It is one thing to say that people will fall through the cracks, it is another thing to say that it is all their fault.
The Health Insurers have already won
- Thread starter walkinwood
- Start date
It is one thing to say that people will fall through the cracks, it is another thing to say that it is all their fault.
M Paquette
Moderator Emeritus
This thread is starting to make me cringe. There are some substantial differences between people's opinions on this issue, to be sure. I'd like folks to consider the other viewpoints, though, rather than pipe them through some ideological filter. If I want that, I can turn on 'talk radio'. 
I'm pretty big on personal responsibility, but I also realize that not everyone is, or is capable of being a rational, independent Randian hero figure. I also recognize that being a member of a society implies a certain degree of functional interdependence. A common theme of societies is that they serve to aid individuals in time of crisis. When an individual requires aid, other members of that society will band together to render aid in some form.
Our society is currently considering changes in the way we render aid to those in need of medical assistance. The current institutionalized model is seen as having grown in an ad hoc manner, nudged this way and that by various legal constructs and tax policies. There has been a desire to rationalize this model for some time.
Now, we stand on the brink of making changes that might improve the way we render medical assistance to those in need. There are various parties who would bend these changes so as to favor themselves, or their constituents. I'd encourage everyone to back away a bit, turn off the radio, and think, for themselves and others, how our society might best alter the way it renders medical assistance to those in need. Try and consider how your proposal affects others, and society at large, not just yourself. Look at models that other countries have adopted.
Oh, and be thankful to our moderators. Really. See the Motley Fool: Retire Early CampFIRE for the reason why.
I'm pretty big on personal responsibility, but I also realize that not everyone is, or is capable of being a rational, independent Randian hero figure. I also recognize that being a member of a society implies a certain degree of functional interdependence. A common theme of societies is that they serve to aid individuals in time of crisis. When an individual requires aid, other members of that society will band together to render aid in some form.
Our society is currently considering changes in the way we render aid to those in need of medical assistance. The current institutionalized model is seen as having grown in an ad hoc manner, nudged this way and that by various legal constructs and tax policies. There has been a desire to rationalize this model for some time.
Now, we stand on the brink of making changes that might improve the way we render medical assistance to those in need. There are various parties who would bend these changes so as to favor themselves, or their constituents. I'd encourage everyone to back away a bit, turn off the radio, and think, for themselves and others, how our society might best alter the way it renders medical assistance to those in need. Try and consider how your proposal affects others, and society at large, not just yourself. Look at models that other countries have adopted.
Oh, and be thankful to our moderators. Really. See the Motley Fool: Retire Early CampFIRE for the reason why.
harley
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Absolutely. I really like this forum, and I personally tend towards libertarianism and personal responsibility. However, I've noticed that as a group we tend to be relatively successful and relatively well off. People forget that there are people out there busting their humps for very little, and just as we don't necessarily deserve our good fortune, they don't necessarily deserve their bad fortune. I know them, I've been them, and they don't deserve to be marginalized. I will respect anyone's well thought out opinion, whether I agree with it or not. But simplistic finger pointing I will ignore. Doing it reflects very poorly on one's humanity and intelligence.
Gotadimple
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Most adults would agree that the world is not perfect. However, there is a theme in this thread that continues to ignore the potential for insuring more Americans. The proposals include tort reform, no underwriting, no pre-existing conditions, and no claim denials (except for fraud). If all of those proposals are implemented, we should see a reduction in the premiums we all pay, and that should help out those who don't currently have coverage by making it more affordable. The insurance carriers are willingly going along with removing these restrictions because they know they can drop rates and attract those who could not afford coverage before. They also know they can provide information to potential members to help them improve their health, and thereby continue to reduce the number of claims presented.
The last I heard the 'public option' would not be available to anyone who was currently covered. Yet to be determined is what the benefit design of the public option would be, and how it would compare to the other plans available. The House bill on the public option authorized $2 trillion in start the plan. But there is no infrastructure established to administer the plan and the $2Tr will probably all go into setting up infrastructure. IMO, the public plan is designed to be a stop gap, not to provide 'competition.' It will take a lot more than $2Tr to cover the 45M Americans who don't have access to health insurance now, and who would demonstrate diminished financial capacity to pay premiums -- the 'entry fee' for the public option.
In fact when you look at the content of the two paragraphs above, what we have is a marginalized population.
So as Martha has said, all of this would lead to adverse selection. But I suspect that the adverse selection would be moderated by the lifting of restrictions such that there wouldn't be a large increase in claims. Of course, if we changed how we pay providers, that would help too (I'm not giving up on this one, friends).
-- Rita
poplew
Dryer sheet wannabe
Love the way you just say 2T like its not realMost adults would agree that the world is not perfect. However, there is a theme in this thread that continues to ignore the potential for insuring more Americans. The proposals include tort reform, no underwriting, no pre-existing conditions, and no claim denials (except for fraud). If all of those proposals are implemented, we should see a reduction in the premiums we all pay, and that should help out those who don't currently have coverage by making it more affordable. The insurance carriers are willingly going along with removing these restrictions because they know they can drop rates and attract those who could not afford coverage before. They also know they can provide information to potential members to help them improve their health, and thereby continue to reduce the number of claims presented.
The last I heard the 'public option' would not be available to anyone who was currently covered. Yet to be determined is what the benefit design of the public option would be, and how it would compare to the other plans available. The House bill on the public option authorized $2 trillion in start the plan. But there is no infrastructure established to administer the plan and the $2Tr will probably all go into setting up infrastructure. IMO, the public plan is designed to be a stop gap, not to provide 'competition.' It will take a lot more than $2Tr to cover the 45M Americans who don't have access to health insurance now, and who would demonstrate diminished financial capacity to pay premiums -- the 'entry fee' for the public option.
In fact when you look at the content of the two paragraphs above, what we have is a marginalized population.
So as Martha has said, all of this would lead to adverse selection. But I suspect that the adverse selection would be moderated by the lifting of restrictions such that there wouldn't be a large increase in claims. Of course, if we changed how we pay providers, that would help too (I'm not giving up on this one, friends).
-- Rita
it is and are kids will pay the bill for it its going to take 2T to insure 15 million people
love the mathhow about we just give them all $100,000 for insurance and save 1.999999999999 T
donheff
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
I have some questions;
1, did he save for emergence's?
2. does he have a car payment?
3. dose he have a home or other assets?
4. has he been on vacation in the last 10 years?
Personal responsability
Emergent care is offered to people you will just need to pay the bill.
No free rides
+1
It always comes back to a toss of the dice. What if you lose your job? What if your employer provided insurance tosses your wife out when she gets cancer because she forgot to mention she had a heart murmur when she was 10 years old? These issues always take me back to my nephew's situation. Just graduated college, back home for the summer while he waited to start a job, and the toss of the dice came up with cancer. 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. Tough luck you didn't think about the possibilities - take out a second mortgage and cash in the 401K, or just let your kid go.
When I think of someone like my housekeeper (white trailer trash mentality) who tells me she has never purchased health insurance, because "It's FREE", my skin crawls. And the thought of her trailer trash kids having to purchase it now, puts a smile on my face.
On the other hand, I would not say that or feel that way about someone else in the same economic moat, who would love to be able to afford to buy insurance for themselves or their family.
So my point is. How can we separate these people? Those who are deserving and those who are not. Do we even have a moral right to say who deserves health insurance and who doesn’t? I know no one is too fond of slackers, who are always there ready to scam the system. They are not a pretty site, and I must admit there are times I wish we could rid the country of them.
But that same sentiment does not apply to all the rest of the less privileged people out there. The people with limited intellectual skills, education, the single women trying to raise children all by themselves. People working two and even three jobs to try and make ends meet and take care of their family.
At least with mandatory insurance, the slackers will be forced to contribute something into the pot, and the hard working will get a break and perhaps be able to afford some coverage.
As for younger kids, they will probably raise the age parents can keep them on their policy at a reasonable rate until they reach the age of 26.
To me justifying health insurance for everyone is simply a matter of priority as far as government spending is concerned. When you have a restricted amount of money to spend, and you can’t buy everything you want or fund everything you want, what do you do. You prioritize.
In my book, health insurance goes to position #1, and all the rest can be cut, trimmed or eliminated until we can afford it again. If I had to cut my life style to the bone, my priorities would be 1. A roof over my head. 2. Food to eat. 3. Health Insurance
4. Transportation. (though I’d ride a bike if I had to) All the rest is gravy. Now think of the federal government budget. What’s more important? War, infrastructure, education, space exploration? Of course we want it all,(except for the war) but when you can’t have it all, you prioritize.
On the other hand, I would not say that or feel that way about someone else in the same economic moat, who would love to be able to afford to buy insurance for themselves or their family.
So my point is. How can we separate these people? Those who are deserving and those who are not. Do we even have a moral right to say who deserves health insurance and who doesn’t? I know no one is too fond of slackers, who are always there ready to scam the system. They are not a pretty site, and I must admit there are times I wish we could rid the country of them.
But that same sentiment does not apply to all the rest of the less privileged people out there. The people with limited intellectual skills, education, the single women trying to raise children all by themselves. People working two and even three jobs to try and make ends meet and take care of their family.
At least with mandatory insurance, the slackers will be forced to contribute something into the pot, and the hard working will get a break and perhaps be able to afford some coverage.
As for younger kids, they will probably raise the age parents can keep them on their policy at a reasonable rate until they reach the age of 26.
To me justifying health insurance for everyone is simply a matter of priority as far as government spending is concerned. When you have a restricted amount of money to spend, and you can’t buy everything you want or fund everything you want, what do you do. You prioritize.
In my book, health insurance goes to position #1, and all the rest can be cut, trimmed or eliminated until we can afford it again. If I had to cut my life style to the bone, my priorities would be 1. A roof over my head. 2. Food to eat. 3. Health Insurance
4. Transportation. (though I’d ride a bike if I had to) All the rest is gravy. Now think of the federal government budget. What’s more important? War, infrastructure, education, space exploration? Of course we want it all,(except for the war) but when you can’t have it all, you prioritize.
haha
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
I think meaningful tort reform is extremely unlikely. The Dems have 3 paymasters: unions (especially auto workers and teachers), Wall Street, and trial lawyers. It wouldn't be prudent to disobey one's employers.
Republicans have theirs too, just a couple of substitutions. Judging by the last 40 years or so, I'd say someone must want war pretty badly too.
Ha
Bravo Martha ! Very well put.
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.
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.
growing_older
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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.
lets-retire
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I didn't mean to upset you, but the small Michigan town where I grew up had an economy driving by two things the military and cars. The town constantly complained about the military at a time when they were closing bases and the base closed. Now the town's economy is solely driving my the auto industry. What is interesting to note is most of the military members did not come from the local area.
The people who stayed in the area could not figure out that there was a better way someplace else. Many would talk about how good their paychecks were, just before they were laid off for the rest of the year. They would get hired back within a few months and get that booming paycheck again, for a couple months. Now that the only thing driving that economy is Detroit the town has all but dried up. There are few who stay around to work a few months only to be laid off for months. The rest are essentially retirees. The average pay for the area just after the military pulled out was less than 15k per year. It hasn't gone up at all. Just about all of the people working in that area, when I was there, didn't want to move because it was home. They couldn't see that their home was drying up and would blow away in the near future. It's blowing away now, but they still refuse to accept the fact that the town is dead and their best interests dictate they should move on to better jobs.
lets-retire
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I don't have a problem helping those who need help in their times of need. As you said that is why we form societies. As we can see from past social experiments, Welfare being the biggest one, helping a person in their times of need typically turns out to be several decades of assistance. That is not "helping out" that is "providing for". The only people who should need several years or decades of assistance are those who are ill or handicapped, not the able bodied who just can't take a good decision or who refuse to acquire the skills to obtain a decent job. As I've told my kid several times, retirement is not a right it is a privilege.
I agree with everything Martha has written.
Healthcare coverage conditioned on employment is not a policy, it is the consequence of no policy for decades. It is a bad idea, makes a complex issue (healthcare) worse, places a burden on employers and makes business less competitive.
The $900B (estimated for the next decade) is not the cost to provide healthcare, it is the cost of inaction for past decades while this problem continued to worsen - in plain view.
As a healthy individual willing and financially able to purchase health insurance but denied coverage due to non-lifestyle factors I have difficulty understanding the basic arguments against change. I do feel many are simply not aware of the amount of discrimination or degree of exploitation currently practiced in the US.
Some people seem to feel that many of the uninsured are so by choice. My own experience, with considerable family and friends struggling with healthcare and coverage, is different – their choices are limited or non-existent, healthcare represents their greatest financial risk, and the stress that results from poor or no coverage is taking a heavy toll on their health and well-being.
Healthcare coverage conditioned on employment is not a policy, it is the consequence of no policy for decades. It is a bad idea, makes a complex issue (healthcare) worse, places a burden on employers and makes business less competitive.
The $900B (estimated for the next decade) is not the cost to provide healthcare, it is the cost of inaction for past decades while this problem continued to worsen - in plain view.
As a healthy individual willing and financially able to purchase health insurance but denied coverage due to non-lifestyle factors I have difficulty understanding the basic arguments against change. I do feel many are simply not aware of the amount of discrimination or degree of exploitation currently practiced in the US.
Some people seem to feel that many of the uninsured are so by choice. My own experience, with considerable family and friends struggling with healthcare and coverage, is different – their choices are limited or non-existent, healthcare represents their greatest financial risk, and the stress that results from poor or no coverage is taking a heavy toll on their health and well-being.
ziggy29
Moderator Emeritus
Regardless of ideology, I think the first thing we should do is separate health insurance from employment status. I think that creates market distortions and economic displacements that really hurt.
It's sad to think about how many good ideas or successful businesses never happened because the person who would have developed them was afraid of losing their Megacorp health insurance.
Texas Proud
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I agree with you analysis... and I would like to see where the whole system of incentives changes... and I would like to see that the health care reform bill actually addressed these perverse incentives... but IMO they do not...
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.
Texas Proud
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Rita.... someone else posted on your easily thrown out number of 2 trillion... but lets look at that number a bit...
2,000,000,000,000
Looks a bit bigger does it not... if you were able to spend $1 PER SECOND... it would take you 2,641 YEARS to spend that amount of money... seems even bigger now...
The whole population of the nation is about 306 million... so YOUR share is $6,536... but wait.. we can not have the people who can not afford insurance pay for this... so... now your share is $7,500... are you married with two kids?? I am.. so my family share is now $30,000...
And the cost PER PERSON of the 30 mill who need insurance (Obama's number in his speech) is $67K... this is not the cost of infrastructure... it is the cost of fully insuring the whole lot of them...
So, before you go out spending $30K of my family's money... I would like a say in what it is being spent on... or NOT being spent at all....
Bestwifeever
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From today's Chicago Tribune:
Firm cancels health insurance coverage for girl, 17, after celiac disease diagnosis -- chicagotribune.com
The insurance company went back and combed this teenager's medical records to find reasons to cancel her insurance and thus not pay for benefits.
Not opining on whether or not the coverage should be rescinded, but if the insurance co. can find out this information before it pays a penny in benefits, why didn't it do this before they accepted the application?
Firm cancels health insurance coverage for girl, 17, after celiac disease diagnosis -- chicagotribune.com
The insurance company went back and combed this teenager's medical records to find reasons to cancel her insurance and thus not pay for benefits.
Not opining on whether or not the coverage should be rescinded, but if the insurance co. can find out this information before it pays a penny in benefits, why didn't it do this before they accepted the application?
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.
Gotadimple
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Texas,
I am not advocating we spend $2Tr on a public option. I am against a public option.
The $2,000,000,000,000 figure is not mine. It is in the House version of the bill. Rep. Barney Franks clearly explained in one of his town hall meetings (see YouTube) that the bill called for this funding to start the public option and no more than that.
That said, all I am saying after working for many years in megacorp health care and managing a $17 million budget for just one division is this: if one megacorp serving over 3 million people spends in excess of $600 million a year, as a not-for-profit, how many half billions ($500,000,000) will it take to insure 45 million Americans?
You and I are on the same page, all I'm saying is that the public option is not an option when it is underfunded. Having worked with health care government contracts I can tell you what will result is minimal coverage because there is insufficient funds to pay providers in the same manner they get paid for providing services for private patients. When that happens the members who have signed up for the health plan get marginal care. We have that today: Medicaid, and to a certain extent Medicare when providers start refusing to see Medicare patients.
Perhaps I wasn't clear earlier.
-- Rita
Texas Proud
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In my reading then... you were not clear earlier... but this clears it up.. thanks..
Our current system "not purchased through" your employer, also has similar consequences. As a small business owner having to purchase a private policy for my son and myself many years ago, has now resulted in our inabillity to move out of state. As my son now has a "pre-existing condition".
I purchased a HMO about 13 years ago, after having my premium tripple in three years and then canceled when I got a swollen lymph node in my neck. The HMO's can't do this (raise an individuals premium or boot you off as far as I know, unless it has changed), so to me it was less risky than carrying a PPO.
Now that my son has a pre-existing condition and I can not get a policy for him if we were to let this one go. So we are stuck, and can't move out of state as we would like to.
I wonder how many more small business owners or workers without employer insurance as well as those with employer insurance are in this same delima? Sure might help the real estate market if we could move when we want to.
I think sometimes the people on this board working for large corporations, federal jobs, etc.with good health insurance provided for them, don't stop to consider how many of us are out there who don't fit this bill. No one would ever call me a slouch. I was an entrepreneur who started my own business that has lasted for over 30 years. It is still a small business, but I created jobs for people and contributed to society. I just never crossed the mega buck line. There are many like me out there, and I think sometimes the people on this board forget this sometimes. The current system of providing the availability of health care is unfair on many levels. Looking at your own fortunate (or so you think) current status, and saying you don't want to pay for those not in your position appears very selfish to me. (sorry to be so blunt)
Much to their credit, I have heard wealthy TV personalities (above the $250,000 threashold) say outload on TV.
"TAX ME". It's OK. I don't mind. If I have to pay higher taxes to insure health care for everyone, bring it on.
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.
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.
youbet
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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.
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