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M&K's Retrievers
10-05-2010, 11:25 AM
....Reducing The Uninsured?

According to Investors Business Daily today:

3M announces that it will end it program for retirees in 2013 as a result of health care reform. 23,000 retirees

McDonalds considering terminating its "Mini-Med" plan. 10,000 employees

Principal Financial exiting the health business. 840,000 insureds

Harvard Pilgram terminating Medicare Advantage. 22,000

Anthem, Aetna, Cigna, Humana, and several Blue Cross companies exiting the "Child Only" market due to Obamacare.

This is only the beginning. Get thy arse ready for Obama, Reid, Pelosi Mutual Insurance Company funded by your dollars.

Eric Johnson
10-05-2010, 11:39 AM
Tthe suit filed by Virginia could invalidate the entire healthcare bill. If a single portion of the 2200 pages is found to be unconstitutional, the whole 2200 pages would be thrown out. This is because Congress forgot to put in a "severability clause". Without this, the whole act stands or falls based upon each single sentence being constitutional. If one fails, they all go.

Be of good cheer. Our boys are in the air...

Eric

tom
10-05-2010, 12:09 PM
Do you really think that big busisness will allow healthcare reform to stand when there are big buck to be made?

If you really want to know what is wrong with healthcare reform, ask a republican congressman or senator, I'm sure they would be happy to tell you how they made sure that sucess would be impossible.

Buzz
10-05-2010, 12:19 PM
Tom, say it isn't so...

YardleyLabs
10-05-2010, 01:13 PM
....Reducing The Uninsured?

According to Investors Business Daily today:

3M announces that it will end it program for retirees in 2013 as a result of health care reform. 23,000 retirees

McDonalds considering terminating its "Mini-Med" plan. 10,000 employees

Principal Financial exiting the health business. 840,000 insureds

Harvard Pilgram terminating Medicare Advantage. 22,000

Anthem, Aetna, Cigna, Humana, and several Blue Cross companies exiting the "Child Only" market due to Obamacare.

This is only the beginning. Get thy arse ready for Obama, Reid, Pelosi Mutual Insurance Company funded by your dollars.
Are you saying these changes are good, bad or indifferent?

3M specifically noted that, because of health care reform, that better medical options were available to its retirees than it was offering. It will terminate its plan, giving retirees the money that it otherwise would have paid, to permit them to buy their own coverage instead. (See http://www.startribune.com/business/104317703.html?elr=KArks:DCiU1OiP:DiiUiD3aPc:_Yyc: aUU)

McDonalds has contested the WSJ report, noting that it has no intention of terminating benefits for its employees. However, it is addressing alternatives since the provider of its benefits for hourly employees does not comply with a Federal requirement that at least 85% of premiums be paid out in benefits unless an exemption is requested and approved. For normal benefit plans, the 85% limit is not that onerous, and many states already have requirements forcing insurance companies to pay out 80-85% of premiums in benefits as a minimum. Most plans have loss ratios much higher than that. However, the McDonalds plan is what is called a mini-med plan. These are plans that offer very low benefit levels with relatively significant premium payments. For the McDonalds plan, premiums of about $727/year yield a maximum benefit level of $2,000 per year. The cost is paid by employees. BCS of Illinois has offered no information on the cost or profitability of this plan, but does not meet the Federal standard. So far, most state insurance commissioners have opposed granting an exemption to such plans because they are seen as abusive, providing almost no real coverage while giving people the illusion that they are protected. (http://www.dailyfinance.com/story/will-mcdonalds-end-health-coverage-for-30-000-workers/19655050/)

Principal Financial is getting out of the health insurance business not because of health reform, but because it has been losing money and business for several years and does not want to make the types of investments needed to make its business competitive. Instead, it has reached an agreement under which United Health will provide coverage for its customers as policies come up for renewal. (http://www.insurancejournal.com/news/midwest/2010/10/01/113746.htm)

Harvard Pilgim is not alone in terminating Medicare Advantage coverage. The entire Medicare Advantage program existed only because of a windfall subsidy being provided to Medicare Advantage participants that was not offered to other Medicare recipients. The cost has been astronomical. The benefit could not possibly be extended to all Medicare beneficiaries without massive increases in the cost of Medicare. Instead, one of the savings in the health reform program was to eliminate the subsidy.

Termination of child only health plans: This development is actually an indicator of why it is impossible to implement restrictions on pre-existing condition limitations (which are overwhelmingly supported by the public) without a program that also requires universal coverage (which is overwhelmingly opposed by the public). Child only plans have routinely excluded children with existing and/or genetic problems. The new law makes that illegal. Insurance companies are pulling out.I disagree with the requirement of the law only because it is not linked to mandatory universal coverage. Maybe this will help people understand why the two components -- universal coverage and universal eligibility -- cannot be addressed separately.

Buzz
10-05-2010, 01:21 PM
\ Maybe this will help people understand why the two components -- universal coverage and universal eligibility -- cannot be addressed separately.

Don't hold your breath...

dnf777
10-05-2010, 02:30 PM
According to conservative dogma, isn't this a good thing? If those workers deserve health care, they will get better jobs and have enough to buy their own care. At the same time, the companies that cut their benefits will have larger profits, to create more jobs, and everyone in America will live happily ever after. Right?

depittydawg
10-05-2010, 06:38 PM
....Reducing The Uninsured?

According to Investors Business Daily today:

3M announces that it will end it program for retirees in 2013 as a result of health care reform. 23,000 retirees

McDonalds considering terminating its "Mini-Med" plan. 10,000 employees

Principal Financial exiting the health business. 840,000 insureds

Harvard Pilgram terminating Medicare Advantage. 22,000

Anthem, Aetna, Cigna, Humana, and several Blue Cross companies exiting the "Child Only" market due to Obamacare.

This is only the beginning. Get thy arse ready for Obama, Reid, Pelosi Mutual Insurance Company funded by your dollars.

More proof that they didn't go far enough. They should have abolishied the insurance industry and set up a single payer system like 70% of US citizens wanted. Insurance companies are useless leaches on society. Thanks for pointing that out again MK.

tom
10-05-2010, 06:52 PM
More proof that they didn't go far enough. They should have abolishied the insurance industry and set up a single payer system like 70% of US citizens wanted. Insurance companies are useless leaches on society. Thanks for pointing that out again MK.

Since insurance is a "for profit business", if you can not afford your medical expenses out of pocket, how in hell will you ever be able to afford the insurance??
Think about it!

If something bad happens, your neighbors gets to help foot the bill with their insurance premiums! Now how socialistic is that !?!
Big business interests is the only reason that we have insurance based health care in this country.

Gerry Clinchy
10-05-2010, 08:40 PM
Maybe this will help people understand why the two components -- universal coverage and universal eligibility -- cannot be addressed separately.

Of course! That is the only way that universal eligibility can work ... the twist is in how you get universal participation. Either you tax people to provide the coverage, or you attempt to "compel" people to participate in coverage.

Therein lies the rub with American culture ... we really don't like people telling us what we have to buy or how we have to live.

The solutions that Obamacare put in the legislation are too weak to accomplish the task. However, the "requirements" for health programs will ultimately result in the govt being the insuror ... think Medicare for everyone. The govt may not provide the services (as is done in most other countries with socialized medicine) ... but govt will regulate the payments for the services as they do for Medicare.

While we complain about what the insurance companies will pay for, be prepared to have the govt face the same arithmetic issues that the insurance companies face. After all, that's why Medicare costs keep going up (participants paying premiums each month, automatically withheld from their benefit checks).

Why does nobody notice what is happening in the UK? The financial burden has gotten so large that they ARE making decisions to deny treatments ... from what I've read the treatments must be anticipated to lengthen life by a year, otherwise the treatment is denied. They are also trying to put some of the health care back into private hands ... letting people purchase health care outside the govt system.

The value of looking carefully at the UK is that, as one of the oldest systems of universal health care, it has gone through the complete evolution of govt-controlled medical care (and make no mistake, whether the govt provides the "insurance" or the actual services, since they will control the payments for the services, they will control medical care). They are now at the stage where they are finding it's not working. Duh?

Imagine the incongruity of the provision that taxes "deluxe" health care plans. If someone (or their employer) is willing to pay for enhanced health care, why would the govt tax them for that? They are already taking a load off the govt's hands by providing for their own high-quality health care. Perhaps it is just another way for the govt to tax the rich: if someone can afford a lot of bucks for their own health care, they should also have enough bucks to chip in for somebody else's health care. Uh ... but I thought "the rich" were already going to be paying a higher income tax because they have a lot of bucks?

I am not unfeeling about those who have health issues & can't afford the care they need. I just don't feel that Obamacare is going to solve the problem.

There was an excellent article in the NY Times the other day about a company that is improving medical records. It hasn't been able to make any $ at it yet. This deficiency could have been addressed without the massive health care legislation.

I can hardly wait to get my booklet on how to prevent Medicare fraud ... Andy Griffith says it's coming soon. I can hardly wait till a booklet comes out for Obamacare.

YardleyLabs
10-05-2010, 09:04 PM
...

Why does nobody notice what is happening in the UK? The financial burden has gotten so large that they ARE making decisions to deny treatments ... from what I've read the treatments must be anticipated to lengthen life by a year, otherwise the treatment is denied. They are also trying to put some of the health care back into private hands ... letting people purchase health care outside the govt system.

The value of looking carefully at the UK is that, as one of the oldest systems of universal health care, it has gone through the complete evolution of govt-controlled medical care (and make no mistake, whether the govt provides the "insurance" or the actual services, since they will control the payments for the services, they will control medical care). They are now at the stage where they are finding it's not working. Duh?

...
Somewhere in your assessment of the UK, you need to address the fact that they are paying less than half of what we do for medical care. The "financial crisis" is that they do not want to pay more. Nobody is suggesting that we cut our spending in half. However, we too have reached the point where we need to be saying "No more!" That will not sit too well with pharmaceutical companies and other public companies that have been valued by investors based on their ability to grow profits by double digits every year. That may work for them, but it doesn't work for us.

Gerry Clinchy
10-05-2010, 10:41 PM
Somewhere in your assessment of the UK, you need to address the fact that they are paying less than half of what we do for medical care. The "financial crisis" is that they do not want to pay more. Nobody is suggesting that we cut our spending in half. However, we too have reached the point where we need to be saying "No more!" That will not sit too well with pharmaceutical companies and other public companies that have been valued by investors based on their ability to grow profits by double digits every year. That may work for them, but it doesn't work for us.

I would have to ask why they spend 1/2 as much ... and still seem to be running out of money.

I believe their taxes are quite high? Is the overall standard of living lower? Is there less disposable income? Is that why govt-run medical care was viewed as necessary?

I'd have to guess that energy costs are surely higher. Much as we complain about the cost of gas, I believe all of Europe pays a lot more than we do for gasoline. I would imagine other forms of energy (for heating, electricity) are similarly more expensive.

A friend who has friends in Germany says that Germans put solar voltaic cells wherever they can find a place to put them on their homes. I'd guess that there is motivation to do that.

The larger question also becomes at what point the govt can stop taking responsibility for providing its citizens with all the necessities of life? I think that is another underlying issue with Obamacare, or any other entitlement program.

In my mind, there is no question that this is an entitlement program. The premise is that everyone is entitled to health care. The level of care they are entitled to appears to be whatever is established as the minimum in Obamacare.

The legislation has already assumed that even if everyone is guaranteed a certain level of care, many of them still won't be able to afford it ... so others will pay more for their minimum level of care, so that it can take up the slack for those who cannot pay for theirs.

Isn't everyone entitled to food? Or a roof over their head? or heat for their home? or clothing? Who determines what the minimum needs are?

The taxation of deluxe plans also seems to make the assumption that people who can afford a higher level of care should have to pay even more (by being taxed) for the financial success they have earned.

While one could be led to think that the very rich can easily afford the extra tariff. However, people who earn $250K/year are in quite a different category from those who earn $2 million/year.

M&K's Retrievers
10-06-2010, 12:18 AM
If you really want to know what is wrong with healthcare reform, ask a republican congressman or senator, I'm sure they would be happy to tell you how they made sure that sucess would be impossible.

If you will recall, the Republicans had absolutely no input to Obamacare and were excluded in all meetings regarding it's design.

M&K's Retrievers
10-06-2010, 12:30 AM
Are you saying these changes are good, bad or indifferent? I'm saying it is adding to the number of uninsureds.

3M specifically noted that, because of health care reform, that better medical options were available to its retirees than it was offering. It will terminate its plan, giving retirees the money that it otherwise would have paid, to permit them to buy their own coverage instead. Where are they going to buy it? From the Government plan as it will be the only program available. (See http://www.startribune.com/business/104317703.html?elr=KArks:DCiU1OiP:DiiUiD3aPc:_Yyc: aUU)

McDonalds has contested the WSJ report, noting that it has no intention of terminating benefits for its employees. However, it is addressing alternatives since the provider of its benefits for hourly employees does not comply with a Federal requirement that at least 85% of premiums be paid out in benefits unless an exemption is requested and approved. For normal benefit plans, the 85% limit is not that onerous, and many states already have requirements forcing insurance companies to pay out 80-85% of premiums in benefits as a minimum. Most plans have loss ratios much higher than that. However, the McDonalds plan is what is called a mini-med plan. These are plans that offer very low benefit levels with relatively significant premium payments. For the McDonalds plan, premiums of about $727/year yield a maximum benefit level of $2,000 per year. The cost is paid by employees. BCS of Illinois has offered no information on the cost or profitability of this plan, but does not meet the Federal standard. So far, most state insurance commissioners have opposed granting an exemption to such plans because they are seen as abusive, providing almost no real coverage while giving people the illusion that they are protected. (http://www.dailyfinance.com/story/will-mcdonalds-end-health-coverage-for-30-000-workers/19655050/)

Principal Financial is getting out of the health insurance business not because of health reform, but because it has been losing money and business for several years and does not want to make the types of investments needed to make its business competitive. Instead, it has reached an agreement under which United Health will provide coverage for its customers as policies come up for renewal.UnitedHealth will make an offer to those previously insured by Principal. UH does not have to accept these people and are not guaranteeing to do so. (http://www.insurancejournal.com/news/midwest/2010/10/01/113746.htm)

Harvard Pilgim is not alone in terminating Medicare Advantage coverage. The entire Medicare Advantage program existed only because of a windfall subsidy being provided to Medicare Advantage participants that was not offered to other Medicare recipients. The cost has been astronomical. The benefit could not possibly be extended to all Medicare beneficiaries without massive increases in the cost of Medicare. Instead, one of the savings in the health reform program was to eliminate the subsidy. More uninsureds.

Termination of child only health plans: This development is actually an indicator of why it is impossible to implement restrictions on pre-existing condition limitations (which are overwhelmingly supported by the public) without a program that also requires universal coverage (which is overwhelmingly opposed by the public). Child only plans have routinely excluded children with existing and/or genetic problems. The new law makes that illegal. Insurance companies are pulling out.I disagree with the requirement of the law only because it is not linked to mandatory universal coverage. Maybe this will help people understand why the two components -- universal coverage and universal eligibility -- cannot be addressed separately. More uninsureds.

My only observation is these actions can add nearly 1,000,000 to the list of uninsureds rather than reducing the number which is one of the goals of Obamacare. These are just the beginning. I've said it before on this forum, Obamacare will likely double the number of uninsureds, not reduce it as supposedly intended.

M&K's Retrievers
10-06-2010, 12:33 AM
According to conservative dogma, isn't this a good thing? If those workers deserve health care, they will get better jobs and have enough to buy their own care. At the same time, the companies that cut their benefits will have larger profits, to create more jobs, and everyone in America will live happily ever after. Right?

Dave, this makes no sense regarding my original post.

M&K's Retrievers
10-06-2010, 12:36 AM
More proof that they didn't go far enough. They should have abolishied the insurance industry and set up a single payer system like 70% of US citizens wanted. Insurance companies are useless leaches on society. Thanks for pointing that out again MK.

More unfounded BS from DS. You say 70% want a single payer system while in fact over 50% of the country want Obamacare repealed.

M&K's Retrievers
10-06-2010, 12:51 AM
Since insurance is a "for profit business", if you can not afford your medical expenses out of pocket, how in hell will you ever be able to afford the insurance??
Think about it!

If something bad happens, your neighbors gets to help foot the bill with their insurance premiums! Now how socialistic is that !?!
Big business interests is the only reason that we have insurance based health care in this country.

So it's OK to have insurance for your life, income replacement, home, auto, boat, airplane, ATV, UTV, D&O coverage, E&O coverage, malpractice insurance, liability coverage for a hunt test, hole in one coverage, business interruption insurance, flood insurance, etc but health coverage should be "free" and provided by the government.

Get real regards,

dnf777
10-06-2010, 04:50 AM
Dave, this makes no sense regarding my original post.

Republican dogma rarely makes sense regarding anything good for working class Americans. We should remember that in November.

You highlighted several companies slashing benefits for workers. This funding will be retained by the corporations, increasing their bottom line. Isn't that a good thing for the company? They don't care if grandma and grandpa have no pension, drug plan, or health coverage. And if it was contractually agreed upon, well, there are plenty of conservative-appointed judges who will gladly nullify any contract if need be.

YardleyLabs
10-06-2010, 05:53 AM
I would have to ask why they spend 1/2 as much ... and still seem to be running out of money.

I believe their taxes are quite high? Is the overall standard of living lower? Is there less disposable income? Is that why govt-run medical care was viewed as necessary?

I'd have to guess that energy costs are surely higher. Much as we complain about the cost of gas, I believe all of Europe pays a lot more than we do for gasoline. I would imagine other forms of energy (for heating, electricity) are similarly more expensive.

A friend who has friends in Germany says that Germans put solar voltaic cells wherever they can find a place to put them on their homes. I'd guess that there is motivation to do that.

The larger question also becomes at what point the govt can stop taking responsibility for providing its citizens with all the necessities of life? I think that is another underlying issue with Obamacare, or any other entitlement program.

In my mind, there is no question that this is an entitlement program. The premise is that everyone is entitled to health care. The level of care they are entitled to appears to be whatever is established as the minimum in Obamacare.

The legislation has already assumed that even if everyone is guaranteed a certain level of care, many of them still won't be able to afford it ... so others will pay more for their minimum level of care, so that it can take up the slack for those who cannot pay for theirs.

Isn't everyone entitled to food? Or a roof over their head? or heat for their home? or clothing? Who determines what the minimum needs are?

The taxation of deluxe plans also seems to make the assumption that people who can afford a higher level of care should have to pay even more (by being taxed) for the financial success they have earned.

While one could be led to think that the very rich can easily afford the extra tariff. However, people who earn $250K/year are in quite a different category from those who earn $2 million/year.
They spend about 9% of GDP on health care while we spend 17%. Like most countries, they have resisted spending more. As it happens, the total tax burden in the UK is about 5% of GDP higher than in the US. Their deficit is high enough that their last election focused primarily on reducing the deficit through tax increases and massive spending cuts. However, if you recognize that their taxes cover medical costs, while ours do not, their tax plus medical care burden is much lower than ours. You are right, most developed countries have decided that basic medical care is an entitlement. Individuals are free to purchase non-basic care out of their own pocket, but receive no help from the government when they do so. Not surprisingly, when the pocket being picked is their own, few make that choice.

Here we conceal the cost of health care by having 90% of it paid by employers and the government. That has been the primary reason why almost everyone assumes the entitlement to be treated like a multi-millionaire when consuming health services. Money is no object as long as I am not the one paying the bill.

The only ones left to worry about the cost are the uninsured -- who are those working too successfully to qualify for government assistance, but in jobs where employers do not provide coverage, and the employers and governments that actually pay the bill. Employers have responded by quietly moving more and more jobs to countries where employers are not expected to pay such costs and labor is consequently much cheaper.

The best thing that could happen in this country to control health care costs and to improve our economic competitiveness is to get employers completely out of the business of financing health care. I find it interesting that those who complain about "ObamaCare" are almost invariably covered by insurance paid for by someone else. I don't see anyone out there fighting to pay the bills themselves.

Buzz
10-06-2010, 08:35 AM
While one could be led to think that the very rich can easily afford the extra tariff. However, people who earn $250K/year are in quite a different category from those who earn $2 million/year.


Yes, those folks making $20,000 a month are living hand to mouth...

Buzz
10-06-2010, 08:49 AM
The best thing that could happen in this country to control health care costs and to improve our economic competitiveness is to get employers completely out of the business of financing health care. I find it interesting that those who complain about "ObamaCare" are almost invariably covered by insurance paid for by someone else. I don't see anyone out there fighting to pay the bills themselves.


I find it unbelievable that those who think you should never tax rich people and businesses, hate the minimum wage, hate regulation, and think that labor makes too much money, are just fine that employers should pay their healthcare bills. Don't they realize that these folks just pass the cost on to the rest of us in the price of their goods? Don't they realize that foreign goods have a competitive advantage because they don't have to pay healthcare costs?

ppro
10-06-2010, 08:55 AM
Since Yardley is a wealth of statistics I am sure he can address the issue of fraud and waste in the medicaid and medicare system and give some insight on how increasing the governments involvement will be a better use of our medical dollars. Sincerely a medical professional for 20 years dealing with the public in which some get "free medicine".

YardleyLabs
10-06-2010, 09:31 AM
Since Yardley is a wealth of statistics I am sure he can address the issue of fraud and waste in the medicaid and medicare system and give some insight on how increasing the governments involvement will be a better use of our medical dollars. Sincerely a medical professional for 20 years dealing with the public in which some get "free medicine".
My knowledge on the specific data is somewhat dated but also relevant. In a prior life, I ran Medicaid in NYC. We were under intense pressure because of payment errors and implements a wide range of improvements. We had an advisory board that included the CEO of one of the largest health insurors in the country and he offered assistance fro his staff. A team came down to review our procedures to control errors and fraud. After few weeks they tripled the number of people involved. It turned out that we wee successfully doing things they had been unable to do in their own operations and they were mining us for ideas. The biggest problems we had with fraud were actually the direct result of legal provisions created at the behest of providers -- particularly clinical labs -- to protect their business interests. Specifically, these prevented us from using our buying power to negotiate pricing or to encourage competition for services (e.g. by contracting out blocks of services or prohibiting kickbacks from labs to physicians for referrals). After I left government, one of the services I offered in the private sector were management reviews of payments by commercial health insurance companies and third party payers.

My first major project was to review the management of a 250,000 employee plan administered by the same insurance company that had assisted us in NYC. The company had its own internal quality control programs that estimated gross errors of under 2% of claims processed with no net payment error. When I did my review, I found a gross error rate exceeding 50% of claims processed with a net overpayment of 5.2%. Almost 70% of the errors were "systematic". That is, they resulted from errors that were built into their payment procedures and happened consistently. The rest were largely attributable to processes that made mistakes all but inevitable. In the first three weeks of the study, my client estimated that they saved $3 million. At the conclusion of the study, the insurance company, with the approval of my client, hired us to work with them over a four year period to assist and monitor their internal quality improvement programs. Over the next four years we were successful in helping the company to reduce its gross error rate to under 2% with no net payment error

In any complex system -- whether publicly or privately managed -- there will be errors. Those errors tend to be easier to conceal in the private sector, but that does not mean they are not there. Wide variability in plan design from plan to plan are one of the major reasons for mistakes. The simpler the plan, the fewer mistakes. If you have universal eligibility for coverage, the primary source of error disappears altogether.

tom
10-06-2010, 09:53 AM
So it's OK to have insurance for your life, income replacement, home, auto, boat, airplane, ATV, UTV, D&O coverage, E&O coverage, malpractice insurance, liability coverage for a hunt test, hole in one coverage, business interruption insurance, flood insurance, etc but health coverage should be "free" and provided by the government.

Get real regards,

OK, let's get real

You PAY for your health care one way or another! THERE IS NO FREE ICE (government run health care is NOT free health care)
So the real question is what costs less, and what are the choices.
Does insurance cost our society less than government run health care?
Sorry but what I see happening in other countries leads me to believe that maybe we have our collective heads stuck in the sand, and are being taken to the cleaners in the process.

Thinking that big business is the only solution to every problem in America is just plain stupid in my opinion. All that does is insure that the rich will get richer, and YOU will become poorer.

I owned my own business for many years, so I am not anti business by any means. But, as a (small) business owner I found out the hard way just what our current health care system actually costs! (thinking that you are getting a "good deal" because your boss is picking up part of the tab for your health insurance is idiotic!) THERE IS NO FREE ICE!

Buzz
10-06-2010, 10:08 AM
OK, let's get real

You PAY for your health care one way or another! THERE IS NO FREE ICE
So the real question is what costs less, and what are the choices.
Does insurance cost our society less than government run health care?
Sorry but what I see happening in other countries leads me to believe that maybe we have our collective heads stuck in the sand, and are being taken to the cleaners in the process.

Thinking that big business is the only solution to every problem in America is just plain stupid in my opinion. All that does is insure that the rich will get richer, and YOU will become poorer.

I owned my own business for many years, so I am not anti business by any means. But, as a (small) business owner I found out the hard way just what our current health care system actually costs!


You're wasting your breath on M&K, he works in the insurance business. So, it's his ox that would be gored if we had socialized insurance. Notice that I didn't call it socialized medicine.;-)

tom
10-06-2010, 10:31 AM
Notice that I didn't call it socialized medicine.

Good point!

As a "senior citizen", maybe we should start a new thread on part A, part B, part -- oh hell, how is a senile old fart suppose to figure all this crap out!
Everyone has this dilemma in their future, and as it is set up now, there is no correct answer because circumstances will change!
Haven't met an insurance agent yet that doesn't say "my product is the best one".

Gerry Clinchy
10-06-2010, 11:01 AM
I find it unbelievable that those who think you should never tax rich people and businesses, hate the minimum wage, hate regulation, and think that labor makes too much money, are just fine that employers should pay their healthcare bills.

Broad generalizations here ...

1) I do not espouse that we never tax rich people. FWIW, I'm not one of those rich people.

2) I've been paying for my own health insurance since 1992, as a self-employed person.

I had employer health insurance for about two or three years. In fact, I was responsible for choosing the insuror. I chose a non-profit for two reasons: the price was good, and if anyone lost their job (and all of us eventually did!) everyone would have the option to convert to individual coverage without a pre-existing condition problem.

For MANY years those who paid for their own health insurance received ZERO consideration from a Federal Income Tax standpoint ... so everyone who received employer health coverage tax-free was WAY ahead of those who were self-employed. Someone FINALLY realized that people who paid for their own health insurance were actually saving the govt money by NOT using govt-subsidized care (Medicaid) ... and agreed to consider that in taxation.


Don't they realize that these folks just pass the cost on to the rest of us in the price of their goods? Don't they realize that foreign goods have a competitive advantage because they don't have to pay healthcare costs?

I absolutely realize that the cost of doing business for any business is passed along to the consumer.

It actually DID make some sense to give employees the choice of taking $ in lieu of their health insurance; and also allowing them a tax deduction as the self-employed now receive (but for MANY years did not receive). The health insurance deduction goes on Schedule A, so the deduction only applies to over 7% (?) of adjusted income. One asks why has health insurance, a valuable compensation, has never been taxable? According to tax law such things as bartered services are taxable. Why has health insurance, when provided by an employer always been tax-free? Was it our govt (IRS Code) that came up with that idea? It seems that unions would have had the most interest in lobbying for this kind of tax treatment.

I don't think we disagree greatly, Buzz ... our difference may be about the best way to deliver the product (health insurance/health care). And, I also believe Jeff is correct in that people don't pay attention to the cost if it is a "gift" from their employer. Actually, will that change greatly if many people who are presently uninsured receive substantial subsidies to get the care they need? Sort of like the food stamps thing when recipients use the food stamps for food that others, without food stamps, would not buy due to the cost of those items.


Yes, those folks making $20,000 a month are living hand to mouth...

I'd say between SS, Medicare deduction, and 35% FIT tax, the amount remaining is about 1/2 the gross. Might be more depending on the size of the household, and deductions allowed on Schedule A (like property taxes and mortgage interest). That doesn't include local and state income tax. Where I live those come to over 4% of gross ... a flat tax with VERY few deductions on the State tax & none on the local tax.

Those income levels generally don't qualify for "assistance" in such things as college tuition. I recently read that private college tuition & room & board is running around $30,000 to $40,000 a year. Those people taking home $10,000/mo better be good savers because when the kids go to college they'll need it. Even state institutions are not cheap anymore.



They spend about 9% of GDP on health care while we spend 17%. Like most countries, they have resisted spending more. As it happens, the total tax burden in the UK is about 5% of GDP higher than in the US.

Their taxes might be higher if they had to spend more on military stuff that the US spends. Some may argue that some of our military stuff is not needed (the two wars in the mid-east, of course) ... but the US also expends a great deal on other stuff militarily. So, one would also have to assess how other portions of the GDP are spent to compare those #s fairly to what the US spends.

Would also be interesting to know what items are the root of their deficit, as those would be the items that would need cutting to reduce the deficit. Or that 5% difference in taxes paid is going to be higher in the coming years. This is also going to be true for the US since we're presently living on "credit" as well.

ppro
10-06-2010, 12:08 PM
I must say I do not have the experience of sitting behind a desk and looking through many reports as you Yardley but I have the limited knowledge of working in various retail pharmacy settings and also as director of pharmacy of a charity now teaching hospital. In my immediate family I have 11 siblings or spouses that work in various settings varying from clinic physician to hospital ceo to nurses. It always gives me pause to think of the differences of opinion to those that have boots on the ground as those that read reports and summarize. I acknowledge that I have a narrow view but from ground level it seems that there is a significant amount of people that get "free" services that should not. My wife works as a nurse surveyor for DHH and she sees a large amount of this in nursing home and PCA(personal care assistant) programs funded by various government entities. My faith in the government being able to efficiently run such a large undertaking as healthcare in such broad terms is non existent. We have train generations of people to rely on help from the government as a way of life that we must not let more personal responsibility leave the individual. I will say that my siblings and I were raised in a home that would have have been considered below poverty and never got assistance. We learned to live without things such as BMW's,Mercedes,Cadilacs,Luis Vutton,Blacberrys, and other such niceties that I see some of these government receivers on a daily basis. I am a little upset to continue to work to pay for other peoples children after I have done so without government help while these same people will come to get free medicine after they come back from "the club". I wonder what reports are out there that show the percentage of people that are milking the system. I doubt it is accurate.

tom
10-06-2010, 12:39 PM
I must say I do not have the experience of sitting behind a desk and looking through many reports as you Yardley but I have the limited knowledge of working in various retail pharmacy settings and also as director of pharmacy of a charity now teaching hospital. In my immediate family I have 11 siblings or spouses that work in various settings varying from clinic physician to hospital ceo to nurses. It always gives me pause to think of the differences of opinion to those that have boots on the ground as those that read reports and summarize. I acknowledge that I have a narrow view but from ground level it seems that there is a significant amount of people that get "free" services that should not. My wife works as a nurse surveyor for DHH and she sees a large amount of this in nursing home and PCA(personal care assistant) programs funded by various government entities. My faith in the government being able to efficiently run such a large undertaking as healthcare in such broad terms is non existent. We have train generations of people to rely on help from the government as a way of life that we must not let more personal responsibility leave the individual. I will say that my siblings and I were raised in a home that would have have been considered below poverty and never got assistance. We learned to live without things such as BMW's,Mercedes,Cadilacs,Luis Vutton,Blacberrys, and other such niceties that I see some of these government receivers on a daily basis. I am a little upset to continue to work to pay for other peoples children after I have done so without government help while these same people will come to get free medicine after they come back from "the club". I wonder what reports are out there that show the percentage of people that are milking the system. I doubt it is accurate.

So you are saying that the system we have been using isn't working all that well. Welcome to the club!! Why not try to see if we can fix it!!!!!!!!

Kinda like saying "someone has to pay the bills", "so lets lower taxes".

Roger Perry
10-06-2010, 12:45 PM
Since Yardley is a wealth of statistics I am sure he can address the issue of fraud and waste in the medicaid and medicare system and give some insight on how increasing the governments involvement will be a better use of our medical dollars. Sincerely a medical professional for 20 years dealing with the public in which some get "free medicine".

We have a bit of a dilema here in Florida on which crook to vote for in the race for Governor. Has somewhat to do with Medicare.

On the Republican side is Rick Scott
One questioned Scott's decision to plead the Fifth Amendment 75 times in a lawsuit involving one of his companies.

After months of being tarred for mammoth fraud at the hospital company he founded, Republican gubernatorial nominee Rick Scott is launching his own hard-hitting ad, accusing Democrat Alex Sink of bilking investors as the Florida president of NationsBank in the 1990s.
Scott has said repeatedly he "takes responsibility" for the billions of dollars in illegal Medicare and Medicaid reimbursements Columbia/HCA collected under his watch. Scott was forced out of the company in the late 1990s after the U.S. Justice Department announced its Medicare fraud investigation.

And on the Democratic side Alex Sink

One claims that as president of NationsBank Florida she was responsible for questionable sales practices conducted by a separate securities company that reported to NationsBank Corp.
The other ad echoes one from Scott's Republican allies that singles out Sink for blame over state pension fund losses she, along with Gov. Charlie Crist and Attorney General Bill McCollum, was one of three members of the board administering the trust fund.

road kill
10-06-2010, 12:49 PM
OK, let's get real

You PAY for your health care one way or another! THERE IS NO FREE ICE (government run health care is NOT free health care)
So the real question is what costs less, and what are the choices.
Does insurance cost our society less than government run health care?
Sorry but what I see happening in other countries leads me to believe that maybe we have our collective heads stuck in the sand, and are being taken to the cleaners in the process.

Thinking that big business is the only solution to every problem in America is just plain stupid in my opinion. All that does is insure that the rich will get richer, and YOU will become poorer.

I owned my own business for many years, so I am not anti business by any means. But, as a (small) business owner I found out the hard way just what our current health care system actually costs! (thinking that you are getting a "good deal" because your boss is picking up part of the tab for your health insurance is idiotic!) THERE IS NO FREE ICE!

Thinking that government is the only solution to every problem in America is just plain stupid in my opinion. All that does is insure that the rich will get richer, and YOU will become poorer.

Just sayin'



RK

tom
10-06-2010, 12:55 PM
We have a bit of a dilema here in Florida on which crook to vote for in the race for Governor. Has somewhat to do with Medicare.

On the Republican side is Rick Scott
One questioned Scott's decision to plead the Fifth Amendment 75 times in a lawsuit involving one of his companies.

After months of being tarred for mammoth fraud at the hospital company he founded, Republican gubernatorial nominee Rick Scott is launching his own hard-hitting ad, accusing Democrat Alex Sink of bilking investors as the Florida president of NationsBank in the 1990s.
Scott has said repeatedly he "takes responsibility" for the billions of dollars in illegal Medicare and Medicaid reimbursements Columbia/HCA collected under his watch. Scott was forced out of the company in the late 1990s after the U.S. Justice Department announced its Medicare fraud investigation.

And on the Democratic side Alex Sink

One claims that as president of NationsBank Florida she was responsible for questionable sales practices conducted by a separate securities company that reported to NationsBank Corp.
The other ad echoes one from Scott's Republican allies that singles out Sink for blame over state pension fund losses she, along with Gov. Charlie Crist and Attorney General Bill McCollum, was one of three members of the board administering the trust fund.

Oh, you mean like ......
http://www.msnbc.msn.com/id/39169696/

dnf777
10-06-2010, 01:01 PM
Thinking that government is the only solution to every problem in America is just plain stupid in my opinion. All that does is insure that the rich will get richer, and YOU will become poorer.

Just sayin'



RK

Especially when the gov't is run by corporate lobbyists.

ducknwork
10-06-2010, 02:23 PM
So you are saying that the system we have been using isn't working all that well. Welcome to the club!! Why not try to see if we can fix it!!!!!!!!

Then we should have attacked that problem, not passed more BS that won't solve any of the existing problems and add its own.

Kinda like saying "someone has to pay the bills", "so lets lower taxes".

No, it's more like saying "someone has to pay the bills", "I like ice cream".

Completely irrelevant and unrelated to the real issues.

tom
10-06-2010, 02:33 PM
Completely irrelevant and unrelated to the real issues.

Oh is it?!?

Bottom line is "how should we pay the bills"!

You guys seem to want lower taxes, less government, and lower wages, so just how is it that you expect to pay your medical bills?

My little go around with the heart surgeons only cost 185K. My share of the bill was $37,000.00 plus insurance premiums already payed over the course of 40 years. Think it won't happen to you ---- guess again my friend!
Having had heart surgery, would you like to take a guess on what I have to pay for insurance!?! (even with Medicare part A)


Then we should have attacked that problem, not passed more BS that won't solve any of the existing problems and add its own.

Now we are getting somewhere! How about you listing what those problems are, and how we should fix them.
All I ever hear is what we shouldn't do, no one wants to say what we should do!!!!
You look at the list of things that the GOP conjured up, and we are right back to the same place. Nothing gets fixed and it adds more problems!

Is there a solution? In my book YES there is, all the idiots in Washington have to do is quit the turf wars, and do what is right for the country!
Doesn't matter if they go insurance based or government based, just as long as they regulate it properly. Everyone pays the insurance premiums OR they pay the taxes. Either way we will have about the same number of people earning their living off it.

Julie R.
10-06-2010, 03:03 PM
much cheaper.

The best thing that could happen in this country to control health care costs and to improve our economic competitiveness is to get employers completely out of the business of financing health care. I find it interesting that those who complain about "ObamaCare" are almost invariably covered by insurance paid for by someone else. I don't see anyone out there fighting to pay the bills themselves.


Normally I'm philosophically on the other end of the spectrum from Jeff, but this is the crux of the problem right here. From my rather unscientific observation, I've noticed that those that have had government or other good health care coverage for all or most of their adult lives aren't the slightest bit concerned with the outrageous costs of certain medications or routine medical procedures, tests, etc.,, because they have no idea what they actually cost. Why, for example, is New Drug A $300 a month, when Generic B at $4 a month would suffice?

If you're under- or uninsured you question the cost and find something that works that isn't as expensive. And if not for insurance Big Pharma wouldn't be able to charge such high prices for New Drug A or Re-invented, extended release New Drug B because people would opt for the cheaper version. Instead, they're allowed to "price fix" via big insurance and Medicare-Medicaid which apparently never question the costs.

Something is very wrong when the very things that perpetuate waste and fraud aren't fixed first, before making any sweeping reforms.

tom
10-06-2010, 03:39 PM
The best thing that could happen in this country to control health care costs and to improve our economic competitiveness is to get employers completely out of the business of financing health care. I find it interesting that those who complain about "ObamaCare" are almost invariably covered by insurance paid for by someone else. I don't see anyone out there fighting to pay the bills themselves.

I have to agree with that also.

Except

I don't see anyone out there fighting to pay the bills themselves

Most small businesses (like me) have been saying that for years.
The problem is the disparity in insurance costs. If a person buys their own it is at a different price.
(seems like that is one of the problems addressed in health care reform --- too bad that the GOP thinks that is one of the things that has to wait for a few years)

Buzz
10-06-2010, 03:44 PM
I have to agree with that also.

Except


Most small businesses (like me) have been saying that for years.
The problem is the disparity in insurance costs. If a person buys their own it is at a different price.


And to think, they claim to be friends of small business. Those defenders of the current system I mean...

Gerry Clinchy
10-06-2010, 05:50 PM
The problem is the disparity in insurance costs. If a person buys their own it is at a different price.


The disparity in insurance costs is due to the arithmetic. You can charge less per person if you know that your group will have enough healthy people to offset the sick people. So, in a small group with mostly older people, costs for the group are likely to be higher than if the group was younger. Based on age alone, if the employees remain stable with their employer, they grow older each year & more likely to need health care.

Every business operates this way really. If you go to estimate a job, and don't get the job, you have to build the cost of your time into one of the jobs you do get. Basically the old saying 20% of your customers are responsible for 80% of your problems. You may have to charge the same price to everyone (except for volume discounts & the like), but you will make more profit on some customers than others. You set your price so that it balances out.

I'm with Julie ... and some health plans now do provide for it, I think, that if there is a generic drug that does the same thing as a newer drug, they will only pay for the generic. If there are stupid things in the way we do things now, fix the stupid stuff, then maybe there's a chance that you can control costs on a universal plan.

When I listen to some of the ads on TV for new drugs, I don't think I want to take any of them! I love the one for asthma relief that notes the drug may cause death from asthma! Uh ... excuse me. Then there's another drug that mentions it can cause cancer. Yup, gonna run right out and try that one.

As an aside, Medicare ain't exactly free. First you pay into the plan during your working life, for Part A. Then they deduct another $93 a month for Part B. But you really need to get your own supplemental coverage (for me that's $130 month); and then the prescription drug coverage is another $103/mo. Granted, as one ages & is more likely to need those coverages, the price may still be a pretty good deal ... but it sure ain't free.

depittydawg
10-06-2010, 06:04 PM
Normally I'm philosophically on the other end of the spectrum from Jeff, but this is the crux of the problem right here. From my rather unscientific observation, I've noticed that those that have had government or other good health care coverage for all or most of their adult lives aren't the slightest bit concerned with the outrageous costs of certain medications or routine medical procedures, tests, etc.,, because they have no idea what they actually cost. Why, for example, is New Drug A $300 a month, when Generic B at $4 a month would suffice?

If you're under- or uninsured you question the cost and find something that works that isn't as expensive. And if not for insurance Big Pharma wouldn't be able to charge such high prices for New Drug A or Re-invented, extended release New Drug B because people would opt for the cheaper version. Instead, they're allowed to "price fix" via big insurance and Medicare-Medicaid which apparently never question the costs.

Something is very wrong when the very things that perpetuate waste and fraud aren't fixed first, before making any sweeping reforms.

Interesting. I don't know anybody who has had "government" health insurance most of their lives. The only people covered by government I've ever seen are kids and old people. The rest of us have always been on our own.

depittydawg
10-06-2010, 06:11 PM
The disparity in insurance costs is due to the arithmetic. You can charge less per person if you know that your group will have enough healthy people to offset the sick people. So, in a small group with mostly older people, costs for the group are likely to be higher than if the group was younger. Based on age alone, if the employees remain stable with their employer, they grow older each year & more likely to need health care.



Now I would argue that the disparity in health insurance costs is a function of the latitude insurance companies have been given to game the system. In reality there is NO disparity in services required because the population is simply, the population. Disparity only comes into play because Insurance companies have been given the opportunity to pick and choose who they insure. They have been given the opportunity to add and drop people at will. A better system would be for Insurance companies to compete for customers at the dawning of adulthood, say 25 years old and then insure those customers for life.

ducknwork
10-06-2010, 08:33 PM
Completely irrelevant and unrelated to the real issues.
Oh is it?!?

Bottom line is "how should we pay the bills"!

...............

How about you listing what those problems are, and how we should fix them. The problems were listed in the thread you responded to. Here it is again.
I acknowledge that I have a narrow view but from ground level it seems that there is a significant amount of people that get "free" services that should not. My wife works as a nurse surveyor for DHH and she sees a large amount of this in nursing home and PCA(personal care assistant) programs funded by various government entities. My faith in the government being able to efficiently run such a large undertaking as healthcare in such broad terms is non existent. We have train generations of people to rely on help from the government as a way of life that we must not let more personal responsibility leave the individual. I will say that my siblings and I were raised in a home that would have have been considered below poverty and never got assistance. We learned to live without things such as BMW's,Mercedes,Cadilacs,Luis Vutton,Blacberrys, and other such niceties that I see some of these government receivers on a daily basis. I am a little upset to continue to work to pay for other peoples children after I have done so without government help while these same people will come to get free medicine after they come back from "the club". I wonder what reports are out there that show the percentage of people that are milking the system. I doubt it is accurate.

In response, you said:


So you are saying that the system we have been using isn't working all that well. Welcome to the club!! Why not try to see if we can fix it!!!!!!!!

Kinda like saying "someone has to pay the bills", "so lets lower taxes".

And I said this and stand by it:


No, it's more like saying "someone has to pay the bills", "I like ice cream".

Completely irrelevant and unrelated to the real issues.

Because you make it seem like the Healthcare Reform has in some way addressed the issues that ppro brought up. It hasn't. We should have attacked those problems before doing any of this other BS.

Gerry Clinchy
10-06-2010, 09:44 PM
Now I would argue that the disparity in health insurance costs is a function of the latitude insurance companies have been given to game the system. In reality there is NO disparity in services required because the population is simply, the population

But one insuror does not necessarily have access to the entire spectrum of the population ... as would be the case in a universal govt program, provided that the govt did make everyone have coverage.

That's how "group insurance" evolved, to spread the risk among many individuals. A group of employees was one of those groups. Sometimes it's a group made up of union members. It can also be a group of "association" members like the AMA.

Here in PA it used to be against the law to form an "association" simply for the purpose of purchasing life insurance. Colonial Penn wanted to sell certain insurance to senior citizens, but they needed an association that had other reasons for existence in order to accomplish that. So, Colonial Penn started such an association themselves ... they called it AARP. The means to their end eventually outgrew Colonial Penn :-)

That is the problem with the "tax" on those who do not choose to purchase coverage. The tax must at least be equal to what their premium would be. If it's cheaper to pay the tax than buy the insurance, then people will wait until they are sick before they buy the coverage.

And to make Obamacare work the taxation must begin right away so that the $ can be put into the health coverage "fund" to anticipate those who would defer buying coverage until they get sick (although I'm not entirely sure that the legislation provides for those particular tax monies to be allocated that way; for all we know they may go into the general treasury & the politicians will just spend it on something else).

Disparity only comes into play because Insurance companies have been given the opportunity to pick and choose who they insure.

It used to be the norm for an insuror to accept a pre-existing condition after one year. In the interim, the individual would pay premiums but only health problems unrelated to the pre-existing condition would be covered. After the one-year waiting period, then even the pre-existing condition would be covered.

For many years, the local non-profit had a one-month period for "open enrollment". Even a pre-existing condition would be accepted during "open enrollment". I do not believe that exists any longer ... for the obvious reason, people waited until they got sick before enrolling.

M&K could give us more current information on that topic.


They have been given the opportunity to add and drop people at will.

As far as I know, no reputable insuror did that unless premium was unpaid. Even then there is a 30-day period of "grace" for payment of the premium. If your premium is due on the 1st of the month & you pay it on the 20th, there is no lapse in coverage.

When a person belonged to a "group" through his employer, then it could be that not all those group plans offered a seamless "conversion" to an individual policy.

A better system would be for Insurance companies to compete for customers at the dawning of adulthood, say 25 years old and then insure those customers for life.

In fact, the insurors would love to have those younger people. The problem is that those younger people tend not to buy health insurance until they think they are going to need it.

If someone chooses to purchase health insurance individually, they probably can carry it with them throughout their life. But like term life insurance, as you get older the premium would increase because actuarily the risk to the insurance company becomes greater.

Could insurors come up with a product similar to "whole life insurance" where the premiums are higher throughout the term of the coverage? They probably could, but how many would have the foresight to buy it? That's exactly why people buy term life insurance. They're betting that as the premium increases in later years they will be better able to afford the larger premium. Personally, I'm a great believer in whole life insurance ... purchased as young as possible & kept forever.

Additionally, insurors must be licensed in each state to do business. Since NYS, as an example, may require insurors to provide certain benefits to all insureds, some companies will choose not to do business in NYS at all.

I'll echo Tom, ain't no free lunch. If you intend to provide a service to people who cannot afford the service on their own, then somebody is going to have to come up with the $ to provide that service for them.

Recently due to the increase in cost for health insurance, more and more employers require an employee to bear some of the cost. For example, the company will pay for the individual's coverage, but if they have a family, the employee pays the difference between individual coverage and family coverage. Actually, that is the fairest to all the employees ... employee with a family would cost an employer a lot more for health insurance than the single employee at the same pay rate. Shouldn't the employees get the same compensation for the same work? So, now, employees are becoming more aware of just how much health insurance costs.

Julie R.
10-06-2010, 10:31 PM
Interesting. I don't know anybody who has had "government" health insurance most of their lives. The only people covered by government I've ever seen are kids and old people. The rest of us have always been on our own.

Well if you lived within commuting distance from Washington D.C. like I do, you would know plenty of people that had government insurance, since it's the largest employer in this area.

M&K's Retrievers
10-06-2010, 11:44 PM
What is so difficult to understand?

Health care is the business of delivering treatment to people who have an illness or injury requiring medical care, confinement, etc.

Health insurance is the business of reimbursing insured individuals for covered expenses incurred as the result of an injury or sickness.

Health care practitioners are not in the risk bearing business and insurance companies do not deliver health care.

Yes, Buzz, I do have a dog in this fight but at least my opinions, observations and explanations come from extensive experience in the business.

It's pretty friggin' simple regards,

M&K's Retrievers
10-07-2010, 12:07 AM
Oh is it?!?

Bottom line is "how should we pay the bills"!

You guys seem to want lower taxes, less government, and lower wages, so just how is it that you expect to pay your medical bills?

My little go around with the heart surgeons only cost 185K. My share of the bill was $37,000.00 plus insurance premiums already payed over the course of 40 years. Think it won't happen to you ---- guess again my friend!
Having had heart surgery, would you like to take a guess on what I have to pay for insurance!?! (even with Medicare part A)



Now we are getting somewhere! How about you listing what those problems are, and how we should fix them.
All I ever hear is what we shouldn't do, no one wants to say what we should do!!!!
You look at the list of things that the GOP conjured up, and we are right back to the same place. Nothing gets fixed and it adds more problems!

Is there a solution? In my book YES there is, all the idiots in Washington have to do is quit the turf wars, and do what is right for the country!
Doesn't matter if they go insurance based or government based, just as long as they regulate it properly. Everyone pays the insurance premiums OR they pay the taxes. Either way we will have about the same number of people earning their living off it.

Three questions, Tom. Did you pay the premium or did your employer contribute? What kind of plan design would allow you to have that much out of pocket expense on a $185M claim?. That is very high. Most plans have a stop loss feature that will limit your out of pocket expense. Lastly, was this claim recent? My reason for asking is that $185M seems low for heart surgery. I think my wife's recent broken leg was close to $50M. That was in southern Oklahoma. Yardley, in PA, just had a similar problem which I guess was even higher than that.

JDogger
10-07-2010, 12:24 AM
Three questions, Tom. Did you pay the premium or did your employer contribute? What kind of plan design would allow you to have that much out of pocket expense on a $185M claim?. That is very high. Most plans have a stop loss feature that will limit your out of pocket expense. Lastly, was this claim recent? My reason for asking is that $185M seems low for heart surgery. I think my wife's recent broken leg was close to $50M. That was in southern Oklahoma. Yardley, in PA, just had a similar problem which I guess was even higher than that.

Millions or thousands Mike? JD

M&K's Retrievers
10-07-2010, 12:27 AM
Millions or thousands Mike? JD

..................

ducknwork
10-07-2010, 06:18 AM
In fact, the insurors would love to have those younger people.

No kidding...If I didn't have 3 kids, I'd be really taking a beating every week on that insurance bill. I personally haven't been to the doctor in probably 5 years. My wife would be the same if it wasn't for prenatal care. I'm getting my money's worth now, but if we stop having kids, the insurance company is going to start making money on me soon!

tom
10-07-2010, 08:19 AM
Interesting. I don't know anybody who has had "government" health insurance most of their lives. The only people covered by government I've ever seen are kids and old people. The rest of us have always been on our own.

My daughter has "Tri-Care" (career military)
My wife has "PEHP" (CPS case worker - state employee)
Anyone that works for a city, county, state, or federal agency probably has some form of "government" insurance.


Three questions, Tom

I owned the business, so I paid for mine (and for others)
Ins paid 80%, I paid the remaining 20% + not covered services. That was also the amounts paid, not the amounts billed, huge difference!! (Yet another problem with our health care system)
It was several years ago

M&K's Retrievers
10-07-2010, 09:45 AM
ce.



I owned the business, so I paid for mine (and for others)
Ins paid 80%, I paid the remaining 20% + not covered services. That was also the amounts paid, not the amounts billed, huge difference!! (Yet another problem with our health care system)
It was several years ago

Not doubting your word, but that is a large out of pocket for that size claim. Most plans pay 80% to a stop loss amount usually $5000 or $10,000 and then 100% after that per calendar year. Also wondering what the not covered expenses include.

Usually the amount billed versus the amount allowed exceeded the reasonable and customary amounts for your area which means the provider overcharged for the service. These differences are usually eaten by the provider.

M&K's Retrievers
10-07-2010, 09:48 AM
Yet another sign of things to come. According to the Washington Examiner today, 3 Catholic Hospitals in PA are for sale. Obamacare was cited as a major reason.

M&K's Retrievers
10-07-2010, 09:52 AM
My daughter has "Tri-Care" (career military)
My wife has "PEHP" (CPS case worker - state employee)
Anyone that works for a city, county, state, or federal agency probably has some form of "government" insurance.




I think you will find that these plans are insured by or administered by insurance companies and funded (premiums) by the particular branch of government . Not government health care.

tom
10-07-2010, 10:13 AM
Also wondering what the not covered expenses include.

Limit on the number of times a service can billed for per calender year.
MRI's comes to mind, because they charged for it every time they drained fluid from lungs.
(we argued over that one just a bit)


I think you will find that these plans are insured by or administered by insurance companies and funded (premiums) by the particular branch of government . Not government health care.

Government paid for health care is government paid for health care! You are splitting hairs a little thin.
But I do understand the point.


These differences are usually eaten by the provider

True ---- unless the patient is paying the bill "out of pocket" (or the patient is uninsured and the provider is billing the state or using it as a write off)

M&K's Retrievers
10-07-2010, 10:30 AM
Limit on the number of times a service can billed for per calander year.
MRI's comes to mind, because they charged for it every time they drained fluid from lungs.
(we argued over that one just a bit)



Government paid for health care is government paid for health care! You are splitting hairs a little thin.
But I do understand the point.

No. Not spiting hairs. Saying it like it is. That is one of the problems with the health care debate. People say what they think and that is usually far from fact.

tom
10-07-2010, 10:36 AM
No. Not spiting hairs. Saying it like it is. That is one of the problems with the health care debate. People say what they think and that is usually far from fact.

If you will notice I stated the insurance provider in both examples given! Both are completly funded by government. (and in the case of PEHP "conributions" by those they insure) ;)

ducknwork
10-07-2010, 10:54 AM
Yet another sign of things to come. According to the Washington Examiner today, 3 Catholic Hospitals in PA are for sale. Obamacare was cited as a major reason.

Obamacare would have forced them to perform abortions, right?

If I'm incorrect, my apologies. Just asking.

tom
10-07-2010, 11:13 AM
Obamacare would have forced them to perform abortions, right?

How many hospitals in your aria have a burn center? How many hospitals in your aria do nothing but cancer treatment?

NO hospital is required to provide every medical procedure that exists.
The Catholic hospital here was sold several years ago for one reason, and one reason only --economics
Would you expect any kind of health care reform not to have economic fallout?
Just changing brands of aspirin has economic fallout!

ppro
10-07-2010, 12:18 PM
I would like to comment on the cost of drugs. It seems to me that Big Pharma sell there product for what they think the market will pay. If the market incorporates insurance as a buyer than insurance companies can limit what they buy. I had a musician from France comment to me that we need at least a little socialism in our system to help with drug cost. I agreed and told I pay too much for CD's and music was not near as important as medicine. I hoped the government would not let music companies charge so much for such an insignificant part of life and maybe limit what they can charge to maybe a dollar or so. How stupid is it that we want to try to tell certain markets what to charge. Big Pharma is there to make money.It does not leave large areas of margin for the pharmacies to make a profit. We on that end need to be creative and ever changing to make a living. I am all for it. If people don't want to buy the newest and best "me-too" drug don"t buy it.Be smart with your money and price your medical services as you would a car or television.Drugs are priced for what the market will allow for a profit. The same drugs are cheaper in Mexico or Canada for 1 main reason. The market there will not support higher prices. Plain and simple.Over the counter Prilosec at the same strength made by the same company is about $25 for 42 pills and the prescription is well over $200.It is what the market will allow.Viagra 25mg is roughly $15 per pill. Viagra 100mg is roughly $16 a pill. You are not buying the medicine but are paying a price that the market will allow. Most insurance companies exclude this from there covered services as they know most everyone that needs this will pay out of pocket.I have a man that has Medicaid pay for his heart,diabetes,blood pressure and acute medicines but will pay $200 for his viagra.Many issues concerning drug pricing but I don't want the government stepping in to control prices. What a bad road to travel.

Julie R.
10-07-2010, 01:22 PM
A friend sent me this today. I think it sums up Obamacare pretty nicely.
http://i490.photobucket.com/albums/rr266/MouseOnAFeedsack/HNIC/4771f042.jpg

M&K's Retrievers
10-07-2010, 01:35 PM
Obamacare would have forced them to perform abortions, right?

If I'm incorrect, my apologies. Just asking.

That may have something to do with it but it was not mentioned. The reason they gave was the required additional investment required by Obamacare.

menmon
10-07-2010, 02:19 PM
Normally I'm philosophically on the other end of the spectrum from Jeff, but this is the crux of the problem right here. From my rather unscientific observation, I've noticed that those that have had government or other good health care coverage for all or most of their adult lives aren't the slightest bit concerned with the outrageous costs of certain medications or routine medical procedures, tests, etc.,, because they have no idea what they actually cost. Why, for example, is New Drug A $300 a month, when Generic B at $4 a month would suffice?

If you're under- or uninsured you question the cost and find something that works that isn't as expensive. And if not for insurance Big Pharma wouldn't be able to charge such high prices for New Drug A or Re-invented, extended release New Drug B because people would opt for the cheaper version. Instead, they're allowed to "price fix" via big insurance and Medicare-Medicaid which apparently never question the costs.

Something is very wrong when the very things that perpetuate waste and fraud aren't fixed first, before making any sweeping reforms.

Julie...it hit the nail on the head!

menmon
10-07-2010, 02:47 PM
The long and short of this debate today is that none us have our hands wrapped around this. Furthermore, we all have different experiences with healthcare, depending on our employers or lack of employers.

Healthcare is complicated that is why there are so many ways to take advantage of it. The politicians have determined that they can make unfounded statements about it and get away with it because none of us really know, tapping into our fears. There are countless edititorial on bits and pieces of it that misrepresent the program, too.

Controlling cost and not making sacrifices is hard to do, so either you don't make sacrifices and let cost skyrocket or you try to manage cost and figure out what you can do without. These sacrifies depend a lot where you are in the lifecycle too.

My take on it is that the new law has problems but the intent is good. So with a good intent written into law, hopefully the ones that implement the intent will make the best of it. However, it will evolve over time and hopefully it meets most needs. That is its intent.

YardleyLabs
10-07-2010, 03:02 PM
That may have something to do with it but it was not mentioned. The reason they gave was the required additional investment required by Obamacare.
In fact, the comments made by the hospital noted that the closure was based on a number of factors. While the hospitals in question are doing well now, they frequently have empty beds and believe that greater regionalization is needed to meet the needs of the community. That and modernization of services is needed. They do not have the resources to make those investments and are seeking to sell the hospitals to a provider that can and will. This decision reflects a variety of factors that are expected to affect the health care landscape over the next five years, including health care reform.
"There is always sadness and mourning when you think of letting go of anything but the Sisters of Mercy are strongly supportive of this decision because we do understand the realities of health care and we do think it's best for the community," said Sister Marie Parker of Mercy Health Partners.

She and Mercy Health Partners CEO Kevin Cook said they are already in talks with potential buyers.

They said Mercy isn't struggling but, they added, now is the time to make a sale.

"We are in position of strength and it's always better to make a move for the future from that position," Sister Marie Parke added.

"Actually we're doing well. We're ahead of budget for the year. It's more that when we look out over the landscape of health care over the next five years and the needs of these facilities, the needs of this community, we understand a different level of investment will be needed than what we can do on our own," Cook said.

They said much of that required investment is the result of the health care reform bill passed in Washington.

The CEO said it means the need for more spending and less federal reimbursements.

"Health care reform is absolutely playing a role. Was it the precipitating factor in this decision? No, but was it a factor in our planning over the next five years? Absolutely," Cook added. (http://www.wnep.com/news/countybycounty/wnep-scr-mercy-hospital-for-sale,0,5633203.story)
At no point does the story indicate what aspects of health care reform would require additional investment, which would have been interesting. Of note, there has been an on-going pattern of hospital closures for years, affected by changes in health care regulation, advances in medical care, and demographic changes among the populations served.

All such closures are traumatic because hospitals are significant entities in the communities they serve. However, most (not all) such closures actually are good from a health care perspective. In my area in southeastern PA, we have lost several hospitals in the last five years -- all predating "ObamaCare".

In NYC, there was a period of time when I was one of the architects of City policies to "encourage" hospital closures. We simply had too many hospitals with inadequate capital facilities. They were cannibalizing the market of patients in a way that left all the hospitals financially incapable of providing good care and of upgrading their plants to meet new needs. Ultimately, we simply withheld government assistance from those hospitals that we believed were not needed. For example, there were times when we would assist a hospital facing cash flow problems by providing them with advances against future Medicaid payments. However, if a hospital was on our "closure list", we withheld such support. We also published the names of hospitals that we believed were redundant. That reduced the likelihood that they would receive foundation grants or even lines of credit. Over a period of a few years, almost all of the hospitals on our list ended up closing or merging with stronger institutions. At the end, we still had more than enough hospitals and the hospitals that were left were stronger financially and in the quality of the care provided.

Of course, it's much easier to blame it on "ObamaCare" and assume that it is a bad thing even when the story provides no support for such a conclusion.

Buzz
10-07-2010, 03:40 PM
Jeff, a lot of people will see in your post what they fear about Obama Care, and that is government making the decisions about which hospitals will succeed and survive, and which do not.;-)

tom
10-07-2010, 04:15 PM
Jeff, a lot of people will see in your post what they fear about Obama Care, and that is government making the decisions about which hospitals will succeed and survive, and which do not.;-)

Or which insurance companies will survive ;-)

YardleyLabs
10-07-2010, 04:40 PM
Jeff, a lot of people will see in your post what they fear about Obama Care, and that is government making the decisions about which hospitals will succeed and survive, and which do not.;-)
Well, the fact is that government and insurance company involvement in health care have been the reality since the 1960's and earlier. In the case I cited, what I did was to simply withhold extraordinary government support. The fact that was enough to force closure of almost 30 hospitals is an indicator of just how fragile the system was.

How did it get that way? One of the major factors in New York was tuberculosis. The incidence of tuberculosis was so high that hospitals throughout the city were being expanded at a rapid rate and new ones were built to house tuberculosis patients who often stayed in the hospital for months and even years. Everybody was happy (except the patients). Thousands were employed.

Antibiotics came along and proved effective in curing tuberculosis. The need for hospitals plummetted, but they didn't close. They broadened the conditions they treated, converted beds to psychiatric wards, and held patients for longer periods of time than were justifiable. One of the biggest changes was convincing people to move child birth from homes and small clinics into the hospitals where stays were often two weeks and more. Despite this, hospital utilization dropped under 50%.

New regulations were adopted to require private and semi private rooms, each with large windows (making the interior spaces of large hospitals unusable in many cases). That used up some of the extra space and gave hospitals justifications for remaining open, albeit at a much higher cost per day. By the 1970's average length of stay had been cut in half to about 11 days, and everyone was certain it could go no lower.

However, hospitals still couldn't afford capital replacement without public financing, and medical care continued to advance. Increasingly, it became apparent that staying in the hospital was one of the major causes of reinfection. Lengths of stay began to drop again. Today, the average is 4.6 days.

Hospitals that used to serve 300 patients saw their loads decrease to non-economic levels. However, our methods of reimbursement under commercial insurance programs and governmental insurance programs simply filled the gap, paying more money for less care. In areas with strong population growth, the problem was not very evident since the beds were taken by a growing population. However, in areas with stable populations such as NYC, the impact was dramatic. There was a brief respite in the 1990's when it looked like AIDS might become the new tuberculosis and save the world from cuts (:rolleyes:). Then along came those pharmaceutical companies and the beds were empty again.

The Sisters of Mercy Hospital System mentioned in M&K's post serves just such an area. The only economic solution in such places is consolidation. Our current insurance systems have simply delayed the inevitable by paying the cost, no matter how high, and shielding the patients from the impact of those increases.

Any approach that permits economic decisions to be made concerning health care will have the effect of pruning the system. This could be done by eliminating the "socialized" system of employer based health insurance that we have now. However, if we wish to continue to rely on insurance, then more artificial strategies will need to be used to achieve some of the benefits of economic competition among providers.

menmon
10-07-2010, 06:02 PM
Well, the fact is that government and insurance company involvement in health care have been the reality since the 1960's and earlier. In the case I cited, what I did was to simply withhold extraordinary government support. The fact that was enough to force closure of almost 30 hospitals is an indicator of just how fragile the system was.

How did it get that way? One of the major factors in New York was tuberculosis. The incidence of tuberculosis was so high that hospitals throughout the city were being expanded at a rapid rate and new ones were built to house tuberculosis patients who often stayed in the hospital for months and even years. Everybody was happy (except the patients). Thousands were employed.

Antibiotics came along and proved effective in curing tuberculosis. The need for hospitals plummetted, but they didn't close. They broadened the conditions they treated, converted beds to psychiatric wards, and held patients for longer periods of time than were justifiable. One of the biggest changes was convincing people to move child birth from homes and small clinics into the hospitals where stays were often two weeks and more. Despite this, hospital utilization dropped under 50%.

New regulations were adopted to require private and semi private rooms, each with large windows (making the interior spaces of large hospitals unusable in many cases). That used up some of the extra space and gave hospitals justifications for remaining open, albeit at a much higher cost per day. By the 1970's average length of stay had been cut in half to about 11 days, and everyone was certain it could go no lower.

However, hospitals still couldn't afford capital replacement without public financing, and medical care continued to advance. Increasingly, it became apparent that staying in the hospital was one of the major causes of reinfection. Lengths of stay began to drop again. Today, the average is 4.6 days.

Hospitals that used to serve 300 patients saw their loads decrease to non-economic levels. However, our methods of reimbursement under commercial insurance programs and governmental insurance programs simply filled the gap, paying more money for less care. In areas with strong population growth, the problem was not very evident since the beds were taken by a growing population. However, in areas with stable populations such as NYC, the impact was dramatic. There was a brief respite in the 1990's when it looked like AIDS might become the new tuberculosis and save the world from cuts (:rolleyes:). Then along came those pharmaceutical companies and the beds were empty again.

The Sisters of Mercy Hospital System mentioned in M&K's post serves just such an area. The only economic solution in such places is consolidation. Our current insurance systems have simply delayed the inevitable by paying the cost, no matter how high, and shielding the patients from the impact of those increases.

Any approach that permits economic decisions to be made concerning health care will have the effect of pruning the system. This could be done by eliminating the "socialized" system of employer based health insurance that we have now. However, if we wish to continue to rely on insurance, then more artificial strategies will need to be used to achieve some of the benefits of economic competition among providers.

Jeff...this proves a lot of the problem in this discussion.

depittydawg
10-07-2010, 06:39 PM
Jeff, a lot of people will see in your post what they fear about Obama Care, and that is government making the decisions about which hospitals will succeed and survive, and which do not.;-)

It may surprise people to remember back one generation. Almost all hospitals were owned and operated by non profit organizations and by the general public in communities around the country. They were very good at providing healthcare services. It is only the last few years that they have become "privatized" and that is when most of the escalating costs have occurred.

depittydawg
10-07-2010, 06:52 PM
I think you will find that these plans are insured by or administered by insurance companies and funded (premiums) by the particular branch of government . Not government health care.

This is correct. As an employer, the government provides an insurance benefit, as do most large companies to their employees. However, this is not the same as a 'government' system.

We have two major government systems in America. The VA hospitals that provide direct healthcare services to their members. I.E. the doctors work for the VA, and the VA owns the hospitals and the facilities. This is the closest we have in america to government provided healthcare.

The 2nd system is the Medicare (and Medicaid) system which is government provided Insurance Coverage. It is not Government Healthcare. Healthcare is provided by private business' and the fees are covered (in part) by the Government.

Would you say this is a good assessment of public healthcare in America MK?

M&K's Retrievers
09-06-2011, 12:51 PM
My only observation is these actions can add nearly 1,000,000 to the list of uninsureds rather than reducing the number which is one of the goals of Obamacare. These are just the beginning. I've said it before on this forum, Obamacare will likely double the number of uninsureds, not reduce it as supposedly intended.

I thought I should point this out. Per Gallup today, the percentage of uninsureds adults has increased from 14.9% to 16.8% since the passage of Obamacare.

Gerry Clinchy
09-06-2011, 01:05 PM
Mike, could be related to more unemployed?

As more people become insured by virtue of Obamacare, some that were insured will end up uninsured because they can't afford it; or smaller employers will cease offering it if the costs are prohibitive.

If unavailable from employers, mid-income, young, healthy people will opt for the "penalty" since it will be less expensive than the insurance. When they get sick & take coverage (since there is no penalty involved there), costs will increase for those who have been paying for insurance all along (even if they stayed pretty healthy & didn't need it).

Net result: for those who maintain insurance now & continue to do so, costs will continue to increase because those who don't have insurance, or delay getting it until they need it, will still be added to the costs of those who do pay for their insurance.

I don't think we'll see cost savings from preventative care that equal the added costs unless cancer, accidents and heart disease are controlled. Only way they might be able to do that is to do something effective about the most common causes of those health issues.