I might have missed this, but why can’t he pay for his own MRI? He says Cigna won’t let him?
True he shouldn’t HAVE to. But are ins co’s actually telling people they can’t take care of themselves?
Yeah you missed it. It was in the next to last paragraph where he wrote that he wants to shell out $1200 for the scan, but CIGNA told him it doesn’t work that way.
In your question is the key to the whole situation.
No, he can't pay for his own MRI, in most cases.
The reason why is complicated, and to understand it, you have to understand Medicare and especially Medicaid, and the political forces that caused them to be created in the first place. "Obamacare" is the result of the financial collapse of Medicare and Medicaid, and unless the underlying politics are reversed, we will have nationalization within five to seven years.
In 1964, most people over 65 who didn't have union or employer provided health insurance as part of their retirement package couldn't buy health insurance. Since Social Security was "for retirement", Congress decided they would directly fund hospitalization and physician services for ALL people over 65. To budget for this, they looked at how much people over 65 spent out of pocket for these services 1952-1962 (which wasn't much). They predicted that, after 25 years, they would be spending $8 billion/year for this, and they were off by a factor of 100. Not 100% - 100X.
This was, of course, because the promise by the government to pay, without limit, for all "reasonable" services created entire industries that did not exist in 1964 - joint replacements, cataract and other eye surgeries, novel treatments for heart attacks, fantastic radiation and chemotherapy treatments, CT scans and eventually MRI, GI endoscopy - none of these things would have been developed by investors without the promise by Congress to pay without limit, because most seniors in the period 1952-1962 could not have funded these things by direct out-of-pocket payments for health care services.
At the last minute during negotiations over Medicare, Congress decided they would also take care of "the poor", with a joint Federal-State program called Medicaid. They couldn't use historical spending by "the poor" to design it, because there was no spending by the poor to speak of in 1952-1962. The poor were cared for in city or county hospitals, which were line items in municipal or state budgets. I trained in such a hospital, and, although services were generally good, when we ran out of money we had to stop spending it.
The crazy promise to pay for the poor led to a massive shift of those poor from county hospitals into private-voluntary and university hospitals, where, of course, there could not be two standards of care. Spending by Medicaid exploded.
By 1986, most of the money flowing into these programs was being printed or borrowed. The taxpayers do have some say, at the end of the day, about how much they will pay for other people's healthcare, and the Great Compromise of 1986 on taxation (Republicans can cut taxes as long as Democrats can borrow and print money to make up the difference) saved the day for almost 20 years.
That brings us to the present day. The government has saddled taxpayers with $19 trillion dollars in debt. The cost of these highly desired services continues to explode. Of course, as with even the simplest highway project, there is waste, fraud, and abuse. But the government's contention that this amounts to 15% of their spending is a lie (that would take another whole long post).
So, the government has increasingly restricted spending through a variety of incentives and punishments. The prime directive, through all of this, has been that "the poor" (and now "the migrant" and "the refugee") get exactly the same care that Donald Trump gets, and since "the poor" can't have MRI on demand, neither can you - even if you want to pay for it.
The core problem is that what people want and what they are willing or able to pay for, when health, life, and death are involved, are radically different.
If government-funded health care could function on a budget, that would have happened long ago. But instead, the budgeting process itself has been destroyed, and popular sovereignty along with it, and "Obamacare" is the result.
“I might have missed this, but why can’t he pay for his own MRI? He says Cigna won’t let him?
True he shouldn’t HAVE to. But are ins co’s actually telling people they can’t take care of themselves?”
I had a never ending bout with bronchitis last winter. It got to the point where I was bad enough that I couldn’t wait 4-6 weeks for an apt with my dr, but not bad enough for a same day or an ER visit. I just needed a chest x-ray and some antibiotics.
I called a walk-in clinic and found out that I could get a chest x-ray, exam and prescription for around $300. At my convenience. No waiting.
Sounds great, right?
Then they found out that I had insurance. They told me that they couldn’t see me without a referral from my physician. (A walk-in clinic?) I told them that I just wanted to pay cash. They said that they can’t see anyone who has insurance for cash. It was the law. They had to use my insurance if I had it.
So no. You can’t just give them money and get a service if you’re insured.
This guy’s situation is worse. If the insurance doesn’t accept that MRI (because it was out of system) they could deny the surgery because he didn’t go through the proper channels.
It’s a big mess right now.