Healthy? Insurers don't buy it

[brewer12345]

That would never happen, because in a free market, inflation would subside as soon as demand = supply. If it got to a point where supply exceeded demand (too many doctors), then they would lower their prices to bring in more business. The consequence is that there will be inequality for a minority of people. However, just as long as the government keeps coming in and trying to make sure that NO ONE is left uninsured, inflation will continue to spiral out of control, because demand will always exceed supply (until price controls are put into place).

**edit...I don't defend the current system and agree that changes need to be made...I'm just not sure what the best way to go is right now. Hybrid systems seem to have some credibility. I prefer capitalistic solutions over socialistic.

What are you, Milton Friedman's halfwit brother?

 

[Nords]

It's interesting to note that the thread is being carried by the debate from one poster who makes her living from selling insurance to help people cope with a broken healthcare system and another who makes his living analyzing & investing in insurance companies that are presumably helping people cope with a broken healthcare system.

The more insurance policies that are sold, the more money each of them could make...

OK, sorry for the digression. Game on.

 

[sgeeeee]

. . .**edit...I don't defend the current system and agree that changes need to be made...I'm just not sure what the best way to go is right now.

I find that hard to believe. You have been arguing passionately for several pages against every proposal and every fact that points to the need for change. If you really recognize the need for change, make a proposal.

Hybrid systems seem to have some credibility. I prefer capitalistic solutions (like incentives) over socialistic (mandates). Some government contol is necessary to prevent "greed" in an inelastic market.

Capitalism is great for a lot of things. I haven't seen any arguments for why it is better for healthcare. That makes no sense to me. What do you think capitalism brings to a healthcare system?

 

[mykidslovedogs]

I find that hard to believe. You have been arguing passionately for several pages against every proposal and every fact that points to the need for change. If you really recognize the need for change, make a proposal.
Capitalism is great for a lot of things. I haven't seen any arguments for why it is better for healthcare. That makes no sense to me. What do you think capitalism brings to a healthcare system?

I've talked about the concepts of tax incentives combined with Medicaid reform, and using HSAs, consumer-driven healthplans, to help curtail demand. ...AND have given lots of examples of successes. You must not have read my earlier posts. I've also given lots of examples of what my concerns are regarding heavy government price controls and my opinions about why I think capitalistic solutions are better. You must not have read my earlier posts on that either.

 

[brewer12345]

I've talked about the concepts of tax incentives combined with Medicaid reform, and using HSAs, consumer-driven healthplans, to help curtail demand. ...AND have given lots of examples of successes. You must not have read my earlier posts. I've also given lots of examples of what my concerns are regarding heavy government price controls and my opinions about why I think capitalistic solutions are better. You must not have read my earlier posts on that either.

Yeah, Sgeeeee, go take some remedial English classes. You just can't read, that's the problem!

 

[lets-retire]

sgeeeee--I don't think I said it in this thread, but the only reform I would support, if there was going to be socialized health care, is catastrophic care. I don't think it would be viable and would probably discourage doctors from going into specialties that would qualify as catastrophic, resulting in rationing. I also don't think socializing health care is a good idea.

Quoting Rich, about 30% of the costs of health care is in admin and advertising and other non-health related items. Of that I'd guess maybe 20% would be cut out from socializing care, the rest is the cost of business. It is often quoted that we spend more than most industrialized nation on health care, but with worse returns. Someone here stated most of the money spent on health care in America is spent at the end of ones life fighting a lost battle. Maybe if we took the common sense approach and did not treat the 90 year old cancer patient, it would cut a large portion of our medical expenses out and decrease demand resulting in lower medical inflation. The DW's grandfather was 91 when he was diagnosed with cancer. The doctor did everything he could to convince him to receive treatment. Grandpa's response was, "What so I can live another couple years with most of that feeling like crap. No thanks, doc, just give me the pain pills doc."

 

[sgeeeee]

sgeeeee--I don't think I said it in this thread, but the only reform I would support, if there was going to be socialized health care, is catastrophic care. I don't think it would be viable and would probably discourage doctors from going into specialties that would qualify as catastrophic, resulting in rationing. I also don't think socializing health care is a good idea.

Quoting Rich, about 30% of the costs of health care is in admin and advertising and other non-health related items. Of that I'd guess maybe 20% would be cut out from socializing care, the rest is the cost of business. It is often quoted that we spend more than most industrialized nation on health care, but with worse returns. Someone here stated most of the money spent on health care in America is spent at the end of ones life fighting a lost battle. Maybe if we took the common sense approach and did not treat the 90 year old cancer patient, it would cut a large portion of our medical expenses out and decrease demand resulting in lower medical inflation. The DW's grandfather was 91 when he was diagnosed with cancer. The doctor did everything he could to convince him to receive treatment. Grandpa's response was, "What so I can live another couple years with most of that feeling like crap. No thanks, doc, just give me the pain pills doc."

Okay, taking your numbers that's a 6% discount on care to start off with. That's not a bad thing. Now consider the heroic final treatment costs you mention. I suspect that you are correct that this is a big part of the problem and I admire your Grandpa's attitude. I expect and hope I will feel the same way if the time comes for me to make that decision.

Curtailing heroic medicine may save a lot of money but it involves rationing medical care. How do you propose to do that? When I listen to people who attack the Canadian or British healthcare system, their criticisms are almost always about rationing. But that is probably a necessary part of the solution. I don't see how you will accomplish rationing without a Government Regulated Healthcare System. Would you rather the priorities are set by corporate profiteers? That is the problem with the system we have today. The nation's health should not be determined by profit motives of CEOs and corporate boards any more than national defense should be. We do not decide how to equip a soldier or which missile to build based on the profit margins of that work. Why should we decide which citizens get to be sick or well or which get to live or die based on profit margin?

 

[mykidslovedogs]

The fundamental difference between liberal mentality and conservative mentality on this issue is that liberals blame corporate greed for the heavy inflation and conservatives blame government regulation for the heavy inflation in the industry.

Take a look at the attached chart, and scroll through it. In any state where there are fewer government mandates, the premiums are MUCH LOWER (look at Colorado - 7% uninsured), and there are fewer uninsured. In states where heavy government mandates exist, premiums are through the roof (have a look at NY and NJ - NYC - 25% uninusured), and there are more uninsured.

http://www.nahu.org/legislative/charts/individual health insurance rates june 2005.pdf

Links to state data on uninsured:

http://www.ahrq.gov/data/safetynet/blewtab2.htm

 

[sgeeeee]

The fundamental difference between liberal mentality and conservative mentality on this issue is that liberals blame corporate greed for the heavy inflation and conservatives blame government regulation for the heavy inflation in the industry.

That's just not true at all. I really hate it when right wingers tell me what liberals think. I am a social liberal by US political standards. I don't really know why medical costs are so high. I don't think capitalism works for a medical system because profit motive does not work to stop disease or cure the sick -- many of whom are poor. Profit motive works to reduce cost of high volume consumer items. If you want cheap commodities, use a capitalist system. If you want a healthy population, you need a system that administers care where it is needed, not where the most money is made. The germs don't know who is rich and who is poor. Neither should our healthcare administrators.

Take a look at the attached chart, and scroll through it. In any state where there are fewer government mandates, the premiums are MUCH LOWER (look at Arizona), and there are fewer uninsured. In states where heavy government mandates exist, premiums are through the roof (have a look at NY and NJ), and there are more uninsured.

http://www.nahu.org/legislative/charts/individual health insurance rates june 2005.pdf

But the medical system is just as broken in Arizona as it is anywhere else. I live there. I know. Cost is only part of the problem and costs that are barely out-of-reach are just as bad as costs that are 10 times out-of-reach for the sick who need care.

 

[windsurf]

So, if all government mandates are eliminated, we will have the best possible system? If I am the insurance exec in that scenario, I sell only to those who are least likely to need expensive care.

 

[mykidslovedogs]

But the medical system is just as broken in Arizona as it is anywhere else. I live there. I know. Cost is only part of the problem and costs that are barely out-of-reach are just as bad as costs that are 10 times out-of-reach for the sick who need care.

Like I said before, we have reached capacity, and healthcare providers/pharmaceutical makers can no longer look to the private sector for additional income. The next step is national care... and the consequences that go with it.

The purpose of the attached chart was to prove that systems involving heavy government regulation make the problem 10 times worse than systems involving capitalistic solutions.

 

[mykidslovedogs]

So, if all government mandates are eliminated, we will have the best possible system? If I am the insurance exec in that scenario, I sell only to those who are least likely to need expensive care.

IMO - Possibly? I don't know. IMO - It's better than EVERYONE having poor care in the LONGRUN. (I'm talking years and years from now....not tomorrow.) All I know is what I have seen in markets that have heavy gov't mandates.

 

[farmerEd]

The fundamental difference between liberal mentality and conservative mentality on this issue is that liberals blame corporate greed for the heavy inflation and conservatives blame government regulation for the heavy inflation in the industry.

Take a look at the attached chart, and scroll through it. In any state where there are fewer government mandates, the premiums are MUCH LOWER (look at Colorado - 7% uninsured), and there are fewer uninsured. In states where heavy government mandates exist, premiums are through the roof (have a look at NY and NJ - NYC - 25% uninusured), and there are more uninsured.

Where are you getting your facts from? Try this link

http://statehealthfacts.kff.org

Using this site, from a fairly reputable source, it shows New York in fact having a LOWER(13%) uninsured rate than Colorado(17%).

• Massachusetts at 11%
• New Jersey 15%
• New York 13%
• Colorado 17%
• Texas 25%

Average family policies don't seem to vary all that much either:

• Mass - $10,559
• Colorado - $10,228
• NJ - $11,425
• New York - $10,397
• Texas - $10,110
  

Interestly, Texas, which generally is considered a "less regulated" state has 25% uninsured rate and the avg family policy still costs north of $10K...guess that blows that theory....

 

[Martha]

Minnesota has the least number of uninsured of any state according to census and other figures and has been rated consistently as the healthiest state in the nation. See, for example, http://www.usatoday.com/news/health/2004-11-07-state-health-chart.htm

Minnesota has plenty of coverage mandates. There is nothing poor about the care in Minnesota. It has some of the best care in the nation, if not the best.

You will feel the effect of the lack of a mandate when you fall through one of the cracks. The big example is mental health coverage. A number of states mandate parity for mental health matters and others do not. I don't know about Colorado, but let's assume it does not have a parity requirement. In that case your insurance policy may have significant restrictions on mental health treatment. I read an article in the WSJ this week on care of anorexic children. Families thought they had good insurance coverage but ran up against limits on mental health care. Families were impoverished getting care for their anorexic children.


Treating illness should be about necessary and reasonable care, not about what a policy reads and whether you have hit your limits on care.

 

[farmerEd]

You are right about Minnesota (tied with Iowa and Hawaii)

http://tinyurl.com/y9x9gh


(moderator resized URL)

 

[Martha]

OldMc, the data you linked to is fairly consistent with the census data. A link to the census data showing percentage of uninsured can be found towards the bottom of this page : http://www.chn.org/issues/statistics/state.html

And also can be found here: http://www.cbpp.org/10-19-05pov.htm

I note that Colorado's unisured population has increased over the past few years.

 

[lets-retire]

sqeeeee--The way I see it no matter what system we have health care will be limited by either a profit motive, like we have now, or a savings motive, if the government takes it over. I'd personally rather have the profiteers controlling it, taxes are raised by people making a profit, not by the government taking more tax money and spending it. Government should be the last resort. I do not believe we have exhausted all private avenues to make health care affordable through government incentives. As far as I can see we have tried one form of health care. Only recently has the government tried to implement programs for health care, which seem to have added to the problem. It is too early to just give up and turn the whole thing over to a government bureaucracy, in any form.

 

[Nords]

It is too early to just give up and turn the whole thing over to a government bureaucracy, in any form.

All we're looking for is a safety net. How hard could that be?

 

[astroboy]

Just a couple questions on the HIPAA option -
If you are HIPAA eligible, you can't be put on a waiting list for a state's high-risk pool, right?
And in same case, I would guess there is no time limit yo can be in pool as long as pay premiums or waiting times between intervals on it (say if you get a you get a PT job with bennies for a period of time)?

 

[ladelfina]

(sigh) I had kinda sworn not to get back into this..

The worries of MKLD's MDs are not entirely founded. From what I know of the Socialized Medicine countries, they do not PROHIBIT either private practice or private insurance. So just calm down on the "enslavement" front, would you please?

MKLD, it's a matter, certainly, of philosophy, but when you say, essentially, let 20% of the population rot in hell, it's their poor luck.. because it's "better than EVERYONE having poor care in the LONGRUN." I'm not so sure (even if that were the case, which it's not... since most countries with UHC allow for parallel private options).

Inherent in this declaration is:
if there's $10,000 in health care dollars available from whatever source, it is better spent on ONE whiz-bang $8000 treatment (we certainly can't forget the ins. co. infrastructure/CEO /investors and deny them their min. 20%) than on ten random $1000 treatments bereft of markup. Is this credible?

In these discussions, we've heard:
-blame on the average person
-putative blame on the government

but I've heard scant blame on the ins. companies.

Tell me, in God's good graces, what the health insurance companies ADD to the equation. I can easily see how they SUBTRACT their CEOs' salaries, how they SUBTRACT the 10% or 20% they need to report to their shareholders (above and beyond what they SUBTRACT for their employees and brokers), but for God's sake, tell me what they ADD.. besides confusion and strife.

I understand that ins. co. bean-counting and gov't bean-counting will, to some extent, be similar.. but gov't. bean-counting won't have the profit motive to satisfy. If that's even a 20% savings right there, isn't it worth it? To bring those 47+ million into the fold of getting a baseline of some basic health care, no strings attached?

Hark to this: I am surely a capitalist, but when it comes to Dr. Durante's "hats, " he is Off His Rocker. "Hat" production can never be an example for health care delivery and WE ALL KNOW IT.

---
Let me talk a bit about my BIL (not the one with the dry goods store.. this is another one).
BIL is an Italian radiologist. A good one, from what I can understand. He was the head of radiology in a major Italian hospital. There was a recent Italian law (with which I don't necessarily agree) that said doctors had to choose whether to operate solely in the public sector, or solely in the private sector. He chose private. That means he drives hundreds of miles back and forth from one private clinic to another, making somewhat more $ but without the stability of showing up in the same place every day and certain other protections. Fine.. Does that mean he can name his price? Not exactly, because the private structures have their own limits, based on profits, as they do in the US. Before, he may've complained about the stinginess of The State; now "it's personal" because he sees the 2 Porsches (one street model and one racing) that the head of the private structure concedes himself at the expense of the doctors and everyone else. He said to us a few days ago: "I earn 20. The nurses and support staff earn 10. And the big boss earns 70."

At an unrelated point in time, I'd asked him what percentage of health care in Italy was 'private'' and what percentage 'public'... he said about "50/50".

But that STILL means when you fall off a ladder and you need stitches (as happened to our friend), when you have painful kidney stones that need breaking up via lithotripsy (like DH, now approaching round 2 of 'bombardment'), when you are, like my MIL, 80 years old and can't walk because you 'need' (could benefit from) 2 knee replacements.. these things get routinely taken care of in public structures.. with a minimum of decency, without contestation, without filling out endless forms, and without paying more than a type of co-payment. In these cases, yes, you may wait a bit for non-emergency care, and you won't have a private room. You may be (gasp!) on a ward! You won't have five different choices of provided meals (your family will possibly bring lasagne, and a portable TV, either of which you are free to share -or not- with your ward mates). Impromptu card games of tre-sette and briscola may break out, and patients freely wander outside (across the street) to the local bar to take a coffee (or drink, or smoke) in their robes and jammies.

Meanwhile (in the US) an 80+ y.o. friend of my mom's fell and dislocated her shoulder and had to wait for 6 painful hours to be seen in a local US hospital. This had nothing to do with what level of insurance she had; it was just the way it was. If we'd heard this story from Italy, we'd say "oooo..socialized medicine", but when the profit motive is invoked it's somehow more acceptable for us to wait like sheep? Why? To immolate ourselves on the altar of capitalism to ''insure' that someone ELSE profits from it?

Insurance companies insure themselves first; while you are the vehicle, you are also utterly the minority interest in the affair.

 

[Martha]

Just a couple questions on the HIPAA option -
If you are HIPAA eligible, you can't be put on a waiting list for a state's high-risk pool, right?
And in same case, I would guess there is no time limit yo can be in pool as long as pay premiums or waiting times between intervals on it (say if you get a you get a PT job with bennies for a period of time)?

If you are HIPAA eligible you might jump the waiting list on the risk pool, it depends on the state. But, the state could offer other options. For example, in Florida the pool is closed so instead you have to get a conversion policy from your current insurer and if that is not available, you will be able to buy a HIPAA qualified plan from a private insurer. There is no cost limit and coverage may not be as good. But you are right, if you are HIPAA eligible there will be a product for you, you just might not be able to afford it.

 

[astroboy]

If you are HIPAA eligible you might jump the waiting list on the risk pool, it depends on the state. But, the state could offer other options. For example, in Florida the pool is closed so instead you have to get a conversion policy from your current insurer and if that is not available, you will be able to buy a HIPAA qualified plan from a private insurer. There is no cost limit and coverage may not be as good. But you are right, if you are HIPAA eligible there will be a product for you, you just might not be able to afford it.

I understand the affordability issue, but would whatever alternative plan that would have to be offered to you have to be at least no more than the what the risk pool premium would be?

 

[Martha]

I understand the affordability issue, but would whatever alternative plan that would have to be offered to you have to be at least no more than the what the risk pool premium would be?

This would be a state law issue. I do know that Florida does not restrict the costs of the HIPAA eligible plans to what would be charged in the pool. I don't know about other states. What state are you thinking about?

 

[tomz]

This would be a state law issue. I do know that Florida does not restrict the costs of the HIPAA eligible plans to what would be charged in the pool. I don't know about other states. What state are you thinking about?

According to healthinsuranceinfo.net, however, Fl does restrict the costs of a conversion policy to "not more than 200% of the cost of the typical rate for an individual policy" and the company must offer you two "standardized policies that meet the state requirements for minimum coverage." I plan to retire at the end of 2007, use COBRA, move to FL, and get a conversion policy when COBRA runs out. As my retirement gets closer, I plan to contact the FL Dept of Financial Services and get more info. Megacorp just switched our health insurance again to United so I plan to wait until I get a better handle on COBRA costs before doing more research.

 

[Martha]

Tomz, I missed that for Florida conversion policies. Sorry! However, if no conversion policy is available there are no cost restrictions that I know of.

I don't know if a conversion policy would be available if you move from your insurance company's service area. Also, the insurance company may not be required to offer a conversion policy, it depends on the state law of the state where you obtained the insurance. For example, if your employer is partially self insured and only buys stop loss insurance, it may not have to offer a conversion policy. So be sure to check to see if you can get a conversion policy. I also don't know if the 200% limit would apply if you were insured in one state and then moved to Florida.

Note that the conversion policy may not offer as good coverage as your original policy so be sure to check the offerings and most importantly, the maximum out of pocket.