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Old 01-03-2009, 09:22 AM   #61
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Hey, I was just thinking, didn't Mr. Obama propose or suggest the same health coverage or equivalent plan as those in congress? I don't know anything about their coverages and/or costs but I'll bet it's something to behold. Does anyone remember that subject coming up on the campaign trail? Why it that sticking in my mind? Refresh my memory.
I recall Edwards using the "same as Congress" line.

This seems like a good 2-page overview of Obama's statements from an independent source. I see voluntary enrollment in "a new public plan". I also notice a real shortage of numbers. http://www.kff.org/uninsured/upload/...m_Proposal.pdf
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Old 01-03-2009, 09:39 AM   #62
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One big issue to me is defining "affordable". Do you have any numbers for that?

I want attempt to put exact numbers on this since the cost is different for each person/family depending on number of persons and locality in the present system. But I will say I would be more than happy to continue paying what I presently pay for my (group) family coverage. With my situation and employer, when a person retires you are basically thrown to the wolves. This is even after 30 years of service. I haven't got it down to exact numbers yet but will need to pretty soon. My best estimate to continue something close to the coverage I have would be over half my retirement check per month for private insurance. It would be almost impossible to live on whats left. Of course I will be doing some shopping when I'm a little closer to my retirement date. It sure would bring a smile to my face if something comes to the forefront in the next year or so. It will probably make the difference in my decision to continue working or give the job up to others.
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Yes, I'd be happy to just continue with my group coverage, too. My employer said that it paid about 90% of the premium on my health insurance, leaving me with only 10%. According to this source, the average worker is paying about 25%. Yearly Premiums For Family Health Coverage Rise To $12,680 In 2008, Up 5 Percent As Many Workers Also Face Higher Deductibles - Kaiser Family Foundation

I think that those of us with "good" group coverage tend to underestimate the actual cost of medical care while we're working. We can be shocked to find out how expensive it is when we have to get it on our own. As I mentioned above, we hear that the US spends 16% of GDP on health care, but have trouble converting that number into 20% of gross income, every year of our lives.
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Old 01-03-2009, 09:44 AM   #63
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Yes, I'd be happy to just continue with my group coverage, too. My employer said that it paid about 90% of the premium on my health insurance, leaving me with only 10%. According to this source, the average worker is paying about 25%. Yearly Premiums For Family Health Coverage Rise To $12,680 In 2008, Up 5 Percent As Many Workers Also Face Higher Deductibles - Kaiser Family Foundation

I think that those of us with "good" group coverage tend to underestimate the actual cost of medical care while we're working. We can be shocked to find out how expensive it is when we have to get it on our own. As I mentioned above, we hear that the US spends 16% of GDP on health care, but have trouble converting that number into 20% of gross income, every year of our lives.
As a data point, I'm in an HSA-eligible HDHP plan with a $2500 family deductible. According to our open enrollment materials, the company pays about $600 a month for it (employee + spouse coverage level) and our share of the premium cost is about $93. That includes an employer match into the HSA which, for us, is $1000 for 2009.
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Old 01-04-2009, 04:14 PM   #64
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I am optimistic that sincere health care improvements will be made. There are more and more stories being published about people either dieing prematurely or going bankrupt trying to pay for health care.

It seems that Congress and the President are both "of a mind" that improvements need to be made.

For my family personally, we've exhausted my work health insurance benefits, and also exhausted the cobra benefits. We are currently on an expensive high deductible private health insurance plan that unfortunately has some existing conditions excluded. So we are hoping for improvements in our own situation through any number of possible changes(medicare for 55+ age people, etc.). Even just moving toward mandatory health insurance for all and eliminating pre-existing conditions would be an improvement for us.

It's not that we're not willing to pay a fair price for health insurance. We've paid all our lives for it already and used it very little. It just needs to be accessible to all and not over-priced so much to make it impossible to pay for.
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Old 01-05-2009, 11:32 AM   #65
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As a data point, I'm in an HSA-eligible HDHP plan with a $2500 family deductible. According to our open enrollment materials, the company pays about $600 a month for it (employee + spouse coverage level) and our share of the premium cost is about $93. That includes an employer match into the HSA which, for us, is $1000 for 2009.
If I understand this correctly, the premium for this plan is $693 per month or $8,316 per year. In addition, there can be $2,500 of out-of-pocket expense for the deductible (I'm not sure it that includes a co-pay). That's a little less than the Kaiser average for a "family", but it appears that you don't have children in this plan.

My comment on "affordable" is about the total cost of health care. It's especially eye-opening for seniors because costs go up with age. I've been doing a little digging, and ended up with this estimate of U.S. per capita spending for 2008:

00-18 $3,383
19-44 $4,302
45-54 $6,650
55-64 $9,940
65 + $18,888

I expect that most ERs in the 55-64 age group aren't expecting to pay nearly $10,000 per person for health care.

(This is total spending, which can be paid by private insurance, out-of-pocket, Medicare, Medicaid, etc. It includes long term care, but excludes insurance administration expenses.)
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Old 01-05-2009, 11:48 AM   #66
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If I understand this correctly, the premium for this plan is $693 per month or $8,316 per year. In addition, there can be $2,500 of out-of-pocket expense for the deductible (I'm not sure it that includes a co-pay). That's a little less than the Kaiser average for a "family", but it appears that you don't have children in this plan.

My comment on "affordable" is about the total cost of health care. It's especially eye-opening for seniors because costs go up with age. I've been doing a little digging, and ended up with this estimate of U.S. per capita spending for 2008:

00-18 $3,383
19-44 $4,302
45-54 $6,650
55-64 $9,940
65 + $18,888

I expect that most ERs in the 55-64 age group aren't expecting to pay nearly $10,000 per person for health care.

(This is total spending, which can be paid by private insurance, out-of-pocket, Medicare, Medicaid, etc. It includes long term care, but excludes insurance administration expenses.)
From this chart, which I do not question, I wonder what the actual "out of pocket" expenses to a couple (or per person) actually averages. If one has Medicare, a low cost (or third party payer policy) supplemental policy without co-pays (or alternatively with reasonable co-pays) I would think the "out of pocket" expenses may be just a smallish fraction of the chart figure.

Personally, we pay only MEDICARE premiums ($1,156.80 per person) and have no other "out of pocket" expenses and we are 70/68 years of age. I wonder how the chart makers came up with the almost double cost as one moves into MEDICARE eligibility.
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Old 01-05-2009, 12:12 PM   #67
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Right now we are paying $6, 532/year for a 57yo/55/23(college student) family of three. This is from Golden Rule(United Health Care private insurer) for a $5,000 deductible/person(100% coverage after meeting deductible) health insurance policy with an exclusion for a condition I had when we started the insurance.

So add in our personal costs pre-deductible and it's not hard to see spending $11,532/yr, $16,532/yr or more if one/two people needed any care at all involving hospitalization in the same year.

Of course, any costs for the excluded condition I have or any "related complications" are not covered at all, and increase this cost.

I do not think these costs are horribly outrageous, however, I hope the new administration and congress will help out to some degree. Even just eliminating the exclusion would help us.

After all, all of us retirees have paid huge amounts of money over the 25-30 years of working and probably taken very little back in health care costs. At least that was the case for my family. That's the way insurance is supposed to work - you don't bankrupt the people whose house burns down, you shouldn't bankrupt the people who need health care.
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Old 01-05-2009, 12:15 PM   #68
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From this chart, which I do not question, I wonder what the actual "out of pocket" expenses to a couple (or per person) actually averages. If one has Medicare, a low cost (or third party payer policy) supplemental policy without co-pays (or alternatively with reasonable co-pays) I would think the "out of pocket" expenses may be just a smallish fraction of the chart figure.
One could chart out a best/average/worst case, I suppose.

For anyone with employer-subsidized insurance, "worst case" would have to include not only health issues causing you to hit the plan's out of pocket maximum, but also losing the employer subsidy and finding your own or going the COBRA route.
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Old 01-05-2009, 01:01 PM   #69
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here's some excerpts from a pretty good cnn article talking about the prospects for health care insurance improvements:

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The cost of providing health insurance to employees continued to skyrocket, jumping by an average of 5.7% per employee after a 6.1% hike in 2007...

health care was the number-one concern of small business owners....

the recent "Call to Action" issued by Sen. Max Baucus (D-Mont.) echoes Obama's plan, but with the added wrinkle that coverage would be mandatory. That's a controversial measure, but one that health experts say is key to keeping premiums low - and it could help get insurance companies on board. Most observers expect health-care reform to wait until after an economic stimulus package is dealt with, but not too long after. The forecast: Smaller reforms are likely in 2009, followed by a full-on throwdown over a major health insurance overhaul in 2010.
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Old 01-06-2009, 09:09 AM   #70
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From this chart, which I do not question, I wonder what the actual "out of pocket" expenses to a couple (or per person) actually averages. If one has Medicare, a low cost (or third party payer policy) supplemental policy without co-pays (or alternatively with reasonable co-pays) I would think the "out of pocket" expenses may be just a smallish fraction of the chart figure.

Personally, we pay only MEDICARE premiums ($1,156.80 per person) and have no other "out of pocket" expenses and we are 70/68 years of age. I wonder how the chart makers came up with the almost double cost as one moves into MEDICARE eligibility.
I certainly agree with the comment that out-of-pocket costs are just a fraction of the total cost of health care for most people. Most of the costs are picked up by the employer share of group insurance or by the taxpayers. This source gives OOP share as somewhere in the teens for all age groups http://www.cms.hhs.gov/NationalHealt...age-tables.pdf page 3. (Note that the employee share of premiums is not included in their definition of "out of pocket".)

I think that's part of the political problem with "health care reform". Lots of people underestimate the actual spending. And, many people think the "solution" is shifting the cost to "someone else".

I also have to agree with Barker that it seems like if you've been paying into "the system" all your life, and you know you've been overpaying because premiums don't vary by age, it seems wrong to find that you don't get any benefit for all those years of premium payments when you get older. (I thought HIPAA was supposed to deal with the pre-existing condition problem, but I'm willing to believe there are problems with that, too.)
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Old 01-06-2009, 09:33 AM   #71
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(I thought HIPAA was supposed to deal with the pre-existing condition problem, but I'm willing to believe there are problems with that, too.)
The problem with HIPAA is that even if you jump through all the hoops, at the end of the day it says nothing about the affordability of a policy offered with no exclusions for preexisting conditions.

There's nothing at the federal level that requires insurers to price these policies affordably, so there's really little protection for people with preexisting conditions. (Some state laws may help, though, that vary from state to state.) So ultimately, in many states, for all intents and purposes all that's left is the state high risk pool.
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Old 01-06-2009, 09:59 AM   #72
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There's nothing at the federal level that requires insurers to price these policies affordably, so there's really little protection for people with preexisting conditions.
To the degree that the marketplace is efficient, we would expect insurers are charging based on the costs they expect to incur for people with pre-existing conditions. I think when people say "affordable insurance for people with pre-existing conditions" we know they really mean "insurance premiums that will not cover the costs of care that is likely to occur. These costs are shifted to someone else."

"Affordable" housing, "affordable" health care--"affordable" is the current codeword for "below market rate, provided under mandate and paid for by others."
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Old 01-06-2009, 10:10 AM   #73
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To the degree that the marketplace is efficient, we would expect insurers are charging based on the costs they expect to incur for people with pre-existing conditions. I think when people say "affordable insurance for people with pre-existing conditions" we know they really mean "insurance premiums that will not cover the costs of care that is likely to occur. These costs are shifted to someone else."
This is why we need to make sure that everyone has insurance. Pay in while young and healthy, maybe take more out later.

If it was true insurance preexisting conditions would never be covered. What we are after is a way to pay for medical care which doesn't break the bank for both individuals and us all.
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Old 01-06-2009, 11:02 PM   #74
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This is why we need to make sure that everyone has insurance. Pay in while young and healthy, maybe take more out later.

If it was true insurance preexisting conditions would never be covered. What we are after is a way to pay for medical care which doesn't break the bank for both individuals and us all.
I wonder if there's any way to do this without breaking the federal bank and without rationing in some form or another. This "rationing" could be a very different kind of medical care system than we have now, for example a system of walk-in minor injury care clinics, like they have at some Walmarts which are very inexpensive.

But I wonder if in the year 2020 for example if elderly people will still be receiving heart bypass operations and elaborate cancer treatments that cost several hundred thousand dollars and paid for by Medicare?

When looking at our federal budget and current deficit it's hard for me to see how our country going forward can afford to pay for the same standard of care for the elderly.
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Old 01-07-2009, 08:28 AM   #75
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When looking at our federal budget and current deficit it's hard for me to see how our country going forward can afford to pay for the same standard of care for the elderly.
In today's system we expect our private companies to pay the majority of health care costs. I've read that both GM and Chrysler would be profitable today if they were not having to pay for employees and retirees health care. Companies in Japan, China, India, Europe, etc., don't have this expense.

So we pay it one way or the other... might as well pay it the cheapest and lowest overhead way possible - "Medicare for all" for instance.
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Old 01-07-2009, 09:20 AM   #76
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So we pay it one way or the other... might as well pay it the cheapest and lowest overhead way possible - "Medicare for all" for instance.
"Medicare for all" -- at least the form encouraged by HR 676 pushed by Dennis Kucinich and others -- is a colossally regressive tax and a giveaway for upper and upper-middle class early retirees since it is almost exclusively funded by payroll taxes (like Social Security and Medicare).

If "universal health insurance" were funded primarily by payroll taxes, the massive whooooooosh you hear is the sound of 50-somethings and early 60-somethings rushing to give their notice to their employer, since they were only working for the health insurance. Plus, they wouldn't pay for it since they have no earned income to tax!

Plus a lot of doctors now won't take new Medicare patients as it is. What if everyone became a Medicare patient with Medicare's reimbursement rates?
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Old 01-07-2009, 10:47 AM   #77
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The problem is we think individually, not collectively. When young we don't need much health care and think "why should I pay for some old fart". However, as we age, we need more and more health care and assuming most of us will age to some point, we have to fund such care.

You can be healthy one moment, and things can change in a flash. Same thing with a home, you think it cannot burn down, but in a flash "sh-t happens"

Insurance however you look at it is simply funding and spreading the risk, plain and simple. So some sort of comprehensive plan must be made for our rather large risk pool and in insurance terms, the greater the pool, the more efficient the scheme will work. Perhaps this can be done on a regional mutual type of basis, but however it is done it takes the sting away from those who are hard hit.
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Old 01-07-2009, 11:40 AM   #78
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If "universal health insurance" were funded primarily by payroll taxes, the massive whooooooosh you hear is the sound of 50-somethings and early 60-somethings rushing to give their notice to their employer, since they were only working for the health insurance. Plus, they wouldn't pay for it since they have no earned income to tax!

Plus a lot of doctors now won't take new Medicare patients as it is. What if everyone became a Medicare patient with Medicare's reimbursement rates?
Two thoughts on the early retiree angle. First, with unemployment expected to approach 10% (and in real numbers considerably more) those folks who could retire early would be helping the unemployed. Second, I've read that Americans in general do not save much, so the number of people ready to retire if their health insurance needs are satisfied is perhaps less than you and I would think. And I don't read anywhere that health insurance will become free, so folks have to assume the costs of health insurance and everything else too.

On the doctors not serving medicare patients, there is a lot of work to be done on that front in any case. I don't know solutions to that one - but it has to be worked on.

Agree on the insurance pool concept jug, that's the biggest problem right now - people are having to buy private insurance with individual underwriting and pre-existing health exclusions. If they could just solve this one issue, it would help early retirees tremendously.
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Old 01-07-2009, 11:52 AM   #79
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If "universal health insurance" were funded primarily by payroll taxes, the massive whooooooosh you hear is the sound of 50-somethings and early 60-somethings rushing to give their notice to their employer, since they were only working for the health insurance. Plus, they wouldn't pay for it since they have no earned income to tax!

Plus a lot of doctors now won't take new Medicare patients as it is. What if everyone became a Medicare patient with Medicare's reimbursement rates?
I think there's an internal inconsistency between your paragraphs. People will be flocking out of their employer-sponsored plans to get into the sinking boat of Medicare--where they won't be able to find a doctor?

Now, if employers drop the coverage they provide anyway (which is entirely possible), then employees ae highly likely to retire. If companies don't want this to happen, maybe they'll sweeten the pot by offering some type of Medicare adjunct coverage.
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Old 01-07-2009, 11:58 AM   #80
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Now, if employers drop the coverage they provide anyway (which is entirely possible), then employees ae highly likely to retire.
Well, that was implicit but not stated -- after all, if part of the reason to do this (in theory) would be so U.S. businesses (such as the automakers) aren't at a competitive disadvantage to foreign-based automakers because of health insurance costs, it stands to reason that most employers would feel little need to continue paying for health insurance as know it. Indeed, HR 676 would require employers to match employee payroll taxes to pay for health care, so they'd pretty much have to drop their coverage or else this increases their costs substantially, not make them more globally competitive.

Obviously, if every patient became a Medicare patient, doctors would have three choices:

(1) Accept new Medicare patients;

(2) Become a "boutique" provider for the well-heeled willing to pay their own money for doctors and procedures that Medicare won't cover;

(3) Retire or find a new line of work.
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