Chart Of New Health Care Law

[goodrich4bk]

Re: Chart Of New Health Care Law

I think that passing out and getting into automobile accidents demonstrates conclusively why insurance companies are apprehensive about insuring you against catastrophic loss.

Believe it or not, there are hundreds of thousands of insured diabetics on insulin who get in a car and drive everyday. They are called employees and they get insurance not because they present less risk to the insurance companies but because their risk is pooled.

I, on the other hand, am self-employed. And to answer another question, I was fully covered by insurance as a partner.

Implicit in your comment is that you gain by keeping people like me out of your pool. That is true, so long as you also don't lose your coverage and acquire a preexisting condition. But you also seem to have missed the fact that their are millions of sick people already in your pool. And when each one of them gets seriously insured or sick, they receive much more in healthcare benefits than they ever contributed to the pool. It must make you very upset.



Forcing the rest of us to overpay for a policy isn't called common sense. If it was voluntary I'd call it charity, but being that it isn't voluntary I have a different word for it.

So I guess the existence of any government funded by taxes is socialism for those who don't presently need or use its services. I've never been robbed or mugged and I live in a nice neighborhood of over 2000 homes that have not had a fire since the neighborhood was formed 4o years ago, so I'm clearly overpaying for police and fire protection. And if I had sent my kids to private school (I did not) the entire school system would surely look like a communist organization. The U.S. hasn't been invaded by a foreign army since 1812 yet we've got the world's largest military by orders of magnitude. I wonder why nobody has noticed that insidious socialist organization.

You appear to believe that if am a greater risk for one disease or complication I should not be able to get insurance at all. You want to keep your rates low by keeping others out of your pool. I get it. I studied feudalism in college. I love castles and moats, too. I just don't see many successful societies building them today, though.

[lektrode]

Re: Chart Of New Health Care Law

ditto.

very nicely done, ms shiny!
couldnt have said it better and wouldnt change a word.

and thanks as well to go4broke for putting some personal stuff into the discussion - this is THE REAL STORY, vs the typical BS spin from the FIre bought-off political class and the agenda-financed lamestream media!

Respectfully, I disagree. The argument has been framed by FIRE politicians as an either/or proposition. Everyone insured -vs- fend for yourself in a climate of unaffordable health care. There are more options than this but they're not on the table.

I say disband the insurance companies. Drive a stake through their black hearts!

Insurance companies have become the locust plague of our economy. Medical insurance was invented to protect us from a catastrophic expense. Now, for millions of us, trying to pay for medical insurance IS the catastrophic event, month after month. For people without insurance, the question is "buy food, or get medical care?" For people who have to pay for their own insurance, it's "buy food, or pay my insurance premium?"

We're being brainwashed into seeing only these two options. Propaganda uses two lies to keep the FIRE system going:

• "We have the best health care in the world" and
• "Stick with the insurance model because socialized medicine leads to rationing."

I call BS. We're being BLACKMAILED: either pay insurance premiums that bankrupt you, or run the risk of financial devastation in our obscenely expensive health care system. But insurance is one of the biggest drivers of rising expenses in health care.

We already have rationing! If you can pay, you get care. If you can't pay, you get no care, or you get substandard care and medical debt that destroys you.

Without insurance, your hospital will bill you far more than the amount an insurer would pay for the same procedure. That's insane! Just charge those low reimbursement fees to everyone directly, and cut out the insurance middle man!

Why is it that an MRI with insurance will cost me $3000 out-of-pocket before my deductible kicks in, but only a few hundred $$ at a private MRI clinic that doesn't take insurance? If I go to that clinic to save money, guess what? I can't submit the bill to my insurer to have it applied towards my insanely high deductible.

Why is veterinary surgery so inexpensive compared to human surgery? Because people pay for it out of pocket. Veterinarians don't need extra staff for insurance billing; they don't charge grossly inflated fees so as to be reimbursed only a portion of it. Ask your vet what a procedure will cost; they give you a printout detailing every charge before you sign on the dotted line. Before we had "universal insurance" human health care was like this. The contract was strictly between patient and doctor.

You guys know I'm a libertarian. But insurance companies have financially raped us so badly that I now favor disbanding the insurance industry completely. Use a mix of government run clinics and private practice care for those who wish to pay for it. When providers don't have to pay extra staff to handle insurance billing, their fees go down dramatically. You also get transparency in pricing.

Cut out the insurance middle-man and health care costs become sane again. It's why health care so much less in Thailand, Mexico, Costa Rica, Ecuador... Some surgical clinics in the U.S. are starting to go adopt this business model already.

I like a model whereby people pay a reasonable fee to be members of their nearby hospital, which charges low fees for services and bills the patient directly. Hospitals provide reciprocity with each other if a member needs emergency care at a distant hospital. Costs could be subsidized by the government.

Private physicians can provide affordable care to patients who pay a modest monthly subscription fee to be a member of their practice. Charge low fees for their services and bill their patients directly. I used to see a doctor in Santa Fe who did business on this model. He got his medical degree from Harvard. He was the only doctor in town who cared for low-income patients who couldn't afford insurance.

It won't be perfect, but I don't see how it could be worse than what we have now. I'd much rather have tax revenues used to subsidize health care than for fighting endless wars around the world. This is why small countries with small economies can offer decent health care for a fraction of what it costs here: they use a non-profit model and they aren't throwing away their money on wars.

[DSpencer]

Re: Chart Of New Health Care Law

Actually, I am wrong and your cynical side is right. The case was US vs. South Eastern Underwriters Association. And the decision went so that Congress could regulate these things and stop states from regulating them.

Then Congress immediately responded with the McCarran Ferguson Act of 1944.

And the Bohner has been trying to repeal McCarran Ferguson, or at least letting attempts hit the House floor. And Pelosi did before him.

Crazy.

I suppose because it had not happened in so long, I just assumed that the Feds butting out of state insurance reform had been a Supreme Court Decision.

Turns out it's a 1944 Congressional decision that for whatever reason Congress has not managed to undo in the wave of deregulation / state power reduction over the last 70 years.

I guess it's a mixed bag. The law limits Federal power, gives states power, but also gives some Insurance companies monopoly power in some states. There's both a federalism and an anti-trust argument baked into this one.

Thanks for the intellectual honesty. The Feds have provided another shield for the insurance industry: ERISA

ERISA Section 514 preempts all state laws that relate to any employee benefit plan, with certain, enumerated exceptions. The most important exceptions — i.e. state laws that survive despite the fact that they may relate to an employee benefit plan — are state insurance, banking, or securities laws, generally applicable criminal laws, and domestic relations orders that meet ERISA's qualification requirements.

A major limitation is placed on the insurance exception, known as the "deemer clause", which essentially provides that state insurance law cannot operate on employer self-funded benefit plans. The Supreme Court has created another limitation on the insurance exception, in which even a law regulating insurance will be pre-empted if it purports to add a remedy to a participant or beneficiary in an employee benefit plan that ERISA did not explicitly provide.

A three-part analysis is used to decide whether ERISA preempts state law. First, preemption is presumed if the state law “relates to” any employee benefit plan. Second, a state law relating to an employee benefit plan may be protected from preemption under ERISA if it regulates insurance, banking, or securities. The third step of the ERISA preemption analysis concerns the “deemer” clause. State insurance regulation may be saved only to the extent that it regulates genuine insurance companies or insurance contracts. As a result, a state may not “deem” an employee benefit plan to be an insurance plan in an effort to sidestep preemption if the benefit plan would not otherwise meet the requirements as an insurance company or contract. The “deemer” clause therefore restricts the use of the “savings” clause to conventionally insured employee benefit plans.^[4]
The result of ERISA preemption is that the only remedy available to a covered person who has been denied benefits or dropped from coverage altogether is to seek an order from a federal judge (no jury trial is permitted) directing the Plan (in actuality the insurance company that underwrites and administers it) to pay for "medically necessary" care. If a person dies before the case can be heard, however, the claim dies with him or her, since ERISA provides no remedy for injury or wrongful death caused by the withholding of care.
Even if benefits are improperly denied, the insurance company cannot be sued for any resulting injury or wrongful death, regardless of whether it acted in bad faith in denying benefits. Insurers operating ERISA plans enjoy several immunities not available to other types of insurance companies. ERISA preempts all conflicting state laws, including state statutes prohibiting unfair claims practices and causes of action arising under state common law for insurance bad faith.^[5] There is no right to a jury trial in ERISA benefits actions.^[6] Although Americans normally take for granted the right to testify on their behalf, plaintiffs have no right to present live testimony in ERISA bench trials, in which the judge simply reads through the documents which formed the record originally before the ERISA plan administrator and performs de novo review.^[7] Finally, punitive damages are not allowed in actions for ERISA benefits.^[8]

It has been argued that in the case of health benefits, the effect of all of this may paradoxically have been to leave plan participants worse off than if ERISA had not been enacted.^[9]

Many persons included among the some 47 million people presently without health care coverage in the United States are former ERISA "subscribers", insurance terminology for Plan beneficiaries, who have been denied benefits-usually on the ground that the prescribed care is not medically necessary or is "experimental"-or dropped from coverage, often because they have lost their jobs due to the very illness for which care was denied.^{[citation needed]}
Many consumer and health care advocates have called for a "restoration of the freedom of contract enforcement," to the 75% of Americans insured under these work place group plans-in effect, a repeal of the ERISA pre-emption. Permitting these insured persons access to customary state remedies (98% of all civil disputes are resolved in state courts) would, they contend, result in a substantial reduction in arbitrary denial of care benefits, simultaneously alleviating a major burden on state Medicaid systems and clogged federal court dockets.^{[citation needed]}

On behalf of lobbyists and their backers, politicians legislated our healthcare system into ruins. Now instead of fixing the underlying problems they built a Rube Goldberg machine on top of it.

So an insurance company can be an anti-competitive monopoly acting in bad faith to deny benefits to its subscribers but as long as they get insurance through their job and die from their illness, it really doesn't matter. And it doesn't matter much even if they do live and get a federal judge to agree with them because the only punishment is paying for the care that they owed in the first place.

But if we could just force employers to cover the grown children of their employees that would fix everything...

[c1ue]

Re: Chart Of New Health Care Law

Pooling resources to protect each of us from catastrophic loss is not socialism. It is common sense.

Universal catastrophic health care cost insurance - if that is what society deems sufficient, is fine by me.

My point all along is that all of the other 1st world and most of the 2nd world nations don't draw the line there.

They draw the line at affordable, universal health care. They treat health care just like primary school education, clean water, electricity, telephone service, public safety, and so forth.

Are these systems perfect? No. If you need a liver to live and have $100 million, the American system is the best.

For the vast majority, however, public health as a utility is far better.

My objection to ObamaCare is that it rejects the above notion in favor of a Potemkin village which simultaneously perpetuates many of the problems of the previous system. Yes, it solves a couple of prominent abuses - but in the process has made health care affordability worse.

Note that I am referring to health care affordability and access - not to the flimsy excuse of Bronze level plans.

[radon]

Re: Chart Of New Health Care Law

You appear to believe that if am a greater risk for one disease or complication I should not be able to get insurance at all.

No, that is between you and your insurer. Your example of passing out and potently doing critical harm to yourself and others makes you a poor insurance risk. Yet you can't seem to see why they shouldn't just fork over a unprofitable policy.

You want to keep your rates low by keeping others out of your pool. I get it.

Why should I have to absorb your risk if not for charity? Are you going to pay cash for insulin, medical checkups, and other sundries or are they going to be billed to you new health plan? I'm sorry about your medical condition, but it isn't about pools, you want someone else to pay for your misfortune, albeit indirectly. Your health plan comes at our expense.

What does your auto insurance look like? If the government forced you to be lumped in with some teenagers with 5 accidents and a DUI I'll bet it would be a bit more expensive. But I'm sure you wouldn't mind paying higher rates - in the spirit of giving you know.

But this really misses the whole point of Raz's quip.

In order to control legal costs we should create some LMOs for managed legal representation. All congress has to do is pass a bill forcing everyone in America to sign up for a legal plan of some sort, but it can't be a good one or they will have to pay a penalty. You'll never be paid directly and so your clients won't care how much of your time they use since it is all the same to them. It will be great for you because you'll be very busy. Don't worry about getting paid, the LMO will send you a token check every once in a while. This is assuming you can hire an office full of people to navigate the maze of new legal billing codes. I'm sure you'll be ok with that, its not like you have a business to run.

You see how ridiculous this situation is if you apply it to another profession.

[c1ue]

Re: Chart Of New Health Care Law

No, that is between you and your insurer. Your example of passing out and potently doing critical harm to yourself and others makes you a poor insurance risk. Yet you can't seem to see why they shouldn't just fork over a unprofitable policy.

Actually, your understanding of insurance is flawed.

The entire point of actuarial work is to even out the risks to everyone. The primary reason insurance companies tried their best to kick out people like goodrich4bk is because there are regulations which affect pricing. By paring their expected payouts down in any given insurance company's actual customer base - as opposed to the 'general' population which regulators look at - the insurance company can increase the actual profitability vs. what is normally expected (and regulated towards).

Note that the relationship with specific conditions is only a matter of degree, not quality. The same could be said for a perfectly healthy person who is 55 years ago. A 55 year old intrinsically is going to be more expensive than a 25 year old.

More importantly - Today it is easier to identify and kick out (for whatever reason) the Type I diabetic. Tomorrow, it will be the 55 year old.

[dcarrigg]

Re: Chart Of New Health Care Law

Thanks for the intellectual honesty. The Feds have provided another shield for the insurance industry: ERISA



On behalf of lobbyists and their backers, politicians legislated our healthcare system into ruins. Now instead of fixing the underlying problems they built a Rube Goldberg machine on top of it.

So an insurance company can be an anti-competitive monopoly acting in bad faith to deny benefits to its subscribers but as long as they get insurance through their job and die from their illness, it really doesn't matter. And it doesn't matter much even if they do live and get a federal judge to agree with them because the only punishment is paying for the care that they owed in the first place.

But if we could just force employers to cover the grown children of their employees that would fix everything...

There's a lot messy about this convoluted system we have now. The push to make an ownership society, however well-meaning, has clashed directly with the parochial industrial boss/labor society of old. Louis Kelso's dream of democratizing access to capital stands in direct opposition often with protection of the institution of labor. The funny thing is, both claim to be helping the same population. But at some point there has to be a scientific consensus here, some metric that shows whether the people purported to be helped by these institutions indeed are being served well compared to the alternative.

Kelso once wrote something along the lines of 'technically the Roman colosseum games were a fair contest with equal rules, but if it's all armed roaring lions and Christians' blood, the playing field was never truly equal.' His solution was to try to make every citizen in America a petite capitalist - make them own stock. His dream was that they would no longer have to be laborers. That capital would set them free. But I think maybe his idea amounts to little more than arming the Christians with a spoon. Every attempt to democratize capital ownership and thrust people into credit and insurance markets has ended badly for the bottom 80% of the population.

And I think maybe that's the weird thing about trying to set up some private market for healthcare. It's a similar idea. Overcomplicated. Hard for even smart people who are good with numbers to understand. Opaque and full of big players. Hypercomplicated multi-corporate structures where a dozen for profit corporations are operating simultaneously in any given hospital. The lions are running the hospitals and the pharmaceuticals and the insurance companies. The Christians are filling the hospital beds and the insurance forms. In the end, the lions get their blood (money).

[lektrode]

Re: Chart Of New Health Care Law

....Hard for even smart people who are good with numbers to understand. Opaque and full of big players. Hypercomplicated. The lions are running the hospitals and the pharmaceuticals and the insurance companies.


The Christians are filling the hospital beds and the insurance forms. In the end, the lions get their blood (money).

gotta hand it to you, dc - you DO have a way of 'splainin stuff in a historically colorful and technically accurate yet descriptive way

(and YES thats a(nother) compliment, big guy)

adding: in any case, whats going on inside the beltway can only be described as 'romanesque'

[radon]

Re: Chart Of New Health Care Law

Actually, your understanding of insurance is flawed.
The entire point of actuarial work is to even out the risks to everyone.

Everyone that qualifies for that policy. You don't pay as much for auto insurance as a high risk driver for that very reason.

More importantly - Today it is easier to identify and kick out (for whatever reason) the Type I diabetic. Tomorrow, it will be the 55 year old.

Sure, insurance companies are in the business of making money. This means paying healthcare providers less and charging clients more. Signing on unprofitable policies forces insurer to make it up the difference by charging everyone higher premiums.

[vt]

Re: Chart Of New Health Care Law

http://www.nationaljournal.com/domes...dable-20130829

[c1ue]

Re: Chart Of New Health Care Law

Everyone that qualifies for that policy. You don't pay as much for auto insurance as a high risk driver for that very reason.

You don't pay as much yet because the auto insurance companies don't have the detailed data like the health insurance companies do. Yet.

That's changing.

Sure, insurance companies are in the business of making money. This means paying healthcare providers less and charging clients more. Signing on unprofitable policies forces insurer to make it up the difference by charging everyone higher premiums.

Wrong entirely. What you failed to understand is that the health insurance company makes money overall no matter what.

They just make more doing extra things.

And as I noted - that dynamic will apply to everyone sooner or later. If you aren't 25 years old, you too would be "sucking off other people's health" as the 25 year olds that are in that pool are subsidizing everyone who is older.

[radon]

Re: Chart Of New Health Care Law

You don't pay as much because your policy doesn't include high risk drivers. Policies that cover them are considerably more expensive.

Care to explain how an insurer with a rising medical loss ratio can remain profitable without raising premiums or seeking government subsidies?

[lektrode]

Re: Chart Of New Health Care Law

....Care to explain how an insurer with a rising medical loss ratio can remain profitable without raising premiums or seeking government subsidies?

not to interrupt (this excellent exchange)
methinks thats NOT part of the calculous/equation in all this (since single payer is likely to be the only way out of obama'scare)

[vt]

Re: Chart Of New Health Care Law

Shiny,

I'm no fan of insurance companies, but the purpose of insurance is misunderstood.

The proper use of insurance is to participate in a pool with a small premium to cover one if a catastrophic health event occurs. It's not to pay for a checkup or flu visit to the doctor. These expenses should be paid out of the health care part of the family budget.

You buy homeowner's insurance to protect against a fire or tornado that could leave you homeless. But you pay for maintenance like painting, plumbing, roof repairs, and lawn care out of pocket.

The use of insurance for health has been taken completely out of sound risk principles.

We look at the government and the potential for a single payer system as salvation, but how will the government save money. The only answer I see is rationing. Yes, insurance companies ration too, but the government may be even more restrictive.

At some point we are all going to have to take more responsibility for our health, and costs may be apportioned based more on health much like life insurance.

Another issue is the use of health insurance in the last year of life, which is predominantly medicare. A physician told me that half of the total cost of Medicare is spent in the last year of life. I foresee some type rationing coming in here too.

[radon]

Re: Chart Of New Health Care Law

You buy homeowner's insurance to protect against a fire or tornado that could leave you homeless. But you pay for maintenance like painting, plumbing, roof repairs, and lawn care out of pocket.

The use of insurance for health has been taken completely out of sound risk principles.

Bingo!