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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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I asked my Dr about Cologuard, and he recommended against it for that very reason = false positives

"You're gonna have to go in anyway"

"What's your claim?" - Ben Gravy
"Your best work is the work you're excited about" - Rick Rubin
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [JoeO] [ In reply to ]
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The lesson I am taking from this (well... one of them) is that when it's my time for this (and it will be soon), I should probably insist on the full colonoscopy and say no to any suggestion of Cologuard.//

Well there are even more reasons to go down this road first. Us guys over 50/60/70, there is a good chance of a polyp, and they can at the same time just snip it off. No extra procedure, and if something else looks funky, then a cut and test too. Just seems to me that the quick easy test is really not there yet, and just causes more headaches than it is supposed to avoid..I have had 4 colonoscopies now, one with a polyp, so that is the way I will be going..At least until they perfect that tiny camera you swallow, and just let it go for a ride while filming the whole trip!! Talk about non invasive, except for picking it out of your you know what of course )-;
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [monty] [ In reply to ]
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except for picking it out of your you know what of course )-;

No need for that if they can build in a WiFi chip, connect it to an app (PoopStream) and then broadcast it back to the doc. If we can have a camera on our doorbells we can certainly have this too.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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I took the Cologuard test two weeks after an Ironman and it was negative so it certainly isn't a given that hard training will cause positives. My doctor recommended the test and he has a bunch of Ironman finishes to his credit.

It's probably worth looking into but I would trust my doctor's opinion before a story on the internet. We have no idea how common that result is.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [HoustonTri(er)] [ In reply to ]
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HoustonTri(er) wrote:
Careful what you wish for with Universal Healthcare.
The concept is great but I don’t know of any country where the actual application of it works where the patients are happy and well cared for.

My current example of this is my father - a 70+ man in the UK that has been employed all his life and paid into the system.
For the past three months he has been suffering from a debilitating loss of strength in his arms, legs, and hands - this has resulted in his quality of life suffering and affecting his mobility. Well after multiple visits to the doc who initially blew it off as just aging has now agreed that an appointment is deemed necessary with a senior consultant (UK NHS terminology for a specialist). Guess how long he has to wait just to see this specialist for the initial appointment - 20 fucking weeks........ during which he is supposed to just deal with not being able to perform day to day normal functions.

Last year my mum had a lump in her neck that affected her ability to swallow - again took 12 weeks to see the senior consultant.

The US healthcare system may be screwed up but let’s not pretend that the universal healthcare model (NHS in the UK in my personal examples) should be held up as this wonderful alternative. I’ve lived within both systems and neither model seems sustainable/preferable as they actually function.

I assume you have never had to get in as a new patient to a specialist in the US. Every time I see someone comment like this I go back to my wife. Needed a hip replacement, unable to sleep, walking with a cane, referred to the surgeon in early February, appt with surgeon in mid-May, surgery performed end of October.

You don't get to walk in tomorrow to a specialist in the US, you have to wait, just like a lot of other countries.

I'm beginning to think that we are much more fucked than I thought.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [RONDAL] [ In reply to ]
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RONDAL wrote:
Every time i read a story about American Health care i am reminded how absolutely broken that system is. - written by someone who is not american
You don't know the half of it. Astronomical bills are probably known to you. That we are at an arbitrary whim of insurance companies is too. What the rest of the world probably doesn't know is that we get multiple bills for the same procedure / same visit, and the bills come 4-8 weeks after the visit. There's no way to know ahead of time what we are going to receive. One bill, or 3-4 bills from 3-4 different directions. This person could get his $1,200 bill as expected, pay it let's say, and then get a bill for $150 from nurses, and $100 from the hospital, and then another week later a bill for $15,000 from anesthesiologist because that is not at all covered. It is fucked up beyond belief.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Dilbert] [ In reply to ]
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Dilbert wrote:
RONDAL wrote:
Every time i read a story about American Health care i am reminded how absolutely broken that system is. - written by someone who is not american

You don't know the half of it. Astronomical bills are probably known to you. That we are at an arbitrary whim of insurance companies is too. What the rest of the world probably doesn't know is that we get multiple bills for the same procedure / same visit, and the bills come 4-8 weeks after the visit. There's no way to know ahead of time what we are going to receive. One bill, or 3-4 bills from 3-4 different directions. This person could get his $1,200 bill as expected, pay it let's say, and then get a bill for $150 from nurses, and $100 from the hospital, and then another week later a bill for $15,000 from anesthesiologist because that is not at all covered. It is fucked up beyond belief.

The story of my life. Due to several pre-existing conditions (several of which I was born with), I have been uninsurable my entire adult life. The only insurance I've ever been able to get is whatever group plans were offered by my employers, and some of those were virtually worthless. I just last week finally paid off surgery I had to rebuild my left leg after an accident in 2005, which the insurance refused to cover because I was "in my mid-40s, and didn't need to do anything anymore"...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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rayman54 wrote:
Monty,

Good points!!

RE: the DR. knowing of blood in the stool, I learned of the blood stool issue by experience, and also visited this doctor immediately after it occurred to be sure there was nothing sever going on!!! He probably didn't remember....

In my running group, there are two physicians. They were aware of the issue, both the false negatives and the non-coverage for the necessitated second test. By the way, they no longer suggest this as the "way to go".


As a physician myself, I can guarantee you he did not remember. Electronic medical records (EMR) have put a large block between patients and doctors (and other healthcare workers). Before EMR, I could recall so many details about my patients.....family members being ill, last procedures performed, visiting grandchildren, etc... Now that we are required to use EMR, I truly do have a very hard time remembering the "little thing" about my patients, and will commonly ask "did I do so and so procedure on you 6 months ago?" It's a bi embarrassing but it's the way of the world with medicine right now.....and it's going to get worse.

As far as your doc's advice is concerned, YES he should have told you "if this comes back positive, you will need a colonoscopy". Also, he most likely had knowledge that some people could face a rather large bill if they need a colonoscopy afterwards so, if i was your doc, I would feel obligated to share that with you as well so you could make an informed consent.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Fuller] [ In reply to ]
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Fuller wrote:
I did the Cologuard test this summer. I felt bad for the UPS guy at the counter, "Here's my shit - in a box!" A little awkward but at least $700 better than drinking "the mix" and sitting on the toilet for 24 hours. The test came back fine, I have the GI tract of a 25 year old (but alas the prostate of a 66 year old).

I'm a bit torn with the whole medical profession: my dermatologist is kind of a dick but he finds all the bad stuff early and has great surgical skills so I put up with him.
My old GP pronounced me fit as a fiddle on my yearly exam 2 years ago - I had complete heart failure that afternoon and was "mostly dead" like the Dread Pirate Roberts. Off to the ER...
My Cardiologist is a saint, he and my NEW GP are totally awesome. I get to talk and they listen without interrupting.

All of this is now paid for by Medicare and my $300 a month AARP supplement plan. Other than my premium there are no out of pocket expenses for anything, anywhere, with any doctor in the country. The stress reduction is amazing, I wish every American could experience it and vote accordingly for Universal Healthcare.

I wish everyone had universal healthcare but I do not wish for a universal healthcare system. We already have a perfect example of universal healthcare in the US and it's called the Veterans Administration (VA). The VA is one of the biggest bureaucracies that has ever existed in our government. I can attest to this as a medical professional who has trained in, and worked withthe VA, as well as my father being a patient at several. In order to make sure the veterans are being properly cared for, in a timely manner, the VA has had to rely on the private medical sector to a large degree. Before congress passed laws mandating the vets receive coverage within 30 days, it could take months to get a patient in for surgery. I would try to refer a patient back to the VA for cataract surgery and would be told "it'll be 4 months before we can get him in for an appointment". I could refer him to a private ophthalmologist and have the procedure done in two weeks. The cataract surgeons have almost NO incentive to take care of a large volume of patients......they pretty much get paid the same whether they do 4 cataract surgeries or whether they do 10 cataract surgeries. There's already a shortage of specialists in almost every field. You go to a universal healthcare system, and you will see wait times go thru the roof unless there is a private option to bail the system out.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Dilbert] [ In reply to ]
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Dilbert wrote:
RONDAL wrote:
Every time i read a story about American Health care i am reminded how absolutely broken that system is. - written by someone who is not american
You don't know the half of it. Astronomical bills are probably known to you. That we are at an arbitrary whim of insurance companies is too. What the rest of the world probably doesn't know is that we get multiple bills for the same procedure / same visit, and the bills come 4-8 weeks after the visit. There's no way to know ahead of time what we are going to receive. One bill, or 3-4 bills from 3-4 different directions. This person could get his $1,200 bill as expected, pay it let's say, and then get a bill for $150 from nurses, and $100 from the hospital, and then another week later a bill for $15,000 from anesthesiologist because that is not at all covered. It is fucked up beyond belief.

100% agree with ya. Even with me being a physician, I get these different bills and shake my head at the absurdity of it all. I have no clue how the "average joe" can comprehend what is occurring. My wife had knee surgery and she gets a bill from the surgeon, the hospital, the radiologist, the anesthesiologist, the nurse anesthetist, and so on. Sometimes, you get a bill saying "this is how much it all costs and this is how much you owe", and this can be before insurance has paid anything at all. So after insurance has paid, then you get another set of bills saying "insurance has paid this, so now you owe X".

Our entire healthcare system makes me sick as well, but I have no clue what to do about it because it is so complex. Right now, insurance companies have way too much power, and continue to be a thorn in the side of both physicians and patients.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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Unfortunately, all of us think that due to the FDA and other entities that the days of voodoo, witchcraft, snake oil salesmen, and leeches are gone. Nope.

No single policy says that profit cannot be the driving factor for providers or insurance companies.

When you have a profit driven system, you see more of this.

I won’t go further into politicking about it, but these days if it isn’t a basic office visit or basic pharmacy purchase.....I ask for a quote on what it’s gonna cost me. And how it goes against deductibles and such.

I’m very happy it’s only your wallet that got lighter.

Just always be on guard asking for quotes. Call your insurance carrier before anything more than an office visit.

It sucks it is that way, but have to protect you r health and wallet.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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Our entire healthcare system makes me sick as well, but I have no clue what to do about it because it is so complex.

It's complex by design, do you think all those companies sending astronomical bills to each other care about complexity? No, that's how they make money and pay their CEO 66 mil per year. It's a well rooted ecosystem with a "to big to fail" defense from the financial industry, fear mongering from their political lackeys and resignation from the medical professionals who really just want to practice good medicine. A medical "Deep State" if there ever was one.

The only way to fix it is to make it simple. Stupid simple. Remove the multiple layers, remove the for profit capitalism, fix prices and use personal and corporate taxes to pay for it. Also include a hefty budget for exposing fraud because we Americans love screwing the government and then complaining that government doesn't work. (/rant)

"They know f_ck-all over at Slowtwitch"
- Lionel Sanders
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [j p o] [ In reply to ]
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I wasn't holding up the US system as this wonderful example of efficiency and economy - rather that when people decry the US system and extol the virtues of "universal healthcare" it seems to me that they look at it through rose tinted glasses. Both systems are broken and both systems currently fail the patient. Further, I don't believe it is the actual principal behind either system rather it is the inept implementation of each system.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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I wish everyone had universal healthcare but I do not wish for a universal healthcare system. We already have a perfect example of universal healthcare in the US and it's called the Veterans Administration (VA). //

What about medicare, or the coverage that our politicians get?? Seems most of those folks are pretty happy with what they are getting. I agree the VA is completely broken, isn't there some talk of rolling that into medicare??
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [j p o] [ In reply to ]
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j p o wrote:

I assume you have never had to get in as a new patient to a specialist in the US. Every time I see someone comment like this I go back to my wife. Needed a hip replacement, unable to sleep, walking with a cane, referred to the surgeon in early February, appt with surgeon in mid-May, surgery performed end of October.

You don't get to walk in tomorrow to a specialist in the US, you have to wait, just like a lot of other countries.

In my case it was a two days from the primary care doctor to the specialist. Then it was two days between that specialist to another, and one day to the one that actually specializes in my diagnosis (Multiple Myeloma). My health care insurer covered all of that with the usual deductible, which I maxed out a couple months later so I had about 6 months of zero deductible service. All told the care that I received in 2017 was very prompt, very expensive, and way beyond anything I had ever even thought of before being diagnosed. All told, I only had to deal with $5K out of pocket expenses for more than $600K in treatment costs, so I cannot complain.

The reason for longer waits in other specialties is the low number of doctors in those specialties. Those shortages are usually regional, a long wait in St. Louis might not happen in Tampa, FL for age related care. In my case it was cancer care, which has gotten MUCH better nationwide over the last 20 years.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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I know the problem very well. I'm funded by the National Cancer Institute and have several grants for colorectal cancer screening.
The issue is really at the insurer level at this stage. Not your physician.

Currently, the US Preventive Services Task Force recommends 3 possible methods for screening, all at the different frequencies, because there is no clear evidence that one is better than the other, for the overall population (does not apply to higher risk folks, e.g. folks with early onset colorectal cancer in their family history, folks who are obese etc.) So, basically you can choose, with your physician, which test to you. Now some insurers like to not have to pay a colonoscopy.
They have to though because it's rated A by USPSTF. So what they do is if you test positive with cologuard (which has a sensitivity of 92% and specificity of 87%, which are actually pretty good and much better than previous FIT/FOBT tests) then they argue that the follow up colonoscopy is not a screening test but a diagnostic test, and therefore, not covered.

One more reason for a public option and not have that man in the middle system with people getting rich denying claims...
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [HoustonTri(er)] [ In reply to ]
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HoustonTri(er) wrote:
Careful what you wish for with Universal Healthcare.
The concept is great but I don’t know of any country where the actual application of it works where the patients are happy and well cared for.

My current example of this is my father - a 70+ man in the UK that has been employed all his life and paid into the system.
For the past three months he has been suffering from a debilitating loss of strength in his arms, legs, and hands - this has resulted in his quality of life suffering and affecting his mobility. Well after multiple visits to the doc who initially blew it off as just aging has now agreed that an appointment is deemed necessary with a senior consultant (UK NHS terminology for a specialist). Guess how long he has to wait just to see this specialist for the initial appointment - 20 fucking weeks........ during which he is supposed to just deal with not being able to perform day to day normal functions.

Last year my mum had a lump in her neck that affected her ability to swallow - again took 12 weeks to see the senior consultant.

The US healthcare system may be screwed up but let’s not pretend that the universal healthcare model (NHS in the UK in my personal examples) should be held up as this wonderful alternative. I’ve lived within both systems and neither model seems sustainable/preferable as they actually function.
Both of them had and have the option of going to a private consultant. If they can't afford it, then they wait and have it for free in the NHS.
In the US, they wouldn't have an option and would still have to deal with the BS private insurers put our friends here through and more.

So, forget about "happy" - what's the better system?
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Thorax] [ In reply to ]
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There is no "free" on the NHS - this is a system that you pay into throughout your working life. People have paid for this healthcare coverage but when it fails its patients your solution is to pay a second time for a service that you have already paid for. For what its worth my dad is trying to go the private route because he can afford it - but many can't.

I have said in other posts that I don't claim that either system (US or UK) is functioning better than the other - they both are failing their patients - so don't hold one system up over the other as being a shining example over the other.

What is wrong with a goal of a patient feeling "happy" about the care they are receiving?
In what other business model is it okay to treat your customers this way and people not have an issue with it?
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [HoustonTri(er)] [ In reply to ]
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You didn't answer.

And I've experienced the NHS, HSE and SNS, so that's three national health services within Europe, having worked in two of them as a professional. I know how they work, from tax to treatment. But thanks for the WOT.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Thorax] [ In reply to ]
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Neither is better - they both suck at what they are supposed to provide, healthcare - that is my point and goes back to what my original post in this thread was stating and to which you replied.

I cannot say I have worked in the healthcare systems not being a healthcare professional, but I have been a customer in both. However, my wife is an ER nurse and has worked extensively in both the US system and the NHS. When asked her response has been that from a patient care point of view the US system provides a better outcome, but as far as the financial aspect goes the US system is broken when as licensed medical professional she cannot make fully informed decisions about our healthcare because at the point of medical treatment it is almost impossible to know what your final costs will be.

(maybe I'm not hip but what is WOT?)
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [HoustonTri(er)] [ In reply to ]
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HoustonTri(er) wrote:
When asked her response has been that from a patient care point of view the US system provides a better outcome, but as far as the financial aspect goes the US system is broken when as licensed medical professional she cannot make fully informed decisions about our healthcare because at the point of medical treatment it is almost impossible to know what your final costs will be.

THIS THIS THIS!!! The patient care aspect is wonderful in this country (once you are in), but that is I believe a contributing factor to the cost problem. When receiving care, there is NO visibility into costs. Doctors order procedures, patients request things / approve procedures with NO idea what it will cost. There is no where in the delivery of care where a cost benefit analysis is done at the consumer level. Once you are in the care of medical professionals, they treat you as if you have full coverage and cost is no object (to an extent). Only when you get out do you get the bill, and wow!!! If you do not have insurance with negotiated rates, that ## skyrockets. Even with insurance, the provider has billing departments that code the procedures to get the most out of the bill.

My daughter had a visit to the ER earlier this year... 3 hr wait for 15 min in the triage room to find out that she ate too much watermelon and it turned her stool red. The test to confirm... $70. 15 min in the room, $900. Doctor to order the test, $450. The latter two my insurance company didn't have a negotiated rate for the code used, so I had no recourse.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [monty] [ In reply to ]
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monty wrote:
I wish everyone had universal healthcare but I do not wish for a universal healthcare system. We already have a perfect example of universal healthcare in the US and it's called the Veterans Administration (VA). //

What about medicare, or the coverage that our politicians get?? Seems most of those folks are pretty happy with what they are getting. I agree the VA is completely broken, isn't there some talk of rolling that into medicare??


Medicare would be a great start but the costs would be prohibitive. Even just covering the 65 and older population, the government is constantly looking for ways to obtain enough funding to cover the costs. Add the remainder of the population and it would be ridiculously expensive.............especially considering a large percentage of the population would not pay into it (just like a large percentage of the US population does not pay federal taxes).
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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 the government is constantly looking for ways to obtain enough funding to cover the costs. //

Well there would be that 35 cents on the dollar the insurance companies carve out, that is a huge amount. I bet they could do it for 1/2 that amount, and I think most of us would be happy to pay that amount in extra taxes. Of course there are problems there too, no system is flawless. But from what I hear from folks in those two programs, they are quite happy with them. There are grumblings from some doctors about how much gets paid and such, but that is always going to be an issue, no?


I think the thing that gets lost in the medicare for all is that 1/3 of our dollar that goes straight to a for profit company. Medical already covers those that are less fortunate and cannot pay, so not sure that there would be that much of a drag on the whole system, once they get some of that profit money to run the show..
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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Do you know why you dislike the EMRs while hospital administrators love them? Because they are a billing system first and an EMR second.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [monty] [ In reply to ]
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monty wrote:
the government is constantly looking for ways to obtain enough funding to cover the costs. //

Well there would be that 35 cents on the dollar the insurance companies carve out, that is a huge amount. I bet they could do it for 1/2 that amount, and I think most of us would be happy to pay that amount in extra taxes. Of course there are problems there too, no system is flawless. But from what I hear from folks in those two programs, they are quite happy with them. There are grumblings from some doctors about how much gets paid and such, but that is always going to be an issue, no?


I think the thing that gets lost in the medicare for all is that 1/3 of our dollar that goes straight to a for profit company. Medical already covers those that are less fortunate and cannot pay, so not sure that there would be that much of a drag on the whole system, once they get some of that profit money to run the show..


Your point is a good one but it would never happen. The health insurance lobby is very powerful. Similar to the pharmaceutical lobby. An example is when Obamacare was being put together. In the beginning, there was a big push to control drug costs. Negotiate drug prices, restrict certain drugs availability, or a myriad of other ways to help drive down this HUGE expense on our system. The drug lobbyist got involved, with both Democrats and Republicans, and all of those ideas went out the window. The same would happen with health insurance companies. Those guys have very deep pockets.
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