# Forced into a Managed Care Plan



## Murrmurr (Dec 6, 2022)

So California is forcing all their Medi-Cal recipients into Managed Care. That's where one of two major insurance companies manages your medical care instead of your doctor. It's very much like national healthcare, except it's at the state level.

Baby steps.

And this will effect me. I don't have Medi-Cal coverage, but something very similar. I was awarded state-affiliated health insurance as part of a lawsuit I won after I fell off a ridge at a state park. There were supposed to be signs and a tourist barrier there on the ridge, and the park had been non-compliant about that for several consecutive seasons. My back and some ribs and my liver were broken in the fall, and along with money, I was awarded coverage for ongoing treatment of my injuries.

But that was like 30 years ago. Today I had to tell a nice lady (not her fault) at this 800 number which major insurance company I wanted to manage my medical care starting in January. If I didn't pick one, they would. Both insurances are accepted by my doctor, so I chose randomly. 

I hate this because I know it's going to the national level. State by state, it's gradually gonna become federal healthcare. And Blue Cross and probably Aetna, my guess, will become even more behemoth and powerful. 

I suggest we advise our grandkids to either get into the insurance business or invest in it.


----------



## rwb (Dec 6, 2022)

It stinks living in California!!


----------



## Gaer (Dec 6, 2022)

Wow!  California leadership is sure doing some STANGE things!


----------



## jimintoronto (Dec 6, 2022)

Murrmurr said:


> So California is forcing all their Medi-Cal recipients into Managed Care. That's where one of two major insurance companies manages your medical care instead of your doctor. It's very much like national healthcare, except it's at the state level.
> 
> Baby steps.
> 
> ...


Or look into immigrating to Canada. We are looking for well educated University graduates, or State certified skilled trades people. Jimb.


----------



## Murrmurr (Dec 6, 2022)

jimintoronto said:


> Or look into immigrating to Canada. We are looking for well educated University graduates, or State certified skilled trades people. Jimb.


Does your government manage your medical care better than (I know) ours will? Is it managed differently in each province?

Not that I'll ever move to Canada, just curious (sincerely).


----------



## JaniceM (Dec 6, 2022)

Iowa medicaid is managed care, also. 
Not that I understand a word of it.. but just to let you know it's not only in California.


----------



## Murrmurr (Dec 6, 2022)

Gaer said:


> Wow!  California leadership is sure doing some STANGE things!


....coming your way asap. Hopefully not.

I'm glad you recognize it's the leadership and not the desires of the people. I read or heard somewhere some time ago that every state should have fiscal voting every year so people could decide how the state government's doing with their taxes so far and what new spending they need, stuff like that. I think that could work.


----------



## Murrmurr (Dec 6, 2022)

rwb said:


> It stinks living in California!!


I hope the stink doesn't spread. It's nearly impossible from here to really know what's happening *out there*.


----------



## Gaer (Dec 6, 2022)

Murrmurr said:


> ....coming your way asap. Hopefully not.
> 
> I'm glad you recognize it's the leadership and not the desires of the people. I read or heard somewhere some time ago that every state should have fiscal voting every year so people could decide how the state government's doing with their taxes so far and what new spending they need, stuff like that. I think that could work.


Well, New Mexico doesn't have the greatest leadership either.


----------



## Murrmurr (Dec 6, 2022)

JaniceM said:


> Iowa medicaid is managed care, also.
> Not that I understand a word of it.. but just to let you know it's not only in California.


Managed care is code for nationalized health system. If gov't outsourced patient care was left up to doctors with medical degrees with oversight from doctors with PhD's, and none of them were paid by a specific insurance company directly, that could work. But everything the US gov't gets their hands in is vulnerable to corruption. (imo)


----------



## Nathan (Dec 6, 2022)

rwb said:


> It stinks living in California!!


Doesn't stink here, is nothing like South Carolina at all.


----------



## Nathan (Dec 6, 2022)

Gaer said:


> Wow!  California leadership is sure doing some STANGE things!


May be strange to you, but California must being do a lot of _somethings_ right, our economy is ranked #10 whereas New Mexico is ranked down at #44.


----------



## Nathan (Dec 6, 2022)

Gaer said:


> Well, New Mexico doesn't have the greatest leadership either.


That was the former leader, looks like NM has a good governor now.


----------



## Gaer (Dec 6, 2022)

Nathan said:


> That was the former leader, looks like NM has a good governor now.


nope.


----------



## Murrmurr (Dec 6, 2022)

Nathan said:


> May be strange to you, but California must being do a lot of _somethings_ right, our economy is ranked #10 whereas New Mexico is ranked down at #44.


Cali rakes in enough tax revenue to spend freely but without success on homeless programs. And I'm guessing that NM spends freely but without success on border issues, but with a lot less revenue.


----------



## jimintoronto (Dec 6, 2022)

Murrmurr said:


> Does your government manage your medical care better than (I know) ours will? Is it managed differently in each province?
> 
> Not that I'll ever move to Canada, just curious (sincerely).


The Canadian system is run by the 10 Provinces and 3 Territories. The Federal Government sets national standards of care, while the Provinces and Territories operate their own individual health care programs. The first point I will make is that EVERYONE is covered. If you are a citizen or a Permanent Resident you are covered, no exceptions. Second point. There are NO restrictions about what Doctor you can see, no restrictions on what hospital you can go to. NO preexisting conditions, no limit on how many times you see your Doctor, no arguing with an insurance company about what you can have or not have. 

Each Province or Territory directly runs the health care program. Doctors all are employed by the Provincial Ministry Of Health, they have an annual agreement with the Provincial Ministry about what they get paid for every type of medical service or surgical operation that they perform. MY Doctor ( for example ) bills the Province once a month for all the services he provided to all of his patients, by electronic means.. 60 days later he gets paid by electronic transfer to his bank account. The average MD in Ontario earns around $275,000. BUT they do not need to employ office clerks to deal with a dozen medical insurance companies, so their overhead is a lot lower than it would be in the USA. All billing goes to ONE source, the Provincial Government. 

When I go to see my MD, or go to the hospital I am asked to provide my OHIP ID card, which is scanned into the computer. It identifies ME so the billing system can route the payment to the correct heath care  provider. My OHIP card and my Ontario driver's license are both photo cards with a number of built in security features. My OHIP card and my DL both show that I am an organ donor. 

So how do we pay for all this ? Everyone who works in Ontario pays toward the health care system through payroll deductions. and through sale taxes on alcohol, smokes, and gasoline. Even the people on welfare pay in when they buy the things I just mentioned. The payroll deductions are the same regardless of how much you earn. Myself and my Wife are seniors, so we do not pay any money for our OHIP coverage. We also get lower prescription prices as we are over 65. I get an infusion of Remicade every 56 days to treat my Colitus. The annual cost is about $10,000 BUT the Trillium Fund covers all of that cost. 

SO what is the Trillium Fund ? The Ontario Lottery and Gaming Commission ( an arm of the Ontario Government ) runs all of the casinos, race tracks and lotteries in Ontario. ALL of the profits go back in to the Provincial treasury. SO every time somebody buys an Ontario lottery ticket, a few cents go towards paying for MY medication. 

Is it perfect ? No, but it sure is better than what 30 million poor Americans have. I explain it this way. WE take care of each other. It is a matter of "we " not "me". What is best for the largest number of people in the community.  

I know that you will have questions, so please feel free to ask me here. JimB.


----------



## Gaer (Dec 6, 2022)

deleted by me.  I'm out.


----------



## Nathan (Dec 6, 2022)

Murrmurr said:


> Cali rakes in enough tax revenue to spend freely but without success on homeless programs.


I have yet to see any solution for the homeless, providing health, counseling and drug treatment is of benefit, but not THE solution.  Perhaps there is no "silver bullet", nobody seems to know.



Murrmurr said:


> And I'm guessing that NM spends freely but without success on border issues, but with a lot less revenue.


The U.S. border with Mexico and enforcement of Immigration Laws fall under the jurisdiction of the Federal government.    California is bordered by Mexico, so we have that in common with New Mexico(and Arizona & Texas).   The only issues that a border state with Mexico would have are when Mexican citizens are arrested for local crimes.  Most(if not all) Californian law enforcement agencies have refused to do the Federal government's job of immigration enforcement, and just focus on enforcing criminal law.


----------



## Nathan (Dec 6, 2022)

Gaer said:


> *I wanted to say something about SF paying all transgender people
> $1200.00 a month for 18 months*, (which I don't understand)
> and Palm Springs too, but,
> maybe it's best I keep my mouth shut.
> Not my state.  Not my business.


@Gaer ,  It looks like you said it.    Is this a lead-in for more California bashing?


----------



## Murrmurr (Dec 6, 2022)

jimintoronto said:


> The Canadian system is run by the 10 Provinces and 3 Territories. The Federal Government sets national standards of care, while the Provinces and Territories operate their own individual health care programs. The first point I will make is that EVERYONE is covered. If you are a citizen or a Permanent Resident you are covered, no exceptions. Second point. There are NO restrictions about what Doctor you can see, no restrictions on what hospital you can go to. NO preexisting conditions, no limit on how many times you see your Doctor, no arguing with an insurance company about what you can have or not have.
> 
> Each Province or Territory directly runs the health care program. Doctors all are employed by the Provincial Ministry Of Health, they have an annual agreement with the Provincial Ministry about what they get paid for every type of medical service or surgical operation that they perform. MY Doctor ( for example ) bills the Province once a month for all the services he provided to all of his patients, by electronic means.. 60 days later he gets paid by electronic transfer to his bank account. The average MD in Ontario earns around $275,000. BUT they do not need to employ office clerks to deal with a dozen medical insurance companies, so their overhead is a lot lower than it would be in the USA. All billing goes to ONE source, the Provincial Government.
> 
> ...


All 30m poor Americans are covered. Most people outside the US don't realize that, and sadly, a lot of Americans don't either. All people who can't afford insurance, including non-citizens, are eligible for a federally subsidized healthcare plan called Medicaid (states can give it their own name. Ours is Medi-Cal). Anyone who doesn't have insurance and they get sick, or their child gets sick, or they find themselves in an emergency medical situation, they're advised of this coverage when they get treatment, and the care staff will even help the person complete the paperwork for either Medicaid or Medicare or both. People who live close to or below the poverty level are automatically eligible for Medicaid.

Each Province or Territory directly runs the health care program - Same with each US state, except the running part is outsourced to one or more major insurance companies operating in their state. It's that company's medical advisors who decide things like whether you get an MRI or just an Xray, have a surgery or not, whether you will be prescribed an opioid, something in the class of anti-epileptic medications, or just ibuprophen, etc. The billing sounds very similar, and state taxes cover 20% to 100% of patient costs based on the reduced charges that doctors and hospitals agreed to and the patient's financial status. But in the US, money from pharmaceutical companies is heavily involved in that end of it in one form or another - cash, trips, shiny things, and/or parties - and doctors who accept these offerings think of it as recouping losses resulting from those agreed-to discounts and pro-bono services. (and the state looks the other way)

The costs are covered by people who work. There are 3 automatic deductions from their paychecks that pay into the worker's company policy or worker's compensation, social services (Medicare) and federal services (Medicaid). States also use regenerating revenue such as state taxes, sales taxes, and "surcharge" taxes from tobacco, gas, and firearms sales, for example. I suppose some states use lottery profits, but Calif claims that our state lottery profits go to schools. (School employees I've talked to say that's true, but it goes to school staff, not schools. Might depend on the district, idk)


----------



## Murrmurr (Dec 6, 2022)

Nathan said:


> I have yet to see any solution for the homeless, providing health, counseling and drug treatment is of benefit, but not THE solution.  Perhaps there is no "silver bullet", nobody seems to know.
> 
> 
> The U.S. border with Mexico and enforcement of Immigration Laws fall under the jurisdiction of the Federal government.    California is bordered by Mexico, so we have that in common with New Mexico(and Arizona & Texas).   *The only issues that a border state with Mexico would have are when Mexican citizens are arrested for local crimes.*  Most(if not all) Californian law enforcement agencies have refused to do the Federal government's job of immigration enforcement, and just focus on enforcing criminal law.


There's also the cost of housing, general needs and medical care of border-crossers and their families who do not leave after they get here. Plus they can apply for federal funds that cover part or all of their immigration services if needed....unless that program is gone, like since 9/11 or whatever; since Homeland Security "melded" with INS and border patrol. 

(I forget what that program is/was called, but I don't think it is/was a Calif-only program.)


----------



## Murrmurr (Dec 6, 2022)

@Gaer - sounds like San Fransisco included particular gender issues on the list of disabilities, making a person with that "diagnosis" eligible for disability benefits.

Drug and alcohol addicts can claim disability benefits, too, and that's also controversial. Now, in Calif, if you want to express disagreement with policies like that, you're probably not gonna get a lot of air-time, but on my threads, please feel free.


----------



## Nathan (Dec 6, 2022)

Murrmurr said:


> There's also the cost of housing, general needs and medical care of border-crossers and their families who do not leave after they get here. Plus they can apply for federal funds that cover part or all of their immigration services if needed....unless that program is gone, like since 9/11 or whatever; since Homeland Security "melded" with INS and border patrol.
> 
> (I forget what that program is/was called, but I don't think it is/was a Calif-only program.)


The border crossers usually drop off the radar, finding shelter somewhere in communities where they go to find work.   I don't know if the State of California incurs any immigration related expense, but the various ICE detention facilities generate income for the county, and presumably the state as well.


----------



## Gaer (Dec 6, 2022)

Murrmurr said:


> @Gaer - sounds like San Fransisco included particular gender issues on the list of disabilities, making a person with that "diagnosis" eligible for disability benefits.
> 
> Drug and alcohol addicts can claim disability benefits, too, and that's also controversial. Now, in Calif, if you want to express disagreement with policies like that, you're probably not gonna get a lot of air-time, but on my threads, please feel free.


Thank you, but no.


----------



## HoneyNut (Dec 6, 2022)

I'm in favor of national health insurance if it would be like Canada.  But it sounds like in California (if I've understood the above posts), the state government is giving away their control to a couple large private insurance companies.  To me that would be like the Social Security Administration giving away our SS control to a couple large private investment companies.   In my experience working for private companies they will lie and cheat as much as they possibly can to increase their profits.


----------



## JaniceM (Dec 6, 2022)

Would this managed care approach have anything to do with individuals needing to settle for nurse-practitioners and osteopaths instead of M.D.s?


----------



## Teacher Terry (Dec 6, 2022)

*People in Canada can wait for a long time to get the surgery they need. Many come to the US for their care. Every system has pluses and minuses. *


----------



## Murrmurr (Dec 6, 2022)

HoneyNut said:


> I'm in favor of national health insurance if it would be like Canada.  But *it sounds like in California (if I've understood the above posts), the state government is giving away their control to a couple large private insurance companies*.  To me that would be like the Social Security Administration giving away our SS control to a couple large private investment companies.   In my experience working for private companies they will lie and cheat as much as they possibly can to increase their profits.


The federal gov't would do exactly the same with national healthcare; they'd assign a major insurance company such as Blue Cross to manage it, and that company would "advise" Congress on what policies to approve, including the company's business and financial policies. And like they do at the state level, those policies would benefit the company far more than the people they cover.

I am absolutely not in favor of national health insurance, but only because the US gov't is so corrupt, especially when they get involved in business. The level of greed is sickening.


----------



## Murrmurr (Dec 6, 2022)

JaniceM said:


> Would this managed care approach have anything to do with individuals needing to settle for nurse-practitioners and osteopaths instead of M.D.s?


YES!!! Yes it does.


----------



## JaniceM (Dec 6, 2022)

Murrmurr said:


> The federal gov't would do exactly the same with national healthcare; they'd assign a major insurance company such as Blue Cross to manage it, and that company would "advise" Congress on what policies to approve, including the company's business and financial policies. And like they do at the state level, those policies would benefit the company far more than the people they cover.
> 
> I am absolutely not in favor of national health insurance, but only because the US gov't is so corrupt, especially when they get involved in business. The level of greed is sickening.


Kinda like the pharmaceutical companies?


----------



## jimintoronto (Dec 7, 2022)

Teacher Terry said:


> *People in Canada can wait for a long time to get the surgery they need. Many come to the US for their care. Every system has pluses and minuses. *


Lies. You are spouting the usual lies put forward by the  American medical insurance corporations. If you really think you know about this subject PLEASE feel free to cite some actual research by a University IN Canada, to support your position. I will wait while you do some searching.  By the way, who do you think knows more about this subject ? A Canadian who has lived here all my life, and who uses our health care program monthly, or you ? Jimb.


----------



## JaniceM (Dec 7, 2022)

jimintoronto said:


> Lies. You are spouting the usual lies put forward by the  American medical insurance corporations. If you really think you know about this subject PLEASE feel free to cite some actual research by a University IN Canada, to support your position. I will wait while you do some searching.  By the way, who do you think knows more about this subject ? A Canadian who has lived here all my life, and who uses our health care program monthly, or you ? Jimb.


I don't know the person you're quoting, but it's possible she isn't intentionally lying.. what she said has been rumored around for a long time.  I guess most in the U.S. figured it was accurate.


----------



## jimintoronto (Dec 7, 2022)

JaniceM said:


> I don't know the person you're quoting, but it's possible she isn't intentionally lying.. what she said has been rumored around for a long time.  I guess most in the U.S. figured it was accurate.


Let me ask you this......Why would a Canadian go to the USA for medical treatment and PAY in US dollars, when they could be treated at home FOR NO COST ?  Bear in mind that today, one US dollar is worth $1.36 Canadian. Does that make any sense to you ? It sure does not make any sense to me. My cardio specialist is originally from Virginia, but she came to Canada about 5 years ago. Why? She said that in Canada she can actually practice medicine, but in the USA she spent a lot of time acting as a bill collector not a Doctor. JimB.


----------



## JaniceM (Dec 7, 2022)

jimintoronto said:


> Let me ask you this......Why would a Canadian go to the USA for medical treatment and PAY in US dollars, when they could be treated at home FOR NO COST ?  Bear in mind that today, one US dollar is worth $1.36 Canadian. Does that make any sense to you ? It sure does not make any sense to me. My cardio specialist is originally from Virginia, but she came to Canada about 5 years ago. Why? She said that in Canada she can actually practice medicine, but in the USA she spent a lot of time acting as a bill collector not a Doctor. JimB.


I have no idea.  Like I said, it's just a rumor that's been around for quite awhile.


----------



## Murrmurr (Dec 7, 2022)

JaniceM said:


> I have no idea.  Like I said, it's just a rumor that's been around for quite awhile.


A few or more decades ago, this was true, Janice, but not because of Canada's healthcare system.

Canadians came here for specific treatments and new forms of diagnostic imaging, and their Canadian healthcare paid for it (eventually). I think the person only had to pay for the travel. This was only done until Canadian doctors completed training on these new at-the-time advanced treatments, which didn't take long. Meanwhile, the US provided Canada with some of that state-of-the-art (at the time) diagnostic equipment, and finally (but temporarily) lifted the patent on a bunch of it so that Canadians could build their own.

If I remember right, the "new, advanced" treatments were for a certain type of aggressive cancer and a certain organ transplant; the liver or something.


----------



## JaniceM (Dec 7, 2022)

Murrmurr said:


> A few or more decades ago, this was true, Janice, but not because of Canada's healthcare system.
> 
> Canadians came here for specific treatments and new forms of diagnostic imaging, and their Canadian healthcare paid for it (eventually). I think the person only had to pay for the travel. This was only done until Canadian doctors completed training on these new at-the-time advanced treatments, which didn't take long. Meanwhile, the US provided Canada with some of that state-of-the-art (at the time) diagnostic equipment, and finally (but temporarily) lifted the patent on a bunch of it so that Canadians could build their own.
> 
> If I remember right, the "new, advanced" treatments were for a certain type of aggressive cancer and a certain organ transplant; the liver or something.


So that was the basis for the ongoing rumor "Canadians are always coming here for healthcare"?  
Interesting info!


----------



## Murrmurr (Dec 7, 2022)

JaniceM said:


> So that was the basis for the ongoing rumor "Canadians are always coming here for healthcare"?
> Interesting info!


Yeah, and it only lasted for 2 or 3 years, and the number of patients was only in the double-digits. Also, Canada got really mad at the US for being a jerk about not lifting the patent on the equipment and for being reluctant to share that technology. But meanwhile, the US and Canadian doctors ignored all the bickering and freely shared knowledge. Some of Canada's best came over and actually did transplant surgeries alongside US's best.

I only read about it, but I remember it felt like a really big deal; science triumphs over politics and greed.


----------



## Muskrat (Dec 8, 2022)

Let’s just say that trying something different is in order. When the united states pays such a large amount per capita for healthcare yet can not compete with the best on longevity, maternal deaths, infant mortality. We have a problem. To some folks those are fighting words….the insistence that the united states has the best healthcare. But the reality is that countries that have national healthcare in place score higher. Lots of things are in play….doctors per capita, emphasis on preventative care, cost and effectiveness of selected care plan, etcetera etcetera. But we are failing.


----------



## Murrmurr (Dec 8, 2022)

Muskrat said:


> Let’s just say that trying something different is in order. When the united states pays such a large amount per capita for healthcare yet can not compete with the best on longevity, maternal deaths, infant mortality. We have a problem. To some folks those are fighting words….the insistence that the united states has the best healthcare. But the reality is that countries that have national healthcare in place score higher. Lots of things are in play….doctors per capita, emphasis on preventative care, cost and effectiveness of selected care plan, etcetera etcetera. But we are failing.


To be clear, though: The people who are being forced into a managed care plot plan are people who are already enrolled with gov't subsidized health insurance, Medicaid (or in my case, the company that insures Cal state employees). This has nothing to do with the quality of US medicine, the gov't couldn't really care less about that...if you don't feel well, they'll tell you to eat your leafy greens. And in Cali, that includes seaweed. 

What the gov't cares about is cost~vs~revenue, and revenue is definitely down, especially post-pandemic when you've got high unemployment, failed businesses, product scarcity, soaring real estate prices, and collapsing investments. So states are forcing certain people into a managed care plan to manage overhead, not the people's health and long life. 

The "something different" we need is getting government out of business and out of the business of managing people's health (and education). They just really suck at it. I just want them to be a government, full stop. Just run the country, keep us safe from foreign aggression, and we'll do the rest. My utopia.

psst....ask a wealthy American how good their doctors are and how good their medical care is. You get an xray of your broken bones, they get 3-D videos. You get asked to say Ahh, they get full body scans. You get pills, they get a whole new liver. 

The quality of American medicine is excellent. And so it is in Bolivia, Japan, Germany, etc. Medical scientists share information and discoveries. They're a-political (with a few exceptions).


----------

