Healthy? Insurers don't buy it

[F M All]

Mykids,

why do you suggest that this shows that the US should spend more on Healthcare via increased taxes?

Other data on this board shows that the US already vastly outspends all other nations on healthcare for a worse result. I do not buy the super stressful lifestyle argument for US malaise, it is, in part, due to the strength of the food industry lobby which promotes unhealthy, highly profitable, factory farmed and processed food on an ill informed population.

We know that US healthcare is not funded via taxes - this data does not compare healthcare costs across nations.

Also, I have not researched the source of your data but can you tell me if the figures quoted for the UK include National Insurance contributions? National insurance is an additional tax which supports the NHS and Social Security in the UK. Do you know how healthcare is funded in any of the other countries cited? In order to do a proper comparison you need to know this.

 

[mykidslovedogs]

Mykids,

why do you suggest that this shows that the US should spend more on Healthcare via increased taxes?

I was actually being a little sarcastic about the extra taxes. Of course we spend three times as much as other countries...because we haven't figured out how to price control/ration the Medicare system yet, so we still have unlimited demand with no incentives for providers to cut prices (providers don't need to compete on price, because the government is paying for half of the nation's care, and they can still make up for the difference by charging higher and higher prices to the private sector - noticed by us in the form of higher health insurance premiums). (see more explanation in the attached article above). Other nations probably have price controls in place combined with extra income taxes to pay the bill (...and there is no large private sector in other countries that the providers can look to for additional income).

I'm pretty sure the data I pasted above are income taxes only. The article I had attached is worth reading and gives some insight as to how costs could have gotten so out of control in the first place. It makes very good sense to me. It doesn't really address any good solutions for dealing with the whole situation we have gotten ourselves into though, other than reversing the process. I still think we need a happy medium in there somewhere.

 

[ladelfina]

Japan 27.7% 24.9%
United States 29.1% 11.9%

Let's assume that's actually the tax burden. Yet the Japanese couple and their kids are covered, but the US family isn't. When I left the US I was paying (for a couple, no kids) a "family" HMO rate of something like $720/month. [Why 2 adults pay the same as a couple with 3 kids, or 10, I have no idea.. let's not even go there for now... 2 single plans = cheaper but not an option.]. That's $8600/year which at the time was almost 15% of our income. Math: 11.9% + 15% = 26.9%. Retirees here are talking about plans now that are $10-12k p.a. Under the Japanese system, not only would I pay less, but I'm also saved the stress of shopping around, being possibly denied coverage, and so on.

The single Japanese person also gets off paying less than his US counterpart, who'd be shelling out $200-300/month on top of his 29% tax burden.

My 26.9% puts me right in league with places where I would expect excellent care, like Denmark or the Netherlands..

I guess I don't see what would be so wrong with adding an extra 5%, 7% 10% in taxes for everyone, and then covering everyone...

We have to also consider whether these tax differences in all these cases are due SOLELY to health care, or also to generous national pension plans or other types of "socialist" government spending. Also unexamined is what the average salary is that is being taxed.. 11% of $40k USD = $4400; 35% of €20,000 = about $9000. So if health care is the only difference, it's "costing" the European $4600 for what I was paying $8600 for.

---

the innocent "poor" who have no personal responsibilty for the situation they are in.

I guess this was supposed to be sarcastic, but only a small %age of health issues can be chalked up to "personal responsibility." If your kid has a brain tumor, or leukemia, is that a Calvinist defect of character?? WTF?

---
and I will chime in to dispute the meaning of these figures on pharma research:

USA: 45%
France: 3%
Sweden: 4%
Belgium: 5%
Others: 6%
Japan: 7%
Germany: 7%
Switzerland: 9%
UK: 14%

Maybe we should be modelling Switzerland seeing as they have 1/5 our level of research, yet only 1/40th the population!!!!!! .. eight times our level of investment per capita.

 

[Rich_by_the_Bay]

and I will chime in to dispute the meaning of these figures on pharma research:
Maybe we should be modelling Switzerland seeing as they have 1/5 our level of research, yet only 1/40th the population!!!!!! .. eight times our level of investment per capita.

Good points, Ladelfina. The credibility gap in this case is vast.

 

[brewer12345]

Good points, Ladelfina. The credibility gap in this case is vast.

Very polite, Rich. I would have said that our man is obviously full of bull excrement.

Request: Can we agree to put the kibosh on political stuff in this part of the forum?

 

[lets-retire]

Very polite, Rich. I would have said that our man is obviously full of bull excrement.

Request: Can we agree to put the kibosh on political stuff in this part of the forum?

As long as people insist on bringing up the hope for socialized medicine, it is doubtful.

 

[lets-retire]

ladelfina--The second set of numbers you posted is the total percentage of new drugs developed not the level of research.

 

[brewer12345]

As long as people insist on bringing up the hope for socialized medicine, it is doubtful.

Ah, but we have moderators equipped with the power to move threads...

 

[jeff2006]

I second the motion -- please move the political crap to "other topics" so most of us can ignore it.

 

[windsurf]

FM All said, in part:
"Other data on this board shows that the US already vastly outspends all other nations on healthcare for a worse result. I do not buy the super stressful lifestyle argument for US malaise, it is, in part, due to the strength of the food industry lobby which promotes unhealthy, highly profitable, factory farmed and processed food on an ill informed population."

Amen

 

[ladelfina]

The second set of numbers you posted is the total percentage of new drugs developed not the level of research.

Thanks, lets-retire.. correct, but I don't think it changes my point.

Sorry, I didn't think any of this was somehow "political"..
Look at the list of countries with Universal Health Care -- I don't see a lot of political kinship between the UK and Turkey, or Korea and Canada.


Anyway.. giving a look at the first page of recent posts in the section, about half of them, based on the titles, are pretty much bound to have some content that could be deemed political. Money is political, taxes are political, health care is political. Life is political.. 8).

I will admit to a personal interest in seeing the system changed, since if I ever should come back to the US, despite having been completely "covered" where I am, I'll no doubt be heaved into the "uninsurable" dustbin, depending on where I choose to live. I just don't think that's fair on its face, and I don't care whether it's a Republican (like Mitt Romney) or a Democrat as long as somebody at least does SOMEthing to change the status quo, which is just OBJECTIVELY not working.

 

[Rich_by_the_Bay]

I agree that the content and text-flooding surrounding this and related threads is clearly obnoxious, of very questionable validity, and distracting. I hear ya.

Notwithstanding that, the H & ER forum is probably as suitable a place for such gas as any other, if it is going to occur.

Lacking any blatant slander, inappropriate content, or xxx-ism of any sort, the most powerful tool to get moderator consensus on taking action is to PM me directly with specific complaints concerning any given poster. If more than an isolated complaint is received, the moderators will take appropriate action.

 

[mykidslovedogs]

I will admit to a personal interest in seeing the system changed, since if I ever should come back to the US, despite having been completely "covered" where I am, I'll no doubt be heaved into the "uninsurable" dustbin, depending on where I choose to live. I just don't think that's fair on its face, and I don't care whether it's a Republican (like Mitt Romney) or a Democrat as long as somebody at least does SOMEthing to change the status quo, which is just OBJECTIVELY not working.

The term "uninsurable" in the USA is really not a good word to use, because you are not really uninsurable, you just have to pay more here if your health status is not as good as others in order to obtain coverage, unless you are employed or eligible for government assistance.

It cracks me up the quotes that people pick and choose to comment on, with no regard to the comments in the same posts that follow. For example...in my statement on my opinions about how the extreme left views things and would like to handle the problem, I also included a statment of my opinion about the extreme right followed by another statement that I don't agree with either and that I do support reform to take care of people that slip through the cracks......but, someone managed to pick my example of my thoughts about the extreme left to pick on.

How many of you actually read the article I posted regarding insight as to how the USA may have gotten into the mess we are in right now? It gives a really good explanation about why costs here are in some cases three times higher than elsewhere.... a summation:

we still have unlimited demand with no incentives for providers to cut prices (providers don't need to compete on price, because the government is paying for half of the nation's care, and they can still make up for the difference by charging higher and higher prices to the private sector - noticed by us in the form of higher health insurance premiums). The USA is now reaching a point where price increases to the private sector are becoming intolerable, thus we have finally hit CRISIS mode. Other nations probably have price controls in place combined with extra income taxes to pay the bill (...and there is no large private sector in other countries that the providers can look to for additional income, so inflation is stifled).

Here's a link to that article again, in case anyone is interested in reading. It takes a few minutes to read through the whole thing, and it is best to read through the whole thing, because the real explanation doesn't really come together untill about the mid-end of the article...

http://doctordurante.com/Socialized_medicine.html

Lastly, an answer to your question:
[Why 2 adults pay the same as a couple with 3 kids, or 10, I have no idea.. let's not even go there for now... 2 single plans = cheaper but not an option.].
Answer: Because you are OLDER, you present a much higher risk to the insurance carrier than a young couple with kids.

 

[brewer12345]

The term "uninsurable" in the USA is really not a good word to use, because you are not really uninsurable, you just have to pay more here if your health status is not as good as others in order to obtain coverage, unless you are employed or eligible for government assistance.

Exhibit no. 328 of how MKLD is [EDIT: "lacking in credibility" colloquialism]. We've seen numerous examples of people posting here indicating that they are "untouchables" to the health insurers in their state.

 

[mykidslovedogs]

Exhibit no. 328 of how MKLD is FOS. We've seen numerous examples of people posting here indicating that they are "untouchables" to the health insurers in their state.

Click here to get information about how to get "guaranteed issue" coverage in your state. You probably have to pay more than in the private market, but your coverage will be guaranteed with NO medical underwriting:

http://www.tnhis.com/statebystateguide.htm

 

[brewer12345]

Click here to get information about how to get "guaranteed issue" coverage in your state. You probably have to pay more than in the private market, but your coverage will be guaranteed with NO medical underwriting:

http://www.tnhis.com/statebystateguide.htm

Unless the state high risk pool is full up. Or you aren't able to follow every letter of the law that gives you access to guaranteed coverage. Or the premiums of your guaranteed coverage don't leave you enough income to eat and live indoors. Or... You get the idea.

 

[ladelfina]

Lastly, an answer to your question:
[Why 2 adults pay the same as a couple with 3 kids, or 10, I have no idea.. let's not even go there for now... 2 single plans = cheaper but not an option.].
Answer: Because you are OLDER, you present a much higher risk to the insurance carrier than a young couple with kids.

Sorry MKLD, no cigar here..

For my small MA company (3 equal partners and no employees) my business partner (same age as I am, married, 2 kids) and I (married, but no kids) paid the exact same amount. At that point in time in HMO-land, "family" = any number of people greater than ONE. Hence we paid the "family" rate. Either that or DH goes w/o health care. Non-group at the time (2000) was either unavailable or insanely expensive (there have since been a series of intervening reforms in MA, so I don't know exactly what the landscape is like there now, cost-wise or otherwise).

Just to have the privilege of accessing the "group" plans we had to pay extortion a 'membership' fee each year to an organization that did nothing but play middleman, lumping small businesses together to make the Almighty Group.

I will look more closely at your links, but I'm not so super-interested how we got INTO the mess, more interested in how are we going to get OUT of it. If every other country in the developed world is getting along OK (and in some cases even better) doing something different than what we're currently doing, I don't see why it isn't worth a try. As I've said elsewhere, I believe in most all of these places there's always ALSO private insurance for those who want it.

 

[mykidslovedogs]

Unless the state high risk pool is full up. Or you aren't able to follow every letter of the law that gives you access to guaranteed coverage. Or the premiums of your guaranteed coverage don't leave you enough income to eat and live indoors. Or... You get the idea.

I have never heard of a risk pool being filled up. (**edit....OK....I stand corrected...my lack of knowledge on other states, but the following links may prove useful to you... just trying to help until we can figure out a way to get out of this mess!)

To be eligible for risk pool coverage, you must meet HIPAA eligibility guidelines in most states. In Colorado, you have to have only been declined by private insurance or have a disease that makes you instantly eligible. If your state doesn't have a risk pool, look here:

http://www.nahu.org/consumer/healthcare/topic.cfm?catID=3

If you still can't afford risk pool coverage, then you are likely eligible for Medicaid OR ONE OF THESE PROGRAMS:

http://www.nahu.org/consumer/healthcare/topic.cfm?catID=3

I know there are still some that slip through the cracks, for which I support reform (as discussed in my earlier posts):

http://www.nahu.org/legislative/uninsured/uninsuredfactsheet.pdf

 

[Martha]

There is guaranty issue only if you are HIPAA eligible. Otherwise, you are dependent on what a state provides. Not all states have risk pools and some risk pools have waiting lists or are closed. The Florida risk pool has been closed for some time. California has had waiting lists and now move people off their risk pool after three years. Risk pools are very expensive and if you are low income you will not be able to afford them. Some have low lifetime limits that leave you SOL if you have hit the maximum. You will have to impoverish yourself to get care and even then you may not be eligible for any coverage.

If you are not HIPAA eligible, the private market does not have to sell you a policy.

Most states do not allow you on medicaid unless you are disabled, elderly, and maybe if you have children in the home. If you are without children, not disabled, and dirt pooryou are not eligible for medicaid.

 

[mykidslovedogs]

For my small MA company (3 equal partners and no employees) my business partner (same age as I am, married, 2 kids) and I (married, but no kids) paid the exact same amount. At that point in time in HMO-land, "family" = any number of people greater than ONE. Hence we paid the "family" rate. Either that or DH goes w/o health care. Non-group at the time (2000) was either unavailable or insanely expensive (there have since been a series of intervening reforms in MA, so I don't know exactly what the landscape is like there now, cost-wise or otherwise).

Ah yes, some healthplans have two-teired rating instead of four. Colorado has four-tiered rating so EE&SP is less expensive FAMILY.

I will look more closely at your links, but I'm not so super-interested how we got INTO the mess, more interested in how are we going to get OUT of it. If every other country in the developed world is getting along OK (and in some cases even better) doing something different than what we're currently doing, I don't see why it isn't worth a try. As I've said elsewhere, I believe in most all of these places there's always ALSO private insurance for those who want it.

From an investigative point of view, I think a look at how we got into the mess in the first place will help shed some light on how to reverse the problem and get out of the mess. All of my counterparts here on this forum are very eager to give their opinions, too, so why not have a closer look at some of the economics of the situation? Being a productive member of society, I am simply trying to get educated (partly by getting some of your opinions and partly by doing some of my own investigations) so I can make good voting decisions in the future.

 

[brewer12345]

I have never heard of a risk pool being filled up.

To be eligible for risk pool coverage, you must meet HIPAA eligibility guidelines in most states. In Colorado, you have to have only been declined by private insurance or have a disease that makes you instantly eligible. If your state doesn't have a risk pool, look here:

http://www.nahu.org/consumer/healthcare/topic.cfm?catID=3

If you still can't afford risk pool coverage, then you are likely eligible for Medicaid or one of these programs:

http://www.nahu.org/consumer/healthcare/topic.cfm?catID=3

I know there are still some that slip through the cracks, for which I support reform (as discussed in my earlier posts):

http://www.nahu.org/legislative/uninsured/uninsuredfactsheet.pdf

Yeah, yeah, we know. You're a [colloquialism, colloquialism, colloquialism] compassionate conservative who just wants to take care of every last [colloquialism] one of us. Save it for your next local chapter meeting.



See, Nords, I saved you the trouble of playng nanny editor.

 

[mykidslovedogs]

---I guess this was supposed to be sarcastic, but only a small %age of health issues can be chalked up to "personal responsibility." If your kid has a brain tumor, or leukemia, is that a Calvinist defect of character?? WTF?

This was sarcasm, and I actually don't believe that everyone who is uninsured is in that situation due to personal responsibility. My point was that the very farthest of the left believe in no personal responsibility at all and would have everyone being equal. Just under half of the uninsured in our country are aged 19-34, the majority of which I assume are healthy. Many of them CHOOSE to be uninsured. I say this, because the cost of coverage for them can be as low as $40-100/mo. (unless they live in a guaranteed issue, community rated state). I don't call that a small percentage: Here is some factual data about the uninsured market in America:

http://www.ncpa.org/pub/ba/ba460/

 

[ladelfina]

Look, I just finished Dr. Durante's article, and I can't say that I've read a more hysterical picture of the situation.

I can, from direct experience (my dad was a surgeon) completely back up this statement:

He'll be told whom he can treat, and how, and what payment he'll receive. His livelihood and his freedom will be in the hands of the same bureaucrats who hold your life and health.

Except in my dad's case (and the case of every other doctor working in the US today, unless their practice is restricted to plastic surgery or wealthy Saudis) the bureaucrats weren't government bureaucrats, they were INSURANCE COMPANY bureaucrats.

I remember, in the mid-'60s, my dad almost in tears from frustration after the umpteenth battle with Blue Cross over a patient's care. At the demand of "why was the patient still in the hospital" he scrawled in big, violent letters "PATIENT IS SICK!!"

When I look at figures like this they just make me want to vomit:

Dale B. Wolf of the HMO company Coventry Health Care Inc., who led the 2004 rankings with $32.3 million in total compensation -- including an especially large option grant that accompanied his elevation to chief executive -- slipped to 12th on the 2005 list with $13.1 million.

http://tinyurl.com/w3fbn

I think it's safe to say that there is no doctor, not even the most specialized neurosurgeon, that makes $32million a year from patient treatments.. despite actually putting their hands inside people's living bodies, hearts, and brains and saving lives day in and day out.

My dad got paid in tomatoes (I am not kidding) from people who needed his help but couldn't afford insurance or out-of-pocket.

Anyone who has ever seen one of their billing code sheets knows how insurance co. bean-counters and paper pushers "enslave" doctors. They just don't want anyone else horning in on the franchise.

 

[ladelfina]

Just under half of the uninsured in our country are aged 19-34, the majority of which I assume are healthy. Many of them CHOOSE to be uninsured.

take a stroll over to http://tinyurl.com/yymt2d
in which the first provider I clicked on offers for singles 25 and under the bargain rate of $784/month. An HMO for $615/month. Gotta flip a lotta hamburgers to come up with $615/month after taxes.

How can you be amazed, then, that so many young people (relatively healthy AND relatively low-salaried) are going to take a pass?

 

[mykidslovedogs]

Anyone who has ever seen one of their billing code sheets knows how insurance co. bean-counters and paper pushers "enslave" doctors. They just don't want anyone else horning in on the franchise.

These high paid executives, albeit earning what seem like rediculous salaries, I don't beleive are at the root of the problem for the high cost of care. As a PERCENTAGE of total sales, their salaries are probably about comparable to any other EXEC. Take a look at total sales in the pharmaceutical market in a recent study:

http://publicintegrity.org/rx/images/gr_topPharmaCos.png

The article I posted earlier totally explains why Drs aren't paid enough. Price controls in the Medicaid and Medicare industry. (Medicaid pays less than 20cents on the dollar for every dollar billed.) Insurance carriers NEGOTIATE pricing with doctors. The government just TELLS doctors what they will make (which is less than what they are paid by insurance carriers, by the way). Therefore, providers look to the private sector to make up lost profits.....Thus....exhorbitant inflation!
Inelastic demand + price controls + no incentive to compete on price due to the ability to look to other markets (private health insurance) for income = Heavy Inflation.