Health Care Bill It's about Fire and Money

[Martha]

A section of This American Life today was about congressional hearings last year on "re-underwriting," where an insurance company when faced with a big claim looks for a reason to cancel the policy. I did not realize that many if not most states do allow cancellation even if there was no fraud and even if the omitted information was unrelated to the current illness or was immaterial. I thought many if not most states restricted it to at least materiality. One person who testified had her insurance canceled on the eve of cancer surgery when the insurer discovered a notation in her file about a skin issue. To no avail, the dermatologist called the insurer and said it was acne and for goodness sakes don't delay her cancer surgery.

The hospital wanted $30,000 up front for her cancer surgery, which she did not have. Six months later she finally got insured (I assume the same company) but her tumor was twice as big and the chance of a good outcome had dropped considerably.

None of the insurance companies were willing to pledge that they would only cancel for fraud.

 

[youbet]

A section of This American Life today was about congressional hearings last year on "re-underwriting," where an insurance company when faced with a big claim looks for a reason to cancel the policy. I did not realize that many if not most states do allow cancellation even if there was no fraud and even if the omitted information was unrelated to the current illness or was immaterial. I thought many if not most states restricted it to at least materiality. One person who testified had her insurance canceled on the eve of cancer surgery when the insurer discovered a notation in her file about a skin issue. To no avail, the dermatologist called the insurer and said it was acne and for goodness sakes don't delay her cancer surgery.

The hospital wanted $30,000 up front for her cancer surgery, which she did not have. Six months later she finally got insured (I assume the same company) but her tumor was twice as big and the chance of a good outcome had dropped considerably.

None of the insurance companies were willing to pledge that they would only cancel for fraud.

These anecdotal stories are no more mundane than the stories regarding issues likely to be caused by the proposed changes.......

Likely, under Obamacare, the unfortunate cancer patient will be denied care because she is too old to qualify for the expense of having the tumor removed.

BTW, my only real hope for all this is that whatever we change to, we pay for it in full and in real time. No ponzi scheme like SS or Medicare where we're counting on future economic growth or population growth to pay for benefits we gobble up today on the backs of tomorrow's citizens.

 

[Midpack]

We are following the lead of Potus and congress critters. The sky is gonna fall if we don't pass this today, this week, this month, this year, this term. Trust us you don't have time to read it let alone discuss or understand it!

Sounds a lot like the tactics used by the previous admin to get us into Iraq and TARP. When will we learn?

 

[Martha]

These anecdotal stories are no more mundane than the stories regarding issues likely to be caused by the proposed changes.......

Likely, under Obamacare, the unfortunate cancer patient will be denied care because she is too old to qualify for the expense of having the tumor removed.

BTW, my only real hope for all this is that whatever we change to, we pay for it in full and in real time. No ponzi scheme like SS or Medicare where we're counting on future economic growth or population growth to pay for benefits we gobble up today on the backs of tomorrow's citizens.

But the testimony was that the insurance companies would not stop canceling people like her. That is evidence, not just a story. Your claim that she would not get treatment under current plans is a claim which is unsupported. It isn't even an anecdote because nothing has happened yet. She wasn't even elderly. If so she would have medicare and the treatment is covered under medicare.

 

[ziggy29]

So Restonham, what would you do? Do you think it is fine the way it is? Did you hear the Texas governor say let the states handle the problem and the feds should butt out? Interesting as his state can't handle the problem, with the highest percentage uninsured of any state at about 25%.

A significant reason (not the only reason) for this is due to illegal immigration -- which again goes back to the federal government failure to address a federal responsibility -- securing its own borders. I have no intention to start immigrant-bashing but this is a significant piece of the puzzle here in Texas and, to some degree, other border states where uninsured are concerned.

So what we have is federal government trying to establish something the federal constitution doesn't explicitly authorize, all the while ignoring to perform duties which clearly are appropriately federal responsibility.

 

[ERD50]

I have no intention to start immigrant-bashing but this is a significant piece of the puzzle here in Texas and, to some degree, other border states where uninsured are concerned.

Does anyone have any numbers on this? I don't want any immigrant-bashing either, but I would like to understand the significance of this.

If it is a small % number, than it isn't a big factor either from a cost standpoint or as a potential savings standpoint. I just haven't seen any numbers.

-ERD50

 

[crazy connie]

Does anyone have any numbers on this? I don't want any immigrant-bashing either, but I would like to understand the significance of this.

If it is a small % number, than it isn't a big factor either from a cost standpoint or as a potential savings standpoint. I just haven't seen any numbers.

-ERD50

This link appears to have some of the info in a fairly concise manner and does not appear to be partisan. Intresting stuff from what I reviewed on it.

About Us | Center for Immigration Studies

 

[Martha]

A significant reason (not the only reason) for this is due to illegal immigration -- which again goes back to the federal government failure to address a federal responsibility -- securing its own borders. I have no intention to start immigrant-bashing but this is a significant piece of the puzzle here in Texas and, to some degree, other border states where uninsured are concerned.

So what we have is federal government trying to establish something the federal constitution doesn't explicitly authorize, all the while ignoring to perform duties which clearly are appropriately federal responsibility.

Fair enough. I know that the border states with Mexico have much larger than average uninsured, but I have not not been able to track down reliable numbers on what proportion of the uninsured are illegals. The numbers seem to be all over the board. I do know that the uninsured numbers come from census numbers but I don't know how many illegals answer the census.

Maybe another thread to deal with Mexico, eh?

 

[ziggy29]

Maybe another thread to deal with Mexico, eh?

Nah. As a standalone topic it's not really germane to the concept of FIRE except very tangentially. And it wasn't meant as an immigration rant either, just as a partial explanation for why Texas has a significantly higher rate of uninsureds (which *is* germane to this topic and to FIRE). It needn't be belabored any further.

If it is a small % number, than it isn't a big factor either from a cost standpoint or as a potential savings standpoint. I just haven't seen any numbers.

My understanding is that it's somewhat insignificant on a national level and probably shouldn't be a dealbreaker. It is significant, I think, in some state and local areas. It's hard to quantify because (a) it's largely an "underground economy" and (b) the costs tend to be eaten by going to the ER where no one can be refused treatment. Of course, (b) could also be used to argue more access to primary care. So it gets pretty complicated in the end.

 

[youbet]

Wouldn't a reasonable estimate be simply the number of so-called illegals that are living here now? I doubt many have health insurance but all are entitled to care through ER visits, free clinics and that sort of thing. Like it or not, we need to provide for them and I'm sure any bill coming out of Congress will include provisions for undocumented workers to be fully covered.

 

[eridanus]

A section of This American Life today was about congressional hearings last year on "re-underwriting," where an insurance company when faced with a big claim looks for a reason to cancel the policy.

BCBS-CA and BCBS-NC were successfully sued for doing this.

 

[samclem]

Sounds a lot like the tactics used by the previous admin to get us into Iraq and TARP. When will we learn?

The soapbox is gone.

 

[Martha]

Wouldn't a reasonable estimate be simply the number of so-called illegals that are living here now? I doubt many have health insurance but all are entitled to care through ER visits, free clinics and that sort of thing. Like it or not, we need to provide for them and I'm sure any bill coming out of Congress will include provisions for undocumented workers to be fully covered.

Maybe, but we don't have good numbers on the numbers of illegals are here in the US now. My guess is that the 45 million uninsured does not count a large number of illegals as it is a census number.

Don't be sure about anything coming out of congress. I think we can all at least agree on that!

 

[beowulf]

I agree with Martha - the problem is not illegal aliens. They ar a cost driver, but the real problem is affordable health care. I don't know the solution - if I did, I'd be in a heck of a lot higher paying job than I am now. I'm a business type - I can reduce eveything to numbers, and the value of a human life for different people can be somewhat easily calculated in economic terms. That, however, is exactly what I am arguing against doing. Whatever level of rationing/withholding of care, etc., that we have now is enough. I do agree that it exists, whether by insurance company, medicare, medicaid or just plain inability to afford treatment.

Whoever said the current proposal is not Obamacare is right - he has not actually proposed anything. Everything we see now is courtesy of our good friends in the House and Senate. All of the 1,000 plus pages came about without any studies, public meetings, etc. - just out of the computers of busy staffers who all have their own agendas. There is no reason to adopt what they say without a lengthy public debate - that's why we have Congress in the first place.

 

[ERD50]

Fair enough. I know that the border states with Mexico have much larger than average uninsured, but I have not not been able to track down reliable numbers on what proportion of the uninsured are illegals.

Maybe, but we don't have good numbers on the numbers of illegals are here in the US now.

Wouldn't a reasonable estimate be simply the number of so-called illegals that are living here now?

I think there are some good numbers at this site that crazy connie provided. I have not taken the time to sort them out yet...

This link appears to have some of the info in a fairly concise manner and does not appear to be partisan. Interesting stuff from what I reviewed on it.

About Us | Center for Immigration Studies

-ERD50

 

[Martha]

I think there are some good numbers at this site that crazy connie provided. I have not taken the time to sort them out yet...




-ERD50

But no good numbers on the extent they are counted in census and as part of the 45 million uninsured (which are related questions). It is hard to figure out the impact of illegals on health care issues because of the back and forth between the US and Mexico and the extent that they really do use US health care, which they would likely use through an emergency room and not seek followup, preventive, old age, or chronic care. But yes, I spoke too quickly on estimates of how many illegals are here at any one time because my head was in another place.

 

[ziggy29]

Sigh. I only mentioned the illegals because Martha referenced the percentage of uninsured in Texas. I didn't want that to become the topic for discussion...

Now... back to health care?

 

[youbet]

Maybe, but we don't have good numbers on the numbers of illegals are here in the US now. My guess is that the 45 million uninsured does not count a large number of illegals as it is a census number.

"Guess" is certainly the operative word....... I'd "guess" that either the 45 million uninsured number includes many so-called illegals or that we are underestimating the uninsured number by not including all the illegals.

Don't be sure about anything coming out of congress. I think we can all at least agree on that!

There have been some surprises from the Dems. The Republicans have been fairly predictable. But, in the end, I believe so-called illegals will be covered since they are consuming health care now anyway and therefore their numbers should be included in the costs we need to understand and prepare ourselves to pay.

 

[Martha]

"Guess" is certainly the operative word....... I'd "guess" that either the 45 million uninsured number includes many so-called illegals or that we are underestimating the uninsured number by not including all the illegals. There have been some surprises from the Dems. The Republicans have been fairly predictable. But, in the end, I believe so-called illegals will be covered since they are consuming health care now anyway and therefore their numbers should be included in the costs we need to understand and prepare ourselves to pay.

Yes, I acknowledged it was a guess. My guess is that we are underestimating the number of illegals without insurance in the 45 million number. I have no idea what congress will do with the illegals issue but if I were betting I bet they will not be covered the same as citizens. Same with legal aliens. It would not be very politically popular to cover them and there are good reasons not to. It could be left for the illegals the way it is now, with a don't ask don't tell policy at the ER. It would be very problematic to offer non-emergency treatment to illegals. Canada doesn't cover you if you slip the border and want free cancer treatments. Why would we?

 

[youbet]

Yes, I acknowledged it was a guess. My guess is that we are underestimating the number of illegals without insurance.

Estimating the cost of insuring so-called illegals must be making it tough for our "leaders" to estimate the future cost of our soon-to-be national health care plan. This is a concern to me as my feeling is that we do need some sort of health care reform but that we need to pay for it in full and real time and not let it become the financial debacle that SS and Medicare have become.

Perhaps Congress should assign a team to do the estimate and publish at least their best "guess?"

We cannot continue to tie rocks to the legs of our future generations and expect them to successfully swim in the world's oceans.......

 

[Martha]

The problem is that we know roughly 46 million are uninsured according to the census. But we don't know how many of those counted in the census are aliens. We do know roughly how many illegals are here at a given time. We probably know someting about what health care they use, which is mostly ER care, if they are illegal.

I say that the goal is to insure us first, not to insure non-citizens or at least non-permanent residents. It would be risky public policy and is not commonly done elsewhere.

So, the question would be what extent is the uninsured number really lower than as reported in the census if we are not insuring aliens, legal or illegal.

 

[youbet]

Canada doesn't cover you if you slip the border and want free cancer treatments. Why would we?

Not a very good analogy. Canada actually enforces it's immigration laws and has very few "illegals" in residence and working. And congruent with that philosophy, they don't provide ongoing medical care to non-citizens there without permission. The USA does little to enforce immigration laws and has (supposedly) millions of "illegals" in residence with popular and esteemed politicians fighting for their rights, etc.

Because of the political controversey, I agree, it's unlikely we'll cover illegals with the first pass of a national health plan. But eventually we will. And my concern is that we plan for and meet all the costs head on.

 

[ERD50]

Sigh. .... I didn't want that to become the topic for discussion...

Now... back to health care?

Well, once we get some kind of number (even a rough number, or a range), we can determine if it is a big deal or not. If not a big deal, the subject should be dropped. If it *is* significant, then it *is* part of the health care discussion.

Not talking about it won't make it go away.

-ERD50

 

[youbet]

I say that the goal is to insure us first, not to insure non-citizens or at least non-permanent residents. It would be risky public policy and is not commonly done elsewhere.

.

As stated in my post above Martha, I'm sure that looking at how other countries do this is not appropriate. We are a country of immigration and where we have have looked away from the problem of controlling our borders. Now we have many millions of undocumented folks living here and many millions of voters supporting them. And, of course, a number of high profile politicians fighting for them too.

Yes, Canada controls its borders and doesn't insure non-citizens. We don't control our borders and we'll likely (but perhaps as a modification to the original plan for political reasons) insure all who arrive, legally or illegally. Our history would be congruent with that.

I would support that policy as long as we do a good job of estimating the cost and establish taxes to pay the cost in full, real time. No bills coming later for the next generation to struggle with. They already have SS and Medicare to deal with.

 

[Martha]

Well, once we get some kind of number (even a rough number, or a range), we can determine if it is a big deal or not. If not a big deal, the subject should be dropped. If it *is* significant, then it *is* part of the health care discussion.

Not talking about it won't make it go away.

-ERD50

The problem is that a discussion board is not a good place to talk about these things in detail. How many studies should one cite? I don't really want to sit here with a lap full of Dartmouth, Harvard, and congressional committees studies, hearing transcripts, census and BLS stats, and GAO reports to work up a good response to every issue. At best, we seem good at pointing to possible issues.