HealthCare

Politicians don't just get money from health care industry, they get money from pretty much everyone (banking, drug/pharmeacetical, guns, whatever).

But getting them to police themselves on "limits" on anything is almost futile. They did pass that campaign contribution limit several years ago, something like only one group could contribute $2500? The way to get around that is just create more groups. Or there was a max limit where you could do unlimited donations (like $100?), so you just do that a lot.
 
I was just talking with some friends last night about problems with the local school board. One of the concerns was that the system seems to easily end up where some people end up being the purported check on their own power, so they're policing themselves and therefore are actually left unchecked for all practical purposes.

Maybe people are just too lazy to avoid letting this happen. I don't know.
 
Still not sure about this, but you guys did give well thought out opinions.

Just one thing I don't agree with is the idea that Canada's "socialized" medicine is a horrible thing..... I have friends from Canada and they wouldn't want to have our style of healthcare. One of my friends had a hip replacement and cancer treatment and is very happy with the care he received. He also is self employed and without the medical coverage from the government he would have had to find a job with some company that offers it. I think one of the problems with small companies and self-employed people is that HC is so expensive (almost $9000 a year for me and my wife) that it is hard to survive in this business environment.

One thing that has to go with reforming the cost of HC is also reforming malpractice.... Going to the hospital or a doctor shouldn't be a ticket to the lottery......

Maybe a government coverage for the regular stuff and insurance coverage for the big stuff... and the politicians have to use the same systems......
 
Oversoul said:
One of the concerns was that the system seems to easily end up where some people end up being the purported check on their own power, so they're policing themselves and therefore are actually left unchecked for all practical purposes.
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Over here, two groups that have been in the news about that are judges and doctors.
 
A couple people mentioned tort reform (lawsuits) and I agree that it needs to happen. Our society is way too litigious.

Having been through it, you cannot completely remove the right to sue a doctor who makes a mistake, but I think that this is actually relatively easy to fix. When my aorta was punctured, I felt like the doctor was trying to distance himself from the situation and a few of the things that happened made me feel like I was the one getting taken advantage of and the only way I could even be listened to was to sue. I ended up having to pay a second $250 co-pay when they redid the original procedure.

I didn't sue, but there were a few times where I felt like it. Not because of what had happened, but because of how I was treated after the fact.

All doctors are already required to carry malpractice insurance. How unreasonable would it be to simply have a system where if something goes wrong during a procedure, there is a standardized settlement, regardless of whether or not malpractice was involved? Having been there, I understand the pressures to sue and I think that at least half of the lawsuits would be avoided, which would reduce costs significantly by eliminating the lawyers and court fees.

If there is strong evidence of malpractice (negligenge), then further action can be taken, but just because something went wrong medically does not automatically qualify. That's why they make you read and sign a release with a list of things that could potentially go wrong. Perhaps you could say that if you decide to sue, your standard settlement is reduced or eliminated to make people really consider their merits instead of just wanting to win the lottery.
 
From YouTube, here is Obama talking about some of the regulations that they want to put into place for existing heath insurance companies.

Around the 3-minute to 4-minute mark, he gives a summary. I'm sure this isn't everything in the bill, but it is a few more specific items:
- Disallow caps of the amount of coverage you can receive.
- Limit out-of-pocket expenses on top of premium (not sure who would determine these).
- Disallow cancellation of coverage due to illness.
- Disallow denial of coverage due to medical history.
- Require insurance companies to cover preventative care and routine exams.

I agree with some of this. I've seen policies that cap how much you will ever have to pay out of pocket, so writing policies that cap how much the insurance company will ever have to pay shouldn't happen. And cancelling coverage when someone gets sick is like rigging the lottery.

The big problem I see with the above list is the medical history. I agree that people with diabetes should be able to get health insurance, but there needs to be something in place to keep people from only buying health insurance after something happens to them or that one item alone with cause premiums to skyrocket.

But I think that the bigger problem still is that I don't see how any of the above items are going to do anything but raise the cost of premiums. I believe that there is still talk about insurance crossing state lines and opening it up to more flexibility in choosing which provider each individual or corporation will use.

In other words, I would like to know what the incentives are for health insurance companies to keep premiums low, because he keeps talking about "affordable" healthcare, but everything I heard is going to raise up-front costs.

BTW - There have been indications that Obama has backed down from the public option in order to get more bi-partisan support for the bill.
 
EricBess;285702 said:
BTW - There have been indications that Obama has backed down from the public option in order to get more bi-partisan support for the bill.
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And that is why this thing is going to crash and burn. To fix the HC in the US will take a concise, coordinated effort. Not some patchwork, feel good for every political leaning.......
 
Mooseman;285704 said:
And that is why this thing is going to crash and burn. To fix the HC in the US will take a concise, coordinated effort. Not some patchwork, feel good for every political leaning.......
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Maybe, but there has been a lot of public outcry specifically against the government option because of the costs involved and unfair market environment it would create (towards the government option), which would likely lead to a single-payer system. We are naive to think that we could do a better job than Canada or England.

I did see something saything that they had removed the end of life counselling because it could "so easily be misinterpreted", which is more of an issue because that is something that actually had a purpose.

It is also interesting to note that as far as I can tell, Sarah Palin wasn't referring to the end of life counselling when she talked about "death panels", but was instead referring to the groups that would determine which treatments would be allowed or disallowed, a practice that happens currently as well with private insurance and would also be part of the government option. It was certainly misattributed and blown out of proportion, but it isn't clear who was responsible for that. Those responsible for the original furvor were concerned over who would be making such decisions.
 
Sarah Palin????? She said something and someone cared?
Wow..... the public is dumb..... I thought that was just a saying.....
What everyone should be asking is, "What does Ransac think?"
 
So to get in late - here's my fix...

Create a public option that covers those that currently have no coverage if they choose to use it...
- Similar to cash for clunkers - it can be used if/when the uninsured go in for treatment, preventive car, etc. - similar to an "on-demand voucher program"
- This is not available to those whose employers currently provide health insurance for the individuals


Concerning business:
- create a penalty that causes the businesses to reimburse the insurance cost to the government if their programs are discontinued so their employees use the public option.
- this is not a one-time policy.
- to protect the cost of the insurance to the company - apply containment pricing to policies so insurance agencies cannot force companies into a lose-lose situation...

Concerning personal care:
- There are no bureaucrats that determine available care. Doctors will continue to determine care options, etc. as is done today.
- Referrals, second opinions, etc are performed if the patient wants them.
- All personal doctors remain personal doctors and a simplified claim process is created to ensure they receive pooled-market-value payment for services rendered.

And if they really just let me run it - it would be great... :cool:
 
train;285905 said:
So to get in late - here's my fix...

Create a public option that covers those that currently have no coverage if they choose to use it...
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How do you feel about "free clinics" for people with no coverage. I'm very concerned about what a public option does in terms of market competition.
- create a penalty that causes the businesses to reimburse the insurance cost to the government if their programs are discontinued so their employees use the public option.
- this is not a one-time policy.
Click to expand...
How would this apply to new businesses who haven't yet offered health insurance? Are they exempt? If so, does this create an unfair advantage to new companies?
- to protect the cost of the insurance to the company - apply containment pricing to policies so insurance agencies cannot force companies into a lose-lose situation...
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Doesn't any price increase become a lose-lose?

- There are no bureaucrats that determine available care. Doctors will continue to determine care options, etc. as is done today.
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Doctors don't always determine care options today. Health insurance bureaucrats must approve many treatment options.

So, the White House just released a "Quiz" to help you determine how reform will help you "personally". It can be found at http://www.whitehouse.gov/realitycheck/quiz. Thing is, as far as I can tell, the actual responses are unimportant and the list of "benefits to you personally" doesn't actually change. The URL when you click "submit" looks like it takes all of your responses into consideration, but the results page is the same.

So either 1) They are trying to gather statistics, which they say they aren't, or 2) they are trying to make you think that it is personalized so that you have more buy-in to the results.

Either way, the fact that they tack a "quiz" onto it is disingenuous to my taste, but the list of "benefits" is interesting in at least seeing what their "goals" are. Unfortunately, most of it is the same rhetoric we've already heard a million times.
 
Free Clinics -
Unless the clinics are government run - most I know of are funded through private means (I consider grants, etc - private as they are their own item, even when federally funded - and some subsidized by pharmaceutical companies...
- A current good example of a "free" public options is open-source software vs. Closed/branded software...
- Even with the free options - there haven't been many competition concerns because there is always the "merging" of markets and further development paid for in one way or another...

Nw businesses -
- New businesses could find insurance plans that fit their needs or if one is not offered - they would also bear the cost and burden of reimbursing government...
- Some companies bring on medical staff to maintain care for employees, etc. or implement health policies, etc.
- whether or not these will all stand up in court - I don't think any litigation exists on the matter yet - but it is a benefit for the company and all individuals involved to localize care.
- even if employees choose the public option - the cost for the company for that employee would be reduced.

Price containment isn't a price increase (I didn't clarify previously)
- I have already seen government cost containment be extremely effective in the electronic WIC programs.
- It basically functions by allowing all markets to participate - but regionally, they will only be reimbursed the amount charged lowest to the customer for all those in the region.
- This actually saves the program "tons" of money... seriously...

Determining Care:
- I believe doctors primarily determine care options (sometimes within bureaucrat limits) and it is ont he rise that some doctors wouldn't deal with insurance companies that don't pay for typical services and procedures they perform.
- Sometimes they don't want to deal with the claim hassles and others can refer out.
- Not every doctor can do it all, and some bureaucrats still have clout - but I think more of the independent medical providers opening up provide more options the insurance companies can either keep up with, or see drops in revenue from losing.
 
So, if I'm understanding, you are requiring businesses to provide health insurance for their employees and charging a penalty if they don't.

I'll be honest, one of the scariest things I see in what the government is talking about is disallowing insurance companies to "discriminate" based on pre-existing conditions. I'm all for that in situations where continuing coverage is demonstrated, but beyond that, the problem exists of people who won't pay for insurance until they need it...and if insurance companies are not allowed to discriminate based on pre-existing conditions, premiums will necessarily be through the roof to account for those people.

One of the "solutions" that government has proposed is sort of what you are talking about where you require everyone to have health insurance or pay a penalty for not having it.

Honestly, I'm undecided on that, but I'm leery of anything where people are forced to do something. If someone wants to "roll the dice" and not have health insurance, I say let them, but if they do end up in a situation where they need coverage, I guess they will simply need to pay for it out of pocket.

I know there is an argument that people who don't have insurance avoid going to the doctor until things get so bad that they need more coverage. I had a co-worker who ended up with bronchial pnemonia and needed surgery because he was technically a contractor without benefits. That's unfortunate.

I think part of the problem we have as a society is that we've gotten used to insurance being supplied by employers. Having been self-employed for a time, I can say that there is a huge difference between group rates and individual rates and that seems wrong to me. But beyond that, people aren't used to having to shop for insurance personally, so the insurance companies end up getting away with things that most consumers wouldn't put up with of any other industry.

Case in point - when my forth child was born, we were told we could spend an extra night in the hospital, but we didn't need to. The booklet of benefits listed a co-pay for "maternity coverage" per night. Elsewhere in the booklet was a "hospital stay", but since this was maternity coverage, we weren't worried about it and we decided to stay the extra night.

When we were billed, they billed us twice as much as we were expecting because they claimed the nightly rate for both mother and child. Personally, I would have thought "maternity coverage" assumed a child.

We pointed this out to the insurance company, who informed us that the booklet of benefits was handled by a third-party company. We called the third party and they said that they had nothing to do with what coverage was actually offered. The insurance company said that my company controlled what was actually covered and what wasn't, so I needed to talk to HR. HR said that based on what was written, we were correct, but there was nothing they could do about it. Back to the insurance company, they said that HR could decide to cover it however they wanted, but it became clear that if they wanted it to be interpreted the way it was written, that the premiums would be increased accordingly.

In short, not accountability and 3 different companies involved, all able to point the finger somewhere else. We wouldn't put up with that if we were purchasing a car, for example, but because the consumer isn't the one making the purchase, the system becomes bloated with too many middle-men.

I guess my big problem with the health-care reform, though, is that while there are certain things they are wanting to do to actually address the problems, there are far more things they are trying to do that just redistributes where the problems occur. I think reform would be great (I'm not sure I would go so far as to say necessary), but I don't like much of how they are going about it.
 
Yep - basically, "PoP - Provide or Pay"...

My issue with pre-existing conditions being used to hold benefits for a time period is that in most cases, it prevents the individuals from getting the proper care they need at the time they need it... for most medical conditions, they can easily worsen if they are prolonged, and pre-existing conditions can do just that...

As for the dice-rollers - I'm all up for people not taking insurance - but more along the all-or-nothing lines... Example - the idiots near Los Angeles that recently decided to stay with their homes instead of evacuate during these fires - when they do that, I don't think anyone should be sent in to rescue them... no one, no thing, period.
- Same for insurance - if you decide to opt-out - you are out - period. No undos, no retries, nada... You can't get coverage later... And in this case - the company wouldn't be penalized...

Concerning the insurance company being able to get away with things - this is another place that price-containment could be imposed... though it allows a fair amount of business to continue, it would prevent abuses and level the playing field for insurance companies.
 
I agree with you completely about the dice-rollers, which is why the "no discrimination based on medical history" is a problem. But I also agree with you about the holding of benefits. I am currently in chronic pain. If I were to switch jobs and then had a 6-month waiting period before I could get my meds, I would lose that job.

But I see both of those as very easily reconciled if you simply have to demonstrate continuing coverage. You avoid the problems of waiting while not allowing the dice-rollers to simply get insurance only when they need it.

I'm assuming that when you say "never", you mean with respect to pre-existing conditions, right? Someone graduates from college and starts consulting, so now they feel they can afford it, but don't have it through a job situation, for example.

I have an aunt that worked for a non-profit health insurance company. The end of the fiscal year was approaching and the company had made money. Because they were a non-profit corporation, they had to spend that money or lose their non-profit status.

So, rather than reduce premiums, everyone in the company received a bonus.

I personally feel that health insurance companies should be non-profit, but under the current rules for non-profit corporations, it doesn't work. The current rules mean that they cannot show a profit during any fiscal year. But the nature of an insurance company is that some years, there are more claims than in other years.

I think they need to revise the non-profit rules or at least apply them differently for health insurance companies. Allow the company to have a certain amount of flexibily in profits, but require that premiums are adjusted accordingly. So, in the case of what happened with my aunt, let the company retain their profit instead of giving everyone a bonus and lower premiums the next year by a certain margin to compensate.

Under the current model, bonuses are paid during the good years, and the company goes bankrupt during the bad years. That's not a recipe for long-term success.
 
Demonstrating continuing coverage could be a required factor - but setup guidelines that must be followed in order to obtain the coverage... these always make or break a plan..

By never I mean that if the individual has the option to obtain insurance for a plan other than public (with current company, organization, etc.) and they decline, they are not eligible for it for the remainder of the time they are there... If they switch jobs, it opens a window of opportunity - but again - if they decline, and then 10 years later when still with the same company - they decide to change heart because circumstances have changed - its a no-go... It should not be a "get it when needed" bit...
- Pre-existing conditions could be one of these also...

This may not be the case everywhere - but I believe that non-profits can always show a no-profit - but I believe it stems through proper management and a new type of monitoring for them...
- and you provided a good example...
The non-profit should place the profit funds in an endowment that includes a planned growth/expense % allotment... This type of fund should be monitored by federal agencies to ensure proper use - but be a safe-haven that allows the non-profit to ensure operating funds into the future... It should also be made necessary that the expense percentage be used to support community efforts, etc. that better social and community benefits.

The remainder of the expense portion is used to provide fiscal resources for items extending beyond budget...

The growth portion is an amount that must be kept in the endowment to allow it to continually grow, and not just remain at a base amount with interest on that amount being distributed. This ensures the endowment would get bigger and bigger and never fall below a minimum amount...

If necessary in the future, the endowment may be borrowed against - but only by amounts that can be covered through future budget allocations that may include the expense portion of the amount distributed from the endowment...

***-Forgot to mention that there would need to be legislation that would not consider money placed into this account as profit as it has to remain in the fund unless used for the social benefit or absolute need for operational expenses...
 
Yes, I like that. But there do need to be limits to how quickly it would grow and require premium reductions rather than allowing the endowment to grow unchecked. If the endowment does need to be borrowed against, then they would certainly raise premiums to compensate, so the oposite should also be true.
 
Well - premium reduction could be a benefit - but if borrowed against - the expense portion would cover the loan repayments... that is the main reason for it...

premium reduction could also be considered an expense since it would reduce revenue

As the planned growth % amount is met - it limits the growth of the endowment - but there would easily be potential to develop another endowment.

As these are in place, the overall cost to insured should reduce since the company would not need as much revenue - but still be able to provide for it's employees and insured in the proper manner... (raises, benefits, expansion, etc.)

edit: Working with non-profits previously - this is a master plan that I have yet to see in place - but I believe could be highly successful...
 
Anyone here have some spare capital that we could use to start a CPA health insurance company?
 
I'm up for looking into it... There are times where you have the idea-makers (our case) and the capital providers (the other party/ies) we need to find... it could still be a non-profit returning their investment with "interest"...

:cool:
 
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