Next Pres. Election and Health Ins.

[mykidslovedogs]

perhaps you don't understand the nature of "NOT- FOR - PROFIT"

You're right. I mean, I understand the words, not-for-profit....I just wasn't thinking about them in that way, because their premiums are no better/lower than any other carriers in the Colorado Springs market right now, and that's the area where I work. Their motivation is probably more of job security for the employees and CEO etc. Strange, but in Colorado Springs, Kaiser insurance is running at a higher premium on average than most of the other carriers right now. How can that be, if the other carrier's are raking customers over the coals with profits?

PPOs do have their place in the market. Some people LIKE having the freedom to leave the network if they want to and still have benefits. It's all really up to the individual. Some prefer HMOs and some prefer PPOs.

 

[Brat]

Maybe because Kaiser charges community based rates...

 

[cute fuzzy bunny]

Huh...in northern cal kaisers rates are half of any other PPO or HMO option I could find. And thats before factoring in that they dont charge for labs or tests, no deductibles, and nothing other than a small office visit/co-pay.

But I think that benefit is easy to figure out. No scum sucking insurance agents eating up my premium dollars with bureaucracy, and a big entity that can negotiate good drugs rates and doesnt have to pay a separate pharmacy business's profit margins either.

Just like Canada!

 

[mykidslovedogs]

Huh...in northern cal kaisers rates are half of any other PPO or HMO option I could find. And thats before factoring in that they dont charge for labs or tests, no deductibles, and nothing other than a small office visit/co-pay.

But I think that benefit is easy to figure out. No scum sucking insurance agents eating up my premium dollars with bureaucracy, and a big entity that can negotiate good drugs rates and doesnt have to pay a separate pharmacy business's profit margins either.

Just like Canada!

One thing is that in Colorado Springs, Kaiser doesn't have any of their own facilities like they do in Denver and California, so maybe that's why their prices aren't any lower down here. In CS, they just have doctors that network with them, and people HAVE to use those doctors. If people leave the network, there's no coverage, but the premiums for the Kaiser insurance are actually HIGHER than other carriers in our city. It has nothing to do with community rating. In CS, all the carriers use age banding for small groups and community rating for groups of 10 or more.

In Denver, however, Kaiser has their own facilities and doctors that work for them, so the premiums are lower. People who buy Kaiser products in Denver MUST use the facilities in Denver. Also, if they live in Denver area, but want to user a Kaiser networked doctor in Colorado Springs, they CAN'T! They are required to use ONLY doctors in their servicing area. That's probably how Kaiser keeps their rates down in Denver - because they have a pretty tight handle over their network and provider costs there. So...if someone in the Kaiser network wants to use Dr. Stedman, the famous knee surgeon in Vail, CO...too bad! They have to use the Kaiser orthopedic surgeon, even if he/she doesn't have the same expertise as Dr. Stedman. It is a form of care rationing, albeit...not as bad as it would be in a single-payor system.

We actually SELL Kaiser in Colo. Spgs AND Denver, and we earn commission on our sales....so there's still a middle man for Kaiser in Colorado. We even have a large Kaiser group in CA as a client, and we earn commision on that group too. In Colorado, Kaiser makes up for the low copays and deductibles by charging high per admission hospitalization fees. So, if someone needs to be hospitalized more than once in a year, they are looking at a $500, $1000 or more PER ADMISSION fee each time they get admitted. Whereas, with the PPO plans, hospitalization applies to the Cal year deductible, and when that's met, you don't have to worry about it anymore until the next calendar year.

Cute! I think you've hit the nail on the head! My husband and I have talked about this before, but talking about it has brought the idea back to me. What if....what if the gov't opened up something like Kaiser facilities for everyone who needs subsidized care. People would be required to at minimum, purchase a plan within their servicing area which gave acces to ONLY the gov't owned Kaiser facility. These people would ONLY be allowed to use the Kaiser facilities in their servicing area. The doctors would work for the gov't. For anyone who wants private care, we can keep a private system in place as it is now.

 

[JustMeUC]

Since I am new here, perhaps someone can give me a little bit of advice??!!?? Am I feeding a troll with my posts? If so, I'll stop. I really want to know.......

 

[FinallyRetired]

Since I am new here, perhaps someone can give me a little bit of advice??!!?? Am I feeding a troll with my posts? If so, I'll stop. I really want to know.......

This thread has proven difficult to kill. We've even tried invoking Godwin's law ("As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches one.") but even that didn't do it.

But after reading many of her posts, I don't think MKLD is a troll, I think she is honest but naive about the real problems of the uninsured, underinsured, and uninsurable. I also think she really is doing good within the system that we have, helping people get help that otherwise might not have gotten it. That's why I compared her to the relief workers after Katrina, but we still have a Katrina going on. Oh, I also think she is like the Nazis and Hitler (just trying once more...)

 

[Nords]

Since I am new here, perhaps someone can give me a little bit of advice??!!?? Am I feeding a troll with my posts? If so, I'll stop. I really want to know.......

Yes.

She's not here because she cares about ER, she only posts on healthcare topics and overwhelms those threads, she shills for her industry, she's not interested in clearly explaining the problem or working with others toward a solution, and when the logic is against her reasoning she resorts to politicizing and patronizing/condescending comments.

 

[FinallyRetired]

Yes.

She's not here because she cares about ER, she only posts on healthcare topics and overwhelms those threads, she shills for her industry, she's not interested in clearly explaining the problem or working with others toward a solution, and when the logic is against her reasoning she resorts to politicizing and patronizing/condescending comments.

So, would you say she reminds you of HITLER and the NAZIS?

 

[cute fuzzy bunny]

My issue is that EVERY health care discussion seems to end up getting gamed into a "why nationalized health care is bad" discussion, with the requisite 3-5 sequential replies. Turns the discussion fruitless after a page or two. Its like a combination of ***** firebombing any and every topic with "why the 4% number is wrong" and Galts sequential handful of "and another thing!" replies.

One derails a topic, the other makes it hard to read and adds no value.

While I'm all for reasoned discussion on a topic and input from a variety of well sourced opinions...thats not what this is.

This is simple fanboyism.

"Fanboys are attributed with a sycophantic devotion to the creators and principles behind a work with which they are currently enthralled. Fanboys are noted for a very emotional attachment to their chosen subject, often taking negative remarks about it as a personal attack. They will readily engage in debates, but will fall back on emotional responses when challenged on facts. For example, a fanboy may go out of his way to point out negative and often untrue statements about their obsession's rivals. Fanboys are often hostile towards critical review of their chosen subject."

 

[mykidslovedogs]

she's not interested in clearly explaining the problem or working with others toward a solution

I wouldn't say that is true. I have explained, in my own words, many many times what I think gets at the root of our problems. ....in one sentence, it's basically cost-shifting and employer-sponsored health insurance. In the eyes of most on this board, it's the profits and admin costs.

I have also presented many, many possible thoughts on what could be done to improve the system without resorting to single-payor, which IMO, does result in a different set of consequences (long-term).

When I suggest any kind of two-tiered system, it typically gets shot down from those farthest to the left, because they don't want any kind of system that gives weathier people an advantage over the less advantaged. I have even admitted that I am not opposed to gov't subsidy for those who slip through the cracks, but it has to be done in a careful and cautious way, and it can't just be "free care". It seems like a good percentage of the people on this topic want free care for all with little or no out of pocket responsibility for anyone. I don't think it's unrealistic to say that that would be a utopia, and who would'nt want that? If it were that easy, there wouldn't be any controversy, but it appears that very few people want to think about what might happen in the long run if we implemented a system like that.

I spent some time talking to my husband, the financial guru, about profits in the industry. He explained to me that insurance companies pay out approx. 85-95% of their income in claims and they make, on average, about 3-5% of income in profts. I asked him if he had some proof on that, and he said he does, and he'll dig it out sometime for me. When he gets around to it, I'll post it on the board if I can.

I'm not a troll - just have a lot of passion. I admit that I get sarcastic at times, but then again, there's been a lot of sarcasm against me on the board as well. Why can't people just have some stimulating conversation about the possibilities without resorting to snikering and teasing. Why can't people from both sides of the fence admit that there are severe problems on both extremes and wise up to the possibility that there may be a better solution somewhere in the middle.

I do care about ER. I am definately a wannabe and that's what first attracted me to this board. People need to know about the healthcare issues they will face in early retirement and what can be done within the current system to avoid problems. Healthcare in early retirement is one of the biggest problems that most early retiree wannabe's face, so I want to offer advice to people as to what can be done within our current system to avoid problems. We can worry about the utopia later, but everyone should be concerned and should be educating themselves about BOTH sides.

 

[Martha]

What if....what if the gov't opened up something like Kaiser facilities for everyone who needs subsidized care. People would be required to at minimum, purchase a plan within their servicing area which gave acces to ONLY the gov't owned Kaiser facility. These people would ONLY be allowed to use the Kaiser facilities in their servicing area. The doctors would work for the gov't. For anyone who wants private care, we can keep a private system in place as it is now.

Mississippi did something similar with its public hospital system. It is a miserable failure. Unfortunately, a two tiered system often means that the tier with no political power gets screwed. This is why medicaid is such a disaster. When it is time to cut budgets, programs for the poor and disabled are easy marks. I do not like at all having a different system for the poor than for everyone else for this reason.

One reason social security is so popular because it is not a program for the poor. There is no shame in collecting social security. There is shame in participating in a welfare program. People who feel shame at participating in a program are going to be poor lobbyists for that program and will suffer quietly when their program is cut.

 

[cute fuzzy bunny]

Hmmm who exactly created and built on the expectations of employer paid health insurance and broader, fuller featured employer paid plans?

 

[mykidslovedogs]

Hmmm who exactly created and built on the expectations of employer paid health insurance and broader, fuller featured employer paid plans?

Cute - employer sponsored health insurance began during WWII, at the time when gov't placed restrictions on wages (wage freezes). The only way employers could attract good labor was to offer benefits....Hence, the birth of employer sponsored health insurance. Before that, everybody had personal catastrophic health insurance plans and we had very little problems with heavy inflation in the industry. People planned for their own deductible expenses, and they did quite well with that.

The birth of the HMO was an even bigger disaster. Insurance companies ultimately hurt themselves by teaching people that they could avoid deductibles by getting low copays for office visits, ER visits and prescriptions. People learned to expect free care and began to overutilize...thus, the birth of salary capitation for doctors by HMOs. Well, you can imagine that doctors didn't really like that very much, so instead, they began to negotiate fees for services with insurance companies instead. Doctors discovered that they could make more money by giving more services, and this was a big mistake made by the payors, because they should have based re-imbursement schedules on outcome vs. productivity....this is one of the biggest problems with our system which has in part, led to inflation.

 

[cute fuzzy bunny]

You didnt answer the question.

Helpful hint: I'm pretty sure the insurance companies weren't dragged, kicking and screaming, into providing broad full featured plans to as many employees as possible.

Further, your answer is wholly incorrect. Prior to WWII almost nobody had any sort of health insurance. People paid a doctor out of pocket and perhaps saved a little for their "final illness".

And no, they didnt do well with it at all.

They did so poorly with it that Teddy Roosevelt pushed strongly for a nationalized plan, particularly for the poor. Who up until that point just worked until they got sick and died.

Oh yeah, and Steely Dan is not one person, we get fringe benefits, not French benefits, it’s not the Leaning Tower of Pizza, and James Dean was an actor—Jimmy Dean makes sausages.

 

[Nords]

This is simple fanboyism.

I think fanboys do it for free, while shills get paid...

I'm not sure what motivates the political conspiracies, the condescending remarks toward Rich_In_Tampa, or all the proposed "solutions" that Martha keeps having to point out aren't working.

Maybe she's no longer welcome at boards like this one:
ASQ: Welcome to the ASQ Discussion Boards!

 

[mykidslovedogs]

Mississippi did something similar with its public hospital system. It is a miserable failure. Unfortunately, a two tiered system often means that the tier with no political power gets screwed. This is why medicaid is such a disaster. When it is time to cut budgets, programs for the poor and disabled are easy marks. I do not like at all having a different system for the poor than for everyone else for this reason.

One reason social security is so popular because it is not a program for the poor. There is no shame in collecting social security. There is shame in participating in a welfare program. People who feel shame at participating in a program are going to be poor lobbyists for that program and will suffer quietly when their program is cut.

Martha, aside from the people with no political power getting screwed, what else caused the program to be a failure? What kind of care did the people in the social program get? Please elaborate. Wouldn't that kind of care be what everybody would get if we were all in the same program?

Do you believe that our children will be able to collect social security when they get old?

 

[mykidslovedogs]

You didnt answer the question.

Helpful hint: I'm pretty sure the insurance companies weren't dragged, kicking and screaming, into providing broad full featured plans to as many employees as possible.

Cute - you are right, I checked into it further and people before WWII didn't need insurance because they didn't see healthcare as that much of a risk. They paid their costs out of pocket, and on average it was just a tiny bit more of their family budget in 1917 percentagewise, than it was in the early 80s. I am sure some died, but then again, we didn't have the technological advances back then that we have nowadays.

I am sure insurance companies were not dragged kicking and screaming to provide benefits, either. It seemed like a great idea at the time, and the HMO seemed like a wonderful idea as well. Both programs worked well until they led to huge inflation down the road.

My information was not wholly incorrect. Employer sponsored plans began around the time of WWII. The invention of employer-sponsored HMOs and pre-paid health insurance throught the Blues WERE a huge pre-curser to inflation, and IMO, part of the root cause of the problem.

C'mon...I'm trying to have an adult conversation here. Can't we be civil to each other?

 

[Martha]

Martha, aside from the people with no political power getting screwed, what else caused the program to be a failure? What kind of care did the people in the social program get? Please elaborate. Wouldn't that kind of care be what everybody would get if we were all in the same program?

I am going to go off of memory here because I don't have the articles I read in hand and can't find them with a quick google search. Much of the problem was not enough money. So, everything was always a crisis with no money for planning better delivery systems. After Katrina, when there were a number of health care workers coming into the state from other areas, people started realizing how bad it had been and not only did they not have enough money to deliver the care they were trying to deliver, they had many inefficiencies, poor training, and other delivery problems that they never addressed.

I don't think this is at all what would happen in we had universal care. This is what happens when a population who has no voice gets poor care. Most people never know and even the care givers end up like the frog in the slowly heating water. Even they didn't know how bad it was.

A small example. When a diabetic person has an insulin reaction and goes unconscious, the simple solution is to give the person glucose to bring the blood sugar up. Most everywhere EMTs know this and will do so on site. In Mississippi, many ambulance workers did not know this and would have to transport the unconscious person to a hospital. Lack of resources for training ends up costing the system more and is more risky for the patient.

Do you believe that our children will be able to collect social security when they get old?

Yes.

 

[mykidslovedogs]

people started realizing how bad it had been and not only did they not have enough money to deliver the care they were trying to deliver, they had many inefficiencies, poor training, and other delivery problems that they never addressed.

As far as going off memory - Don't worry...I won't get in a tizzy if you don't have one of your facts exactly perfectly right.

But seriously, how will we know how much money will be enough in a universal system? What happens if there isn't enough money? What will we do then? Do we really want to risk that possibility? At the very least, in a two-tiered system, people can fall back on the private sector when money becomes a scarcity in the public sector....am I not correct on that point?

Didn't I read somewhere that Medicare at the current pace will run something like 70 billion or 70 trillion in debt 20 years down the road? We still have to think about where that money is going to come from too.

 

[twaddle]

Nice short article in the NY Times today:

Sending Back the Doctor’s Bill

But many health care economists say both sides are wrong. These economists, some of whom are also doctors, say the partisan fight over insurers and drug makers is a distraction from a bigger problem: the relatively high salaries paid to American doctors, and even more importantly, the way they are compensated.

 

[Martha]

I agree that we cannot consider universal health care without considering cost. I have been very disappointed in the presidential candidates who are all glossing over the cost issue. One of the biggest weaknesses of our current system is its high cost. This is true for both the public financed systems as well as the insurance financed systems. This is a problem that does not lend itself to sound bites or even much of a discussion on a discussion board. One organization that is trying to get its arms around the cost issue is the National Institute of Health Policy. This organization has members of every political stripe and from all aspects of the health care industry. I suggest reading the series on the medical arms race. National Institute of Health Policy- Medical Arms Race Syndrome

It would be wonderful if we could have dispassionate. practical reviews of cost issues, without getting into unproven political theories of how to control cost. I think there is no one simple formula for cost reduction.

 

[kcowan]

Nice short article in the NY Times today:

Sending Back the Doctor’s Bill

There is also a series on how health care is not doing its job for cancer patients:
http://www.nytimes.com/2007/07/29/health/29OBSTACLES.html?_r=1&oref=slogin

At least the patient survived and got his money back. A good outcome. However this woman was not so lucky:
Cancer Patients, Lost in a Maze of Uneven Care - New York Times

 

[mykidslovedogs]

Nice short article in the NY Times today:

Sending Back the Doctor’s Bill

But many health care economists say both sides are wrong. These economists, some of whom are also doctors, say the partisan fight over insurers and drug makers is a distraction from a bigger problem: the relatively high salaries paid to American doctors, and even more importantly, the way they are compensated.

This is a fantastic article. It gets at one of the earlier points I was trying to make with how fee for service has, in-part, led to incredible inflation.

 

[mykidslovedogs]

There is also a series on how health care is not doing its job for cancer patients:
http://www.nytimes.com/2007/07/29/health/29OBSTACLES.html?_r=1&oref=slogin

At least the patient survived and got his money back. A good outcome. However this woman was not so lucky:
Cancer Patients, Lost in a Maze of Uneven Care - New York Times

That cancer article on the guy who had the Presbyterian health plan was very interesting. We recently had a client (Village 7 Pres) who needed to replace their Presbyterian Health insurance plan because that plan went bankrupt. The church thought it was doing the congregation a favor by offering not-for-profit group health insurance at very low rates with very low deductibles and copays. They drove themselves out of business.....couldn't charge high enough premiums to pay for all of the claims.

Do you think that same guy would've gotten in right away for tests and surgery in the Canadian system?

 

[mykidslovedogs]

It would be wonderful if we could have dispassionate. practical reviews of cost issues, without getting into unproven political theories of how to control cost. I think there is no one simple formula for cost reduction.

No doubt, you are right on that account! Whenever I go to NAHU meetings, the general consensus is that health insurance is expensive because HEALTHCARE is expensive. It's not just all about the profits and the admin. costs. As I stated in an earlier post, I spent some time talking to my DH about profits, and he says there is plenty of documentation to show that profits in the insurance industry generally run around 3-5% of total revenue, and that claims paid run around 85%-95% of total revenue.

I think cost-containment of equipment and suppliers of care would be one of the biggest hurdles to jump....and how could it be done without having a negative impact on the supply of caregivers and diagnostic equipment?

One of the things I think a lot of people fail to realize is that here in America lots of things cost 2-3 times more than they do in Europe....not just healthcare....our houses, for one! Doctors salaries are certainly relative to how our economy is doing. Can we fairly mandate pay cuts and expect that they will all keep their doors open...and what would the impact of pay cuts do to the quantity of new talent coming into the healthcare profession industry?