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#21 | |
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Thinks s/he gets paid by the post
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Posts: 1,510
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Re: Healthy? Insurers don't buy it
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Here in New Jersey, where they can't turn you down, I'm told comprehensive insurance for me and my wife (ages 35 and in good health) will run around $11K. Not exactly affordable when considering the median family income is somewhere around $42K before taxes. Elsewhere, insurance is less expensive if you're healthy, but perhaps not available to everyone. To the larger point, when companies discontinue health care coverage they discontinue it for the healthy and sick alike. The young and healthy are welcomed by the insurance industry as profitable customers. The rest, well, tough luck. Oh, and about those pre-existing conditions, tough luck. That is until we see you in the emergency room. |
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#22 |
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Thinks s/he gets paid by the post
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Posts: 4,461
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Re: Healthy? Insurers don't buy it
Just to get a feel for the magnitude of the issue....
Google tells me that the total spending on US health care in 2005 was about $2 trillion. Assuming 100 million families, that's an average of $20,000 per family per year (and rising). Median household income was $46,000 in 2005 (couldn't find the mean). |
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#23 | ||||||
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Full time employment: Posting here.
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Posts: 865
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Re: Healthy? Insurers don't buy it
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Quite a few years ago, several insurance companies left the state of Colorado because loss ratios were 1.65 to 1. $1.65 was going out in claims for every $1.00 that came in. This happened right after Colorado decided to adopt modified community rating in the small group market and insurance carriers were required to charge flat age-banded rates, regardless of gender or health status of the group. About half of the big players left our market at that time. (Aetna and Pacificare were two of the biggest to leave). Because competition dropped so much, insurance rates went through the roof, inflating at 20-50% per year for several years. As soon as new legislation was passed, allowing carriers to rate small groups up to 25% lower for "healthier" groups and up to 10% higher for "sicker" groups, several new players came into the market, creating new competition which helped hold rates much steadier over the past few years. I don't think corporate greed is a root cause of the healthcare problems in the U.S. I'm not saying it doesn't exist at all, but I lean more toward 3 yrs' opinions about inelastic demand and consumers having been sheltered from the cost of their care for so many years. Quote:
It always kills me when people say, "I really am healthy...the insurance company just doesn't want my business because...." It's simply not true. Whether or not a group or individual is accepted for coverage depends purely on a logical, statistical analysis of the risk of taking them on as customers. |
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#24 | |
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Full time employment: Posting here.
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Posts: 865
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Re: Healthy? Insurers don't buy it
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#25 | ||||||
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Moderator
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Location: minnesota
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Re: Healthy? Insurers don't buy it
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__________________
. Do not rely on the information provided--my posts are not to be taken as legal advice. Needless to say you must consult with your legal representative. I am not responsible for errors. If I offended you with cya I apologize. If I did not, I tried. |
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#26 |
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Recycles dryer sheets
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Re: Healthy? Insurers don't buy it
My throw-ins on this topic: Too many people are on too many drugs. I have an aunt and uncle, both with type II diabetes and now, consquently, cardiac issues who are each on over a dozen drugs. I cannot imagine that their docs know the interactive effects of all of these. Type II diabetes is a preventable epidemic that is driving up the cost of care. Smoking: I have lost a parent and a brother to lung cancer, the end stage. What proportion of cost are we non-smokers bearing to pay for preventable maladies tracable to smoking? Our government is complicit in both epidemics. The standard American diet recommendations don't do enough to warn people away from an overemphasis on refined grains and sugars and arise from intense lobbying by interest groups. You know about tobacco subsidies. Talk about government interference in health. While not insignificant, I do not think that malpractice suit costs are in any way a major factor across the board. One aspect that is not often mentioned is that the fact of malpractice also burdens the system. Brain damaged babies requiring lifetime care would be an example. This thread is raising some great points. In the meantime, I am bracing myself for the mess to get worse. The lobbying forces that conspire against rational treatment are entrenched and wealthy.
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#27 |
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Thinks s/he gets paid by the post
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Posts: 3,762
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Re: Healthy? Insurers don't buy it
they only increased premiums because i work out at the gym which throws off apparent bmi. i fully disclosed both allergies and arthritis on application and was accepted without riders or increased premiums on those.
when i went to the doctor for pain in my shoulder which i thought might be a torn rotor-cuff, he diagnosed the arthritis. i asked him what i can do about that. he said "blame your mother." i asked "is that your professional opinion?"
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"off with their heads"~~dr. joseph-ignace guillotin "life should begin with age and its privileges and accumulations, and end with youth and its capacity to splendidly enjoy such advantages."~~mark twain - letter to edward kimmitt 1901 |
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#28 | |||
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Full time employment: Posting here.
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Posts: 865
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Re: Healthy? Insurers don't buy it
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If you had an HSA under an employer-sponsored plan, your asthma drugs would be covered subject to the plan deductible, and you would be able to purchase them on a tax-deductible basis with your HSA dollars, so how can you say an HSA will do nothing for you? Oftentimes, the cost of a prescription is not much more than the copay itself. My kids take Zyrtec. If I were on a copay plan, I would pay $45 for the prescription. The retail price of the drug is $80.00. On my HSA, I pay $60.00 on a tax-deductible basis with my network discount, AND, the cost of the prescription reduces my deductible which would NOT happen on a copay plan. Many people do not take that benefit into consideration. I had a client who owned her own business. Before she purchased her HSA through employment, she was paying about 4000/yr. in copays for prescription drugs alone. After she purchased her HSA she was receiving 100% coverage for all services including prescriptions after her 2000 deductible was met. The additional cost to the insurance carrier was offset by the number of other healthy people in the group who now have an HSA. Before the client purchased the HSA, she used only brand name drugs. After, she started purchasing the generic equivalents for some of the drugs she was taking....a HUGE savings to the insurance carrier. This is a perfect example of how consumer-driven plans can influence our buying decisions in the healthcare market. For the chronically ill and the consumers with the highest expenses, HSAs under an employer-sponsored plan are often the best solution, because the premiums are much lower, and coverage kicks in oftentimes at 100% after deductible. There are no un-ending copays or high co-insurance maximums to meet. For this particular client, the savings to her in premiums plus copays and coinsurance splits ended up being about $10,000/yr. We have many groups that are now either offering HSAs solely to their members or offering HSAs as part of their benefit mix. As this trend continues, I truely believe that HSAs will begin to have a positive impact on consumer spending. Some employers are saving so much on their premiums, that they are able to fund almost the entire deductible into their employees HSA accounts as a BENEFIT! I think that's fantastic. There are many ways to save on costs within the medical industry. For example...last year, my daughter needed an ultrasound. It would have cost $1000.00 at the local hospital, or $200.00 at her Drs office in Denver. Since I have an HSA, where do you suppose I decided to take her? If I had been on a copay plan, I never would have had any incentive to shop around. Here are some facts regarding the adoption of HSAs since they began. We need to give this concept more time. So far, 31% of people who have adopted HSAs were previously uninsured and 42% were families with incomes below $50,000. http://www.treas.gov/offices/public-...tic-growth.pdf Martha, if asthma is your only illness, Assurant Health will take you on their HSA plan and even cover your asthma under a separate, condition-specific deductible. Humana one is also much more lenient with contolled asthma on their high-deductible healthplans. You might want to check into it. If the premium savings is enough to justify the OOP cost of your meds, it might be worthwhile for you to look into the possibility of an individual plan for yourself. |
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#29 |
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Thinks s/he gets paid by the post
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Posts: 2,648
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Re: Healthy? Insurers don't buy it
http://lefarkins.blogspot.com/2007/0...universal.html
I and others have gone into the points made above on other threads, but I thought I would highlight these two comments: "As someone who works in the field, I can tell you that insurers' administrative costs run about 30% of premium. That's for advertising, broker fees (paying to have new customers brought in), underwriting (ie screening out really sick people), claims handling (ie trying not to pay claims due to prior existing conditions, etc), reinsurance (laying risk off onto other insurers, typically overseas). The great majority of these costs are entirely unnecessary for the delivery of health care. And this is the insurers' costs only- the costs imposed on employers, doctors and hospitals in dealing with this system are additional." [I don't think MKLD is a shill, but while she has given us some valuable info here, she'd be crazy to support something that would give her less business.] and, this.. eye-opening!! "I don't even go to the doctor anymore, it's a two month wait for an appointment, makes no sense to me. I just go to the ER, pay the $50 deductible, and at least get some kind of medical record going as to the condition I am reporting." ![]() |
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#30 | ||
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Full time employment: Posting here.
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Posts: 865
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Re: Healthy? Insurers don't buy it
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Here is one staggering statistic. Hmmmm.....who will innovate all of the new breakthrough prescriptions without the U.S.A leading the race? I'm sure France is using plenty of drugs that were developed in America and reaping the benefits of all of the R&D that we insurance payers and tax payers in America have had to pay for: See below: U.S. Leads in Development of Global Drugs Source: Pharmaceutical Research and Manufacturers of America. USA: 45% France: 3% Sweden: 4% Belgium: 5% Others: 6% Japan: 7% Germany: 7% Switzerland: 9% UK: 14% How about this statistic which came straight from information published by Medicaid....Over 70% of Medicaid claims stem from illnessess related to obesity and alcoholism. I've heard others on this board comment that lifestyle issues are a drop in the bucket compared to the other problems in our healthcare industry. Seems to me that lifestyle is a very important consideration when comparing the cost of care in our country to other countries. Quote:
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#31 |
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Thinks s/he gets paid by the post
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Posts: 1,286
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Re: Healthy? Insurers don't buy it
The way I see it there are only three was national health care can be done. 1) The government accepts bids form independent insurers, 2) The government provides the insurance, similar to Medicare, or 3) the government provides the service, similar to the military or VA.
The problems as I see it from 1 are. Right now there are numerous insurers to provide benefits and competition, but as soon as the government issues the contract, even if they are bid regionally, the number of insurers will drastically decrease. The end result is lower competition. This will result in one of two things. The insurer naming their price or the government taking over the game. If the insurer names their price it will be more expensive than what we already have. Then comes the second problem since the insurance companies are mandated by the federal government and are private companies they would basically be able to tell the providers what they will receive for their services. You can guess it will be rather low after all the insurers are in the business of making money. That leaves the insurer dictating the salary of the health care provider. If the doctors don't like the pay the can simply not accept the insurance and close their doors. The problems with number two are essentially the same as with number one. I haven't heard too many people who are pleased with Medicare, I'm sure they are out there I just haven't heard of many. The problem with number three, as I have seen it, is the government is not a very good provider of health care. I suffered through 29 years of government health care. I wouldn't wish that on anybody. My experience has been very poor service and many incompetent doctors. It is interesting that I only receive VA disability for items supposedly fixed by military doctors. A couple items I had to have removed from the VA rating because after consulting a private sector doctor they were correctly fixed. With no profit motive to encourage the development of new medicines or procedures most of the research would be paid for by the federal government, further increasing the costs. If you think the federal government can do anything without involving large administrative overhead then you need to seriously take a look at how this government works.
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You don't want to work. You want to live like a king, but the big bad world don't owe you a thing. Get over it--The Eagles |
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#32 | ||
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Moderator
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Location: minnesota
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Re: Healthy? Insurers don't buy it
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Do you have a cite to the contrary? State law also governs to extent not inconsistent with ERISA/HIPAA. By the way, I couldn't help but bold your statement about my office being declined due to the nature of its business or industry. Kinda funny given that we are a bunch of lawyers. ![]() Quote:
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__________________
. Do not rely on the information provided--my posts are not to be taken as legal advice. Needless to say you must consult with your legal representative. I am not responsible for errors. If I offended you with cya I apologize. If I did not, I tried. |
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#33 |
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Thinks s/he gets paid by the post
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Posts: 2,648
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Re: Healthy? Insurers don't buy it
Hmm.. I know a lot of people have violent feelings towards lawyers, so...?
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#34 | |
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Full time employment: Posting here.
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Re: Healthy? Insurers don't buy it
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