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Old 11-12-2009, 12:19 PM   #141
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"What makes you think he would be able to afford the premiums on a guaranteed-issue basis if he couldn't afford them as it was? A public option would not change that. People seem to think a public option will wave its magic fairy dust and lower premiums by 50%, except they have it completely backwards."

I agree with you re: being unable to afford the premiums. All these years, he was promoting products that were in essence: breathtakingly unethical, well organized in their ability to bilk citizens out of millions of dollars, and manipulating the primal fear that we all have of losing everything we have worked so hard to enjoy.

My advocacy for a public option arises because I am fed up with business as usual. I see no argument that favors the insurance companies. I think many who work for those companies are self-serving people who have lived a lifetime dedicated to the feathering of their own nests - at the expense of others.
I would hope your agent isn't selling "breathtakingly unethical" products, unless you are simply referring to what is available from the insurance company and have a very jaded view of them. Blue Cross/Blue Shield is a non-profit organization in many states, and yet, the premiums are still expensive!

Here is the crux of the issue - if everything is guaranteed-issue with no pre-existing waiting period, younger, healthier individuals will almost certainly balk at the insanely high premiums they would be forced to pay. As more young people decide not to participate in the pool, what is left is a bunch of unhealthy older people. In comes the domino effect - premiums rise to cover the cost of claims from the pool of sick people, more healthy people find the premiums ridiculous and cancel their policies, leaving yet an even sicker pool of insureds, and so on.

Sometimes the disease is better than the cure. I am just curious, how much do you think your average family of 4 would pay for their health insurance premiums under Obamacare, whether getting a policy from the public option (if it existed) or from a private insurer?
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Old 11-12-2009, 12:24 PM   #142
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Can we get civilized and provide insurance for everyone just like other industrialized countries in the world? They pay only 10 percent of their GDP and everyone is covered while we paid 16.5 of our GDP and 46 millions are uninsured?
Probably for the same reasons that we can't provide public education that is as good as the other industrialized countries in the world, even though we spend more. Why should we expect US governement provided Health Care to be different?

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We simply need to agree upon a system wherein our neighbors are covered.
There may be a "simple" solution, but Congress does not seem very interested in that. They have all sorts of complex "solutions" that do not address the real problems. I think they are more interested in control (of various sorts) than they are in fixing any problems. The problems are a side-show in all this, just something to point to while they try to "sell" whatever it is they want us to buy.

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Old 11-12-2009, 12:25 PM   #143
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Actually, a high deductible policy covers just as much as any other higher-priced policy. You just pay more out of your own pocket in expenses before the insurance company pays anything. I'm not sure about the laws in your state or whether you have a state risk pool, but after COBRA runs out you would still be able to get guaranteed-issue coverage with no pre-existing conditions under the HIPAA law. The premiums would be very expensive but everything would be covered in full. If I was in your position and you work for a company that offers severance packages or retiree benefits, I would strongly consider exploring the option of continuing your health coverage through the company instead of going on COBRA and HIPAA. Maybe they can work something out with you to provide coverage until you are eligible for Medicare.
Thanks, I appreciate the info. We do have a state risk pool. Unless something changes, I won't have any medical retiree benefits - just 18 months of COBRA as an option. Ironically, I work for a large health system . I would like to have pre-existing conditions covered if possible.

My current game plan (unless some legislation that affects this is passed) is to wait until close to my birthday, apply for insurance and see whether I can get coverage. Then I still will probably take COBRA but I'll know if I'm likely to get declined and have to be looking at the high-risk pool.
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Old 11-12-2009, 12:29 PM   #144
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So... I will sound like a broken record, but having everyone insured does not do anything for the 'costs'.... we need cost controls... those are hard to do...

I will give a a couple of real life examples of why are costs are high. Both have happened in the last few months.

My mother had a seizure. Not good at the time, but it seemed that it might have been a reaction to the flu shot. She goes to the emergency room. They admit her and do a scan (not sure which kind). Then give her some medicines etc. Nothing more that I know of... she is admitted into the hospital where she stays for 4 days of testing and monitoring. The first benefit info showed up and the hospital bill was $30K... but the insurance amont was just under $5K. Either it cost $5K to have here there and they were charging a lot more... or they are losing money for everyone that has insurance. Not sure which. But, I am not sure why she needed to be in there 4 or 5 days.


This one is a sad one for me. I had this lady who worked for me who was diagnosed with pancreatic cancer. She was only 45, but died about a week ago. There was no hope of recovery as it had spread to her liver. Now, in another country, they would have not done anything. But she was having problems with an ulcer, so she could not eat well. So they did an operation to resection her stomach (not sure if I am getting this correct or not... but she did have a major operation). She was in the hospital for over a week. She was not able to eat well for a full month. She died less than two months after the operation. Now, compare the cost of my mother, who did not have much done to her to this lady. I bet that the 'bill' will be $60K... If you want to get the costs down, then these are the costs that have to be removed from the system.

I am not saying that she should not be able to get this procedure done, but that the cost of doing it should fall mostly on her and her family.



Back to my original premise.... we need competition on the cost side (or cost controls), not the insurance side...
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Old 11-12-2009, 12:32 PM   #145
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Dgoldenz,

Yes, after paying, since say, 1990 about $259,200 (I low-balled it) to Blue Cross; yea, I do have a jaded attitude.

Re: your question: I would like to see national health care available to all - like Medicare. Being an American citizen would give you entry. I would like to see those making over $250,000 per year (couple) have their taxes raised. I won't even get into the wall-street tar-baby.
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Old 11-12-2009, 12:39 PM   #146
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I would like to see those making over $250,000 per year (couple) have their taxes raised.
Democracy is two wolves and a sheep voting on what to have for lunch.
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Old 11-12-2009, 12:40 PM   #147
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Dgoldenz,

Yes, after paying, since say, 1990 about $259,200 (I low-balled it) to Blue Cross; yea, I do have a jaded attitude.

Re: your question: I would like to see national health care available to all - like Medicare. Being an American citizen would give you entry. I would like to see those making over $250,000 per year (couple) have their taxes raised. I won't even get into the wall-street tar-baby.
You must either have a very, very good plan or some sort of condition if you've been paying an average of $1000/month for the past 19 years. Have you ever explored the possibility of lowering your benefit level to keep your cost down, or changing carriers if you don't have any major conditions? Would you have felt better if you had paid your $259,000 and then had cancer, but were able to receive your $1 million/year cancer treatments for $13,000?

Medicare is nearly insolvent because the money that has been put into it by taxpayers has not been enough to offset the claims. Medicare is also a system that people pay into for years before they ever get to use it (usually). When talking about health insurance, most people are covered cradle to grave, so there is no 20, 30, 40 years of taxes to be paid before entering the system.

Why should those making over $250k be forced to pay for everyone else's health insurance premiums on top of paying for their own? Does everyone making over $250k get to have their health insurance for free if they have their taxes raised, or do they have to pay the same ridiculous premiums as everybody else on top of a tax increase?
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Old 11-12-2009, 12:41 PM   #148
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Where is free enterprise and a sense of fairness? If the health insurance companies are so altruistic and caring about my well-being, ...
antmary - I'm going to suggest that if this is your take on life, you are going to find frustration at every turn.

Free enterprise will produce "fairness" only because most businesses realize that if they want repeat business, they need to treat their customers well. If an industry is in a closed market, don't expect any "fairness", but that is not the fault of "free enterprise", it is the fault of closed markets.

Companies have no inherent interest in being altruistic or caring, but in a free market they usually will go out of business if they are always screwing their customers. That makes them "care". It's not perfect, but I'd rather take my chances that some company will do right by me because they are afraid of losing my business, than to count on the owner of the business being a "good guy/gal".

There have been proposals to increase competition across the insurance cos, but Congress won't go there ( ins cos are actually exempt from some anti-trust regulations - gee, who passes the laws?).

These are old ideas:
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Why Adam Smith is important

Adam Smith (1723-1790) was a Scottish philosopher and economist who is best known as the author of An Inquiry into the Nature and Causes of the Wealth Of Nations (1776), one of the most influential books ever written.


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It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our necessities but of their advantages.

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Old 11-12-2009, 12:46 PM   #149
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Companies have no inherent interest in being altruistic or caring, but in a free market they usually will go out of business if they are always screwing their customers. That makes them "care". It's not perfect, but I'd rather take my chances that some company will do right by me because they are afraid of losing my business, than to count on the owner of the business being a "good guy/gal".
Which is why I think a significant part of the problem is lack of real and transparent competition among insurers. Many consumers, depending on their employer and/or the state where they live, have an artificially limited number of options.

Even if there was a universal mandate with no underwriting or exclusions allowed, if there was real and transparent competition you'd have a lot more efficient health insurance market than we have now, and you'd see much more incentive for better customer service and cost containment. Maybe we'd start seeing statistics for the percentage of claims that are denied, too, as part of the transparency.

That's not a magic bullet by itself -- but then, nothing in this debate is, and what we need to do is look at things which might not make all the difference by itself but might help a lot in the aggregate. And that might paradoxically mean increasing government control in some areas and adding free market reforms in other areas.
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Old 11-12-2009, 12:47 PM   #150
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Re: your question: I would like to see national health care available to all - like Medicare. Being an American citizen would give you entry. I would like to see those making over $250,000 per year (couple) have their taxes raised.
OK, you are certainly entitled to your viewpoint. But could you flesh that out for us? How much would we need to raise the taxes on couples over $250,000 in order to pay for universal HC (and I mean pay for it each year, not push the bill onto future generations)?

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Old 11-12-2009, 01:00 PM   #151
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Which is why I think a significant part of the problem is lack of real and transparent competition among insurers. Many consumers, depending on their employer and/or the state where they live, have an artificially limited number of options.

Even if there was a universal mandate with no underwriting or exclusions allowed, if there was real and transparent competition you'd have a lot more efficient health insurance market than we have now, and you'd see much more incentive for better customer service and cost containment. Maybe we'd start seeing statistics for the percentage of claims that are denied, too, as part of the transparency.

That's not a magic bullet by itself -- but then, nothing in this debate is, and what we need to do is look at things which might not make all the difference by itself but might help a lot in the aggregate. And that might paradoxically mean increasing government control in some areas and adding free market reforms in other areas.
Absolutely.

And if we need to provide subsidies to the very poor--okay. But let's be reasonable: 60% of the people are not "very poor."

Regarding the "% of GDP we spend on medical care" issue: We're at the very high rate because we don't have a truly functional, efficient market for either health care or health insurance. There are only two ways to decrease the cost of health care (or anything else): Increase the supply or decrease the demand. Giving everyone access to "free" care will, unarguably, increase the demand for service. Going to a market-based approach may help moderate demand and also encourages greater supply (people will want to build rapid-care clinics, build hospitals, and study medicine if there is money to be made. We want this--it increases supply, keeps waiting times low, and moderates cost. They won't do these things if compensated at the Medicare reimbursement rate).

I want medical personnel to be smart, knowledgeable, and focused on the needs of the patient. That may not be possible at government-set rates.
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Old 11-12-2009, 01:03 PM   #152
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Dgoldenz,

Yes, after paying, since say, 1990 about $259,200 (I low-balled it) to Blue Cross; yea, I do have a jaded attitude.

Antmary says:
Re: your question: I would like to see national health care available to all - like Medicare. Being an American citizen would give you entry. I would like to see those making over $250,000 per year (couple) have their taxes raised. I won't even get into the wall-street tar-baby."

Erd,
Yes, my share has been borderline sarcastic - that is because I am so frustrated with insurance costs. "Tongue-in-cheek"

I don't know what tax rates should be. What do you think?
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Old 11-12-2009, 01:06 PM   #153
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Dgoldenz,

Yes, after paying, since say, 1990 about $259,200 (I low-balled it) to Blue Cross; yea, I do have a jaded attitude.

Antmary says:
Re: your question: I would like to see national health care available to all - like Medicare. Being an American citizen would give you entry. I would like to see those making over $250,000 per year (couple) have their taxes raised. I won't even get into the wall-street tar-baby."

Erd,
Yes, my share has been borderline sarcastic - that is because I am so frustrated with insurance costs. "Tongue-in-cheek"

I don't know what tax rates should be. What do you think?
It seems you sidestepped the questions:

Have you ever explored the possibility of lowering your benefit level to keep your cost down, or changing carriers if you don't have any major conditions? Would you have felt better if you had paid your $259,000 and then had cancer, but were able to receive your $1 million/year cancer treatments for $13,000?

Why should those making over $250k be forced to pay for everyone else's health insurance premiums on top of paying for their own? Does everyone making over $250k get to have their health insurance for free if they have their taxes raised, or do they have to pay the same ridiculous premiums as everybody else on top of a tax increase?
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Old 11-12-2009, 01:10 PM   #154
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Dgoldenz,

. I would like to see those making over $250,000 per year (couple) have their taxes raised.
It's interesting that you make your tax rate increase suggestion based on "couples." Are you a proponent of the so-called "marriage penalty?" Or, would you expand the $250k/couple filing jointly to also be $125k for single filers?
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Old 11-12-2009, 01:12 PM   #155
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I do side-step some questions, because I choose not to reply. I think we have paid much more than the $200,000+ I mentioned above. I don't have the time to do the research.

Well, I'm off to the doctor's appointment - the one who would drop me in a heartbeat if I don't have insurance!
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Old 11-12-2009, 01:26 PM   #156
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"Fix it! Charge somebody else more, and don't give the money to the people I don't like. Don't bother me with details!"
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Old 11-12-2009, 02:04 PM   #157
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There are so many varied expectations regarding what so-called "health care reform" will do. Everyone seems to want access for all and help available so the poor can pay for it. After that, expectations are all over the place..........

I do note that included in the more popular options are:

1. Today's "problems" will be fixed.

2. It will be "better."

3. It will "cost less for me."

4. Even if I'm not poor, I'll be able to game the system. (Key for asset laden FIRE types!)

5. Someone else, probably those "rich" folks, will pay for it.

6. There will be a fair way of deciding who is covered and whether full citizenship is required.


What am I leaving out?

For myself and my family, I'm just hoping we still have medical insurance when this is all done and that any extra costs I might have to pay are small enough that my FIRE status is not interupted. And, oh yeah, if we could keep our current docs and not have to go through a gatekeeper, that would be nice too. I don't think that's asking too much........
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Old 11-12-2009, 02:15 PM   #158
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dgoldinz--Be careful in these parts. The last person we had here who was in any way affiliated with health insurance finally grew tired of the insults and being called a liar when she tried to explain how the insurance business worked in her state and left.
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Old 11-12-2009, 02:34 PM   #159
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I do side-step some questions, because I choose not to reply. I think we have paid much more than the $200,000+ I mentioned above. I don't have the time to do the research.

Well, I'm off to the doctor's appointment - the one who would drop me in a heartbeat if I don't have insurance!
If you can't be bothered to take the time to research and save yourself $100,000 with about a day of work each year, you should not be complaining. If you had a good health insurance agent, you wouldn't even have to worry about doing the research yourself.


"Quick, somebody fix the problem, but let's act now and fill in the details later, the rich will pay for it one way or another!"
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Old 11-12-2009, 02:35 PM   #160
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My mother had a seizure. Not good at the time, but it seemed that it might have been a reaction to the flu shot. She goes to the emergency room. They admit her and do a scan (not sure which kind). Then give her some medicines etc. Nothing more that I know of... she is admitted into the hospital where she stays for 4 days of testing and monitoring. The first benefit info showed up and the hospital bill was $30K... but the insurance amount was just under $5K. Either it cost $5K to have here there and they were charging a lot more... or they are losing money for everyone that has insurance. Not sure which. But, I am not sure why she needed to be in there 4 or 5 days.
A few years ago the DW had a seizure where she banged her head resulting in a cut approximately 3-4 inches to her forehead. She went to the emergency room, because she did not recover from the seizure quickly enough to not raise concern (learned about seizures after her brain surgery). She had butterfly stitches applied and I think an X-ray to make sure she didn't break her skull. She also had an MRI and several blood tests done. She was released the next afternoon. The cost for that trip was $8000. This year she went into a seizure monitoring unit for a week, because the normal medication for seizures wasn't working to stop or even slow down her symptoms and she was in a general state of decline. While there she had an MRI, CAT scan, and was connected to an EEG all the time. She experienced each of the different types of "seizures" she was having while hooked up to monitors. Total cost was about $10,000. So a trip to the ER and a weeks worth of monitoring at one of the county's best hospitals cost less than the 4-5 days you mom was in the hospital. That just goes to show the the difference in health costs between different areas of the country.

The final diagnosis was the medication was causing the issues with the exception of her first seizure. That one was probably a result of passing out while she was sleeping (I didn't know that was possible until the doctor explained it).
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