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. I sincerely hope you read this as is it is really the, TRUE, fundamental problem that no one, no one is considering. Moreover, it’s evident that you, not do most people who are ‘for’ universal health care for all.

Starting there, ‘health care’, may I ask do you actually understand WHAT that was before Obamacare? Let me explain, there were Insurance Companies, ( Indemnity Insurance ), and there were (starting w/ the Kaiser Permante, which should sound familiar), who were HMO’s. The difference between the 2 is night and day, unfortunately people have no interest in health care, so really why would they know. So HMO, (BlueCross, Tufts, Etc, also POO’a are quite the same with a small caveat), stands for ‘Health Maintainence Organization’, slight emphasis on Organization, as they ARE NOT INSURANCE CO’s.

. Before Health Coverage became a ‘god given right’, there were uninsured people, and like yourself they got treatment, and you think for a second, that you WOULDN’T have gotten they surgery and treatment you did, being ‘uninsured’, you are WRONG. Factually not only wrong, but may I inquire, did ‘YOU GET to choose your surgeon, see his history/ any malpractice claims, did you even know if there were any cutting edge techniques available better than what you got?’. No you didn’t, but back to where I started the uninsured runner gets the same, but also has a Legal Right to be sure it’s the right treatment, like you got. THAT’S how insurance Rates were determined, if you chose a plan in which underwriting was involved you got a lower premium, and rate hikes, were from costs of uninsured consumers. The THEORY behind auto, home, liability insurance,( insurance not HMO), is to pool the premiums of a group of people, premiums based on their historical liability. By pooling the premiums, it offsets the pre calculated risk of those individuals that may be injured ( physically or monetarily). As such if an event occurs the person is ‘indemnified’, ( made whole, as in equal to where they were before the loss, ie car accident), THAT IS THE ENTIRE STRUCTURE OF INSURANCE. Moreover it works, an HMO, is an Organization of Medical Professionals, who have accepted a predetermined rate of reimbursement (not based on qualifications, tenure, or expertise, solely based on a business plan), in order to be part of a large Group Health Care provider, allowing access to existing patients they may not have already. BUT, and this is the Hum Dinger of BUT’S, as such they are confined in their coarse of treatment to the most cost effective path for any patient. Even more relevant, any service is confined to within the ‘Organisations’ network of providers regardless of available options of greater success elsewhere. ALSO, there is a Standard CAP to the outlay of any individual, which might not concern anyone, but when my Father in law was run over in his car by a Semi changing lanes, required brain trauma surgery, heart surgery, and a year of therapy, + dozens of meds=$1000’s each month, the sum total calculated to be 1.87M $$, {Had he not been on a private Insurance Indemnity plan, he would have capped out at 1M$ w/ BC& BS. And if you think for 1 second that patients lives aren’t lost due to the VERY SYSTEM YOU WANT SO BADLY FOR ALL AMERICANS, Think Again. I was an Ins Agent, I met with 100’s of families who suffered the tragedy of; ‘Untilization Review’, not familiar, ok it’s a dept where RN’s not Doctors, but simple RN’s w/ no other training but how to use the Risk Analysis formulary of the HMO, to APPROVE, or DENY, EVERY PROCEDURE REGARDLESS OF COST OR RELEVANCE, a patient has done. Pre-Auth you say, guess what I also happen to suffer from a horrible illness called Sarcoidosis, don’t worry no ones ever heard of it. It’s a rare, auto immune disease, with no known cause, it’s initial wake from dormancy is triggered by Stress, ( which is easy to avoid right ), it can effect ANY ORGAN, always it attacks the lungs, in my case I’ve got the, ‘you look so good you could die’ type, where I appear relatively healthy, & for 49 my blood work is A+, except the unknown cause of nearly deadly low red and white blood cells, the golf ball sized modules of scar tissue that cover my hands. Which I’ve had 4 surgeries so far removing 7 and guess what! My 1st surgery cost me 28,900$ because the surgeon didn’t remove a 3cm x 3cm mass, she took out a 5cm x 5cm mass, not pre authorized. It took me a year to clear that bill.

. But more to the point if my mentioning, is Mass has one of the top Sarcoidosis Research Facilities actually 2 in the world. Tufts, and BU, I was denied access to either for 28 months, until now, I’ve got irreversible blood sugar issues, my feet are numb, I’ve got insufficient peripheral vascular blood flow return to my heart, ( not from any major vein, from the crushing of all the capillaries in both legs during tourniquet use for hand surgeries,), leaving my feet slowly getting darker, until , ‘no one knows what next’, but I can’t walk up stairs, I can walk only short distances, I can’t stay seated for long periods of time, cant stand in 1 spot for long, can’t do really anything or I cause more and more of the same damage. Now in 07 of 2017, after 13 specialists, and a total of 4.5 years unable to work,( w/ no qualification for SSDI even on a 12mo emerge basis), My HMO, has decided the most cost effective treatment is to send me into BU’s Sarcoidosis Research Clinic, as the totality of my 8+ symptoms, need to be addressed as a whole! If that’s not ironic enough, they chose BU, as Tufts is more expensive,( the way the coordinate intake), and TUFTS IS MY INSURER!!!

. I Can Sum up this entire problem in one thought, -Why do you ALL, ‘get’ ( understand) auto insurance and home owners insurance ,( WHICH BTW CAR ACCIDENTS FALL UNDER AUTO, PERSONAL INJURY JUST ABOUT ANYWHERE FALL UNDER LIABILITY, {In FACT 98% of Claims are outpatient, 98%!!!!! } So why shouldn’t health INSURANCE BE EXACTLY THE SAME? No it’s not, by GUARANTEEING everyone gets it, and pricing it so a healthy person gets no discount over, a 4 time heart attack crack addict, or a Diabetic who drinks Coke all day, {{WHILE A FAMILY MEMBER PRETENDS TO ASSIST THEM ON THE STATES $$ under Programs like CompassionateCare or Stravros, where family or friend even get time + a half for sleeping over 4 nights a week, some programs allow 38+ hrs a week, much of which if fraudulent}}? You’d right War and Peace if Auto Insurance was mandated to be premium regulated, and your insurance cost the same as a 5 time DUI, 7 accident, 3 personal injury law suits person, had to pay. So why is it so baffling that ( not to mention there was a system I’m sorry to say, but was working, it WAS, until Obama just slapped down Guarantee Issue!!), a system that takes no notice of a persons current health conditions, meds, and history, will be grouped beside you? I may know, ‘You we’re lucky enough to be covered under your family’s health insurance’, start realising those costs on your own, and think carefully on this: Your story intrigued me because of the way you broke your thigh, not really hip, you didn’t get hip replacement, cuz you do know that both hip and especially knee replacement is not permanent. Knees last about 10 years, so if at 32, you’ve been pounding the Floor in dress shoes at World Mortgage Whls lending for 10 years, and have worn out the meniscus cartilage in both knees, unable to even walk w/ inflammation, {You don’t qualify for replacement surgery until min mid 40’s at best. So if Your breaking thigh bones from exercising, and I’m only saying that’s unusual in my experience, you don’t look like you weigh 70lbs or anything, I’d be far more concerned with the Utilization Review policies, and Medically Necessary clauses in your plan. Because you have an MIB report, which all Insurers can look at, to reduce fraud on applications, and each ‘dinger’ you get added, is weighed in UR analysis, of payout of claims. Overall I’m just perplexed why people think it’s possible to payout something they’ve never paid into, like Dental Insurance, like how you can’t but it then go get 6000$ worth of braces for your kid, makes sense yes? Or maybe no? I’d start with defining Indemnification, and go from there.

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