The Health Insurers have already won

[ERD50]

What is "nicer" coverage? You either need the medical service or you don't. You want everyone to have preventive care, to save cost in the long run. A private hospital room versus a shared room isn't going to be a big cost savings. ....

That's the beauty of a free market - it could be whatever some creative group offers that people decide they want to pay for.

Private versus shared room was just an example, I don't know what the cost delta is. I'm sure there are many others I have not thought of, but that's my point, free markets fill needs/wants, sometimes ones we don't even realize we have until they are offered. Another might be more flexibility of non-time-critical procedures:

A) Mr X, you since you paid extra for the Executive Level Plan, you can schedule your wisdom tooth extraction at any of these offices, at any time that is convenient for you.

B) Mr Y, you are on the basic govt subsidized plan. We will call you 24 hours in advance when we have an opening for your wisdom tooth extraction, be prepared to show up at the appointed time and place.

Or maybe two equally effective procedures exist, but one is more expensive, but can be done in a single visit, the other requires multiple visits. The Executive might choose (and have access to, since he paid extra) the more expensive procedure, because his time is money to him. And on and on.

And if no one wants to pay extra, there is no extra plan - it's a free market, with a govt admin plan as a back-stop. It just opens up options that maybe the govt "one size fits all" might not include.

I guess I don't see how these options add any burden to people who accept the basic voucher (if that is what you are saying).

-ERD50

 

[poplew]

I will be as nice as i can be. good health "insurance" is not a right it is part of a pay package you get for working (part of your pay). so its something we work hard for. i would expect the guy who gets up in the morning drives 50+ miles to WORK to get better care then the guy sitting home watching TV Not Working. i hope this doesn't get zapped

 

[Martha]

This is a horrible idea.

If I have a medical condition, there are usually many options for what kind of treatment could be used. Likewise, if I have an issue, not yet fully diagnosed, there are many options for what kinds of tests or treatments could be tried.

The idea that I will ONLY be allowed to use what specific medical service I NEED and not any optional services flies in the face of common sense. I had a doctor who tried to practice like that, once. He would advise ONLY a specific treatment that he considered the "standard" of care and would not consider any alternatives or possibility that there were other considerations, nor would he ever test for any other conditions once he had determined the "current issue" for my visit. I think his approach is completely wrong and I found him impossible to work with, so I changed doctors as soon as possible. I hope this quote has been taken out of context, because if this kind of thinking is any part of future medical care we will all be poorly served by doctors like my former doctor and care like tickmarks on a checklist.

My post was in reference to what a basic insurance policy should cover. Yes, I know that there are different treatment options and treatment options may very depending on your own personal situation, but that is not my point. My point is that a basic plan is not going to be that different from a so called cadillac plan. The term Cadillac plan usually was used in reference to low deductibles and copays, without dollar limits on coverage, not so much what it will cover. Now there are some states that allow very crappy plans to be sold, that I would find less than basic. Maybe they don't cover drugs at all. Maybe they put a cap on coverage per year or per illness. Maybe they don't cover pregnancy. These kinds of caps should not be in a basic plan. What is the point of the insurance if it doesn't cover the catastrophe and doesn't cover necessary treatments?

That said, I don't know that a plan should cover every goof ball treatment around just because some doctor likes it. If it isn't supported by at least some evidence, why should the plan pay? Like using chiropractic to treat allergies. Shouldn't be covered because there is no evidence to support that it works.

 

[Texas Proud]

The most "cost efficient" system any way you slice it is a single payer system. Only all the political leaders don't want to put all the insurance companies out of business. Any other attempt at a fix is a band aid, without true cost savings possible in the long term. There is too much money currently being taken out by the insurance companies not designated to health care. There are too many young people without coverage, cause they think they are invincible, and too many people using the emergency rooms for their health care, cause they can. Think social security. You probably don't need it when you are young unless you become disabled, but you pay it when you are young, so you have it when you get older and need it.

It appears as not enough people have suffered the wrath of the insurance companies, and until more are personally effected, we may not be able to make necessary changes.

My "fantacy dream" would be for every member of congress to lose their insurance with no alternatives but to try and buy private insurance for themselves and their family. A few years of this, and we would have a very speedy solution.

Yes... the most 'cost efficient' system when it comes to PAYMENTS is a single payor system... but that is if it works right... who thinks the government can run a cost efficient payment system

Also, having a single payor does NOT address the cost side... with almost all these proposals... they are just trying to spread the current costs among more people (let's make those young-uns pay into the system to support US)... now, you can have your single payor tell the docs and hospitals that they will not get paid if they do "X" or "Y"... so they will not do it and now you have rationing.... that is what people are concerned with the proposals.... that rationing will kick in big time...

 

[Martha]

I will be as nice as i can be. good health "insurance" is not a right it is part of a pay package you get for working (part of your pay). so its something we work hard for. i would expect the guy who gets up in the morning drives 50+ miles to WORK to get better care then the guy sitting home watching TV Not Working. i hope this doesn't get zapped

As a country, we can make something a right if we want to.

If you have money no one says that health care should be free.

I know someone who was laid off in his mid 50s, he can't get health insurance as he couldn't afford COBRA and now can't get on the state's risk pool because he didn't take COBRA. He is looking for work and hasn't found it. So no chemo for him if he gets cancer?

Our country currently divides people into the worthy and unworthy for health care, in my mind in an arbitrary fashion. Some people have the right and some do not. In most states if you are poor but not elderly, not totally disabled, or don't have young children there is no health care program for you. You are not worthy. This is also true if you are working for an employer that doesn't offer health insurance and you can't buy or afford to buy on the market, or if you are laid off and can't find work and can't pay the premiums, or if you are homeless and have no skills to get yourself into the work force, or if you are partly disabled and just can't find work, or yes, even if you are just a lazy ass sitting on the couch. But given that there is no "dole" the number of lazy asses sitting on the couch fully able to work but not doing so because they just don't want to may not be too high, though I suppose they could be sucking off of a spouse or family.


If you are in prison you will get health care. Or if you are poor and have a baby (for a limited time). Or if you are old. Or if you are disabled and you can prove it to the satisfaction of the SSA. They are the worthy. But being poor or having a preexisting condition does not put you in the worthy category.



That said, I do not support health insurance for illegal immigrants. No country to my knowledge does. But I still believe that hospitals have to treat everyone in an emergency to the point of stabilization. It is not practical to prove citizenship in those circumstances and pretty brutal too.

 

[growing_older]

But I don't WANT a health plan that pays for every little thing. If I have one of those, I have to get every little thing approved by the insurance company and I have to fight about every bill for every service. I never know the true cost of anything and I cannot make any reasonable value choices about medical care.

OTOH, I do want to be covered in case there is an accident or very expensive disease in my future. But I can ONLY get that by taking health insurance that includes all that other stuff (and hassle) that I don't want. If I'm unlucky enough to have a pre-existing condition that might affect that coverage, I won't even be able to get that, which means I won't be able to get coverage for future accidents or very expensive diseases at any price, because the coverage I didn't even want cannot be obtained. This is just too twisted.

 

[Martha]

That's the beauty of a free market - it could be whatever some creative group offers that people decide they want to pay for.

Private versus shared room was just an example, I don't know what the cost delta is. I'm sure there are many others I have not thought of, but that's my point, free markets fill needs/wants, sometimes ones we don't even realize we have until they are offered. Another might be more flexibility of non-time-critical procedures:

A) Mr X, you since you paid extra for the Executive Level Plan, you can schedule your wisdom tooth extraction at any of these offices, at any time that is convenient for you.

B) Mr Y, you are on the basic govt subsidized plan. We will call you 24 hours in advance when we have an opening for your wisdom tooth extraction, be prepared to show up at the appointed time and place.

Or maybe two equally effective procedures exist, but one is more expensive, but can be done in a single visit, the other requires multiple visits. The Executive might choose (and have access to, since he paid extra) the more expensive procedure, because his time is money to him. And on and on.

And if no one wants to pay extra, there is no extra plan - it's a free market, with a govt admin plan as a back-stop. It just opens up options that maybe the govt "one size fits all" might not include.

I guess I don't see how these options add any burden to people who accept the basic voucher (if that is what you are saying).

-ERD50

I started getting away from my concern that I raised a number of posts back when I provided a link discussing problems with the private health insurance market. As I said above, and Rita discussed a bit as well, if you make the public option too much less desirable than group options the risk is that the public option market will be unstable and become expensive from adverse selection, especially if it is required to be a self supporting program.

And maybe it won't be a problem, maybe there will be enough people in the market to make it work. It just is an issue that will have to be followed if current proposals get passed. With employer coverage the best deal the private market and if it exists, the public option market, may end up being second class coverage. I don't care if group benefits get you a few tasty morsels, but I don't want to see the public option ending up like the crappy plans that are allowed in many states.

 

[Martha]

But I don't WANT a health plan that pays for every little thing. If I have one of those, I have to get every little thing approved by the insurance company and I have to fight about every bill for every service. I never know the true cost of anything and I cannot make any reasonable value choices about medical care.

OTOH, I do want to be covered in case there is an accident or very expensive disease in my future. But I can ONLY get that by taking health insurance that includes all that other stuff (and hassle) that I don't want. If I'm unlucky enough to have a pre-existing condition that might affect that coverage, I won't even be able to get that, which menas I won't be able to get coverage for future accidents or very expensive diseases at any price, because the coverage I didn't even want cannot be obtained. This is just too twisted.

Yup.

 

[ERD50]

I will be as nice as i can be. good health "insurance" is not a right it is part of a pay package you get for working (part of your pay). so its something we work hard for. i would expect the guy who gets up in the morning drives 50+ miles to WORK to get better care then the guy sitting home watching TV Not Working. i hope this doesn't get zapped

poplew, even though I am big on the whole "personal responsibility" thing, I agree with Martha that there are issues with having HC tied to employment (can be tough to change jobs, start your own business, and even responsible people lose their jobs sometimes).

And I don't like the idea that someone who falls through the cracks cannot get efficient medical care (although I've heard that a poor person w/o ins will get care, but they won't get much in the way of preventative treatment?). I think that caring for people is not only the "right" thing for our country to do, but probably also the most cost effective overall (avoid the ER treatment of small issues, and get preventive care).

Here's a thought that has been running through my mind though.... I think most people want any govt subsidy to be a "helping hand up and out" of a problem for most people (some will need a lifetime of support though). So what if you had to take a govt hand-out for ins for 3 years, but then got yourself into a good employment situation? Why not track what people have received in bennies, and then deduct them at some reasonable % over their life so that they are paid back? Similar to student loans. So it's not a "free-bie" for most, but a helping hand in time of need. And why shouldn't they pay it back, once they are settled in? That might make it more acceptable to a larger population?

-ERD50

 

[Martha]

that is what people are concerned with the proposals.... that rationing will kick in big time...

Yeah. Unfortunately we do know that we need some rationing. McAllen Texas does too many procedures as compared to Rochester Minnesota or El Paso Texas. McAllen needs some "rationing" out of unnecessary care. I think that we have to look at positive creative ways around the incentive problem of pay per service.

 

[ziggy29]

So what if you had to take a govt hand-out for ins for 3 years, but then got yourself into a good employment situation? Why not track what people have received in bennies, and then deduct them at some reasonable % over their life so that they are paid back?

In principle I like this, but in practice I don't know that it's a good idea to create a financial disincentive for getting back on your feet.

 

[poplew]

As a country, we can make something a right if we want to.

If you have money no one says that health care should be free.

I know someone who was laid off in his mid 50s, he can't get health insurance as he couldn't afford COBRA and now can't get on the state's risk pool because he didn't take COBRA. He is looking for work and hasn't found it. So no chemo for him if he gets cancer?

Our country currently divides people into the worthy and unworthy for health care, in my mind in an arbitrary fashion. Some people have the right and some do not. In most states if you are poor but not elderly, not totally disabled, or don't have young children there is no health care program for you. You are not worthy. This is also true if you are working for an employer that doesn't offer health insurance and you can't buy or afford to buy on the market, or if you are laid off and can't find work and can't pay the premiums, or if you are homeless and have no skills to get yourself into the work force, or if you are partly disabled and just can't find work, or yes, even if you are just a lazy ass sitting on the couch. But given that there is no "dole" the number of lazy asses sitting on the couch fully able to work but not doing so because they just don't want to may not be too high, though I suppose they could be sucking off of a spouse or family.


If you are in prison you will get health care. Or if you are poor and have a baby (for a limited time). Or if you are old. Or if you are disabled and you can prove it to the satisfaction of the SSA. They are the worthy. But being poor or having a preexisting condition does not put you in the worthy category.



That said, I do not support health insurance for illegal immigrants. No country to my knowledge does. But I still believe that hospitals have to treat everyone in an emergency to the point of stabilization. It is not practical to prove citizenship in those circumstances and pretty brutal too.

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

 

[Martha]

In principle I like this, but in practice I don't know that it's a good idea to create a financial disincentive for getting back on your feet.

Big burden on the poor that will continue to help keep them poor. We already have a big spread between haves and have nots. You are on public assistance when your kids are babies, are forced off into a shitty job and get a bill to start paying it back. I don't know the current state of the law but I do know that it used to be that when kids went into foster care their parents would be billed for the care. It was a huge burden on the family.


I am ok of having things like medicaid liens on your assets to if you die medicaid gets repaid first.

 

[Martha]

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

Wtf does going on a vacation have to do with this? If you are poor you don't get vacations? He lives in California. Doesn't own a home. Gets laid off frequently because of the nature of his work. Divorced. No savings to speak of--rent is high and income is low. He even has roommates to share expenses. Has health problems so he can't buy insurance on the individual market. Owns an older vehicle free and clear, as a car is necessary to find and keep a job in LA.

Come on, do you know people who have unskilled jobs and who make $20,000, $25,000 a year? I know many in that position. They work hard, rent, have cars that have problems or payments. There isn't room to save for months and months of unemployment.

I also know people who have jobs that offer no insurance and due to preexisting conditions they can't buy any. Minnesota has Minnesota Care, which subsidizes health insurance for the working poor, with the poor paying a sliding fee. Is that so bad? Minnesota has one of the lowest percentages of uninsured in the US (after MA with its reforms).

The polarization on this issue in the country is tough. You and I are so far apart on our world views that there likely will be no way that we will ever be able to discuss the issues without being just irritated with each other. I feel so strongly about people being accused of irresponsibility when bad things happen to them that it is hard for me to even type this and maintain a modicum of politeness.

 

[Texas Proud]

Yeah. Unfortunately we do know that we need some rationing. McAllen Texas does too many procedures as compared to Rochester Minnesota or El Paso Texas. McAllen needs some "rationing" out of unnecessary care. I think that we have to look at positive creative ways around the incentive problem of pay per service.

I don't disagree at all... I saw the same program about McAllen... I think they do a lot since it is one of the poorest counties in the nation... so a lot are on Medicaid... and why not charge the government more procedures... you don't want to be discriminatory against the Hispanics do you (yes, this is a bit of a rant... probably will be edited)...


The real problem is where is the line between rationing out the unneeded medical procedures and the needed ones...

 

[poplew]

Wtf does going on a vacation have to do with this? If you are poor you don't get vacations? He lives in California. Doesn't own a home. Gets laid off frequently because of the nature of his work. Divorced. No savings to speak of--rent is high and income is low. He even has roommates to share expenses. Has health problems so he can't buy insurance on the individual market. Owns an older vehicle free and clear, as a car is necessary to find and keep a job in LA.

Come on, do you know people who have unskilled jobs and who make $20,000, $25,000 a year? I know many in that position. They work hard, rent, have cars that have problems or payments. There isn't room to save for months and months of unemployment.

I also know people who have jobs that offer no insurance and due to preexisting conditions they can't buy any. Minnesota has Minnesota Care, which subsidizes health insurance for the working poor, with the poorhe need to paying a sliding fee. Is that so bad? Minnesota has one of the lowest percentages of uninsured in the US (after MA with its reforms).

The polarization on this issue in the country is tough. You and I are so far apart on our world views that there likely will be no way that we will ever be able to discuss the issues without being just irritated with each other. I feel so strongly about people being accused of irresponsibility when bad things happen to them that it is hard for me to even type this and maintain a modicum of politeness.

take it easy we are all getting old and you don't wont to pull something
I do agree that some folks have fallen through the cracks. but we don't need a trillion dollars and change everyone's insurance to pay for that do we? people need to make insurance a priority before they spend money on things like vacations. as for your friend he would qualify for medicaid. FOR SURE.
We do seem to be on polar opposite sides of this issue. but sorry i think just you are dead wrong.

 

[Martha]

I don't disagree at all... I saw the same program about McAllen... I think they do a lot since it is one of the poorest counties in the nation... so a lot are on Medicaid... and why not charge the government more procedures... you don't want to be discriminatory against the Hispanics do you (yes, this is a bit of a rant... probably will be edited)...


The real problem is where is the line between rationing out the unneeded medical procedures and the needed ones...

Remember, El Paso is cheaper and has better outcomes, yet their demographics are similar.


I agree the real problem is how to get best practices and evidence based medicine working well, while acknowledging individual differences. The pay per service model doesn't help, we need to allow some experimentation with different models.

 

[lets-retire]

Martha your friend in Cali probably should have figured out several years ago that he needs to change jobs if he's getting laid off often. That is no way to live. Survive yes, but not live. It's good for someone in their 20's but by the time you are in your thirties you should have figured something out.

 

[Martha]

take it easy we are all getting old and you don't wont to pull something
I do agree that some folks have fallen through the cracks. but we don't need a trillion dollars and change everyone's insurance to pay for that do we? people need to make insurance a priority before they spend money on things like vacations. as for your friend he would qualify for medicaid. FOR SURE.
We do seem to be on polar opposite sides of this issue. but sorry i think just you are dead wrong.

He is not eligible for Medicaid. I suggest you get your facts before stating that he is eligible FOR SURE. This is a misunderstanding that many people have. Medicaid doesn't cover you just because you are poor and out of work. The federal government does require certain groups get medicaid and certain minimum benefits but my friend does not fall into those groups. The states can add more groups and benefits, but it is tough for them to do so because state budgets are tight and they have to balance.


Here is what California Medicaid version offers to poor individuals: Find Out if I Qualify


If you are enrolled in one of the following programs, you can get Medi-Cal:

• SSI/SSP
• CalWorks (AFDC)
• Refugee Assistance
• Foster Care or Adoption Assistance Program
• In-Home Supportive Services (IHSS)

You can also get Medi-Cal if you are:

• 65 or older
• Blind
• Disabled
• Under 21
• Pregnant
• In a skilled nursing or intermediate care home
• On refugee status for a limited time, depending how long you have been in the United States
• A parent or caretaker relative or a child under 21 if:
  The child's parent is deceased or doesn't live with the child, or
  The child's parent is incapacitated, or
  The child's parent is under employed or unemployed
  ​
• Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)

 

[Texas Proud]

The polarization on this issue in the country is tough. You and I are so far apart on our world views that there likely will be no way that we will ever be able to discuss the issues without being just irritated with each other. I feel so strongly about people being accused of irresponsibility when bad things happen to them that it is hard for me to even type this and maintain a modicum of politeness.

I think you were pretty polite...

I agree with you in some ways... but also disagree in others... mostly from the snippits I see here and there...

I have a BIL whose exteded family are not that great... many on welfare or in jail.. some took to many drugs when they were young... very few brain cells left... and the sister of the BIL is taking care of a nephew and niece while their father is in jail... so she is strapped for money even though she is getting some from the state... but buys both of them cell phones at $50 per month (I think 10 and 14 are the ages)... then she buys a HORSE.. because she lives in the country and it would be good for the kids... and someone gives her another.. so there is more money feeding a big animal... she has zero money sense... and never will... she goes from one crisis to another..

I have a friend who's sister is a teacher and gets paid reasonably well... but also goes from one crisis to another... picks the 'bad boy' boyfriends who cheat on her and steal her money (if she has any)... has car repoed and gets kicked out of her house... now, she was married twice, and was living nicely... but got divorced for whatever reason... (I never heard)...

When my sister did audits for the state of California for welfare.. she said there were so many people who gamed the system it was a joke... the knew the rules and how to get around them... this was many many years ago, so I do not know if it still is there... but I would bet it is..

True... I do know of people who work hard and live paycheck to paycheck... and are not blowing their money on drugs or drinking.. and I do not mind helping them... but it is hard for me to want to help people who have the means, but are so stupid in how they handle money they are always in trouble and want a handout....

 

[Texas Proud]

Remember, El Paso is cheaper and has better outcomes, yet their demographics are similar.


I agree the real problem is how to get best practices and evidence based medicine working well, while acknowledging individual differences. The pay per service model doesn't help, we need to allow some experimentation with different models.

Did not remember that... but I am sure it is in the program...


But, here is the crux IMO... we CAN require insurance companies to cover everyone who wants a policy... and pay for this and pay for that... and we CAN say we are not going to pay for every procedure you want to do... because it is outside the best practices and is not adding to health care... and we can do all of this without spending billions of dollars to cover the uninsured...

So, the policy that is being proposed is to cover the uncovered... and it will cost us a lot of money to do that... I would much prefer to fix the system on the cost side and make insurance available to everybody... but if you do not want to pay... so be it... but if you do... and you come to the doctor and get cancer... sorry, that is not covered (yes, it is a pre-existing condition... but the law should have it that if you decide to go it alone.... you go it alone forever for anything that happens to you if you do not buy insurance.....)

 

[Martha]

Martha your friend in Cali probably should have figured out several years ago that he needs to change jobs if he's getting laid off often. That is no way to live. Survive yes, but not live. It's good for someone in their 20's but by the time you are in your thirties you should have figured something out.

Cripe, don't you realize that there are people who are doing the best they can and that is what they end up with? Small town clerks in a hardware store. Taking inventory in a small factory. Secretaries in small offices. Drivers of delivery vehicles. Etc.

We aren't all going to have the good jobs and not everyone is going to "figure something out."

This is what is polarizing: You folks are talking about my family and some of my friends. Some of you post about what they should have done or claim that they lived irresponsibly. It is painful when people think your relatives and friends are losers when I know them to be hard working caring people.

 

[Martha]

So, the policy that is being proposed is to cover the uncovered... and it will cost us a lot of money to do that... I would much prefer to fix the system on the cost side and make insurance available to everybody... but if you do not want to pay... so be it... but if you do... and you come to the doctor and get cancer... sorry, that is not covered (yes, it is a pre-existing condition... but the law should have it that if you decide to go it alone.... you go it alone forever for anything that happens to you if you do not buy insurance.....)

I understand. I favor an insurance mandate to drag in all those young people who never believe that they might wake up with leukemia someday or have a car accident.

 

[IndependentlyPoor]

Did not remember that... but I am sure it is in the program...

I didn't see the program, but the point Martha is talking about was made in the New Yorker article.
McAllen, Texas and the high cost of health care : The New Yorker
I'm going to go out on a limb here and paraphrase from memory without re-reading the article and say that the author was trying to make the point that healthcare costs have skyrocketed, at least in part, because of out-of-whack incentives.

 

[poplew]

Cripe, don't you realize that there are people who are doing the best they can and that is what they end up with? Small town clerks in a hardware store. Taking inventory in a small factory. Secretaries in small offices. Drivers of delivery vehicles. Etc.

We aren't all going to have the good jobs and not everyone is going to "figure something out."

This is what is polarizing: You folks are talking about my family and some of my friends. Some of you post about what they should have done or claim that they lived irresponsibly. It is painful when people think your relatives and friends are losers when I know them to be hard working caring people.

I do see that this is a very personal issue for you. but we cant take care of everyone. not everyone will be covered if this plan was to go through and it for sure will not be free so your friend might still fall through the cracks. unfortunately the world and mankind are not perfect