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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:22 am 
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Hank Scorpio wrote:
Cashman wrote:
Hank Scorpio wrote:
Cashman wrote:

HSA are just another way of Health Care companies limiting your healthcare. So now you makes the decisions if you should go to the doctor. If you penny pinch, you are probably gonna use the doctor less.


This is exactly what happened with us. Now we don't take the kids to the Dr except for yearly checkups and when they are really really sick. That's probably how it should be though. They don't need a trip to the doc every time they have a little cough. I've got several lingering minor issues that I'm not checking out because I don't want to deal with the costs. If they get to be major issues, I'll go to the doc.



Small coughs, I get it. I have a 1 and 3yr old. But the other part is the opposite of what should be happening. Preventative care not reactionary.


My 3yr old twisted her ankle really bad and was not putting any weight on it. We elevated it and put ice on it but after a day she still didn't feel any better. We took her to the doc and he said it looks like its just a sprain but he wanted an xray to be safe. That set us back $700.

This is the problem that I have. The Dr knew that foot/ankle was fine but he sent us out to waste money on a CYA errand.


I get it, I really do. Had something similar(kid had the flu) and doctor said it could be a blockage. Ended up in ER with a $5k bill. With kids, I will not take a chance though.


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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:23 am 
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Hank Scorpio wrote:

Well your company is just aces. No one else I know that moved to a high deductible plan with an HSA saw their premiums go down. They all increased and we got worse coverage.


Hank, the premiums have to go down. You're not getting traditional coverage. The doctor's costs are borne by the employee. I think you might be misunderstanding what other people have gotten. The "coverage" is worse because there is no coverage until you hit the annual cap. You are getting a stop loss product in exchange for lower premiums. Since the individual incurs their own healthcare costs, they are more likely to watch what they spend.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:23 am 
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Ugueth Will Shiv You wrote:
Hank Scorpio wrote:
My 3yr old twisted her ankle really bad and was not putting any weight on it. We elevated it and put ice on it but after a day she still didn't feel any better. We took her to the doc and he said it looks like its just a sprain but he wanted an xray to be safe. That set us back $700.

This is the problem that I have. The Dr knew that foot/ankle was fine but he sent us out to waste money on a CYA errand.


This is a great example of something that neither the ACA or AHCA will address, and what I believe to be the root cause to this issue.

I'm to guess you mean physician liability?

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:24 am 
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Don Tiny wrote:
Ugueth Will Shiv You wrote:
Hank Scorpio wrote:
My 3yr old twisted her ankle really bad and was not putting any weight on it. We elevated it and put ice on it but after a day she still didn't feel any better. We took her to the doc and he said it looks like its just a sprain but he wanted an xray to be safe. That set us back $700.

This is the problem that I have. The Dr knew that foot/ankle was fine but he sent us out to waste money on a CYA errand.


This is a great example of something that neither the ACA or AHCA will address, and what I believe to be the root cause to this issue.

I'm to guess you mean physician liability?


Correct, in addition to incentives for referrals.


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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:25 am 
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Cashman wrote:

I get it, I really do. Had something similar(kid had the flu) and doctor said it could be a blockage. Ended up in ER with a $5k bill. With kids, I will not take a chance though.


Yep. Denis makes a great point about HSAs being your own money so you shop around and analyze costs but when you are in the ER with a sick kid and they say they need to do an endoscopy, you aren't telling them to stop while you call around for price quotes. You tell them, "Do whatever you need to make sure my kid is OK".

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:26 am 
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Ugueth Will Shiv You wrote:
Hank Scorpio wrote:
My 3yr old twisted her ankle really bad and was not putting any weight on it. We elevated it and put ice on it but after a day she still didn't feel any better. We took her to the doc and he said it looks like its just a sprain but he wanted an xray to be safe. That set us back $700.

This is the problem that I have. The Dr knew that foot/ankle was fine but he sent us out to waste money on a CYA errand.


This is a great example of something that neither the ACA or AHCA will address, and what I believe to be the root cause to this issue.

This goes back to my point earlier about tort reform being needed.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:28 am 
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Once again, no one wants to talk about the entire approach seemingly. When you reform something you should take into account all of the parts of the whole. In this case they just try to "reform" the way people pay to have the same insurance pretty much in the same system pretty much.

If they wanted to go big they should go big. They could address medical professional's compensation while at the same time examining malpractice premiums. Address the tort reform while at the same time creating a fair and equitable table for wrongs and how they should be compensated. I think they already have tables for value when you lose a finger for instance.

If the visionaries could truly work on this you get to a place more closely resembling how people can pay for their heatlh care. You simply give the doc $50 for a visit out of your pocket like you paid a car maintenance cost. You don't pay $50 because the doctor as the price set at $450 so the insurance will give him $300 and "discount" the rest. You can have insurance for big costs but if you examine everything even that should go down.

Lastly, none of that will ever happen.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:28 am 
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Hank Scorpio wrote:
Cashman wrote:

I get it, I really do. Had something similar(kid had the flu) and doctor said it could be a blockage. Ended up in ER with a $5k bill. With kids, I will not take a chance though.


Yep. Denis makes a great point about HSAs being your own money so you shop around and analyze costs but when you are in the ER with a sick kid and they say they need to do an endoscopy, you aren't telling them to stop while you call around for price quotes. You tell them, "Do whatever you need to make sure my kid is OK".


And that is exactly right. But you have stop loss coverage. My son had surgery this year and hit our "high" deductible in January.

The healthcare system is driven by the mundane year in year out costs. Of course people need coverage for catastrophic stuff. Once you hit that deductible it is taken care of. Where dollars are really wasted is by people running in all the time for minor stuff and poor lifestyles as Ugie points out.

I can't even begin to explain how much we have changed because of the plan redesign.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:29 am 
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Cashman wrote:
Exactly. This is why I don't follow this logic.


Farms to factories is not that big of a jump in duties. You go from manual labor to manual labor. If you want employment now you have to be skilled so people pay huge dollars to go to college. Within 5 years everything you learned there will likely be obsolete.

It's becoming what Marx predicted. Knowledge is far more important than labor. The knowledge inside our machines is going to replace labor, so what happens when this knowledge is controlled by a select few. Right now Apple is sitting on almost $300 billion in cash.

I expect this to grow. How much money will the first self-driving truck program be worth?

How much is the value of of the program that controls the Amazon stores that have no cashiers or checkout lines?

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:30 am 
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denisdman wrote:
Hank Scorpio wrote:

Well your company is just aces. No one else I know that moved to a high deductible plan with an HSA saw their premiums go down. They all increased and we got worse coverage.


Hank, the premiums have to go down. You're not getting traditional coverage. The doctor's costs are borne by the employee. I think you might be misunderstanding what other people have gotten. The "coverage" is worse because there is no coverage until you hit the annual cap. You are getting a stop loss product in exchange for lower premiums. Since the individual incurs their own healthcare costs, they are more likely to watch what they spend.


No, I'm not misunderstanding. We had a traditional $20 co-pay plan that we paid X for bi-weekly. They got rid of that plan and offered the high deductible plan with an HSA and our bi-weekly premiums went up. In addition they would match what you put into the HSA. So you had to pay even more money per check.

When I say the coverage is worse, I mean that I get the same thing and pay more per check and more out of pocket at the Dr.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:40 am 
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Hank Scorpio wrote:
denisdman wrote:
Hank Scorpio wrote:

Well your company is just aces. No one else I know that moved to a high deductible plan with an HSA saw their premiums go down. They all increased and we got worse coverage.


Hank, the premiums have to go down. You're not getting traditional coverage. The doctor's costs are borne by the employee. I think you might be misunderstanding what other people have gotten. The "coverage" is worse because there is no coverage until you hit the annual cap. You are getting a stop loss product in exchange for lower premiums. Since the individual incurs their own healthcare costs, they are more likely to watch what they spend.


No, I'm not misunderstanding. We had a traditional $20 co-pay plan that we paid X for bi-weekly. They got rid of that plan and offered the high deductible plan with an HSA and our bi-weekly premiums went up. In addition they would match what you put into the HSA. So you had to pay even more money per check.

When I say the coverage is worse, I mean that I get the same thing and pay more per check and more out of pocket at the Dr.


Then your company may have used that transition to cut the overall employee benefit. If you don't mind me asking the following:

1) What was your biweekly rate before?
2) What is your biweekly rate now including your HSA contribution?
3) How much is the biweekly match?

What I am really wondering is if the biweekly rate that went up includes the HSA contribution, meaning part of your premium is going into the HSA. The premium now is only for the network access and stop loss coverage, so the rate should never go up. It would be like you calling State Farm and going from a $20 deductible to $2,500, and then they charge you more. Something doesn't add up.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:41 am 
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pittmike wrote:
Once again, no one wants to talk about the entire approach seemingly. When you reform something you should take into account all of the parts of the whole. In this case they just try to "reform" the way people pay to have the same insurance pretty much in the same system pretty much.

If they wanted to go big they should go big. They could address medical professional's compensation while at the same time examining malpractice premiums. Address the tort reform while at the same time creating a fair and equitable table for wrongs and how they should be compensated. I think they already have tables for value when you lose a finger for instance.

If the visionaries could truly work on this you get to a place more closely resembling how people can pay for their heatlh care. You simply give the doc $50 for a visit out of your pocket like you paid a car maintenance cost. You don't pay $50 because the doctor as the price set at $450 so the insurance will give him $300 and "discount" the rest. You can have insurance for big costs but if you examine everything even that should go down.

Lastly, none of that will ever happen.


This is exactly my point.

AHCA is just changing the bloody band-aid that ACA has become, but nobody stops the bleeding. You can't throw frosting on a shitty process and call it "better."


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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:41 am 
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WaitingforRuffcorn wrote:
Cashman wrote:
Exactly. This is why I don't follow this logic.


Farms to factories is not that big of a jump in duties. You go from manual labor to manual labor. If you want employment now you have to be skilled so people pay huge dollars to go to college. Within 5 years everything you learned there will likely be obsolete.

It's becoming what Marx predicted. Knowledge is far more important than labor. The knowledge inside our machines is going to replace labor, so what happens when this knowledge is controlled by a select few. Right now Apple is sitting on almost $300 billion in cash.

I expect this to grow. How much money will the first self-driving truck program be worth?

How much is the value of of the program that controls the Amazon stores that have no cashiers or checkout lines?


Automation would not stop on the farm. They do automation at car plants. Less jobs because of it.

And that amazon website is putting payless and other store a like out of business.


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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:41 am 
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Ogie Oglethorpe wrote:
Here is a question, if health care becomes nationalized and we have to pay for it, can we then all as a group have the fiduciary responsibility to condemn Julie for her eating habits?

No.


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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:41 am 
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Ugueth Will Shiv You wrote:
pittmike wrote:
Once again, no one wants to talk about the entire approach seemingly. When you reform something you should take into account all of the parts of the whole. In this case they just try to "reform" the way people pay to have the same insurance pretty much in the same system pretty much.

If they wanted to go big they should go big. They could address medical professional's compensation while at the same time examining malpractice premiums. Address the tort reform while at the same time creating a fair and equitable table for wrongs and how they should be compensated. I think they already have tables for value when you lose a finger for instance.

If the visionaries could truly work on this you get to a place more closely resembling how people can pay for their heatlh care. You simply give the doc $50 for a visit out of your pocket like you paid a car maintenance cost. You don't pay $50 because the doctor as the price set at $450 so the insurance will give him $300 and "discount" the rest. You can have insurance for big costs but if you examine everything even that should go down.

Lastly, none of that will ever happen.


This is exactly my point.

AHCA is just changing the bloody band-aid that ACA has become, but nobody stops the bleeding. You can't throw frosting on a shitty process and call it "better."



If sprinkles are involved, you can!


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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:48 am 
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denisdman wrote:
Hank Scorpio wrote:
denisdman wrote:
Hank Scorpio wrote:

Well your company is just aces. No one else I know that moved to a high deductible plan with an HSA saw their premiums go down. They all increased and we got worse coverage.


Hank, the premiums have to go down. You're not getting traditional coverage. The doctor's costs are borne by the employee. I think you might be misunderstanding what other people have gotten. The "coverage" is worse because there is no coverage until you hit the annual cap. You are getting a stop loss product in exchange for lower premiums. Since the individual incurs their own healthcare costs, they are more likely to watch what they spend.


No, I'm not misunderstanding. We had a traditional $20 co-pay plan that we paid X for bi-weekly. They got rid of that plan and offered the high deductible plan with an HSA and our bi-weekly premiums went up. In addition they would match what you put into the HSA. So you had to pay even more money per check.

When I say the coverage is worse, I mean that I get the same thing and pay more per check and more out of pocket at the Dr.


Then your company may have used that transition to cut the overall employee benefit. If you don't mind me asking the following:

1) What was your biweekly rate before?
2) What is your biweekly rate now including your HSA contribution?
3) How much is the biweekly match?

What I am really wondering is if the biweekly rate that went up includes the HSA contribution, meaning part of your premium is going into the HSA. The premium now is only for the network access and stop loss coverage, so the rate should never go up. It would be like you calling State Farm and going from a $20 deductible to $2,500, and then they charge you more. Something doesn't add up.


Yeah, it was a bloodbath. No one in HR could explain it and it became a salary cut for everyone. I quit that job because of it. :lol:

The new job also has a HDP with an HSA and similar premiums but they give you a free chunk of money in the HSA at the start of the year and then you choose to add more in if you wish.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:51 am 
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I think we can all agree that the old, the disabled, and the infirmed should just be liquidated so as to really bring healthcare costs and taxes down to a reasonable level.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:55 am 
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Don Tiny wrote:
I think we can all agree that the old, the disabled, and the infirmed should just be liquidated so as to really bring healthcare costs and taxes down to a reasonable level.


Mmmmmm... I've got a hankerin for some Soylent Green!

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 10:56 am 
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Hank Scorpio wrote:
Don Tiny wrote:
I think we can all agree that the old, the disabled, and the infirmed should just be liquidated so as to really bring healthcare costs and taxes down to a reasonable level.


Mmmmmm... I've got a hankerin for some Soylent Green!

I'm afraid you'll have to wait until Tuesday.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:00 am 
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http://slatestarcodex.com/2017/02/09/co ... t-disease/

Someone had posted this earlier, and it is interesting. Cost disease and healthcare. We keep getting less for more.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:07 am 
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Kirkwood wrote:
Ogie Oglethorpe wrote:
Here is a question, if health care becomes nationalized and we have to pay for it, can we then all as a group have the fiduciary responsibility to condemn Julie for her eating habits?

No.

Even though her diabetes due to poor lifestyle choices will be responsible for driving up costs?

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:09 am 
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WaitingforRuffcorn wrote:
http://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/

Someone had posted this earlier, and it is interesting. Cost disease and healthcare. We keep getting less for more.


My goodness, I think that's what I have been saying in thread after thread. Look at how much money we are throwing at these "problems" and then look at out comes.

By all accounts, our health care and educational outcomes are mediocre at best. And our spending on those is off the charts.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:14 am 
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what we need is a nice universal payer system like Venezuela. Obesity rates there are non-existent! I bet literacy rates are off the charts too!

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:17 am 
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denisdman wrote:
Hank Scorpio wrote:

Well your company is just aces. No one else I know that moved to a high deductible plan with an HSA saw their premiums go down. They all increased and we got worse coverage.


Hank, the premiums have to go down. You're not getting traditional coverage. The doctor's costs are borne by the employee. I think you might be misunderstanding what other people have gotten. The "coverage" is worse because there is no coverage until you hit the annual cap. You are getting a stop loss product in exchange for lower premiums. Since the individual incurs their own healthcare costs, they are more likely to watch what they spend.

our costs went down the first year, and by year two they are up, with a higher premium. I pay the bills...I saw the numbers. We're small here but still.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:18 am 
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Costa Rica has a better healthcare system than the United States.


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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:19 am 
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Caller Bob wrote:
Costa Rica has a better healthcare system than the United States.


you'd be healthy as an ox if all you ate was rice and beans and plantains all day.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:24 am 
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denisdman wrote:
WaitingforRuffcorn wrote:
http://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/

Someone had posted this earlier, and it is interesting. Cost disease and healthcare. We keep getting less for more.


My goodness, I think that's what I have been saying in thread after thread. Look at how much money we are throwing at these "problems" and then look at out comes.

By all accounts, our health care and educational outcomes are mediocre at best. And our spending on those is off the charts.


You posted something earlier that ties into this. People do not act rationally. So in some industries markets do not work. I believe that health care is one of these.

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:26 am 
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Ugueth Will Shiv You wrote:
Healthier lifestyles make preventable diseases (that account for the majority of drug costs) obsolete. Preventable cancers included.

If we continue to research ways to make healthcare cost less for people's bad decisions, we'll never find an acceptable answer across the board.


A great point that could be applied to other areas (substitute "bad decisions" with drug abuse, having babies out of wedlock, etc.) As with the "bad luck" element of poor health (which is real), it's unfortunate that policies are created under the assumption that every malady is due to unforeseen bad luck and nothing is ever anyone's fault. The trick has always been creating a safety net without introducing excessive moral hazard.

Ogie Oglethorpe wrote:
Ugueth Will Shiv You wrote:
Hank Scorpio wrote:
My 3yr old twisted her ankle really bad and was not putting any weight on it. We elevated it and put ice on it but after a day she still didn't feel any better. We took her to the doc and he said it looks like its just a sprain but he wanted an xray to be safe. That set us back $700.

This is the problem that I have. The Dr knew that foot/ankle was fine but he sent us out to waste money on a CYA errand.


This is a great example of something that neither the ACA or AHCA will address, and what I believe to be the root cause to this issue.

This goes back to my point earlier about tort reform being needed.


The CYA aspect could be part of it, but I think it's even more likely the doctor is just doing what he can to maximize his income (through whatever deal he has with the xray folks...who knows, he may own the company).

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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:36 am 
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Hatchetman wrote:
Caller Bob wrote:
Costa Rica has a better healthcare system than the United States.


you'd be healthy as an ox if all you ate was rice and beans and plantains all day.


What about their deadly roads just like the Dominican Republic?


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 Post subject: Re: GOP Congress
PostPosted: Fri May 05, 2017 11:38 am 
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Caller Bob wrote:
What about their deadly roads just like the Dominican Republic?


lot of people love CR. I had to go there for 3-4 days on business once. could not get out of there faster. I was out in the country visiting farming operations. lot of poverty there when you get away from the tourist encampments.

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