Money Matters
Dear Community,
Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
If you have questions about this, please email help@theknot.com.
Thank you.
Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
If you have questions about this, please email help@theknot.com.
Thank you.
Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
Re: Health Insurance Marketplace - can I choose to buy a plan in another state?
My hospital straddles a state line and 51% of out patient population is Medicaid/SCHIP. This includes not only the poor but also families with serious or chronic illness, like cancer, heart failure or serious birth defect; all of which can easily incur expenses of $1M+. One state reimburses at less than 40% of actual costs while the other gives us a generous 60%.
On on top of that huge budget deficit, there are also several ACA exchange policies that won't even include us in their coverage; and we're the only children's hospital in the city, and in state of Kansas. (In MO they could drive 4 hours to St. Louis but that's a huge burden for families.) So what ends up happening is those families come for care, are billed their full amounts. We do provide generous financial assistance covering in full the costs for families who make 3x the federal poverty level or less, but the bills from those who don't qualify for financial assistance and can't pay end up as bad debt (we don't send our debtors to collections) and is written off. On average, bad debt, charity care and other write-offs totals more than $120M annually.
So, yes I agree that our system needs an overhaul, but I think providing some background on how a hospital operates and explaining some of the costs the lay person doesn't always consider (personnel, amenities, equipment) is important. Again, I'm pro single payor and would love to see the US move toward universal health care, but unfortunately I think we're headed in the opposite direction.
My chiro is the one who told me why some doctors don't take Cigna - because they don't pay out much for claims.
@als1982, thanks for the perspective. And I do understand there are a lot costs on a provider's end that the average person doesn't see or think of. But there is also a lot of outrageousness.
Same for pharmaceutical companies. I understand their research and development costs are enormous and only a small fraction of those drugs ever come to market. I certainly agree they need to include those costs in the prices of their drugs that ARE on the market. But there is a limit and, in my eyes, they are the WORST offenders for bilking the public and taking advantage of the sick.
I know it is a very unpopular opinion in this country, but I also think it is too bad we haven't gone the route of universal healthcare like pretty much all the other first world countries have done.
Or maybe a different hybrid where people with extensive medical costs, either an ongoing basis or a major surgery, have their costs capped at a certain level per year and a special state/government program pays the rest. Meanwhile, everyone else can have more affordable insurance rates.
And, yeah, "healthy" people will probably have to pay more in higher taxes. Some of them will bitch and whine about. Until their 5-year-old is diagnosed with leukemia. Or until they need their appendix removed. Or are in a horrendous car accident. And are in the ICU for one month and then have 12 months of physical therapy.
The most precious things we have is our life and our health. And if I have to pay higher taxes, so more people can enjoy those things and prolong their life, than that is what I think we need to do as a society. And the people who are 60 or whatever years old and "have never had to see a doctor, so why do I have to pay" can kindly STFU and count their blessings.
You bet that people moaned about 'but it's going to increase our taxes' and 'we don't have kids in the schools,' and I'm over here like 'only $10 a month, per household, so that the kids in our community can have a better education? Sign me up!' Education & healthcare affect the entire community, society, and world. It's shortsighted to believe that they don't impact you (general you) personally.
ETA: the referendum passed, although it was a pretty split vote.
My issue isn't with the $10. My issue is with how taxes in general are flittered away on wasteful spending and then they turn around and go "we need more money for schools, police, fire departments, etc".
My other issue is that I have to live within my budget. If the costs go up, my paycheck doesn't go up, but each year the government just raises taxes like it's an unlimited money pot.
A number of years ago, the people out here voted down a gas tax referendum that was slated to fund badly needed transportation projects. Why? The whole reason we even had the referendum was the state government had robbed the transportation fund to pay for other pet projects. The voters demanded that the new funds be restricted to only pay for transportation needs. State government wouldn't guarantee it. Voters voted it down.
In our city's case, the 'no' people mostly argued the money point. The 'don't raise my taxes for any reason' people are strong around here, and IMO detracts from the larger conversation of how to provide a quality education, add value to the community, etc. The current middle school is old, falling apart, is laid out in an archaic, super-spread-out design that is no longer conducive to quality learning, and most importantly doesn't have adequate facilities for music/art/science classes. The school needed replacement back when I attended 15 years ago lol. The other thing is, building a new/bigger middle school allows for the 6th grade to move from elementary to middle school (there are pros/cons of this; I personally am not well versed in which is best) but then the elementary schools will have room for our district to finally offer 4k, which is needed/wanted by community families and makes our city more attractive for new families to move here (more families = more/faster population growth = decreased tax burden per household, in theory).
Long story short, money had to be the answer in this case. Either way, it's money toward updating an old school or money toward building a new one. Delaying the inevitable new school only increases costs in the long run. No one likes their taxes to increase, I certainly don't either, but there are certain reasons that they should increase and IMO education is one of them.
I do also have issue with doctors being unable to tell you the cost of something. I recognize that medical complications can happen and there is no crystal ball that can tell you the outcome for every patient. However, there are averages and routine costs that could be disclosed. A hospital that delivers thousands of babies per year should know the average cost of a delivery both vaginally and by c-section. My doctor should also be able to tell me how much she bills me per hour or per visit to meet with her, but she can't.
This isn't that different from a client calling me and asking how much it will cost in legal fees to sell their company. Can I tell them for certain? No. There are any number of things that are unpredictable or could go wrong. But I can meet with them, ask some probing questions, review some documents, and then provide a estimate/range with certain assumptions (all of which, by the way, I do for free before they ever sign an engagement letter). I can also tell them my billable rate and the billable rate of every other person in my firm.