Healthcare/Convince me

[Night Train]

Alright everybody. I am always soooo very impressed with how some of you present such intelligent arguments on so many important issues. I would love to hear what you all have to say about healthcare. Im quite certain that we in the United States have it pretty well off compared to the rest of the world, but Im also certain that we could be doing a lot better. As for me, my ex wife was a state employee and...well...we had the best of the best coverage. I rarely paid for anything. Since the divorce, Ive had to go on the program my work offers (A small business type plan) And well....It really sucks, comparitively speaking. Today, for instance, I spent $90.00 at the dentist. (A visit that was free before) And I was told Ill probably have to pay another $200.00 by fall. (Again...free under state plan) So Im thinking, whats wrong with a national health care plan? And would it help ME? If im struggling with healthcare cost THERE MUST BE MILLIONS who are really hurting. Shouldnt SOMETHING be done? Are there any REAL good answers?
Dwayne

[Steve Machol]

Heathcare and insuarance costs are pretty bad in this country for many, including if you are self-employed like I am. I just got notice today that my plan (which has a $5000 annual deductible) has gone up another 25% to over $500/mo!

Note: Both my wife and I are healthy and have had virtually no major medical expenses over the last 10 years. However that did not stop several insurance companies from refusing to cover us.

I can barely afford this payment now, and in another year it's very likely I will not be able to afford insurance at all.

This is a big concern for me and frankly in the not too distant future it's possible I won't be able to afford medical insurance in this country.

That's what it's like for me.

[Steve Machol]

Oh, and for the person that left this comment in my reputation box:

quite misleading.. not enouph info..

Please kindly explain what was misleading about my post and what other information you require.

[mrba]

Your post is mileading in the sense that you do not list all of the factors that go into an insurance companie's rate decisions (including greed).:) In that sense there is not enpouph information.

Past health history, continuance of coverage, age, diet, income level, family pathology, etc etc could be in your file and you not know it.

I for one would not like to see a bandaid funded by taxpayers for a national health plan. I see no reason why the health and Law professions need furthur subsidy!

[Steve Machol]

Where anywhere did I state I was in favor of bandaid funded by taxpayers for a national health plan? I was telling you my current experience and situation. And how is anything I posted misleading?

Both my wife and I have very good health and histories. We had to submit 10 years of medical records to each of the 3 insurance companies we applied for. Cigna and Blue Cross/Blue Shield both turned us down. The reasons they gave were misinterpretations of some of the Doctor records they reviewed. We had the Doctor write a letter clarifying these issues, but neither insurance company budged. I honestly don't know why since their stated reasons for refusing coverage were illegitimate as confirmed by our Doctor. If I had to guess, I would say they didn't want us because of our age (49 and 50 at the time.)

The third company did approve us - Golden Rule. We were able to obtain a policy with $1500 deductibles for each of us - $3000/yr for both. Two years ago that cost was $325/mo. Not very good coverage for that price, but it was the best we could do.

One year later, they informed us the rates were increasing to $440 - a 36% increase. During that year we had absolutely no medical expenses. I couldn't afford that amount so we increased the annual dedeuctible to $5000 ($2500 each) and the rate only rose to $393/mo.

During this past year we have had about $800 in medical bills - not of them covered by the insurance because of the high deductible. One was for an emergency room visit after I got stung on the thumb by a scorpion. That came out to $500 alone. The others were some problems my wife was having with her feet.

Today, I got the notice that our rates were increasing from $393/mo to $502/mo - a 27% increase. The sad fact is that I don't make enough money to afford that amount. Sorry but my income is none of your business so I won't provide you any more details no matter how many negative reputation comments you leave. ;)

I have contacted our insurance guy and we'll meet with him to see if he has any other ideas. It may be that we will be forced to take a very high deductible (probably $50k annually) and can only afford coverage for something catastorphic.

If anyone has any advice I'd like to hear it. I'm sure some of you have been in similar situation. One thing we are going to look at is Medical Savings Plans, but even then I will need to have some sort of catastrophic coverage.

The fact is that medical insurance and healthcare costs are increasingly unaffordable to a large segment of Americans - myself included. I realize that you don't really care and believe this is my problem to deal with, and that's fine. I'm not asking for any handouts. I would just like some affordable and reasonable options.

Is that enough information now?

P.S. I fogot to add that we are both non-smokers and have been for over thirty years. That's supposed to count for something. We rarely drink, have never been arrested and as I said we have had pretty good medical histories.

When I can do it without breaking down, I'll try to tell the story of my beautiful Daughter Liz - one of the many working poor in this country that have full time jobs but no health insurance. In her case this had deadly consequences. On the otherhand I'm sure you really don't care about that either so why bother.

[Diane]

Steve,

You went over and above in your explanation to a worthless question and/or unjustified comment. I admire your ability to maintain your composure, as this was certainly an obviously intended slam. No person has the right to basically demand answers to personal questions here, and place a poor comment in your reputation if you don't. Of course, I'll probably get one, now.

Diane :hammer:

[hcjilson]

Unfortunately, Congress does not have the coujones to attack this problem. The simple fact of the matter is that they owe too much to the insurance lobby's.Lets face it, a National Heath Plan would seriously curtail their profits so it is not in their interest to move in that direction.The CEO of BCBS in MA is paid somewhere in the vicinity of 5 million a year. NH pays their CEO about 7 mill. That money has to come from somewhere. The insurance companies have squeezed the docs about as far as they can go, so now, its back to squeezing their customers.They work in concert, and they hold all the cards.

Steve, if Arizona has an insurance commision, I would bring the refusal of BCBS/et al to their attention and call for a hearing on your complaint.Someone from the companies involved with have to respond and given the circumstances listed, they're going to come up looking pretty bad. They HATE that kind of publicity.

Nothing will happen until folks like Night Train, Steve, and all the others who are disinfranchised from adeqate heath care make noise.....a lot of NOISE. I'd get into the politics of it but don't feel that those who have worked so hard to address this problem deserve the bashing they would get here...specifically Senator's Kennedy and Clinton.For all that anyone can say about them, they have been up front trying to solve this problem.

hj

[Pete Hanlin]

Unfortunately, Congress does not have the coujones to attack this problem.
This will be yet another area where we simply disagree. In my opinion, this is an area where Congress needs to have the wherewithal to leave it alone! This was exactly my point with drug coverage for seniors. Procuring healthcare is not one of the governent's responsibilities.

This is my reasoning- and since I'm putting it here it is naturally open to criticism... Let's assume the government creates a program to make sure all citizens receive insurance. The problem is, everyone is not equally "insurable" (if I'm 255 lbs., 62 years old, and smoke, the financial exposure faced by a company providing my medical coverage is pretty high).

Additionally, insuring individuals is also prone to high exposure- as is the case with Steve. For instance, if I insure a group of 10,000 people, I can calculate the likely average cost of their medical bills and come up with a group rate. If I insure just two people, it is much harder to predict the average likely cost of their medical care (if one person is diagnosed with an expensive condition, my cost for covering that life just skyrocketed, and I have no group to balance out the cost).

So, the national government would need to average in the cost for, well, pretty much everyone. For a lot of people, this will mean higher rates than they pay now (or, it will mean increased Federal deficit spending if taxes aren't increased to cover the cost). Also, the government- which doesn't care if it makes a profit or not- will naturally ineffectively manage the business of healthcare provision (like Medicare does now). Also, in an effort to actually control costs, the government will likely put caps on all procedures (like Medicare does now). These caps will no doubt be lower than the private pay fees charged by doctors.

Great! Nail those docs we all say! Well, sure- except there will be less money to be made in the medical field, so less people will seek to enter the field and those who do will be people who couldn't make more money doing other, more profitable, things (that's right, we don't live in a vacuum- people are not going to endure medical school and internships for the "altruism" of being able to perform open heart surgery for the $3,000 cap- or whatever it turns out to be).

At this point, we will have one of two systems naturally come into place. Either some docs will simply refuse to be part of the national health plan (and therefore be able to charge what they desire). At this point, you will really have two healthcare systems- and the Dems will really cry about the "inequity" of it all. So, we will probably end up with the other alternative- namely, all medical professionals HAVE to participate in the national healthcare system. Of course, this means you are stuck with whatever the result is- with no alternative providers (unless you go to another country that hasn't socialized their medicine yet).

The simple fact of the matter is that they owe too much to the insurance lobby's.
The simple fact is, the Dem party owes too much to the litigation lobby to put any caps on things like malpractice lawsuits. One of the largest inflationary factors in the cost of healthcare is the cost of malpractice insurance and the costs of all the unnecessary tests performed to avoid being sued in the first place.

Yes, there are uninsured people in this country who require a solution- no, it is not a good idea to nationalize a private (and heavily regulated) industry like healthcare in the name of "covering all." Control costs by controling litigation. If we have to pump more money into a non-governmental activity like healthcare, let's figure out ways to invest in things like the pharmaceutical process- fund the R&D with an arrangement that certain non-elective drugs will be cost controlled. We'll find out R&D for a drug that has real benefits and makes it through the FDA process is a bigger gamble than people think (which is part of the reason why some drugs are very expensive).

It comes down to this- healthcare is a business. That means people enter it to make a living. Heck, WE are in the healthcare business. You mark up your frames and lenses, right? Can all people afford the glasses you sell- probably not. Is the answer to have the government purchase glasses for everyone, tell you how much you will receive for your services, and limit what you can sell (anyone out there ever take Medicaid- wanna try to build a whole business upon Medicaid- thought not)?

Healthcare costs money- even when insurance "pays" for it, it is costing money. Truth be told, if we just went to ALL private pay (no insurance whatsoever), the healthcare system would be far more efficient, costs would be reduced, and we'd all be happier- it would be a more free-market environment. However, this brings us back to the reason for insurance- its basically a bet. If you pay the insurance and don't get sick, the insurance company wins. If you pay the insurance and contract a horrible and prolonged illness requiring $1,000,000 in procedures, you "win" (well, sorta).

[mrba]

Where anywhere did I state I was in favor of bandaid funded by taxpayers for a national health plan?

You didn't. I felt the comment was in line with Night train's oridginal post.

I was telling you my current experience and situation. And how is anything I posted misleading?

I suppose you are correct. How could you be wrong about your own expirience. I think I just read into what you said a bit much. I apologize.

It sounded as if you were implying that all the good information in the world to the insurers would help you, and that just is not the case.

The lawyers that sue sue sue sue, and drive up the cost of healthcare are mostly to blame... Not the drug companies, and to a lesser extent not the HMO's. I'm sure everyone in the chain is to blame for some greed, but especially the lawyers, to whom a huge chunk goes. How else could one explain 30% increases every year...

In my company we are perhaps in a more desparate situation than you. Not only can we not afford to insure our people, but even when we jump that line (and we will be very soon) it will not be enouph. There are those that work for me with pre existing conditions and no insurance. Without medicine they would die quickly. I am not sure what i am loking at yet, but Somehow we are going to have to pass the buck amongst ourselves and our customers to make it work...

Diane And Steve,
In the past perhaps I thought I was being too sensitive about reputation comments... hence they are private, I didn't think it a big deal. But I am not one to sit and hide when called into the open... And I am not too worried about the reputation of a moderator. Reputuation comments are stupid. I would just settle for the comment... and I personally could care less what my reputation is, as would most grown ups on this web site I would assume.

Pete,
I just read your post... Please tell me when our represenatives will take on the lawers? I'm not as worried about the insurance lobby... And never mind, they are mostly lawyers after all.

Best Regards,
mrba

[ikon44]

here in the uk we have the much maligned NHS but it will treat anything from an ingrowing toenail to heart surgery ( part of its problem).It does need updated,

I find the US system very iniquitious, someone like steve machol who is an honest lawabiding taxpayer, can have his life savings confiscated by the medical industry if he is unfortunate enough to be ill, it STINKS:angry:

It seems to me the only people who are doing ok are the lawyers and the insurance companies. Doctors are paying massive insurance fees in case they are prosecuted for malpractice/negligence, ambulance chasers are encouraging people to sue, as they may win a million dollar payout. so everybodys fees and
costs go up.
I dont know how you solve it... put a limit on payouts ?
there must be millions of people in the same boat as steve, perhaps if they all paid their 300 dollars a month direct to a hospital instead of an insurance company and funded it directly they would be members of that hospital. and would be treated by it.

anyhow hope you dont mind a Brit putting his tuppence worth in .

[Pete Hanlin]

I dont know how you solve it... put a limit on payouts?
Precisely how to solve it. Most people think their doc is on "easy street," but medical professionals make less than one might think (and certainly anything they do earn is earned- given the training required).

Naturally, I'm not aware of the particulars of Steve's health insurance- but it would seem there should be a group policy of some kind out there. If the government could resist the temptation to start subsidizing it, perhaps one program could be for the government to create a group policy for people who want to participate. Unfortunately, this is basically what Medicare represents- and it is grossly mismanaged, IMO.

Plus, for every person who cannot get health insurance for a reasonable price, you have at least one or two people like me- it costs me (and the company I work for, which also chips in) about $200-300/month to insure my family of 4 with a per person deductible of $500/person. To me, that's reasonable enough... (we certainly don't use up over $3,000 in services in an average year- so for now, the insurance company makes a bit on us- but someday, one of us might become seriously ill, so...).

Anyway, our insurance situation is not as good as a government employee's benefits, but heck, those friendly, dedicated, always helpful fed workers deserve the best of everything I can afford for them!

[Steve Machol]

Harry,

Arizona is generally regarded as one of the worst healthcare states in the U.S. Consumers have almost no rights via the Insurance Commission and Insurance Companies have free reign to do pretty much whatever they want.

[chm2023]

IMO the US will have a version of universal coverage in the next ten years. The HMO, third party system we have is hugely wasteful in that way too much money flows into the coffers of people and institutions not providing care. Everyone's premiums are going up, and the insurance companies say this is due to malpractice payouts etc. Try this little exercise: look up the financials of any of the big insurance companies. Take a look at the earnings trend. It's quite interesting.

I have said this before, but again: Canada pays less % of GNP for healthcare than we do in the US, everyone is covered, life expectancy is higher, infant mortality is lower.

One of the underlying problems here that is rapidly coming to a head is that our demographic make-up is skewed toward the elderly and the quite elderly. The hard truth is that a large portion of health care dollars are spent on people who have little quality time left. You see where this is leading and it ain't pretty.

My husband is a doctor, my sister and niece are nurses. They all tell me that checking into a hospital is becoming quite a risky business--more and more tasks are being handled by people with little training.

I guess this is why I am so confident we will have a major change in this area, clearly draconian measures are called for.

PS Steve, you're a better man than I am friend.

[chm2023]

It comes down to this- healthcare is a business. That means people enter it to make a living.

But does it need to be a for profit business? Why is education publicly funded and not healthcare? Even private colleges are non-profits. I remember when hospitals were run by religions and municipalities. Is what we have now really better, or as good as that system? Well it's good for investors in hospital corporations, but I scarcely see anyone else who benefits.

Capitalism is terrific for many things, but not really sure that includes healthcare. Think of it this way, in any market situation, there are winners and losers. Are we comfortable looking at healthcare that way? Because that is what is happening. This anything for a buck mentality has gone way too far.

[mrba]

I have said this before, but again: Canada pays less % of GNP for healthcare than we do in the US, everyone is covered, life expectancy is higher, infant mortality is lower.

Yes but there is a completely different standard of care. I suppose Canadians come here for healthcare for a reason...
You get what you pay for in life.

[ikon44]

Yes but there is a completely different standard of care. I suppose Canadians come here for healthcare for a reason...
You get what you pay for in life.

so if you can pay , you live

if you cant then you might not,

surely there has got to be a more humane way of dealing with this.

[mrba]

I agree. There is a better way.

[walt]

so if you can pay , you live

if you cant then you might not,

surely there has got to be a more humane way of dealing with this.

I agree that there has to be improvement to make insurance affordable. Here are some random observations...

The high costs are not just the fault of one individual influence. Just about every player in the system can stand to be corrected For example...

Medical malpractice -
Lawyers are often vilified,yet most of them would be out of business if they had no valid cases. Unwashed hands during surgical proceedures, leaving surgical devices inside patients, performing the wrong operations due to sloppy medical records, cross-contamination, and on and on. Check Google for "medical malpractice" and you get 1,160,000 hits loaded with case histories. This causes vast increases in malpractice insurance for all parctitioners and the costs are passed to the patients. If the medical community cleaned up its act we wouldn't have to worry about the lawyers.

Insurance premium misuse -
Some years ago a major insurance company had a side business investing in Denver real estate. They bought some major skyscrapers. When the realty bubble burst, they found themselves stuck with some bad investments. To compensate for their loses, they raised their insurance premiums. Their insurance customers were treated like a herd if dairy cattle. I don't know if this kind of stuff is still going on but assume it is.

Price fixing -
Today California has a rather good insurance commission watchdog to control this and other industry abuses. Apparently many other states don't?

Stop abusing your policy -
A friend's wife takes her kids to the doctor everytime the kids get a cold or someone wets the bed. They've got three kids and she's at the doc's at least once a week because her husband's insurance pays for it. What do you think that does to the cost of insurance for those of us who may seek medical attention once every 5 years?

Summary -
Get the medical community to clean up its act. Less law suits, less lawyer involvement.
Force insurance companies to get out of any business other than insurance.
Get better state supervision to watch 'em every minute.
Don't milk your benefits.

[Steve Machol]

Walt, yes all of those are important contributing factors to spiraling healthcare costs in this country. The question then becomes, what can we do about this?

I know it's easy for people with insurance to turn their backs on people who cannot afford it, but there's got to be a better way then blaming the non-insured for their predicament. There are millions of people working full-time jobs without medical insurance. Let's face it. There are millions of jobs in this country that do not offer benefits. Someone has to fill these jobs.

Unfortunately this problem is far too large and pervasive to be solved with a simple solution. It needs to be addressed from all angles as Walt points out.

And Pete:

In my opinion, this is an area where Congress needs to have the wherewithal to leave it alone!

I disagree. The first sentence in the Constitution states:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

This issue is at least as important as general defense.

[rep]

Hi Everyone:

As a former employer, health insurance was a major expense for me. I covered my employees 100% as long as I was in business (1977-1996) It cost me plenty. Roughly 25 to 27% of every dollar in salary. Now I don't know of any independent who does not pass the cost along to the employee. At that time I could not pay for my personal insurance with out paying for my employees too. That may not be the case now but at one time everyone had to be covered equally.

I am shocked at how LITTLE your paying for insurance. I am 57 my wife is 55 and my daughter in college is 23. Non smokers, no pre-existing conditions and my payments are $738 per month for an HMO. Even with this I have no dental and no prescription drug benefits.

Having said all that the government is not the answer. National healthcare would a momumental disaster. Remember these are the people who run the post office and with billions of support they can't beat UPS, DSL and Fed X.
The proposals I saw in Washington while I was there from 1997 to 1999 regarding national managed care HOM's were worse than any you could possible imagine. The inpending baby boom move into senior status will have a lot of implications on every working family and few of them are beneficial.

I too will be shopping for insurance soon, as my daughter is graduating this August, so she will be off my insurance, off my auto and off my credit cards.
Come to think of it I might just be able to pay for it after all.

Rep

[walt]

Walt, yes all of those are important contributing factors to spiraling healthcare costs in this country. The question then becomes, what can we do about this?

In California enough people raised enough hell to get the state to create a strong insurance commissioner, with amazing results. It didn't require federal intervention, just some damn good policing. Maybe the same could be done in Arizona. Get the medical community to clean up its act. Just like good sh*t flies and maggots, you can't blame the ambulance chasers for doing their jobs.

I know it's easy for people with insurance to turn their backs on people who cannot afford it, but there's got to be a better way then blaming the non-insured for their predicament.

You're right. Don't know how easy it is, but everyone SHOULD be able to afford it. Being self-employed, there was a period of years when we went without. I used to be pi*sed at the insurance companies for gouging, which I'm convinced they were, and probably still are. But I think the whole game's now become much more complex as I noted above. My concern is that unless we resolve those problems first, no ambitious government takeover will make the problems disappear, but rather add another enormous layer of expensive bureaucracy to it. (Ever known a gov't agency to try to cut waste?) It needs a much more holistic approach.

promote the general Welfare,

You Bet. But again, I believe it begins with first cleaning our own house. I think you would agree that throwing the world's biggest bandaid over a person's cancer will not cure the cancer. It will only create a good place to hide while it continues to grow.

During the politically polarized precious plastic-flower-children hippy days of the '60, it was fashionable to flaunt bumper stickers saying "America, love it or leave it."
No one ever suggested "Love it and fix it".

[mrba]

promote the general Welfare

Where do you draw the line then? I for one would love to live in a mansion.

[Steve Machol]

I am shocked at how LITTLE your paying for insurance. I am 57 my wife is 55 and my daughter in college is 23. Non smokers, no pre-existing conditions and my payments are $738 per month for an HMO. Even with this I have no dental and no prescription drug benefits.

Little is a relative thing. Obviously you are making better income than I. ;)

Nonetheless I'll hazard a guess to say that you're policy probably does not include a $2500 deductible per person before any benfits kick in. Considering this and the fact that you are covering 3 people to my 2, I'd say you most likely have the better deal.

Like you I don't have dental. I do have prescription drug coverage though but that falls within the $2500 deductible per person. And like many Arizonans we go to Mexico to purchase prescription meds when we need them.

Having said all that the government is not the answer. National healthcare would a momumental disaster.

I used to believe this too, but I'm not so sure any more. The facts from other industrialized nations don't seem to support this conclusion. Besides, we already have national health insurance. The problem is that it only covers the wealthiest segment of our society (Medicare for the elderly) and the poorest segment (Medicaid).

The people left out are: 1) the ones in the middle who work fulltime but don't have health coverage through their employers, and 2) the self and under-employed.

Right now my taxes (and being self-employed I pay a lot of them) go to pay healthcare costs for Seniors and for people that are in this country illegally. The irony is that I may soon not be able to afford health insurance for myself and my wife while my taxes go to pay for this coverage others.

[JennyP]

Ok, I don't feel so bad anymore about my costs for healthcare ($797/mo, $500 deductible per year on at least 2 of the 3 of us; no dental, but semi-decent drug benefit) through my husband's retirement plan. I cringe every time I write the check for our premium. I have to keep working to afford the insurance!
The ONLY reason we keep the plan is that there is NO lifetime cap on the benefits paid out....and we have a permanently disabled daughter who has been covered since birth and has been known to rack up a $100,000 expense year, and most years at least $10,000 in dr visits, equipment replacement costs and high tech tests to monitor her health. We count ourselves lucky to have the plan! Fortunately, we are part of a VERY LARGE group.

[walt]

Where do you draw the line then?

I'm definitely against big gov't. But I also firmly believe in providing a safety net for those unfortunates who through no fault of their own need our common support. There's a vast difference between those who purposely "tune in, turn on, drop out", those who work just enough to get by, and those such as the mentally or physically impaired who have no options. The truely "Homeless" vs "The Professional Camper". As in most things, it's not an "either-or" problem but somewhere in-between.

I for one would love to live in a mansion.

Marry a rich woman (or your significant-other). :D

Ouch! Just felt another negative Comment being pasted to my Reputation.