A hospital fee, minus the hospital

Quote from SigX : I understand you are frustrated with the system but you seem to be railing against physician income only. as if that is the only (or maybe biggest?) problem. if this is what you think I am afraid you missing so many other ways to achieve meaningful reform. the problem list is long and part of the problem (as usual) is the gov itself. look above... see how medicare is throwing money down the drain.... and its not doctors that are cashing in, it is hospitals and hospital admins. but keep railing on docs....

I guess I need to elaborate. I think the whole system is the problem (from big pharma pushing expensive meds that aren't even better then the previous versions, to insurance companies, medical supply companies, to drive-by specials).

The two groups I think gets the shaft are the GP's and ER docs, from what I hear most don't make more then 150-250k a year and bust their arse doing it.

Quote from SigX : not to repeat my previous post but I think that some gov intervention would be nice but what you got from the ACA is not what you think you got. an ACO is a good idea on the surface but the bill could have done so much more to cut costs. it did nothing to address the single biggest reason the system is so expensive.... peoples bad life style habits... it did nothing to increase revenue (no VAT like tax), did nothing to curb the cost of durable medical goods (actually made them more expensive), did nothing to curb legal costs (again, just drove those up), did nothing to address the expense of prescription drugs... the bill was essentially a bait and switch: look at Europe and Canada, aren't those systems great!!! o wait, our bill did nothing to even remotely make us like one of those systems. lol Take a look around the net at PQRI and incentives for using an EMR system... yet another gov failure. but lets just ignore all these gov failures and blame doctors.

1) I am against the ACA as it's a pile of poo with a couple nice bows on it.

2) I agree the government getting involved will usually mess it up and make things worse. I am not under the illusion that the government will make things right. I expect them to make things worse.

3) Government gets involved when an industry can't seem to get it's head out it's arse and come to some meaningful self-regulation. It's been years of watching things get more and more fraked and more expensive. How can anyone not in the industry not see that if they didn't come up with something meaningful that the government would do what it did.

4) ACA did not pass because people wanted "free health care", ACA got passed because people were sick of what was going on. When health insurance started exceeding the cost of people's mortgages, and the insurance companies looking for any reason to deny claims. When people get charged $10/pill for something they can buy at a cornor store for $4 for 30 pills, things start to stick.

True Story / Helpful hint: If you are a Kaiser member, check your prescriptions against Walmart's/Target's $4 prescription list. If it is on there, ask your MD to print out the presciption go to walmart and tell them you don't have insurance and buy it for $4.

I am amazed, that after paying Kaiser $1300+ a month for health insurance the co-pay on 3 of my 4 prescriptions were $15 and walmart had them for $4/each without insurance. How fraked is that..

Quote from 808Lurker : 1) I am against the ACA as it's a pile of poo with a couple nice bows on it. 2) I agree the government getting involved will usually mess it up and make things worse. I am not under the illusion that the government will make things right. I expect them to make things worse. 3) Government gets involved when an industry can't seem to get it's head out it's arse and come to some meaningful self-regulation. It's been years of watching things get more and more fraked and more expensive. How can anyone not in the industry not see that if they didn't come up with something meaningful that the government would do what it did. 4) ACA did not pass because people wanted "free health care", ACA got passed because people were sick of what was going on. When health insurance started exceeding the cost of people's mortgages, and the insurance companies looking for any reason to deny claims. When people get charged $10/pill for something they can buy at a cornor store for $4 for 30 pills, things start to stick. True Story / Helpful hint: If you are a Kaiser member, check your prescriptions against Walmart's/Target's $4 prescription list. If it is on there, ask your MD to print out the presciption go to walmart and tell them you don't have insurance and buy it for $4. I am amazed, that after paying Kaiser $1300+ a month for health insurance the co-pay on 3 of my 4 prescriptions were $15 and walmart had them for $4/each without insurance. How fraked is that..

The $4 prescription thing really grinds my gears too.

Quote from Xygonn : The $4 prescription thing really grinds my gears too.

Why? $4 prescriptions that are offered at these places are offered at that price if you have insurance or not. Places like Walmart and Target are baiting you to come for these prescriptions that they make no money off of because you'll go there for all your prescriptions as well as additional shopping. The $4 generics exist for the sole purpose of getting you through the door.

Quote from Tony_Danza : Why? $4 prescriptions that are offered at these places are offered at that price if you have insurance or not. Places like Walmart and Target are baiting you to come for these prescriptions that they make no money off of because you'll go there for all your prescriptions as well as additional shopping. The $4 generics exist for the sole purpose of getting you through the door.

It's because (true story)

30 day supply of generics - Kaiser Insurance at a Kaiser Facility (at 1300/month)
Cost 68.70, Co-pay $15.00 (Amount I pay with insurance $15.00)

The same 30 day supply of generics - Walmart with no insurance $4.00

I am not upset at walmart/target, I am upset at Kaiser. I am locked into their pharmacies and pay $1300 a month for their insurance and they charge me 3.5X the cost of the prescription that I can get at walmart without any insurance.


(Disclaimer, I should update that I dropped Kaiser as my healthcare provider very recently ~1.5 months ago, due to several issues like the above)

Quote from Tony_Danza : Why? $4 prescriptions that are offered at these places are offered at that price if you have insurance or not. Places like Walmart and Target are baiting you to come for these prescriptions that they make no money off of because you'll go there for all your prescriptions as well as additional shopping. The $4 generics exist for the sole purpose of getting you through the door.

Right, I get it, but what I mean, is that it grinds my gears that the co-pay is higher than the total cost of these generics. Obviously, you can go get them at the low price anyway (sometimes you have to specify to NOT apply insurance). You force employers to offer say, birth control coverage, which is negotiated at $60 a month so the premium is about $22 a month for coverage from everyone (men and women because the law is going to force them to be the same if I recall correctly) to get a $15 copay on a drug that is $4 at walmart or target.

Quote from 808Lurker : It's because (true story) 30 day supply of generics - Kaiser Insurance at a Kaiser Facility (at 1300/month) Cost 68.70, Co-pay $15.00 (Amount I pay with insurance $15.00) The same 30 day supply of generics - Walmart with no insurance $4.00 I am not upset at walmart/target, I am upset at Kaiser. I am locked into their pharmacies and pay $1300 a month for their insurance and they charge me 3.5X the cost of the prescription that I can get at walmart without any insurance. (Disclaimer, I should update that I dropped Kaiser as my healthcare provider very recently ~1.5 months ago, due to several issues like the above)

Right ... and the previous poster was trying to explain to you that Walmart/Target only offer a (very limited) $4/generic formulary b/c the cost is subsidized by the other stuff you'll buy when you come in for the medication. So in effect, you'll end up paying quite a bit more than $4 (on average) for that $4 prescription.

In addition, there are many Kaiser plans for which you only pay $15 for a 90 day supply of generics (and for some plans, they'll actually just charge you $10 for a 90 day supply if you have your meds mailed to you (free of cost) instead of picking them up at the pharmacy). Your employer probably went with a cheaper plan. Maybe you need to talk with HR.

Quote from apurvab : Right ... and the previous poster was trying to explain to you that Walmart/Target only offer a (very limited) $4/generic formulary b/c the cost is subsidized by the other stuff you'll buy when you come in for the medication. So in effect, you'll end up paying quite a bit more than $4 (on average) for that $4 prescription.

I am already paying 1300 a month to subdize ... bah let's try an example...

Let's say you sign up for Costco to take advantage of the pricing, you pay your annual dues, then go shopping. The next day you go to walmart and find everything you bought at 1/3 the price. Wouldn't you be pissed at paying the membership fee?

I am already (was) paying Kaiser a tidy sum to subsidize my health coverage, so I expect to get my goods/services less then what a person without insurance pays. Let's try another example..

You get health insurance, go to the hospital with a broken arm, insurance pays X, you pay $300 in co-pays. You find out your friend also went to the hospital without insurance and paid them 50 for the same service. Wouldn't you wonder wth you were paying for insurance to be more out of pocket then someone without insurance.

Quote : In addition, there are many Kaiser plans for which you only pay $15 for a 90 day supply of generics (and for some plans, they'll actually just charge you $10 for a 90 day supply if you have your meds mailed to you (free of cost) instead of picking them up at the pharmacy). Your employer probably went with a cheaper plan. Maybe you need to talk with HR.

Plans vary by state, here it is $15/30, $30/90 mailed or $12 bucks for 90 days at walmart.

Sorry but I trust our HR department over random_internet_person_01

Quote from 808Lurker : I am already paying 1300 a month to subdize ... bah let's try an example...

Your examples are terrible and have no bearing in reality. The reality is, Walmart/Walgreens get huge price breaks due to volume, plus they make those drugs loss leaders by marking up other drugs. KP on the other hand keeps prices flatter overall. Yes, that means you may pay more for that el cheapo generic, but it also means you pay a crapload less on more expensive drugs than if you had another plan. Not to mention, the joker of a pharmacist down at Walgreens doesn't have access to your lab values, medical chart, full med list etc. All information that helps the KP pharmacist catch mistakes, make recommendations to your PCP, or optimize your therapy.

Quote : Plans vary by state, here it is $15/30, $30/90 mailed or $12 bucks for 90 days at walmart. Sorry but I trust our HR department over random_internet_person_01

No, plans vary by both state and the available options KP gives your company to chose from. Sorry, but I trust someone who has worked at KP (me) over a brain dead HR rep who cares more about their company than about its employees. It is entirely possible your company went with, or was only offered the lowest tier plan.


Oh, and SigX, what up bro, you gonna share your Big Pharma kickback $$$ from 2012 or not? You want people to get angry about CMS paying docs extra who work out of hospitals, how angry they gonna be when they see their doc is a prostitute for big pharma, pushin brand new drugs that are 500% more expensive and yet likely not even 5% more effective. Or did I hit a nerve?

Quote from 808Lurker : I am already paying 1300 a month to subdize ... bah let's try an example... Let's say you sign up for Costco to take advantage of the pricing, you pay your annual dues, then go shopping. The next day you go to walmart and find everything you bought at 1/3 the price. Wouldn't you be pissed at paying the membership fee? I am already (was) paying Kaiser a tidy sum to subsidize my health coverage, so I expect to get my goods/services less then what a person without insurance pays. Let's try another example.. You get health insurance, go to the hospital with a broken arm, insurance pays X, you pay $300 in co-pays. You find out your friend also went to the hospital without insurance and paid them 50 for the same service. Wouldn't you wonder wth you were paying for insurance to be more out of pocket then someone without insurance. Plans vary by state, here it is $15/30, $30/90 mailed or $12 bucks for 90 days at walmart. Sorry but I trust our HR department over random_internet_person_01

1) Lets compare apples to apples then. I'll compare what it would cost using walmart's pharmacy for my chronic meds, vs using your insurance (my insurance plan with Kaiser actually has zero co-pay for everything, including meds, imaging and office visits, so probably not a fair comparison).

The Rules:

I used Walmart's online lookup system for the example below. For the ones that it wouldn't list a price, I used average retail prices as listed by drugstore.com. Walmart also gives a ~ 20% discount for their generic meds if you get a 90 day supply (so 3 months of a $4 generic = $10 instead of $12). I factored that in to the calculations. Kaiser gives a 30% discount on 90 day supplies for many of their plans if you get it mailed to you instead (effectively waiving one co-pay). I DIDN'T factor that in to the calculations.

The Meds:

I take a few meds for some chronic health conditions. 5 are generic, 1 is brand-name only (generic didn't work as well in that case).

Of those generics, Walmart only has 3 on their $4 formulary. The 90 day supply total for those comes to $30 (pretty good deal!).

One generic (which has no substitute, except for its parent brand-named drug) is $24 for a 90 day supply.

Another generic is not on any discounted formulary at Walmart, nor are any of its equivalent generics. It just says "Retail Price". Drugstore.com lists the average retail price for a 90 day supply of this medication as $84

The final medication is a brand-name (since all of the generics I tried didn't work well enough, and I went through 4 alternatives first). This medication's price is also not listed on Walmart's website (just says "Retail Price"). The average price for a 90 day supply as per drugstore.com is $702.

Now, I really don't' want to hear any whining about the "Retail Price" estimates not being accurate. So let's say, just for the sake of my sanity, that Walmart is super-competitive, and prices its "Retail Price" meds at HALF the national average.

So, lets do the math:

Retail Priced meds = ($702 + $84)x 0.5 (Wally-world discount) = $393 for a 3 month supply.

$4 formulary meds x 3 = $30 for a 3 month supply

Generic discounted formulary med = $24 for a 3 month supply

Grand total = 393+30+24 = $447 for 3 months of my medications at Walmart.

Assuming your Kaiser plan follows the highest tier pricing scheme (until you get to a high-deductible plan, where you basically pay full price for everything until you get to your deductible):

$15 per mo for generic, $35 per mo for brand-name forumulary, and $45 per mo for brand-name non-formulary, and assuming that for some reason you DON'T take advantage of the 30% discount for having your meds mailed to you, and assuming that the brand-named med is not on the branded formulary:

$15/mo x 5 meds = $225 for 3 months
$45/mo x 1 med = $135

My total cost using your insurance and VERY conservative math (in Walmart's favor): $360 for 3 months of my medications at Kaiser .

Mind you that many Kaiser members have far cheaper co-pay tiers than what I used. Yours actually is on the higher end of the spectrum for an employer-subsidized plan.

To recap:

Walmart (assuming massive discounts): $447
Kaiser (heavily over-estimating the cost): $360

So your "club membership" (which is really not an appropriate analogy for HMO insurance, but whatever) buys you, at worst,, a 20% discount on you meds. That's also assuming that you NEVER EVER buy anything else at Walmart when you pick up your meds. Also factor in the cost of gas and your time having to drive over to Walmart (all Kaiser plans include free delivery of your meds to your home. You can request these refills online or by phone (or in person, but that would kind of defeat the purpose)). You can also get them mailed to you out of state if you're travelling, or studying out of state (as a lot of students on their parent's plans do).

2) The Walmart generic med list is mostly a marketing scheme - it brings people in, and increases good will in the community. Its not really designed to cover the cost of the meds + overhead. But like all marketing, it IS designed to increase profits OVERALL, mostly by convincing people to give you more of their money than they would otherwise. Try not to loose sight of this very transparent and common strategy - the loss-leaders. Your insurance company doesn't use that business model, so yes, on a very few select items (which represent a minuscule part of your total cost of coverage), you might be able to shop around and get a better price. That's hardly shocking.

3) I'm still puzzled by the high monthly premium you're paying though. $1300 x 12 = $15,600 for just one person?!?!. What the heck kind of Cadillac plan is that? Is your employer even contributing anything, or are you bearing the full cost of insurance? My friend, who has serious cardiac issues (congenital heart disease, requiring lots of expensive specialist visits, regular and very expensive cardiac tests, and a high risk of multiple complex surgeries over his lifetime) pays about $25,000 per year fully out-of-pocket for his insurance, and this covers all 5 people in his family for a "Cadillac" type plan. So that's ~ 5k per person, or about $420 per person per month. And that's without any contribution from his employer (he's considered an independent contractor). Maybe there's some unique details about your health that you want to keep private, but the cost does seem exceedingly high for a single subsidized plan.

Quote from apurvab : 3) I'm still puzzled by the high monthly premium you're paying though. $1300 x 12 = $15,600 for just one person?!?!. What the heck kind of Cadillac plan is that? Is your employer even contributing anything, or are you bearing the full cost of insurance? Maybe there's some unique details about your health that you want to keep private, but the cost does seem exceedingly high for a single subsidized plan.

Kaiser Comprehensive -
1337.00 per month family plan (3+ members) 50/50 employer/employee split.
No pre-existing condition exclusions, no charge room and board hospital stays
6000 max co-pay (excludes drugs/medical equipment/etc) no yearly limit, no lifetime limit
I call it the 15 plan, just about every co-pay is 15 (doc visits/labs/drugs/etc)

Quote : So your "club membership" (which is really not an appropriate analogy for HMO insurance, but whatever) buys you, at worst,, a 20% discount on you meds. That's also assuming that you NEVER EVER buy anything else at Walmart when you pick up your meds. Also factor in the cost of gas and your time having to drive over to Walmart (all Kaiser plans include free delivery of your meds to your home. You can request these refills online or by phone (or in person, but that would kind of defeat the purpose)). You can also get them mailed to you out of state if you're travelling, or studying out of state (as a lot of students on their parent's plans do).

It's 15 co-pay for any prescription (generic/name-brand/formulation) it that helps.

In your case and example it works out to your benefit, in mine it doesn't. The fact that we are comparing a *health insurance plan* -vs- *not having insurance* should be telling.

It only really works because of 1 specific brand name expensive medication, take that out and let's compare...

Grand total = 30+24 = $54 for 3 months of your medications at Walmart.

Grand total = 4 X $15 = $60 for 3 months of your medications at Kaiser

The only real benefit I can see of health insurance over a hsa (and one of the reasons I haven't switched) is the discounts that I can't seem to get with the hospitals and doctors.

That 4,000 er visit for a couple stitches magically comes down to 1,700 and a 105 dollar copay with insurance.

Quote : 2) The Walmart generic med list is mostly a marketing scheme - it brings people in, and increases good will in the community. Its not really designed to cover the cost of the meds + overhead. But like all marketing, it IS designed to increase profits OVERALL, mostly by convincing people to give you more of their money than they would otherwise. Try not to loose sight of this very transparent and common strategy - the loss-leaders. Your insurance company doesn't use that business model, so yes, on a very few select items (which represent a minuscule part of your total cost of coverage), you might be able to shop around and get a better price. That's hardly shocking.

Actually you do make a decent point here. It would be about total overall cost, and if a hospital stay is involved then there is no comparison.

However those miniscule items are a vast majority of my experience with Kaiser over the years. While I can count the number of years that I have required a hospital stay on one hand, the number of years where I have needed a prescription would take both hands, both feet and some other parts of my anatomy.

It's not just the $4 generics. I use a presciption tooth paste (Prevident) 15 bucks Kaiser -vs- 15.47 Warmart. It had gotten to the point where I would call walmart for every prescription (not just the $4 generics) to compare prices. Unless it was for a specific brand name or formulation the prices (in my experience) were within 10-50%..

Quote from travathian : Oh, and SigX, what up bro, you gonna share your Big Pharma kickback $$$ from 2012 or not? You want people to get angry about CMS paying docs extra who work out of hospitals, how angry they gonna be when they see their doc is a prostitute for big pharma, pushin brand new drugs that are 500% more expensive and yet likely not even 5% more effective. Or did I hit a nerve?

you need to learn to approach people with a better attitude and not be so accusitory. If you had any sense you would know that kickbacks are 100% illegal. So no, I have not recieved any payments AT ALL from any pharmacy company EVER. I have eaten at a few free lunches. if you want to rant and rave about some pizza and burgers go for it.

FYI, I almost excuslively use generics when at all possible. So to that end I agree with you 100%. But based on your attitude in this thread you clearly dont have a problem with government waste, you would rather just point the finger and make shit up. Excuse me if these millions of dollars of waste per year doesn't bother you any,

I remain unclear as to why people are not against government waste. is it cause we have a democrat president that did not fix this with his ACA bill?

It's because most of us have $$$ and premium healthcare (in other words IDGAF) OR are so poor that the current system is better than nothing.