The Health Insurers have already won

[poplew]

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Originally Posted by Sevo God how I wish I could get every one to understand that the INSURANCE COMPANIES AND THE GOVERNMENT ARE THE SAME PEOPLE. The insurance companies pay staggering amounts to politicians to get them reelected. The Federal politicians pass thousands of laws that makes it impossible for there to be free and reasonable competition in health care. The cost of medicine has gone up every since and every time that the government gets involved. The result is this insane crisis we are in. Our country is being bankrupted and lives are being ruined every day. Cosmetic Surgery is the only area of medicine that is not totally smothered by federal law and insurance regulations that are enforced by the government. And Guess what. The number of procedures have gone up and up. THE PRICES FOR PROCEDURES ARE THE ONLY THING IN MEDICINE THAT HAS GONE DOWN... Free market forces work. We have to stop fighting with each other. The only rational way to behave is to go to the poles and vote to throw the corrupt politicians out of office. All of them. If they have been in office for more that two terms it is time for them to go. Let free markets and free men and women work.

+1

[growing_older]

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Whoops, the school health policy ended two weeks ago. If this happened to your kid what would you do- let him fend as best he can, blow your nest egg to give him the best you can afford? Personal responsibility - it is your family, you should have anticipated this and made sure he had a short term policy for those two weeks.

Something like this happened to me once. I was between jobs and being a little overly cautious I did purchase a short term health policy. Lucky for me I did because a medical issue came up. I got treated and when the policy was almost over, I renewed for another term. At the end of that term I let it lapse and joined my new employers group plan.

However, when I tried to get continued treatment for the medical condition on the second policy I was denied. It was ruled a "preexisting condition" and I was directed to claim against the first policy. The first policy denied becuse the treatment occured during the time period of the second policy. I never was able to get this claim paid and had to just pay it myself. THIS IS THE SAME CARRIER and the same agent and indeed it's the exact same policy. I even disclosed the issue on the application for the second policy. But because they could give me the runaround they were able to refuse the coverage I had actually bought. By making the effort to get a claim paid greater than the claim was worth to me, they avoided having to pay it. Needless to say I distrust insurance companies. I have had other dealings with them involving inflated prices and deductibles that furhter reinforce that this is a broken system in which insurance companies make money by skimming health dollars, instead of providing real insurance. I see that the proposals under debate do nothing to address these real problems, but do further entrench insurance companies. I am very disappointed that we are squandering this opportunity for real reform.

Getting everyone health care is a laudable goal and maybe we'll make some progress on that, but this is a hideously wasteful and inefficient way to do so that perpetuates a broken system and will likely make it even worse in many ways. What a shame our so called "leadership" is playing politics as usual instead of actually solving a real problem.

[quietman]

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I think the first thing we should do is separate health insurance from employment status.

This would be a big help to many, not just those unemployed with difficulty finding insurance. I'm employed and recently started using some medical equipment (like a wheelchair) at home. There is a 12 month period during which my insurance rents the equipment before buying it, really 12 months rent then I own it. If I leave my job or if my employer changes health insurance companies that 12 month period starts over. So far, this employer has changed health companies every year in search of lower payments. If they continue this, I would rent this thing perpetually for a monthly charge about 20% of the outright purchase price. The waste and abuse in this system is unbelievable.

[quietman]

This is even more worrisome in light of the kinds of questions the applications ask. such as "Have you ever consulted a doctor or been treated for any condition not covered above?" Does this mean I have to describe EVERY medical issue I ever talked to a doctor about. I'm sure to miss some. If they can then retroactively look through my medical records and disqualify me in case I make a catastrophic claim, then my insurance is really pretty worthless. It makes me think of the retroactive fire insurance from the MGM Grand, where the insurers wrote the policy AFTER the event, in the belief that they could deny or delay claims long enough to still make a profit. This system is fundamentally broken.

[Martha]

That is one problem with having health insurance a matter of state regulation and licensing. Your plan in one state is rarely portable to another, with some exceptions.

There are very few states that I could move to. The state would have to allow me to enter their risk pool (if they have one) with no advance residency requirement (many have a 6 month requirement) and no preexisting condition waiting period.

[IndependentlyPoor]

Another couple of ugly but true insurance anecdotes.

I don't want the Libertarians and Republicans here to think I am just piling on. I really am trying to make a positive contribution to the discussion.

1. My best friend (since deceased) was a successful freelance programmer in California. He had group insurance through a professional organization, I believe either the IEEE or ACM. As you probably know, an insurer cannot raise rates unless it raises the rates of the whole group. In a sad coincidence, shortly after he became seriously ill, the insurance company offered an "improved plan" at a significant discount. You would have been a fool not to switch to the new plan. Unfortunately, it required a physical and did not accept folks with pre-existing conditions. A year later, after all the healthy folks switched to the new plan they quadrupled the rates on the old plan. All perfectly legal. Nice huh?

2. I retired from a mega-corp in 2004 after being diagnosed with advanced prostate cancer. Since I had worked there for 27 years, I could retire early and remain a member of the health insurance group. I have to pay 100% of the policy cost (no company subsidy), but it is a good deal. The problem is that mega-corp isn't nearly as mega as it used to be and will likely go paws up taking my insurance with it. What chance do you think I will have at getting individual insurance with active prostate cancer? I have been insured for every single day of my life, and now when I need it, I might be out in the cold.

Yes, I know about the assigned risk pool in Texas. But that is just more government interference with the free market isn't it?
Forget that last part. Like Martha, I get a bit upset writing about this.

Our system is profoundly unfair to a large minority of the population. Unfortunately, the majority enjoys good medical care and does not realize the fragility of their situation... until it is too late.

[modhatter]

Right on. I was beginning to feel really alone. I don't wish misfortune on anyone, but maybe on this issue, it will take more crossing over to the unfortunate side, before anything substancial happens.

[Texas Proud]

I agree with the various post about how insurance is very unfair... what I am saying is FIX THAT... also, fix the medical cost side, because this is also where the true costs are so high....

So.. in a quick summary...

If you have health insurance... the costs are to high and going up higher... you risk losing your health insurance if you get laid off, if you decide to go out on your own and open up a business, if you company goes belly up, if you company just decides to stop paying because of the costs... but other than that, you are OK with the current system...

There are people who have health insurance who find out it is not really there when you need it (my mother's did not pay a claim of $7,000 because she did not get pre-approval for a procedure one of their doctors recommended... and since you can not undo a procedure... they just refuse to pay it)... they either do not pay, or find something in your past to drop you like a rock...

There are people who would like to get a good plan, but because of some medical history that might not even have anything to do with today... they either pay an even higher cost or pay the higher cost and do not get covered for everything...


Again... I do not have any problem in having these problems addressed in some insurance bill.. but they do not fix the cost problem... and paying a lot of money for the uninsured does not fix the cost problem (nor the one mentioned above... we can fix them without having everybody on board)...

So, I wish they would stop saying it is a plan to fix healtcare and call it what it is... a welfare bill to pay for insurance for the uninsured... with some benefits thrown in for the rest of us...

[Sevo]

2. I retired from a mega-corp in 2004 after being diagnosed with advanced prostate cancer. Since I had worked there for 27 years, I could retire early and remain a member of the health insurance group. I have to pay 100% of the policy cost (no company subsidy), but it is a good deal. The problem is that mega-corp isn't nearly as mega as it used to be and will likely go paws up taking my insurance with it. What chance do you think I will have at getting individual insurance with active prostate cancer? I have been insured for every single day of my life, and now when I need it, I might be out in the cold.

Yes, I know about the assigned risk pool in Texas. But that is just more government interference with the free market isn't it?
Forget that last part. Like Martha, I get a bit upset writing about this.

I am very sorry to hear about your advanced prostate cancer. I wish you the very best. I am frustrated about your situation with the Govenmental/Insurance complex that have put you so at risk. You have to understand that FDR and the Democratic Congresss forced the link between your employer and your insurance. Your personal tragedy started with government interference in the health care in 1943. I sincerely hope that your mega corp stays on it's feet and this has a happy ending.

Our system is profoundly unfair to a large minority of the population. Unfortunately, the majority enjoys good medical care and does not realize the fragility of their situation... until it is too late.[/QUOTE]

Our System is PROFOUNDLY unfair to every one except our elite/elected. Every thinking honest, working, tax payer knows this. Every one lives in fear of being uninsured.

We have a national tragedy in that the same Representatives and Senators that have stayed in power by taking the [-]bribes/ reelection donations from the insurance companies will get reelected again next year. Some of them have been in power for 30 years and longer and have totally destroyed our ability to provide adequate health care to our citizens. They will just keep lying to the voters and passing cynical and unconstitutional laws that will keep us all as servants of the insurance/government complex.

Unfortunately we are now too far down the road to serfdom to do anything about it. The average voter is totally and absolutely blind to what is happened. They will go back to the polls and put the same crooks back in office as long as they promise to "take on the mean special interests" while they take money hand over fist from the supposed bad guys and tack little deals into the next law. For instance, forcing people to buy "insurance" from insurance companies, you know the bad guys. You either buy or get charged 3800 bucks. If you refuse then the good guys you know them as the Federal government will just come take the money from you and if you refuse that they will put you in jail and if you resist that then they have the right to subdue you with force or kill you. It really would be funny if it wasn't such a tragedy.

Again reality is that this is just a chance to vent. The feds are going to do what every they feel will get them reelected. We now have zero input as citizens because we have been trained to know that there are only two parties and and no matter how crazy it gets we will just reelect the same crooks.

Hang on and hope. That's all we can do now. In a few months our masters will let us know what we are going to get. Reality is that the only people responsible for this system are the voters. You will get what you voted for! Good luck to all of us. We are going to need it.

[MichaelB]

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What difference does it make if the factors causing rejection for insurance coverage are lifestyle or non-lifestyle based? Are you trying to say that if a person has a condition that is due to lifestyle choices such as tobacco, alcohol, diet or stressful employment, then he/she shouldn't be covered? IMO, that would be ridiculous. Perhaps I'm misunderstanding your implications here. I hope so.

I’m not implying anything. I am saying I am denied coverage due to factors not related to lifestyle. Just a simple fact.

Being denied coverage for a reason not within my control while someone else gets full coverage (and perhaps tax subsidies and most favorable pricing) in spite of having poor health, diet and lifestyle habits is quite difficult to accept. It would be funny if it weren’t so pitiful.

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Forget that last part. Like Martha, I get a bit upset writing about this.

I think that your civil tone, along with Martha’s, is quite the positive example.

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Again... I do not have any problem in having these problems addressed in some insurance bill.. but they do not fix the cost problem... and paying a lot of money for the uninsured does not fix the cost problem (nor the one mentioned above... we can fix them without having everybody on board)... So, I wish they would stop saying it is a plan to fix healtcare and call it what it is... a welfare bill to pay for insurance for the uninsured... with some benefits thrown in for the rest of us...

This is a harsh assessment. Two of my children will likely be recipients of some subsidy. Both are professionals. One works for a non-for profit that can’t afford to provide insurance and doesn’t pay enough to buy it separately. Another has to pay 30% of her after tax for a health care premium that has a $1.5K deductible – but she cannot do without. No welfare here – these are hard working people, like many others, trying to get ahead.

If current health care benefits were taxed like salary, almost the entire cost of the program would be paid for.

[Texas Proud]

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Originally Posted by MichaelB This is a harsh assessment. Two of my children will likely be recipients of some subsidy. Both are professionals. One works for a non-for profit that can’t afford to provide insurance and doesn’t pay enough to buy it separately. Another has to pay 30% of her after tax for a health care premium that has a $1.5K deductible – but she cannot do without. No welfare here – these are hard working people, like many others, trying to get ahead.

So, what you are saying is one of your children is in the group of the uninsured... and if the government pays for their insurance it is not welfare You are using the word subsidy...

I just want to get our definitions straight here.... this is mine from dictionary.com


"financial or other assistance to an individual or family from a city, state, or national government: Thousands of jobless people in this city would starve if it weren't for welfare.
(initial capital letter) Informal. a governmental agency that provides funds and aid to people in need, esp. those unable to work."
These are two of the definitions... I think "financial or other assistance to an individual or family from a city, state or national government" is what we are talking about here with the trillion or so dollars...

Subsidy is "a grant or contribution of money." for one of the definitions... I think mine is closer to what is being planned...

So, harsh I am... guilty as charged.

[IndependentlyPoor]

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Originally Posted by Sevo You have to understand that FDR and the Democratic Congresss forced the link between your employer and your insurance. Your personal tragedy started with government interference in the health care in 1943.

I will not defend FDR's wartime wage and price controls, which certainly led to the employer based system we have now, but I think forced is stretching it a bit.

The most unbiased-sounding source I could Google up confirmed my recollection of what happened. It was sort of accidental.

From:
The New England Journal of Medicine
Vol. 355:82-83 No. 1
July 6, 2006
Downloadable PDF available here.

Roosevelt discussed health care over lunch with Cushing the day before he signaled his decision not to push for the immediate passage of a health insurance component of Social Security.
President Roosevelt’s decision left a pressing need for alternative forms of protection against the growing costs of illness. Private insurance emerged to fill this gap in the early 1930s in the form of the nonprofit Blue Cross and Blue Shield plans. Commercial insurers subsequently entered the business, once they saw that the Blues were successful. The resultant private insurance industry was therefore ready to sell insurance to employers when the opportunity to do so emerged during World War II.
This opportunity arose because, to control inflation in the overheated wartime economy, the federal government in 1942 limited employers’ freedom to raise wages and thus to compete on the basis of pay for scarce workers. However, the federal government allowed employers to expand benefits for workers, such as health insurance, which resulted in a rapid increase in employer- sponsored insurance.

The key word here is allowed.

FDR decided against pushing for a national health plan, although many think he could have rammed it through.

...putting on my asbestos underwear now.

[modhatter]

We are not totally powerless. The odds are stacked against us, but nothing is ever hopeless. The most important legislation we citizens should rally for to take the devil out of politics, is to make it illegal for companies to contribute to compaigns in any form and in any amount. All money for campaigns should be sent in as a % of income by every US citizen to the party of their choice with their income tax reform.

They did pretty good this last election by non mandated contributions from ordinary people. They would do just fine with a mandated small contribution from every US citizen. Then we could perhaps have more representatives working without so many favors to pay back.

Change can come with large numbers and persistance. Good government is an on going battle that never ends. All government is corrupt. Its just a matter of degree by measure to other countries or point in time. The day we all throw up our hands, and claim "it's useless" is the day we all surcomb to "surfdom".

These discussions on this important subject on this board has been constructive for the most part I think. There are things and opinions by others that are very valid and have expanded my own thought process on the subject. Conversely, there are some statements made that I strongly disagree with and would like my opinion considered by their authors.

So dialog is good. As long as we can listen too.

[lets-retire]

The Congress critter who really surprised me was the Democrat who was elected in a conservative district. During a town hall meeting in August he told his constituents that he didn't care what they thought, he was voting for HR 3200. Talk about nerve. I think you can count him unemployed after the next elections.

[youbet]

I agree Texas Proud. In fact, it seems that almost everyone agrees that there are problems with the current "system."

Agreeing on what the new "system" should look like and how it should operate and who should pay for it seems more contentious.

Politicians, from the President on down, spend way too much time citing anecdotal examples of individuals facing problems today and not nearly enough time explaining how their new proposal will work and answering questions such as:

Why won't every citizen have the same coverage?

Why are there efforts to allow special interest groups (unions, politicians, etc.) to be exempted?

How much will it cost and who will pay? Will it be paid for real time or on the backs of the next generations?

Who will decide what procedures will be covered and who qualifies?

Etc. Etc.

We've all heard the endless anecdotal stories. Let's get on to detailed proposals with explanations of why they're being constructed the way they are.

[Martha]

Quote:

Originally Posted by youbet I agree Texas Proud. In fact, it seems that almost everyone agrees that there are problems with the current "system." Agreeing on what the new "system" should look like and how it should operate and who should pay for it seems more contentious. Politicians, from the President on down, spend way too much time citing anecdotal examples of individuals facing problems today and not nearly enough time explaining how their new proposal will work and answering questions such as: Why won't every citizen have the same coverage? Why are there efforts to allow special interest groups (unions, politicians, etc.) to be exempted? How much will it cost and who will pay? Will it be paid for real time or on the backs of the next generations? Who will decide what procedures will be covered and who qualifies? Etc. Etc. We've all heard the endless anecdotal stories. Let's get on to detailed proposals with explanations of why they're being constructed the way they are.

The first two questions are due to political expediency. I'm not happy about it.

I do know some about your other questions, but remember we have several plans being circulated around so what is true today may not be tomorrow or is being negotiated.

The intent is to be pay as you go on all the plans, through savings, taxes, and premiums. Arguably because our federal government runs a deficit nothing is really pay as you go. Also, we tend to and may need to spend more money in bad times and catch up in good. Eg, more people will need subsidized insurance when unemployment is as high as it is and fewer will when the economy is booming. That is the problem with medicaid and state funding. More people need it now but because of the financial problems of states less people are able to get it.


I think the nuts and bolts aren't talked about much in the press partly because it isn't sexy. The other reason is that or legislators are still working on it.

[Sevo]

unfortunately for so many people in the US the end result, regardless of what the intention was, is that we are all in the same boat you are. Insurance that belongs to the Government/Insurance/ megacorp/ complex rather than to individuals. We have to understand that Megacorp and the Insurance companies can and always will have far far more influence than you or I have because they can wine dine and Bribe Donate far more than we can.

Again I have all the sympathy in the world for all of us caught up in the god awful mess that we have made by sticking to 2 major parties and reelecting the same people over and over again.

Unfortunately There is no hope in sight for now. We are going to get what ever the Feds feel are best for their chances for reelection next election cycle and when they are through with us we'll all fuss with each other and then march back to the polls and put the same cynical ruthless crooks back in power. We just had this great big vote for "Change" and we still have almost the EXACT SAME people in congress.

[quietman]

Oh boy. I'm seeing debate now about the plan to tax the so called "goldplated" plans that cost more than 24,000 per year, presumably because they offer such great coverage out of reach for most people that it's seen as a progressive way to fund the other changes to offer insurance to everyone. This seems like a pointless distraction. If I were an insurance company offering such a plan, it would be simple to lower the price by X dollars to get under the threshold while simultaneously raising the deductible by the same X dollars. People who can afford such a plan, can surely afford the SAME cost to buy the modified plan and the side savings account, or whatever they call it, and avoid the tax. If this is the secret sauce that has been proposed to pay for a significant share of this plan, the actual revenue will likely be far far short of projections. Not to mention the possibility that folks will simply buy an inexpensive plan that offers mostly catastrophic coverage and then pay out of pocket for routine care. Everyone in this equation is an independent actor who will work in their own best interest and possibly think creatively about what that means. If the proposals don't recognize that, then the "projected" costs and revenue are going to be far off the projections.

[Sevo]

Modhatter I hope that you are right. At the same time when I watch the letter and the intent of our constitution being simply shredded and it seems that there are very few citizens that even notice it is hard for me to have much hope. I know this jumps out of the realm of "Health care" but does the average voter have any concept of any restrictions on the power of our central government.

[M Paquette]

I suspect that if the policymakers want everyone to have insurance, and without some effort to contain costs or alter underwriting groups that insurance may cost as much as or more than the gross income of many people, then we will see cases where folks will need to be subsidized.

In my case, the quote for a family insurance plan that we could get in spite of our pre-existing conditions comes to about 24,000/year. That's considerably more than the gross pay of someone at the poverty level. The choice between violating the proposed law and providing food and shelter for ones family isn't a good one.

Now, I know that the Randian rugged individualist would never let themselves get in such a situation, but out in the real world bad things happen. Folks might not be able to get a high paying job with insurance. They might not be capable of learning the skills needed, for example. (This isn't Lake Wobegone. Some folks are just below average.) We can be altruistic, which I know some view as a flaw and not a virtue, and as a society help out, or we can go the 'enlightened self-interest' route, say the heck with them, I got mine, and ignore the difficulties of others.

This is a choice we get to make for the direction of our society.