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Old 09-24-2009, 12:13 AM   #241
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Sounds like a better plan to me. Sign me up.
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Old 09-24-2009, 06:05 AM   #242
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Exclude all the nonsense that shouldn't be insured in the first place, glasses, acupuncture, fertility, viagara, etc, etc. And then set a tax similar to what people and corporations are currently paying for insurance now but no-longer would be.
Who decides what is covered and what isn't covered? Right now the insurance companies have decided, for the most part, experimental procedures aren't covered. That makes sense because if they aren't sure the procedure will work they shouldn't have to pay for it. Insurance companies, for the most part, don't pay for elective procedures, though they often do pay for Cialis or Viagra.

There is separate insurance for vision that will pay for glasses, that normal health insurance won't pay for. If the person doesn't have vision problems then they don't buy the vision insurance. Personally vision insurance doesn't really work out for the benefits I receive. I can purchase a new pair of glasses every two years. Most of my normal eye appointments are paid through my medical insurance the rest is put on the vision policy. I pay more for the premiums than I would for the glasses.
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Old 09-24-2009, 09:47 AM   #243
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I think the idea of what Yrs to Go was suggesting was that there is no "first dollar" insurance coverage. If that's so, then vision makes no sense for insurance. If you want glasses, then you buy glasses. You don't need "insurance" to buy your glasses for you.
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Old 09-24-2009, 09:52 AM   #244
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Right now the insurance companies have decided, for the most part, experimental procedures aren't covered. That makes sense because if they aren't sure the procedure will work they shouldn't have to pay for it.
This is so wrong I don't know where to start.

Insurance companies use the excuse of not paying for experimental procedures, but what they really are trying to do is deny as many claims as they can legally get away with.

If you really believe that ALL medical discoveries and procedures are already known and in the insurance company approved list, then perhaps you are willing to sign up for such a plan. If instead there are new treatments available, especially if your doctor is recommending a new approach, then wouldn't you want the treatment your doctor recommends.

This gets even worse if there is UNIVERSAL health coverage. If all care is paid for by insurance companies, and those insurance companies ONLY pay for old procedures, what innovations are going to be made in developing new cures and treatments.
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Old 09-24-2009, 10:30 AM   #245
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Before a procedure can be no longer considered experimental it has to undergo strict scientific scrutiny. Now this does present problems with procedures that have worked well enough and could be considered on the edge of acceptance, unless there is a medical board that gives it's blessing saying a procedure has proven itself as at least as effective as existing procedures. I can cut and paste out of many different health insurance policy manuals that specifically state experimental procedures are not going to be paid for by the insurance company.

Like I originally stated, I don't believe insurance should pay for treatment that has not proven itself to be at least as effective as what is currently out there. It is a gamble and might not be effective. If it is not effective the insurance company must pay for not only the experimental procedure they must also pay for the accepted treatment. If it is effective then great, but since the treatment has not been subject to strict scrutiny then all of the risk in on the insurance company.

Many people don't want glasses, but in order for them to function in society they must have them. If these people can't afford their glasses then we say sorry you're not allowed to participate in society? Some even are required to wear glasses at work because their visual acuity must meet certain standards. Do we tell these people that they are no longer employed, because they can't afford to buy their glasses? We seemed to be concerned about the poor having to pay $50 or $100 for a doctors appointment, but tell these same people that the have to pay $100-$200 for glasses on their own. I can work with a cold, I can't work without my glasses and you wouldn't want me to.
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Old 09-24-2009, 11:42 AM   #246
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I can (and do) buy glasses for about $20. Are you suggesting that I should pay that $20 to the insurance company, plus some kind of overhead for administration and paperwork, so that they can give the $20 to the manufacturer of my glasses? "First Dollar" coverage is inherently wasteful. I'd rather lower the premium $20 and then I can decide to buy glasses or soemthing else with that money.

BTW there are already outlets that provide FREE glasses to people who cannot afford them. Why does something as trivial as this have to be an insurance function?
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Old 09-24-2009, 12:43 PM   #247
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First dollar coverage implies a maintenance policy. Certainly, insurance actuaries are happy to construct a rate and benefit design for health maintenance, but can you afford it?

If first dollar coverage is so valuable, why does the IRS allow deductability of non-reimbursed medical claims and premiums (if you qualify for itemized deductions).

With first dollar coverage, cost of care will go up. Why? Because you have no vested interest in how much it costs. You've paid your premium, everything should be covered. The providers know you have first dollar, so the costs they bill to the insurer have no relative value in the marketplace.

And it can be, but understand that you will be the only one with a policy like that.

The premise of insurance is to try and keep in you the same financial position you had before you had the claim. In addition, it is by pooling dollars from a community of people who have the same policy language that economies of scale allow the insurer to keep rates lower, than if you had the only policy in the world. Insurance is not about maintenance, it is about reducing the cost of loss.

As Quietman has said, this is just so wrong on so many levels.

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Old 09-24-2009, 01:32 PM   #248
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If I have so called first dollar coverage, I am giving up any visibility or influence over the cost of my health care. In most cases, I will have almost no way of even knowing what the costs of treatments are, except that after the fact I may receive a bill for any "deductible" amount. I can make no reasonable value judgement, because I have no idea of the cost of anything.
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Old 09-24-2009, 01:38 PM   #249
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I don't know.

I wonder how much we'd save if we got rid of 1st dollar insurance for stuff. Everyone has a deductible at 5% of AGI, phased in and maybe capped at some level (or not). Exclude all the nonsense that shouldn't be insured in the first place, glasses, acupuncture, fertility, viagara, etc, etc. And then set a tax similar to what people and corporations are currently paying for insurance now but no-longer would be.
I'm on board.
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Old 09-24-2009, 01:41 PM   #250
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This is so wrong I don't know where to start.

Insurance companies use the excuse of not paying for experimental procedures, but what they really are trying to do is deny as many claims as they can legally get away with.

If you really believe that ALL medical discoveries and procedures are already known and in the insurance company approved list, then perhaps you are willing to sign up for such a plan. If instead there are new treatments available, especially if your doctor is recommending a new approach, then wouldn't you want the treatment your doctor recommends.

This gets even worse if there is UNIVERSAL health coverage. If all care is paid for by insurance companies, and those insurance companies ONLY pay for old procedures, what innovations are going to be made in developing new cures and treatments.
Experimental treatments are done by participating in a clinical trial. The funders of the trial pay for it.
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Old 09-24-2009, 03:15 PM   #251
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I can make no reasonable value judgement, because I have no idea of the cost of anything.
I have no interest in the "first dollar coverage" discussion, but I think that there is an even more important point here.

I cannot make a reasonable value judgment about treatment even if I know all of the costs in advance, and that is the basic flaw in the free market approach to our medical system's problems.

I do not have the knowledge or skill to decide whether a treatment is necessary or cost effective; that is why I seek the service of a professional. What is worse, the self-policing medical guild makes it almost impossible to find out whether a doctor is good or bad, wasteful with treatment dollars or a great bargain. Whether a hospital has high rates of secondary infections, good or bad mortality rates, or high or low cost-per-procedure is almost impossible to discover.
A side rant: Keeping tabs and controls on doctors and hospitals is what HMOs and PPOs were supposed to be about. After the scare tactics of Harry and Louise helped defeat the Clinton health plan, we got insurance bureaucrats instead on government bureaucrats inserted between us and our doctors and look how that turned out.
A free flow of information and knowledgeable consumers are required for a free market to function, and neither exists in the case of medical care. As far as I know, there is no "Consumer's Reports" for doctors and hospitals.

I agree that an insurance company inserted between me and my doctor makes things worse, but I believe that free market economics has almost nothing to offer in solving the problems of our medical system. Shopping for a doctor is not like shopping for an DVD player.

I do not believe that medical care is a right, but I do believe that insurance is a great idea. Spreading risk among a population has great value, and the larger the population the better. OTOH, if insurance companies could not deny coverage for preëxisting conditions, they could not stay in business if young healthy folks were allowed to opt-out until they got sick.

The insurance companies would howl about it, but I do not think they should be allowed to compete on an actuarial basis (read: cherry pick the healthy clients). Once everybody is required to have insurance, the playing field would be level if the first three federal regulations were:
1. Exclusions for preëxisting conditions are prohibited.
2. Insurers may offer any policy features they wish above a required minimum set, and may set any price it wishes for this optional coverage, but the prices charged must be the same for everybody.
3. Policies may be canceled only for non-payment or other breach of contract, not because the client was seriously injured or contracted an expensive disease.
Essentially, such regulations would just create one giant group comprising everybody in the country. Insurers would compete to sell policies to the members of this group just like it sells policies to employee groups. Want to raise the rates? Fine, but you have to raise them equally for everybody. Want to change the rules on say, deductibles? No problem, but the changes apply to everybody. There would still be plenty of room to compete. Insurance companies are competing just fine with their employer based group policies now. Why not just extend the existing model? Indeed, the precedent for required minimum insurance already exists in our auto liability policies.

I know that this does not solve all of the problems, but straw men arguments are fun and sometimes useful. As I understand it, this is similar to the Swiss system, and I present it to show that there are potential "solutions" that do not involve a big-brother type government autocracy.

I am not capable of assessing what effect this would have on medical costs, but it would solve many of the cruel and unfair situations that our existing system creates. I contend that it would even reduce costs (although I can't say how much) by eliminating the free and extremely cost-ineffective care hospitals are required to give in emergency rooms, and in uncollectible bills. If I recall correctly, a major hospital lobby group has estimated that universal coverage would save something like 30%-40% (although that sounds high to me) just for these reasons. If somebody insists, I will go Googling for some data to back that up.

I'm recovering from a minor surgical procedure and writing this under the influence of pain medication, so I reserve the right to disavow it after the hydrocodone wears off. However, if I were completely sober, I wouldn't have the nerve to post this.
Anybody know where I can get a good Nomex suit air-freighted to me? peace.gif
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Old 09-26-2009, 10:27 AM   #252
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My hydrocodone induced screed seems to have brought this discussion to a screeching halt. I didn't want that to happen. Anyway, my discomfort from this week's minor surgery has passed and I have gone cold turkey on the drugs. I must admit I miss the dreamy haze though.

Several of you have said enough with the anecdotes and get on with the specifics. Bingo. I admit that I have been too lazy to dig into the details and you have shamed me into exerting some effort. But I am way to lazy to wade through the original sources, and have little patience with partisan articles from either side. Anybody know of sites with half-way decent summaries; sites with a minimum of hidden agendas? I can handle opinions, but don't want to feel like I have to examine every word like an opposing council.

Something like "Health Care Reform for Dummies".

Here's your chance. Help me educate myself.
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Old 09-26-2009, 10:32 AM   #253
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Unfortunately Congress learned a lesson with the recent health insurance debacle. It was the wrong lesson though. Instead of learning that their constituents don't want a BS bill, they learned that if they don't post the bill they won't have to answer to their constituents. They won't post the bill being debated on the open internet, so really there is no place that I know of where you can read and evaluate what is being proposed for yourself.
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Old 09-26-2009, 10:55 AM   #254
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Unfortunately Congress learned a lesson with the recent health insurance debacle. It was the wrong lesson though. Instead of learning that their constituents don't want a BS bill, they learned that if they don't post the bill they won't have to answer to their constituents. They won't post the bill being debated on the open internet, so really there is no place that I know of where you can read and evaluate what is being proposed for yourself.

Do you mean the finance committee bill? Here is the link to the bill and amendments: Finance
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Old 09-26-2009, 11:20 AM   #255
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Coming in late to the bar-fight here -

I received a letter from my employer yesterday - Just letting me know that the cost of my policy is 6,000 a year. I do not contribute - they are really good about this - but I know that my coverage isn't free.

I think everyone should know their number, employed or receiving aid.

( I was raised by a mother who would usually add a snarky 'ha-ha' after the word 'free' in most commercial contexts. (thanks, Mom! ) However, many folks really do believe in the bluebird of freestuff. )

I have Canadian friends & relatives. Their system isn't perfectly perfect, but it works pretty well. Ditto what the Europeans have told me.

We have this idea that the employer-linked coverage is the god-given model, the right, true, and one way, just because it is a few generations old at this point.

Re-engineering a system in use is much harder than building from the begining. With human systems, we get scared.

I have to have coverage - my family does a couple of diseases really well. So far, I'm well - which means I haven't been diagnosed yet.

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Old 09-26-2009, 11:28 AM   #256
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I cannot make a reasonable value judgment about treatment even if I know all of the costs in advance, and that is the basic flaw in the free market approach to our medical system's problems.
I may not be able to make a perfect value judgment, but that's typical in any medical situation. Sometimes things even get better or worse unexpectedly no matter what you do. I can still make a somewhat informed choice if I am given some information to work with. Withholding cost information because I do not have perfect medical outcome information is nonsensical and harmful.

So here's an example everyone may experience. I need to have a new filling in one of my teeth. It's a little bigger than what I've had before, but not terribly so. My insurance covers only silver amalgam fillings, as they are medically necessary, but will not cover composite plastic materials. They claim this is a cosmetic procedure with no medical evidence it is a superior treatment. I do not really know if this is a superior treatment or not. I do not really know if additional mercury amalgam in my mouth will be detrimental in 50 years. I can ask the dentist my costs to make the choice (I pay 20% of the amalgam filling or 100% of the composite) and then decide what I want to do. Even this decision is somewhat distorted by the different percentages of coverage, but I can still make a somewhat informed choice.

Here's an example a relative recently faced. He suffers from a debilitating and deteriorating condition. Existing treatments are effective in reducing the spread of his illness, but only somewhat, and need to be repeated often. A promising new treatment has finished clinical trials and is much more effective and in some cases halts the deterioration so much that treatments can be given annually. He has insurance, but this new treatment is not on the approved list and although it is being rapidly adopted around the country, his insurance told him it will likely be at least 3 years before they would consider covering it. No guarantee they would cover it even then. It's likely by then his condition would have worsened to the point the new treatment would be pointless. He had to (luckily he can) pay for this out of pocket. It was hugely successful and probably saved his insurance a bunch of money on the old treatments, too.

Insurance companies maintain the lists of allowed and effective procedures as a way to control costs, not as a way to promote effective medical treatment.
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Old 09-26-2009, 11:40 AM   #257
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Coming in late to the bar-fight here -

I received a letter from my employer yesterday - Just letting me know that the cost of my policy is 6,000 a year. I do not contribute - they are really good about this - but I know that my coverage isn't free.

I think everyone should know their number, employed or receiving aid.
We did this at my office too, once a year sharing the cost of all benefits with employees.
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Old 09-26-2009, 11:58 AM   #258
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We did this at my office too, once a year sharing the cost of all benefits with employees.
I have an individual health insurance plan that was billed to my house. I opened it and physically carried it into the office every month and added it to the payables. At retirement I just switched to paying the bill myself.

My share of the Keogh was under my control and monthly statements were mailed directly to me. Once a year my employer gave me two checks for me to deposit into that account.

I also knew exactly what the all-important fresh brewed coffee benefit cost.
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Old 09-26-2009, 12:00 PM   #259
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....I also knew exactly what the all-important fresh brewed coffee benefit cost.
I hope you had "first-cup" coverage, Joe!
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Old 09-26-2009, 01:02 PM   #260
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Who decides what is covered and what isn't covered?
As we're talking about a government plan, the government would be the "decider".
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