Every horrible thing you ever heard about the health insurance industry is true

[jk]

Re: Every horrible thing you ever heard about the health insurance industry is true

for the last 15 years, the practice in which i work has been almost 100% managed care. in that time, there has been exactly 1 instance in which an insurer suggested more care than a patient was getting. that insurer was acquired by another with more rigorous policies. that's the free market at work!

[cjppjc]

Re: Every horrible thing you ever heard about the health insurance industry is true

Thanks for your thoughtful reply. I really value opinions like yours from other parts of the world. The more I hear about health care in other countries, the more I think we should simply study the more successful plans and try to emulate these instead of redesigning things from the ground up.

I think the wool has been pulled over the eyes of Americans in regard to the real consequences of national health plans. Some of the lies have been repeated so much that nobody even questions them, as the whistle blower in that video described.

Any serious attempt at health care reform in the US has a uphill battle against it. Not only the current drug companies, hospitals, insurance establishment, but the lawyers who could lose out if they find themselves unable to sue the government. Torts, that's probably the single biggest obstacle that we in the US face than other countries don't. Its big business here, and it dominates how we are forced to do things here. Physicians and hospitals are so worried about getting sued they tend to over do everything. Big part of the high costs.

I wanted to have a discussion regarding the theory that it is okay to walk away on your debt. We always tell our children two wrongs don't make a right. Maybe I am wrong. When we meet our maker will we be able to say that we lived with honor, or did we just meet our obligations under the law. If a person is unable to pay their mortgage, I can understand. They should assist in a short sale however. As for credit card debt. Unless some unforseen circumstance has happened, that debt should be paid. Stop the interest from accuring, and work it off. It is a slippery slope to say they are bad, I will be bad too. Socrates allegedy believed virtue could not be taught. Lack of virtue, I think can be taught.

[charliebrown]

Re: Every horrible thing you ever heard about the health insurance industry is true

BCBS won't pay, but I'm sure a gvt sponsored program is going to have restrictions too on what treatment options are available. If we do have a one payer system, you won't have an option to go to another company. I've read that the Aussie system has both private and public options.

Is the 30k price in this article inflated? What if BCBS would pay? would she get the treatment for 15? A single mom might be working off a 30k bill for the rest of her life. That is a big problem I have with the current system. If you don't have insurance your going get ripped off. In fact if the BCBS cost is 15K, if she pays with cash she ought to get an even bigger discount by avoiding all the silly fighting between insurance, physician and hospital.

Name another business where the cash customer pays 2x more than a customer with credit?

[sadsack]

Re: Every horrible thing you ever heard about the health insurance industry is true

Name another business where the cash customer pays 2x more than a customer with credit?

I think your observation here captures the utter insanity of medical billing in a nutshell.

Apropos, a recent Forbes article on how those uninsured/partially-insured entrepreneurs haggle with their medical providers:

http://www.forbes.com/forbes/2009/08...tor-bills.html

Hospital billing offices are starting to act like used car lots. Get yourself a deal.

:rolleyes:

I'm getting the "opportunity" to try this out myself . . .

[jk]

Re: Every horrible thing you ever heard about the health insurance industry is true

Is the 30k price in this article inflated? What if BCBS would pay? would she get the treatment for 15? A single mom might be working off a 30k bill for the rest of her life. That is a big problem I have with the current system. If you don't have insurance your going get ripped off. In fact if the BCBS cost is 15K, if she pays with cash she ought to get an even bigger discount by avoiding all the silly fighting between insurance, physician and hospital.

Name another business where the cash customer pays 2x more than a customer with credit?

name a business in which your biggest customer, with a huge volume of purchases, pays more than your casual walk-up customer.

[thriftyandboringinohio]

Re: Every horrible thing you ever heard about the health insurance industry is true

Hasn't widespread availability of Company provided health-care - combined with more and more Government mandated exams driven the price of health-care. If most people had Insurance coverage that kicked in after say $5000 - wouldn't doctors be forced to lower prices for procedures. Shouldn't Insurance be reserved for life and death emergencies. Yes - there will be many that will need to find family or friends or community groups to help with this first $5,000 in Medical Bills. When there is lots of Money available - don't prices Rise to meet the Availability of Cash or Credit or Insurance.

Also - there would be much less opportunity for Specialist to make a killing. Specialist be involved when it was truly necessary and life saving.

I always think of what has happened to Dentist prices since Dental Insurance. My Dad paid cash for all of our dental work - there were six kids and Dad lived pay-check to pay check. This was during the 1970s - and it would be impossible for a father of six to do this today.

Am I way off in my assumptions?

You make some interesting points.

The whole definition of insurance is many people putting a little premium into a fund (cleverly invested by the insurer to generate his profits) paying only when a very unlikely calamity occurs - homeowner's fire insurance is a great example. It isn't "insurance" when everyone in the plan is certainly going to make many claims on a regular basis. It's foolish to talk about "insurance" that buys your groceries, or your routine health care.


The effect of high deductibles on price might be as you say for routine office visits or child birth, but not for crisis care. Consumers only get treated for heart attacks or cancer or major trauma once or twice in their life, and they are in no condition to shop around before purchasing. Cagey insurance companies could rake in premiums for years then fail to deliver good care when the tragedy arrives. ( Given the insurance industries' sterling reputation for fair play and generosity, you must be shocked-SHOCKED! - to hear such an accusation).

[bpr]

Re: Every horrible thing you ever heard about the health insurance industry is true

Why is this so hard to understand?

No eight year olds losing fingers in manufacturing plants, no 12 year olds with Black Lung, no company stores in company towns that accept only company scrip - no unions.

No rivers on fire, no soot-covered downtowns, no Love Canals - no EPA.

No rotten meat, no cat guts sold as beef steak - no FDA.

No tax money to oligarchs making more in bonuses during a financial crisis than their companies made in profits - no revolutions.

All the things Conservatives love to hate result from the times when the world was run as they wanted it to be. Times when the average person was being FUCKED. The parts of government they don't like were a reaction to their own (mostly wealthy business) excesses.

Don't want bigger government, resurgent unions, new regulatory institutions and health care reform? Stop screwing people. It's really not very complicated.

Rob, you just became my favorite ituliper.

A true free market involves a consumer and a producer negotiating price. In the health market there is rarely such thing.

This is really insightful, but glosses over something very fundamental: in the health market negotiation is often impossible.

One cannot negotiate when experiencing trauma.

cjppjc's thought experiment was interesting, but it fails to capture the problem in real life: what of someone who needs medical treatment but cannot afford it and thus must walk away from the debt, or be refused treatment?

This is the case for at least the 10-15% of uninsured Americans, and probably another 10-20% that have inadequate insurance.

At least one poster here has experienced the "out of network" emergency provider. This is extremely common, particularly among ambulance providers, since patients can't choose which ambulance is closest to their accidents and private ambulance providers often choose not to accept the billing expectations of insurers. The end result is that people with excellent insurance have a traumatic event, get treatment, pay their $35 copay at the emergency room and six months later get a $500 bill for the MICU.

Most folks don't have any financial cushion, so an unexpected $500 bill may mean bankruptcy to the paycheck-to-paycheck crowd.

I don't own a home to walk away from. And I don't have health insurance. Ultimately, I guess I'm the problem, since I have no collateral, should a catastrophe strike.

[Chris Coles]

Re: Every horrible thing you ever heard about the health insurance industry is true

There are a number of points here.

The fundamental principal of insurance should surely be that everyone pays for the possibility that some of them may need to cover the cost of an unexpected event. Fire insurance is a good example. Everyone pays for the small possibility that their house will catch fire and burn down. The fact is, very few actually have such a result and in the insurance industry they have a class of people called actuaries whose entire responsibility is to keep track of the "events" and thus track the number of times any insurance scheme has to pay out for a fire. So, in principle, insurance is a very simple business model and there are very clear rules of engagement and professionals available to be employed to ensure the scheme remains stable and profitable. The problems are not about the business model of insurance per se, as health insurance in many other nations is very efficient and delivers.

Munger got closest when he remarked something to the effect "this should all be covered by what we call a free market". (I want to keep this free flowing and have not back tracked).

But first I want to talk about another aspect of the video that came right at the end. The 50 million or so not currently a customer of the health insurance industry that the existing insurance companies claim to want to include within a "private" scheme, rather than within a government scheme. My instincts tell me that what the insurance companies really want is for the government to say they must include them and for the existing insurance companies to then bill government for the costs.

That they want the government to pay THEM to provide the health services, rather than the government to pay the health industry for the health needs of the citizens currently outside of the system.

What they are saying is they want to be able to cream off another 20% nett profit from the health care needs of the citizens.

But even more importantly, that would make free competition, in a free market, impossible. Why? Because only the existing insurance companies would be "regulated" to take the government funding, (YOUR TAXES), to provide the service.

THERE IS ONLY ONE WORD TO USE FOR SUCH A SYSTEM.
FEUDALISM
When the world set out to destroy a foreign concept called communism and, to a large part succeeded; everyone forgot a system that had been endemic in Europe that is by a long margin far far worse. Feudalism.

You do not live in a free nation. Why?

Because you cannot obtain the capital to compete. Why not?

Because the very source of the capital to compete is controlled by Wall Street and as it is made crystal clear in the video, mergers and acquisitions have suppressed the very thing that would deliver all the health care you need..... WITH THE ONE THING THAT A FEUDAL SYSTEM WILL DO ANYTHING IN ITS POWER TO SUPPRESS.
COMPETITION
Until the United States wakes up to the fact that it is a feudal nation with all competition suppressed by the very same people that should be charged with the delivery of competition; nothing will change.

The video interview gives the very best example of what is a classic feudal system that will only benefit a very small group right at the top of the tree. That is your problem. Health insurance is just a very good example. The problem is not insurance, it is lack of competition and the total lack of an understanding in your Congress of the effect of a feudal system on your nation.

[cobben]

Re: Every horrible thing you ever heard about the health insurance industry is true

Here in Latvia, my wife was feeling out of sorts and called the "skoraja pomoshsch'".
In short order two (2) doctors arrived, did a quick exam, found nothing, calmed her down and told her there was no problem.
Cost: 0.

This, including my wife's expectations, is a remnant of the soviet style medical system, where doctors were cheap & plentiful.

The new minister of health, an experienced health care professional, charged with reducing state health costs, after taking stock of the situation for a month and a half, reported back to the guvm'nt that there was nowhere to cut, rather more money was needed everywhere.
She is to be replaced.

"the utter insanity of medical billing in a nutshell"

Consider Ada, who keeps Cuddles, a pet duck to bring her luck...

The other day, Ada rushed her very limp duck into the veterinary. As she laid Cuddles on the table, the vet pulled out his stethoscope and listened to the duck's chest.
After a moment or two, the vet shook his head sadly and said, "I'm so sorry, your Duck Cuddles has passed away."
Ada cried out, "Are you sure?
"Yes, I am sure. Cuddles is dead," he replied.
"How can you be so sure," Ada protested. "I mean, you haven't done any testing on him or anything. He might just be in a coma or something."
The vet rolled his eyes, turned around and left the room, and returned a few
moments later with a black Labrador Retriever.
As Ada looked on in amazement, the dog stood on his hind legs, put his front paws on the examination table and sniffed the duck from top to bottom. He then looked at the vet with sad eyes and shook his head.
The vet patted the dog and took it out, and
returned a few moments later with a cat. The cat jumped up on the table and also sniffed delicately at the bird. The cat sat back on its haunches, shook its head, meowed softly and strolled out of the room.

The vet looked at Ada and said, "I'm sorry, but as I said, this is most definitely, 100% certifiably, a dead duck."
Then the vet turned to his computer terminal, hit a few keys and produced a bill, which he handed to Ada.
Still in shock, she took the bill, "$150.00", she cried, "$150.00 just to tell me my duck is dead?!!"
The vet shrugged. "I'm sorry. If you'd taken my word for it, the bill would have been $20.00, but with the Lab Report and the Cat Scan it's now $150.00...."

[flintlock]

Re: Every horrible thing you ever heard about the health insurance industry is true

Are there economies of scale that produce savings with the insurance company vs the individual? I can understand a discount for that.

This phenomena has more to do with bad credit of those with no insurance than any real cost savings or other reason to give insured a discount. They start high then settle for less

A former employee of mine with no insurance went to the emergency room with what he thought was a broken ankle. Had an x-ray, $600. He got the bill and of course ignored it for a while. When he told them he couldn't pay, they said they'd accept $250. My out of pocket with high deductible insurance would have been about $500! How is that fair??:eek: I've since learned to haggle on everything.

[cjppjc]

Re: Every horrible thing you ever heard about the health insurance industry is true

The vet shrugged. "I'm sorry. If you'd taken my word for it, the bill would have been $20.00, but with the Lab Report and the Cat Scan it's now $150.00...."

Very funny. Thanks for that.

[thedanimal]

Re: Every horrible thing you ever heard about the health insurance industry is true

The Onion with its usual incisive wit.

Congress Deadlocked Over How To Not Provide Health Care

August 18, 2009 | Issue 45•34

WASHINGTON—After months of committee meetings and hundreds of hours of heated debate, the United States Congress remained deadlocked this week over the best possible way to deny Americans health care.

"Both parties understand that the current system is broken," House Speaker Nancy Pelosi told reporters Monday. "But what we can't seem to agree upon is how to best keep it broken, while still ensuring that no elected official takes any political risk whatsoever. It’s a very complicated issue."

"Ultimately, though, it's our responsibility as lawmakers to put these differences aside and focus on refusing Americans the health care they deserve," Pelosi added.

The legislative stalemate largely stems from competing ideologies deeply rooted along party lines. Democrats want to create a government-run system for not providing health care, while Republicans say coverage is best denied by allowing private insurers to make it unaffordable for as many citizens as possible.

"We have over 40 million people without insurance in this country today, and that is unacceptable," Sen. Orrin Hatch (R-UT) said. "If we would just quit squabbling so much, we could get that number up to 50 or even 100 million. Why, there's no reason we can't work together to deny health care to everyone but the richest 1 percent of the population."

"That's what America is all about," he added.

Read the rest here.