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Old 10-06-2010, 12:59 PM   #21
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Sure there is over-utilization and I agree about the insurance paperwork. In fact, that accounts for at least 25% of health care spending, the administration and processing of insurance. Some doctors have full-time staff just to handle that.

But if people pay out of pocket, they may not go for routine exams and screenings.

In any event health care reform kept the insurers in place so they missed a big chance for cost savings. But the plan hasn't been fully implemented so all this discussion is moot. We're going to have to let it take effect and see if things improve.
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Old 10-06-2010, 01:15 PM   #22
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We're going to have to let it take effect and see if things improve.
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Old 10-06-2010, 01:31 PM   #23
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2. Guaranteed issue coverage for everyone from birth to death. Anyone who tries to game the system is subject to a fine equal to either 5% of income or $5,000, adjusted for inflation, for treatment needed for pre-existing conditions to those who do not have continuous coverage with no break of more than 63 days. Anyone with continuous coverage may jump from plan to plan with a higher deductible and max out of pocket cost. Jumping to a plan with lower deductible if you cannot pass underwriting and max out of pocket requires another penalty equal to 5% of income or $5,000, or the difference between the old deductible and new one (e.g. going from $10k deductible $2500 would require $7500 penalty). No penalties for not carry coverage, penalties described above double for those who have had no creditable coverage for more than 365 days.
I don't understand this part. Does it mean everyone must have coverage and they pay for it?
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Old 10-06-2010, 01:46 PM   #24
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Sure there is over-utilization and I agree about the insurance paperwork. In fact, that accounts for at least 25% of health care spending, the administration and processing of insurance. Some doctors have full-time staff just to handle that.

But if people pay out of pocket, they may not go for routine exams and screenings.

In any event health care reform kept the insurers in place so they missed a big chance for cost savings. But the plan hasn't been fully implemented so all this discussion is moot. We're going to have to let it take effect and see if things improve.
Not going for routine checkups and screenings is like not getting your car serviced. IMO, paying into the system so that it can be redistributed as an incentive to take care of yourself is social engineering. I do agree that something needs to be done, especially for those who can't afford insurance. We will indeed have to see, though I don't hld out much hope...
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Old 10-06-2010, 02:32 PM   #25
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I don't understand this part. Does it mean everyone must have coverage and they pay for it?
You would not required to have coverage under what was noted. However, if you do not purchase a policy and then seek care for pre-existing conditions, you would pay a penalty for that. If you have not had any coverage for a full year, the penalties would double if seeking care for pre-existing conditions. I don't know how that would be administered, but I also don't know how some of the risk pools available today that require waiting periods do it either if they aren't asking any medical questions.

One of the problems with guaranteed-issue coverage is if you have a $5k deductible and then find out you will need surgery in two months, you could change to a $500 deductible policy, get the surgery done, then go back to a $5k deductible. Having a penalty equal to the difference would stop that abuse from happening, or at least as frequently as it would under the system set up for 2014.
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Old 10-06-2010, 03:36 PM   #26
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You would not required to have coverage under what was noted. However, if you do not purchase a policy and then seek care for pre-existing conditions, you would pay a penalty for that. If you have not had any coverage for a full year, the penalties would double if seeking care for pre-existing conditions.
The issue I see with this is the penalties would have to be pretty high to avoid the incentive to go without insurance. At the ballpark penalty levels you listed, I would be willing to not insure at all until I developed a medical issue costing over $25k or so. If I require treatment costing around $100k (not all that uncommon), I'd come out way ahead by saving premiums for many years and then only having to fork over $10-20k or so once I get sick.

Granted, I'm probably not a typical American in terms of being willing to self-insure up to $25k, but if I'm tempted, I'm sure many others would be too. Then you have the adverse selection problem again.
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Old 10-06-2010, 03:55 PM   #27
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The issue I see with this is the penalties would have to be pretty high to avoid the incentive to go without insurance. At the ballpark penalty levels you listed, I would be willing to not insure at all until I developed a medical issue costing over $25k or so. If I require treatment costing around $100k (not all that uncommon), I'd come out way ahead by saving premiums for many years and then only having to fork over $10-20k or so once I get sick.

Granted, I'm probably not a typical American in terms of being willing to self-insure up to $25k, but if I'm tempted, I'm sure many others would be too. Then you have the adverse selection problem again.
That would still be better than what the new law states. Like I said, the numbers are not the key, the concept is. The numbers could be figured out later, perhaps even with less than 2700 pages.
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Old 10-07-2010, 07:53 AM   #28
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That would still be better than what the new law states. Like I said, the numbers are not the key, the concept is. The numbers could be figured out later, perhaps even with less than 2700 pages.
That's one of the big problems with presenting ideas on this topic. Many people get hung up in examples of specifics and throw the whole idea out, instead of looking at the concept and coming up with better specifics. Or they just simply dismiss the idea for lack of specifics. Either way it is a no win. I do like some of the ideas you presented.
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Old 10-07-2010, 11:49 AM   #29
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So how likely is it to throw out the passed law and how likely is it to pass a new one?

How likely is both to happen?
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Old 10-07-2010, 12:12 PM   #30
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The problem with starting over is the little things that got into the 2,700 pages. Like all gold sales over $600 have to be reported. A new bill would have just as many of these type of things in it, plus pet projects.
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Old 10-07-2010, 03:01 PM   #31
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So how likely is it to throw out the passed law and how likely is it to pass a new one?

How likely is both to happen?
You may recall that when the party that hates the health care reform law had the opportunity, they were not successful in reforming heath care, either. Just sayin'
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Old 10-07-2010, 04:02 PM   #32
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You may recall that when the party that hates the health care reform law had the opportunity, they were not successful in reforming heath care, either. Just sayin'
Oh yeah. In the spirit of bipartisanship, I propose a new bumper sticker...

Heath Care: The Issue Both Political Parties Don't Get and Screwed Up.
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Old 10-07-2010, 04:26 PM   #33
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I hearken back to the old statement 'How do you eat an elephant?' One bite at a time!' I am amazed that they did not break this up into several smaller bills. Hey think of the pork that could have gone into each one!
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