No health care for you! Come back one year...

[ziggy29]

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Originally Posted by eridanus If you have concerns about your health and don't want the results disseminated, go to a doctor that doesn't take your health plan (some don't take ANY health plans). Pay with cash. Carefully read the privacy form you're given. If something is found, and it's expensive to test or treat it, go back to the first doctor and get insurance to cover it. Unethical? Perhaps. But it beats being denied because a benign polyp was found.

Wouldn't you have to lie on your insurance application to do this?

[eridanus]

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Originally Posted by ziggy29 Wouldn't you have to lie on your insurance application to do this?

You mean for any future applications? Depends on the question and depends on the results.



Have you had any symptoms of sleep apnea? (I sometimes snore when I have a cold. Snoring is a symptom. Does that count?)

Have you ever had a headache? (I was hiking in the desert and got a heat headache. I was dehydrated, too.)

Have you ever had acne? (Yes. I was 17.)

Have you ever had a muscular disorder? (Does a sprained ankle count? It's an "irregularity," which is a "disorder" according to Webster's.)

Have you ever had chest pain? (A frige fell on me once and hit my chest.)

Have you ever had anxiety? (I was really worried about a physics final in college.)

[lets-retire]

Quote:

Originally Posted by eridanus You mean for any future applications? Depends on the question and depends on the results. Have you had any symptoms of sleep apnea? (I sometimes snore when I have a cold. Snoring is a symptom. Does that count?) Have you ever had a headache? (I was hiking in the desert and got a heat headache. I was dehydrated, too.) Have you ever had acne? (Yes. I was 17.) Have you ever had a muscular disorder? (Does a sprained ankle count? It's an "irregularity," which is a "disorder" according to Webster's.) Have you ever had chest pain? (A frige fell on me once and hit my chest.) Have you ever had anxiety? (I was really worried about a physics final in college.)

Those questions are vague for a reason. They want to illicit the exact answers you are giving and it is a lawyers argument. What does "must" mean really is simply playing "words" with the application. The simple answer to your questions is if the questions are vague or can be interpreted in different ways, interpret in the manner that most suits you. The insurance company is going to interpret the question in the manner that most suits them, but they have lawyers on staff and can came up with questions that only have one interpretation if they wanted. If however they ask if you've ever been diagnosed with polyps (benign or otherwise) then answering no, when you had is not unethical, it is illegal and called fraud.

[Zoocat]

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Originally Posted by MichaelB You gotta start somewhere. My preference would be to begin with universal access and no underwriting – put in place a structure that lets consumers shop and change. An expanded public offering, fully priced. Then I would eliminate the tax benefit for employers. Then I would expand coverage for those that can’t pay. Then reform the punitive damages and develop a national arbitration process for malpractice.

Your suggestions are great. And I think that health insurance reform is going to necessarily be a process. One step that should be taken soon is to ban health insurance company lobbyists. They are spending millions to influence the outcome. I would also like to see the administrative overhead costs reduced considerably. Not sure how unless we get rid of the for profit system.

I'm not very happy at this point with the way the proposed reforms are being presented. I wish congress would detail how the savings are going to occur so that we don't add to the national debt (like Bush's prescription drug plan).

[Lakewood90712]

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Originally Posted by oliverdickens Am I understanding this right or missing something? It states under the #Making health care affordable section", that the provisions stated within the bill with not start until 2013! Four years to implement? So it would mean none of the provisions would occur until than? If that is the case, so much for all the buzz around immediate implementation that the WH is advertizing? Appreciate the experts on this forum interpretation. Thanks

A distant timeframe for several reasons:

1. Plenty of time for stakeholders to restructure and still make money as providers.

2. To allow large investors ( Hedge funds, Mutual Funds ,etc. ) to get out of medical related stocks if they don't want to be a part of it.

3. To allow stakeholders , like insurance executives , elected officials etc. to retire or term-out . This is nothing new. A lot of new laws/ regulations are done this way.

4. For the optomist , the economy may be better and able to handle the cost.

The thing coud be done in 18 mo. , good or bad . But the political landscape will not allow it now.

[samclem]

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Originally Posted by Oldbabe One step that should be taken soon is to ban health insurance company lobbyists. They are spending millions to influence the outcome.

I think this is unconstitutional as well as impractical. Is there some reason that this particular industry should not be allowed free speech? To insure purity of the process, I suppose we could also muzzle other special interests with a stake in the US health care system. But who then would take the legislators on ski trips and pay for their campaigns after we ban lobbying/contributions from unions, employers, doctors, nurses, and ambulance drivers?

[eridanus]

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Originally Posted by lets-retire If however they ask if you've ever been diagnosed with polyps (benign or otherwise) then answering no, when you had is not unethical, it is illegal and called fraud.

Give me a moment while I shed some tears for the poor insurance companies. (

I wrote, in response to lying on the application, it "[d]epends on the question and depends on the [test] results." Perhaps you didn't read that sentence. In any case, applications rarely ask such specific questions.

[ERD50]

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Originally Posted by eridanus Give me a moment while I shed some tears for the poor insurance companies. (

I dunno, my "moral compass" says that legalities and fraud are not a one-way street. At any rate, the cost of fraud will be passed onto the customer....

Quote:

In any case, applications rarely ask such specific questions.

Here's an excerpt from the application to get my son some catastrophic coverage ($5K deductible). Have you ever applied for coverage? This looks pretty specific to me. (edit/add) In fact, every single question you listed, without exception, is specifically included (apnea, headache, acne, muscular disorder, chest pain, anxiety)

Quote:

Has any person applying for coverage been advised, counseled, tested, diagnosed, treated, hospitalized or recommended for treatment within the last 10 years for the following: Please check Yes or No. If any boxes are checked “Yes” ( Yes), also circle the condition, e.g. migraines , and give details on the next page. " " " A. Migraines; headaches; carpal tunnel syndrome; seizure disorder; paralysis; multiple sclerosis; any neurological disorder, or any disorder of the central nervous system? ................. Yes No B. Attention deficit disorder; anxiety, depression or chemical imbalance; any behavioral, emotional or eating disorder; mental retardation; bipolar disorder or psychosis; psychotherapy; marital or any form of counseling or therapy? ...... Yes No C. Chest pain or palpitations; heart murmur; mitral valve prolapse; heart attack, stroke or TIA, any other heart or circulatory disorder or condition, or hypertension/high blood pressure (HBP)?......... Yes No If “Yes” to HBP, provide 3 readings and their dates w/in the last year D. Varicose veins/spider veins/varicosities; elevated cholesterol or lipids; anemia; blood clot or any other blood disorder?......................................... ...... Yes No E. Asthma; allergies; sinusitis; bronchitis; pneumonia; tuberculosis; apnea; chronic obstructive pulmonary disease (COPD); emphysema; or any breathing difficulty, lung or respiratory disease, disorder or condition? ........ Yes No F. Hernia; colitis; chronic diarrhea or intestinal problems; hemorrhoids or rectal disorder; gastroesophageal reflux; any disorder of the esophagus; ulcer of the stomach or duodenum, or any other digestive disorder or condition? ............................................. Yes No G. Any disease or disorder of the gallbladder, pancreas or liver; elevated liver function tests; cirrhosis; hepatitis? (indicate type of hepatitis )..... Yes No H. Cancer; tumor; growth; cyst; polyp; enlarged lymph nodes; leukemia? (indicate diagnosis and location ) ..... Yes No QUESTION CONTINUES AT RIGHT I. Acne; keratosis; psoriasis; basal cell carcinoma; lesions of the skin or mouth, or any other skin disorder? ......... Yes No J. Kidney stones; reflux; urinary incontinence or any infection or disorder of the urinary tract, bladder or kidney? ...... Yes No K. Breast cyst or nodule; gynecomastia; fibrocystic breast disease; breast implants, or any other disease or disorder of the breast?........................................... ......................... Yes No L. Arthritis (osteo, rheumatoid, psoriatic); bursitis; herniated, bulging or slipped disc; gout; temporomandibular joint syndrome (TMJ); any injury to, disease or disorder of the spine, back, knees, jaw, bones, muscles, or joints; bunions; joint replacement; or manipulation therapy? ................ Yes No M. Thyroid disorder; goiter; Graves disease; diabetes; lupus; pituitary or adrenal disorder?......................................... . Yes No N. Cataracts; glaucoma; hearing loss; deviated nasal septum; or any eye, ear, nose or throat disorder? ........................ Yes No O. Acquired Immune Deficiency Syndrome (AIDS); AIDS-Related Complex (ARC); HIV positive or other immune disorders?........................................ .................. Yes No P. Question for Male Applicants and Dependents Only Prostate disorder; elevated prostate specific antigen (PSA); sexually transmitted disease; genital warts; herpes; impotence; infertility or any other disease or disorder of the genital or reproductive system? .................................................. .... Yes No Q. Question for Female Applicants and Dependents Only Fibroid or uterine tumor; ovarian cyst; endometriosis; cystocele/rectocele; abnormal pap smear; infertility; sexually transmitted disease; genital warts; herpes; or any other disease or disorder of the genital or reproductive system? ........ Yes No

-ERD50

[ERD50]

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Originally Posted by samclem I think this is unconstitutional as well as impractical. Is there some reason that this particular industry should not be allowed free speech? To insure purity of the process, I suppose we could also muzzle other special interests with a stake in the US health care system. But who then would take the legislators on ski trips and pay for their campaigns after we ban lobbying/contributions from unions, employers, doctors, nurses, and ambulance drivers?

As much as we malign lobbyists (rightfully in most cases, IMO), there is a place for them.

I worked with a guy who had some research responsibilities for environmental compliance for our MegaCorp. He explained to me one time that a bill was in committee that would have been very difficult to comply with. His team provided some alternate methods that would achieve the same final results, but with much less impact on the manufacturers (an ultimately the consumer). That's a good case for lobbying, IMO.

Of course, I think bills should rarely get that specific - set a goal and let the market figure out the process to achieve it.

-ERD50

[eridanus]

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Originally Posted by ERD50 I dunno, my "moral compass" says that legalities and fraud are not a one-way street. At any rate, the cost of fraud will be passed onto the customer....

Ok.

Quote:

Here's an excerpt from the application to get my son some catastrophic coverage ($5K deductible). Have you ever applied for coverage? This looks pretty specific to me. (edit/add) In fact, every single question you listed, without exception, is specifically included (apnea, headache, acne, muscular disorder, chest pain, anxiety)

Well, of course. The questions I posted were also from an application. It includes "symptoms."

I wouldn't lose any sleep if someone neglected to mention their cancerous growth to get medical coverage. In fact, some doctors have been known to assist their patients in doing so.

[ERD50]

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Originally Posted by eridanus I wouldn't lose any sleep if someone neglected to mention their cancerous growth to get medical coverage. In fact, some doctors have been known to assist their patients in doing so.

I understand. Desperate people will take desperate measures. I think that is why so many of us are in favor of universal coverage. Just gotta find a reasonable way to do it.


-ERD50

[Martha]

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Originally Posted by ERD50 I dunno, my "moral compass" says that legalities and fraud are not a one-way street. At any rate, the cost of fraud will be passed onto the customer.... Here's an excerpt from the application to get my son some catastrophic coverage ($5K deductible). Have you ever applied for coverage? This looks pretty specific to me. (edit/add) In fact, every single question you listed, without exception, is specifically included (apnea, headache, acne, muscular disorder, chest pain, anxiety) -ERD50

Note how the specific is followed by the open ended and ambiguous. For example, "any breathing difficulty," "any other digestive disorder or condition," "enlarged lymph nodes," etc.
Obviously ambiguous and could easily include symptoms long forgotten or insignificant. Even the requirement to list any abnormal pap smears is problematic. You could have had one when you were 18 and never again. You might forget when applying for insurance at age 55. Innocent mistakes and immaterial omissions should not be grounds for cancellation of a policy.

In some ways I am glad I am on the risk pool.

[Martha]

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Originally Posted by ERD50 The numbers in wiki get ref'd back to: Overview National Health Expenditure Data I guess I wouldn't be surprised at differences, the methodology might not be the same, and they might not be apples-to-apples at all. But in a more general sense, whatever number we use, I am having trouble with the "conclusion", which seems to be (paraphrasing) - Canada has lower admin costs, Canada has single payer, so if US had single payer, the US would have lower costs. I think that the reasons that the US has higher costs are much more complex than that. You know, what we really need is a document like the "energy conservation without the hot air". David MacKay: Sustainable Energy - without the hot air: Industry leaders Something that would line up all these costs and show the relative amounts and what can be clipped and what cannot. When we talk about changing one, it might just shift the cost somewhere else. We need the big picture. -ERD50

Those figures don't jibe with the huge amount of data I have read on admin costs. I think that they are omitting the admin costs of the providers and put each provider in a separate category. It is impossible to trace back their data.

What we do know and is supported by significant research is that the US is very high on admin costs at about 1/3 of the health care dollar, and as compared with single payer systems. Now the question is whether we can reduce those costs without single payer.

[samclem]

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Originally Posted by Martha One issue with the CBO analysis is that it does not take into account any savings from use of best practices as they are too hard to quantify. At least Obama is emphasizing the need to get cost down through better practices.

Martha, do you happen to know if the new CBO analysis mentioned below captures the cost savings you referenced?

Quote:

Underscoring the challenge, the Congressional Budget Office on Saturday issued a report finding that relatively little savings would be realized by one of the few deals reached between party leaders and moderate Democrats who want to change the health bill: an agreement to create a panel to find cost savings in Medicare. The report said the proposal, which the White House is pushing as a crucial, cost-saving change to the legislation, would save $2 billion over 10 years.

Link (Might require subscription):
Idea to Tax Insurers Gaining Traction(WSJ)

[Martha]

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Originally Posted by samclem Martha, do you happen to know if the new CBO analysis mentioned below captures the cost savings you referenced? Link (Might require subscription): Idea to Tax Insurers Gaining Traction(WSJ)

I don't know. I'll see what I can find out. Though it does seem unlikely as they said the savings from best practices are too hard to quantify.

[ERD50]

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Originally Posted by Martha Those figures don't jibe with the huge amount of data I have read on admin costs. ... What we do know and is supported by significant research is that the US is very high on admin costs at about 1/3 of the health care dollar, and as compared with single payer systems.

I have no idea which, if any, of those numbers are correct.

Quote:

Originally Posted by Martha Now the question is whether we can reduce those costs without single payer.

But as I stated before, whichever numbers we use.... it is also a legitimate question to ask whether the US can reduce those costs with single payer. You seem to keep pushing single payer on what appears to me to be an 'a priori' argument.

Quote:

Originally Posted by Martha Note how the specific is followed by the open ended and ambiguous. ... Innocent mistakes and immaterial omissions should not be grounds for cancellation of a policy. In some ways I am glad I am on the risk pool.

I agree, it is a minefield. I was very nervous as we filled it out, trying to remember everthing that occured. Since we had ins all the time he was a child, and I could not deduct medical, my records are not that great. To us, if an event was over, it was over.

I did a bit of research and learned that IL has a risk pool somewhat similar to Minn (125-150% of group rates, no cancellation). There are 43 pages of details to slog through, it looks like you need to be covered by some plan for 18 months prior to qualify. I'll review this with my son, there may be a few things he would want to do just to stay eligible, just in case.

-ERD50

[Martha]

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Originally Posted by ERD50 I have no idea which, if any, of those numbers are correct. But as I stated before, whichever numbers we use.... it is also a legitimate question to ask whether the US can reduce those costs with single payer. You seem to keep pushing single payer on what appears to me to be an 'a priori' argument. I agree, it is a minefield. I was very nervous as we filled it out, trying to remember everthing that occured. Since we had ins all the time he was a child, and I could not deduct medical, my records are not that great. To us, if an event was over, it was over. I did a bit of research and learned that IL has a risk pool somewhat similar to Minn (125-150% of group rates, no cancellation). There are 43 pages of details to slog through, it looks like you need to be covered by some plan for 18 months prior to qualify. I'll review this with my son, there may be a few things he would want to do just to stay eligible, just in case. -ERD50

Well, you can do your own research but I am comfortable that we know that admin costs of single payer are much less than our admin costs. That is the only thing that I am pushing about single payer. This isn't battles of the researchers. Researchers agree that our admin costs run at over 30%. I guess it is time for me to work on editing the wiki article with the misleading information. But the real question is how can we reduce admin costs without single payer as we are not going to get single payer. That is why I keep pressing the issue. If we can't reduce admin costs we will continue to be in big trouble.

My argument is not a priori, it is based on comparison of other countries with ours and what makes up our higher admin costs. For example, the size of billing departments in Canadian hospitals are a tiny percentage of the size of billing departments in US hospitals. (Sorry, can't remember exact numbers). We know that we spend a lot of money dealing with different payment mechanisms. We would save that money if there was only one payer. That doesn't mean that there wouldn't be other worries from single payer, but admin costs are very likely to be reduced.

Yes, Illinois like Minnesota uses a risk pool if you are HIPAA eligible, that is covered by a group plan on the last day of your current insurance and have 18 months of continuous coverage. My health care FAQ covers HIPAA eligibility requirements.

[samclem]

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Originally Posted by Martha For example, the size of billing departments in Canadian hospitals are a tiny percentage of the size of billing departments in US hospitals. (Sorry, can't remember exact numbers). We know that we spend a lot of money dealing with different payment mechanisms. We would save that money if there was only one payer. That doesn't mean that there wouldn't be other worries from single payer, but admin costs are very likely to be reduced.

Maybe this is another area that is amenable to government standardization with private sector implementation (just as standardization of private insurance policy types could be). If the government established a standardized billing format for use by all insurers and providers, the admin costs would be reduced considerably. Better yet--the govt could threaten such a thing (after what we've seen to date, is there anyone who wouldn't believe this government would do it?) and the private insurers and HC providers could instead for a voluntary industry group to set and enforce the standards.

It seems to me that the high admin costs are likely due to the number of different insurance billing systems, not the existence of private (vs public) insurers.

[Martha]

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Originally Posted by samclem Maybe this is another area that is amenable to government standardization with private sector implementation (just as standardization of private insurance policy types could be). If the government established a standardized billing format for use by all insurers and providers, the admin costs would be reduced considerably. Better yet--the govt could threaten such a thing (after what we've seen to date, is there anyone who wouldn't believe this government would do it?) and the private insurers and HC providers could instead for a voluntary industry group to set and enforce the standards. It seems to me that the high admin costs are likely due to the number of different insurance billing systems, not the existence of private (vs public) insurers.

I just read that in Seattle there are 755 insurance plans out there insuring Seattle residents. It isn't just a billing system, it is the differences in these policies, such as different coverages, different reimbursement amounts, and different referral networks. It is also the high overhead of insurance companies. To fully resolve you would need each plan to be the same. I hope we can do something to help with this issue.

[lets-retire]

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Originally Posted by Martha Though it does seem unlikely as they said the savings from best practices are too hard to quantify.

Something I'm having difficulty with, is the government is saying they will save hundreds of billions of dollars from implementing best practices. Going from where we are now that would mean they would be able to lower the cost of Medicare/caid so that instead of spending more than they take in, those programs would start throwing money off. Since that hasn't happened in the past I don't see how they are going to do it in the future, without a complete take over of the system. Most of the savings from requiring the implementation of best practices would go to the private insurance industry, since they provide most of the coverage. The government is expecting to cause trillions of dollars in savings throughout the industry?