So, members may recall that Shooter had cardiac bypass surgery just over a month ago. Cardiac bypass means they open up your chest, stop your heart, fix whatever, and then restart (hopefully) your heart and put you back together again.

This is a painful process. In fact, it hurts like hell for about a month.
But, it also gave Shooter a new lease on life. The surgeon said she had never, in 27 years, seen a heart with such bad veins and arteries that was still working. The good news however is that the heart muscle is undamaged and the valves are fine, so basically Shooter got a new heart.

Shooter got a new lease on life.

He also got an estimate from Medicare of the cost of this surgery.
$418,000
Really. And because the actual operation took longer than expected, the final tag was probably more than $425,000.

But here's the thing. Shooter is on Medicare (has to be, once one hits the golden age of 65 Medicare is the only option) and that means that the hospital, medical team, and greedy fat cats get what Medicare is willing to pay. In Shooter's case, the total Medicare actually paid for Shooters new heart was (drum roll) $128,935. He does not know how that broke down, you know, for the surgeon, hospital, etc. Just that Medicare told everyone involved before the surgery that they were getting $128,935 and fuck your $418,000 figure. And, Medicare didn't actually pay that $128,935; you see, Shooter has supplemental insurance, so between Medicare and the insurance company, they paid $128,935.

Now, as an aside, whatever the surgeon and medical team who took care of Shooter got, it wasn't enough. Not even close. Without exception, they were pros, treated Shooter like the second coming even when he was being a true asshole, and without doubt, saved his life. And Shooter was indeed a grade A asshole a few times. But, that's a story for another time.
Whatever the anesthesiologist got was too much (there's another story there but we'll save that for another time).

Anyway, without getting into whether Shooters life is worth $425,000 or $128,935, the question surfaces, how does one pay that damn bill? Who can afford it? Shooter cannot, so thank God for insurance.

Cause so far, Shooters part of all this is $18.

That's right. $18.
Mainly for drugs.

See, here's how that all works. While working we all pay 2.9% of our wages to Medicare. Then, when we're 65 we enroll in Medicare, and that's our medical coverage, not whatever insurance our employer has for us or that we get on our own.

But, Medicare doesn't begin to cover everything. In fact, Medicare will cover only a small percentage of that $128,935 for Shooter's new heart.

But, there's supplemental insurance. You know, private insurance just like before Shooter was 65. Only, Medicare dictates to all insurance companies what the insurance covers, how it's marketed, and to some extent, the premiums. For example, insurance companies have to call their plans "Plan A, Plan B" and so on and Hartford's plan A has to cover exactly what United Health's plan A covers.
You know, so us old farts can easily compare plans and costs.

So anyway, Shooter had supplemental coverage that cost him about $300 a month. What with a prescription plan and the bit that Medicare still charges for its part B (what is it, all these "part A and Part B and Plan A and Plan f and so forth?), his monthly bill for health insurance runs about $500. Same for his wife.
Which, if one thinks about it, is a hell of a lot of money for retired people.

But, as noted above, if Shooter gets in serious trouble and needs some state of the art expert medical care, a $500,000 bill actually costs him $18.

Not bad. Not bad at all.

So, one has to ask, this "Medicare for all" deal sounds like just the ticket, right? Everyone gets on Medicare now, not when they're 65, they get supplemental insurance, and everyone is happy.
So, what the hell, what're we waiting for?
Well, a couple of problems with that idea.

First, Medicare is not, contrary to popular belief, financially sound. The latest projection is that the funds will be bust in 2026. And, expanding Medicare from the 58 Million Americans now covered to all 350 Million of us will only make it all worse.

Like, about $2 Trillion a year worse.

So just raising taxes won't fix that problem. Expanding the program will just make it worse.

And the other problem is that while Medicare would cover some costs, it doesn't begin to cover all of it, which leads to the supplemental insurance thing explained above, which means we have a public/private mix of paying for health care.

And frankly, most insurance companies aren't very much in favor of supplemental plans.
They don't make much money on them, unlike homeowners, or auto, or their favorite, Life insurance.
But, they gotta offer them and hope they can make it up selling us old farts home owners insurance and auto insurance and especially Life insurance, which is like giving those fucks an open line into our assets.

So anyway, Shooter is sitting here with his new lease on life and contemplating what should be done with the insurance mess, and decided he'd toss it out there. Knowing, the radicals will probably hijack the thread, and the rest will be shouted down by the radicals, but what the hell.

 

You're welcome.

 

First why not do what democrats have been trying to do for years and allow medicare to negotiate prices? That would make the goods and services HAVE to offer the product at a competitive price, the same as Medicaid does already. The same would go for the military and the items they buy, instead of having to pay the price that the contractor says to pay they can leverage that cost with another contractor to get a real world price instead of a $300 Band-Aid.

 

You didn't read the initial post, or didn't comprehend it, did you?

The hospital, and the medical team, and that fucking anesthesiologist, and everyone else involved came up with a estimate for $418,000 for the surgery and immediate follow up care.
Medicare responded, for both Medicare and the insurance company, that yeah, that was impressive and all, but the fact is, you're gonna get $128,935.

Now, since you seem to have difficulty grasping the way this works, Shooter will explain.

Lets say the hospital sets a price for removing a wart. They take into account things like the disposable scalpel, the drugs, a suture or two maybe, the disposable drapes, the nurses and doctors time, liability insurance cost, overhead, etc. etc. and decide that removing your standard wart will result in a bill of $2,500.

Along comes Medicare, and they say "well, if this is billed for a Medicare enrollee, you're getting $150, cause that's what it really should cost." The hospital, if it wants Medicare business, says fine; $150 it is.

Medicare negotiates prices with medical care providers for services and goods.

Now, the insurance company, they go along with it.

And on top of all this, before Medicare approves the billing, the procedure has to meet all sorts of requirements. In Shooters case, this meant 5 separate tests of his cardiac functions (at a separate billed cost of $28,000 that Medicare paid $1,885 for), but did not include a chest X Ray, which, if Shooter wanted, he would have to pay for himself. Really. It was an option. The doctor said if I wanted it, she'd even autograph it. Kind of a before and after thingy. Surgeons, by the way, have a weird sense of humor.

So, yeah, Medicare negotiates with service providers. What they don't negotiate for is drug costs, especially with Canadian companies.
Which, Shooter assumes, is what you are really talking about.

And which insurance companies do negotiate for. Shooters drug bill, as he recalls it, was almost $200, the insurance company paid something like $35, and Shooter paid $18.

Now why, one might ask, do hospitals and what not, come up with these huge bills, if they know insurance companies and Medicare aren't going to pay even a meaningful percentage of? That, in fact, no one pays?

Because when someone walks in without insurance, and they need cardiac bypass surgery, they'll get the surgery because no one is turned away, but they'll get the bill for $418,000. The hospitals don't really expect to get that much, not by a long shot, but whatever they don't get paid of that $418,000?
Tax write off.
Which, if you think about it, can be worth as much to a hospital as getting paid the full amount.

So the point is, yeah, Medicare negotiates.

 

Medicare has standing contracts that say the price they will pay, that price is not negotiable at all, it is set in ink by LAW. Insurance companies have similar contracts with providers. IT IS NOT THAT DIFFERENT. Insurance companies and Medicare set prices for services as does insurance providers, but since the doctors work for the insurance companies, they have the ability to say that if the person is uninsured the standard procedure is to bilk them but if they have insurance the costs are way less.
This is why the Dems are fighting for medical care cost oversight/ control laws or a nationalized health care system that takes the power away from the corporations.
Hell Americans go to Cuba for free healthcare because they cannot afford medical help in their own fucking country.

 

I am glad things turned out for you shootersa. I wish you a long and healthy life, posting on XNXX.

 

Anyone who ever had their car repaired after an accident knows insurance companies have a tight grip on what it costs to replace a fender and paint it to match.

For some reason, they can't apply the same principle to heart surgery.

 

And how many Cubans are coming to America for free everything else

 

"You come across like"...DONT EVER ASSUME TO KNOW ME!

"Most people come here to work for a better life, the people that were born here work harder at avoiding work in hopes of a better life."....Oh, so Americans are the scum of the earth and the rest of the world want to emigrate to America to become entrepreneurs,
work hard, pay taxes and become better Americans than Americans

 

Here in England my husband has all manner of operations on his heart, he didn't get a bill only a date of when to turn up.

 

I guess shooter got a new pipes on his heart. Good for you man. What bout your sex life can you serve your woman. Wish you long and happy life.

 

I’m glad that having to depend on a government run insurance scheme didn’t mean a death sentence for Shooter.

 

Exclusive: Drugmakers from Pfizer to GSK to hike U.S. prices on over 200 drugs

Exclusive: Drugmakers from Pfizer to GSK to hike U.S. prices on over 200 drugs

NEW YORK (Reuters) - Drugmakers including Pfizer Inc <PFE.N>, GlaxoSmithKline PLC <GSK.L> and Sanofi SA <SASY.PA> are planning to hike U.S. list prices on more than 200 drugs in the United States on Wednesday, according to drugmakers and data analyzed by healthcare research firm 3 Axis Advisors.

Nearly all of the price increases will be below 10%, and around half of them are in the range of 4 to 6%, said 3 Axis co-founder Eric Pachman. The median price increase is around 5%, he said.

More price increases are expected to be announced later this week, which could affect the median and range.

Soaring U.S. prescription drug prices are expected to again be a central issue in the presidential election. President Donald Trump, who made bringing them down a core pledge of his 2016 campaign, is running for re-election in 2020.

Many branded drugmakers have pledged to keep their U.S. list price increases below 10% a year, under pressure from politicians and patients.

Drugmakers often negotiate rebates on their list prices in exchange for favorable treatment from healthcare payers. As a result, health insurers and patients rarely pay the full list price of a drug.

Pfizer will hike prices on more than 50 drugs, including its cancer treatment Ibrance, which is on track to bring in nearly $5 billion in revenue this year, and rheumatoid arthritis drug Xeljanz.

Pfizer spokeswoman Amy Rose confirmed the company's planned price increases. She said the company plans to increase the list prices on around 27% of its portfolio in the United States by an average of 5.6%.

Of the medicines with increases, she said 43% of them are sterile injectibles, and many of those increases are less than $1 per product.

GlaxoSmithKline said it will raise prices on more than 30 drugs. The company will raise prices on the blockbuster respiratory treatments it delivers through its Ellipta inhaler, its recently acquired cancer drug Zejula and on several products in its HIV-focused ViiV joint venture, according to 3 Axis Advisors. Price increases ranged between 1% and 5%.

Sanofi said it will raise prices on around 10 of its drugs, with hikes ranging between 1% and 5%. The drugmaker noted the increases are in line with its commitment to not raise prices above medical inflation.

Teva Pharmaceutical Industries Ltd <TEVA.TA> raised prices on more than 15 drugs, in some cases by more than 6%, according to 3 Axis Advisors. A Teva spokesperson said the company regularly reviews prices in the context of market conditions, availability and cost of production.

3 Axis advises pharmacy industry groups on identifying inefficiencies in the U.S. drug supply chain and has provided consulting work to hedge fund billionaire John Arnold, a prominent critic of high drug prices.



STAYING OUT OF THE CROSSHAIRS?

Ian Spatz, a senior adviser at consulting firm Manatt Health, said that drugmakers could be holding to relatively low price hikes in an attempt to stay out of politicians' crosshairs. Trump, for instance, targeted Pfizer after a proposed round of price increases in 2018, saying in a tweet that the drugmaker "should be ashamed."

"I’m sure many manufacturers are interested in making sure they are not called out on a large list price increase," Spatz said.

The United States, which leaves drug pricing to market competition, has higher prices than in other countries where governments directly or indirectly control the costs, making it the world's most lucrative market for manufacturers.

Trump, a Republican, has struggled to deliver on a pledge to lower drug prices before the November 2020 election. His administration recently proposed a rule to allow states to import prescription drugs from Canada.

The administration had previously scrapped an ambitious policy that would have required health insurers to pass billions of dollars in rebates they receive from drugmakers to Medicare patients.

The House of Representatives, controlled by Democrats, passed a bill earlier in December that would cap prices for the country's most expensive drugs based on international prices and penalize drugmakers that do not negotiate with the Medicare insurance program for seniors. Trump has threatened to veto the bill, saying it would undermine access to lifesaving medicines.

 

"Hmmm nobody knew health care could be so complicated"

 

When Trump says something like that he is really saying, "I never knew health care could be so complicated." Of course a lot of other people did know

Once he said at a rally, "I bet you never knew Lincoln was a Republican." One of his advisers had to tell him that too.

 

It's like a light bulb went on. Too bad its only 25 watts.

 

As he said, "How does anyone pay the bill"
but in response to DL: Yes of course, and you know the obvious point is how can a person who is surprised by that fact get elected to be president. It begs the question "What else doesn't he know?" and is he capable of even getting started on a resolution. I'm sure the lobbyists are willing to help him and he likes it when other do the work for him.

 

I'm thankful for government run medicare. It's affordable for people on a fixed income who can't afford to pay a couple thousand dollars a month for private health insurance without government subsidies..
Now if they would just fix the drug costs so getting a prescription filled doesn't require mortgaging the farm, things would be better... I had a customer who was elderly and couldn't afford the $1,200 per month for his meds so he discontinued taking them. RIP.
I think most people with any common sense at all can see that heath care and healthcare insurance is unaffordable for the average worker. Something needs to be done. It's like having another house payment. The only people who say we don't need affordable healthcare are the people who are getting it free from their employer or it's it's heavily subsidized by them or they're so rich it doesn't matter.

 

Folks I dont wonna bragg bout our medicine service but if shooter did that kinda treatment in Russia it would cost im 10 times cheaper. With every day morning blowjob included

 

Here in the United States we hear all kinds of complaints about how bad the health care system is in the UK. He hear about long waiting lists, terrible service, and so on. The only thing is, those complaints are not made by citizens of the UK. They are made by Americans.