Posted on 08/08/2025 7:05:00 AM PDT by Red Badger
Obama giggles on the toilet ,in the shower, when he gets up, as he eats breakfast, when he plays golf, the guy is giddy with delight over how “ Healthcare for everyone” has become a fiscal nightmare for the average white American. Giggidy giggidy, giggidy!! Giggles
The Giggler-In-Chief................
“That call was just this wake-up call. If they can ring me in the operating room, not for something urgent, just for that, and to ask me to justify her staying overnight … we have lost our way.”
She takes a call while operating? She cannot be reached if she doesn’t want to be reached. I can’t imagine my surgeon taking a call.
There is mention of her social media posts. Some have a good picture here. A social media darling who will take a call on her phone during surgery whining about not having her way.
If she was any good she could have a practice not reliant on insurance. The best plastic surgeons are usually out of network if they are in any network at all.
Thanks. I stopped reading about then. It was too boring.
I almost missed that as well.
My understanding is that if you are on traditional Medicare with a supplement policy, if Medicare pays, the supplement pays too. They don’t get to challenge that.
While it is true that many doctors are in Advantage plan networks and take traditional Medicare as well, there are many more that take Medicare but are not in Advantage plans. These are usually the doctors you want to have if you need care that requires a high level of competence.
I opted for traditional Medicare when I turned 65. No regrets. I pay my $250 deductible, and the rest is taken care of by the gummit and the supplement company. I had Mohs on my nose last week, and I am going in for cataract surgery the next 2 weeks. No fighting bureaucrats for authorizations. It costs me more every month, and I don’t get $900 of funny money to spend at some website, but I do get the care I want when I want it.
“Potter said she left hospital work and opened her own clinic in April 2024 after realizing she could provide the same services at a lower cost to both patients and insurance companies — while earning more herself.”
“She said she took out $3.5 million in personal loans to open the clinic”
“then you have to approach insurance companies.”
She did things in the wrong order.
“Why shouldn’t a doctor providing medical care make a living from it?”
A doctor’s salary would be paid as a business cost.
“There is nothing wrong with for profit medical care.”
I completely disagree. The well being of the patient should be the primary concern, not the share price or earnings per share.
In our recent hospitalization the case worker came in to review our insurance / expected costs. I pay for traditional medicare and Part G supplement. I also paid in to the system handsomely during my working years. The case worker said we would have very little out of pocket expense. She was right, about $400, less than 1% of the billed cost.
I asked her what happens with Advantage. Short answer, lots of unexpected bills for out of network. We live near the state line and to stay in network one must travel over 100 miles for medical care comparable to what can be had across the state line just 25 miles away.
I know the country is broke and that the medicare, medicade and SSI are going broke. I can’t do a thing about any of it. I paid in a lot of money to these systems and I will take all I can get for as long as I can get it. NO remorse at all.
If they want to change the programs and keep me whole that is fine with me as well if there is a reasonable and affordable alternative.
Medical “care” in this country is busted with too many hogs at the trough lapping up 17% and increasing of the economy. It has gone on much longer than I ever expected without reform. Medical costs are a problem on par with illegals but it is not even on the radar screen for reform. I wonder why? Could it be that they are paid well and pay their friends in gooberment just as well or better?
There is the in-network/out-of-network issue.
By channeling insured to a subset of providers, the insurer can get better pricing.
However, there are limits to that, hospitals that provide emergency service are better able to insist on being in-network providers even if their charges are higher as some insureds are going to need hospital emergency service.
What I would do is to break most hospitals into two operations as separate as possible. The breakups might start at the largest operations and work downward.
An ambulance might turn right or left depending on your insurance coverage.
The EMTALA mandate should be cut back. Only one visit in any 12-month period per facility, with a $200 per visit limit waiver. The EMTALA hospital should be able to collect as with student loans. EMTALA providers who are not hospitals should be able to collect to the scope of the IRS, but second to the IRS.
As for out-of-network, the insurer should have to pay what it pays to its lowest cost provider for the item, less 10% once the insured pays the policy co-pay/co-insurance, with the balance being the patient responsibility.
“Could it be that they are paid well and pay their friends in gooberment just as well or better?”
The local and state government employees typically have wonderful coverage, far better than that of members of Congress.
What might be done is to make employer health care contributions taxable if the employer coverage costs more than 90% of the PPACA base silver plan premium amount for the ratings area. The PPACA had a luxury plan tax, but it did not adjust for local conditions and was dropped.
“If she was any good she could have a practice not reliant on insurance”
Breast reconstruction is typically a mandated benefit.
Patients expect insurers to pay for most of the cost.
“The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy.
“If WHCRA applies to you and you are receiving benefits in connection with a mastectomy and you elect breast reconstruction, coverage must be provided for:
“All stages of reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of all stages of the mastectomy, including lymphedema.”
“WHCRA requires group health plans and health insurance companies (including HMOs), to notify individuals regarding coverage required under the law. Notice about the availability of these mastectomy-related benefits must be given:
To participants and beneficiaries of a group health plan at the time of enrollment, and to policyholders at the time an individual health insurance policy is issued; and
Annually to group health plan participants and beneficiaries, and to policyholders of individual policies.”
https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/whcra_factsheet
NOTE: The page is probably outdated. The PPACA is based on “medically necessary”.
Insurance companies are evil.
If she was any good she could have a practice not reliant on insurance
So, only patients who can pay out of pocket deserve a surgeon who is “any good”?
Read the rest of my post. The profit should be to those directly providing the care. Not to some investment group that bought up a string of hospitals.
I have the same Medicare setup. One of the pluses is that we have much better access to medical care here than they have in other countries. I cannot complain about wait times or any of that.
The real problem with medical care is that there is so much that can be done now. Take leukemia. Back in the 60’s if you were diagnosed with that, it was all over. Go home and get your affairs in order and they’ll give you morphine if anything hurts. Today, it is treatable, but with long, drawn out, complicated, and expensive procedures.
Not too long ago, a woman on dialysis got an engineered pig kidney made especially for her. It actually lasted for 2 months before they started tinkering with her medication and then it quit working. That is very promising, very impressive, and undoubtedly very expensive. What is going to happen if this treatment comes online? Every kidney patient is going to want a bespoke pig kidney, and they are going to want it now. Who is going to pay for this? And this is just the tip of the iceberg.
I suppose we could set a cap on how much of the economy can be devoted to medical care, but I don’t know how that would be administered.
There is a lot of soul searching that going to need to be done.
“So, only patients who can pay out of pocket deserve a surgeon who is “any good”?”
Let’s say that “any good” means the top 10%. How do you propose we ration that?
I did read the rest of your comment and wholeheartedly agree, that’s why I didn’t mention it. My bad. 😁
I think of medical care as a service and of course those providing the care need to make a living. If they became doctors to be rich, they’re in the wrong profession, IMHO.
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