American Health Insurance (1 Viewer)

[Brianwarnock]

Beards of course should be banned altogether

Only on women.

Brian

 

[dan-cat]

Then it's a quick visit to the Intercity express line to London for a walk along the track.

I hear the Shinkansen line is fairly painless

 

[Brianwarnock]

I hear the Shinkansen line is fairly painless

Far too aerodynamic, Col will slide off.

I would go for a large packet of pills and a bottle of fine Malt whisky.

Brian

 

[Rich]

Far too aerodynamic, Col will slide off.

I would go for a large packet of pills and a bottle of fine Malt whisky.

Brian

You'll either wake up with a hangover or not survive to decide whether it was a fine malt or not

 

[Brianwarnock]

I'd know before I started I moght buy myself something specisl but if I had to go with what's in close to Christmas i've got open
10 yr Tomatin - not much left
10 yr Talisker - I'd probably skip that

waiting
12 yr Macallan
10 yr Edradour
12 yr Glenlfiddich
18 yr Glenfiddich

Oh! decisions, decisions

Brian

 

[dan-cat]

Far too aerodynamic, Col will slide off.

Oh he's train surfing is he? Sorry I thought he was train jumping

 

[Alisa]

ok, I am getting tired of the atheist thread again, so it is time to resurrect this one instead: http://www.truemajority.org/HealthCareRules/

You folks on the other side of the pond may not get the joke . . . but it is funny as hell to anyone who has gone through the system over here.

 

[secretcrowds]

We have the free NHS in the UK (except for dental treatment) there are many anomolies with it, but basically if you need treatment you get it for free.

That is very kind of the doctors, nurses, medical technicians and all other staff associated with the health industry to work for no salary. Of course there generosity would not amount to much if the drug companies did not supply all the drugs for free and along with all medical instruments, beds, hospitals.

Our health service is great. For example, we dont have to pay to go and give birth to a child in a hospital, or anything ridiculous like that.
You cant mock our health service here.


If you want to know about it by the way, watch the film 'Sicko' by Michael Moore

 

[Alisa]

If you want to know about it by the way, watch the film 'Sicko' by Michael Moore

Another good one is "Sick around the world", done by PBS frontline.

 

[oumahexi]

Yes what Col should have said is that it is free at the point of delivery.
Can I ask the Americans if people are refused health insurance? what do they do then?

One of my wife's drugs costs £42 per day, 365 days per year, she has other drugs regular clinic visits and blood transfusions every 6/7 weeks, would she be refused continuation of insurance. I should add all her drugs and treatment are free to her.

Brian

In South Africa we couldn't get health insurance (medical aid) to cover my husbands diabetes. But our medical aid covered everything else, from dental cover, glasses etc. He had to attend a state run diabetic clinic every month and that cost the equivalent of around £3 for insulin, syringes, swabs etc.

For the record though, we were in the motor bike trauma unit at Johannesburg General one night when a young woman came in with a man she had found at the side of the road. The "good Samaratin" was asked to cough up R200 before they would treat him. She'd never met the guy, but she paid up anyway because he was unconscious and nobody would make it clear what would happen if they didn't get their deposit.

 

[statsman]

Our British friends can be excused as they have had the National Health for over 50 years.
Government health insurance is still the exception rather than the rule in most parts of the world.
We've had it in Canada since the '60s but it only covers the basics. Drugs are not included.

 

[lmnop7854]

Ok, the beast has been awakened.....

Well, I am one of the American posters, and I just happen to work for a health insurance company. A Blue Cross and Blue Shield, as a matter of fact. Much of what other Americans have posted is correct about how health insurance in America works. You get your health insurance coverage offered to you through your employer, and they deduct your portion of the premiums from your paycheck. At the time of service, you are charged either a copayment or a deductible, and the remainder of the service is covered by your insurance. Depending on what kind of insurance company you have.

Most of the Blue Cross organizations are non-profit (although for the life of me, even working here, I can't figure out what that means, because there are definitely profits), others are for profit, and I think that could be the major difference between health care in this country. The for-profit insurance companies are interested in the bottom line only, not in the lives of their customers, and so there are more likely to be pre-existing condition clauses (which are the ones where they may refuse you if you have chronic illnesses), and more likelihood if you actually get the insurance, that some things will not be covered. I read ShaneMan's rant, and it is a valid one - those companies exist, and they scare me. I have to admit that we don't do things like that where I work. I will say, however, that at least for my company, they do NOT pay less for medical care than they did 10 years ago. I know what we pay for a lot of services, and it has only be increasing over the long haul, mainly because we also contract with the providers, and if we didn't give them what they wanted, they would walk.

Our community was the one that Bill Clinton was all over when he was president, and used us as an example of good health insurance in America. That was based on a long-standing tradition of community rating in our area. Unfortunately, almost the minute after he said that about our area, Aetna, MVP, and all the giants started banging down doors, and we basically have the same crap going on here as pretty much everywhere else. Our BCBS, however, has tried to stay true to the original tradition - it is just harder with for-profit companies in the area, because they can drive premiums down with their huge revenues.

Ok, I think that is enough. Let me know if you have more questions about health insurance in general, without pointing fingers, please.

And I purposely did not respond to any of the sexist comments by Colin. It is obvious that he doesn't have children. Whoops. I responded.

Lisa

 

[ShaneMan]

Ok, the beast has been awakened.....

Well, I am one of the American posters, and I just happen to work for a health insurance company. A Blue Cross and Blue Shield, as a matter of fact. Much of what other Americans have posted is correct about how health insurance in America works. You get your health insurance coverage offered to you through your employer, and they deduct your portion of the premiums from your paycheck. At the time of service, you are charged either a copayment or a deductible, and the remainder of the service is covered by your insurance. Depending on what kind of insurance company you have.

Most of the Blue Cross organizations are non-profit (although for the life of me, even working here, I can't figure out what that means, because there are definitely profits), others are for profit, and I think that could be the major difference between health care in this country. The for-profit insurance companies are interested in the bottom line only, not in the lives of their customers, and so there are more likely to be pre-existing condition clauses (which are the ones where they may refuse you if you have chronic illnesses), and more likelihood if you actually get the insurance, that some things will not be covered. I read ShaneMan's rant, and it is a valid one - those companies exist, and they scare me. I have to admit that we don't do things like that where I work. I will say, however, that at least for my company, they do NOT pay less for medical care than they did 10 years ago. I know what we pay for a lot of services, and it has only be increasing over the long haul, mainly because we also contract with the providers, and if we didn't give them what they wanted, they would walk.

Our community was the one that Bill Clinton was all over when he was president, and used us as an example of good health insurance in America. That was based on a long-standing tradition of community rating in our area. Unfortunately, almost the minute after he said that about our area, Aetna, MVP, and all the giants started banging down doors, and we basically have the same crap going on here as pretty much everywhere else. Our BCBS, however, has tried to stay true to the original tradition - it is just harder with for-profit companies in the area, because they can drive premiums down with their huge revenues.

Ok, I think that is enough. Let me know if you have more questions about health insurance in general, without pointing fingers, please.

And I purposely did not respond to any of the sexist comments by Colin. It is obvious that he doesn't have children. Whoops. I responded.

Lisa

Hey Lisa,

BCBS in NY may be as above board as you claim but BCBS of Texas couldn't make the same claims as you. Our company submitted a power wheelchair to them which they authorized at the negotiated rate (discount), thus my reasons for stating they (Funding Sources/Insurance) pay less for their services, they did not get reduced or discounted rates 10 yr + ago. According to law we have to deliver before be can bill but why should we worry, right? We have an authorization from BCBS and surely they are good at their word, right? Wrong. We provided the power chair (very expensive) and 8 months later BCBS still had not paid us. They eventually did but not at the agreed upon rate. One of the supervisors, at BCBS, I finally got to talk to about it and what she told me to do is send her the invoice of how much we paid for the chair and she would let me know how much BCBS would give us for it. I told her that this was a case of the golden rule. "he would has the gold, makes the rules." BCBS went on to do this to us 2 more times. We now have a form in place, due to BCBS, that the patient has to sign that states if their funding does not pay the full agreed upon amount, then it becomes their responsibility. I am not trying to be a "get in your face" person but I can definitely tell that my experience with BCBS is not the same as you have stated. My company is not the only company that they have done this to. BCBS has a reputation, in my area, with companies that provide the services we do, and it is not the best of reputations.

 

[georgedwilkinson]

I don't care much for BCBS of TX either. We're supposed to have a $500 out of pocket maximum per person. My daughter just had surgery and so far we've paid out over $900 just for this one event. It's unclear whether BCBSTX will compensate us.

 

[lmnop7854]

Yes, I know BCBS in other states are not as good as mine, although I can't say our company always does the right thing, but I know from working here and with the people who agaonize over some of the medical review decisions, that there really is a feeling of caring here. At least from my perspective. I have also heard some bad things about BCBS in California, and I think it may be because they are allowed to be for-profit. Not sure how that works, because all of the BCBS companies are governed by one BCBS association, and I guess they are supposed to follow consistent rules, but I do know that some companies working under the BCBS name are not part of the association.

And I hear ya about the power wheelchair - my dad had to have one due to his ALS, and it took FOREVER for his insurance to pay for it. He couldn't walk at all, and had trouble with his arms, and they said it wasn't medically necessary. Of course, my parents don't have health insurance with the company I work for (figure that one out) and so I couldn't help them with it, but they eventually got the company to pay.

You know, sometimes I just hate capitalism.

Lisa

 

[Banana]

I think there are other things we need to consider.

Yes, the healthcare is a clusterfuck, and I certainly do not believe that it will be fixed by socializing it. To contrary, I believe the problems we face are *caused* by socializing (if only partially in US). The real issue is the economics.

Like it or not, medical services costs something. This remains to be true even if all doctors suddenly were full of goodwill and volunteered to do everything for free. This is still true even if all pharma had a change of heart and freely shared their patents and dispensed their drugs. More to the point, there is scarcity of medical services. (If it weren't scarce, then this would be nonissue, no?)

But unfortunately with the current system, the economic is totally out of whack. It is now basically tied into our employment and we have insurance middleman muddling the waters. Instead of a consumer paying a doctor for service rendered, we now have a consumer presenting a doctor a insurance card which the doctor then present a bill and insurance does some exotic math then pays doctor X and say patient pays Y. This breaks the laws of demand and supply on so many levels, just like what taxation does.

Next, it is important to remember that everyone *will* game the system. It's human nature to want to get the most out of something. Therefore, doctors has no incentives to rein in the costs since he just presents the insurance a bill and call it "reasonable." Insurance has less incentives to control premiums because employers will still buy plans through them for tax deductibles (which is a wrong reason to save.) Employers has no incentives to provide a comprehensive healthcare; they just need to get one that behooves their bottom line. Who gets screwed? The consumers, that's who.

And this isn't even capitalism!

In a true capitalism (there are no such thing as true or pure capitalism anywhere in the world) economy, the price of any medical service would be determined solely by the market, never by the bureaucrats. Furthermore, it will go down over the time. Consider two relatively unregulated medical services, LASIK and cosmetic surgeries. When they came out, they were expensive and offered little in terms of quality, but as people innvoated, LASIK declined in cost, so much that it was now affordable to have a LASIK set up in doctor's office, and cosmetic surgeries (celebutards not withstanding) has in fact become more cheaper and more accurate than they were 10 years ago.

Contrast this with a regular visit to doctor. It used to be fairly cheap to just show up, pay the receptionist a small bill ($35-$50?) then the doctor would see and give you a thumb up if you were healthy. Now it's not common for them to charge more than $150 for exactly same service, citing administrative bullshits. Which supports the earlier point that that demand and supply are now broken and they'll just charge whatever they can get from insurance. You know the mindset- "Let's screw them! They're a big, faceless company who thirst for profits!" And it's ultimately the consumer who get fucked.

 

[Alisa]

Yes, the healthcare is a clusterfuck, and I certainly do not believe that it will be fixed by socializing it. To contrary, I believe the problems we face are *caused* by socializing (if only partially in US). The real issue is the economics.

I don't think the evidence bears that out. The problem we have in the U.S. is not that medical care is too expensive, it is that a third of the money we spend on medical care, doesn't go towards medical care. It goes towards claims review, billing, advertising, and other administrative costs, not to mention the astronomical profit margins of the insurance and pharmaceutical companies.

We spend almost 16% of our GDP and only get "health care" for some of our citizens, meanwhile most other industrialized countries spend 8-11% of their GDP and get health care for all of their citizens. Those numbers show us that it can be done.

I agree that having the insurance co as the middle man muddies the waters, but going to a cash only system for everything won't work - what happens when you get in an accident and the bill is suddenly 50 or 100k? It is sort of like your house - you don't call your insurance company when you need a new light bulb, right? You just buy a new light bulb. But when a tree comes crashing through your roof, or the sewer backs up and floods your house, you call them right up. Likewise, I think going back to a cash system could work for basic medical care - things like check ups, immunizations, minor urgent care, etc. But the real issue here is how do you pay for those major medical expenses? You can't put the burden of major medical expenses on an individual's shoulders - the burden is already partially there now, and it causes half of all bankruptcies.

Next, it is important to remember that everyone *will* game the system. It's human nature to want to get the most out of something. Therefore, doctors has no incentives to rein in the costs since he just presents the insurance a bill and call it "reasonable." Insurance has less incentives to control premiums because employers will still buy plans through them for tax deductibles (which is a wrong reason to save.) Employers has no incentives to provide a comprehensive healthcare; they just need to get one that behooves their bottom line. Who gets screwed? The consumers, that's who.

I don't think that is true at all. I for one don't want to visit the doctor even when I need to, much less just because I can get something for nothing. Medical care is something that when you need it, you need it. It is not like candy where you want more just because you can have more. I do agree that insurance companies have no incentive to reign in premiums though - the greater the divide between the premium and the cost of the care provided, the fatter the profit margin. That is why the profit motive should be taken out of health care.

 

[redneckgeek]

Well said Banana!

I think much of our problem was brought about by Medicare. It created a paperwork nightmare, and caused prices to rise. Throw malpractice insurance - too a smaller extent - into the mix, and you get today's costs.

As far as gaming the system goes - I see it all the time. Ask anyone over 70 when their next doctors appointment is. I'll bet it's within 7 days. Why not - the government (read as taxpayer) is picking up the tab.

 

[Alisa]

I think much of our problem was brought about by Medicare. It created a paperwork nightmare, and caused prices to rise.

That is just not true. Medicare has an overhead cost of 2 or 3%, while the private insurance companies have an overhead cost of 31%. Medicare takes no profit, private insurance takes massive profits. I agree that they have begun trying to destroy Medicare in the last decade or so, by turning the administration of Medicare over to private insurers, and creating Part A, Part B, etc. That IS a paperwork nightmare, but it didn't used to be that way, and the only reason that it is that way today is because the private insurers have become involved.

 

[Banana]

I don't think the evidence bears that out. The problem we have in the U.S. is not that medical care is too expensive, it is that a third of the money we spend on medical care, doesn't go towards medical care. It goes towards claims review, billing, advertising, and other administrative costs, not to mention the astronomical profit margins of the insurance and pharmaceutical companies.

We're on same wavelength here, though I think I can have had worded it a bit better, but we're in same general agreement.

One thing I should make clear- right now what we have here is really neither a socialized medicine nor free market healthcare. We have a chimera of the worst from each, and it just hurts everyone. I simply do not believe that socialized medicine is the better solution because it still has the problem: a bureaucrat makes the decision on whether to provide coverage or not with *your* money.

I agree that having the insurance co as the middle man muddies the waters, but going to a cash only system for everything won't work - what happens when you get in an accident and the bill is suddenly 50 or 100k? It is sort of like your house - you don't call your insurance company when you need a new light bulb, right? You just buy a new light bulb. But when a tree comes crashing through your roof, or the sewer backs up and floods your house, you call them right up. Likewise, I think going back to a cash system could work for basic medical care - things like check ups, immunizations, minor urgent care, etc. But the real issue here is how do you pay for those major medical expenses? You can't put the burden of major medical expenses on an individual's shoulders - the burden is already partially there now, and it causes half of all bankruptcies.



I don't think that is true at all. I for one don't want to visit the doctor even when I need to, much less just because I can get something for nothing. Medical care is something that when you need it, you need it. It is not like candy where you want more just because you can have more. I do agree that insurance companies have no incentive to reign in premiums though - the greater the divide between the premium and the cost of the care provided, the fatter the profit margin. That is why the profit motive should be taken out of health care.

I wasn't advocating for cash only system, though I know that there are more and more doctors popping up who will accept cash only because this allow them to treat patients without all that paperwork crap that comes with insurance coverage.

Cash only for routine visits is one way, and I doubt we'll be able to do away with insurance especially for major medical expenses, but at least we can make them less obstentious. For example, if we forced everyone to sign up, it just gives insurances less incentives to compete for people, because they'll come anyway, high price or no high price.

It's easy to say that we should take out profit motive, but I already pointed out that the resources to provide medical care are scarce, and always will be. There's no free lunch, and forcing insurance to cover everyone isn't going to magically make more resource available for everyone. I'd rather put my faith in invisible hand of the market to allocate the scarce resource than in some faceless bureaucrat, whether he works for a for-profit company or for the government, to rubber-stamp my claim.

Regarding the health care spending, while an average Joe may have substandard healthcare here in US, it bears to note that when we look at where rich people, despotic dictators, or anyone else with money to burn will go to US to get the top quality care.