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Healthcare IS NOW LAW!!!

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  • Re: Healthcare IS NOW LAW!!!

    Originally posted by JCsPlumbing View Post
    Gattica mfer's! GATTICA!

    J.C.
    We are getting there, slowly but surely.

    Comment


    • Re: Health care IS NOW LAW!!!

      Originally posted by Frankiarmz View Post
      ...but why should people who live moderately active lives pay for the folks who bungee jump, ride without a helmit, or drive under the influence. There is a line between assumed risk and wrecklessness.
      Two of your three examples are illegal, and I have no quibble with them being illegal.

      But the things on my list are not illegal.

      The answer to your question is that if you are not willing to assume the distributed risk, then you are not in favor of the concept of insurance. If you don't want to assume other people's risks, which you don't fully know about and can never really know about, then the solution is that everyone pays for their own health care -- there is no insurance.

      And that may be a perfectly fine solution. Insurance was not synonymous with healthcare until AFTER the 1960s. I am actually well-convinced that the existence of comprehensive health care insurance is in itself largely responsible for ballooning health care costs. For one thing, the insurance company takes a substantial portion of every premium dollar off the top. Then they ration out the rest, continually trying to increase their take. Consumers contribute by using services they don't really need. If you know any doctors, you know that there is a constant state of struggle between them and the insurance companies to get coverage. My brother is a surgeon and he had to hire an extra person in his office just to navigate the insurance, Medicare and MEdical paperwork and deal with the more or less constant rejected claims,etc. Certainly there are doctors that perform unnecessary procedures and order unnecessary tests to jack up their billing. The whole thing is fertile ground for abuse, and that's also part of why a broken arm costs $17000. As usual, the insurance guys making the money tell us that it's all OUR fault, we drink, we are not healthy, we are stupid. Nonsense. Well, maybe we are stupid if we believe them. Yes of course behavior affects health. But I don't believe that's the root of the cost problem. What are the insurance guys gonna tell you? "Your premium went up so I could get a new Mercedes 500"??

      I believe that we should forget the entire notion of comprehensive insurance. Everyone should pay for their own routine and normal medical care. When you need tires or a termite inspection you pay for it, right? Well you should pay for your routine twisted ankles and cuts needing a few stitches and your kid's broken nose. If someone can't pay then they don't get the treatment. I'm sorry, but despite the bleeding hearts opinion, it's not society's problem, there is no reason to spread that cost out. If there's a real emergency and someone needs treatment and truly can't pay, then maybe they get to do community service or maybe they get a payment plan. I think that could be worked out.

      We need something though, to cover the biggies. Major medical. Cancer treatments, heart surgeries, liver transplants, and the like. The things that will literally ruin people financially. Now yes, I don't want the government messing with my rights (or yours, even if you don't mind as much). So I think everyone gets that benefit equally. Give me that, please. Everyone pays the same amount of premium. Young people, old people, fat people, drunk people, stupid people.

      Next, tax the hell out of booze and tobacco so that persons that want to use a lot get to pay that way - and put the money toward the major medical costs. I will happily accept that my martinis will cost twice as much. It won't break me. Use fines from OSHA and EPA violations to defray costs. In CA prepared food is taxed... add a federal excise tax to all fast & junk food that doesn't meet nutritional standards and use the money for, you guessed it, the major medical program. Sharpen up FDA regulations for food products, especially those targeting kids... like high-sugar cereals, snack foods, etc. Right now junk food tends to be abused by low income people because it is CHEAP. If it becomes costly, less of that crap will be sold. Supply and demand, it's an immutable law. I'm sure we could come up with more ways to penalize unhealthy behaviors without spreading the risk via health care insurance, but you get the idea.

      Private insurance companies will administer this plan and they get 10 percent profit before tax, not a penny more. Defense contractors got that for years, they will squeal like stuck pigs but it's 10 percent of a huge number - that's plenty of dough. The amount of people that each insurance company gets to service each year depends on how well they control costs relative to other competitive insurance companies... in other words, they have to shop hospitals and doctors and get a good deal for the buck. The National Labs have supercomputers that could crunch the statistics in a couple of seconds.

      There needs to be more about health care than just insurance. We will also have to establish real standards for care and make physicians and hospitals accountable. Right now most people know more about their mechanic's qualifications than they do about their physician. And the medical community is famous for protecting its own. Those days need to be over. Everyone in healthcare needs to be accountable to We The People.

      I don't know... this kind of thing makes more sense to me than Obamalosi care, which is gonna cost a lot and the quality of care will decline. Hope I'm wrong, but I don't think so.

      Comment


      • Re: Health care IS NOW LAW!!!

        Originally posted by Andy_M View Post
        The answer to your question is that if you are not willing to assume the distributed risk, then you are not in favor of the concept of insurance. If you don't want to assume other people's risks, which you don't fully know about and can never really know about, then the solution is that everyone pays for their own health care -- there is no insurance.
        That's not entirely true. I want to assume other people's risk in proportion to what they are willing to pay for it. If you have high cholesterol life insurance costs more, why not the same for health insurance. In a proper market insurance is a zero sum game, what you pay in is going to be (roughly) equal to what you get out. Life insurance is a very good example. Title insurance is a bad example (the title insurance companies pay out a very small percentage of the premiums).

        Comment


        • Re: Health care IS NOW LAW!!!

          Originally posted by Andy_M View Post
          Two of your three examples are illegal, and I have no quibble with them being illegal.

          But the things on my list are not illegal.

          The answer to your question is that if you are not willing to assume the distributed risk, then you are not in favor of the concept of insurance. If you don't want to assume other people's risks, which you don't fully know about and can never really know about, then the solution is that everyone pays for their own health care -- there is no insurance.

          And that may be a perfectly fine solution. Insurance was not synonymous with healthcare until AFTER the 1960s. I am actually well-convinced that the existence of comprehensive health care insurance is in itself largely responsible for ballooning health care costs. For one thing, the insurance company takes a substantial portion of every premium dollar off the top. Then they ration out the rest, continually trying to increase their take. Consumers contribute by using services they don't really need. If you know any doctors, you know that there is a constant state of struggle between them and the insurance companies to get coverage. My brother is a surgeon and he had to hire an extra person in his office just to navigate the insurance, Medicare and MEdical paperwork and deal with the more or less constant rejected claims,etc. Certainly there are doctors that perform unnecessary procedures and order unnecessary tests to jack up their billing. The whole thing is fertile ground for abuse, and that's also part of why a broken arm costs $17000. As usual, the insurance guys making the money tell us that it's all OUR fault, we drink, we are not healthy, we are stupid. Nonsense. Well, maybe we are stupid if we believe them. Yes of course behavior affects health. But I don't believe that's the root of the cost problem. What are the insurance guys gonna tell you? "Your premium went up so I could get a new Mercedes 500"??

          I believe that we should forget the entire notion of comprehensive insurance. Everyone should pay for their own routine and normal medical care. When you need tires or a termite inspection you pay for it, right? Well you should pay for your routine twisted ankles and cuts needing a few stitches and your kid's broken nose. If someone can't pay then they don't get the treatment. I'm sorry, but despite the bleeding hearts opinion, it's not society's problem, there is no reason to spread that cost out. If there's a real emergency and someone needs treatment and truly can't pay, then maybe they get to do community service or maybe they get a payment plan. I think that could be worked out.

          We need something though, to cover the biggies. Major medical. Cancer treatments, heart surgeries, liver transplants, and the like. The things that will literally ruin people financially. Now yes, I don't want the government messing with my rights (or yours, even if you don't mind as much). So I think everyone gets that benefit equally. Give me that, please. Everyone pays the same amount of premium. Young people, old people, fat people, drunk people, stupid people.

          Next, tax the hell out of booze and tobacco so that persons that want to use a lot get to pay that way - and put the money toward the major medical costs. I will happily accept that my martinis will cost twice as much. It won't break me. Use fines from OSHA and EPA violations to defray costs. In CA prepared food is taxed... add a federal excise tax to all fast & junk food that doesn't meet nutritional standards and use the money for, you guessed it, the major medical program. Sharpen up FDA regulations for food products, especially those targeting kids... like high-sugar cereals, snack foods, etc. Right now junk food tends to be abused by low income people because it is CHEAP. If it becomes costly, less of that crap will be sold. Supply and demand, it's an immutable law. I'm sure we could come up with more ways to penalize unhealthy behaviors without spreading the risk via health care insurance, but you get the idea.

          Private insurance companies will administer this plan and they get 10 percent profit before tax, not a penny more. Defense contractors got that for years, they will squeal like stuck pigs but it's 10 percent of a huge number - that's plenty of dough. The amount of people that each insurance company gets to service each year depends on how well they control costs relative to other competitive insurance companies... in other words, they have to shop hospitals and doctors and get a good deal for the buck. The National Labs have supercomputers that could crunch the statistics in a couple of seconds.

          There needs to be more about health care than just insurance. We will also have to establish real standards for care and make physicians and hospitals accountable. Right now most people know more about their mechanic's qualifications than they do about their physician. And the medical community is famous for protecting its own. Those days need to be over. Everyone in healthcare needs to be accountable to We The People.

          I don't know... this kind of thing makes more sense to me than Obamalosi care, which is gonna cost a lot and the quality of care will decline. Hope I'm wrong, but I don't think so.
          We won't be changing anything, but we have good ideas and we are thinking beyond insurance. I agree that competent doctors, healthy choices, bringing to task the junk food and other bad stuff we indulge all works into healthcare costs and quality of life. Our legislators were not about to rock the boat and suggest or legislate such effective changes, they took the easy for them way out. Legal, food and beverage, tobacco and liquor industries, escaped any attention.

          I don't want to cookie cut people, I do want to reduce costs and have kids given better examples and choices, exciting, fun, but less wreckless childhoods. Those are my thoughts, they won't be pushed on anyone but my not so little children. Man, you should see some of the young folks coming in the gym. I wonder how the heck they got so out of shape at such a young age? I recently quit my gym, but I'm still exercising at home. I know it is important.

          Comment


          • Re: Health care IS NOW LAW!!!

            Originally posted by cpw View Post
            That's not entirely true. I want to assume other people's risk in proportion to what they are willing to pay for it. If you have high cholesterol life insurance costs more, why not the same for health insurance. In a proper market insurance is a zero sum game, what you pay in is going to be (roughly) equal to what you get out. Life insurance is a very good example. Title insurance is a bad example (the title insurance companies pay out a very small percentage of the premiums).

            I have two life insurance policies, and neither company knows what my cholesterol is. The first insurance company required a blood test when I signed up at 24. That was 30 years ago. The second company didn't bother with the blood test. Knowing how their actuarials operate, this tells me that they don't think it matters very much.

            Cholesterol is a great example, though. Say you did put high cholesterol people in a pool for increased risk of vascular disease, heart disease and stroke. But you also had better assess their family history, which is not something that the insurance company is entitled to... it's confidential. You also better take a look at the person's stress level on the job, fitness level, and get an assessment of their personality type. All these things are just as important as cholesterol. And of course, cholesterol may have nothing at all to do with the boatloads of other health problems that these individuals may or may not contract. Does it make any sense to ignore any of these things and charge high cholesterol people more? Sorry, I can't see how it does.

            On the other hand, I just saw a doctor on TV the other day that said that 80% of the breast cancers occurred in women that had NO risk factors at all - including family history.

            And what do you do about the 60 year olds that used margarine all their lives because they (and their parents) were told it was better for them and now have bad markers? Are the bad markers because of the transfats that they were told were healthier?

            What about the medications that you are being given today that may well be found to cause serious liver or other problems in ten years? Would it be ok for you to be in the high risk pool because you had bad liver enzyme results due to that medication?

            I would agree with you if the data on risk was complete, accurate, deterministic and under the patient's control. But I don't see any evidence that it is.

            Comment


            • Re: Health care IS NOW LAW!!!

              Originally posted by Andy_M View Post
              I have two life insurance policies, and neither company knows what my cholesterol is. The first insurance company required a blood test when I signed up at 24. That was 30 years ago. The second company didn't bother with the blood test. Knowing how their actuarials operate, this tells me that they don't think it matters very much.
              I did the same thing, I have two policies one from when I was 23, and another from last year (27). My wife has the same policies, but because she had gestational diabetes when she was pregnant (for the second policy), they put her in a standard risk pool; but none of my health problems disqualified me from the preferred ultra rating. Since there all level term policies, it doesn't matter what my cholesterol is for the next 25 years; they're taking a risk based on the information that both parties had at the time we signed the contract.

              Comment


              • Re: Healthcare IS NOW LAW!!!

                Insurance companies are only one part of the problem. As an employee of an insurance company, I just had to add my 2 cents here. I do believe we need healthcare reform(not just insurance reform) and do believe the insurance companies need to change some of their practices. I'm not denying that, but to say insurance companies are the reason for high cost is far from the truth. Anyone who sees a doctor without insurance pays double or triple what a person without insurance pays. And if they can't pay their bills, the hospitals will find a way to make those who have insurance pay for that.

                Healthcare is extremely complex. For example, there is varying types of coverage ie Fully insured vs Self insured. With fully insured, we administer every aspect of the plan, with self insured, we basically take care of all the admin work and your employer and they manage your plan. A good percentage of our business is self insured. So if your claim is denied, it might not be our fault. Not to mention there is alot of red tape we deal with and there are many many regulations and laws we have to comply with. No two states are the same and some states are heavily regulated and this does nothing to reduce cost.

                We also deal with lots of fraud and providers double billing for the same procedures. Not to mention unnecessary procedures getting performed to either cover the docs butt in a lawsuit or to get extra cash from the insurance company. Lawsuits against doctors aren't keeping cost down either. Lifestyle and behavorial choices do contribute to the overall cost of healthcare. The cost of coverage for a healthier person ie someone who is in shape, is not overweight, doesn't smoke etc is significantly less than for someone who is consider extremely overweight with heart disease and smokes. The healthier person would only require only one exam per year while the unhealthier person will require their doctor to monitor their situation much more closely. More office visits, more procedures, more drugs etc more cost.

                The proposed new law will do little to reduce cost which is the main problem with our current system. Inflation is the main reason. Cost of hospitals, doctors, medical devices, drugs, they all keep going up. We recently had a hospital request a 35% increase in reimbursement over the next two years or they were terming their contract with us. Also the economy has forced many people dropped their healthcare coverage so less premium is being taken in so premiums for those with coverage are going to go up. We also have an aging population which is requiring complex and very expensive treatments.

                Now I'm not a fan of the salaries of the big wigs or the prexisting condition clause that is currently in place, but were not bending everyone over like the government is leading you to believe. We had a profit margain of around 5.4%. Just to give everyone an idea of why their premium goes, for every dollar of premium we take in around $0.80 is spent reimbursing doctors, hospitals or other providers, $0.11 or so is spend on operating cost, $.06 is profit, and $0.04 is used to pay taxes both federal and state.

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