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| Name: |
GoneFishin
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| Subject: |
JUST DON'T GET SICK
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Date:
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9/4/2009 11:46:35 PM
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I am not advocating a government program but this is an interesting article.
URL: http://www.reuters.com/article/newsOne/idUS202570+02-Sep-2009+PRN20090902
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| Name: |
wix
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| Subject: |
CA Democrats
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Date:
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9/5/2009 12:03:57 AM
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should be able to run a better ship than that. Like most liberal stuff the meat of the subject is left out of the story. The article talks about denial of claims. Claims are not filed until treatment is accomplished. Either the reporter has no clue about healthcare or the article is intentionally misleading.
The article insinuates that pre-treatment approvals are denied, but that is never stated. Weird article.
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| Name: |
Yankee06
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| Subject: |
Don't Get Sick
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Date:
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9/5/2009 9:42:20 AM
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-This is another issue I don't think should break down along party lines --insurance reform. I can't understand why only dems are supposed to be for it, while most repubs are suppose to be against it. this should be a bipartisan issue.
-Good capitalism should have the following core principle: produce a good product/service and make a reasonable profit. DO that and you'll continue getting customers, making your product, growing your wealth and teh wealth of your workers, etc.
-The dark shadow of capitalism is the human failing called greed which can lead to exploitation of workers and customers.
-Now enter teh insurance companies. The focus of insurance companies should be to produce a good product/service and make a reasonable profit. However, in some insurance companies the focus has been to make big profits and provide a promised product that no one gets to look at until some time in the distant future. Too often when the product actually arrives on our door step its not what was promised. Now enter the government which does have a role here to protect the consumer. A valid governemnt role is to prevent/punish crime, whether it be a mugging in the street or a mugging from the board room.
-We need insurance company reform. A lot of insurance companies are good, Unfortunately alot aren't. I believe government regulation --and enforcement--are necessary here for such things as carryovers of insurance from job to job, pre-existing condition acceptance, no drops once a person gets sick, etc. The health insurance companies are not here to make profits, they are here to provide a good product/service for us that makes a honest profit for them.
-Effective health care reform requires progress on many fronts; insurance company reform is one of them. Others are doing away with waste, preventing fraud, tort reform, increase in doctor/nursing schools, preventing special interest support to political races, etc
-Fixing teh health care system should be less about party politics and more about good management practices.
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| Name: |
Psycho
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| Subject: |
the way I see it
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Date:
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9/5/2009 1:19:24 PM
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I went to a new Dr. a while back...was really pleased with the service...but when I got the bill it was 3 times what it would have cost at my usual Dr. I talked with friends about this..they all said they didnt care, because they had insurance. This train of thought takes stupid to a new level...When health care cost more...insurance company is going to do one of two things...Raise your rates, or not cover as much. Then everyone that could care less how much a Dr. visit costs, starts crying my insurance company is screwing me over.
Plain and simple..the insurance company cares about you just as much as you care about them...They are a business that makes money.thats it...
Our health care system is not perfect...but better than any where else....the only overhaul we need is to cut out the overcharging, the fraud, the lawsuits and free health care for the illegals
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| Name: |
GoneFishin
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| Subject: |
the way I see it
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Date:
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9/5/2009 3:01:56 PM
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Insurance companies traditionally have negotiated physican charges and pay a specific amount irrespective of the charge you see. The question to be concerned is if you have to pay the excess.
If you were to look at a statement from Medicare, you would see Physician Charge, Medicare Approved Amount, and Amount Paid. Under Medicare B which covers physican charges, Medicare pays 80% after the annual deducticle. Having experience with Medicare, I have found the charges are always well in excess of the amount approved by Medicare. Physicians who accept Medicare patients accept the reduced payment and will not bill for the excess.
A person without insurance would pay the higher charges. Insurance Companies and Medicare pay the "wholesale" price because of volume. An individual without insurance pays retail.
An Insurance Company does not make alot of money on the real big corporate accounts. These are typically on a cost plus basis. The Corpration reimburses the Insurance Company each month for the claims paid the previous month plus a prenegotiated amount for administrative costs and profit.
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| Name: |
architect
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| Subject: |
As is often the case
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Date:
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9/5/2009 3:23:44 PM
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Yankee gets it!
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| Name: |
JustAGuy
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| Subject: |
Everybody seems to be skipping
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Date:
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9/6/2009 8:04:43 PM
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... the point of the original post.
Do we have health care rationing under our current health insurance system?
What say you?
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| Name: |
Yankee06
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| Subject: |
Rationing?
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Date:
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9/6/2009 11:53:31 PM
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JAG,
-Based on your comment above, I went back and reread the article at teh top of this thread on Health Insurance companies rejecting claims. I'm not sure if that's the article you were refering to, because I don't see that article to be about rationing. To me that article is primarilly about an industry that doesn't want to do what it promised to do.
-These companies have actuaries that develop "odds" that say something like if the company insures 100 people, one of those people will eventually need X body part fixed at Y cost. To cover that possibility and cost, the company has to charge teh 100 people Z amount of premiums to pay for teh future body part as well as the overhead to run the company. That is the basic XYZs of teh insurance industry. If teh company doesn't have the money to pay out when the time comes, it means: 1) the actuaries suck and should be fired, 2) the managers suck and should be fired, 3) teh managers are crooks and should be jailed, or 4) some combination of teh above. ...but it's not about rationing.
-Rationing is about supply and demand, ..or better put, ..rationing results with the unavailability of supply to keep up with demand.
-Since I have an artificial hip, I always like that example. I've written about my experience in detail in the past, so I won't bore anyone again with alot of detail. Simply put, ....
---British Health Care Panels (Socialized medicine-you pick a country, all the examples will be about the same) have set aside a certain amount of money for new hips and have set up a scale of acceptabilty for receiving those hips (old people are at the end of this list with a wait of several years, which means never). Thus if there are 100 hips available but 200 people who need them, the first 100 get them. the next 100 don't . that's rationing ---in this case, politically determined by the state health commissions.
---In the US there are more hips available than there are people who need them. ..thus there is no need for rationing. Following is a perfect example and it really happened, my 90 year old mother-in-law fell and broke her hip two weeks ago, she was immediately taken to a hospital, a doctor was called in, and three hours later she had a new hip. The bills will be sent to medicare and her secondary insurance carrier. No rationing. She has her hip. If a month from now her secondary insurer says it won't pay,, that becomes a legal matter, ---but it is not health care rationing, --she's got the hip.
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------NOw back to your question (without reference to the insurance company article), do we have heathcare rationing in the U.S.? I think the answer is "yes." ---and "No." First, in one way It's rationed by money or the ability to pay. If you have insurance or can pay out of pocket you get it. If you don't have insurance or can't pay out of pocket you don't get it, ---or at least you don't get it right away. If you can't pay, you get Medicaid, certain Social Security Programs, certain free clinic programs, Emergency Rooms, etc. So quality, or at least speed of quality service, seems to be rationed by ability to pay. But the supply of health care is there and everyone seems to get it eventually, so I guess it's speed of delivery that is rationed by abilty to pay, but eventual delievery of service occurs in most cases , so health care is really not rationed.
--of course heart replacements, liver replacements etc are rationed by supply and demand, because at the moment there doesn't seem to be a way we can manufacture new livers, etc. BUt that is not a political rationing, that is a source product scarcity rationing. We're still working on artificial hearts, so maybe some day we....
-So even if Health care is rationed some way by ability to pay (i.e., speed of providing), health care is not rationed in the way other commodities are; it is a much more compassionate rationing.. For example, if you don't have teh money to buy a new car, you don't get the new car. --at least for the time being you can't go to a government agency and plead your caes for a free new car.
-As I have said before, I believe the real need is fixing teh insurance industry, so that they can't drop you when you get sick, that you still have coverage between jobs, etc. The big crime here is hard working people who go bankrupt because thier insurance won't pay up and they can't get medicaid until all their life savings are spent.
-I believe we need serious, bipartisan, focused reform (insurance, tort, med schools, univrsal coverage), --I don't believe we need socialized medicine. ---but then again, maybe that's just me
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| Name: |
au67
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| Subject: |
Rationing?
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Date:
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9/7/2009 8:56:39 AM
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Food for thought questions:
If insurance companies (home, auto, health, etc.) paid fully for every claim submitted regardless of cost, could anyone afford the premiums?
If no money could be made in the insurance business, would we expect someone to be forced to provide that service?
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| Name: |
Yankee06
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| Subject: |
Rationing?
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Date:
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9/7/2009 10:23:06 AM
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My answers to AU67's above questions would be "No" and "No"
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| Name: |
GoneFishin
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| Subject: |
HEY YANKEE
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Date:
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9/7/2009 1:58:04 PM
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"If a month from now her secondary insurer says it won't pay,, that becomes a legal matter,"
The secondary carrier cannot deny the claim as they base their decision on one criteria. If Medicare approved the charge, then they cover it. If Medicare denies the charge, then they deny.
Other than the financial state of Medicare, I very rarely hear any criticism of the program itself which is a govenment run program.
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| Name: |
Yankee06
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| Subject: |
HEY YANKEE
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Date:
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9/7/2009 5:23:00 PM
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Really? 2nd insurer pays as long as medicare pays? I didn'y know that. Thanks for the info.
-Medicare is a great system for the 65+ crowd, --which I is one., ...and it is a governemnt program. BUT (there always seems to be a "but") ........there are several things wrong with it. #1--it apparantly doesn't know how much things actually cost, or there wouldn't be a need for all of us to have secondary insurers to pay the difference between what medicare thinks a thing/service should costs and what it actually cost. #2 --it is grossly ineffcient in controlling waste and fraud. I have only been in it for 6 months and have run into several instances. These old coot scooters is one example. I know "loads" of prople who have them and never use them, ..but have them cuz they can get them free thru Medicare. In another example, I needed a nebulizer for breathing assistance periodically for asthma.. Medicare set me up with a provider. The only way I could get this thing is by having Medicare rent it for me for a year, and then if I still need it Medicare will buy it for me. The thing costs about $150 if I buy it from a store myself. The rent-buy Medicare system means it will cost Medicare over $600. That just shouldn't be.
-Now, yes, Medicare is a government program, ---but it is not government health care. What Medicare is is a pool of money that pays private providers for products and services. It is a pool of money, to which I've contributed as an insurance premium for 50 years. Medicare is another insurance company which is welching on our deal. I pay them premiums for 50 years and they tell me, in 1965, that they will pay my health bills when I'm 65. But they screw up and don't have enough money, so-o-o-o-o-o I now have to go to a second provider to pay more premiums to cover the bills. --not to mention part b, c, and D.
-Yes, Medicare is a government program. But let's not confuse Medicae as being government health care, it is not. It is a government health insurance company.
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| Name: |
au67
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| Subject: |
Another point...
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Date:
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9/7/2009 7:22:54 PM
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Original Medicare vs Medicare Advantage. In the Medicare Advantage plans all benefits are paid by a private insurance company...Medicare pays them a lump sum per medicare covered enrollee. I am in the Blue Advantage plan (BCBS)...I still pay my monthly Medicare premium plus my private insurance premium. Blue Advantage pays Part A, Part B, Part D, plus some vision and dental benefits. My benefits under Blue Advantage are better than under the Original Medicare. Obama wants to eliminate the Medicare Advantage program, supposedly as a cost savings. My take would be that he wants the federal government in complete control of Medicare benefits.
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| Name: |
GoneFishin
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| Subject: |
Another point...
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Date:
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9/7/2009 8:36:51 PM
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Medicare Advantage was a propram implemeted by Republicans in order to eventually convert all Medicare recipients from the Government program to private insurance. The current problem with it is that the money paid by Medicare to the Advantage program for each covered person is more than the amount it costs under current Medicare. Congress plans on cutting back the premium they pay Advantage carriers.
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| Name: |
GoneFishin
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| Subject: |
HEY YANKEE
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Date:
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9/7/2009 9:59:33 PM
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Yankee from your comments:
“it apparently doesn't know how much things actually cost, or there wouldn't be a need for all of us to have secondary insurers to pay the difference between what medicare thinks a thing/service should costs and what it actually cost.
It is a pool of money, to which I've contributed as an insurance premium for 50 years. Medicare is another insurance company which is welching on our deal. I pay them premiums for 50 years and they tell me, in 1965, that they will pay my health bills when I'm 65. But they screw up and don't have enough money, so-o-o-o-o-o I now have to go to a second provider to pay more premiums to cover the bills. --not to mention part b, c, and D.”
Medicare was never designed to pay all the costs.
Under Part A, Hospital there is a $1,068 deductible for each hospitalization.
Under Part B , Physicians there is an annual deductible this year of $135. In addition, Medicare pays 80% of the approved charges. You are responsible for the other 20%.
That is why you buy the supplement to cover the deductible and co insurance.
As to welching on our deal........... Medicare premium for those working is
1.25% of earnings. This deduction is used to pay for your Part A premium and 75% of Part B. You pay $96.40 for Part B unless you have gross income over $170,000(married). If you paid the entire cost of Part A it would be $443/month. You pay $0. If you paid the entire cost of Part B, it would be $385.60. You pay $94.60.
Seniors are fortunate to have Medicare as it will insure everyone over 65 and those disabled covering ALL pre existing conditions.
Look at your mother’s Medicare summary and see how much the charges are and what Medicare approved. You will find there is a tremendous discount.
I assume you are aware that Medicare does not process claims. Rather, they hire contractors to process the claims.
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| Name: |
Yankee06
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| Subject: |
HEY GoneFishin
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Date:
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9/8/2009 1:24:35 AM
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GF,
-I'm getting an education on medicare thru these posts, -so thanks.
-I agree with you that seniors are "fortunate" to have medicare, just as they are to have social security. BUT (there's that "but" again",,I'm continually amazed when people tell me that I should be glad that the government, young workers, or both are nice enough to provide me these benies. That's just wrong.
-Social Security: I've posted before my thoughts on social security payments. I will have to live to be 81 before I get out of Social security what I put into it. Never mind what I would have in retirement funds if that money had been invested just in government bonds.
-Medicare: Medicare is different. Hopefully, I will never get out of medicare what I put into it, because if I did , it would mean I would be sick alot. Medicare takes about 3% of our salary during working years. Over the years I have paid upwards of $100,000 into medicare. Using the numbers you say we save in not having to pay part A premiums or all of part B premiums, I would be saving about $8,000 per year on premiums. However, if I take that $100,000 I paid into medicare, I would have all my premiums paid up for teh next 12 years or until I'm 77 years old. And if teh government had been smart enough to invest that $100,000, even in its own treasuries, I would probably be paid up till I'm a 177 years old. So, we have to ask if you are right when you say we seniors are "fortunate" to have medicare.
-Now , I understand that not everyone was fortunate enough to have paid medicare contributions that would have gotten them civilian insurance benefits equal to Medicare benefits, --or better. Thus medicare provides a low-wage earner with a better health insurance system in retirement than he/she would have had if medicare was not available. I'm all for that. BUt then let's understand and call it what it is, Medicare is a wealth-transfer insurance system, in which everyone is in teh same age/risk categories, but not everyone pays the same premiums.
-Medicare is faced with the same basic conceptual flaw as Social Security. When they were both instituted, the originators were not planning on such long life spans. In other words we were suppose to die in our late 60s or early 70s.
-Medicare has two additional flaws (well it has alot of additonal flaws), that also go to the heart of its cost problems. 1) the size of its insuree base (old people) keeps growing while its money from premiums keeps falling; 2) Insurance is an "odds" business. If an auto insurance company insures 100 cars, it knows only 1%-2% will be totalled each year. The company can absorb those costs. HOwever, medicare knows that 70%-80% (pick a number) of its insurees will be making big time claims each year. HOw you gonna change those odds? ---No, don't say pull-the-plug on granny!
-Bottomline. Medicare is great for most seniors and good for some. I don't think it's bad for anyone, -----except the treasury of coourse!
But we must remember, Medicare is a government insurance company/program. It is not government health care.
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| Name: |
MartiniMan
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| Subject: |
Don't Get Sick
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Date:
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9/8/2009 1:30:16 PM
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"This is another issue I don't think should break down along party lines --insurance reform. I can't understand why only dems are supposed to be for it, while most repubs are suppose to be against it. this should be a bipartisan issue."
You are mistaken if you think only Dems favor some reforms to address potential abuses by private insurers. But I would counter with why is it only Republicans want tort reform (yes, I already know the answer)? But government takeover of health care and insurance is a more frightening than abuses by insurance companies where market forces can at least exert some influence versus the court of last resort (i.e., the federal government where you need their permission to even sue them).
"Good capitalism should have the following core principle: produce a good product/service and make a reasonable profit. DO that and you'll continue getting customers, making your product, growing your wealth and teh wealth of your workers, etc.
-The dark shadow of capitalism is the human failing called greed which can lead to exploitation of workers and customers."
As Winston Churchill said, "The inherent vice of capitalism is the unequal sharing of blessings; the inherent vice of socialism is the equal sharing of miseries." We cannot allow imperfections in the system of capitalism to be used as support for the devastation that will be caused by socializing our health care system. That is the intent of an article like this that ignores the millions of people who get the care they need from private insurance or how else would 85% of those polled indicated they like their health care insurance?
"-Now enter teh insurance companies. The focus of insurance companies should be to produce a good product/service and make a reasonable profit. However, in some insurance companies the focus has been to make big profits and provide a promised product that no one gets to look at until some time in the distant future. Too often when the product actually arrives on our door step its not what was promised. Now enter the government which does have a role here to protect the consumer. A valid governemnt role is to prevent/punish crime, whether it be a mugging in the street or a mugging from the board room."
You obviously have little faith in the markets to self correct. The proper role of government should be to prevent abuse and collusion. That does not mean to take over what is being provided very well, albeit imperfectly, by the private insurance system. I can assure you when we had problems with Humana, and I heard about it aplenty, we switched to BC/BS even though they were more expensive. Now the complaints are minor and the market corrected itself.
"-We need insurance company reform. A lot of insurance companies are good, Unfortunately alot aren't. I believe government regulation --and enforcement--are necessary here for such things as carryovers of insurance from job to job, pre-existing condition acceptance, no drops once a person gets sick, etc. The health insurance companies are not here to make profits, they are here to provide a good product/service for us that makes a honest profit for them."
I don't get the last sentence as it seems to be a contradiction. If an insurance company provides a product that companies will buy they have every right to make a profit. I think you are saying that insurance companies should make a certain profit but not "too much". Well who decides what is too much, the government?!?! I hope you are not advocating government control of profit because that is never going to work and it never has.
"-Effective health care reform requires progress on many fronts; insurance company reform is one of them. Others are doing away with waste, preventing fraud, tort reform, increase in doctor/nursing schools, preventing special interest support to political races, etc
-Fixing teh health care system should be less about party politics and more about good management practices."
What exactly constitutes "insurance company reform"? If you mean government control or government mandates we all saw how well that worked with Fannie and Freddie, the Post Office, Amtrak and so on. Government does very little well and is infinitely less effective than the markets in correcting excess. If you want to talk politics explain to me why Republicans in Congress have been totally excluded from the creation of the Obamacare health plan?
I agree that government has a role to play in addressing excesses and abuses but I would argue that it is limited and it certainly is far from the role being proposed under Obamacare. Some sensible and very cost effective reforms like tort reform could have a significant impact on costs but Dems will never agree to that because they are in the pocket of the trial attorneys. Making portability is really only a first step in getting employers out of the insurance business (after all we don't have to provide your life insurance, car insurance, etc.). Right now the only choice my employees have are choices I provide. Imagine if they had access to hundreds of potential health insurance options? Eliminating denials for pre-existing conditions would increase overall costs for everyone but I think most Americans see this as an issue they will be prepared to pay the extra freight.
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| Name: |
JustAGuy
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| Subject: |
Don't Get Sick
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Date:
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9/8/2009 11:42:59 PM
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Very long and detailed post MM .. .and much of which I agree with ... some I don't disagree ... I just don't know....
But here's the kicker ... "If you want to talk politics explain to me why Republicans in Congress have been totally excluded from the creation of the Obamacare health plan?"
I would ask a different question .. Bush was Pres for 8 years ... what did Repubs do during those 8 years to fix the problems with health care/health insurance reform .. answer? They did nothing.
So now ... they get the Dem version ... whether I agree with it or not ... at least the Dems are taking a shot at health care/health insurancer reform ...
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