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Old 02-15-2009, 10:04 AM   #121
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I think, to a large extent, we have that now, since the states allow the insurance companies to raise premiums based upon their experienced costs with a particular risk pool. Insurance companies continuously offer new products which compete with their existing policies. In order for a policyholder to switch to one of the new policies he/she usually needs to pass underwriting. This results in the "healthy" switching to the new cheaper policy, and the risk pool for those who can't now pass underwriting becomes a generally less-healthy and more expensive pool with premiums rising considerably faster than average. It turns out to be an "indirect" way for the insurance companies to raise rates on those less-healthy folks who have more claims. IMO, this is the biggest problem with our current health insurance system. The only way I can see to avoid this adverse selection is to mandate insurance for all and have everyone in the same risk pool. Any new product created by an insurance company should then be available without underwriting to anyone currently in the risk pool. Since everyone would be in this risk pool from birth, the only subsidy would be for the relatively small number who were born with a pre-existing condition, and I think that's fine. The total cost of insuring this pool would then be spread equally across all those in it, with no stratification due to adverse selection. All would pay the same premium (with a possible sliding scale based upon age).
It is commonplace for people to be in a low risk category with insurance companies tripping all over each other to insure you, then a week later you see your doctor and find out you now have [diabetes/kidney failure/slipped disc/liver abnormality/aortic aneurysm/melanoma, etc. etc.] and are now shunned like an insurance leper for the rest of your life. Just when you really need the coverage.

At least Medicare covers everything, however inadequately.
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Old 02-15-2009, 10:36 AM   #122
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Here is what worries me, and maybe others on the board. I am happy with my health care alternatives. I always have been.

Now we are about to embark on a change that will effect my health care. That worries me. While I have not facts or figures to back this up, I'll bet a significant number of the people in this country are OK with their health care. There are about 300m people in the U.S. A figure for the un-insured battered around is 40m, however, this figure would be trimmed when Medicaid is taken into consideration. At any rate, that leaves 260m with some kind of health care. I think we should be very cautious when we change the health care for 260m to accommodate the care of 40m.

Now, before the rhetoric gets out of hand, I'll concede that 260m happy customers is high, but the situation is not reversed! There are not 40M happy customers out there and 260M people fearful they will not get health care. I believe there are between 30m and 40m on medicare alone.
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Old 02-15-2009, 11:28 AM   #123
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I think our under-insurance problem in the USA and its unhealthy link to employment are in part results of too much pure free market influence.
As I understand it, it is just the opposite. It was govt intervention, not free markets, that led to the current "unhealthy link" between employment and insurance.

The govt gave employers a tax break for supplying insurance. This made the cost of the benefit of health insurance artificially cheaper than the cost of salary. So companies fought to out-do each other for health benefits to attract new employees, and the whole "value proposition" of health care was distorted by the tax break the govt offered. And that also made other means of getting insurance relatively more expensive for an individual. That created a spiral - people had even more desire to get their insurance through their employer. It also distanced the connection between the consumer of the service and the "payer" of the service, which inhibits free market efficiencies. That old law of Unintended Consequences at work again.

That paragraph summarizes why I am highly skeptical of govt offers to "help" any situation. But they are needed in some cases. We must choose wisely.

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IMHO, federal oversight should be implemented to assure universal access to health insurance, basic quality of care (from drug approval and testing to continuing medical education, licensing, etc.), and objective research among others.
Clearly, some amount of regulation and oversight is needed. But I do think that the idea of getting vouchers so that everyone is covered, and require that an ins co cannot accept any unless they are open to all (for the basic coverage) fixes a lot of the issues facing us today.


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... It turns out to be an "indirect" way for the insurance companies to raise rates on those less-healthy folks who have more claims. IMO, this is the biggest problem with our current health insurance system. The only way I can see to avoid this adverse selection is to mandate insurance for all and have everyone in the same risk pool.
That is what the voucher system would be designed to address. I could picture basic coverage, and maybe a few "upgrade" packages that would be offered w/o review for middle-to-middle/upper-class, and maybe also some "boutique" packages that could require medical tests, for those who can afford it and want it.

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Old 02-15-2009, 11:35 AM   #124
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Here is what worries me, and maybe others on the board. I am happy with my health care alternatives. I always have been.
While I might be able to say I am reasonably happy with my *current* health care alternatives, I must admit I am very afraid of what *could* happen. If my company dropped my retiree insurance, what would I do? It could be tough for some of us to get affordable coverage, depending upon pre-existing conditions.

Also, my son lost our family coverage when he graduated. He didn't have a job with coverage lined up at the time, so we had to scramble. He has coverage now, but considering that he could change jobs or get laid off, he is still in an uncomfortable position. I decided to keep the high deductible policy we got for him in effect until we have a clearer picture of his needs/risks (which may be never).


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Old 02-15-2009, 11:43 AM   #125
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I read a lot about most of these arguments, both for and against. I think a lot of it, as most things do... sort themselves into two camps of thinking.

Camp #1 (and yes this is where I am)... beleives that a vast majority of people CAN in fact find ways of taking care of themselves, but there are also a lot of lazy people out there. If a lot of the social benefits provided by the govt were suddenly removed, people would not just wonder about aimlessly, but would in fact find ways of earning what they need to survive, and this includes heathcare. People in this group believe that by and large people will rise to the challenge presented to them.

Camp#2 believes that most people are incapable of caring for themselves. That if govt social programs were removed, people would litterally die on the streets. People in this camp feel it is the moral responsibility of all those who ARE capable and responsible to take care of all those who are less so. This group tends to believe that those with more "owe" what they have to those with less.
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Old 02-15-2009, 11:46 AM   #126
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While I might be able to say I am reasonably happy with my *current* health care alternatives, I must admit I am very afraid of what *could* happen. If my company dropped my retiree insurance, what would I do? It could be tough for some of us to get affordable coverage, depending upon pre-existing conditions.
As you should be. And it's not just limited to company retiree insurance. I had private insurance with a major company, who decided to exit the individual insurance business and canceled all its existing policies. Since I had developed some "pre-exisitng" conditions I could only get a last resort BC/BS guaranteed-issue policy, which more than doubled my premium. IMO, this is the sort of thing that shouldn't happen.
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Old 02-15-2009, 12:11 PM   #127
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Here is what worries me, and maybe others on the board. I am happy with my health care alternatives. I always have been.
Me too, personally; I believe most of us who are gainfully employed (or retired) with subsidized health insurance provided for us would agree. While that is still the rather large majority of the people, the degree to which the system is broken for those who do NOT have good, heavily employer-subsidized (or government-subsidized) health insurance is becoming an increasingly intolerable situation, and one I personally hope we can find a way to address with a radical overhaul or complete socialization of the health care system. I'm not extremely optimistic that can happen, because I don't know how the greatest obstacle -- reasonably affordable coverage for all without preexisting condition exclusions -- can be overcome without a "universal mandate" for coverage.

I have good coverage now. But I'm just one chronic condition or one job loss away from having all of that come crashing down. And so are untold millions of other people, especially when finding a new job -- particularly one with decent medical benefits -- is as difficult as it is today.
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Old 02-15-2009, 12:17 PM   #128
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Camp #1 (and yes this is where I am)... beleives that a vast majority of people CAN in fact find ways of taking care of themselves, but there are also a lot of lazy people out there. If a lot of the social benefits provided by the govt were suddenly removed, people would not just wonder about aimlessly, but would in fact find ways of earning what they need to survive, and this includes heathcare. People in this group believe that by and large people will rise to the challenge presented to them.
The classic balancing act of a compassionate society, I think, is trying to balance the desire to have a social safety net for those who truly can't help themselves with the desire to not see it become overused and abused by those who can. And if the only issue is temporary tough times, those who make use of the safety net need to be encouraged to bust their tail to get off of it as soon as possible.

In other words, the safety net should be a trampoline you can bounce back from -- and not like a hammock you just comfortably lay in.
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"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

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Old 02-15-2009, 12:17 PM   #129
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At least Medicare covers everything, however inadequately.
IMO, the Medicare model is a good one, at least parts A & B. The supplemental policies, while a big improvement over individual insurance available to those under 65, still have elements of adverse selection due to multiple risk pools. As I understand it, switching supplemental carriers often requires underwriting after the first six months of eligibility (age 65.5 for most people), but at least you have a window of guaranteed-issue opportunity at no additional premium cost when you first join.
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Old 02-15-2009, 01:33 PM   #130
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Ok, how about this.

Individual/family is responsible for all medical expenses up to $5k after that a Gov policy takes over and pays the remaining expenses. You could have it reset each year or continue paying for service if it is for the same disease.

Individual either pays the first 5K or gets insurance to supplement. Insurance co must take all. The insurance co would know that in any given year they would only be responsible for 5k and set policy accordingly.

The poor are still taken care of by Medicaid, and the old by Medicare, however, even Medicare could be made to conform.

The numbers may not be right, but the idea of the Gov taking care of catastrophic expense and individuals the day to day stuff makes since to me.
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Old 02-15-2009, 02:04 PM   #131
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Rustic23 - the only problem I see with the $5K deductible is that it would not promote preventive maintenance. I suspect many of the poorer people would still end up in the ER after letting a problem get worse.

IIRC, WalMart instituted some donut-hole policies? They cover something like $1,000 a year, so you get your checkups and small stuff, but then you are on your own until you hit a "catastrophe" number (might have been $5K). I think that could work.


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Old 02-15-2009, 03:50 PM   #132
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As far as "national health care" or "universal health care" or whatever you want to call it goes, I would reserve judgment until I saw the specifics. But I do have to say that using Keith Olbermann to defend one's position is about as meaningless as having Rush Limbaugh do it.
Did you click the link I provided? Yes Olbernam's name is in the headline of the citation, however, the article goes on to provide input from: CNN senior medical correspondent Elizabeth Cohen & James Fallows, Atlantic Monthly.

I am currently covered by Kaiser. I value the fact that Kaiser uses technology ( an electronically based record keeping system) to improve the quality of care I receive. I value the fact that every practitioner I see, at Kaiser, has immediate and accurate access to all of the care I have received. I receive, via email, summaries of doctors visits and lab results and the web based appointment scheduling system saves me and Kaiser time. Prior to being covered by Kaiser my PPO coverage was punctuated by vague assurances that my lab tests were OK, questions about medications I was taking from the practitioner who may have prescribed them, and interminable hold time while making appointments.

Closing the loop Olberman had the intellect to graduate from a 1st class university, Cornell, Limbaugh dropped out of Southeast Missouri State University.
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Old 02-15-2009, 03:56 PM   #133
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Here is what worries me, and maybe others on the board. I am happy with my health care alternatives. I always have been.

Now we are about to embark on a change that will effect my health care. That worries me. While I have not facts or figures to back this up, I'll bet a significant number of the people in this country are OK with their health care. There are about 300m people in the U.S. A figure for the un-insured battered around is 40m, however, this figure would be trimmed when Medicaid is taken into consideration. At any rate, that leaves 260m with some kind of health care. I think we should be very cautious when we change the health care for 260m to accommodate the care of 40m.

Now, before the rhetoric gets out of hand, I'll concede that 260m happy customers is high, but the situation is not reversed! There are not 40M happy customers out there and 260M people fearful they will not get health care. I believe there are between 30m and 40m on medicare alone.
The 45 million uninsured do not include those on medicaid or other government programs.
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Old 02-15-2009, 04:22 PM   #134
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I read a lot about most of these arguments, both for and against. I think a lot of it, as most things do... sort themselves into two camps of thinking.

Camp #1 (and yes this is where I am)... beleives that a vast majority of people CAN in fact find ways of taking care of themselves, but there are also a lot of lazy people out there. If a lot of the social benefits provided by the govt were suddenly removed, people would not just wonder about aimlessly, but would in fact find ways of earning what they need to survive, and this includes heathcare. People in this group believe that by and large people will rise to the challenge presented to them.

Camp#2 believes that most people are incapable of caring for themselves. That if govt social programs were removed, people would litterally die on the streets. People in this camp feel it is the moral responsibility of all those who ARE capable and responsible to take care of all those who are less so. This group tends to believe that those with more "owe" what they have to those with less.
I think that you are exaggerating the camps way too much.

Story time. I know a secretary that had cancer, she was in her 50s. She was eligible for SSD but there is a two year waiting period before Medicare eligibility from the date of disability. She had a house so wasn't eligible for medicaid. SSD payments were not enough for her to pay her COBRA and live on. She ended up working longer than she should and dying not that long after she left work.

I know another secretary that had an unusual illness that caused her tremendous headache pain all the time. She had to leave work. She managed to pay COBRA from short term disability payments. She went through her savings, waiting for social security disability. She was in her 20s. She died not long ago after 10 years of terrible pain, even with narcotics.

Busted. And they both had health insurance. They both were taking care of themselves and were competent people. Bad things happen to competent people too.
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Old 02-15-2009, 04:38 PM   #135
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Martha,
Your examples are, IMHO, part of the problem. We all 'know someone who fill in the blanks.'

So lets say with the 46M there are another 10M stories. That is still 230M people that will undergo a change they may not want or like for the 70M. And, as we have discussed before, your 46M includes people that do not insure by choice, illegal aliens, and others.

As with the stimulus package, the only ones that are going to come out on top are the politicians. Those of us that pay the bill will pay more.
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Old 02-15-2009, 05:33 PM   #136
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Your examples are, IMHO, part of the problem. We all 'know someone who fill in the blanks.'
Rustic, Martha's stories are anecdotal and represent something that is difficult or impossible to quantify. Absent statistics, I can verify that such stories are brought to my attention regularly. I work in a tertiary cancer referral center so probably see the worst end of the spectrum.

Hard for me to fathom how such reports are "part of the problem." My experience suggests rather that such events are the problem, at least part of it. There are just system problems that need to be fixed, like a malfunctioning system in the space shuttle or something.

Many people have no idea how little stands between them and financial disaster if they happen to get sick under the wrong circumstances. Seems to me we'll all benefit from a more reliable, durable system of payment. Republican, democratic, liberal or conservative -- could care less. Let's just get this buggy fixed: universal access for all citizens with reasonable basic coverage mandated, no cherry picking, subsidies for the legitimately poor or disabled, and fair pricing for the rest of us. That would be a good start.
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Old 02-15-2009, 05:43 PM   #137
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Let's just get this buggy fixed: universal access for all citizens with reasonable basic coverage mandated, no cherry picking, subsidies for the legitimately poor or disabled, and fair pricing for the rest of us. That would be a good start.
When you say "disabled" here, I'm assuming you mean those of modest means who can't reasonably be expected to find a job capable of paying the full cost of coverage. "Disabled" isn't always poor just as "fixed income" in reference to the elderly doesn't always mean a LOW income. Someone can have a non-COLA'd pension or non-inflation adjusted annuity of $100,000 a year and be on "fixed income."

With that clarification, I pretty much agree.
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Old 02-15-2009, 05:47 PM   #138
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Rustic, Martha's stories are anecdotal and represent something that is difficult or impossible to quantify. Absent statistics, I can verify that such stories are brought to my attention regularly. I work in a tertiary cancer referral center so probably see the worst end of the spectrum.

Hard for me to fathom how such reports are "part of the problem." My experience suggests rather that such events are the problem, at least part of it. There are just system problems that need to be fixed, like a malfunctioning system in the space shuttle or something.

Many people have no idea how little stands between them and financial disaster if they happen to get sick under the wrong circumstances. Seems to me we'll all benefit from a more reliable, durable system of payment. Republican, democratic, liberal or conservative -- could care less. Let's just get this buggy fixed: universal access for all citizens with reasonable basic coverage mandated, no cherry picking, subsidies for the legitimately poor or disabled, and fair pricing for the rest of us. That would be a good start.
This has to be true. The difficulty is that those of us with decent coverage know all the possibilities for mischief once the US Congress gets down to doing their reliably dirty job, rewarding their buddies, trying to give life to their fantasies, etc.

Very rich people and people who have a personal need or family need for better coverage are the natural constituency for change, The rest of us are understandably wary.

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Old 02-15-2009, 06:09 PM   #139
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Rich,
The reason I say it is part of the problem is it pulls on the heart strings but does not represent the majority of the population. It is like the stimulus bill. You would think there was not a person in the U.S. that had a job, or were not about to loose their job. Lots of people paraded before the press with their hard luck stories to convince us Congress just has to spend 800B they don't have. However, at the same time, we hear that the economy will recover weather they spend or not.

I do not question you see these cases. I do not question that medical expenses can ruin an early retirement. However, IMO, Congress could have taken the 800B they just spent and provided for all these cases forever and all the others that will pop up. I promise you a Health Care Reform bill will be just as full of PORK as the bill they just passed, and within the first 5 years the horror stories, will still be out there.

I have no faith in the Federal Government's ability to solve this problem without wrecking the health care for the rest of us. I've said it before 'Be careful what you wish for'. I also believe the Doctors may end up carrying the brunt of the cost.
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Old 02-15-2009, 06:45 PM   #140
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The reason I say it is part of the problem is it pulls on the heart strings but does not represent the majority of the population. It is like the stimulus bill. You would think there was not a person in the U.S. that had a job, or were not about to loose their job....
I have no faith in the Federal Government's ability to solve this problem without wrecking the health care for the rest of us. I've said it before 'Be careful what you wish for'. I also believe the Doctors may end up carrying the brunt of the cost.
Yes, points taken. No doubt that the gut-wrenching stories can be misused to curry sympathy, and are sometimes inaccurate. But 40mm people underinsured and lots more on their way, while it may not be the majority of the population, is waaay too high and even the best of us can too easily enter those ranks.

BTW, some would argue that doctors already are carrying a large part of this burden in the way of uncollected bills and underpayment by MC and Medicaid. Partly true, but fortunately the incomes are already high enough that no one is feeling sorry for us , nor should they. Yet.

I share your concerns about the competency of a federal level program of any sort, but if MC is an example, mechanically, it sort of works -- the fees, rules, etc. are crazy but the checks get cut, and mistakes get detected most of the time. The competency of the private carriers is often worse -- usually regarding the part where they kite cut the checks.

Complicated.
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