How would you reform health care?
 

We have heard about many plans that are out there and we all have opinions on what we would do to reform health care. Let's start out a simple discussion of what is wrong with our current health care system and what we could do to reform it (or leave it as is).

This discussion was initially restricted to what was wrong with the system. It has now been expanded to include how to fix what is wrong.



I'll start with some things that I see as wrong (in no particular order):

1) People needing treatment can't always get it because they can't afford it or the insurance company says sorry we won't pay.
2) Costs are so high that a single medical emergency can put a family in massive debt for their entire life.
3) People are afraid of these costs that many times they won't get help for something minor which escalates into something major.
4) Doctors and institutions who are honestly working twoard helping individuals have to fear getting sued.

5) Lobbyists for Insurance and Pharmaceutical companies have far too much influence on legislation in Washington, DC

I would definitely agree with that.

I'm an insurance agent so some may consider my opinions slightly biases. That being said, Most of my sales are from supplemental products, namely a gap plan that is designed to fill the gap between rising deductables. From my 6 years of experience, the number one reason health insurance premiums rise is due to the risk factors of the groups employee's. And that makes sense, it works the same way with car insurance or homeowners insurance...if you don't live within so many feet of a fire hydrant then your premiums will be higher than someone who does. If you have several speeding tickets on your record your premiums will be higher. The same goes for health insurance. The higher the risk the higher the premiums. People need to take an initiative and start living healthier lifestyles. Some will say that the govn'thas no right to tell you how to live, and their right they don't. But it isn't fair for everyone to pay the same premiums when people are intentionally making themselves sick by not excercising or smoking or eating mcdonalds 3 times a day

That is interesting information rahl. I would agree that people have varying risk factors and some people intentionally make themselves higher risk. The question I have for you is right now risk is risk it isn't divided into risk that is caused by ones own behaviors (not eating well or staying in shape, wild outdoors enthusiast, etc) and risks that just are (consecutive abnormal pap-smears, previous cancer victim, birth defects, etc).

Is it fair to take people who are high risk due to no fault of their own and treat them the same as people who choose to live a risky lifestyle? I do think there should be intensives for people to live healthy but we need to be careful that those incentives do not become punishments for people who are sick.

How does one assess the collective risk of several thousand employees of a major corporation?

Risk levels for large sized groups are calculated differently than smaller groups. The larger groups acutally have cheaper rates because there are so many people generating premiums that the premium to payout ratio is more in favor for insurance companies. Smaller groups are rated based on applications each employee fills out and based on prior medical history(pre-existing conditions).

---------- Post added at 08:13 PM ---------- Previous post was at 08:09 PM ----------

Is it fair to take people who are high risk due to no fault of their own and treat them the same as people who choose to live a risky lifestyle? I do think there should be intensives for people to live healthy but we need to be careful that those incentives do not become punishments for people who are sick.[/QUOTE]

It is fair from a free market standpoint. If the govn't passes a single payer plan then things will obviously change. But keep in mind it is extremely expensive to take care of sick people, so the costs are going to be spread out to all tax paying americans in some form or another.

It's expensive to take care of sick people, so the answer is to deny coverage to customers who have been paying into the system for years and years?

No one is being denied coverage. People are denied affordable coverage. If you can afford $3,000 a month then your covered, if not then too bad. Thats the way the system is set up now, and it makes sense in a free market. If you have a car with engine trouble and problems with the frame, how is it fair that you would pay the same as me for coverage when my car is in pristine condition? I'm not saying that it is fair for everyone, just that this is how it works currently. And i can't see any way of fixing it without seriously long term initiatives. The cost of care from hospitals and doctors needs to be way down from the current prices. How to do that I don't know, but if all we do is adopt a government plan then that plan will be just as expesive as the current system so whats the point. I understand something needs to be done but it's going to take decades to implement, otherwise the economy will get even worse.

part of the reason the doctors/hospitals charge so much is because the insurance companies aren't reimbursing them for everything that they're "covering" for the patient

Thats the least of the reasons. The number one reason is that doctors are sued like crazy for malpractice, which lead to over testing and needlessly testing. Which insurance companies rightly don't want to pay for.

Another reason that prices are so high, especially in ER's is that people go there for every little thing. People need to be better educated in that ER's are for EMERGENCIES only. Not colds or back pain. that's what family doctors are for and urgent care facilities. Also every ER in the country has to accept people whether or not they have insurance. The people who don't have insurance, for what ever reason, almost never pay their bills. Granted it may be expensive but they can easily work out a payment plan with the hospital. My wife is an ER nurse and 2/3rds of the people who go there are either drug seeking or bringing their kid in for a runny nose

Isn't malpractice's share of total health care costs pretty minuscule? Low single digit % if I remember correctly

EDIT: Malpractice payouts account for less than 1% of total health care expenditures

it's around 1% per hospital. but those suits cost the hospital itselft millions of dollars. Driving up the cost of malpractice insurance which is then passed on to patients in the form of over testing, which in turn the insurance companies often deny because they are unneccessary. Again there is no easy answer or quick fix that I can see. Lots of people can have opinions on the best course to take but I seriously doubt any one person, even experts in the are, have any clue how to fix the problem without bankrupting the country

not-for-profit insurance is the only way to go, IMO, but that's something I doubt you'll agre with (ha ha ha)

What's wrong? A for-profit health care industry. It puts health care out of the price range of 1 in 6 Americans and treats the other 5 out of 6 like they're money bags. They'll use basically any excuse that's legally defensible to deny care, they refuse to treat people that have "preexisting conditions" (most people do), and they allow people under their care to die more often than most people think. Put simply, the health of an individual is too important to entrust to a for-profit entity.

How would I reform health care? I'd create a universal single payer system and make it compulsory, paying for it through an immediate progressive tax increase.

and that tax increase is what scares the majority of americans. Like I stated earlier, the cost of healthcare isn't going to go down if we have a universal healthcare system. The government plan may cover everyone but they will most definately put a limit on how much they will be willing to pay for any given procedure, they have to otherwise they will be in the same boat as the insurance companies are now. Medicaid is a perfect example. Most Primary care physicians will not accept medicaid patients because they only pay a fraction of what an hmo or ppo will pay them. There's no way the government will be able to totally get rid of insurance companies, because the vast majority of people can afford them, and most doctors will only accept private insurance. The government should not be able to tell doctors that they have to accept their plan over private insurance. A state funded hospital is a different story but not a privately owned medical practice

The cost of health care will go down if we have a universal health care system. It won't happen overnight, but just as we can see in every other industrialized nation in the world, universal health care is ultimately cheaper.

If most Americans were to understand that instead of paying $5,000 a year to an insurance company they could pay $2600 a year in taxes, they're not going to be scared anymore. They're going to be livid that they've been giving in to scare tactics for like 70 years.

Those other countries didn't have a runaway healthcare system like we do. Why would hospitals and doctors offices reduce how much they charge for procedures or visits just because there is a government plan? Do you think they would do it out of the goodness of their hearts? if you do you are incredibly nieve

Do you think that they'd quit? What happens when you're a free market doctor in a universal world? You die or you adapt.

why would they adapt? The government can't outlaw private insurance, or the right that doctors have to run their business how they see fit. The problem I have with Healthcare Reform is that yes while costs are climbing, only a very small fraction of the population aren't covered for various reasons(unemployed, can't afford it, etc.) so the current system can work if we can find a way to drive down the cost of treatments. The easiest way to do that imo is to limit malpractice suits, and for americans to live healthier lifestyles. As i said earlier a person who drives recklessly has higher car insurance rates than someone who has a perfect record.

The government won't have to outlaw private insurance, it will die because it can't compete with government health care. Very quickly.

BTW, since when is 1 in 6 "a very small fraction"?

and how is curbing malpractice (0.36% of total health care costs) going to make a scratch (much less a dent) in rising health care costs?

how about CEO salaries for the Insurance companies? I'm guessing those account for more

1 in 6 is a false number. All it means is they don't have private insurance, it groups together all the people who are currently on medicaid/s-chip, people who are eligible for said programs who have not yet signed up and illegal aliens. Again I ask you why would a doctors office accept a government plan that pays only a fraction of what a private insurance carrier does? They wouldn't, so the government plan would never overtake private insurance companies. So without outlawing private insurance companies(wich will never happen) how would the government plan hope to compete with private insurance?

private insurers already pay a fraction of what the doctors bill. Can you cite an article or government plan that states the government plan would pay less than the private insurers please?

Malpractice causes Hospital to do unneccessary tests in order to cover their asses so they won't get sued. Insurance companies rightfully don't want to pay for things that are unneccessary, and neither will the government. If the government gets involved they will most likely pass an immunity clause like most municipalities for liability. Meaning if the hospital or doctor screws up, oh well, they have immunity.

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This is a pub discussion so no citations, but if a doctor bills an insurance company, and the procedure/test was neccessary, then the company will pay. The vast majority of doctors offices will not accept medicaid because they only pay doctors a fraction of what he normally charges. Thats why people with medicaid just go to the ER because they are forced to accept medicaid, driving up the cost of ER visits for everyone else.

I was rounding, but yeah 46.6 million out of 300 million as of 2005 is something to be deeply ashamed of as a civilization.
This is where PUB discussions fail. I can verify that this isn't true through citations, but we don't allow those. All I can do is say, "You're wrong," and get stuck in a stalemate.
Universal health care would completely decimate private insurance in savings (private health care has administrative costs of about $300 billion annually). Private insurers would start going belly up left and right, and the few stubborn conservatives and ultra rich wouldn't be able to support the huge number of physicians that would want to work privately. Some might get lucky, but a vast majority would have to either enter a new profession, which means a waste of 8 years of schooling and god knows how much tuition, or they'd be absorbed into the public system. If they're anything like every other time that a private system has become a public system, most will join the public health care system and do just fine.

Not only that, but over half of US doctors support universal healthcare according to that Reuters newspaper on the bar beside you.

I'm afraid you're not on the right side of this one.

Isn't the point of insurance to mitigate risk over a large group? You yourself have said large group plans are cheaper because the risk is averaged over everyone. So why not put anyone that wants on the same group plan?

Also wouldn't eliminating insurance remove a middle man in the health care process there bye reducing the cost of health care? I think what really scares the insurance agency is that they are a middleman and if the government were to assume all risk by being a single payer there would be no need for the health insurance industry. In a single payer system what role do insurance companies play?

I worked with a doctor once who would put patients in for admissions based on what the chief complaint was in triage, long before he even saw the patient. He got sued once and was determined to never let it happen again. Worked with many a doctor who would order CAT scans or MRIs even though they knew it wasn't going to tell them anything.

Part of that problem lies in the fact there are too few primary care physicians. The general practitioner has gone the way of the dodo bird. Everyone is a specialist these days. Most people don't have one doctor, they have 2 or 3 depending on the number of medical conditions they have. The ones that do see patients as a primary care are horribly overbooked and can't see the back pains/colds for weeks if not months. They always tell their patients that call in to be seen to go to the ER if they want treatment that day. Then there is the instant satisfaction group that want to be treated immediately and will return in 24 hours if they still feel bad.
I won't even go into the drug seekers (either the street bred variety or the ones created by physicians) and the drunk homeless that local police will no longer hold in the cells but instead send to the ER where they tie up beds and staff till they are sober enough to walk out and do it all over again in a few hours.
Lets not forget the abuse of the EMS system which in my area is looked at as a form of taxi service. You'd be amazed what people will call 911 for.
Then there is the problem of an appalling lack of psychiatric services. Too many mentally ill people that need long term care and no where to put them.
Substandard nursing homes and rehabs.
Nursing shortages.
Patients on 10 or 20 different medications.

These are just some of the problems facing ERs. There is an entirely different list of things wrong from the hospital wards perspective, or just about any other department for that matter.

People actually think the government is going to be able to fix things? The same people who rely on polls and lobbyists to tell them what to do. The same ones that want to build bridges to nowhere and can't seem to pass anything without a healthy doses of pork included. Do you really want the government mandating your health care?

well you must be reading something i'm not because I can verify it's true. Like I said 45 millions americans don't have PRIVATE insurance, some are covered under current govn't plans or are eligible. The real number is closer to 10-15 million, which is still alot i'm not saying it isn't.

The govn't plan would have just as many admin costs as private insurance. Doctors will not accept the government plan unless they pay what the doctor charges period. They can't be fased out, they won't simply put up their hands and surrender.

You assume I'm not on the right side of this issue. I agree that something needs to be done to stop run away costs, a complete government take over of medicine isn't the answer. I don't know what the CORRECT answer is, but I'm able to admit it. I've been in the insurance industry for 6 years, my wife has been in the ER for 5 years, most of you have absoulutely no idea what you are talking about when it comes to this issue you just have opinions, not realistic solutions

The figures I have seen are that about 25% (10-12 milion) are eligible for Medicaid or S-CHIP.

A large majority of those w/o insurance are small business employees making more than the threshold for those programs, but faced with paying the full cost of insurance w/o employer contributions, which could easily approach or exceed a third of their take home pay.

The other problem? The patchwork nature of state regulations where there is no incentive for private insurers to control costs. In many states, profits (and admin expenses) are tied to a fixed percentage of premiums...so, in fact, if as an insurer, my profits are based directly on a fixed rate of 15% of premiums, there is a built in disincentive to lower premiums....lower premium means less profit....higher premiums means more profit.

It seems to me an insurance exchange of public and private that would encourage greater competition would likely reverse, at least to some degree, those current incentives to keep premiums rising.

IMO, there is no reason to abandon our current employer-based system. The issue is containing costs of those employer-based plans and expanding affordable coverage to those w/o ....and generally, greater competition not only accomplishes that, but it also stimulates greater innovation.

The other problem? The patchwork nature of state regulations where there is no incentive for private insurers to control costs. In many states, profits (and admin expenses) are tied to a fixed percentage of premiums...so, in fact, if as an insurer, my profits are based directly on a fixed rate of 15% of premiums, there is a built in disincentive to lower premiums....lower premium means less profit....higher premiums means more profit.

It seems to me an insurance exchange of public and private that would encourage greater competition would likely reverse, at least to some degree, those current incentives to keep premiums rising.

IMO, there is no reason to abandon our current employer-based system. The issue is containing costs of those employer-based plans and expanding affordable coverage to those w/o ....and generally, greater competition not only accomplishes that, but it also stimulates greater innovation.[/QUOTE]


Profits for insurance companies are based on a premium to payout ratio, so if the cost of care went down then the insurance companies would be more willing to reduce premiums. so competition by itself will not bring down the cost to insureds.

As un-American as it sounds, I am slowly coming to this same mindset. I know in my own case my family's deductible and premium's both went up by half this year, my co-pay doubled and our coverage was reduced (we paid nearly over twice as much to have our second child in March when compared to the first one back in 2006) all while my insurance carrier posted record profits.

Although, having said this I think any real reform to the medical industry has to start with tort reform to reduce the cost of malpractice and all that is associated with it. From there, we need real reform in Washington to reduce the influence of the insurance and pharmaceutical lobby on Congress. Once these two things are under control, we can start to see what things look like.

The problem is that even once those two things are fixed (assuming they could be fixed, that is) I doubt prices would come down. After all, why charge less than you have been charging?

Not for profit sounds great to everyone who proposes it because it's not their job they will be loosing. What if whatever your job happens to be, suddenly there is a public outcry to have the government take it over and make it not for profit, you'd be pretty pissed. The economy is already hurting my sales and if a single payer system is passed I will be totally out of work, and so will millions of other americans, but hey atleast everyone will be covered under the new plan

not-for-profit doesn't mean no one gets paid. it means at the end of your fiscal year, your balance sheet should read $0.00. This means you lower premiums in order for your payouts/salaries/etc. to balance out, or you reinvest any "profits" back into the company. I've worked for many not-for-profit groups (in various industries) and I always drew a paycheck

I'm not willing to take a pay cut, would you be?

Why would you take a pay cut?

If my company were to turn non profit I would be paid less commissions. But if there is a single payer system implemented I would loose my job outright. I don't want either of those things

right, so you're arguing from a personal point of view rather than a national one. completely understandable considering your job. somehow I doubt that every work in the private insurance industry would lose their jobs

Find me another way for insurance companies to act ethically and I will listen but right now I don't see it. The drive to post a bigger profit is killing heathcare in this nation, in my humble opinion.

I'm coming to this thread late, but this quote:

...speaks to precisely what's wrong with our current system. You know who else talks in terms of payout ratios being in their favor? Casinos.

Insurance Companies are basically big gambling operations, where people bet against the house that they'll get sick some day, and gamble that on that day the house will honor its agreement to pay out.

Lots of people would be better off putting their premiums into a slot machine.


ALSO: I think it's very strange that people get their insurance through where they work. Really... If that wasn't "how it is", and somebody came along and proposed that, I think we'd all look at them funny. These days, anyway--back when you got a job and it was your job for life, and your pension and retirement came from there, it made more sense. These days, not so much. Why not get insurance through your church? Or your neighborhood watch association? That would be about as strange. The two things that make ANY real sense, logistically speaking, are private insurance, and government insurance.

You could get insurance through your church, or any association you belong to as long as they form a group. Group Health insurance is way cheaper than inidvidual insurance, especially if you have any health problems. If you have pre-exes you will be covered under a group plan but you would be unlikely to obtain individual coverage, at the least it would be extremely expensive that is why there is group coverage.

---------- Post added at 02:37 PM ---------- Previous post was at 02:36 PM ----------

Everyone is private health insurance would, and depending on the type of plan the government puts out, Everyone in the supplemental market like myself would also. The only insurance agents left would be life insurance, and property and casualty.

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just like any business or government agency, there are those who act ethically and those who don't but the vast majority of health insurance companies act ethically. They are strictly regulated by each states department of insurance so if you think this problem is solely the fault of the big bad insurance companies think again. Premiums go up as a result of the cost of care going up.

I've got to think that the job losses would be offset by new hires in the administration of government programs, at least somewhat. It wouldn't be the raw carnage you're depicting.

That may be the way you justify it as somebody inside the industry. Caregivers say the cost of care goes up because of how insurance handles claims. So, who do you listen to? I can tell you from the outside that the whole thing is like betting against the house. The house will fuck you any way it can. Occasionally you get a comped dinner or something, but only so the money keeps coming out of your pocket and into theirs.

That may be the way you justify it as somebody inside the industry. Caregivers say the cost of care goes up because of how insurance handles claims. So, who do you listen to? I can tell you from the outside that the whole thing is like betting against the house. The house will fuck you any way it can. Occasionally you get a comped dinner or something, but only so the money keeps coming out of your pocket and into theirs.[/QUOTE]

It's not the way I justify it, thats the way it is. The majority of my business comes from groups in the healthcare field(hospitals, nursing homes etc.) As far as hospitals go, they have to do a certain number of tests in order to cover their backsides from malpractice suits, in which case insurance companies will not pay for blatenly unneccessary tests. That is the ONLY time your insurance company will deny payment, or if you went to see a specialist without a referral from you PCP, which is stated in plain english in your policy. If your insurance company doesn't pay a claim it is most likely your own fault for not following the terms of the policy, but most times the insurance company will work with you or give you the benefit of the doubt. I know the company I work for does it all the time...someone has an accident that is not covered on their supplemental plan but a phone call to me from the insured then a phone call from me to my company will 90% of the time get them paid.

My point is people need to read their policies and stick to the guidelines, if they don't understand I guarantee you a quick phone call to their agent or to customer service will clear up any misunderstandings

interesting perspective, rahl.

someone else already said this, but the difference between your viewpoint and that which should logically be informing the debate about the healthcare system and what should be done with it is that of the anecdotal to the systemic.

roughly 40 million people without healthcare insurance of any kind in an advanced post-industrial society is a political and ethical problem. it is a systemic problem. what it really cuts to is the american class system and its inequities, but rather than talk about that, we're instead assuming, as conservatives long have, that the american class system is a fact of nature and not a matter of social choices and history and so produces "natural" outcomes that may not be wholly swell and which may require certain adjustments be made once people figure out--and god knows why it's taken this bloody long--that there are both political and ethical problems which follow from the existing arrangement in the states.

i would think something like the french model would be pretty well suited to the united states--basic health care is universal and provided free to everyone---more advanced health care is covered by mandatory insurance which is subject to a sliding fee scale--so that for the poorer segments of the population, it is free as well, but not for the more affluent. this is not a problematic situation from any viewpoint so long as you keep in mind that the objective is not to allow a so-called advanced society to have it's less affluent members subjected to poor-to-non-existent health care because of their income---or if you want to use a conservative trick--for the children of the poor to find their lives socially valued less than the lives of the children of the more affluent.

medical schools are state operations, there is no mountain of debt that you acquire to go through it.
doctors are state functionaries, so do not command whatever the market will bear as salaries.
pharmaceutical prices are strictly controlled
and whaddya know, france has one of the best health care systems in the world, and there is no compromise on research etc.

why this kind of model is not an option and only the vastly inferior english one is, i have no idea.

In case you're not aware, that's what justification sounds like.

And your "partners" in providing health care say the opposite.

Who is a consumer supposed to believe?

I already stated that I don't know what the best answer is, my opinion is that switching to a single payer over night would make things infinately worse for quite some time. But like I stated earlier as well unless you work directly in the insurance field or medical field you really have no clue as to what you are talking about

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I will also concede that Malpractice insurance PREMIUMS play a factor in health care costs as well, but as long as a doctor is on the hook for several million dollars, and an insurance company is needed to help cover those costs, the premiums are going to be extremely high.


I'm very hesitant to say this next part because it is a very synical way of looking at it, and I'm sure I will get hammered for this but please keep in mind this is just one way of looking at it. Some people complain that their insurance has caps on it, usually around1.5 million lifetime benefit. If there is a government plan it will almost certainly have a cap as well, because your typical american doesn't warrant the spending of 1, 2, 5 or 10 million dollars to keep alive because if it costs that much to treat it is most likely a terminal illness, and the few years you may be kept alive your monitary contribution to society will never justify that sort of expenditure to keep you alive.

rahl---that's like saying that unless you have worked on social and/or class analysis, you don't know what you're talking about.
which i have. which you haven't.

because your viewpoint, while interesting in this context, is anecdotal, you can't maintain this position of He Who Knows if the type of question gets shifted away from your baliwick.

one of the underlying issues here really is: what kind of question is "what should be done about the health care system"

i think it's a social and political question.

so it's fine to offer versions of one's expertise in the context of a question the nature of which you imagine you control--but the fact is that you don't control the nature of the question.

Understanding the causes of the problem is the first step to fixing it. My point is that if you don't work in either industry it's hard to know what they are, all you have to go on at this point is what your particular political party is spueing, whether it be republicans or democrats. I also understand that there are social aspects contributing to the problem, but as soon as something gets politicised like this, imo whats best for people usually gets tossed out the window and it becomes whats best for the party

um first off i really have no idea, apart from the number 40 million, what makes you assume that i am repeating (spewing as you so daintily put it) a line from either of the rather sad mass political parties.

i don't recall the french system factoring into debates in the state much at all---i assumed this was a function of parochialism---you know, that most of what's available about the system is written in french.

secondly, i really have no idea what possible basis you can have for arguing in effect that because you work in insurance that you have a monopoly on the coherent way to frame the question of what to do about the health care system. you've done it several times.

again, the information that you've offered is interesting, but its relevance to the discussion hinges on the kind of discussion that it is--you want to restrict it to a technical discussion which presupposes that the existing system is functional and legitimate.
you don't seem to recognize that you do this because, it appears, you default into this position because your technical knowledge presupposes it.

but what happens if the organization and orientation of the american insurance industry is a significant expression of the problems that the thread is designed to address?

one thing that means is that your viewpoint gets positioned in a way that you might not like.
obviously you recognize that implicitly, if your pissiness in response to my reply is any indication.
but you don't seem to even go as far as to acknowledge that the industry which situates your technical knowledge is a player in this game, with very particular interests at stake in this game, and so your attempt to position yourself as The Man with respect to the game as a whole amounts to a political move on your part.

the next move you make is predictable and frnakly kinda depressing and crude: if you do not work in the same industry--which appears to mean also that if you do not share your particular understanding of what is and is not a political interest within this larger debate--then you cannot know what you're talking about.

so what you're saying, rahl, is that the question of what should happen should be decided by a technocratic panel of people like yourself whose institutional interests militate against any change at all.

and anyone who disagrees with you on that is some partisan shill.
not the paragon of neutrality that you are.

again, if the debate were actually about the existing system, you'd be in a pretty strong place to position yourself as you do.
but given that the debate is not about that, but about how to change that system, you aren't in a strong position.
no amount of snarkiness changes that.

That is bullshit. Many people in this world can tell you things that are wrong with the health care system based on their own experiences with health care. Maybe they had their plan recinded, maybe they were denied coverage, etc. Just because someone doesn't work in the profession does not mean that they don't know anything. You have great qualifications to discuss this topic but that doesn't mean others don't have qualifications or unique experiences that add to this discussion.

Very true, but when people who don't know the industry on either side(medical,or insurance) and they try to tell me whats wrong or that they know better than me what would be a better system, I just don't get it. I only responded to this discussion to try to give my viewpoints and experiences from an insurance point of view and I get bashed and told others know more on the subject because they read about it somewhere.

RoachBoy I know you are the end all and be all of political discussions and the rest of us should bow down before you, but with all due respect almost every one of your post are snarky and condescending not mine.

I think a single payer universal system would be best but I don't think it is feasible with all the insurance companies already existing.

What I would like to see is have govt take the place of employers in negotiating insurance premiums. Instead of each insurance company having to negotiate with each business they work with they instead negotiate one rate for each type of plan that they want to offer in a regional market.

Insurance companies would be able to negotiate with regional/local doctors and hopsitals to determine what they will pay them on their own as it is now. They create plans based on local market areas. Consumers would then pick whichever insurance company fits their needs based on cost, coverage, doctor network.

The plans can be paid for by taxes on employers on a per employee basis. Determining that rate would be tricky. Ideally, it would be as close as possible to the current average amount businesses pay towards their typical employee's premiums. Therefore there is not much of a change in what they are paying. Hopefully, since it would be much cheaper for an insurance company to negotiate one rate with the govt vs 1,000's of different rates with varying businesses based on multiple factors, there could be an immediate reduction in costs. Obviously we can work out subsidies for small businesses where this would be a major burden and assistance for low income families.

Under the new plan, people could continue to have their premiums deducted from their checks if they wanted to.

This could completely replace medicare for seniors and any state-specific publicly funded health care options for the poor so that might also have big changes in costs.

The problem with that is that Insurance companies don't negotiate prices with employers. The premiums are what they are based on the risk level of the employees, which is determined by medical history, age, gender and type of work that is performed.

From a health care consumer standpoint it is valid to point out that there is little or no competition which may be one of the causes of out of control costs. It seems that the government will have to step in and try to control costs somehow if the so called free market does not.

In my small circle of friends and family, no one shops for health care provider pricing, most seem to only be concerned with the co-pay required from their employer subsidized insurance plans. Those few like myself who try to shop pricing soon learn that it is very difficult. For whatever reason this seems to be an industry that does not lend itself to competition and probably must be controlled.

there's zero competition on an individual level because almost everyone's insurance is through their employer. If your company says "we're switching from Blue Cross/Blue Shield to Cigna this year", you don't have a whole lot of choice in the matter (unless you want to drop your company insurance and pay double to get it individually)

Make doctors and hospitals PUBLISH rates, everyone pays the same rate. No "group discount" everyone is in the SAME group, everyone gets that discount.

This way I can shop around to see just how much all the ITEMS cost and make decisions based on actual costs as opposed to estimates and unknown items. Getting 4 bills for my operation was just stupid. Getting billed for an Xray for a normal visit because the insurance company decided that it's a different company so it's covered differently and I pay that out of my own pocket, I guess when I'm being wheeled on a gurney I need to ask what is and isn't covered by my insurance BEFORE they provide service.

Finally, pay. I'm now on 80/20 instead of the $10 copay. I can tell you that it's more painful to pay for the 20% but I am much more thoughtful in going to the doctor or dentist. Much more thoughtful.

---------- Post added at 07:42 PM ---------- Previous post was at 07:41 PM ----------

Most employers I have been employed by have 2 or 3 different plans, basic, middle tier and most expensive tier. All with different companies.

which is MUCH different than getting to choose between 3 similarly priced plans from 3 different companies

Actually I"ve been in companies that also offered a choice from the same company.

BUT there's people like me that are DINKs and when my wife works in another company come open enrollment for insurance we compare and contrast. It gives us plenty of choices, in fact, sometimes the choice of 6 different companies and plans.

You're missing the point. Whether or not there is a 'negotiation' they still need to evaluate each business (or group) individually and come up with different numbers based on that evaluation.

They may not do much negotiation with the little guys but if a giant corporation didn't like the rate that their current insurer was offering for the next year of coverage and threatened to leave they are going to reconsider.

Shopping around works just fine when you are planning treatment or routine visits. In the event of an emergency you don't have time to shop around.

It really isn't that simple. In exchange for 80/20 you might have lower premiums. You trade a lower monthly bill for more expensive treatment. Then you might even have deductibles, and all sorts of shit. When we had the HMO we had copays and no deductable. We switched to a PPO. We got much lower premiums but now we have deductibles and shit like that.

I've had two professional jobs. With the first one, there was one plan. Take it or leave it. My current employer has about four plans to choose from but they are all with Aetna.

There are multiple companies to choose from so prices are extremely competitive. Your employer shops around each year come renewal time and decides what is the best and often cheapest plan for the employee's

---------- Post added at 08:06 PM ---------- Previous post was at 08:03 PM ----------


The reason you pay one company for an er visit and another for an xray has nothing to do with insurance. Each hospital basically subcontracts certain departments. so there are multiple companies billing your insurer for each incident

Competition does not always drive down prices, especially in an industry that often collectively asserts its power. That competition always equates to lower prices is an economic myth. It certainly can, but it's no guarantee.

Companies are going to shop around for the cheapest option FOR THE COMPANY, which often means worse coverage for the employees.

I like this... I explain how I would reform it and everyone is more interested in bashing other people's responses without including their own.

follow directions much?

Ah, but you yourself are doing the same thing in the post where you're calling people on doing it.

It's preciesely situations like this that provide me an opportunity to offer supplemental products to groups. It's cheaper to offer a high deductable plan and supplement it with a gap plan to help cover that deductable.

got it, but quite busy and very tired.
is that like insurance insurance?

No, it's insurance that fills in the holes that your medical insurance doesn't cover. 5 years ago the typical deductable was around $500. Now it's around $2,500, so my company has a product that will pay out $2,000 to help you with the rise in deductable.

I can't afford my insurance because my insurance insurance copays are too high when I want to access my insurance.

And I was just razzing you there, Cynth.

I don't know how I would reform it. What I do know is that anything from the government is shitty. Ever eaten government food? It's shit. Government clothing? More shit. Housing? SUPER SHIT.

Health care will be no different. Anything for the people, by the government, will be shitola. No exceptions.

Ever hear of the Human Genome Project? Or the CDC? Maybe you've used this "internet" thing (which was invented by the Defense Department)? How about employee rights, do you like not being exploited by your bosses? Maybe you'd like the lead put back into your gasoline, the CFC's back in your aerosal and the DDT and PCBs in your food? Oh, and of course there's public police and fire protection, public libraries, and the military.

I could probably name hundreds if not thousands of things like this. I could list them until I'm blue in the face, without even cheating and linking you to tons of websites.

The government already runs a health care program. It's called Medicare. It's not without problems, but generally speaking it's a damn-sight better than anything you can get privately. Enough so that you can't pry it out of old people's fingers until they're cold and dead.

I'm talking about what I think of as "handout agencies". Food stamps, projects, that sort of thing. You ever been to the projects, Will? Try some of that good ol gov't cheese - every day. Make something with it. It's like bad cheddar mixed with velveta. The almond butter was fantastic, too.

I fear the country will be one big charity hospital. Ever been to one with a broken bone? You get to sit for a couple of hours and bleed while several illegals in front of you complain about having a cold or are there with 5 kids because one of them has a simple salmonella/food poisoning incident. You don't get to jump ahead in line unless you have a coronary on the floor, but as we've seen in the news, sometimes even then you get to die alone.

...........

And old people often hang on to medicare because usually it's about all they've got left, aside from their kids chipping in. You should hear my mom. She's scared shitless that the gov't is going to leave the aging baby boomers out in the cold.

I can't tell you how many people in the NORC (naturally occurring retirement community) that I live in who are divesting ALL their monies and assets so that they can jump on the free medicare bandwagon. Transferring hundreds of thousands of dollars.... all so that they can get themselves from free healthcare.

When the medicare doesn't want to pay for the level of healthcare they want to have... oh you should hear them kvetch in the laundry room.

I can't tell you what kind of crap my grandparents go through to get some of that free medicare. My grandmother is in the hospital right now and I can't even begin to tell you the difference in the level of care between someone with medicare versus private insurance.

I have to pick through this a bit to get at what you're saying. The only thing specific I can see is that you don't think food stamps work. Only they do work, and they work incredibly well. Do you know anyone that lives in Oregon? I do (HI SNOWY! *waves*). Back around 2000, Oregon had a serious hunger problem. Low income workers simply couldn't afford to feed themselves and their families, and it was at a rate that was alarmingly high. Because of welfare reform in the 90s, Oregon was able to change the income limit for food stamps, and between 2000 and 2004, Oregon was the only state in the country that was able to lower its hunger rate. Without food stamps, many hard working Oregonians would have starved.

But it gets a lot better. Food stamps are one of the most efficient ways for the government to stimulate the economy, according to most economists. Why? It's incredibly efficient.
Are you asking if I've ever had to wait in line at an ER because of an illegal guest worker? I haven't. In fact, according to statistics that you can find on google, most uninsured people in ERs are white American citizens.
Fear of something is not evidence of something because fear can be irrational.

Oh hey good for them. They could have also moved to better areas, or found ways to make ends meet. It's called survival, and as you should see by now, my personal view is that daily rations for rational adults should not be doled out by your gov't. For kids? Sure. For illegals or drug dealers or former inmates that don't want to flip burgers because of their felony/murder rap? Never. I hate food stamps. Yeah, give me food and housing so I can sit on my uneducated ass all day. Way to enable the laziness and breeding and keep the population dumb, all by gov't funding. Don't get me started on the lack of drug testing for recipients. Don't have enough to feed your kids? QUIT HAVING SO MANY FUCKING KIDS.

Fuck google. I sat there personally, more than once. This is Texas. I don't know about your nice little neck of the woods, but I have yet to visit a hospital for whatever reason and not see a stack of illegals in front of me. Hell, even when I'm not there for stitches or worse, if I walk by - oh look, a bunch of illegals in the ER. no halba espanol. That's not a racist thing, that's an immigrant thing. If it was germans instead, I would be complaining just as much. Danke.

Fear is always irrational. When you fear a grizzly charging you, if you are afraid, you are not rational. That doesn't mean you shouldn't be concerned. Plus if I say "I fear", you know I'm not talking in that panic-stricken sense of the term.

Yeah, shame on them for being poor! Obviously everyone that's poor isn't working hard enough. They're all lazy and working as little as they can so they can get food stamps and work even less. DARNED POOR!
I see, so if you experience it personally, it's obviously very common. Interesting axiom. Let's see how it stands up, shall we? I've personally been shot in the leg, therefore being shot in the leg must be very common, and we have to do something about this leg shooting epidemic. If you've not been shot in the leg, you're one of the few lucky ones because my personal experience supersedes yours. And I don't need verifiable statistics on how common leg shootings are. Fuck them, my own personal experience is evidence enough.

And I never suggested you were a racist, please don't put words in my posts.

Wow. I totally didn't put words in your post, Mr. Pissy Pants. Maybe you shouldn't put "irrational" in my posts either then. Boo hoo. Seriously? That was there in case someone wanted to point that out - a disclaimer, if you will.

I never said shame on the people in Oregon. I simply said you can change your life if you get up and do something about it. Say one family owned 50 acres, but the economy was so bad, they couldn't feed their 5 kids. Well, 50 acres is alot. Sell 25. Now you can feed the kids. Or better yet, sell it all and move to a more prosperous state or town. Novel idea there. Sell your house and move. People do it every day. Sell your extra car to give you some time to find a job. Sell your body. That's a joke, but you get the idea. Ebay! Craiglist! That old baseball card collection. Really, you can do it if you think creatively.

The lazy part deals with what I see in Texas and the south in general. Fuck if I know what's going on up north - never been there. I would suspect it's not that much different though. Down here I've been threatened just for driving by the projects on the way to see family. Something about "wrong color". The cars are mostly SUVs with gold or chrome trim, drugs are being sold on the corner, and out that one window you can smell weed. Typical day. Great work, gov't!

I've been to the ER about half a dozen times for various stupidity and clumsiness. 5 out of 6 times I'm backed up with half the people not speaking english in front of me, and they all had 2 to 6 kids. The one time I didn't get backed up was because I got strapped to a board and brought in by waaambulance. Go figure, Will. It's Houston man, come on. Half the town is illegal. It's my demographic and obviously not your's.

It funny how you claim I put words in your posts, but that is your primary form of attack. We're speaking english, but not the same language. Try dialing it back a little man. I don't really feel like being pissy. If the proposals are so good, then give some facts as to why instead of trying to hammer on my posts.

So, what's so good about it? I haven't read everything, but does anyone have a list of what is actually being proposed?

Of course, it was just a disclaimer. How silly of me.
It's still the same conservative rhetoric. It's their own fault that the poor are poor. If they'd just work a little harder, they'd not be poor anymore! You assume that the poor are poor simply because they're not working hard enough, they're just not willing to "get up and do something about it". I cannot imagine a more untrue and horrible attack on the poor. Roachboy had a really eloquent response to a similar claim made recently, I'll have to find it tomorrow.
You know poor people that own 50 acres of land? By what measure are you determining "poor"?
Sweet, you just figured out a brilliant way for every poor person with 50 acres of land to make some money! Maybe, since you're on a roll, you can figure out how a poor guy with a Porsche can put some food on his kids' table. Or how a poor family that owns land that's sitting on oil can finally pay their credit card bills!
I'm not sure what this has to do with the government, the poor, or healthcare. Sorry you were threatened, though.
Do you have health insurance?

You think I'm saying this because I have money and poor people are lower than low? I hope not. I grew up with nothing. My aspirations were to make pizzas in high school or flip burgers and become a manager of a mcdonalds. In the orphanage, I made 2 dollars a week on good behavior. Less if I fucked up. My goal every weekend was to buy a quart of cookies n cream ice cream and a bottle of sprite so I could have a cookies n cream float.

I met my wife, got my shit together and now I have a BS in the sciences from A&M and I am an IT professional. This is the first time in my life that I am not dependent on my folks, and that's only been in the past few months. We're living paycheck to paycheck, but at least we're making it. And how are we making it? By not having kids and working hard. Oh and we took out loans and worked through college.

So guess what, I got up and did something about it. If my ADHD crazy violently beaten and damn near psychotic childhood ass could do it, so can some level-headed but otherwise poor individual. Use a fucking condom and go get a job. Sorry, that's my truth man. No other way to put it.

Down here several farmers went under or nearly went under because they had land but either lost crops because they couldn't treat them, or couldn't drum up enough money to raise cattle. That's my example. Of course, the rest that own a house can sell it. If they don't own a house, move in with the folks. No folks? Find a roommate to split the rent.

Umm, so have you never visited the projects?

Tell you what, Will. If you ever come down here to Houston, shoot me a PM. We'll get a beer and lunch, then head over to the projects in a town I used to live in. By the time we're back, you'll wish they had never been invented.

It's gov't funded living. Food stamps keep the massive families fed. Baybay kids run around without shirts. Since the food stamps and drug money keep them fed, the parents can chat all day, or sit around smoking weed or drinking, or use surplus money for gold trimmed wheels. All thanks to the wonderous food stamp act.

What I would like to know is why we can't wean those families off the stamps, and start paying more kids to go to college. Those project families aren't going to college. Half of them didn't even finish high school. With food stamps, they sure as fuck don't care now. It's like jail - why work when you can get free room and board?! A few of them ended up dead from the gangs they join. I know a few that went that route, one was even in my 9th grade science class. Another one got locked up for holding up a school bus with a shotgun.

Yep. I pay 400 a month for it. My wife has her's paid through work. When I get my next job (next week) I'll have much cheaper insurance through them.

the key problem is that a fractioned system based on employment generates all sorts of perverse incentives. It is easier to compete for the "healthy" population than it is to compete via costs, and given the fact that its employment based the time horizon that is included in the actuarial calculations is generally shorter than it would be if different incentives were given (especially with medicare as a light at the end of the tunnel). The end result is that the American healthcare system has significantly higher overhead costs than any other industrialized nation, even in the most generous single payer systems.

Personally, I think that the primary goals of reform should be to end employment based health insurance, discourage the current "competition by denial of coverage" model, provide incentives for long term insurance contracting so that there is a bigger incentive to provide preventive care. How to do this all in a system where the government does not step in would be a challenge. Which is why I am in complete support of a single payer system, which has been significantly more efficient given international healthcare comparisons. State inefficiencies are ridiculously low if compared to the overhead costs of a system where companies compete to insure only the desirable demographics and every single procedure has to be verified ad nauseum by dozens of non medical professionals.

---------- Post added at 12:12 AM ---------- Previous post was at 12:09 AM ----------

non profit doesn't mean low salary or no commission. In fact, several non-profits pay quite well. Non-profit means that the net profits of the company are reinvested in it instead of being distributed to the owners or share holders. And while I appreciate your concern for your job, the fewer non-medical people the system employs, by definition the more efficient the system is and the lower the overhead costs are.

Who funded the orphanage?

Where did your college money come from?

Vig, see the guys here will come up with all the ways that you didn't forge ahead on your own. You know, someone else filtered the water and brought in electricity, built the roads and all that jazz. You didn't do it all by yourself.

Someone made the operating systems and built the computers... blah blah blah blah. Bunch of horseshit reasoning in my opinion.

We all get an OPPORTUNITY. At some point in time, we either get one or we make one. If you don't exploit that opportunity, and many people don't. Listen to how they talk about how they missed the boat on something... coulda, shoulda, woulda...

but yeah, i've been talking about having done it also from little to nothing... of an immigrant family but they go back... claim some crap about better education or something like that. Yet there are illegals, sorry undocumented workers who also make the same claims and achievements....

The fewer non-medical people in the system to keep a check on the health care industry, the faster prices will skyrocket for treatments. Hospitals and doctors offices are for profit, they should be they are a business. The doctor is providing a service that people want, he deserves to charge what he wants within reason. the haggleing between insurance companies and doctors offices does keep prices from going completelty out of control

Most people probably do get SOME opportunity, but not everyone gets the SAME opportunity

i didn't nor ever imply that it's ever the same... but hey isn't that what the idea of socialism is for? that everyone get the same?

if you're into socialism, I suppose.

I'm all for increasing the opportunities for those who are dire situations though.

I have to say Vigilante you are making some of the most ignorant and insulting comments I have ever read. You say you are not racist but your comments say otherwise. First you immediately assume any person who doesn't speak English is illegal, second you assume anyone on welfare or food stamps is lazy, third you assume anyone in the projects is a drain on society.....

Good grief you should really spend some time volunteering in the projects or with a church that is doing service projects to the needy. You need to open your eyes and stop generalizing. Are there illegals that go to the ER? Yes, but that doesn't mean every immigrant there is illegal. Are there lazy people on well fare and food stamps? Yes but that doesn't mean everyone on well fare and food stamps are lazy. Are there bad people in the projects? Yes but there are lots of really good people in the projects also.

The world exists beyond your own personal experiences and until you understand that your experiences will never explain everything you will be ignorant and in this case racist. And while were talking about generalizations why don't we throw another out there to see how you feel about it:

Well of course he didn't. That's the great myth of Libertarianism--that we're all self-determining little atoms, pulling ourselves up by our bootstraps independent of all the other little bootstrap-pulling-or-not atoms.

You don't have to reducto-ad-absurdam it about the electricity and the roads, by the way. If the guy really grew up in an orphanage, well yes, it's very impressive that he accomplished what he did, and a testament to his ability to cause results in his life. But there had to be SOMETHING paying for his college. SOMETHING kept him fed and housed, when he was a kid.

He's vehemently opposed to the public dole. Think he's trying to distance himself from anything? The psychology of his position isn't hard to fathom.

i'm curious: is there any other way of interpreting the introducing of this libertarian nonsense into this debate than as a rationale for basically arguing that the poor (or uninsured) are as they are because they're less than those manly men who pull themselves up by their bootstraps blah blah blah so fuck em, let em die...who cares about the physical well-being of the less-than-us, the social parasites.

hell, why not speed that fine thinking up and set up camps where these inferiors can learn some manly virtues?

See this is the problem with political or religious debate. If someones views are different from your own you have to resort to name calling or the belittling of other political parties or ideals. I've got new for you, you're not always right. No one is, so instead of being a condescending dick to everyone you feel you are above inilectually, simply state your views, and your reasoning behind them

except that as we know, this is not true. The American healthcare system is, at the same time, the healthcare system with the highest overhead costs, and the healthcare system with one of the highest spending per capita, while having the worst outcomes of industrialized nations.

what is it in your mind that contributes to high overhead costs?

By definition, a high proportion of non medical personnel employed by hospitals and insurance companies.

$750 billion/year in administrative costs, if I remember correctly.

rahl---you have got to be joking.

you have been running a tiresome little game of trying to control the way in which this discussion unfolds. you've been called on it repeatedly, and you've responded either by being an ass or ignoring the posts.

this in response to posts that have even tried to be polite.

given your m.o. in this thread, it's kinda hilarious to find you then turning around and taking a series of arbitrary potshots at me.


i wonder that if your technical knowledge is as dubious as is your ability to conduct yourself in a debate when you start to loose control of how it's framed.

i know.
let's start over.

how about you fill me in again on why an insurance man is a necessary reference point for discussing a social and political problem again?
how is it that social and political problems surface for you in your professional line? they're administrative problems, arent they? they kinda get dissolved, don't they?
isn't it the case that you have a personal. economic interest in the maintenance of the existing arrangement?
and that the company you work for also has such interests?

so where exactly is your competence in talking about the politics of health care?

So are you saying that hospitals will run themselves without an administration department?

---------- Post added at 01:18 PM ---------- Previous post was at 01:12 PM ----------


Thanks for proving my point. My intention was to provide a perspective from and insurance stand point which I have done. I have stated over and over that I don't know how to fix the problems, I'm able to admit that, others aren't. It's all a matter of opinion anyway. I also said that I have no experience in social or political arena's. I absolutely have an economic interest in keeping my job, anyone would when facing the extinction of their market. From my perspective I would rather we fix the current system rather than abolish it, but that's my OPINION

The problem is that no matter how much you want to talk about opportunities, the number of people far exceed the number of opportunities. In the end we still need dishwashers, grocery baggers, and all the other low wage jobs in order for our economy to work. Whether or not those people are lazy is irrelevant, we need those jobs filled. Those people may not need the amenities that the higher paid people get but they still have the same health care needs.

Are you being willingly obtuse? At no point anyone even suggested that. But the fact is that there are systems with lower overhead costs and systems with higher overhead costs. The current American system has much higher overhead costs than those of any other developed nation.

It is not like people are pushing for a "never seen before" utopian system. Quite a few nations have achieved an efficient single payer universal health care system.

If I'm being obtuse I don't mean to. I don't know how other nations healthcare systems work, or what their administrative duties or costs are like, never said I did. I just don't know how we could adjust our system to have less overhead costs

Here are a couple of questions.

Is health insurance primarily about helping people afford health care or primarily about making profit?

Are hospitals primarily about helping people or are they primarily about making profit?