The Health Insurers have already won

[growing_older]

Quote:

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.

[lets-retire]

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Originally Posted by Martha 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 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]

Quote:

Originally Posted by M Paquette 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.

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.

[MichaelB]

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.

[ziggy29]

Quote:

Originally Posted by MichaelB 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.

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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Originally Posted by IndependentlyPoor 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.

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...

[quietman]

Quote:

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.

[Texas Proud]

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Originally Posted by Gotadimple 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.

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]

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?

[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.

[Gotadimple]

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Originally Posted by Texas Proud 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....

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]

Quote:

Originally Posted by Gotadimple 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

In my reading then... you were not clear earlier... but this clears it up.. thanks..

[modhatter]

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Originally Posted by ziggy29 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.

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.

[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.

[youbet]

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Originally Posted by MichaelB 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.

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.

[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...

[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.

[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.