The Health Insurers have already won

[Sevo]

We do agree about a lot this but we must understand that what we are talking about and what our rulers are talking about are two entirely different subjects. That's where the confusion comes in. We are concerned about health care for us and the other people in this country.

The professional ruling class that is the life time Senators ,Representatives, Lobbyist and their political apparatus have only one goal and that is to stay in power. The entire push is to buy enough votes with " Free/Subsidized health care to win every election for the next 40 years.

Unfortunately for us they are going to do it. Because we will go back to the polls and re-elect the same people over and over again. The only people out side of professional politicians who really have any say so in this are now the people who hold our Debt. If they pull our limitless credit card.

hang on and hope!

 

[ziggy29]

Frankly, I could be talked into a Medicare for everyone scheme as long as we're allowed to buy private supplemental policies (just like seniors on Medicare), everyone has to do it and we pay for it 100% as we go. Admittedly, this is a pretty neutral plan for me. The cost of Medicare and a supplement would be about the same as I'm paying for retiree coverage now and the benefits would be similar. Plus, I'll be on Medicare with a supplement in 3 yrs anyway.

To me, the biggest problem with the "Medicare for all" proposal (other than the question about doctor reimbursement rates and how many would retire rather than accept Medicare's rates for everyone) is the funding mechanism.

The original Kucinich bill, HR 676, would have imposed something like a 4.9% payroll tax on employee and employer plus small taxes on each stock trade (something like 0.25% of the trade amount, if I remember correctly).

I believe a funding mechanism that relies almost entirely on earned income is a massive wealth transfer from the working class to the idle class. It would encourage a lot of high-earning older folks who are only working for the health insurance to quit, because (a) they wouldn't need to keep working for health insurance and (b) the taxes make working less attractive financially. These are likely people who pay a lot in income and other payroll taxes, so encouraging them to hang it up is probably questionable public policy. (But on the flip side, it might open a few jobs for people looking now...)

When I hear plans about "universal health care" my first three questions are: (1) What will it do to the availability of health care? (2) How does it address exploding health care costs? And (3) Is the funding mechanism fundamentally fair and economically sound?

 

[Martha]

I learned this managing people........

If you screw 'em all, they get over it. If you screw some and do well by others, those screwed will hate you and fight you to the grave.

So....... why not propose a "one plan for all - including Congresscritters and vote generating unions" and detail out the cost and coverage and cutover plan and go with it? Right now we're spinning our wheels over who gets screwed and who gets icecream for dessert.

Frankly, I could be talked into a Medicare for everyone scheme as long as we're allowed to buy private supplemental policies (just like seniors on Medicare), everyone has to do it and we pay for it 100% as we go. Admittedly, this is a pretty neutral plan for me. The cost of Medicare and a supplement would be about the same as I'm paying for retiree coverage now and the benefits would be similar. Plus, I'll be on Medicare with a supplement in 3 yrs anyway.

That's what I wanted. Though I agree with Zig that it can't all be funded with payroll tax.

 

[haha]

I don't want political expediency and the concern of winning/keeping votes for the next election to influence what our healthcare reform looks like any more than it absolutely has to.

You are in luck! Political factors will definitely be weighted no more than necessary.

Unfortunately, it is necessary that they be weighted 100%.

Ha

 

[Texas Proud]

Agreed, but...

• I don't think taxpayers should be subsidizing that better plan by making it tax-free, unless you make all health care expenses tax deductible.
• In the mega-corp where I worked, the executives had a great plan that was heavily subsidized by the company. The rest of us couldn't buy into it for any price. I think this is pretty common.
• The congressional and senatorial plans are like employer plans and heavily subsidized. Plus, their employer is not likely to file bankruptcy to get out of employee commitments.

I don't think we are as far apart on this topic and it might seem.

I have no problem with either taxing all insurance or having them all tax free... just remember the unintended consequensis (wow.. how do you spell that..) IF you made them all taxable, the number of lower waged people with insurance would go down a lot... and the higher paid people would more than likely demand a higher salary to pay the taxes (and probably get a lot since this would become the standard to hire people)... so, you would just make it where more people need subsidies... and more people losing jobs...

 

[Texas Proud]

Yup. I, for one, was truly astonished when I saw video of people lining up on a rainy day to get into a free clinic that was set up on some old fair ground lot. Some of the services were provided in animal stalls.

The ~80% of us with good insurance have no clue how the other quintile lives.

I saw 60 minutes do a story a few years ago on the same group...

Some of the 'poster people' on there were not the best to put there... one guy had insurance, but brought his daughter there to get health care (driving a long way in either a truck or SUV when it was $4 per gallon)... there was one older lady who needed help, but never told her children, her church or anybody else... and probably all would have helped her... (I think hers was needed glasses... you can get cheap glasses around here if you need them)...

So I am not as impressed with that story.. just show that a lot of people will take advantage of something free...

And yes, I am jaded... because I remember back when the gvmt was giving away free cheese and a lot of people who did not need anything free when and got some... sorry... side track...

 

[lets-retire]

Kind of going along with TP's posts. If you look at health insurance as a right then all of this makes sense. If you look at it for what it is, compensation for doing work for a company then Saying the companies would be more efficient is a rather stupid statement. Of course they will be more efficient, they just gave all of their employees a pay cut. As for the employees not only did they receive a pay cut, but they receive an expense increase, so they get a double whammy.

Since anecdotal evidence is king dour jour, anybody can easily tell stories of thousands of people who go to hospitals and doctors every day and have little problem paying for health care. Anecdotes are poor evidence at best.

 

[quietman]

Oh, I was so interested in health care reform. I know people are sometimes unable to get needed operations or treatments because insurance companies can simply deny claims, not matter how medically necessary doctors say it is. I know insurance companies sometimes retroactively cancel policies, in some cases based on otherwise trivial discrepancies in applications, especially when faced with a large claim. I know pre-existing conditions are often uncovered or sometimes make getting any coverage for any medical issue (even unrelated ones) impossible. I know insurance companies make complex rules that require referrals and pre-authorizations and change the rules frequently, so legitimate claims are often denied because arbitrary procedures were not followed or mistakes were made. I think that insurance companies are colluding (perhaps not explicitly) with providers to manipulate prices so that "discounts" are available to insured consumers, but not to the uninsured. Meanwhile deductibles and copays on durable medical equipment (like wheelchairs) coupled with the inflated prices let insurance companies make a profit, while consumers still pay inflated costs, even if insured. And a host of other problems, including quality of care, weird incentives that distort care given, overburden of paperwork, doctors leaving their practices and on and on...

It looks like very little of this is being addressed in the "reform" being proposed. The main focus seems to have shifted to making sure people without insurance are brought into the system, at huge cost and to great benefit of the insurance companies. The focus doesn't even seem to be on whether people get medical care. The focus is on whether people have insurance. When did this happen?

 

[lets-retire]

quietman--I think it happened when the media, politicians, whoever erroneously convinced people that health care was too expensive to pay out of pocket. By convincing most that health care was too expensive they effectively duped people into believing they must have health insurance and the two became synonymous.

 

[youbet]

quietman--I think it happened when the media, politicians, whoever erroneously convinced people that health care was too expensive to pay out of pocket. By convincing most that health care was too expensive they effectively duped people into believing they must have health insurance and the two became synonymous.

I agree. And I also notice the tendency for people of substantial financial means to claim that a loved one is dieing because an insurance company won't pay for an experimental or controversial procedure, yet they could easily afford to simply pay for it themselves. They've been brainwashed into thinking that if insurance won't pay, they can't have the challenged treatment....... even if paying for it themselves wouldn't break their budget.

 

[growing_older]

The anecdotes are interesting and sometimes helpful in trying to understand specific details, but they can also confuse or be edited to promote a certain point of view.

With respect to people of means fighting with insurance companies, the situations can be complex. Having paid substantial premiums against the promise to pay for medical care in the future, people can quite legitimately feel like they've been stiffed when insurance companies unexpectedly produce lists of approved and unallowed treatments at the point where someone has a time critical need for medical attention. As for allowing a family member to die, that's an extreme anecdote. I'm not sure what you were trying to convey with that example.

 

[youbet]

I'm not sure what you were trying to convey with that example.

I was agreeing with Lets-retire that it seems like folks today link insurance and treatment as the same thing when they're not. From time to time, I've seen news coverage featuring an interview with a person, usually fraught with grief, that their child, spouse, whoever, is going to die because the insurance co won't pay for a experimental/controversial procedure. It makes me wonder why they don't pay for it themselves and fight the insurance co later. Or perhaps they're just saying it for the publicity power.......

If people don't like insurance companies refusing to pay for some procedures today, wait until we get a Canadian-like plan when it's the govt deciding which procedures are allowed.

Having some treatments and procedures not covered (or in the govt med system cases, not allowed) is not unique to the USA.

 

[ziggy29]

Yup. I, for one, was truly astonished when I saw video of people lining up on a rainy day to get into a free clinic that was set up on some old fair ground lot. Some of the services were provided in animal stalls.

The ~80% of us with good insurance have no clue how the other quintile lives.

Maybe. But after observing Cash for Clunkers, I'd also add: don't ever underestimate the public's appetite for free stuff. I doubt these are all destitute people who can't afford to pay for an exam or a simple office visit.

 

[Martha]

Maybe. But after observing Cash for Clunkers, I'd also add: don't ever underestimate the public's appetite for free stuff. I doubt these are all destitute people who can't afford to pay for an exam or a simple office visit.

True. But there also are people who are too proud to go in for the free service even when they need it.

 

[Gone4Good]

That's what I wanted. Though I agree with Zig that it can't all be funded with payroll tax.

I don't know.

I wonder how much we'd save if we got rid of 1st dollar insurance for stuff. Everyone has a deductible at 5% of AGI, phased in and maybe capped at some level (or not). Exclude all the nonsense that shouldn't be insured in the first place, glasses, acupuncture, fertility, viagara, etc, etc. And then set a tax similar to what people and corporations are currently paying for insurance now but no-longer would be.

 

[quietman]

Sounds like a better plan to me. Sign me up.

 

[lets-retire]

Exclude all the nonsense that shouldn't be insured in the first place, glasses, acupuncture, fertility, viagara, etc, etc. And then set a tax similar to what people and corporations are currently paying for insurance now but no-longer would be.

Who decides what is covered and what isn't covered? Right now the insurance companies have decided, for the most part, experimental procedures aren't covered. That makes sense because if they aren't sure the procedure will work they shouldn't have to pay for it. Insurance companies, for the most part, don't pay for elective procedures, though they often do pay for Cialis or Viagra.

There is separate insurance for vision that will pay for glasses, that normal health insurance won't pay for. If the person doesn't have vision problems then they don't buy the vision insurance. Personally vision insurance doesn't really work out for the benefits I receive. I can purchase a new pair of glasses every two years. Most of my normal eye appointments are paid through my medical insurance the rest is put on the vision policy. I pay more for the premiums than I would for the glasses.

 

[quietman]

I think the idea of what Yrs to Go was suggesting was that there is no "first dollar" insurance coverage. If that's so, then vision makes no sense for insurance. If you want glasses, then you buy glasses. You don't need "insurance" to buy your glasses for you.

 

[quietman]

Right now the insurance companies have decided, for the most part, experimental procedures aren't covered. That makes sense because if they aren't sure the procedure will work they shouldn't have to pay for it.

This is so wrong I don't know where to start.

Insurance companies use the excuse of not paying for experimental procedures, but what they really are trying to do is deny as many claims as they can legally get away with.

If you really believe that ALL medical discoveries and procedures are already known and in the insurance company approved list, then perhaps you are willing to sign up for such a plan. If instead there are new treatments available, especially if your doctor is recommending a new approach, then wouldn't you want the treatment your doctor recommends.

This gets even worse if there is UNIVERSAL health coverage. If all care is paid for by insurance companies, and those insurance companies ONLY pay for old procedures, what innovations are going to be made in developing new cures and treatments.

 

[lets-retire]

Before a procedure can be no longer considered experimental it has to undergo strict scientific scrutiny. Now this does present problems with procedures that have worked well enough and could be considered on the edge of acceptance, unless there is a medical board that gives it's blessing saying a procedure has proven itself as at least as effective as existing procedures. I can cut and paste out of many different health insurance policy manuals that specifically state experimental procedures are not going to be paid for by the insurance company.

Like I originally stated, I don't believe insurance should pay for treatment that has not proven itself to be at least as effective as what is currently out there. It is a gamble and might not be effective. If it is not effective the insurance company must pay for not only the experimental procedure they must also pay for the accepted treatment. If it is effective then great, but since the treatment has not been subject to strict scrutiny then all of the risk in on the insurance company.

Many people don't want glasses, but in order for them to function in society they must have them. If these people can't afford their glasses then we say sorry you're not allowed to participate in society? Some even are required to wear glasses at work because their visual acuity must meet certain standards. Do we tell these people that they are no longer employed, because they can't afford to buy their glasses? We seemed to be concerned about the poor having to pay $50 or $100 for a doctors appointment, but tell these same people that the have to pay $100-$200 for glasses on their own. I can work with a cold, I can't work without my glasses and you wouldn't want me to.

 

[growing_older]

I can (and do) buy glasses for about $20. Are you suggesting that I should pay that $20 to the insurance company, plus some kind of overhead for administration and paperwork, so that they can give the $20 to the manufacturer of my glasses? "First Dollar" coverage is inherently wasteful. I'd rather lower the premium $20 and then I can decide to buy glasses or soemthing else with that money.

BTW there are already outlets that provide FREE glasses to people who cannot afford them. Why does something as trivial as this have to be an insurance function?

 

[Gotadimple]

First dollar coverage implies a maintenance policy. Certainly, insurance actuaries are happy to construct a rate and benefit design for health maintenance, but can you afford it?

If first dollar coverage is so valuable, why does the IRS allow deductability of non-reimbursed medical claims and premiums (if you qualify for itemized deductions).

With first dollar coverage, cost of care will go up. Why? Because you have no vested interest in how much it costs. You've paid your premium, everything should be covered. The providers know you have first dollar, so the costs they bill to the insurer have no relative value in the marketplace.

And it can be, but understand that you will be the only one with a policy like that.

The premise of insurance is to try and keep in you the same financial position you had before you had the claim. In addition, it is by pooling dollars from a community of people who have the same policy language that economies of scale allow the insurer to keep rates lower, than if you had the only policy in the world. Insurance is not about maintenance, it is about reducing the cost of loss.

As Quietman has said, this is just so wrong on so many levels.

-- Rita

 

[growing_older]

If I have so called first dollar coverage, I am giving up any visibility or influence over the cost of my health care. In most cases, I will have almost no way of even knowing what the costs of treatments are, except that after the fact I may receive a bill for any "deductible" amount. I can make no reasonable value judgement, because I have no idea of the cost of anything.

 

[Martha]

I don't know.

I wonder how much we'd save if we got rid of 1st dollar insurance for stuff. Everyone has a deductible at 5% of AGI, phased in and maybe capped at some level (or not). Exclude all the nonsense that shouldn't be insured in the first place, glasses, acupuncture, fertility, viagara, etc, etc. And then set a tax similar to what people and corporations are currently paying for insurance now but no-longer would be.

I'm on board.

 

[Martha]

This is so wrong I don't know where to start.

Insurance companies use the excuse of not paying for experimental procedures, but what they really are trying to do is deny as many claims as they can legally get away with.

If you really believe that ALL medical discoveries and procedures are already known and in the insurance company approved list, then perhaps you are willing to sign up for such a plan. If instead there are new treatments available, especially if your doctor is recommending a new approach, then wouldn't you want the treatment your doctor recommends.

This gets even worse if there is UNIVERSAL health coverage. If all care is paid for by insurance companies, and those insurance companies ONLY pay for old procedures, what innovations are going to be made in developing new cures and treatments.

Experimental treatments are done by participating in a clinical trial. The funders of the trial pay for it.