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Re: Group health coverage for ER's?
Old 04-26-2006, 07:24 PM   #21
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Re: Group health coverage for ER's?

Quote:
Originally Posted by HaHa
IMO, our system is broken but not for this reason. To allow what you suggest is to destroy insurance, because of adverse selection.

You should always be able to continue insurance at whatever level you chose when you were underwritten, but not to carry a cheap high deductible policy and then exchange it for an all-coverage policy when you get seriously ill. The people who paid for a full policy all along would pay for this system gaming.

Ha
I agree - since the purpose of insurance is to average the risk on all. That's is why it should be mandatory to all (or available to all), just as auto insurance is.
Several levels of deductibles and coverage "riders" doesn't destroys the insurance system (not completely anyway). Just as auto insurance you can choose deductible, collision ... ou might chande your coverage when the car value is below a certain amount.
What seem important is minimum mandatory coverage for very expensive stuff such as hospital. Not the runny-nose visist to a familly doctor.
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Re: Group health coverage for ER's?
Old 04-26-2006, 09:40 PM   #22
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Re: Group health coverage for ER's?

I'm not looking to start a fight Let me observe that I think there are two very different situations here ...

Situation #1) Good example is a motorcycle accident - A friend of mine at work just went throught that and the bills will be in excess of $700,000. This is a "one time" event and is exactly what health insurance is supposed to insure against (and in his case did insure against) by spreading a HUGE one-time risk over the population of insured ... the company (and the insured) both hoping that only a VERY SMALL percentage of the population incurr a $700,000 bill in a given calendar year. Will this person have another motorcycle accident NEXT year? I think not... thus this year his premiums did not come CLOSE to covering what the company paid out, but in the big picture / long haul everything is ok.

Situation #2) Lets say I have a on-going condition that will require treatment every year for a long long time .... maybe forever (forever being defined as - the period for which I pay permiums). I'm a diabetic, I take anti-depressants, or ... whatever. To be fair to the other customers I should be paying something in excess of the average cost of my care. The company has to make a reasonable profit, and they have to have reserves to cover situaiton #1. So if my expected cost of coverage is $10,000/year, year in and year out how much should the company really charge me? Well ... absent "social engineering" I would say they HAVE to charge say $11,000 or so....

If they do not they are in effect consistantly "robbing Peter to pay Paul". That is to say charging people that are on-average healthy more than they should pay (to cover the cost of a 1 in 1,000,000 motorcycle accident plus normal expenses) to help cover the "expected cost" of other clients.

It would be kind of like charging the person at the bottom of an active volcano the same rate for fire insureance as a home owner that lives on a small island in the middle of a big lake. The guy in the middle of the lake is only going to get "burned" by the typical grease fire / electrical wiring issue while the guy at the bottom of the volcano is gonna get burned by lots more.....................


Just my thoughts and again... not trying to cause a fight ... and in this case I'm not sure if I would be "Peter" or "Paul" :P

Jim








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Re: Group health coverage for ER's?
Old 04-27-2006, 09:48 AM   #23
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Re: Group health coverage for ER's?

This discussion and examples show why I think that it is difficult to use an insurance model to pay for healthcare.

So you get type 1 diabetes when you are 7 years old. You could be priced out of the market forever. Or, like my grandneice who requires an intestine and now liver transplant. No insurance company will ever want to insure her and she already has reached lifetime limits that many policies have in place. And she isn't a year old.

Most people are never underwritten for insurance. They get it through work. But tying insurance to employment has numerous problems--family coverage may not be available, employers unable to purchase affordable coverage, what happens if you lose your job, portability issues, divorce, death, ER. . .

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Re: Group health coverage for ER's?
Old 04-27-2006, 10:15 AM   #24
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Re: Group health coverage for ER's?

Martha:

"Yeah, what you said!"

Individual policies being what they are currently - offered by for-profit private companies that have to try and on average make a bit of a profit from each customer simply can not write policies that fit the needs (and pocketbooks) of many individuals. Its a mess.

The only reason I have any hope that it will get even partly addressed in the next few years is that things can not continue along their current course for much longer before we have a total implosion - salaries going up on average of 3%/yr, health costs rising @ 10%+ per year and group/employers passing thru more and more of the cost increases to employees....

It will be totally broken soon and our elected officials will no longer be able to ignore the problem.

Jim
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Re: Group health coverage for ER's?
Old 04-28-2006, 03:59 AM   #25
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Re: Group health coverage for ER's?

Quote:
Originally Posted by jrwooden
It would be kind of like charging the person at the bottom of an active volcano the same rate for fire insureance as a home owner that lives on a small island in the middle of a big lake.
This is a terrible analogy. The vast majority of health issues are not the result of choices, so the "free" market of insurance is currently woefully inappropriate and inadequate in its rationing of health care. You can choose whether to live next to a volcano, on the coastline, etc. and either pay for higher insurance or assume the risk. You can choose whether to ride a motorcycle or drive a Volvo. No one chooses diabetes or cancer. We collectively end up paying as a society for the emergency-room visits, the reduced productivity, the bankruptcies, etc. caused by the current system.

The question should not be "can we afford to do it?" but "can we afford NOT to..?" Even with 40+ million uninsured we pay double per capita what other developed countries pay, yet they have overall better results.. If we were to recoup savings on overhead and spread that number out over all Americans, we'd still be way ahead of the game, yet covering everyone.
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Re: Group health coverage for ER's?
Old 04-28-2006, 05:45 AM   #26
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Re: Group health coverage for ER's?

I did not mean to imply it was a good or socially responsible system. It is indeed a crappy system.

I was only trying to describe it, as it stands, the perspective of the INSURER.

In our current system, insurer means "the company that is trying to make a (hopefully fair) profit from each and every customer". In a system such as this the insurer is not paid to evaluate how or why some people are more expensive to insure than others only that, to the best of the company's ability, he should price each individual policy in line with the financial risk the being assumed by the company for writing that policy. To do otherwise will eventually cause the company to go out of business. If the company charges healthy customer relatively higher premiums than they as an individual "deserve" to have to pay based on their consumption of healthcare services in order to "cover" their ability to insure less-healthy customers at a discount the healthy customers will leave the company - The healthy customers being able to find better rates elsewhere. This will leave the company with too many unprofitable customers and cause it to go bankrupt.

To compare to my analogy the company can not take into account WHY someone choose to live at the base of the volcano -- perhaps that is where 20 generations of their family have always been buried and this person has a strong sense of family. To be blunt that is not the company's job ... it's not why they are in business. The company is in busness to make a profit pay their employees and shareholders and not to take on imprudent risks with the company's funds. The underwriters job is to assess a "fair" profitable premium for each and every policy.

Again, I'm not saying its right or good, only that its "the way it is". At least that's my opinion o of the way I see that it is. Don't kill the messenger

Jim
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Re: Group health coverage for ER's?
Old 04-28-2006, 06:14 AM   #27
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Re: Group health coverage for ER's?

PS:

On a somewhat lighter note, there is an old comedy movie "Head Office" in which Judge Rinehold stars. He works for a major corp. that decides to close down a US mfg. plant and move it overseas causing the losss of many US jobs. Judge's character gets interviewed and is SUPPOSED to tell a made-up story about why the mfg. plant is being moved but instead, in an unrehersed moment of truth, says something like "Corporations act in their own best interest which may or may not coincide with the best interests of the publc." At present, in the USA I think that's where we are with health coverage unless you qualify for Medicade/Medicare.

On a somewhat BRIGHTER note, there is one method of obtaining health coverage (note I said coverage NOT "insurance") that is far more reasonable than the typical path. One example is Medi-Share - http://www.medi-share.org/ There are several companies like this and they charge far less for coverage (my family of four could be covered for ~$3500/yr) than commercial insurers.

They are a christian faith-based organization and is a means to "pool" risk in a non-profit setting. The company holds a "reinsurance" policy on each member with a $50K annual deductable to avoid sending them into finanical trouble for hugh events. The policy does not cover problems caused by non-christian behavior (drug addiction ....). They have been in busness for 10+ years so they must be doing something right. Strictly speaking they do not and can not legally call the policy "insurance" as the way the policy works is not within the legal definition as govered by state/federal authorities. The impact of that once "insured" via an outfit like this, if you ever wanted to switch back to traditional insurance you would have to report your time on a medi-share program as an uninsured lapse in coverage. For some folks this is a problem.

**** If anyone else has experience with Medi-share or similar outfits I'd love to hear about it!!!


Jim


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Re: Group health coverage for ER's?
Old 04-28-2006, 07:09 AM   #28
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Re: Group health coverage for ER's?

Quote:
Originally Posted by ladelfina
The question should not be "can we afford to do it?" but "can we afford NOT to..?" Even with 40+ million uninsured we pay double per capita what other developed countries pay, yet they have overall better results.. If we were to recoup savings on overhead and spread that number out over all Americans, we'd still be way ahead of the game, yet covering everyone.
I agree with Ladelfina entirely. Whatsmore, possibly a third of all costs now are going to administrative expenses due to the complexity, cherry-picking, and profit incentive of the insurance carriers. A nationwide system, perhaps picking up at some high deductible adjusted for ability to pay would eliminate billions just waste. Would it create new problems? Of course, but I doubt it could be worse than the current chaos.
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Re: Group health coverage for ER's?
Old 04-28-2006, 07:36 AM   #29
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Re: Group health coverage for ER's?

Yup, I agree 110%

It will get fixed when the people with the power to fix the problem feel & share enough of the pain caused by the problem to make it one of their top priorities.

I'm hopeful that is coming soon :

Jim
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Re: Group health coverage for ER's?
Old 04-28-2006, 08:58 AM   #30
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Re: Group health coverage for ER's?

jrwooden, didn't mean to "kill" you (the messenger)!* I think people pretty much realize how insurance companies will try to do anything and everything to rig the situation so they don't have to pay out, whether that is cherry-picking, stalling and denying claims, or whatever. I'm sure Rich_in_Tampa can tell us some stories!! I know my Dad filled out Blue Cross forms that wanted to know why the patient required more time in the hospital; he'd write "PATIENT IS SICK".* (Doubt he could get away with that nowadays.)

The point of following the insurance co.s' reasoning is reductive, though, because if followed to its natural limit, it would mean individually-tailored policies for every human on the planet, which is darn close to no insurance at all / self-insurance. As I've said on another thread (I think) insurance is the only "product" I can think of where it behooves the supplier to sell ever less of it..

Quote:
The healthy customers being able to find better rates elsewhere.
Maybe in some El Dorado people could actually shop around for coverage, but that is just not possible for most purchasers of insurance. Most are locked in to what their employer chooses to subsidize. If not, various states get in the game with reg.s (As a MA resident, I was not allowed to purchase a high-deductible or catastrophic policy). And if you look outside the limitations of the "group" that you DO have access to, you'll find individual policies cost 2x as much (at least I did..).. sheer insanity.

I could never figure out why ins. co.s were so much happier when I was a member of a "group". I bought coverage for a while from a "small-business association" that existed solely in order to form the sainted "group" (obviously charging a not-insubstantial yearly fee from each member on top of the insurance.. this seemed to me just a form of out&out extortion, but the group access was worth it, so I paid..). If it's all about the power of numbers, why doesn't some company step forward and offer "group" coverage to the 40-odd million? They can't ALL be that much higher-risk than a run-of-the-mill employee...* *

Bill 'n' Hillary tried at least to address the problem, and got brickbats for their trouble. The ones not throwing brickbats were going "lallalalalala la la" with their fingers in their ears, I guess.* Voters need to start demanding political action on this front--ask for scorecards and results--just as the religious right does with their non-negotiable issues.

The MediShare idea is very interesting.. I wonder if it is available in all states? I, too, worry about a future where we might decide to come back to the US, and would likely face denial or other problems due to "lack of prior coverage", though of course we are covered by the Italian health system here.. (THEY even sent ME a notice about when to come in for a PAP test, fancy that!* That didn't happen with my US HMO.. they couldn't have cared less--the less they saw of me the better.)*
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Re: Group health coverage for ER's?
Old 04-28-2006, 10:48 AM   #31
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Re: Group health coverage for ER's?

This subject is really bothersome. Especially now I got a PaceMaker. Currently I have a group health plan but it is not Infinite. I am now considered uninsurable!

OK, so if I am broke or an illegal alien, no worries the country MUST provide me health care, they cannot get blood out of a stone.

But because I have a little cash, they will get all of it before I can become elligable for the above.

Solution(s):

1) Go back to Canada and get Almost Free Emergency Healthcare

2) Buy a VERY expensive house, as in Florida, the Homestead laws prevent creditors from taking your home.

3) Go without health insurance.

4) Spend 6 months in the US and 6 Months in Canada, buy US emergency health insurance from Canada for about $800 for 6 months no deductables. This will require a permancent addess in both places but in the long run the Monthly US insurance payment, if I could get it would cover a mortgage?

5) ?

Some Super Power the US is. Can't even look after it's own Citizens without bankrupting them.

SWR
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Re: Group health coverage for ER's?
Old 04-28-2006, 11:02 AM   #32
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Re: Group health coverage for ER's?

I beleive that products like Medi-share are available in all 50 states.

They are very careful to NOT define themselves are health insurance so that they can escape being regulated by the "authorities". They are not a solution for everyone but for some.....

On the "why doesn't someone offer insurance to the defined group of the 40M that are currently uninsured my guess would be that "on average" the group would not be able to afford the premiums that would have to be charged. Just speculation on my part I have never seen income statistics or any composite medical profile data on the uninsured ..................

Sigh..........
Jim

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Re: Group health coverage for ER's?
Old 04-28-2006, 11:07 AM   #33
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Re: Group health coverage for ER's?

6) Get a job at Starbucks

7) Go to school and get student insurance

8) Go to medical school so you can "provide your own" medical coverage

9) Get another amendment added to the constitution requiring "Healthcare\Insurance" as a right for everyone.

Possibilities are endless...
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Re: Group health coverage for ER's?
Old 04-28-2006, 11:21 AM   #34
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Re: Group health coverage for ER's?

Quote:
5) ?
W*rk at the Depot 20 hrs/wk.
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Re: Group health coverage for ER's?
Old 04-28-2006, 12:16 PM   #35
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Re: Group health coverage for ER's?

Quote:
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W*rk at the Depot 20 hrs/wk.
You used the W%$& word!

SWR
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Re: Group health coverage for ER's?
Old 04-28-2006, 12:20 PM   #36
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Re: Group health coverage for ER's?

"Go to school and get student insurance"

I've seriously looked at going back to college when I send the kids ;-)
Alas many of the college programs have caps....

Jim
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Re: Group health coverage for ER's?
Old 05-30-2006, 04:28 PM   #37
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Re: Group health coverage for ER's?

Hey SWR....
I've been off for a while..........
A question if you don't mind... Are you a Canadian citizen?
Is that why you can get Health care in Canada so cheap?

I think I could EASILY stand 6mo/yr in Canada as long as it did not include Jan/Feb/March ;-)

Jim
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Re: Group health coverage for ER's?
Old 05-30-2006, 05:00 PM   #38
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Re: Group health coverage for ER's?

Quote:
Originally Posted by jrwooden
Hey SWR....
I've been off for a while..........
A question if you don't mind... Are you a Canadian citizen?
Is that why you can get Health care in Canada so cheap?

I think I could EASILY stand 6mo/yr in Canada as long as it did not include Jan/Feb/March ;-)

Jim
Yes, I am a US Citizen and a Canadian Citizen as is my wife. We hold both. But I really do not want to spend 153 days a year there.

SWR
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Re: Group health coverage for ER's?
Old 05-30-2006, 05:44 PM   #39
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Re: Group health coverage for ER's?

I am ready to join the early retirement ranks but have been unable to solve the health insurance issue due to family pre existing conditions. I see not reason to give up my good paying job for 20 hrs/wk at HD. Wish there were other options.
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Re: Group health coverage for ER's?
Old 05-30-2006, 06:19 PM   #40
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Re: Group health coverage for ER's?

Quote:
Originally Posted by ShokWaveRider
Yes, I am a US Citizen and a Canadian Citizen as is my wife. We hold both. But I really do not want to spend 153 days a year there.

SWR
Yup.......... I understand that... and since I am not Canadian citizen ... well I guess it's not even a "fall back" option :P

Thanks,
Jim
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