0
CanuckInUSA

Canadian Politicial heading to USA for Heart Surgery

Recommended Posts

Quote

Quote


Today - we have (for example) 50 choices, about 10 of them are actually usable, and the other 40 are not a good option for anyone.



This is incorrect assumption. No matter which of those 10 actually usable plans you choose, you'll get the same availability and quality - so this is not a price/quality/availability choice, this is "pay more now/pay less later" or "cover maternity as well" choice.



There is considerable differences in quality out there right now. Kaiser may be great if you're shot, but their lack of interest in physical therapy is a real problem if you have a sports injury. You do get to avoid the hassle of getting billed by 7 different parties, but with a PPO you can pick the surgeon recommended by other metal club members on DZ.

Availability at the HMO is also compromised in comparison to the PPO. Took me 8 weeks to get ok for a Hep A booster shot when I had an HMO plan with a PCP. (ended up not even being covered by the same clinic that did the shots)

PPO versus HMO is a clear example of a cost and quality tradeoff.

Share this post


Link to post
Share on other sites
Quote


PPO versus HMO is a clear example of a cost and quality tradeoff.



Not at all. Just compare the prices for Blue Shield individual PPO and Kaiser - they're basically pretty much the same. Kaiser would provide more services for the same money (because of lower copay), while PPO provides more flexibility. Everything else, however, stays the same - costs are same, availability is the same, and quality is the same.
* Don't pray for me if you wanna help - just send me a check. *

Share this post


Link to post
Share on other sites
Quote

Quote


PPO versus HMO is a clear example of a cost and quality tradeoff.



Not at all. Just compare the prices for Blue Shield individual PPO and Kaiser - they're basically pretty much the same. Kaiser would provide more services for the same money (because of lower copay), while PPO provides more flexibility. Everything else, however, stays the same - costs are same, availability is the same, and quality is the same.



You know, it's clear we shouldn't bother with you. We can give you all the information on earth, and you'll simply repeat your prior claim.

The price for Kaiser and BS PPO are certainly not the same. Quite far apart in fact. $375 versus $642 on my 2010 benefits choices.

Share this post


Link to post
Share on other sites
Quote


You know, it's clear we shouldn't bother with you.



Nobody forces you to do so.

Quote


We can give you all the information on earth, and you'll simply repeat your prior claim.



No, what you give me is your personal opinion, and somehow you expect me to treat it as "information" or "fact". It is not.

Quote


The price for Kaiser and BS PPO are certainly not the same. Quite far apart in fact. $375 versus $642 on my 2010 benefits choices.



For exactly the same terms? Or you conveniently comparing a plan with $25 copay and no deductible versus a plan with $40 copay and $2000 deductible?

Everyone can go here, enter the ZIP code (I entered 94085), the nearest effective date and two people of 35yo. The quotes I've got were $740.00 for "COPAY25" (which looks like $25 copay HMO) and $725.00 for $25/500 deductible plan. Of course, if I compare it with $40/$2000 deductible plan, I'll get a $446.00 plan, but this wouldn't be comparing apples versus apples.

YOUR benefit choices only apply to you
* Don't pray for me if you wanna help - just send me a check. *

Share this post


Link to post
Share on other sites
Quote



Quote


The price for Kaiser and BS PPO are certainly not the same. Quite far apart in fact. $375 versus $642 on my 2010 benefits choices.



For exactly the same terms? Or you conveniently comparing a plan with $25 copay and no deductible versus a plan with $40 copay and $2000 deductible?



actually, the Kaiser plan is equal or better on every attribute: per calendar max (1500 v 2000), deductible (0 versus 250), hospital in patient (100% v 90%), lifetime max (unlimited v 6M), ER visit ($50 v $75+90%), outpatient surgery ($10 versus 90%). Visits and drugs are the same for both.

What's your next excuse?

Share this post


Link to post
Share on other sites
Quote


actually, the Kaiser plan is equal or better on every attribute: per calendar max (1500 v 2000), deductible (0 versus 250), hospital in patient (100% v 90%), lifetime max (unlimited v 6M), ER visit ($50 v $75+90%), outpatient surgery ($10 versus 90%). Visits and drugs are the same for both.



The most expensive Blue Shield individual PPO plan ($0 deductible/$25 copay) for a single 35yo male in 94085 costs $278. Kaiser equivalent (worse) for the same plan is $347 (it provides better coverage though).

$672 for BS PPO? Maybe that's how your company encourages anyone to use Kaiser, but individual situation is different.
* Don't pray for me if you wanna help - just send me a check. *

Share this post


Link to post
Share on other sites
$672 for BS PPO? Maybe that's how your company encourages anyone to use Kaiser, but individual situation is different.



As is every state!

If you care to dig some more into what different states mandate and restrict (as companies not being able to sell HC in a state unless they HQ there) you will see a bid difference.

Removing mandates and letting comanies go national would go a long way to reducing HC policy costs.

I am not saying remove oversite or some regulation but what we got today does not allow (in many cases) an options for HC insurance companies to build polices for what individual consumers want
"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

Share this post


Link to post
Share on other sites
Quote

You do realize, I hope, that next year you'll be 36?

Basing your entire analysis on individual plan quotes for a 35 yo is not exactly comprehensive work.



You do realize, I hope, that we need to use the same base (age, sex, zipcode) to compare the plans?
Put 36 in both quotes if you want to.
* Don't pray for me if you wanna help - just send me a check. *

Share this post


Link to post
Share on other sites
Quote


If you care to dig some more into what different states mandate and restrict (as companies not being able to sell HC in a state unless they HQ there) you will see a bid difference.

Removing mandates and letting comanies go national would go a long way to reducing HC policy costs.



I agree with you. However this would mean you approve federal government regulation of healthcare industry by taking those rights from states (as there must be SOME basic mandates and restrictions - and someone has to set them up uniformly everywhere)
* Don't pray for me if you wanna help - just send me a check. *

Share this post


Link to post
Share on other sites
Quote

Quote


If you care to dig some more into what different states mandate and restrict (as companies not being able to sell HC in a state unless they HQ there) you will see a bid difference.

Removing mandates and letting comanies go national would go a long way to reducing HC policy costs.



I agree with you. However this would mean you approve federal government regulation of healthcare industry by taking those rights from states (as there must be SOME basic mandates and restrictions - and someone has to set them up uniformly everywhere)


No, fixing this does not "require" fed regulation. And no again, there does not have to be required mandated minimums. And no, it would not have to be uniform. If the insurance companies are allowed to sell across states borders the market will take care of the rest
"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

Share this post


Link to post
Share on other sites
Quote

Quote

Quote


If you care to dig some more into what different states mandate and restrict (as companies not being able to sell HC in a state unless they HQ there) you will see a bid difference.

Removing mandates and letting comanies go national would go a long way to reducing HC policy costs.



I agree with you. However this would mean you approve federal government regulation of healthcare industry by taking those rights from states (as there must be SOME basic mandates and restrictions - and someone has to set them up uniformly everywhere)


No, fixing this does not "require" fed regulation. And no again, there does not have to be required mandated minimums. And no, it would not have to be uniform. If the insurance companies are allowed to sell across states borders the market will take care of the rest



There's a technical problem of practicality with that. Insurance regulations are generally a matter of each individual state's laws. That being the case, the only way to enable insurance companies to universally sell across all states' borders - without involving Federal law and/or regulations - would be to separately amend each of the 50 states' respective insurance laws/regulations to permit it. And for sure, even if that did happen - big "if" - inconsistencies - i.e., a lack of predictable uniformity - from one state to another will inevitably occur. That's why it really does have to happen at the Federal level: one set of standards, effective at one time and applicable across the board.

Share this post


Link to post
Share on other sites
Quote

Quote

Quote

Quote


If you care to dig some more into what different states mandate and restrict (as companies not being able to sell HC in a state unless they HQ there) you will see a bid difference.

Removing mandates and letting comanies go national would go a long way to reducing HC policy costs.



I agree with you. However this would mean you approve federal government regulation of healthcare industry by taking those rights from states (as there must be SOME basic mandates and restrictions - and someone has to set them up uniformly everywhere)


No, fixing this does not "require" fed regulation. And no again, there does not have to be required mandated minimums. And no, it would not have to be uniform. If the insurance companies are allowed to sell across states borders the market will take care of the rest



There's a technical problem of practicality with that. Insurance regulations are generally a matter of each individual state's laws. That being the case, the only way to enable insurance companies to universally sell across all states' borders - without involving Federal law and/or regulations - would be to separately amend each of the 50 states' respective insurance laws/regulations to permit it. And for sure, even if that did happen - big "if" - inconsistencies - i.e., a lack of predictable uniformity - from one state to another will inevitably occur. That's why it really does have to happen at the Federal level: one set of standards, effective at one time and applicable across the board.



No it doesn't. I'm sure the insurance companies are entirely capable of providing policies that satisfy the requirements of the various states.
Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

Share this post


Link to post
Share on other sites
Quote

Quote


There's a technical problem of practicality with that. Insurance regulations are generally a matter of each individual state's laws. That being the case, the only way to enable insurance companies to universally sell across all states' borders - without involving Federal law and/or regulations - would be to separately amend each of the 50 states' respective insurance laws/regulations to permit it. And for sure, even if that did happen - big "if" - inconsistencies - i.e., a lack of predictable uniformity - from one state to another will inevitably occur. That's why it really does have to happen at the Federal level: one set of standards, effective at one time and applicable across the board.



No it doesn't. I'm sure the insurance companies are entirely capable of providing policies that satisfy the requirements of the various states.



Of course; but I was making a separate point, and it's something I learned when I was an in-house attorney at an insurance company. In the US an insurance company cannot simply write policies in any state it wants to. It must apply for permission to do so, on a state-by-state basis. Each state has its own individual application, application standards and procedures, laws and regulations, etc. For example, let's say Allstate writes polices in all 50 states. That's the result of it having undergone 50 separate application-review-approval processes.

Share this post


Link to post
Share on other sites
Quote

Quote

Quote

Quote


If you care to dig some more into what different states mandate and restrict (as companies not being able to sell HC in a state unless they HQ there) you will see a bid difference.

Removing mandates and letting comanies go national would go a long way to reducing HC policy costs.



I agree with you. However this would mean you approve federal government regulation of healthcare industry by taking those rights from states (as there must be SOME basic mandates and restrictions - and someone has to set them up uniformly everywhere)


No, fixing this does not "require" fed regulation. And no again, there does not have to be required mandated minimums. And no, it would not have to be uniform. If the insurance companies are allowed to sell across states borders the market will take care of the rest



There's a technical problem of practicality with that. Insurance regulations are generally a matter of each individual state's laws. That being the case, the only way to enable insurance companies to universally sell across all states' borders - without involving Federal law and/or regulations - would be to separately amend each of the 50 states' respective insurance laws/regulations to permit it. And for sure, even if that did happen - big "if" - inconsistencies - i.e., a lack of predictable uniformity - from one state to another will inevitably occur. That's why it really does have to happen at the Federal level: one set of standards, effective at one time and applicable across the board.



and in the end you may be correct. We have seen however how effective the threat of withholding money (speed limit arm twisting) can be

I would rather see that than a new set of federal regulations on the states.
Heck, I would rather just see the states do it cause it is the right thing to do
"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

Share this post


Link to post
Share on other sites
Quote

Quote

Quote


There's a technical problem of practicality with that. Insurance regulations are generally a matter of each individual state's laws. That being the case, the only way to enable insurance companies to universally sell across all states' borders - without involving Federal law and/or regulations - would be to separately amend each of the 50 states' respective insurance laws/regulations to permit it. And for sure, even if that did happen - big "if" - inconsistencies - i.e., a lack of predictable uniformity - from one state to another will inevitably occur. That's why it really does have to happen at the Federal level: one set of standards, effective at one time and applicable across the board.



No it doesn't. I'm sure the insurance companies are entirely capable of providing policies that satisfy the requirements of the various states.



Of course; but I was making a separate point, and it's something I learned when I was an in-house attorney at an insurance company. In the US an insurance company cannot simply write policies in any state it wants to. It must apply for permission to do so, on a state-by-state basis. Each state has its own individual application, application standards and procedures, laws and regulations, etc. For example, let's say Allstate writes polices in all 50 states. That's the result of it having undergone 50 separate application-review-approval processes.



Thanks for the info - I wasn't aware of that. That seems to support my point that the insurance companies are already geared up to be able to provide policies for the various states.

Also, isn't the ban on sales a Federal one?
Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

Share this post


Link to post
Share on other sites
Quote


And no, it would not have to be uniform. If the insurance companies are allowed to sell across states borders the market will take care of the rest



If the regulations are not uniform, and each state has its own regulations, the related overhead expense for selling across state borders (investigating, checking compliance, following the state laws) make sense only for a large companies. Then you don't need to change anything as a large company can create an "independent company" in a state and sell there.

Imagine how much online commerce would there be if every online seller would have to, for example, withhold and properly credit sales tax for any location in the USA, and was required to follow all the laws in the destination locations (like not selling vibrators to Alabama)? How many small businesses would be able to do so?
* Don't pray for me if you wanna help - just send me a check. *

Share this post


Link to post
Share on other sites
Quote

Quote


And no, it would not have to be uniform. If the insurance companies are allowed to sell across states borders the market will take care of the rest



If the regulations are not uniform, and each state has its own regulations, the related overhead expense for selling across state borders (investigating, checking compliance, following the state laws) make sense only for a large companies. Then you don't need to change anything as a large company can create an "independent company" in a state and sell there.

Imagine how much online commerce would there be if every online seller would have to, for example, withhold and properly credit sales tax for any location in the USA, and was required to follow all the laws in the destination locations (like not selling vibrators to Alabama)? How many small businesses would be able to do so?



Again, if the states would drop the HQ in the state requirement (which many have) as well as dropping mandated coverage, insure truthful advertising all of you concerns are answered as the best value insurers would be the ones picked by the consumer. So I am talking REMOVING regulations to some extent. The mish mash you post to goes away then
"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

Share this post


Link to post
Share on other sites
Quote


Again, if the states would drop the HQ in the state requirement (which many have) as well as dropping mandated coverage, insure truthful advertising all of you concerns are answered as the best value insurers would be the ones picked by the consumer. So I am talking REMOVING regulations to some extent. The mish mash you post to goes away then



How would you realistically force all the states to drop those requirements? To have every state agree which requirements they would have to drop, as well as somehow enforce it to ensure some state didn't stuff it back to squeeze a nice payment from health insurers? They would require you to set up some entity which would have authority over states on that subject. And we already have such authority, which is Federal government.

One of the main reasons I support Feds getting more rights from states (and therefore states losing rights to Federal government) is that it makes the laws more uniform across the country, and greatly reduces business efforts when providing services interstate. Imagine different currency in different states?

(and it is also cheaper to have one set of bureaucrats doing crap in hope to be reelected than having 51 set of bureaucrats doing the same)
* Don't pray for me if you wanna help - just send me a check. *

Share this post


Link to post
Share on other sites
Well here is an update on the surgery he wanted a procedure his doctor didn't recommend or offer for male in his condition so he went shopping for the procedure he wanted.


http://www.healthzone.ca/health/newsfeatures/article/770560--u-s-surgery-let-premier-avoid-scar-doctor-says?bn=1

An international expert on heart repair says he would rarely recommend the type of heart surgery Newfoundland Premier Danny Williams received earlier this month in Miami because its only long-term benefit is cosmetic.

Dr. Thierry Mesana, chief of cardiac surgery at the University of Ottawa Heart Institute, said Tuesday he would consider offering the "minimally invasive" procedure only to young women hoping to avoid a chest scar.

The mitral valve repair Williams received Feb. 4 involves surgeons making a 5-centimetre incision on the side of the chest, near the armpit. The traditional method requires a 10-centimetre incision in the middle of the chest and cutting through the breastbone, or sternum.

Mesana issued a statement saying a survey published last month by the Society of Thoracic Surgeons expressed "caution" about the less invasive procedure because the rate of complications – strokes in particular – is higher.

"Many world-renowned experts do not advocate it," the statement said. "It is done in Canada, but again, with caution."

However, Mesana confirmed there are short-term advantages, including a more rapid recovery, less need for blood transfusions and less likelihood of an irregular heartbeat after surgery.

Hugues Jeanmart, a cardiac surgeon at the Montreal Heart Institute, and nearby Sacré Coeur Hospital, disagreed with Mesana, saying the less invasive surgery is as safe and effective as traditional methods, with fewer complications. As well, he said the advantages of the procedure, which has been around since the 1990s, are more pronounced than Mesana suggests, particularly when it comes to recovery.

"(Patients) have less pain, they have less chance of bleeding (and) the risk of having a chest infection is very, very low," Jeanmart said. "The patient can leave the hospital and, as soon as they're home, they can do what they want."

Recovery from the larger chest incisions, known as sternotomies, typically takes about six to eight weeks because more time is needed for bones to heal.

Williams, 60, has said his doctors told him he would be offered only full or partial sternotomies.
SO this one time at band camp.....

"Of all the things I've lost I miss my mind the most."

Share this post


Link to post
Share on other sites
Quote

More minimally invasive approaches are the future of surgery. Physicians that aren't already utilizing minimally invasive techniques are behind the times.



Not if the Risks are higher and it's not as effective. The rates of stroke are higher in the minimally invasive procedure he had done the the repair to the valve is not as effective. That's why the doctor doesn't offer or recommended it.
SO this one time at band camp.....

"Of all the things I've lost I miss my mind the most."

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

0