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Archive for Friday, September 11, 2009

Policyholders could pay more if all Americans get coverage

September 11, 2009

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If President Barack Obama gets what he wants in his health care plan — covering all Americans and barring insurers from denying coverage — some analysts say individuals could wind up paying higher premiums.

The Obama plan would impose new costs on insurance companies, which would probably then raise the prices customers pay for coverage. Employers also would likely pass on some of their higher costs to employees.

An individual in a typical plan might have to pay up to $780 more for the same coverage in the first year of Obama’s plan, estimates Erik Gordon, a health care analyst and assistant professor at the University of Michigan’s Ross School of Business.

Gordon said employees now typically pay 20 to 40 percent of the premium for a typical health care package costing about $13,000 a year for a family of four, with employers picking up the rest.

Obama’s plan would raise insurers’ costs 10 to 15 percent if reform doesn’t provide other savings, Gordon estimated. He thinks employers would stick employees with perhaps 40 percent of the higher premium, or $520 to $780 more — though they might also receive better coverage because of mandatory preventive care and screenings.

The president told Congress most of health care reform can be paid for by eliminating waste and abuse in the existing system. Better screenings that prevent chronic diseases later would also save money, the administration has argued.

“The president’s plan will introduce choice and competition into the health insurance market. The increased availability of affordable health insurance options will lower health costs for all Americans,” said Linda Douglass, spokeswoman for the White House Office of Health Reform.

In his speech to Congress on Wednesday night, Obama said he wants to bar insurers from denying coverage to anyone because of a pre-existing health problem, canceling policies for sick people or refusing to cover preventive care.

He also suggested limits on Americans’ co-payments and deductibles. “We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick,” the president said.

Obama would also charge insurers a fee for their most expensive policies as a way of encouraging insurers to keep costs low and keep their rates low.

In addition, Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, has proposed a new fee on insurers that would subsidize coverage for uninsured Americans. The fee would generate about $6 billion a year.

Covering tens of millions more Americans would heap hundreds of billions of dollars in costs on managed care companies.

Yet insurers stand to benefit in other ways. Consultants estimate Obama’s priorities would shower the industry with at least $1 trillion in new revenue from premiums over the next decade.

Industry representatives counter that, even if insurers take in more money than they pay out, profit margins are so thin that additional taxes and fees would wind up being passed on to policyholders.

“There is no room for these taxes,” said H. Edward Hanway, CEO of Cigna. “What you’re ultimately going to see if those taxes hold is everybody’s costs going up, not just the new people being covered. The concern I have is these taxes don’t do anything but add to the cost of people already insured.”

Others said Obama’s plan might not raise costs as much as expected if everyone is required to have insurance and receive preventive care like regular checkups or mammograms, which can save money in the long run.

Lawmakers have yet to settle on any single health care plan.

Comments

just_another_bozo_on_this_bus 5 years, 2 months ago

Under a single-payer plan, the average premium would almost certainly go down-- substantially.

SettingTheRecordStraight 5 years, 2 months ago

Now the government is going to force Americans to buy a certain product? Outrageous. This requirment is a clever and nefarious mix of:

a) more government control over you b) government telling you that you're too dumb to make decisions for yourself c) government bribing insurance companies to support "reform" legislation by guaranteeing them millions of new (if not unwilling) customers.

just_another_bozo_on_this_bus 5 years, 2 months ago

No, barry, what I want is a system that doesn't suck money out working peoples' pockets just because folks like you think insurance companies have a "right" to suck it out.

craigers 5 years, 2 months ago

jabotb, how in the world would Obama's healthcare plan with the limits mentioned in this article and his speech?

craigers 5 years, 2 months ago

Sorry, I got interupted with that comment. :)

I was wondering how in the world with the limits Obama wants to impose, wouldn't money be sucked out of working peoples' pockets?

Richard Heckler 5 years, 2 months ago

Whether a company picks up the tab,it's a partnership or individually the most expensive insurance in the world comes back to us as consumers each time we make a purchase.

For 2010 full coverage think $18,310. If not full coverage then it is under insured which is truly a waste of money. Under insured will not see anyone through a long term serious situation such as cancer.

By the time one spends the co-pay,the deductible and the under insured premium cost how much are you spending?

Is being under insured worth the under insured premium considering what one must spend before the insurance company finally finally comes to your aid?

Consider the amount on is throwing away to be underinsured. Then consider how much is devoted to co-pays and deductibles? Add them together.

Would one have been money ahead paying out of pocket and putting the remainder in a savings account instead of GIVING it to the high profit medical insurance industry?

Read the fine prints in your policies.

just_another_bozo_on_this_bus 5 years, 2 months ago

I didn't say it would, but it would suck it out of working people's pockets, and transfer it to insurance companies.

Which is why I advocate a single-payer system. The current system is broken beyond repair because of its inefficiency and unbridled profiteering.

SettingTheRecordStraight 5 years, 2 months ago

bozo,

The first step is you admitting that no one is forcing "working people" to do business with anyone. If you don't like insurance companies, don't do business with them.

Your plan, however, is so far to the left of the mainstream that it doesn't even pretend to offer choice or encourage personal responsibility; it eliminates both.

just_another_bozo_on_this_bus 5 years, 2 months ago

"If you don't like insurance companies, don't do business with them."

Well, there are 50 million people who don't, and another 50 million who give them money, but will not receive adequate coverage.

The insurance companies are little more than a criminal enterprise.

Richard Heckler 5 years, 2 months ago

Go To: http://www.healthcare-now.org/hr-676/

The problem is we DO NOT have the best insurance coverage in the world.

According to the CBO HR 676 is the only proposal that DOES save dollars. Yes in fact $350,000,000,000(billion). HR 676 is the only proposal with 86 co-sponsors. Yet the media,the white house and too damn many legislators pretend this bill does not exist.

So what would the new HR 676 Medicare For ALL Insurance offer to americans 365 days a year,24/7? employed or not moving on to a new job or not single mom or not struck down with cancer or not

What would a new HR 676 Medicare Insurance Plan cost 365 days a year 24/7?

A family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. About $225 per month. Today the below insurance coverage actually costs about $1,100 per month.

  • long term care such that cancer would require
  • prescription drugs
  • hospital
  • surgical
  • outpatient services
  • primary and preventive care
  • emergency services
  • dental
  • mental health
  • home health
  • physical therapy
  • rehabilitation (including for substance abuse)
  • vision care
  • hearing services including hearing aids
  • chiropractic
  • durable medical equipment
  • palliative care

A family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. About $225 per month. Today the above insurance coverage actually costs about $1,100 per month.

HR 676 ends deductibles and co-payments. If a deductible and/or co-pay policy is in effect this usually indicates under-insured.

HR 676 would save hundreds of billions annually by eliminating the high overhead of the private health insurance industry and HMOs. The privatized medical insurance industry is anything but efficient. AND DOES NOT PROVIDE HEALTH CARE.

Richard Heckler 5 years, 2 months ago

Hey shareholders be smart like the Gates Foundation. Get out now while there is money to made. Why wait for low dollar day? That would not be investor smart.

By JESSICA HODGSON

SAN FRANCISCO -- The Bill and Melinda Gates Foundation, the world's largest private philanthropy fund, sold off almost all of its pharmaceutical, biotechnology and health-care investments in the quarter ended June 30, according to a regulatory filing published Friday.

The Seattle-based charity endowment, set up by Microsoft Corp. founder Bill Gates and his wife, sold its total holding of 2.5 million shares in health-care giant Johnson & Johnson in the quarter, according to the filing.

The foundation also sold millions of shares in major drug makers, including 14.9 million shares in Schering-Plough Corp., almost 1 million shares in Eli Lilly & Co., 8.1 million shares in Merck & Co. and 3.7 million shares in Wyeth, over the same time period. The foundation no longer holds shares in any of those companies.

Among the other health and life sciences-related investments the foundation liquidated are Allos Therapeutics Inc., InterMune Inc., Auxilium Pharmaceuticals Inc. and Vertex Pharmaceuticals Inc.

The only life science-related holding the foundation retains is a 3 million-share stake in Seattle Genetics Inc.

The foundation's decision to drastically reduce its exposure to health-related stocks is striking, as many of its charity grants have been disbursed to address developing country health issues.

Its move comes against the background of anxiety among drugmakers and healthcare insurance firms about the potential impact of the Obama administration's proposed overhaul of the U.S. healthcare system, which could put pressure on prescription drug prices.

just_another_bozo_on_this_bus 5 years, 2 months ago

"Remember the military paying thousands of dollars for a hammer or a standard toilet seat."

Yep, and that was made possible by the "capitalists" you think ought to be running things.

Richard Heckler 5 years, 2 months ago

Staying with the insurance industry will increase the cost to all policy holders no matter what...AS ALWAYS. Yes $18,310 is a number I have seem for 2010.

BTW I do not support making employers pay one single dime. They have been paying long enough.

$1.2 trillion medical insurance tax dollars cover a wide variety of teachers,city,state and federal employees. That amount of money would cover the entire nation. Let's bring all of those federal medical insurance tax dollars,billions of corporate welfare tax dollar money under one umbrella plus figure in the savings and there is plenty of money to care for all in the USA. Tell this to the elected officials WHO WORK FOR US... NOT THE OTHER WAY AROUND.

Practicality 5 years, 2 months ago

"I didn't say it would, but it would suck it out of working people's pockets, and transfer it to insurance companies."

How is that any better than sucking it out of working people's pockets and transfering it to the government?

Serious question.

just_another_bozo_on_this_bus 5 years, 2 months ago

"How is that any better than sucking it out of working people's pockets and transfering it to the government?"

Serious answer-- the money wouldn't stay with the government-- it'd be transferred to healthcare service providers for services rendered, and the government does that with a 4% cost of overhead, while private insurance siphons of 30%. It's basic math.

SettingTheRecordStraight 5 years, 2 months ago

Following bozo's logic, maybe we should nationalize food distribution. And clothing distribution. And let's nationalize transportation while we're at it. Then we can let government takover the entire housing market.

Err, umm....

BrianR 5 years, 2 months ago

right_thinker (right_thinker) says… "Obama's life-long vision is to rule Americans with an iron fist. Pelosi and Reid are his incompetent lieutentants, therefore, it probably will never come to fruition."

You are delusional. Or a liar. Or both.

just_another_bozo_on_this_bus 5 years, 2 months ago

STRS-- Ah yes, changing the subject is a tried and true method when all other arguments fail.

A couple of points-- A single-payer plan would not nationalize healthcare, although I guess it is accurate to say that it would nationalize health insurance. An alternative would be the Swiss and German models, which still use private insurance, but they are prohibited from the criminal abuse of their clients that US companies engage in.

Food distribution-- to the contrary, I'd like to see it taken away from the centralized control of multinational conglomerates and transferred to local and regional companies and farmers.

Transportation-- it's already been nationalized to a very large extent.

Housing market-- It's already socialized-- Banks and Wall Street make the profits when things are going good, while the losses are "socialized" and taxpayers pick up that tab.

Flap Doodle 5 years, 2 months ago

In the O'dude's Brave New World, we'll pay much more for just about everything.

paisley 5 years, 2 months ago

I'm sure that premiums would go up. I had carried insurance with one of the "big" companies. The next year and the year following that, premiums went up 36% each year! I hadn't even filed a claim! I called the company and asked "Why?" I was told that premiums were based in part by demographics. Here in Lawrence we have a lot of elderly and a lot of young people that are having babies. Needless to say, I had to drop coverage and hope for the best. I was one of the lucky ones that didn't have a life altering event at that time. Add more people to the mix with pre-existing conditions, etc. and premiums will sky rocket.

just_another_bozo_on_this_bus 5 years, 2 months ago

"Buyers remorse?"

No, I voted for Nader. But if I lived in Missouri, I would have voted for Obama, and still would, given the alternative of McCain/Palin.

Sure, most of the Democrats are too chickensh!t to actually do what's needed (including Moore, my rep,) but let's not pretend that the Republicans provide anything like viable alternatives.

salad 5 years, 2 months ago

TomShewmon (Tom Shewmon) says…

"Obama's life-long vision is to rule Americans with an iron fist."

Actually that's what YOUR guy tried to do. There's curious George looking a shiney objects, while Cheney cuts paper dolls out of the constitution and you think it's OK. Go see your proctologist Tom and see if he can dislodge your head. BTW, it's funny to see you whimmpering like a scared little boy, "Ohhhh!!! Scary black man!!! He's GOT to be bad!!!"

Jimo 5 years, 2 months ago

"The first step is you admitting that no one is forcing “working people” to do business with anyone."

The worst piece of sophistry I've heard since "Gays aren't discriminated against because they have the same right to marry someone of the opposite gender just like everyone else."

SettingTheRecordStraight 5 years, 2 months ago

Jimo,

Free market captialists do not consider that comment trickery; they consider it a fact. And the attempted parallel with homosexual "marriage" is a non sequitur.

Again, any plan that gives government more control of your life will produce fewer, not more, choices; will make health care more, not less, expensive; will produce fewer, not more, private sector jobs; and will result in higher, not lower, mortatlity and morbidity rates.

jafs 5 years, 2 months ago

STRS,

So how do you account for the fact that in countries with more centralized systems, health care seems to be better than what we've got (ie. mortality/morbidity rates)?

Richard Heckler 5 years, 2 months ago

Substantial reasons why Medicare Insurance for All should be the choice for all in America:

  • Makes the USA more attractive to NEW industry thus jobs thus new wealth for the USA.

*Eliminates Politicians as shareholders: http://www.washingtonpost.com/wp-dyn/content/article/2009/06/12/AR2009061204075.html

*Eliminates Leading Cause Of Bankruptcy http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html#ixzz0IQKZLHHh&C

  • Creates JOBS JOBS JOBS JOBS JOBS

  • Why use Medicare? It eliminates reinventing the wheel therefore saves a big bundle of money and time = efficient use of existing resources.

  • Medicare is in place therefore it is ready to roll which is convenient.

  • The USA needs to STOP being be the most expensive insurance/health care of the industrialized nations if americans want jobs back.

  • HR 676 Medicare for All insurance coverage is key to creating new wealth for america.

  • The most expensive health insurance in the world is not the answer for keeping business costs down and keeping our cost of living somewhat in check.

Richard Heckler 5 years, 2 months ago

One fact that has been documented year after year after year. Medical insurance premiums rise year after year after year.... that is a given. Been increasing for 70 years ORRRRR co-pays and deductibles increase OR services are reduced or all of the above.

ORRRRRRRR after years of taking money from clients cut the client off for some bogus reasons.

The most expensive medical insurance in the world simply is NOT a good program. In fact it stinks.

KansasVoter 5 years, 2 months ago

America needs either a Public Option or a full-on Single Payer system. For-profit insurance is immoral and they have proven that they can't be trusted.

Richard Heckler 5 years, 2 months ago

Why would anyone want to be invested in an industry that does this to its' shareholders?

Insurers Wrongfully Charging Consumers Billions http://www.washingtonpost.com/wp-dyn/content/article/2009/06/24/AR2009062401636.html

jonas_opines 5 years, 2 months ago

"If you don't like insurance companies, don't do business with them."

Just take on immense debt, or get sick and maybe die.

rhd99 5 years, 2 months ago

Hey, I have a great idea!! Here's a concept the liberals in Congress can comprehend, right? Uh, they impose this health care policy on all Americans, right, then we revoke their health care benefits or we raise their premiums as well!! Take that Liberal Congressional freaks!

notajayhawk 5 years, 2 months ago

just_another_bozo_on_this_bus (Anonymous) says…

"No, barry, what I want is a system that doesn't suck money out working peoples' pockets just because folks like you think insurance companies have a “right” to suck it out."

Yeah, barry, what boohoozo wants is a system that sucks money out of other people's pockets just because HE thinks HE has the right to suck it out.

"and the government does that with a 4% cost of overhead, while private insurance siphons of 30%. It's basic math."

Too bad basic math is something you are obviously so incompetent at (but then again, that applies to about everything).

If you really believe that Medicare/Medicaid is run with 4% overhead, you're a bigger idiot than even I suspected (and that's saying a lot). The treasury department collects the money. The Joint Commission and CMMS approve, inspect, and regulate providers. State social services departments, departments of health, and departments of mental health (and a few others) sign people up and administer payments. There are numerous administrative functions that private insurance companies have to do for themselves that Medicare/Medicaid have done by other agencies, and the true costs are hidden in those agencies' budgets. Oh, not to mention they don't have to follow state regulations and keep billions in reserve like private insirers do.

"A single-payer plan would not nationalize healthcare, although I guess it is accurate to say that it would nationalize health insurance."

Okay, I guess you ARE that big of an idiot. If you can only sell your services to one entity, boohoozo, you work for that agency.

"Food distribution— to the contrary, I'd like to see it taken away from the centralized control of multinational conglomerates and transferred to local and regional companies and farmers."

But that makes it cost more, Herr Klowne. And food is somewhat more important to survival than healthcare.

Why do you want poor children to starve, boohoozo?


jafs (Anonymous) says…

"So how do you account for the fact that in countries with more centralized systems, health care seems to be better than what we've got (ie. mortality/morbidity rates)?"

Maybe because healthcare is not the direct cause of mortality/morbidity?

The number one cause of infant mortality is congenital defects. That has more to do with lifestyle and environmental factors affecting the mother than access to healthcare.


merrill (Anonymous) says…

"One fact that has been documented year after year after year. Medical insurance premiums rise year after year after year…. that is a given."

So has car insurance, merrill. Perhaps because cars cost more to fix these days.

bad_dog 5 years, 2 months ago

We already pay more for our insurance coverage than we should due to the uninsured patients receiving treatment in hospital ERs. The cost of care for non-emergency treatment is much higher than at a clinic and is often left unpaid by the patient.

The hospital doesn't just eat those costs-they get passed on to the insurance companies through higher charges for goods and services rendered to insured patients and then guess what the insurers do? They pass it off to you and I through ever higher premiums. This merry-go-round is one of the primary reasons medical inflation outpaces ordinary inflation at such a high rate.

notajayhawk 5 years, 2 months ago

bad_dog (Anonymous) says…

"We already pay more for our insurance coverage than we should due to the uninsured patients receiving treatment in hospital ERs. The cost of care for non-emergency treatment is much higher than at a clinic and is often left unpaid by the patient."

People going to the ER, or even a non-hospital after-hours urgent care clinic, rather than going to their doctor has always been a problem contributing to the system-wide costs in healthcare. The problem is that not all of those people do so because they can't afford to go to a doctor - some people do it by choice. And if everyone suddenly has carte blanche with their healthcare, what's the incentive to cut down on that practice?

jafs 5 years, 2 months ago

nota,

I was responding to STRS' comment that if we had a "government-run" health care plan, we would see an increase in those rates.

From your comments, I'm sure you would disagree with him, no?

Where do you get the idea that everyone would have "carte blanche" with their healthcare?

bad_dog 5 years, 2 months ago

"And if everyone suddenly has carte blanche with their healthcare, what's the incentive to cut down on that practice?"

The same incentive already present and defined within most insurance policies-if you go to your network physician you pay a modest co-pay auch as $25 per visit. If you go to the ER and are not admitted, the co-pay rises to $100 per visit.

If patients seeking non-emergency treatment insist on ER attention, collect the elevated co-pay prior to being seen. You could even go so far as to refuse treatment for non-emergency conditions (emergency conditions will be defined by specific conditions/causes or a hospital admission) and send them back to their network physician or to a "Quick-Med" facility. After a person gets turned away from the ER a few times or pays a substantial co-pay, even chronic abusers/slow learners should get the message.

And I don't concur that health care reform inherently constitutes "carte blanche" to access health care. Many people have only a nominal understanding how the current system works, much less what reform may ultimately consist of or the ultimate financial and practical implications. Instead they are led to their beliefs on reform by political affiliation. That's why there needs to be an honest debate, free of acrimony, fear mongering, hidden agendas and ulterior motives.

Contact your representatives, express your thoughts and try to gain a better understanding of the issues and implications rather than just going along with the bombastic polarizing BS eminating from either side.

jaywalker 5 years, 2 months ago

"some analysts say individuals could wind up paying higher premiums."

Some analysts?! Who are the morons that don't think so?

"Better screenings that prevent chronic diseases later would also save money, the administration has argued"

No, it won't.

"Obama said he wants to bar insurers from denying coverage to anyone because of a pre-existing health problem, canceling policies for sick people or refusing to cover preventive care."

Noble cause, impossible to implement. I do believe it should be against the law to cancel any policy once someone's been accepted unless they lied on their screening, and preventive care I could go either way on. But forcing insurers to take on anyone? Fine, insurers can't deny coverage and here's what transpires:
"Ok, Mr. X, we will underwrite you even though you've had two bypasses, are 150 pounds overweight and smoke, and you suffer from diabetes. Your monthly premium will be $2500, even though you're virtually guaranteed to cost us 10 times whatever you pay in."

"He also suggested limits on Americans’ co-payments and deductibles"

Now that's a good idea and should be standardized, at least in regards to deductibles and total out of pocket expenses. Limiting co-pays is petty and a waste of time, they're already incredibly low as it is.

"Obama would also charge insurers a fee for their most expensive policies as a way of encouraging insurers to keep costs low and keep their rates low."

Yeah, right, it's a "fee", not a tax. And how in the hell would that encourage insurers to keep costs low?! You slap a tax on each insurers' most expensive policy no matter what they cost, it's always going to be there.......where's the incentive for keeping the rates low? Even if you drop 'em, the tax is still there. Brilliant logic.

"Obama’s plan might not raise costs as much as expected if everyone is required to have insurance and receive preventive care like regular checkups or mammograms, which can save money in the long run."

How is it that this crappola keeps coming up? It's a numbers game and everyone getting preventive care will raise costs, not save them. It's a good thing to be pro-active and avert potential health dangers, just don't keep perpetuating the myth that it's going to save money. That's a flat-out lie.

bad_dog 5 years, 2 months ago

"I do believe it should be against the law to cancel any policy once someone's been accepted unless they lied on their screening..."

It's already there in the contract. It's called an incontestibility provision. Aside from failure to pay premiums, this is the only legal basis for cancelling a policy and its utilization is strictly limited. In most states an insurer can't contest the information obtained during the screening (more appropriately referred to as the application and underwriting process) after two years. Some states will permit such contests on health insurance after two years if the insurer can prove material misrepresentations were made with the intent to deceive, i.e. fraud, on the part of the applicant. Life insurance contracts absolutely cut off such insurer defenses after two years without exception-no matter how brazen the fraud. This is the only area of contract law I'm aware of where fraud, if proven, is not an absolute defense to performing under the contract.

hwarangdo 5 years, 2 months ago

Ah heck, let's just shoot everyone over 30 and be done with it.

hwarangdo 5 years, 2 months ago

Oh, and by the way bad-dog: insurence DO cancel policies - whenever and for whatever reason. They do it, and they get away with it. And if our health care system stays the same, they will continue to do it. Perhaps a jar of vaseline will help those who don't believe we need an insurance overhaul ... you'll need it when you become ill with anything your insurance company doesn't want to pay for. Seen it. It happens. All the time.

feeble 5 years, 2 months ago

bad_dog did hit upon one of the major problems with health insurance. It is regulated at the state level, so while some states have provisions which make it difficult or impossible for insurers to cancel policies when a policy holder becomes ill, others do not.

In any event, reading about the CEO of Cigna complaining about shrinking profit margins does little to persuade me that reform is not needed. Cigna is on track to take in 4.8 billion in revenue this year, and that is with a 5% drop in policy holders, due to the recession.

jaywalker 5 years, 2 months ago

"It's already there in the contract. It's called an incontestibility provision. Aside from failure to pay premiums, this is the only legal basis for cancelling a policy and its utilization is strictly limited"

Not sure where you're comin' from, bad dog, but if it was already illegal it wouldn't be such a problem. There are number of insurers that state in their policies that the insured can be canceled at any time without cause; BC/BS does it all the time. If you're strictly referencing the insurers rights regarding fraud/false statements of the insured, that's correct, there is a statute of limitations. But that doesn't keep them from manufacturing other rationale to eliminate policy holders. The company I worked for was the only one in the KC area that guaranteed a policy could never be canceled as long as you paid your premiums. That guarantee is far from common.

notajayhawk 5 years, 2 months ago

jafs (Anonymous) says…

"I was responding to STRS' comment that if we had a “government-run” health care plan, we would see an increase in those rates. "

"From your comments, I'm sure you would disagree with him, no?"

No, I would not disagree with him, really. While a government-run healthcare system is not likely to improve mortality rates, it could quite easily make them worse. Think about it, the dynamic is already obvious in medical care - if someone gets the best possible medical treatment for cancer or after being brought to the emergency room for a serious accident, there's no gurantee the doctors can save them. But it doesn't take much to kill them.

"Where do you get the idea that everyone would have “carte blanche” with their healthcare?"

What would you call it if everyone's covered for everything?

notajayhawk 5 years, 2 months ago

bad_dog (Anonymous) says…

"The same incentive already present and defined within most insurance policies-if you go to your network physician you pay a modest co-pay auch as $25 per visit. If you go to the ER and are not admitted, the co-pay rises to $100 per visit."

Medicare and Medicaid don't work that way. Why would you assume any other government-created health plan will? Besides, I thought that was one of the things the whole reform movement was clamoring for - getting rid of those unaffordable co-pays and deductibles?

"If patients seeking non-emergency treatment insist on ER attention, collect the elevated co-pay prior to being seen. You could even go so far as to refuse treatment for non-emergency conditions (emergency conditions will be defined by specific conditions/causes or a hospital admission) and send them back to their network physician or to a “Quick-Med” facility."

Um, you can't do that. Any hospital that accepts Medicare (which is to say just about any hospital) can NOT turn away anyone that presents requesting services without a complete evaluation. By the time you've done that evaluation and determined it's non-emergent, the expenses have already been incurred. For example, if someone goes to the ER for the flu, by the time you've had them there getting nursing care, a doctor's assessment, a chest x-ray (if not a CT scan), blood tests, etc., it really doesn't matter of you give them a prescription for anti-biotics or not.

"And I don't concur that health care reform inherently constitutes “carte blanche” to access health care. Many people have only a nominal understanding how the current system works, much less what reform may ultimately consist of or the ultimate financial and practical implications. Instead they are led to their beliefs on reform by political affiliation. That's why there needs to be an honest debate, free of acrimony, fear mongering, hidden agendas and ulterior motives."

Again, as I said to jafs, what terminology would you prefer for coverage for everyone that pays for everything? And your policy can't even be cancelled?

"Contact your representatives, express your thoughts and try to gain a better understanding of the issues and implications rather than just going along with the bombastic polarizing BS eminating from either side."

Isn't it amusing that nobody ever thinks their side of the argument is doing exactly that. My thoughts on this issue come from being employed in an allied health field, one funded almost exclusively by government-run programs, and as a consumer of services who has experienced the system both with and without insurance. I DO write my legislators - not to get their spin on it, though.

bad_dog 5 years, 2 months ago

"Oh, and by the way bad-dog: insurence DO cancel policies - whenever and for whatever reason. They do it, and they get away with it."

"Not sure where you're comin' from, bad dog, but if it was already illegal it wouldn't be such a problem. There are number of insurers that state in their policies that the insured can be canceled at any time without cause; BC/BS does it all the time."

This isn't a matter of legality per se-i.e. it's not a criminal offense if your coverage is terminated. It is, however, a matter of contract law, with enforceable rights and obligations. If an insurer terminates your coverage inappropriately, you have the right to bring a lawsuit for breach of contract and seek monetary damages and/or enforcement of the contract in a court of law.

Health insurance policies are issued on either an individual or group basis. In my experience Individual policies are issued as either guaranteed renewable or non-cancelable policies. After the expiration of the contestable period, if you have a guaranteed renewable policy, it may not be canceled/terminated as long as you pay the premiums. The insurer can raise the rates, but they must do so on an entire class of policyholders and only after receiving permission from the state insurance departments of affected policyholders. Again, once the contestable period lapses, non-cancelable policies can only be terminated for non-payment of premiums. Period.

Group health insurance policies are somewhat different. The policy owner is the employer or an association, etc., not the employee or association member. These folks are called certificate holders. Group insurance typically renews annually and the insurer has the right to raise premiums/terminate based upon loss experience. Either party can choose not to renew the contract if they can't agree on renewal rates.

So while policy terminations can occur, it is still a matter of contract law. The contract either provides the insurer the right to do so, or they are in breach of contract. If this happens to you, contact your state insurance department's consumer assistance division first. If you are still unable to get what you believe you are entitled to, consult an attorney.

bad_dog 5 years, 2 months ago

"Medicare and Medicaid don't work that way. Why would you assume any other government-created health plan will?"

You asked for a way to incentivize-I provided one. Just because Medicare/Medicaide or any other program doesn't work in a given manner doesn't mean you can't have another program set up to operate differently based on what you've learned or in anticipation of a particular problem.

"Um, you can't do that. Any hospital that accepts Medicare (which is to say just about any hospital) can NOT turn away anyone that presents requesting services without a complete evaluation. By the time you've done that evaluation and determined it's non-emergent, the expenses have already been incurred."

Again, different programs can have different rules and current ones can be amended. I would suggest you estabish clear guidelines such as traumatic injuries-fractures, lacerations requiring sutures, heart attacks, strokes, pregnancies, etc. to qualify for hospital admission. Granted a person can have chest pain and the ultimate diagnosis is that it eminated from musculoskeletal pain or a respiratory infection, but any sane person is going to go to the ER if they have chest pain. If you go to the ER and are not admitted, then you pay a higher co-pay. For what it's worth, while I favor reform, I am not in favor of abolishing co-pays.

"Isn't it amusing that nobody ever thinks their side of the argument is doing exactly that."

My comment was directed at those who prefer to sling crap at one another without understanding the issues, following whatever political agenda they ally with. I'm not an absolutist on this topic.

BTW, my experience on this topic arises from 25 years of experience dealing with all aspects of the insurance industry, from the regulator to the consumer, including insurers and courts of law.

Feel free to respond if you like, I'm getting ready to go stimulate the Las Vegas economy for a week, so if you do, I'm not likely to see it. I'm sure you can understand ;-)

Have a good week.

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