, the equivalent of almost four months' premiums. And that's with relatively minor injuries, no hospitalization, no surgery, no scans outside of a few plain films, no super expensive medications.

Also: manual manipulation counts as "physical therapy" and it's subject to the session limit regardless of whether it's performed by a PT and billed as PT, or performed by a DO and billed as OMM. But a hand injury that's normally rehabbed by an occupational therapist with stretching, strengthening and massage - the same modalities a PT would use - is not covered at all, because it's OT.

Dental? (got my sixth crown this year) Zilch. Vision? (thank goodness my vision at least is uncomplicated and I'm just wearing single vision contacts) No coverage there either. Mental health coverage? That depends on the diagnosis (talk about crazy). Acupuncture? Forget about it. But it covers my prescriptions and my allergy shots, covers the emergency room when I need it. So that's considered "Cadillac" coverage.

That's what I pay, I don't have a choice of insurance, but I'm lucky enough to be able to afford it. Think about how most people would be able to pay for insurance. Think about what someone who's really sick or badly hurt would have to pay.

Then you start to understand why there are constantly fundraisers for people to cover their medical expenses ... let alone their living expenses while their ability to work is reduced or nonexistent. And you really understand whose interests it serves to have us resenting each other, rather than the ones who are profiting from all this.

[lph]

I'm finding this whole thread rather distressing. I wish you could all move here.

[Becky]

This thread reminds me of why I still work where I do and why I'll be here for at least another 10 years.

[Selkie]

This thread reminds me of why I still work where I do and why I'll be here for at least another 10 years.

Me, too, but I'm down to 73 months and 4 days until I can retire at full pension (but who's counting?).

I hope that the health insurance reforms that are going to be implemented have a positive impact on the system. I'm ashamed to admit that I haven't paid too much attention to it because I am blessed to have a good plan. That said, I pay a good bit in premiums and every year, my premiums increase (while my salary has been frozen for the past two years and looks like it will be for 2013---another year without a COLA).

Early in my adulthood, I had no health insurance and was out of pocket for everything. I will be forever indebted to Planned Parenthood, which provided me healthcare when I otherwise would have been without.

[Irulan]

I'm not resentful. I accept our options and choices, and am grateful that we can afford to fill the holes ourselves. I do think the system is totally f-ed up; the disparities and inefficiencies are down right terrifying. I think it's important for everyone to be aware of what is happening out there. I know this is sliding into the dreaded political territory.

[Crankin]

I just feel lucky. I am not resentful. But, I don't know how to fix the problem any differently. I guess I am also lucky that I live in a state where 98-99% of the people have coverage. What I have found is that there are some people, usually in a "low risk" category, as far as their health goes, who have chosen to not get insurance through the Mass Health Connector and they basically just pray they don't get sick. These are people who are working, usually in their 20s-30s, in no benefits jobs. They don't want to pay for the 200.00-300.00 a month for a moderate coverage plan. They can afford it, but it eats into their disposable income. My son was in this position. We insisted he pay for insurance, and then after 3 years, he let it lapse. For 2 years, he had no coverage and he did have 2 medical things where he ended up paying a good amount out of his pocket. These weren't life threatening things, but, you can see how it could have easily snowballed. Believe me, benefits were a very big part of his decisions in taking the next job, and the one he just got in November. His wife's employer offers terrible benefits and she finally went on his plan. I am not sure what her reasoning was not to do it in the first place, but they are starting to think about maybe having kids and she's been going to the doctor, doing proactive things, now that she has insurance.
This shouldn't vary so much from state to state, but I am not going to get into the political aspect of it.

[Pax]

Monetarily it seems to be a toss up in my life, I have typically worked jobs with excellent benefits but very poor pay. Someone mentioned $1200 a month for healthcare? That is well more than half of my pay for a month.

Seems like "good benefits" come with an indentured servant component, even if I wanted to leave my job and try my luck elsewhere I can't because of the cost of healthcare.

Don't you gals wonder how many wonderful entrepreneurial ideas out there are withering on the vine,] because the person with idea can't afford to risk the leap into non insured status?

[Veronica]

I started this thread to kind of work for myself how I felt about this new contract since I have to vote on it. Much of my resentment is towards my union - they insist teachers at a site all be treated the same, regardless of performance. We have years of testing data to look at and some teachers just stink at their jobs. They continue to teach as if we have the clientele we had 15 years ago and refuse to adapt. It's likely that because of the school's declining test scores, we're going to start receiving the "assistance" of coaches which means an increase in meetings and paperwork for all of us, including the few teachers whose test scores are not declining. Yet this same union thinks this variance in benefit compensation is fine. And yes, I do resent those teachers who refuse to adapt and whine every time we have any sort of staff development designed to help them becoming better at engaging their students.

We'll never get anything into the contract about teacher performance unfortunately.

Since the change in benefit compensation really doesn't affect me, I've come to the conclusion to not let it affect my voting decision. I appreciate hearing from all of you about how important good health insurance really is. I've had the good fortune to have no significant health issues and since I'm on Thom's plan, I never really paid attention to how much we pay.

Veronica

[Crankin]

Veronica, I felt exactly the same way. I ended up going from a right to work state where the union was just something I could say no to (and I was also part of a merit pay program) to a highly unionized and politicized teaching force. Usually, I am a true blue Massachusetts liberal, but these teachers sickened me for the same reasons you state. They just hated the kids, couldn't deal with working with kids from different cultures and viewed anything innovative as "extra." Well, they mostly left or retired and I stayed. When I left in 2007, I was one of the oldest teachers in the school, and I had only been there 9 years. What scared me was that a few of the younger teachers were taking up the "cause." I would have gladly accepted the chance to have my pay based on my performance. My kids' test scores were always the highest in grade 7 English. What other professional job has the same pay for everyone, irregardless of their performance?

[Koronin]

I know when I looked at insurance when my husband was unemployed it was horribly expensive and there was no way to afford it. (Couldn't afford Cobra either). I ended up with insurance through the restaurant I worked for at the time, but in truth that insurance was not really worth anything unless you ended up in the hospital. I actually was shocked the first time I looked for insurance after graduating college and moving. My dad retired from GM and always had great insurance. I've just been surprised how horribly expensive it is. Currently through my husband's work we do have very good insurace, low co-pays, $5 for generic prescriptions (20% for non generic), we pay just over $200 a month out of his paycheck. Dental and vision are less than $10 per paycheck and are together in a plan that is sperate from the health. I agree with the rest of you that health care costs are crazy.

[Irulan]

Currently through my husband's work we do have very good insurace, low co-pays, $5 for generic prescriptions (20% for non generic), we pay just over $200 a month out of his paycheck. Dental and vision are less than $10 per paycheck and are together in a plan that is sperate from the health. I agree with the rest of you that health care costs are crazy.
These kinds of plans, as wonderful as they are for those who have them, are part of the problem in that real costs are hidden. I mean, if you are paying $2400 a year for coverage, and a handful of change, that doesn't begin to cover the actual costs of checkups, regular visits, prescriptions etc for two people assuming you have regular type issues.... but then again, the system is so screwed up, who knows what things really cost, eh?

We were out to dinner a few weeks ago and one of the guys works for Big Pharma, regional sales rep or something. For some reason the conversation got on to health care costs, and he was saying it was so great that no one had to pay more than $5 for a prescription. I was all, "what planet do you live on?" He was, "you can get yours at Walmart for $5, right?"
Well, the answer is absolutely not. He didn't believe me at first but It's not on the list. My plans doesn't cover it, and it's $300/month at most box stores last time I checked. Thank God for Costco Pharmacy.

[tulip]

I have an individual (non-work related) plan that costs $155 per month. It's not bad in my opinion. The deductible is high, but when I had a lower deductible, I only met it once so what's the difference? I save alot more in premiums with the higher deductible. It is an incentive to stay healthy--to keep my premiums low. It includes three doctor visits per year at $35 copay. Historically, I have rarely gone to a doctor three times in a year; usually it's just the one check up per year. Having insurance means getting insurance rates, which are much lower than non-insurance rates, so even out of pocket expenses are lower than if I didn't have insurance. Frankly, I really like having a non-work related plan. I spent way too much of my life tied to a job I hated just because it had insurance. Never again.

I could never afford $1000+ on premiums that some of you pay. There are alternatives out there.

When I got sick in Europe and had to go to the ER, I didn't pay anything. That was refreshing.

[OakLeaf]

It is an incentive to stay healthy--to keep my premiums low.

As you know (with your history of TBI), healthy behaviors are a choice, but being healthy isn't. And not all states allow individual rating. I'm paying the same premium as any 53-year-old female on the same plan as I am, whether they've been in perfect health their entire life, or whether they have serious chronic illnesses.


I could never afford $1000+ on premiums that some of you pay. There are alternatives out there.

Not when you have a pre-existing condition and insurance. If you're willing to go without insurance for six months, then you're eligible for open enrollment, and for the high risk pools in states that have them. Otherwise, I'm stuck with the insurance I have.


When I got sick in Europe and had to go to the ER, I didn't pay anything. That was refreshing.

No kidding. I was with my parents when my dad got sick in Austria. It wasn't nothing that he paid, but it was less than $200 including doctor visits and a prescription that would have been $300 all by itself in the US. :mad:

[Irulan]

Don't forget that the "free" health care in Europe comes out of a tax base, or pools that everyone pays into. So it's not really free, but at least the systems and coverages are consistent within each nation.

[OakLeaf]

Don't forget that the "free" health care in Europe comes out of a tax base, or pools that everyone pays into. So it's not really free, but at least the systems and coverages are consistent within each nation.

I don't think anyone suggested it was "free." On the consumer side, it's consistent from individual to individual, which is the key point of this thread ... on the provider side, costs aren't inflated with huge marketing bills and duplicative administrative expenses.

[Catrin]

When I start complaining to myself about how much my employer covered insurance has changed over the past 11 years, I will remember this thread. It may not be as good as it was at one time (then again, how many of us can say that), but my premiums are only around $80 a month as a single individual (we have a wellness program that decreases our premiums a bit). We didn't used to have co-insurance and deductible requirements at all until 4 years ago - but I know what it is like to not have access to insurance. I am thankful to have what I have - and it is an incentive to continue with healthy behaviors. It gets frustrating when I know I should go in to get something checked out, but I have to be very careful about that. I am now responsible for 20% of all scans (outside of a simple x-ray) and many other treatments. No more flat co-pay that we used to have on everything. Thankfully mammograms are still fully covered...

[OakLeaf]

Thankfully mammograms are still fully covered...

Only because the law says they have to be.

Cripes, who got me started? :rolleyes:

[Irulan]

Only because the law says they have to be.

Cripes, who got me started? :rolleyes:

Probably me. :D I think you and I are on the same page about this.

[tulip]

Well I do have two pre-existing conditions. They put me at Level 2 ( of 4 levels). The lowest premium level is Level 1. So I do not pay the same premium as every other 45 year old woman; the insurance company considers more than just age and sex. I had to ask about my options because my premiums on my old plan (same company) went from $185 to $329 over 6 years and I've hardly used the services. I could not afford the $329 so I called them up and found out what my options were. It took perseverance but I now have a plan that I can afford. If my premiums were $1000+, it would not be possible to pay them on my income--the premiums would be more than my mortgage! I do not see how anyone on a normal income could afford that; it's like having 3car loans or an extra mortgage !

I just want people to know that there are options. They might be hidden and take a while to uncover, but I was surprised to find out that affordable options do exist.

[emily_in_nc]

Just read this entire thread with interest as we (my DH and I, both retired) are in the process of looking at individual health insurance plans prior to our move back to the US in the spring. We have had a catastrophic Latin American plan provided by a UK company for the past year an a half that we've been living in Belize and have not used it once. But it's not something I'd take the risk of going without.

I've been comparing plans using ehealthinsurance.com, and it looks like we'll be applying for the very least expensive plan that UnitedHealthcare offers, the Saver 80, with the highest deductible ($10K each for my DH and myself). It covers preventive care (because that is mandated by law), which is in many years all we ever get or need. And other than that, it covers just inpatient care if we should ever meet the deductible (no outpatient coverage). They also have an interesting new benefit where if you don't meet your deductible in a given year, it is reduced by 20% the next year, and so on until it is reduced by 50% max.

The base cost of the plan is $358/mo for the two of us. To get a plan that covers more (Rx, outpatient care, etc.) the costs just go up up up. Since we retired early, we knew we'd have to pay for most of our medical care other than really huge catastrophic problems, which we hopefully won't have for a long, long time.

We just feel very fortunate that we can afford to self-insure up to the limits of our deductible and pay for our own dental and vision care. So many people could not do this, and could not manage a $10K deductible, so have to pay for much more expensive policies. We also have no children to cover.

I do realize how lucky we are, and how very fortunate we were for decades to have "Cadillac" plans sponsored by our large corporate employer. We are very healthy and use very little health care, even in our 50s, but it may not always be that way. And an accident can happen to even the healthiest person.

I just hope we get approved!

[Koronin]

These kinds of plans, as wonderful as they are for those who have them, are part of the problem in that real costs are hidden. I mean, if you are paying $2400 a year for coverage, and a handful of change, that doesn't begin to cover the actual costs of checkups, regular visits, prescriptions etc for two people assuming you have regular type issues.... but then again, the system is so screwed up, who knows what things really cost, eh?

We were out to dinner a few weeks ago and one of the guys works for Big Pharma, regional sales rep or something. For some reason the conversation got on to health care costs, and he was saying it was so great that no one had to pay more than $5 for a prescription. I was all, "what planet do you live on?" He was, "you can get yours at Walmart for $5, right?"
Well, the answer is absolutely not. He didn't believe me at first but It's not on the list. My plans doesn't cover it, and it's $300/month at most box stores last time I checked. Thank God for Costco Pharmacy.

My husband works for the Federal Govt (Dept of the Navy as civil service, good luck figuring out what exactly the cost of the plan actually is. I do have pay a good portion of any lab work. It's somewhere between 40 and 50% for any lab work done. I know this because I know how expensive that can be without insurance. And my old doctor did what she could with not doing more than she had to with lab work then, and got me a discount by having it billed to the office instead of billed directly to me. Although I did see what the cost was before the deduction.) Our insurance is through an insurance company that is apparently only for govt employees and actually has very few doctors even in a military city that takes the coverage. The other insurance packages from other companies which are very similar in benefits are between $50 and $100 more per paycheck than the one we have. The one through Blue Cross Blue Shield is the most expensive and actually covers less, yet is the one my husband was told is the one most people opt to use.

I know you are correct about Walmart not carrying some prescriptions. They don't even carry the birth control I take, forget getting it for $5, you can't even get it there. Actually that prescription I pay more than $5 for anyway (well until that part of the ACA kicks in).

[Selkie]

Probably me. :D I think you and I are on the same page about this.

I'm with the both of you. As I've gotten older, I've become more and more progressive in my views. :)

[lph]

I don't think anyone suggested it was "free." On the consumer side, it's consistent from individual to individual, which is the key point of this thread ... on the provider side, costs aren't inflated with huge marketing bills and duplicative administrative expenses.

To me the real bonus is not that our health care is "free", because it's not, but that paying for it is not optional. And that good health care is not only for the well-to-do or for those who plan well. It has a cost, but these are still good things in my book. But I realize that these are hot political topics in the US and I won't pretend to know what it's like. It's a different world.

[OakLeaf]

The one through Blue Cross Blue Shield is the most expensive and actually covers less, yet is the one my husband was told is the one most people opt to use.

I'd hazard a guess that's because most doctors, hospitals and labs are in-network with BCBS. Knowing whether your provider is covered is just as important as knowing whether the service is covered.


I do not pay the same premium as every other 45 year old woman; the insurance company considers more than just age and sex.

Your state allows that. Mine doesn't. When my insurance company raises my premium, I get a form letter with a grid on the back. It's got three columns, "Male," "Female w/o Maternity," and "Female w/Maternity," and ten or twelve columns with (mostly) five-year age ranges. Those are the only criteria they're allowed to use in setting premiums for individual policies.


I do not see how anyone on a normal income could afford that; it's like having 3car loans or an extra mortgage!

They can't. That's why over 18% of all adults in the USA are uninsured (http://http://aspe.hhs.gov/health/reports/2011/CPSHealthIns2011/ib.cfm), and over 70% of adults under 25..


I just want people to know that there are options. They might be hidden and take a while to uncover, but I was surprised to find out that affordable options do exist.

Again - in your state there are options, and I'm glad that there are. In a few states there are even more options. In most states, there are not, at least not unless and until the ACA goes fully into effect (and we have yet to see what may happen with that, in terms of either implementation or affordability).

My first husband has several family members in the insurance industry, so if anyone is familiar with the options in my state, they are. He is older than I, but his health history at the time was similar. After our divorce and after his COBRA ran out, he couldn't afford premiums. He went bare for a couple of years, longer than the six months it took for him to be eligible for open enrollment. He found a fly-by-night policy that claimed to cover catastrophic conditions, after that company went out of business he went bare for another couple of years, until he was able to get eligibility for VA. If it weren't for the VA he'd still be uninsured.

[malkin]

To me the real bonus is not that our health care is "free", because it's not, but that paying for it is not optional. And that good health care is not only for the well-to-do or for those who plan well. It has a cost, but these are still good things in my book. But I realize that these are hot political topics in the US and I won't pretend to know what it's like. It's a different world.

Of course, like everyone I am concerned about my own health care and coverage, but I also believe that there is enormous value in living in a community where EVERYONE is covered. I rarely hear this mentioned in US discussions about the issue.

[Irulan]

Of course, like everyone I am concerned about my own health care and coverage, but I also believe that there is enormous value in living in a community where EVERYONE is covered. I rarely hear this mentioned in US discussions about the issue.

++++
However, I've deliberately stayed away from the Universal needed in US sub topic as that tends to descend into the political fairly quickly. Unless everyone on TE is unanimous and there's no debate?:D

More crazy tidbits: My sis is a lawyer, fairly high up, for a major, national health insurer. She won't use their product, but uses her husband's. Some of her more famous sayings, while helping our mom w/Medicare...." I work in the industry and I don't understand the paperwork".

My SIL, who has worked her whole life until she has a debilitating stroke at 47, is fully disabled and on Medicaid. They recently sent her a letter stating that her income of $1079 a month ( yes, that's what she lives on) is $300 too high to qualify for full benefits, and she now has a $2000 copay she has to meet before she has any coverage. She can barely pay her rent and utilities, and they've done this. I've been trying to call in for MONTHS and the state systems doesn't allow you to talk to real people.

I will stop for the moment.

[Koronin]

I'd hazard a guess that's because most doctors, hospitals and labs are in-network with BCBS. Knowing whether your provider is covered is just as important as knowing whether the service is covered.
I'm sure of that. I was still living near Charlotte when hubby got this job. My old doctor there took any coverage they knew about because they wanted to make sure if their current paitents ended up with different insurance for any reason they would be covered there no matter what. When I was choosing a plan I also looked up doctors on line where I was moving to. Of course not knowing anyone here had no idea who was/was not worth seeing. Strange part about that is the doctor I ended up picking who takes our insurance is apparently one of the best in the area. Like my old doctor she tries to make sure she takes any insurance she knows about. Of course here well over half the population is military and many of them just use the facilities on base. I picked the doctor I did because she does have over all good reviews on line (the major complain is wait time), and a big thing is that as long as you are a patient you do not need an apt to see her or the nurse practitioner, you can go as a walk in. (Which I was extremely thankful for a couple weeks ago). The vast majority of doctors here do not allow walk ins, you have to call for an apt. before they will see you. I figured being able to walk in if need be was worth waiting a bit longer in the waiting room.

[girlontheroad]

Of course, like everyone I am concerned about my own health care and coverage, but I also believe that there is enormous value in living in a community where EVERYONE is covered. I rarely hear this mentioned in US discussions about the issue.
Ditto. I guess that is what concerns me most. I have similar issues to an earlier poster with pure existing conditions and realize how fortunate I am to be able to afford the premiums. I wouldn't expect that would be the case in most situations and if I couldn't it would mean having to return to a job I am glad to be rid of rather than working for myself. It just seems that those who can't afford it have a double whammy. Not only can they not count on insurance help with costs but they are saddled with no insured rates that are significantly higher than for the person in the next chair with the same treatment. My surgery just really brought this issue home to me recently. And this thread has made it clear that The options available vary greatly from state to state making the debates more complex.

[goldfinch]

Of course, like everyone I am concerned about my own health care and coverage, but I also believe that there is enormous value in living in a community where EVERYONE is covered. I rarely hear this mentioned in US discussions about the issue.

Absolutely. Health care for our country is about values. I lobbied for health care reform, favoring a plan such as medicare for all or a plan presented by Senator Wyden which was also simple and would cover everyone. I so burnt out on the lobbying effort that I had to retire. :(
I do know more than anyone should have to know about the varied complicated mess that is individual state options on health care coverage.

[Selkie]

To me the real bonus is not that our health care is "free", because it's not, but that paying for it is not optional. And that good health care is not only for the well-to-do or for those who plan well. It has a cost, but these are still good things in my book. But I realize that these are hot political topics in the US and I won't pretend to know what it's like. It's a different world.

++++++++++++++++
I like hearing about your country's system, actually. In the US, some view being required to hold health insurance as a violation of their constitutional rights (or---egads---the US descending into "socialism"). At the risk of being "flamed" or inviting a heated discusssion, I'm going to say it :eek:: there are those who use the constitution to justify selfishness (example: those who think that having to pay taxes violates their constitutional rights and see it as akin to having the government steal your hard earned income).

[Irulan]

I'm not going to flame you for that, that for sure. I remember similar arguments way back, when i lived in Wyoming, and they were putting seatbelt legislation into play. People actually said things like, " no ones going to tell me what do, I can send my family through the windshield if I want..." (Really, not making that up)

For a thorough,non biased comparison of five Westernized capitalist countries and their variations on single payer health care systems, Frontline did a very good piece several years ago. Singapore, Germany, Japan, UK, and one other nation are compared to the US system. It's only about 50 minutes long
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

[lph]

Well, I guess there's a kind of bizarre logic in being allowed to send your family through the windshield if you want, as long as you pay for the ambulance, the ER and every minute of sewing them up again afterwards yourself... Justifying, quantifying and paying for the trauma to everybody else who witnessed it, friends, co-workers and family is a bit harder.

Sorry to be facetious, but it's really hard for me to get my mind around the idea that society as a whole somehow does not suffer and therefore should not care about or try to prevent bad things happening to individuals.

[Veronica]

Where does the line get drawn at the role of government in protecting individuals from themselves? How much power do you want to give your government over you?

Veronica

[lph]

Personally, quite a lot. For someone else, maybe not so much. I'll leave it at that.

[Crankin]

I have no problems with the government protecting us from ourselves. You can flame me for this, but it generally comes down to the old "individualist" vs. "collectivist" mentality in various cultures/countries. I get to see first hand about some of this, as my DH is a director in a US based, but multi-national company. He deals with employee situations all over the world, and believe me, it seems a lot more civilized in other places. Now, I have nothing to complain about, but as LPH says, the right to good health care should be a given.
OK, I said my piece, you can go back to your regularly scheduled conversation.

[shootingstar]

One thing for certain, when finding a family doctor, as a patient I focus on:

*convenient/accessible location
*covenient hrs.
*good rapport with the doctor: aka someone I can ask all sorts of questions and not get brushed off. And from doctor, who conveys current info.
*choice of another doctor in urgent situation, if my doctor is not immediately available

I have never spent any time or need to, figure out what sort of arrangement there is between doctor and some other party on insurance since I haven't had catastrophic/major illnesses, surgeries yet. But even if I did, it's not going to change for whatever extra out of pocket costs there will be, no matter which doctor I choose on my own in any city in any province. It will always be what the province has set for special drugs by legislation and what additional costs patient will have to pay.

Depending on the income (lower income), disability (if any) and age (ie. seniors), there may be some discounting.


Yes true, regular medical lab tests, pap test, breast cancer screening.. are not out of pocket billed. In fact, the provincial health authorities send notices to all women as a reminder. I know I've lived in Ontario, B.C. and Albera.

Depending on the province, there are some differences for certain services that a resident will have to pay if not covered by an extended employer paid health care benefit..ie ambulance services, certain drugs.

to answer :
Where does the line get drawn at the role of government in protecting individuals from themselves? How much power do you want to give your government over you?

I would want govn't to control over ...alot in the areas of health care and public safety. Example: Alberta dentists don't have a much of a fee cap on their services. It's pretty shocking to pay hundreds of dollars just for teeth cleaning and check-up. B.C. and Ontario have stronger controls on capping fees for dentists. Very different.

After working for a provincial regulatory agency on fire safety and haz mat clean-up, then at a major construction engineering project, you really do want govn't regulatory control plus follow-up inspection and fines....to protect people. The private sector will cut corners and it's pretty shocking what can happen quickly... I've seen it.


I expect our Canadian income tax rate might be different (meaning a bit higher) than some of the state income tax state rates which might account again, for some people very resistant to perceived govn't control which they tend to equate to govn't costs.

[Veronica]

Not all of our elected officials are all that bright. There's the "Legitimate rape," guy who thinks, "women can shut that whole thing down." Or the guy who thinks if we send too many troops to Guam the island will tip over. I don't want either of those guys deciding what I can and can't do. :D

Veronica

[Irulan]

Or the guy who thinks if we send too many troops to Guam the island will tip over.

Veronica


whoa, missed that one!

[Trek420]

Or the guy who thinks if we send too many troops to Guam the island will tip over. :D

Veronica

I missed that one too! Is he on the science committee? You know the group: when the NASA scientists who built and launched the Curiosity rover testified before the science committee one of our esteemed, wise, learned representatives asked them if they saw Armstrong's footprints where they landed. :)

[goldfinch]

Not all of our elected officials are all that bright. There's the "Legitimate rape," guy who thinks, "women can shut that whole thing down." Or the guy who thinks if we send too many troops to Guam the island will tip over. I don't want either of those guys deciding what I can and can't do. :D

Veronica

We always have someone telling us what we can and cannot do. Right now it is primarily insurance companies. Unless government tells them otherwise, they decide who gets insured. They decide the cost. They decide what medical procedures will be covered. They decide what doctors you can see. And because costs are so high, and inflated to give artificial discounts to insurers, you pretty much have to be insured.

[Artista]

We always have someone telling us what we can and cannot do. Right now it is primarily insurance companies. Unless government tells them otherwise, they decide who gets insured. They decide the cost. They decide what medical procedures will be covered. They decide what doctors you can see. And because costs are so high, and inflated to give artificial discounts to insurers, you pretty much have to be insured.
+1 Who's to say that all of the insurance company directors are smarter than the "legitimate rape" and "island tipping" guys.

[girlontheroad]

+1 Who's to say that all of the insurance company directors are smarter than the "legitimate rape" and "island tipping" guys.

Not to mention that at least we elect the government but not the insurance companies.