jeanlucneptune

Thank you for your sane reply.

Your solution to the healthcare crisis is just make everybody lose weight and all the problems of our system go away. You ever try to lose 10 pounds? 100? Spend some time in a general medicine clinic and come back to me.

#3 - Kaiser is great, no question. Just not familiar with them since they don't have a presence in NYC. Honestly, if we had to emulate one model in the country it would definitely be the Kaiser model.

Kaiser is legendarily great healthcare, so I hear you.

Not familiar with Kaiser being in NYC, but I can say that Aetna is probably the best insurer here (again, depending on your plan).

"The poor apparently deserve their poor health access." Exactly what a large percentage of Americans believe. I disagree with them, but hard to make an argument for a better system when many believe that the poor shouldn't have quality healthcare.

Yes, you definitely should have a health insurance plan of some type. Your concierge doc fee will not pay for a visit to the ER, which can bankrupt the average person who doesn't have coverage.

@ShredKazoo

Most providers do communicate with the payor and have a decent idea of what you owe, so I was being a bit snarky there. If they know you have a zero copay, you make no payment on site with no follow up bill afterwards.

A high deductible plan can save you money on the front end, but if you start using that plan you should prepare for rain - a deluge of bills from providers who have no idea what the insurance owes and what you owe.

And God-forbid you use a narrow network plan like an EPO because it's hard to figure out ahead of time what services are covered by the network and what's not. I went to see a doc who was in-network and only paid a $25 copay, which was great, but the lab where my routine blood work was sent was NOT in network and now I'm looking at $1,000 in lab bills for a test I didn't ask for.

If you have a zero copay plan and your provider is in-network, for example, you're not going to be getting a bill in the mail later saying you owe XYZ dollars.

If, however, if you have a situation where you are using co-insurance (you pay x% and the insurance pays 1-x%) the backend bills and related paperwork can be a nightmare.

In terms of quality I'm really talking about the plan design moreso than the insurer and I'm really talking about a benefit rich plan, which is always going to cost more (and a lot more upfront).

Agreed. If your employer is trying to skimp on cost you can end up with some really poor options. Lesson there is to find an employer that offers generous benefits. Easier said than done, I know.

Veteran doc and health services executive here. Three recommendations to improve your overall healthcare experience as a patient.

Number one recommendation: spend $$$ on a concierge primary care doc. Depending on your market can be anywhere from $1,500 to $15,000 per year. Why? Concierge doc will help you triage your problems, give you great access, keep you out of the hospital/ER, and help you cut through red tape if you need to engage the system.

Number two recommendation: seek care in facilities in high-income communities with relatively small general hospitals (i.e. Greenwich Hospital in CT) UNLESS you need tertiary/quarternary care. Why? Much better staffing. Much less riff-raff common people stuff (i.e. like homelessness) and much higher patient expectations about quality of care.

Number three recommendation: pay up for/seek out a cadillac insurance plan from a high quality insurer like Aetna or United with a low deductible (not high) and low copays. Why? Makes the patient experience much better on the back end with much less paperwork if you do engage the system.

Yes, I understand that I'm saying "be rich", but if you can afford any of the three recommendations above your healthcare experience will be MUCH better.

Can't begin to LOL this enough. Go ask people in Appalachia, on an Indian reservation, in urban public housing about their increased living standards. Living standards have surely gone up if you're on the leading edge of the economy, but basically for everybody else in the US things are getting worse and not better. Get out more.

Word, my brother.