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Old 11-28-2011, 07:41 PM   #21
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Might be getting closer. I just read today, that Britain passed on providing treatment for the deadliest type of skin cancer. The Bristol Meyer Squibb treatment was $126,600 per person, and was cited as too expensive. Critics called it a death sentence. However, this brief article in the newspaper did not mention the actual success rate of the treatment, so there could be more to the story than just cost issues.
In the UK an independent panel assesses the efficacy of treatments. So there is rationing in the UK, but not to the extent that private health insurance rations care in the US by excluding many because of pre-existing conditions.
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Old 11-28-2011, 08:12 PM   #22
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... But let's honest: anyone want to go back to 1970s medicine?
No, today's medicine is amazing and I don't want to go back to 1970's medicine - but what good is is today's medicine if we can't afford it and it bankrupts us?

I think the unfortunate reality is that we will need to draw lines somewhere (like the expensive cancer treatment that has been passed on by the UK).
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Old 11-29-2011, 08:08 AM   #23
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One thing for sure, there are good paying jobs still available. The WSJ recently reported on jobs for welders, machinests and big motor electricians that are going begging. Part of it is the working conditions (lots of travel, outdoor bad weather work), but a lot has to do with our inability to train people for these jobs. Our schools are stuck on the 'college' track for every student, even those who don't want to go and can't qualify to go. But, highly skilled technical jobs that ONLY require an AA or special training often pay as much or more than many degreed jobs.
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Old 11-29-2011, 08:43 AM   #24
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One thing for sure, there are good paying jobs still available.
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The WSJ recently reported on jobs for welders, machinists and big motor electricians that are going begging.
Perhaps they're not high-paying enough if they're not getting any takers...
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Old 11-29-2011, 09:03 AM   #25
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Perhaps they're not high-paying enough if they're not getting any takers...
Perhaps. And then they will use that as proof that there are "not enough qualified Americans" as an excuse to either bring in "guest workers" who will work for a lot less or, where feasible, move the jobs to China. And no pesky health insurance to pay! I think it's another example of our "health insurance tied to employment" example of making American labor less competitive internationally.

We also have a big problem in terms of unprecedented (at least in the post-WW2 era) unwillingness to provide on-the-job training. As long as companies can offload training costs on taxpayers (through subsidized public colleges and universities) and on job seekers (expecting them to rack up tens of thousands of debt to get all the "entry level" training), why would they do something to take a penny or two off of quarterly earnings?
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Old 11-29-2011, 09:25 AM   #26
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To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.
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Old 11-29-2011, 09:30 AM   #27
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To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.
I smell bacon...
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Old 11-29-2011, 09:34 AM   #28
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But let's honest: anyone want to go back to 1970s medicine?
I see no reason to couple the quality of the technology with the payment/insurance system. They are independent. Yes MRIs are expensive, but IIRC in the good old days, if you wanted to see if you were pregnant you had to kill an actual rabbit. Today you get a stick for a few bucks at Kmart.

IOW I do think many would like to go back to the insurance system of the 1970s or the 1950s. The one with fewer, cheaper liability issues.
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Old 11-29-2011, 09:38 AM   #29
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To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.
Mmmm, bacon!

No particular love for unions, but it's more complicated, IMHO.

It's true that folks in this country wanting more money than peasant/slave labor in other countries are at a disadvantage, as are companies who are expected to provide worker safety, and minimal environmental standards. Not sure how we solve that dilemma...
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Old 11-29-2011, 09:46 AM   #30
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To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.
I would take this in another direction besides union-bashing: Other countries have unions, but they don't have a situation where all of your health insurance is expected to come from your employer. I would submit that this unfortunate expectation that health insurance comes from employers is a bigger problem than unions here. If the U.S. didn't have this unique and dysfunctional model of tying health insurance to full-time employment, the unions wouldn't need to demand it from employers, would they? For that reason, U.S. unions are even at a competitive disadvantage to unions in other countries where the cost of employer-provided health insurance isn't a huge additional burden to the employer that grows by 10% a year or more.

So the real problem here: Sever the link between health insurance and employment once and for all. This is really hurting our global competitiveness *and* the prosperity of our middle class, for union and non-union shops alike.
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Old 11-29-2011, 09:52 AM   #31
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So the real problem here: Sever the link between health insurance and employment once and for all. This is really hurting our global competitiveness *and* the prosperity of our middle class, for union and non-union shops alike.
+1
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Old 11-29-2011, 10:14 AM   #32
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I recall upon starting my first full-time job being surprised it offered health insurance. IMO insurance works best to spread risk on unlikely events; trouble begins when insuring something virtually everyone will need, like health care.

I don't know which group was the first to obtain a discount on health insurance simply by nature of being a group. My understanding is the Group Discount had been the initial justification for health insurance as a job benefit.
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Old 12-01-2011, 12:45 PM   #33
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I've felt that a lot of large mega corps with huge employee bases do a lousy job of leveraging their volumes for group rates. It is really much easier for them to simply pass on increased costs to employees vs battling the healthcare providers/drug companies to lower costs.

Also, the other area the I find annoying is the so called family plans that have the same price tags regardless of how many kids you. That just seems fundamentally unfair to me.
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Old 12-01-2011, 12:52 PM   #34
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No, today's medicine is amazing and I don't want to go back to 1970's medicine - but what good is is today's medicine if we can't afford it and it bankrupts us?

I think the unfortunate reality is that we will need to draw lines somewhere (like the expensive cancer treatment that has been passed on by the UK).
This is a lot like the battle to balance the budget -- many of us believe that we need both tax increases and spending cuts to get there, but we refuse to accept it if it raises *our* taxes or cuts *our* preferred spending programs.

It's similar here -- many folks recognize that tough choices may need to be made about what is covered, how we deal with "end of life" care, how much expensive modern technological procedures we can afford... but if it limits our own access to the very best, most expensive care imaginable, it's a non-starter.
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Old 12-01-2011, 01:11 PM   #35
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I've felt that a lot of large mega corps with huge employee bases do a lousy job of leveraging their volumes for group rates. It is really much easier for them to simply pass on increased costs to employees vs battling the healthcare providers/drug companies to lower costs.

Also, the other area the I find annoying is the so called family plans that have the same price tags regardless of how many kids you. That just seems fundamentally unfair to me.
Most megacorps self-insure - they hire an insurance company to administer claims and pay the actual claims + an administrative fee + a stop-loss insurance policy in case experience is particularly bad that year so I'm not sure your first point is valid.

While I understand your second point it is easier administratively and the reality is that kids health care costs don't cost a lot on average so the difference probably isn't very significant and they don't have to deal with kids being added and dropped.
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Old 12-01-2011, 01:37 PM   #36
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Most megacorps self-insure - they hire an insurance company to administer claims and pay the actual claims + an administrative fee + a stop-loss insurance policy in case experience is particularly bad that year so I'm not sure your first point is valid.

While I understand your second point it is easier administratively and the reality is that kids health care costs don't cost a lot on average so the difference probably isn't very significant and they don't have to deal with kids being added and dropped.
Self insure yes, but they still they pay the bills and with their admin company do exert leverage over the healthcare providers, much more so than the individual subscriber does.

On the second point, most of these enrollments are computerized, so not really a big admin burden. On the cost of such coverage, when my son came off my plan this year, the cobra fee was $9K for a healthy 25 yo. Seems like there is no reality in that cost.
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Old 12-01-2011, 02:56 PM   #37
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Self insure yes, but they still they pay the bills and with their admin company do exert leverage over the healthcare providers, much more so than the individual subscriber does.

On the second point, most of these enrollments are computerized, so not really a big admin burden. On the cost of such coverage, when my son came off my plan this year, the cobra fee was $9K for a healthy 25 yo. Seems like there is no reality in that cost.
I noticed the same thing with my cobra rates that my healthy 23 yo would cost about the same as me or DW and we are each 56 (the diff between family rate and couple rate). Doesn't make sense.
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Old 12-01-2011, 03:05 PM   #38
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I noticed the same thing with my cobra rates that my healthy 23 yo would cost about the same as me or DW and we are each 56 (the diff between family rate and couple rate). Doesn't make sense.
I've don't know that I've ever seen an employer group plan that charges by age (I haven't ever been in one that did). That would tend to make COBRA a horrible deal for most younger folks, but for some 50+ folks with health issues it's probably better than you'll find on the individual market for the same level of coverage -- possibly by a considerable margin.
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Old 12-01-2011, 03:23 PM   #39
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To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.

The number of people in he insurance system compared to the number of union members is not even close... it is not the unions that caused the health care problem
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Old 12-01-2011, 03:30 PM   #40
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That would tend to make COBRA a horrible deal for most younger folks, but for some 50+ folks with health issues it's probably better than you'll find on the individual market for the same level of coverage -- possibly by a considerable margin.
While not 50 when I went off Cobra last month my conversion plan went from around $340 per month on Cobra to $660 per month on the high deductible plan or $875 for the same coverage. The conversion rate was still better than I could get on the open market thanks to pre-existing conditions.
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