How's That Obamacare Doing...

[depittydawg]

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]

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]

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.]

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]

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]

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]

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]

Millions or thousands Mike? JD

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[ducknwork]

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]

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