Health Insurance Debate

[LaughingCat]

First, I have no interest in starting a dark, antagonizing, insult-hurling, threat imposing debate. We need a health (pun intended) discussion on major concerns about the health insurance. If we are going to have a worthwhile debate in this country, it needs to start with direct communication amongst peers, not through the cable news programs.

Below, I am going to paste a letter sent to a blogger about health insurance and paradox of being the "insured/uninsured", not the doctor or insurance company. I'll let the letter speak for itself, add my thoughts beneath it, then look forward to hearing points from my different views on this.

For a few months, I worked at an electronic medical billing company. I was astounded at how complicated and convoluted medical billing is, and this is ultimately why we need to have significant health insurance reform. What happens is a doctor's office will decide on a price for a procedure - for instance, a checkup typically costs around $180. Say I have Tufts. They might pay out $100 for a checkup - the rest the doctor writes off. Why not just charge $100 and not have to write off $80? Well, that's because other insurance companies - say Blue Cross and AETNA - might pay $120 and $150 respectively. So it make sense for doctors to charge significantly more than they would expect from most insurance companies. However, if somebody doesn't have good insurance or has no insurance, they are billed for the full amount -$180, even though the doctors office might expect to write off up to $80 dollars of that charge from somebody with good insurance. Given that the majority of the people without health insurance are lower income, this can cause crippling financial problems, or result in a denial of service. And why? Is someone with insurance "better" than somebody without? Are they more deserving of good health because they happened to not get laid off during a particular bad recession?

The problem with predicting medical expenses is that, even though you can find the codes (they're called CPT codes and you can find them here) you would have to get the price from the doctors' billing coders, which they would probably be loathe to give out- how can we expect the market to work when the consumers don't get to know the price BEFORE consuming? And your other reader didn't include that if you get an ultrasound, you're billed for the ultrasound and the use of the ultrasound machine. If you have the time to sit down and do the research, it would be nearly impossible for the average person to make an accurate decision about the most cost effective doctor to have. Imagine trying to make that decision in a panic.

There are many enlightening issues addressed in this letter. As a health care consumer, I find it troubling that doctors have to 'game' the system in order to get paid a decent amount for their work. But the part I highlighted is the scariest. I cannot fathom a scenario in life where we enter a situation on understood pricing, but are legally bound to pay the much higher "surprise" price after the work is done with no recourse. At this mooment, I can only compare this to the operating methods of Sea-Tow.

Maybe someone on here has experience with being the uninsured and getting jacked like this. Help me understand why we are not all engaged in some kind of debate AGAINST the insurance companies and these practices?

I have more thoughts, but want to hear yours. I want to hear them all. i want to understand the rationale of any views different than mine on this.

[sledge]

The highlighted question is a valid one. But people need to take the personal responsibility to educate themselves. Anyone, even if you have insurance, can go in and offer to pay "reasonable and customary" charges...with cash. Some doctors will be glad to take your payment and not deal with the hassle of billing insurance. Some doctors will tell you that even if you have insurance, they expect you to pay the difference between what the ins co pays and what the dr charges.

It's the insurance companies that set what's called "reasonable and customary" charges for every single billing code. The only reason drs accept the lower prices is the perceived tradeoff of higher volume of insured patients.

Insured people use their coverage as an entitlement. They pay their copay or meet their deductible and see a doctor for every little ailment. They have zero motivation to negotiate the cost of service because they perceive their costs as fixed to the copay/deductible.

Uninsureds only go when something is wrong; and if they're smart, they insist on a "cash discount" and negotiate the price upfront. If they're really smart, and can afford it, they purchase a catastrophic coverage policy which is basically a high deductible but will cover all costs over that amount.

Private insurance companies occupy a sweet spot in the demographic right now. There's still plenty of healthy people that contribute to the pool. By the time a person gets into the age range where medical expenses start to climb, they're not covered by private insurance. For those elderly who decide to purchase additional coverage over Medicare, the insurance cos will fight to minimize their payouts so as not to drain the profitibility out of the younger pool contributions.

"Group coverage", administered by your employer, probably needs to go away and everybody should have the freedom to choose their health coverage. But there will still be plenty of young, healthy people who will decide they don't need to pay thousands of dollars per year for an annual checkup and an occassional visit now and then. Any way you structure it, if it's not the government, any business involved will seek to maximize their profits.

[LaughingCat]

Interesting. It makes me wonder if the government involvement in health insurance could result in the same business and economic environment shared by the untility companies. For clarity, I'm talking about the view where everyone needs power, so if the prices are regulated, more people can have it. Hence, the more people signed up, the more money they make. At the same time, power consumers really cannot sue the power company because the power went out. . unless maybe they had a bed-ridden family member on an iron lung or something. But in that case, they probably should've invested in a back-up generator.

I sound long winded, but I'm just wondering out loud if there is a good profitable business model that encompasses price regulation and tort reform or limits on liability. The latter I see would be huge for profits.

I just cannot get my hands on how governemnt can give us much improvement over the current system. however, the stories of people falling between the cracks of coverage and concurrent wealth for self-insurance seem almost horrifying.

Glad I'm not in that industry.

[Ratickle]

I look at the examples the government has set with trucking, when controlled, airlines, same thing, post office, medicare, medicaid, social security, free senior drugs, etc.

Every program "CONGRESS" has control over has been a failure, period.

Only the military semi-excels because they are not controlled by Congress.

The one thing no-one seems to get, medicare-medicaid is currently subsidized by private insurance. That's one of the main reasons it's so expensive. Doctors and hospitals do not get reimbursed for what operations and treatments cost by the government, so they charge everyone else more to make up the difference.

[TCEd]

I recently turned 65 and went on Medicare with BC/BS as primary. I just had an annual physical and my family Phd. doesn't even charge for it due to the paper work and payback. I'm sure he recovers the cost over time with other visits.

also....

My daughters husband is a orthopaedic surgeon with a sizeable practice and two associates and he states the most important person on his office staff is the insurance/billing person. With all the differet policies/coverages and government forms one could understand his opinion.

ed

[clayinaustin]

No worries, guys. Obama says that his health care plan will work as well as the Post Office!

Obama: Government health care will be like, um, the post office

We are in big big trouble!

[Ted]

LC, you say you look at all viewpoints, so since you have seen the "Insurance is the problem" viewpoint (the Dems new tactic on this one BTW) can you look at the Wall Street Journal explanation of why insurance companies are acting in response to federal or local mandate (also posted here in the Bar) and give your thoughts please.

[LaughingCat]

Sure, do you have a link?

[LaughingCat]

No worries, guys. Obama says that his health care plan will work as well as the Post Office!

Obama: Government health care will be like, um, the post office

We are in big big trouble!

Biden "Foot in Mouth" disease is spreading!

[Ratickle]

Biden "Foot in Mouth" disease is spreading!

Career politicians have absolutely no clue on how things really work. I'm sure he was misquoted.

They go to school to practice learning how to be elected, how to manipulate facts, and how to lie with a straight/sincere look on their face.

No wonder so many have a minor degree in law.

[Ratickle]

And they are doing well. Only lost a Billion $ the last two years compared to the Post Office's loss of 8 billion $.............


Fourth Quarter Results

FedEx Corp. reported the following consolidated results for the fourth quarter:


Revenue of $7.85 billion, down 20% from $9.87 billion the previous year

Operating loss of $849 million, compared to an operating loss of $163 million last year

Net loss of $876 million, down from last year's net loss of $241 million

Loss per share of $2.82, down from a loss of $0.78 per share a year ago

Excluding the impact of impairment and other charges from both years, earnings per share were $0.64, down from $1.45 a year ago (see table)

[Ted]

Sure, do you have a link?

http://www.seriousoffshore.com/forum...ead.php?t=9386

[LaughingCat]

Ted,

Been swamped. Will try to look at the other thread tonight.

[Big Time]

I think people are starting to come around and are now realizing that the healthcare reform proposed by the president is going to come at a huge cost to the tax payers and will not improve coverage for those with plans already in place.

[LaughingCat]

Ted,

I checked out the story. the only points I see worthy of debating (not arguing) are as follows: (The rest I just agree with)

Obama's stories are from people who buy individual policies: My problem is that as a small business owner, i am paying a tremendous amount of money for the plan. i would like my employees to go get their own. I don't want to pay half their premium or more. They make it sound like premiums for corporate plans are fine, but individual is high. hogwash. i'm paying 1200/mo plus $2250 deductible before insurance co touches an expense. That means I have to generate over 15k in expenses before the insurance company is just breaking even. i want them to make money, but not this much at my expense. I'm a capitalist, but **** them. And **** the gas companies for making so much when commodity prices rose. it hurts our economy.

I like the articles point about guaranteed insurability. People only apply when they need it, meaning probably when they are very sick, then pay a premium and get coverage. Not a good thing there.


Personally, I'd like to see the tax susidy. Especially since we are on the slow trend of migrating from a debt consumption to a manufacturing economy. If the gov't subsidizes HC costs to the business, we can be more competitve. As we sell and export more, govt will get sales and export taxes. This is the formula developed over time by Japan and China. Massive gov't revenues not ont he backs of worker, but paid by customer in sales taz.

[2112]

OPINION AUGUST 12, 2009

The Whole Foods Alternative to ObamaCare

By JOHN MACKEY

“The problem with socialism is that eventually you run out

of other people’s money.”

—Margaret Thatcher


With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people’s money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

•  Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees’ Personal Wellness Accounts to spend as they choose on their own health and wellness.

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan’s costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

•  Equalize the tax laws so that that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

•  Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

•  Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

•  Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

•  Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

•  Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

•  Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America

Even in countries like Canada and the U.K. , there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Although Canada has a population smaller than California , 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor’s Business Daily. In England , the waiting list is 1.8 million.



At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an “intrinsic right to health care”? The answer is clear—no such right truly exists in either Canada or the U.K. —or in any other country.

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.


Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.

Health-care reform is very important. Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our lives and will help create a vibrant and sustainable American society.



—Mr. Mackey is co-founder and CEO of Whole Foods Market Inc.

Printed in The Wall Street Journal, page A15

[2112]

No worries, guys. Obama says that his health care plan will work as well as the Post Office!

But with the compassion of the IRS
.

[Ratickle]

I still cannot figure out why anyone is concerned at all.

Look how well the government has done with Medicaid. It is currently in the red and this proposal will cut 1/2 Trillion from it's current funding.

Social Security? Supposed to operate in the red next year, and currently owed approximately $85 Trillion from the taxpayers and government.

Maybe the Post Office. Only $8 Billion in the red this year.

Or would you like to consider Medicare, Amtrak, or any of many numerous other well run government programs? Like Cash for Clunkers, the new energy grants, Fannie May, Freddie Mac, or ????????


What's the problem?

Just because the 45 million people they talk about without health care inclused 14 million illegal aliens? So what.

Because under their own estimates, 470,000 more doctors will be needed to give the care they say everyone needs?

I can't see any reason for concern. What's the big deal?

[clayinaustin]

Pelosi said a government-run plan “is the best option to lower costs, improve the quality of health care, ensure choice and expand coverage.”

I really hate that b!tch!

[LaughingCat]

Allow me to fix your quote:

Hef said a government-run brothel “is the best option to lower their inhibitions, improve the quality of the visitor's sex life, expand choice and ensure 'coverage'.”

I really love *****es!

We need photos of healthy Claymates to make this thread worthwhile.




Good morning to all of you.