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Re: Senator Wyden's "health care plan for all Americans"
Old 12-17-2006, 06:16 PM   #41
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Re: Senator Wyden's "health care plan for all Americans"

With the exception of clearly cosmetic surgery, there is no moral distinction between "basic" care and "good care." You cannot legally or ethically withhold needed care from any patient. "More" care is not better care, as an aside - unnecessary "executive" stress tests and CT scans can actually increase morbidity through wild goose chasing.

Even the cosmetic surgery issue gets murky. Varicose vein injection (cosmetic or do they "hurt a little," breast reduction because of back pain vs cosmetic; surgery to improve the appearance of a facial scar from an injury, nose job because of congestion v. appearance, hair transplant because of emotional distress from baldness in a 25 year old, etc. I think these should be carefully scrutinized, but not sweepingly excluded.

Perhaps MyKids can provide an example of the kind of care that he should get (with the fortress of private health insurance approach) but which a less protected "other" shouldn't be reimbursed for. I'm confused about that.

No one is invulnerable, health-wise or financially, and often crises with the former lead to crises with the latter -- insurance or not.

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Re: Senator Wyden's "health care plan for all Americans"
Old 12-17-2006, 07:11 PM   #42
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by Rich_in_Tampa
Perhaps MyKids can provide an example of the kind of care that he should get (with the fortress of private health insurance approach) but which a less protected "other" shouldn't be reimbursed for. I'm confused about that.
Well, in my previous post, I already stated that I have a healthplan with a $5150 deductible and 100% coverage thereafter, including prescriptions. Maybe a better idea would be to have a BASIC plan for ALL with the healthy given the option to buydown and receive a tax REFUND if they don't want the better, basic plan.

Like I said before, many of the healthy don't need a lot of the front end benefits, so we could buydown to a plan with a higher deductible, and then maybe get a tax refund instead. Just a thought... or...maybe the healthy won't like the basic plan and decide to buyup....

I'm just saying that if we are going to offer a basic level of care for all, it is going to have to be defined in some manner. It can't just be a free for all....
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-17-2006, 07:16 PM   #43
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Re: Senator Wyden's "health care plan for all Americans"

one more thing...I'm not saying that "better" means it covers more illnesses.. Perhaps better just means a lower deductible...
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-17-2006, 07:58 PM   #44
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Re: Senator Wyden's "health care plan for all Americans"

mykids,

I think in one of your total of 36 posts you mentioned you were passionate about health insurance. That's pretty obvious since that's the only subject you've posted about since joining the forum 4 days ago.

We know a lot about Rich, Martha and others in this discussion, but very little about you. How about filling in a few holes for us so we can understand better where you're coming from.

I think you've told us you sell insurance, live in Colorado, and have a family. Since this is a forum about Financial Independence and Retiring Early, where are you on that journey? Are you in your 30's and just getting started, in your 40's and well on your way or in your 50's, financially ready to retire but afraid to pull the trigger for whatever reason? Are you a real estate investor or do you invest in the equity market? Do you buy funds or individual stocks?

Just curious. Thanks.

Everyone please note: I didn't ask if mykids thought it was better to pay off his/her mortgage early or what he/she thought about annuities.

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Re: Senator Wyden's "health care plan for all Americans"
Old 12-17-2006, 10:02 PM   #45
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by Martha
Mykids, I don't favor a two tier system because the bottom tier usually gets shafted.

[i]. . . an individual mandate would be implemented, forcing every American to purchase one of the options offered by their state's newly formed Health Help Agency (HHA).
You should keep an eye on Massachusetts...the law recently change and as of (I think) July 1st everyone must have or purchase insurance. Companies (with more than 10 employees) must contribute or pay (a pitifully small) "tax" of $295 per employee. For those that can't afford it (based on a multiple of Fed poverty levels and family size and income), there is a sliding scale reimbursement or premium assistance. It'll be interesting to watch and see what happens. I live in Mass, and would like to see it work out, so I have more than a passing interest - hope it doesn't become a real budget buster.

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Re: Senator Wyden's "health care plan for all Americans"
Old 12-17-2006, 11:37 PM   #46
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by REWahoo!
mykids,

I think in one of your total of 36 posts you mentioned you were passionate about health insurance. That's pretty obvious since that's the only subject you've posted about since joining the forum 4 days ago.

We know a lot about Rich, Martha and others in this discussion, but very little about you. How about filling in a few holes for us so we can understand better where you're coming from.

I think you've told us you sell insurance, live in Colorado, and have a family. Since this is a forum about Financial Independence and Retiring Early, where are you on that journey? Are you in your 30's and just getting started, in your 40's and well on your way or in your 50's, financially ready to retire but afraid to pull the trigger for whatever reason? Are you a real estate investor or do you invest in the equity market? Do you buy funds or individual stocks?

Just curious. Thanks.

Everyone please note: I didn't ask if mykids thought it was better to pay off his/her mortgage early or what he/she thought about annuities.

Well, I don't like people on the internet to know too much personal information about me. You never know who's out there checking into you, or who's gonna go postal on you 'cuz of the things you say, so I like to remain pretty anonymous. I am definately passionate about health insurance, and and I'm a little over halfway to retirement. I have a pretty diverse portfolio, and I invest in real estate, mutual funds, and stocks. I have a really good start on my retirement fund, and I am already locked in with a high deductible HSA plan with Humana One which I plan to keep for the rest of my life or at least until Humana drops out of the market. Hopefully, they never will, as they are a very financially sound company. But, I guess if I am forced into a nationalized plan (which will likely force my health insurance carrier out of business), I might have to rethink my whole retirement plan, because my guess is that a nationalized plan won't even come close to as good as the coverage I have right now (100% covered - I have already saved my deductible twice over because my premiums are so low).

I love my current helath plan because it's inexpensive and the huge amount of premiums savings I get allow me to save on a tax-free basis towards my retirment. If I don't use the money in my health savings account, it grows on a tax free basis and I can take it out when I am 65 with no penalties or taxes if I use it for medical care. If I take it out after age 65 and don't use it for medical care, I will just have to pay taxes on it, much like an IRA.

By the way, I think it's better to annuitize than to pay off your mortgage.....

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Re: Senator Wyden's "health care plan for all Americans"
Old 12-17-2006, 11:50 PM   #47
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Re: Senator Wyden's "health care plan for all Americans"

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Originally Posted by mykidslovedogs
Well, I don't like people on the internet to know too much personal information about me. You never know who's out there checking into you, or who's gonna go postal on you 'cuz of the things you say, so I like to remain pretty anonymous. I am definately passionate about health insurance, and and I'm a little over halfway to retirement. I have a pretty diverse portfolio, and I invest in real estate, mutual funds, and stocks. I have a really good start on my retirement fund, and I am already locked in with a high deductible HSA plan with Humana One which I plan to keep for the rest of my life or at least until Humana drops out of the market. Hopefully, they never will, as they are a very financially sound company. But, I guess if I am forced into a nationalized plan (which will likely force my health insurance carrier out of business), I might have to rethink my whole retirement plan, because my guess is that a nationalized plan won't even come close to as good as the coverage I have right now (100% covered - I have already saved my deductible twice over because my premiums are so low).

I love my current helath plan because it's inexpensive and the huge amount of premiums savings I get allow me to save on a tax-free basis towards my retirment. If I don't use the money in my health savings account, it grows on a tax free basis and I can take it out when I am 65 with no penalties or taxes if I use it for medical care. If I take it out after age 65 and don't use it for medical care, I will just have to pay taxes on it, much like an IRA.

By the way, I think it's better to annuitize than to pay off your mortgage.....

My guess is that you are a shill. We'll se soon enough I guess. If you don't trust us, why should we trust you?

I promise to never respond seriously to anything you say after this.

Ha
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 08:00 AM   #48
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Re: Senator Wyden's "health care plan for all Americans"

Martha--In reference to the buy up. At our last jobs both my wife adn I hadinsurance from our respective employers. Hers cost half as much as mine did in monthly premiums. Hers also had more co-pays and deductibles than mine. In the end hers was more expensive if we needed it. Since everyone in our family is relatively healthy we would opt to go with her plan since it has cheaper monthly payments.

If soemone decides their family is healthy enough to warrant a cheaper plan, but are willing to take on the higher 'use fees' then they should be allowed to opt into this plan and receive the difference in cost between that and the basic plan. Conversely if someone is not so healthy, they could opt into a higher cost plan, but have less use fees resulting in a savings for them.

I still don't like univsersal health care.
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 08:30 AM   #49
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by HaHa
My guess is that you are a shill. We'll se soon enough I guess. If you don't trust us, why should we trust you?

I promise to never respond seriously to anything you say after this.

Ha
Wow - I don't know what a shill is, but it doesn't sound very nice. I swear my responses have all been truthful and I don't think I have said that I don't trust the people on the forum. I simply have differing views on the economics of healthcare. I do however, think I have a pretty open mind, but I don't think I will ever be swayed much more to the left than I already am (which isn't very far....heehee). I am an economic conservative to the core. I believe strongly in capitalism and the American way. I believe strongly that there are four main reasons for the high cost of healthcare in our country:

1.) The barriers to entry for Doctors in this country are very high. Medical schools keep a tight rope on who they allow into and out of the medical schools. This hurts the supply of doctors in our country....Therefore the law of supply and demand kicks in. Too few doctors, too many patients = higher prices.
2.) Heavy Regulation in the food and drug administration drives pricing up on prescription drugs. Prescription drug companies only have x amount of time to recover costs before they lose their patents - Thus too much regulation = higher costs for prescription drugs.
3.) Liability costs are way to high for healthcare professionals. The threats of lawsuits drive up costs which are passed onto consumers.
4.) Medicare and Medicaid reimbursement levels are too low. Therefore, Doctors have to recover costs from the private sector, thus passing on higher prices to consumers who already have health insurance. This creates a never ending self-perpetuating cycle. Prices go higher, fewer people are insured, more people go on the governement plan, doctors need more money, higher prices are passed on to the private sector...and so on and so on....

I believe the only way to fix the problems are to get at the root causes. I think nationalizing care will only put a bandaid on the problems and ultimately lead to poorer quality of care as well as higher prices for consumer and taxpayers. It's as simple as that.

Isn't it OK for me to have differing views than most of the other people in the forum?
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 08:44 AM   #50
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by mykidslovedogs
Isn't it OK for me to have differing views than most of the other people in the forum?
You are doing just fine. I don't go for the socialistic plans that they like either. I love our high deductible ($2500 per person) retirement medical which has saved us thousands of dollars so far. If our health needs changed we could switch to a PPO at the next annual enrollment time.

We haven't been to a doctor for over ten years and have no plans to do so. It is too risky to visit a doctor especially if one were to actually consider doing what they "order". Still, life has risks of accidents so we do need insurance.
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 08:46 AM   #51
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by mykidslovedogs

Isn't it OK for me to have differing views than most of the other people in the forum?
I don't think the fact that you have differing views is the issue, as few of us agree on everything. The point is you appear to be a one-dimensional, one-topic poster which is very suspect and quickly grows old.

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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 09:00 AM   #52
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Re: Senator Wyden's "health care plan for all Americans"

OOps! Well, I had a few days off and the topics that I saw out on your forum got me all fired up, so I just wanted to get my points of view across, which i guess I already have... I would love to hear from some more people who have ideas about how to fix the problems. I hear a lot of complaining and a lot of animosity towards the insurance industry with very few concrete thoughts about how to begin to fix the issue.

When people start talking about the evil insurance companies, it gets me all fired up, because I am not a believer in conspiracies or corporate greed. I believe that corporations do what they need to be profitable and to stay in business, and all of it (pricing, etc..) is influenced by the laws of supply and demand as well as the impacts of goverment regulation.

Anyways, I have to go back to work this week, so you all probably won't be hearing much from me anymore. Thanks for listening...I hope some of my ideas hit home for some of you. I'll check in every now and then. If anyone needs help or advice about health insurance in the state of Colorado, let me know. I'll do the best I can....
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 10:38 AM   #53
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by OldMcDonald
You should keep an eye on Massachusetts...the law recently change and as of (I think) July 1st everyone must have or purchase insurance. Companies (with more than 10 employees) must contribute or pay (a pitifully small) "tax" of $295 per employee. For those that can't afford it (based on a multiple of Fed poverty levels and family size and income), there is a sliding scale reimbursement or premium assistance. It'll be interesting to watch and see what happens. I live in Mass, and would like to see it work out, so I have more than a passing interest - hope it doesn't become a real budget buster.

Yes, I am really curious as how this is going to work in MA.
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 10:41 AM   #54
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by lets-retire
Martha--In reference to the buy up. At our last jobs both my wife adn I hadinsurance from our respective employers. Hers cost half as much as mine did in monthly premiums. Hers also had more co-pays and deductibles than mine. In the end hers was more expensive if we needed it. Since everyone in our family is relatively healthy we would opt to go with her plan since it has cheaper monthly payments.

If soemone decides their family is healthy enough to warrant a cheaper plan, but are willing to take on the higher 'use fees' then they should be allowed to opt into this plan and receive the difference in cost between that and the basic plan. Conversely if someone is not so healthy, they could opt into a higher cost plan, but have less use fees resulting in a savings for them.

I still don't like univsersal health care.
I don't have a problem with different deductible levels. Minnesota does that with its risk pool. You can chose anywhere from a $500 deductible to a $10,000 deductible.
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 11:15 AM   #55
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Re: Senator Wyden's "health care plan for all Americans"

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Originally Posted by Rich_in_Tampa
If insurance carriers remain predominant in the system, $.35 of every $1.00 spend on health care will still go toward administrative costs and profits.
Rich_in_Tampa:

The 35 % for administration and profits must include all of the caregivers/hospitals/labs etc. It can't just include the insurance aspects. Otherwise this number is way way too high.

To then conclude that there is 35 percent that could potentially be wrung out of the system is perhaps misleading.

Do you have a reference to your number ??
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 11:15 AM   #56
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by mykidslovedogs

Anyways, I have to go back to work this week, so you all probably won't be hearing much from me anymore. Thanks for listening...I hope some of my ideas hit home for some of you. I'll check in every now and then. If anyone needs help or advice about health insurance in the state of Colorado, let me know. I'll do the best I can....
That statement just convinced me that Ha Ha was correct.
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 11:29 AM   #57
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by MasterBlaster
Rich_in_Tampa:

The 35 % for administration and profits must include all of the caregivers/hospitals/labs etc. It can't just include the insurance aspects. Otherwise this number is way way too high.

To then conclude that there is 35 percent that could potentially be wrung out of the system is perhaps misleading.

Do you have a reference to your number ??
Rich can probably give you several sources. I have read that admin costs are about 1/3 of the health care dollar. Attached is a link to an abstract of New England Journal of Medicine article which shows admin costs at 31%. The article dates from 2003 and my understanding is that the costs have increased. Unfortunately, the abstract doesn't break down what exactly are admin costs, but I am sure you are right that not all can be wrung out of the system. If we could cut it down to closer to what Canada pays for admin costs (17%) that would be great.

http://content.nejm.org/cgi/content/abstract/349/8/768
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 11:35 AM   #58
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Re: Senator Wyden's "health care plan for all Americans"

Martha:

OK, so that 35% is for ALL administration. Not just for insurance.

Rich_in_Tampa had implied that by doing some sort of medical re-arrangement that got rid of the insurance aspect that 35% could be saved. That number is just way too high.

So if we take the Canada model maybe there is 10 or 15% savings to be had. That seems more plausible.
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 11:39 AM   #59
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Re: Senator Wyden's "health care plan for all Americans"

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Originally Posted by FIRE'd@51
Thanks! I just printed it off and am reading it. Far more complete than the bits and pieces we have been talking about.

The premiums for the insurance would be paid through people's annual income tax filings. Poor people's premiums would be subsidized. Employers also will pay an assessment ranging from 2 to 25% of the national average premium for the minimum benefits package, depending on size and revenues. What I like about this is it is an easy way to get everyone covered if premiums are collected through the tax system.
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Re: Senator Wyden's "health care plan for all Americans"
Old 12-18-2006, 11:41 AM   #60
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Re: Senator Wyden's "health care plan for all Americans"

Quote:
Originally Posted by MasterBlaster
To then conclude that there is 35 percent that could potentially be wrung out of the system is perhaps misleading.

Do you have a reference to your number ??
I re-read my post and don't believe I said or meant that all adminstrative costs could be wrung out of the system. Just that 35% of every dollar spent is spent on administration, and that this is very, very high compared to other systems. Drastic reductions are possible within reasonable scenarios. 30%-35% is unprecedented world-wide.

http://content.nejm.org/cgi/content/abstract/349/8/768

"Methods For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars.

Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.) "


Other estimates range even higher, but this article is considered to be accurate if conservative. Of course, there will always be some administrative cost - it would be naive to claim otherwise. The absolute difference of 14% of all health care dollars between the US and Canada is a staggering amount of money.

Hope that clarifies.
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