Personal responsibility

If only it were that simple. In fact it's a whole lot more complex - and subtle - than that. Lots of things factor into what initiates the individual's visit to the health-care provider (not just doctors), and what happens from that point (not just prescriptions, maybe referral's, lab tests, out-patient or in-patient services, and so on...). What we need is a chart that shows these factors. Will this website let participants upload a chart?

I agree, Mark. Participants that make conscience decisions to manage our healthcare costs by eating right, not smoking, having routine check-ups, should not be penalized by paying costs established to cover those who make the conscience decision not to manage their healthcare costs.

Not only do I have Blue Cross insurance but I also work in a doctors office and have strong opinions regarding health care. It is sad to watch our surgeon hardly get paid for doing a very involved surgery that takes 4-6 hours and may get paid 1,000 and that is with 2 physicians having to work together. Then you find out the hospital got paid 2-3 times more than the physician that is taking all the risk. A plumber gets paid more to come into your home than a physician gets paid to go in the middle of the night and see a patient in the emergency room. What is wrong with that picture. Then you have patients coming in thinking that you are getting all this money from their insurance company when we are the lowest paid. I can see why physicians are not wanting to practice anymore. They hardly get paid and are unable to help their patients until they jump through hoops that the insurance puts in place.

Thank you for visiting Letstalkcost.com and sharing your perspective.

Not to be over cynical, but how many homeless surgeons do you know? Not getting paid? Really? We can, very subjectively, discuss whether surgeons are paid fairly in comparison to other professions but to argue that they are 'hardly getting paid' seems a bit much. The average surgeon in America makes over $300K/year. Contrary to your statement, I would wage that most plumbers would not be too upset with such a salary.

ck Why do you quote salary figures for surgeons on a nationwide scale but then talk about what BCBS executives make specifically. How about you make the same broad statment about insurance executives nationwide. I feel certain surgeaons in NC charge a competitive amount, probably less than the national average same as the BCBSNC executives.

I also feel comparing BCBSNC executives pay, that of a non-profit insurer with those of for profit with shareholders to answer to is similar to apples and oranges. I would assume the executives of the for profit have additional responsibilities with the shareholders the executives of BCBSNC do not have to deal with, thus justifying their higher salary.

I had a tbi 4 years ago and have no lasting effects due to this yet I get denied left and right so tell me why that is

sorry mark this convo was up when I got to the page I thought it was a general convo but have since started my own if I could delete it I would.

And so we have another PR barrage from the Saints at BCBS of NC.

As a captive BCBS "customer" (State Employees/Retirees Health Plan) I know full well that your company has caused my family tremendous hardship, physical pain, and financial distress for most of the last decade.

I look forward to the time when you Bozo's go bankrupt!

This is one of the most ridiculous comments I have ever heard. If they go bankrupt, who will pay the healthcare costs for 80% of this state? I don't think Les understands the true difficulties that all these parties face. Doctors are barely getting paid, BCBSNC is a non-profit healthcare corporation with admin costs much lower than its competitors, the pharma companies have large R&D costs, attorney's are helping people get the support they need after injuries caused by medical procedures, etc.. Unless you are deworming orphans in somalia, Les, I would say you should not throw the first stone. Let's work around what this site is trying to accomplish--to understand everyone's perspective and then provide ideas how we can move towards a sustainable healthcare solution.

Does NNNN C. Work for BCBSNC?

I agree BCBSNC is a monoply and the consumers have suffered long enough. Time to strike back. GO Les T.

While I completly empathize with the frustration of everyone in this discussion regarding the system as a whole, it seems that many here haven't researched the realities here in North Carolina. Is BCBSNC a monopoly...well technically no, but practically yes. What has this yielded? North Carolina has the lowest insurance costs of the 50 states in America for families and second lowest for individuals, in spite of many demographic obstacles. Why is this? There may be a number of reasons but my guess is that a big part of this is that a non-profit insurer insures the overwhelming majority of privately covered North Carolinians....again, they are nearly a monopoly. With such a massive presence, they can negotiate provider rates that would not go over in more balanced states and ones that could not be considered by for-profit insurers (United, Aetna, Coventry, etc.) that have to answer to shareholders. Is NC's system perfect? No way. Not even close. But there are very few places in America where it is better.

Les T, I empathize with you, but it would help if you had some specific examples of your hardship/pain/distress. That would help get to the root cause and hopefully a solution for you and others.

I agree; however I find that even with great healthcare (such as BCBS), it can be frustrating

acclimating to a new system such as the mail order system.

BCBS could have done a better job teaching employees/ subscribers how to transfer to the mail order system.

Sometimes a change in how subscribers obtain maintenance drugs can drive the frustration level up for non computer savvy patrons.

My wife (who is a teacher) advised me that her fellow colleagues found it too difficult to navigate through the Medco site; therefore obtaining thier drugs the old way through thier local pharmacy.

Taking better care of yourself means understaing the means/ tools available by which to do it.

Individuals when going to the doctor need to understand that prescriptions are not always the answer. If you have a sinus infection it maybe viral and not need an antibiotic. Parents and patients that insist on getting a prescription even if the doctor does not feel it is warranted need to stop. Most doctors are not going to fight with an angry patient that wants an antibiotic and they shouldn't have too. We are so used to the easiest fix, that sometimes are just not warranted.

I am not sure what the point of this is all about. Most people responding to this topic will not talk about the 'root' of the overall issue but the issue that impacts them directly. Even though I sympathize with many of you, I would like to see and hear what solutions there are instead of pointing the finger which is why this forum may have been created. It may be true for a long time BCBSNC may have had a strong hold on the state and there are great experiences and not so great experiences because of this. Overall, I do wonder what it would be like if we were under a different type monopoly. Being new to NC and having BCBSNC as an insurer has made little difference to what 'I' need to do personally to practice preventive health care. To me that is part of the health care dilemna.."what are you willing to do at a personal level to help prevent this overall crisis"? Just my 2 cents!

You won't be able to dictate personal responsibility. I suggest (instead) that we provide incentives for changing behaviors.

Unfortunately, we live in a society where people feel like they should be rewarded for doing the right thing. It baffles me that people aren't willing to take hold of their own health -- the one thing in life they have a lot of control over. But, let's face the facts, people want something in return for good health. Currently, our system is reactive; we treat illness and disease once it has already taken control of someone's life. Why can't we shift the paradigm towards health promotion and wellness -- keeping the healthy people healthy.

Health insurers should employ what many behavioral economists have been preaching for years -- nudge individuals to do the "right" thing. That is, choose what's healthier. This sort of thing can be accomplished gradually through the years by introducing policies and rewards.

Want lower prescription co-pays? Why not create a medication adherence program that offers reduced co-pays if demonstrate adherence?

Want lower premiums? What about taking certain health actions in a given period? Annual physical, foot exam, Hemaglobin A1c check, etc.

These are opportunities to engage consumer more directly in their health and well-being and also shifting the paradigm towards preventive instead of reactive.

And for the nay-sayers, these incentives can be monitored through claims being sent to the insurer. Talk about negotiating power...BCBSNC has the most power of any scapegoat. If they want claims to be filed with certain information, then you better believe they'll get their way.

It's not a perfect solution, but I think the idea should be explored.

And you're a racists bigot! Ok, that isn't a fair statement because I don't now you; but my statement is just as fair as yours, making a broad, generalizing statement smilar to yours. You are making individuals the scapegoat with your stereotyping general statement.

ck - You mentioned your opinon of the average salary of a surgeon, how about posting the salary/total compenation package of the CEO of BCBSNC and other BCBSNC executives?

NNNN C - I challenge you to do the same with your comment about BCBSNC being non-profit and having lower admin costs than competitors.

Charles - Pay for BCBSNC employees is well below industry average. Take the most obvious example, the CEO. BCBSNC's CEO earns less in a year than the CEOs of other large insurers such as United and Aetna make in a month. In fact, BCBSNC's CEO, Brad Wilson didn't earn nearly as much in the year of 2010 as his peers earned in January of 2010. Is he well compensated? Come on, of course he is. Too well compensated? Depends on your perspective, as does anything. Compared to his peers, clearly not even close. Compared to the average American...certainly, but that is a completely different, politically-charged conversation (that I would likely enjoy with you in another forum). No matter the motive, I hail BCBSNC and Mr. Wilson for having the guts to present the public with an open forum for discussion. I am having fun reading everything you and other posters are sharing. Negative, positive or neutral, the more open the dialog the more we can help shape the future of healthcare in our state. The fun part will follow something really good we come up with here on the discussion board. Then we can test if BCBSNC execs are really listening. If so, we will see the good idea addressed and implemented. I am incredibly excited to see what comes from this site and what happens with it once it is shared.

This is a joke. How much responsibility can you have when you are surrounded by high fructose corn syrup, BPA, and pesticides?

You can say all day that you can offset it but you cannot. Obesity is even a problem in Africa. Corporations should have been regulated. But we didn't want that. We wanted BP to do whatever the heck it wanted and all the others in the name of the fair market.

The average person has almost 50 chemicals in their blood now.Some of these are endocrine disrupters. Do you think these are all benign?

I say make it a fair game. Ban BPA like they have in other countries. Get rid of HFCS in bread. Make healthy food cheaper and clean up the emissions from plants and THEN tell me to walk more.

ck - I see you dodged my question by using a national comparison of salaries. And, I am suppose to believe what you say is the truth why, just because you said it, I don't think so. How about you compare surgeons salaries in NC to those nationally? And, while you brought up the issue of surgeons salaies, how many in administration at BCBSNC have held a beating heart in their hand, crack open a skull to save a life? I didn't think so! When it is your child on the table in surgery I want to hear you complain about a surgeons salary. If it is a competent surgeon he earns every penny of his decreased reimbursement from BCBSNC!

It has to start with the one. I totally agree. Getting that one to make a conscious decision to change is a whole other matter.

While people of all races and walks of life are both healthy and unhealthy, getting the majority of the lower socioeconomic citizens of the US to be motivated to make a change is going to be harder as they are typically not well-educated about nutrition and they have a hardship falling out of generations of unhealthy eating habits. Personal responsibility for their own health is a lot of times not even on the radar. I have seen this in my professional life as well as in my own family. There are a ton of great Southern cooks in my family that appreciate the old recipes. (I do not come from a wealthy background).

But the shock factor of seeing people in end-stage renal disease due to uncontrolled type 2 diabetes, exacerbation of COPD due to smoking, or seeing a 700 pound man on a ventilator getting a wound cleaned and packed, which is the size of a dinner plate and as deep into his body tissue as your fist, needs to be put into peoples thinking. There are consequences for actions. A lot of the people with these problems have no insurance. They are on the Medicaid or Medicare system or are marked self-pay and will owe the hospital forever.

Making changes permanent is a hard thing to do, but having motivation in not wanting to end up like those people above is something to consider. There was a commercial regarding a cancer patient that recently aired where he was explaining that he could not play with his kids after chemo treatments and that he wishes he'd never started smoking at age 15. The brave man made those commercials before he died. We need more REAL people on ads like that.

If reason will not convince people, making an economic impact usually motivates people to do something when nothing else will. Perhaps making blood/urine tests and annual physicals/preventative measures mandatory for anyone receiving government assistance on Medicaid and Medicare? Then you'll have some that say you're picking on the poor and elderly? I don't know how else to motivate some of those people who will not do better?

People with insurance typically have preventive benefits covered now - some at 100%, with no deductible. While preventive care isn't a panacea for everything, as people who take all of these preventive care efforts still do get sick, it would start a cascade in the right direction. Exercise, eating right, and drinking water=better health. It boils down to simply that. It's not a complicated equation. It is just complicated to get everyone on the same page doing that.

I know I'm all over the place on this with my comments but it is all intertwined. It's a free country and people can make their own choices. Expecting others to pay for their poor choices is another matter.

When business started providing health insurance for their employees, the public decided that health care was a right and not a privilege. Before that, society paid or barter for their health care. Everyone, patients, doctors, hospitals and medical companies became depended on the payment of insurance companies. Now here we are 40 to 50 years later in a mess. An individual is responsible for their lives. If we have a car,house,or boat we pay insurance. We pay for our phones, TV, etc. If you have a car with no insurance and you wreck it, then it is your problem. Why is it we think that we should not have to pay for health insurance or our health care?

The news media plays up every unfortunate death, asking why, oh why, when sometimes, there is not an easy answer. NO one wants to be sick or die. No company, doctor, or insurance company wants anyone to die. Hopefully, because they care, but also because of the bottom line dollar. If you have an unfortunate death and it goes public, then the fall out is on everyone. The product is investigated, the doctor is looked at and the hospital is looked at. Then the family gets a lawyer and then the lawyer sues everyone involved and the insurance company and the public has to pay for all of the above. Even if no one did anything wrong and it was all unavoidable, millions of dollars are still spend. Medicine is not an exact science. You can not legislate life. Everyone dies sooner or later. For example, if Aunt Sally is an alcoholic and starts to bleed due to her alcoholism and the doctor cannot stop it, and she dies, then the doctor and hospital should not be held liable. We need tort reform, unfortunately ,most politicians are lawyers. We need to educate the public that it is our responsibility to help pay for our own care, to ask questions, to get second opinions and to realize that a pill might not save you no matter what the commercial says. Doctors are human; the medical profession needs to police itself better. If a doctor is not doing his job, then get rid of him. Fortunately, most doctors are very good at what they do.

We as a sociality have decided that no one should die or get old. We have spent billions of dollars on medical advances that have cost billions of dollars to develop. We are all brave and question how we do things until someone we love is sick. Then we want every thing done, all the new advances, everything, even if we know the out come. We need to wake up and realize that you can throw all the money in the world at some things and it will not make a difference. I have worked in the hospital, I have sold medical devices and I have had close friends and family to die in the hospital and in hospice. I know the pain of having to make the decision to stop medical treatment and just making the person I love comfortable.

Medical companies have made wonderful progress, but it cost millions of dollars to bring a product to market, plus all the money spend on making sure that all the products are up to code for the FDA and stock holders. There is a company that started with a man that had an idea to help a friend that was having a heart problem. His idea worked, the friend was helped. Now years later they are a leader in heart products, it cost billions of dollars to get here and billions of dollars to stay there. One law suit can cost that company, time and lots of money. I am sure you see a worrisome circle here. Bottom line, it is money and EVERYONE needs to readjust their thinking, and develop some self responsibility, and we need tort reform, nothing is going to change until this happens. Thank you my soap box is now closed

Isn't "How often you go to the doctor or get a prescription and how much those things cost" the opposite of Preventative Medicine?

No matter how you turn it - it is the flip side of not spending on medical.

After all - you have to go to the doctor to prevent it! ... and THAT costs.

... however; you can do like I have to do being a diabetic.

I pay for my own 100% - when I WILL need more serious issues handled - I WILL get insurance then.

That is how I plan to do. Won't make it reasonable now? I won't later!

My choices are to get a group policy of one through my business which is a LOT CHEAPER than a

personal policy for myself or wait and hit insurance later when it is needed. If someone is going to try yanking my chain ... they need to live with their own chain!

My company is dormant and I do not lie

Insurance is not going to rake me across the coals because I am not on a group of one corporate policy.

Hospitals should be required to post the cost of everything you are being charged for. How much is the shots going to cost how much for the asprin , how much for chest x-rays be upfront don't hide cost behind codes tell how much for that breakfast tray that is usally cold and not eatable

I pay over $600/month for health insurance and I haven't been to the doctor in 4 years. Feels good. Feel the burn!!