Health Insurance

[Julie Marie]

True, but an employer will typically purchase health insurance for their employees on a need as you go basis.  In a good job market a company might try to sweeten the deal of trying to get you to work for them by providing better benefits.  It might also not purchase health insurance that could bring in "undesirables" thereby discouraging them from even applying for a job.

[JessicaH]

Great points! I have heard from a lot of people that "capitolism" caused the healthcare mess in the US. I would argue that the "exclusion of free market" has caused the problem and the only way to fix the problems is with Federal legislation to crack the system up so that free market principles can work.  It wouldn't take a thousand pages to write unless you let the special interests write it.

Question: How do you think it would affect prices at the grocery store if there were no posted prices on anything and you only got the bill 6 weeks later? I promise you, nothing would EVER go on sale and they would have no incentives to streamline things.

I have a lot more to write on this subject so I will just start a thread called, "How would you fix healthcare in the US."   The things I would suggest would cost consumers nothing and cost little if anything to implement and make a HUGE difference.

Realistically, even car insurance isn't quite "free market".  I can't reasonably buy car insurance that covers my car in case of nuclear attack, for instance - that insurance just doesn't exist for most mere mortals (sure, someone with resources can sell a policy at Lloyds, and get it insured - I can't).

Health insurance is even less of a free market.  I get what my employer selected.  Sure, I could personally buy insurance in addition to that, but realistically, it's not a real option for me or most other people.  I'm not going to pay twice for insurance - I don't have the money to do that.

The free market works best when both sides of a transaction need each other equally badly.  Those are transactions that don't need regulation.  When I sell a car to a private person, they need the car, and I need their money, so it's going to generally be a fair transaction - I hurt myself if I try charging too much.  Something like electricity is the exact opposite - my $50/month payment to the electric company isn't enough to change how they set their rates.  If they set them too high and lose my business, but get enough other business to make up for the lost (maybe 20 fold!), they would raise the rate.  They don't need my payment as much as I need their service.  That's why we regulate utilities.  Where the needs of the two sides are unbalanced, abuse can easily occur.

Insurance is typically one of those things where people need it far more than the insurance company needs an individual person's business.  So they set the terms, not me, and certainly not me and them negotiating it together to find a mutually acceptable deal.  I have to take or leave what they offer.

I believe in the free market, but only when it is truly free.  Having multiple companies selling a product isn't enough to make it free, however.

[gennee]

    The AMA and APA have a huge influence in policy decisions. Pharmaceutical companies drive the engine. The APA, which is totally corrupt, pathologizes African-Americans. When soldiers coming back from war zones sought trreatment, black soldiers were labeled that their PTSD was attributed to drug use. Can you say bigotry? And PTSD wasn't added to the DSM until 1980.                                                                                                                                      It's difficult to get the DSM to change their policy, but has
been done.

Gennee

[tekla]

"How would you fix healthcare in the US."
Extend Medicare to everyone who needs it.

[JessicaH]

"How would you fix healthcare in the US."
Extend Medicare to everyone who needs it.

Sorry, but that doesn't fix health care. Any scheme that takes the financial responsibility away from patient drives the cost up tremendously. Insurance IS the problem. Health insurance should be like car insurance and should kick in when there are major problems. Can you imagine what an oil change would cost if it was covered under your auto insurance? 

[Pinkfluff]

"How would you fix healthcare in the US."
Extend Medicare to everyone who needs it.

Couldn't agree more. I think the problems run deeper than that though. Insurance companies allow medical service providers to charge insane prices knowing that for most people the insurance will cover most of it. Obviously that leaves the poor sick and dying unless the government will give them Medicare/caid.

The costs associated with it could be largely fixed by getting people employed, and jobs paying an actual liveable wage. More people earning means more people have the money to pay for insurance and for treatment, and it also means more people paying taxes to cover those who aren't able to work.

We have to see the healthcare problem as a symptom of the larger economic problem.

[regan]

Couldn't agree more. I think the problems run deeper than that though. Insurance companies allow medical service providers to charge insane prices knowing that for most people the insurance will cover most of it. Obviously that leaves the poor sick and dying unless the government will give them Medicare/caid.

Providers charge what they do becuase insurance has negotiated lower prices for their subscribers.  Outside of that, provders are able to charge what the market will bear, they're not bound by the insurance carriers (your post makes it sound like the insurance carriers regulate what health care providers can charge).  The real problem is that reimbursements are tied into medicaid/medicare rates that have essentially remained flat since the 1970s.  If the government is paying for health care at 1970s rates, the private insurers see no need to reimburse providers at a higher rate.

The real problem with health care in America is that the poor guy in the middle is the one who gets squeezed.  For the folks at the top, with premium insurance plans, they could care less what a provider charges since all they'll ever have to pay is their deductible/co-pay.  The people at the bottom, of limited financial means and no insurance don't really care either, becuase no matter what they get charged, they're never going to have the means to pay it anyways, have no credit rating worth wrecking with threats of collection efforts and are highly mobile making it next to impossible to track them down to secure payment.  Its the people in the middle that have the means to at least make minimum payments on their health care, but lack adequate insurance that have to pay the high dollar rates they do (which are set to cover losses from the uninsured and offset losses from the private insurers).

Finally, the emergeny room is about the only place that will treat a patient without regard to their ability to pay.  People are forced either to seek primary care through an emergency room, or amoung the more rational, wait until their symptoms are emergent and require life saving treatment.  Hands down, the emergency room is the most expensive delivery model that exists.

Don't claim that free clinics work either.  They don't.  People that rely on free clinics often lack the means to access them and the limited availablity of them often means that they can see a limited number of patients in the time that they are open.  Its not uncommon for people to try to seek care at a free clinic only to be turned away because the clinic has already triaged the number of patients they can see that day.  Not to mention that they might only be open once a week (or more often once a month).

The problem with our current healthcare system is that we've turned it in to a profit making business.  Insurance companies don't want to insure people they're going to lose money on.  Businesses don't want to pay for all the bells and whistles (like full coverage for transgender related care) becuase its expensive and of limited benefit to their employees.  Take big business out of healthcare, mandate that medicare and medicaid reimbursement rates be updated from their 1970s price points and make it available to everyone regardless of their ability to pay.  Of course our taxes will have to go up to pay for "free" healthcare and no one likes higher taxes. 

[Pinkfluff]

(your post makes it sound like the insurance carriers regulate what health care providers can charge).

I meant that the existence of insurance companies allows for the high prices. Providers can charge alot because they know everyone will need help at some point (really need, not just want) and they know that most people have insurance and so the insurance will pay most of it. Higher prices doesn't mean they'll do less business, it just means the insurance will have to pay more, and thus the insurance will charge more. Just last week I got this prescription which they said costs $82 without insurance, and this is for the generic version. I looked at the ingredients and there is less than 1mg of the drug per gram of the cream. The rest of the ingredients are just things like water, petrolatum, and other chemicals you see in everything from hand cream to shampoo. Now I can understand having to also pay for future research costs of the company on a newly released product, but with a generic? You can probably get illegal drugs on the street for way cheaper (not that I would know but still).

If there was no insurance, just direct healthcare, then these drug companies couldn't charge so much because most people couldn't afford. Sure they could sell to the rich but that would be nothing but a niche market. They'd have to either be content with that niche market or lower the prices to what normal people can afford.

[regan]

If there was no insurance, just direct healthcare, then these drug companies couldn't charge so much because most people couldn't afford. Sure they could sell to the rich but that would be nothing but a niche market. They'd have to either be content with that niche market or lower the prices to what normal people can afford.

Ok you're changing the argument...

Drugs are more expensive in the US because other countries fix the price that drug companies can charge for their medications.  Not so in the US, so the drug companies charge higher rates in the US to offset their losses in other countries.  Health insurance has nothing to do with it.

[Cen]

I'm not sure if I'm misunderstanding this, but it sounds like the APA suggests that medical treatment necessary to transition should be covered by insurance...

http://www.apa.org/about/governance/council/policy/transgender.aspx

THEREFORE, BE IT FURTHER RESOLVED THAT APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments;

[LordKAT]

I'm not sure if I'm misunderstanding this, but it sounds like the APA suggests that medical treatment necessary to transition should be covered by insurance...

http://www.apa.org/about/governance/council/policy/transgender.aspx

That is exactly what that means. What it doesn't mean, is that insurance companies HAVE TO cover anything.

[tekla]

If the ->-bleeped-<-ing doctors feel so strong about it, they can pay for it.  Nothing?  Thought so.

[Cen]

That is exactly what that means. What it doesn't mean, is that insurance companies HAVE TO cover anything.

Oh, I agree.  I just hadn't looked into the APA's stance before.

[Joelene9]

  I am unemployed, uninsured and on a fixed income.  I had nothing but bad luck with them in the past.  I was in my company's group plan and when I was laid off, I bought into the COBRA plan.  COBRA lasted 18 months as required by law and I was then dropped.  I had to pay the monthly premiums after I was laid off.  The group plan did pay for some deductable for doctor's visits and blood tests.  It did not pay for those expensive antidepressants that were fed me.  My doctor also dropped me after the COBRA lapsed. 
  I bought insurance independently later when my PSA tests were showing over 4.0 and I waited a period before getting a prostate biopsy.  The biopsy didn't happen.  I went into the hospital for abdominal pain and was charged $1650 including doctor's fee.  It turned to be something I ate that irritated my duodenum and caused it to leak bile into my stomach causing gastritis.  Something that a cheap dose of Pepto Bismol would cure.  The insurance didn't pay for that.  I then found that the policy had changed two months before and it was on an obscure link on my billing page!  I dropped that insurance immediately and just this year that insurance company said that they will no longer cover my state and that the ones that are on their plans had 3 months to find somebody else.  This was the major player in my 4-year cancer scare. 
  It was a urologist who wanted me to get the insurance for a possible cancer diagnoses/ surgery, his specialty.   He would not give any terminal diagnoses for anybody uninsured because the patient will not get insurance at all if he or she is diagnosed with cancer and have no income.  That $1650 was equivalent to 3.5 months of premiums paid!  And they wanted to raise my premium as a birthday present?  Sayronara!  If you are over 55 and unemployed, you're screwed!  I have to wait till age 64.5 to get Medicare.  They may raise the age bar on that in my age group as well, they already have done so for those 2 years younger than I.   This is what I call an uninsurance crack. 
  Joelene

[RhinoP]

I personally do not see why things have to be so complex, I believe there should be a universal insurance plan that covers every single medical need across human knowledge, and every person should be on this plan, paying exactly a certain percentage of their exact income. Simple percentage payment, nothing more complex than that. With that, all the government would have to do is crack down both on the rich and poor, making sure that people aren't earning an extra income anywhere under the table, and problem solved. No co-pays, no whatevers, just one company making money off everyone and paying for everything that everyone encounters health-wise in life. I'm not sure why this wouldn't be an even better option for an insurance company themselves; if everyone mandatorily belongs to one company, that one company will be super rich - it'll obviously make money off the healthy, who should be contributing to the not-healthy anyway. And if they for any reason start to make the rates and expenses unnaffordable for anyone, they'd loose money the same second.

I mean, I'd gladly have my rates even a bit higher than what would be comfortable to me, if it meant that I could just avoid any and all paperwork, confusion, plans, conspiracy, ect ect, and just pay a simple rate fee by dropping it off at some government or insurance office. Heck, even the businesses you work for could just chunk it out of a person's paycheck and do it for them, in order to avoid under-the-table scams. I mean, you do have to make insurance expensive enough where people have to work for it, or else some healthy people will be wasting all their time at doctors offices seeking attention. Then of coarse, for the people who have disabilities and don't have a dime, they should all be given government housing, food stamps water and electricity, education, ect ect and it should trickle up from there until a person has all around a diagnosis and paycheck that by numbers says they can now support themselves.

[tekla]

With that, all the government would have to do is crack down both on the rich and poor, making sure that people aren't earning an extra income anywhere under the table, and problem solved.

Umm, we're Americans.  Making money under the table is in our blood.  It's the missing Constitutional Amendment.  Cracking down on poor people doing it is kinda stupid, if they were doing it right they wouldn't be poor, hell the reason they they might be poor is because they can't figure out a way to do it.  Finding me working for cash on off-days on some construction site?  Damn near impossible.  Find all the people who have a grow room in their house, or some plants out back and are making anywhere from $50-100K and up growing marijuana (just in the states that have legal medical marijuana) is going to prove to be impossible until it's legalized.  (And make no mistake, one of the reason that the pot legalization measure failed in Cali last time is exactly because these people didn't want to give up that cash flow)  Marijuana is the number one cash crop in both Sonoma and Napa (and lots of other places too, but these are two awesome examples) counties.  MORE THAN ALL THE WINE (over 700 different wineries in all) FROM THOSE TWO PLACES.  That's a lot of money.  That you would just say 'problem solved' tells me you don't even begin to understand the scope of any of this.

every person should be on this plan, paying exactly a certain percentage of their exact income
And why should I pay more just because I make more?  My medical bills are going to average the same.

I'm not sure why this wouldn't be an even better option for an insurance company themselves
Well because you just said, just one company making money off everyone, so while it might be swell for that one company, I'm sure the other companies you just put out of business will not find it a better option at all.

I'd gladly have my rates even a bit higher
Are you crazy?  How much do you pay?  I'm on group plan, that is financed totally by our union and our union alone.  It's basically self-insurance administrated through Blue Cross.  It's about as cheap as it can get, a hella lot cheaper by almost half compared to the similar coverage my friends have through their employment, and if it got any higher it would be farkin' Jerry Garcia.  We're trying to lower medical costs, (which in the US are the highest in the world and we're not even treating 35-45% of the population) not raise them.

they should all be given government housing, food stamps water and electricity, education, ect ect
Well I can make that cheaper right away, because if I gave people food, housing, water and power I could skip the education and ect, because 40% of them are not going to want to be educated or work.  Why would they?

[BunnyBee]

We're doing it wrong.

[JungianZoe]

We're doing it wrong.

And you know what happens to bubbles that float away from the rest of the cluster?  They get chased by kids and dogs!  Yowzas!!!