US Healthcare Expensive and Inefficient

[teejayevans]

If you choose to stay with group coverage, the risk you take is to become uninsurable later on or to be tied to employment until age 65. If you want to retire early, think about getting your own policy before you become "uninsurable".

Yes, all this is good, but what happens when you RE at 50, are healthy, and at
55 develop cancer and are treated, now what happens at 56?
If the insurance company jacks your rate from $200/month to $2000/month, then
what? You are deem uninsurable by any other company, you are now screwed,
what do you do??
TJ

 

[Rich_by_the_Bay]

My apologies. I edited my response and someone felt the need to quote it. Ill excuse myself from such a passionate discussion.

I'm confused -- you are upset that I quoted your own brief post, in full context?

 

[unclemick]

Ah yes - so healthcare joins the classics: pay off the mortgage, early SS, SWR, etc.,etc.

Like the ancient Ford vs Chevy, Rep. vs Dem - no solution will found here.

But at least once in while some info on the equivalent as to where to buy a car or get your absentee ballot.

And we all get to vent.

Morning coffee anyone??

heh heh heh 8)

 

[Rich_by_the_Bay]

Ah yes - so healthcare joins the classics: pay off the mortgage, early SS, SWR, etc.,etc.

A good observation. Actually, I think the ongoing and recurrent exchanges are for the most part a good thing, until things come unhinged as they invariably seem to do.

I've learned a thing or two about the point of view of the "the other side" and have in fact softened my stand on some issues based on that. I've come to realize that compromise will be a big part of any solution.

But if you take a step or two back and prune off the digressions related to passion, various personal demons or other "lapses in protocol" (it happens to all of us), the net effect still seems beneficial to me.

I hope I'm not the only one who finds some underlying merit in all this.

 

[mykidslovedogs]

Yes, all this is good, but what happens when you RE at 50, are healthy, and at
55 develop cancer and are treated, now what happens at 56?
If the insurance company jacks your rate from $200/month to $2000/month, then
what? You are deem uninsurable by any other company, you are now screwed,
what do you do??
TJ

See, this is the mistaken thought process that so many people have. As an agent, part of my job is to process annual renewals for all of my customers. Even if there has been a large claim, your insurance rates don't get jacked up 2000 percent. Insurance carriers are prohibited by law from excessive rate increases in the individual market. if they raise your rates X percent, they have to do that for everyone in your membership group. Rate bumps are based on factors such as age bracket, claims experience of large groups of members, and overall inflation in the industry. 99 percent of the renewals I process anually are within 10% of the new business rates for the same or similar plan design. I don't understand where people get the idea that health insurance carriers single them out for huge rate increases. It's not like car insurance. You don't get a huge bump, just because you file a claim with an individual health insurance carrier.

 

[FIRE'd@51]

MKLD,

I really think it is unrealistic for you to tell people who have employer-based insurance to refuse it and purchase their own individual policy while they are young and healthy. That's like telling people to voluntarily take a pay cut. The health insurance they get with their employment is part of their total compensation package.

 

[REWahoo]

Actually, I think the ongoing and recurrent exchanges are for the most part a good thing, until things come unhinged as they invariably seem to do.

Rich, you silly slut. That's about the stupidest thing I've seen posted on the subject of health care.

I've remained silent long enough, so I'm gonna give it to you straight. Although the solution is obvious, everyone keeps dancing around it like they were walking blindfolded and barefoot through a well-fertilized cow pasture full of fire ant mounds. The only solution our health care problem is to issue every Red-Blooded American Patriot a 5th of whiskey, a scalpel and a bullet to bite on ... or to do away with the evildoer known as Exxon-Mobil.

It's about time everybody wised up to the fact that Exxon-Mobil is behind it all. (Can you say c-o-n-s-p-i-r-a-c-y?) We wouldn't have any health care issues if there were no people, right? And where do people come from? Sex of course! And where does Exxon-Mobil make their billions in profits? From people buying Exxon-Mobil $0.25/gal gasoline for the outrageously jacked up price of $3/gal! So those greedy, evil Phd executives at Exxon-Mobil keep promoting sex through the secret funding of everything lewd and lascivious under the sun. Why? Because they know "sex sells"... gasoline!

When it comes to health care we're all screwed...literally.

(Please do not quote any of this as I'm already risking everything by posting it even once....and I'm not about to say it again.)

 

[Rich_by_the_Bay]

Rich, you silly slut. That's about the stupidest thing I've seen posted on the subject of health care.

Prickly pear wine so early in the day?

 

[mykidslovedogs]

MKLD,

I really think it is unrealistic for you to tell people who have employer-based insurance to refuse it and purchase their own individual policy while they are young and healthy. That's like telling people to voluntarily take a pay cut. The health insurance they get with their employment is part of their total compensation package.

I'm just offering it as an alternative. Why not see if you can get your employer to give you a raise in returning for opting out of a group and purchasing your own coverage.? In return for the lower premiums, ask them if they can provide additional income for you to save towards your deductible. It's a just a CHOICE for anyone who wants to make it.

For the others who don't want to do that, they can CHOOSE to take the risk that they might not be able to retire early if they don't want to take care of their own health needs. The risk? Possibly having to work until age 65.

I don't understand why many of you think it's more fair to make the young healthy person pay out the ying yang for your health insurance, just because you want to retire early. Many of those younger people don't have the income and assets that you have to be able to pay twice as much for their coverage. The necessity (or is that really a desire) for Early Retirement, IMO, is not good argument for nationalizing healthcare.

 

[Martha]

See, this is the mistaken thought process that so many people have. As an agent, part of my job is to process annual renewals for all of my customers. Even if there has been a large claim, your insurance rates don't get jacked up 2000 percent. Insurance carriers are prohibited by law from excessive rate increases in the individual market. if they raise your rates X percent, they have to do that for everyone in your membership group. Rate bumps are based on factors such as age bracket, claims experience of large groups of members, and overall inflation in the industry. 99 percent of the renewals I process anually are within 10% of the new business rates for the same or similar plan design. I don't understand where people get the idea that health insurance carriers single them out for huge rate increases. It's not like car insurance. You don't get a huge bump, just because you file a claim with an individual health insurance carrier.

In Colorado.

As I have said repeatedly, this is a matter of state law and there are states that do no bar re-underwriting and some evidence that the practice is increasing.

 

[unclemick]

Rich, you silly slut. That's about the stupidest thing I've seen posted on the subject of health care.

I've remained silent long enough, so I'm gonna give it to you straight.
When it comes to health care we're all screwed...literally.

(Please do not quote any of this as I'm already risking everything by posting it even once....and I'm not about to say it again.)

So Rich commited some transgression - that nobody told him about the secret decoder ring?

AND - now that YOU HAVE BLABBED!

I guess I toss my ring in the closet where I keep my bronzed dryer sheets nobody wants to talk about anymore - either.

Rats!

heh heh heh -

 

[Martha]

The necessity (or is that really a desire) for Early Retirement, IMO, is not good argument for nationalizing healthcare.

I don't disagree with this.

My reasons for wanting a national solution doesn't have to do with my ER. I am retired and I can afford the risk pool and I wouldn't have retired if I wasn't able to afford it. My reasons have to do with too many uninsured people, too many people who end up with gaps in insurance, too many underinsured, too many small employers unable to offer insurance, problems of job lock. In fact, I believe national health care could promote entrepreneurial ventures because new small businesses wouldn't have to worry about finding health care options for their employees.

 

[teejayevans]

MKLD,

I really think it is unrealistic for you to tell people who have employer-based insurance to refuse it and purchase their own individual policy while they are young and healthy. That's like telling people to voluntarily take a pay cut. The health insurance they get with their employment is part of their total compensation package.

definitely applies to the first part of ER, you may find your COBRA is more $ then
individual insurance
TJ

 

[REWahoo]

AND - now that YOU HAVE BLABBED!

This from a guy who has spent most of his adult life lusting after the latest "hot one" while shacking up with a Norwegian widow...and living off her meager dividend income! No wonder you've been certified...

 

[unclemick]

This from a guy who has spent most of his adult life lusting after the latest "hot one" while shacking up with a Norwegian widow...and living off her meager dividend income! No wonder you've been certified...

The doc's say I'm ok - as long as I stay on my coffee - and it's ok to drink generic - as long as I keep my prescribed dose.

So there!

heh heh heh heh heh heh heh - BTW my Cobra at layoff was over $700/mo in 93 - a huge reason I went naked for 12 years - remember I'm the cheap bastard who had a 12k/yr budget - one year back in the day. Don't try this at home folks.

 

[MasterBlaster]

Re: US Health care Expensive and Inefficient

What choice? Only healthy people with money or jobs have choices. I have no choices, there is only one plan my husband and I can buy. It is much pricier than $750 a month.

But at least I have something. And I am blessed with money. Other people have no choices. I refuse to accept that it is anti-democratic or socialist to have a national solution to the health care coverage problem. And as FIRE@51 says, it simply isn't socialism; Wyden's plan keeps the insurance model.

I grew up where most people had very little money, in the poorest area of Minnesota. Some people had subsistence farms. Some people didn't even have indoor plumbing. I know today plenty of people who make less than $20,000 a year. I knew a woman with a poor paying job and no health insurance, always lived a healthy lifestyle. In fact, she worked in a health food store. She delayed having a breast lump checked because of the cost and because, after all, most are benign. She now is dead of breast cancer. I know street kids who struggle with a childhood of abuse and neglect. They get no health care to speak of. I recently paid copays for Risperdal and Lexapro for a young woman with PTSD who lost her job and ran out of money to pay even a small copay. Without the drugs she will end up in the hospital or may even be suicidal. I know people who struggle with mental illness who are limited in the care they can be reimbursed for under insurance plans or Medicare. I filed bankruptcy for a young woman with cancer after a collection agency for a hospital told her she should have died if she had no intention of paying her bill. I spent law school working on social security disability appeals after the government decided it would deny claims based on mental illness. I am tired of them all getting ****ed.

The question in my mind is... IS healthcare a right or is it something that is earned ?

And related questions...

To what degree do we owe people with little means the very best healthcare ?

Is such an obligation unlimited or is there a reasonable limit of which we will pay no more ?

Healthcare could, if we let it, take all of the available resources. So what is the correct balance of healthcare welfare ?

This is a discussion that needs to take place in the healthcare debate. Right now we skirt the issue.

 

[Martha]

Re: US Health care Expensive and Inefficient

The question in my mind is... IS healthcare a right or is it something that is earned ?

And related questions...

To what degree do we owe people with little means the very best healthcare ?

Is such an obligation unlimited or is there a reasonable limit of which we will pay no more ?

Healthcare could, if we let it, take all of the available resources. So what is the correct balance of healthcare welfare ?

This is a discussion that needs to take place in the healthcare debate. Right now we skirt the issue.

Excellent issues that I agree we must look at head on.

A few pages ago I linked to an article from Dartmouth Medical School about how more health care isn't necessarily better health care. I think we need to talk more about cost and what we can do to efficiently and effectively deliver health care. Rich promotes evidence based medicine. I think this type of medicine can also reduce cost. We have to look at the cost issue.

Wel ive in a rich country. We provide education for everyone. We provide police and infrastructure. I see no reason why we can't provide health care. Whether or not you are a good earner. In fact, poor health inhibits the ability to earn.

How much to provide? As I mentioned, more isn't necessarily better. But health care providers should always provide the best they can. Mississippi has had experience with two tiered health systems with public hospitals open to all. Poor funding and other issues resulted in poor care. I am wary of two tier systems.

Some issues are just plan tough. I'll give my grand niece as an example. She was born with short gut syndrome, without enough intestine. She spent most of her year and a half life in the hospital. She was on a transplant list but did not make it. She had multiple surgeries and suffered a lot. She was on medicaid and government paid for all her care. Her total cost of care exceeded a million dollars. Medicaid has limited funds. Who went without? Was it the right decision to do one surgery or the other? Tough questions totally separate from the cost issue. And how can you weigh one life against another? What about end of life care?

Given how much our country already spends on health care as compared to other countries, I believe we can improve delivery and manage to have good solid health care available to everyone.

 

[Nords]

My apologies. I edited my response and someone felt the need to quote it. Ill excuse myself from such a passionate discussion.
Thanks

You know what. Im tired of the working class being asked to foot the bill for the lazy pieces of **** who cant get a job and afford health care. Or who wont even bother to better themselves. Save your bleeding heart stories Martha. For everyone of your ohnoes stories there is someone who made better of themselves. Dont worry there will be alot of assholes like me voting anything like universal health care down as long as we can.

There seem to be conflicting priorities between these two posts, but one of the reasons posters get their posts quoted is because they sometimes try to go back and edit or erase their record. That can really screw up a thread. You don't want it quoted, then consider carefully before clicking that "Post" button.

As for footing the bill, taxpayers will have to pay for it one way or another and prevention is arguably cheaper than cure. We could always go with the type of "safety nets" that I've seen outside the U.S., but after you've seen a few Bangkok beggars near Bumrungrad the "socialist solutions" start to look pretty good.

 

[mykidslovedogs]

In Colorado.

As I have said repeatedly, this is a matter of state law and there are states that do no bar re-underwriting and some evidence that the practice is increasing.

I'm sorry Martha, but I just don't think "re-underwriting" happens to the degree that you think it does. Maybe with some of the rinky dink carriers, but not with your national carriers such as Golden Rule (UHC), Humana, Assurant Health. People have got to do their homework before they buy.

Martha, I really admire you and your passion, your compassion, and your smarts, but we'll just never agree on the solution to the problem of coverage for the poor. I want them to have it just as bad as you, but trying to nationalize, IMO, is going to eventually hurt more people than it helps....especially to the degree of coverage that you want for everyone, and the idealism of very little out of pocket responsibility for anyone.

Guess we'll just have to agree to disagree.

 

[teejayevans]

Re: US Health care Expensive and Inefficient

The question in my mind is... IS healthcare a right or is it something that is earned ?

To what degree do we owe people with little means the very best healthcare ?
Is such an obligation unlimited or is there a reasonable limit of which we will pay no more ?
Healthcare could, if we let it, take all of the available resources. So what is the correct balance of healthcare welfare ?
This is a discussion that needs to take place in the healthcare debate. Right now we skirt the issue.

Some would say it falls under the "life, liberty, and pursuit of happiness" clause.

I would be happy if they just made federal law for the health insurance standards,
so we could eliminate all the different state regulations, with this standardization,
there could be more competition, more efficiency, and less expensive insurance.

I'd support tort reform and put absolute limits on pain and suffering, something
like a 1 million, because this is were the huge settlements come in.

I'd support the idea of buying drugs from outside the US over
the internet. Ever see the sweet heart deals drug companies make with other
countries BTW? google for "Merck Brazil drug deal" to get an idea. They can
do this because they are screwing Americans!

I support elimination of prescriptions for many drugs that would not be used
for recreation purposes. If you can't read a label, too bad!! I say promote
Darwinism!

I'd support subsidized the insurance, children under 18 would ALWAYs be
covered, healthy & young wouldn't pay anything.
Raise SS taxes to pay for it, add a little extra to handle SS problems.
Eliminate the max rate for SS as well instead of capping like they do
now. SS tax on all the income, especially all the bonuses give to the
big execs these days. I would have a 50% tax rate for over $500K

Max limit payout of $1 mil, you want more, buy more insurance.

I think that will equally piss off both dems and reps.

TJ

 

[Freein05]

We keep going around in circles. The countries listed at the beginning of the post provide health care to all at prices less than the US. Why can't it be done in the US? Special interest groups who profit off the system won't let changes occur. Good examples are the drug companies who continue to lobby congress not to let people buy drugs from Canada or the recent TV blitz ads against congress requiring Medicare to negotiate lower drug prices. The VA does and buys drugs a lot cheaper than Medicare can. If you believe in capitalism our current health care system is not a good example. It is controlled by a few who make large profits off of it. In our town (POP 400,00) there are two hospitals that are full all the time. Try to negotiate for a rate they will laugh you out of town. It took almost two months for my doctor to schedule me for back surgery.

Our medical care system is on the verge of bankruptcy and the politicians won't do anything because the insurance, drug, and hospital groups control them.

Those who say screw the poor and you don't want to help them get health insurance remember you are only the loss of your job away from being without health insurance. Or drive carefully should you have an accident and can not work there goes your health insurance.

 

[mykidslovedogs]

We keep going around in circles. The countries listed at the beginning of the post provide health care to all at prices less than the US. Why can't it be done in the US?

Free - It could be done in the U.S, too. All we need to do is have the gov't take over and then allow it to put price controls on the fees that our doctors, hospitals and providers of medical services and supplies can charge. That's why other countries pay less per capita than the USA - because their govt's put price caps on services. It's easy to control spending when you disallow providers to charge more than a certain amount for their services. We spend twice as much, IMO, because we CAN, and as long as there are people out there with the ability to pay more for services they want, who also have the ability to get the services when they want them, we will always spend more. When you put the cost of care per capita side by side with Canada, our govt's both spend about the same amount. The additional amount the USA spends per capita all comes from private sector spending.

In addition, When computing cost per capita, the USA adds in the cost of services given to people who cross borders and come to the USA for medical care when they don't have access to it in their own countries. Yet, we don't add those same people from other countries who come here to get services into our population figures. Therefore, our per capita figures get a little bit skewed - because of services we provide to people who don't reside in the USA, but who come here to take advantage of our technology and relatively short waiting times.

 

[Freein05]

It won't be long before we will not be able to afford the cost of health care in the US. One of the major reasons our auto industry can not compete is the cost of health care. Corporations are already forming lobbying groups to do something about the cost of health care because they can not compete against countries that have national care programs. At average rate increases of 8 to 10% a year no one will be able to afford health insurance. We also do not have a free market health care program in the US. Drug companies control congress. Why do drug companies have to spend millions of dollars on TV ads? There are few and fewer insurance companies in the US due to consolidation. This gives them a pricing monopoly.

There are too many layers of profit in our system. I have given you an example of the German single payer system. Insurance companies are part of the system. They may not have as many CEOs making a million dollars plus like in the US but htey make good money. The government does control costs. Doctors in Germany make good money but nothing like they do here. Insurance companies profits are also nothing like they are here.

Cost in the US could be reduced by just going to a single payer plan. The government could set a standard basic policy that all insurance companies would have to offer in all states. The price for the policy would be set by the insurance companies. They would benefit because they would not have to comply with various state regulations. Everyone would be required to have the basic policy. We could pay for those who can not afford to pay for even the basic policy by getting out of Iraq by using the billions we are spending there.

 

[lets-retire]

Cost in the US could be reduced by just going to a single payer plan. The government could set a standard basic policy that all insurance companies would have to offer in all states. The price for the policy would be set by the insurance companies. They would benefit because they would not have to comply with various state regulations. Everyone would be required to have the basic policy. We could pay for those who can not afford to pay for even the basic policy by getting out of Iraq by using the billions we are spending there.

You lost me. A single payer plan is where a single payer, the government, pays the doctors. You say there are too many profit layers in the system, but what you are saying in this paragraph does not take any of the layers out. By past practices, making insurance "must cover" tends to force the insurers to increase their prices.

I remember not long ago the insurance companies complaining that the reason car insurance was so expensive was because of the people who were not insured. To fight this many states decided to require liability insurance at a minimum. The insurers did not lower their prices, because now they had people who could not drive very well buying insurance. These are the companies we are trusting to lower their rates once everyone is required to have medical insurance.

What I see happening, if Congress decides to change the system, is we would go to a system of insurance providers being required to provide insurance subsidized by the government. The promised savings will not be seen. The supporters of the system will make the argument, that the reason the savings are not being seen is because the private insurance companies are taking too much profit and they need to be forced out of the system. The result will be a government take over of the system.

The reason drugs are cheaper in Canada is simple, the government will not allow the drug manufacturers to charge more. The result is US patients are subsidizing Canada's medication use. This is also, why we are prohibited from re-importing Canadian drugs. If we were able to purchase medications for less than it costs the manufacturers to make and develop them, how long do you think the manufacturers would stay in business?

There are many reasons US medical expenses are greater per capita than most other countries. One solution will not solve the problem. As Rich points out billing is a huge expense. How do you solve that problem? Single payer. Now since the prices didn't go down what is another huge expense? Doctor's pay. So limit the amount that doctors will be able to earn and cut their pay. We can go on and on, but the point is health care is so expensive in this country because that's what we can pay.

 

[mykidslovedogs]

The reason drugs are cheaper in Canada is simple, the government will not allow the drug manufacturers to charge more. The result is US patients are subsidizing Canada's medication use. This is also, why we are prohibited from re-importing Canadian drugs. If we were able to purchase medications for less than it costs the manufacturers to make and develop them, how long do you think the manufacturers would stay in business?

I've been doing a lot of research on some of the reasoning behind why prescription drugs here in the USA are so expensive. No doubt, profit enters the equasion, but an even bigger part of the "problem" is that the USA does subsidize the cost of prescriptions that are exported to other countries, simply because we have to. If the Rx companies could not sell drugs to other nationalized systems and/or third world countries at a greatly reduced (way below cost) price, many many people in other countries would not have any access to current technogies for disease prevention and cures. It is in our nation's best interest to intervene in the general health of third world and other nations.

Rx companies agree to export drugs to other countries at greatly reduced pricing:
1.) Because those countries simply would not purchase the drugs at a higher price due to government price
controls and:
2.) The drug companies know that the can cost-shift to the USA markets to overcome the lost income &
profits.

If we were allowed to freely re-import cheaper drugs from other countries, the affect would basically be that we would hinder supplies to patients in the third world and other countries. This is because those other countries have limited supplies of the drugs that they are allowed to purchase at the heavily discounted prices. When those drugs are sold or re-imported to people in the USA, that supply is no longer available to the overseas patients, and it also cannot be replenished. Canada is already starting to feel the affects of drug re-importation to USA patients, and they are beginning to have shortages of supplies of many important drugs, such as Lipitor.

On the one hand, I would like to support re-importation, because I think it would eventually drive Rx prices down a bit in the USA. On the other hand, many of the other countries we supply drugs to are extremely poor nations, and I would hate to take away supplies from those millions and millions of other people, when #1.) we as a nation can afford to subsidize the cost of their drugs, and #2) their nations generally don't have the technology to produce their own drugs.

Last point: One of the biggest purchasers of prescription drugs here in the USA is the Medicaid System. I'm not 100% sure on this, but I'm pretty sure that Medicaid does not negotiate discounted pricing on prescriptions. If Medicaid were able to negotiate discounted rates, surely, costs would then shift even further to private markets in the USA, and Rx costs would be even worse int the private markets than they are now.

I'm not one to advocate price controls, but I do believe, more-so than any other healthcare providers and suppliers, drug companies do take extremely large profits. I really don't think consumer-directed marketing of prescription drugs is necessary, and I agree that it doesn't help the situation of drug costs in our country. I'd like to see the TV ads for "stiffy in a jiffy" and other desireable, but not necessarily life-saving, drugs go away. Americans are learning that there is a pill to fix every ailment. Who the heck knows what those combinations of chemicals that people continuously put into their bodies is doing to their health and what that is ultimately costing society?

I'm also sick of the ads on TV from legal professionals who taunt and bait customers by asking things like "Have you suffered XXX or other xxx symptoms from X drug? If so, you may be eligible for a large settlement. Please call to find out more. All this does is add to the problem.