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Thread: Where Do You Get

  1. #11
    Senior Member road kill's Avatar
    Join Date
    Feb 2009
    New Berlin, WI


    The reason people think "The Obama" wants single payer is because HE said he did.


    Should we not beleive what "The Obama" says??

    stan b
    Stan b & Elvis

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  3. #12
    Senior Member
    Join Date
    Jan 2003
    Boston, GA


    I worked in the P & C insurance industry for a long time at some fairly high levels. Therefore, I know some of the "tricks of the trade" when it comes to Loss Ratios. Like you indicated, Loss Ratios take into account the loss paid vs the premiums received. However, in the losses paid area it includes all claim expenses including claim employee salaries, legal fees, expert fees, and some reserves set aside. Very easy to hide money in thses areas to drive up your Loss Ratio and then ask the state for higher rates. The sad thing is that the state hardly ever audits the companies books to catch this type of abuse. Even if they did, the state auditors would not be smart enough to catch it.

    I think the best way to guage it is to make it a pure claims paid vs premiums received. This way if a company wants to overpay their staff or legal fees, it only hurts them. Of course you could get into premiums received vs earned premiums, but that's another discussion.

    Just my 2 cents.
    Tom Dorroh
    Boston, GA

  4. #13
    Senior Member tpaschal30's Avatar
    Join Date
    Oct 2005
    Salisbury, MD


    Quote Originally Posted by YardleyLabs View Post
    If the only reason employers have for providing health benefits is to avoid paying penalties, why do you think that they now pay more than 11% of payroll in health benefits when there are no penalties at all? The fact is that this provision is directed at employers such as Walmart which provides no employer paid healt benefits to half of its employees. Given that Walmart now pays about 5-6% of payroll for health benefits, but that these benefits are restricted to only some of their employees, I suspect that they will restructure their health plans if the law is passed.

    With respect to single payer coverage, there is no proposal to implement that. Why do opponents feel compelled to make up false claims to justify their positions. Are arguments against the actual proposals that weak?

    With respect to your proposals regarding universal catastrophic insurance, I believe those have merit. Would the catastrophic plan be a single payer plan? A pure high deductible plan, as distinct from a plan with significant co-pays and a high out of pocket maximum cost limitation as the tendency to encourage people to defer preventive care and treatment of problems before they become too serious. This actually ends up increasing total health care costs.

    With respect to regulation of the insurance industry, the principle sounds good. Unfortunately, the reality is that most buyers of insurance are not able to understand or evaluate policy language and typical marketing materials walk very close to the line of being criminally fraudulent. This is apparent in those segments of the insurance market that are not regulated where policies typically have loss ratios (percent of premium paid out for claims) of less than 50%. To put that in context, most state lottery programs have a higher payout than most unregulated insurance policies.

    This level of profit is typically sustained through a mix of gotcha language to exclude claims, cancellation provisions that are exercised as soon as you file a claim, and abusive claim management procedures designed to force claimants to give up and settle for lesser amounts. A policy of "buyer beware" is inadequate when it is not reasonably possible for a buyer to evaluate what they are buying. While it is neither possible nor desirable to protect the consumer fully, a certain level of protection is essential. That's why we have, for example, relatively universal standards governing merchandise saying that a good must be suitable and usable for the purpose for which it is advertised. Services such as insurance require similar csonsumer protections.
    They would rather pay a 8% penalty than an 11% HC bill. Walmart won't restructure, they will drop it totally letting employees go the public option and pay the 8%.
    The bill is setup with the above mentioned where employers will opt out and everyone will end up on the public option. Except congress of course. That is how we get to single payer.
    The catastrophic coverage would allow people to purchase stop gap insurance. Preventative behavior will increase when there is additional charges for health care rather no extra charge really in the present system. How often would people check their oil if there was an 80/20plan covering repair bills on their autos. People need "skin" in the game.
    You get much more info on insurance policies than you do from your health providers, who do not show results stats much less pricing where comparisons can be made like they can in insurance. (A fool and his money are soon parted.) The info is there consumer advocate groups to discussion forums. Doctors are not allowed to advertise price and operate under a veil created by the current ins. structure, the AMA, and custom.

    Just noticed this Jeff. The small employer pays less than 8% penalty down to 0. They have more incentive to move their employees to the public option.

    "f the annual payroll of such employer for the preceding calendar year: The applicable percentage is:

    Does not exceed $250,000 0 percent

    Exceeds $250,000, but does not exceed $300,000 2 percent

    Exceeds $300,000, but does not exceed $350,000 4 percent

    Exceeds $350,000, but does not exceed $400,000 6 percent "
    Last edited by tpaschal30; 08-13-2009 at 10:07 PM.

  5. #14
    Senior Member Hew's Avatar
    Join Date
    Jan 2003


    Quote Originally Posted by YardleyLabs View Post
    With respect to single payer coverage, there is no proposal to implement that. Why do opponents feel compelled to make up false claims to justify their positions. Are arguments against the actual proposals that weak?
    There was no proposal within the 1935 Social Security legislation that said, "...and endeavor to create a multi-tentacled leviathan that takes money out of every working American's pocket and give it to the government so that it can be squandered into insolvency by both politicians and a bumbling bureaucracy and whatever's left over can be given back to those we took it from...after taxing it, of course" but here we are.

    And I don't believe there were any provisions in Lyndon Johnson's Great Society Legislation that said, "...we will create generations of Americans who are cradle-to-grave wards of the working tax payers, and oh yeah, while we're at it, let's wreck the black family unit" but again, here we are.

    Sorry, but it doesn't take much imagination to see where this particular health care reform will eventually take us.
    I'll take the river down to still water and ride a pack of dogs.

  6. #15
    Senior Member K G's Avatar
    Join Date
    Feb 2003
    southeast us


    C'mon, Hew....the BHO machine is here to SAVE us....can't you see that? Surely they wouldn't say one thing then do another...or NOT say one thing and then do it later because it's not on paper now...where's your FAITH, man?!?!?!?!?!

    Pay no attention to the man behind the curtain regards,


    Just a reminder from my buddy George Santayana...."he who forgets the past is condemned to relive it...."
    I keep my PM box full. Use email to contact me: rockytopkg@aol.com.

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