Quote: Original post by HostileExpanse

Quote: Original post by Dreddnafious Maelstrom

Quote: Original post by HostileExpanse

Quote: Original post by Dreddnafious Maelstrom
Contrast this with the unregulated lemonade stand market today. Which is more competitive?

So ... I'm still not clear. It seemed to be implied within your original assertion, but to be clear...

Oligopolies can only arise as the product of government regulation?

No, oligopolies CAN occur regularly under non-coerced market conditions. Monopolies can not occur except as the product of government regulation and monopoly grant.

There is nothing inherently wrong with oligopolies by the way, where-as a monopoly implies the ability to artificially control the market.

So ... a "free market" with two suppliers is wholly unlike a government-regulated market with one supplier?

You do realize there is a difference between a monopoly and oligopoly don't you? By difference I mean a profound difference, not some semantic parsing. Do you have a firm grasp of your verbage or is it a catch all boogy man?

Quote: Original post by Oluseyi

Quote: Original post by Eelco

Quote: Original post by jakem3s90
I have a friend whose husband worked at the same place for 20 years, paying private insurance for their family. He lost his job, and couldn't afford COBRA. While laid off, she was diagnosed with cancer. Her husband got another job after some time, and his new insurance wouldn't cover her cancer treatments, because it was a "pre-existing condition". They're now hundreds of thousands in debt, and are going to have to sell their house, and change their retirement plans. It doesn't seem fair (legal?), since they paid in for all those years, and basically got nothing in return.

You are confusing an insurance with a savings plan.

Why would you want to couple either your insurance or savings to your employer? That's a recipe for disaster (no wonder the government encourages it).

Let's do some math. Assuming the same contribution of $15,000 per year over a 20 year span for a family of four, the savings plan would have a total of $300,000. Let's throw in some interest, 4.25% per year, compounded. That brings us to $477,921.12. That doesn't deduct any medical expenses over the 20 years prior, but we'll ignore that.

Is $477,921.12 enough to cover cancer care for a woman in her late-50s or early 60s, with a reasonable expectation of living for another 20-odd years? Of course not. Cancer care can cost up to $300,000 per year. She has as little as 2 years of care saved up for. So much for the "savings plan" as a comprehensive solution to medical expenses.

The entire point of insurance is not to save for an unexpected expense, but to contribute to a fund to spread the costs of an unexpected expense outside of the amounts a single individual can normally bear.

(to the preceeding post as well)

Im not saying they should have gotten a savings plan instead of insurance. Im saying that the complaint 'they paid all these years, then they broke their contract, and then when they got into trouble they got nothing for all their years of payment' is not a valid complaint to level against an insurance company. Thats how insurance works, and i repeat: you seem to be confused with a savings plan. You, not me.

That said, perhaps they should have had a savings plan as well, so they wouldnt immediately have to be without insurance when they lost their job.

In general, a good insurance contract shouldnt be unilaterally voidable on the spot. It should include an appropriate amount of time to find another insurance company. Why youd want to added volatility of tying your insurance contract to your job contract, is beyond me.

Quote: Original post by Dreddnafious Maelstrom

Quote: Original post by HostileExpanse
So ... a "free market" with two suppliers is wholly unlike a government-regulated market with one supplier?

You do realize there is a difference between a monopoly and oligopoly don't you? By difference I mean a profound difference, not some semantic parsing. Do you have a firm grasp of your verbage or is it a catch all boogy man?

We'll just safely assume I'm well-aware of all the terminology I use.


I don't believe that I caught an answer for my question above.

Quote: Original post by Eelco
Im not saying they should have gotten a savings plan instead of insurance. Im saying that the complaint 'they paid all these years, then they broke their contract, and then when they got into trouble they got nothing for all their years of payment' is not a valid complaint to level against an insurance company. Thats how insurance works, and i repeat: you seem to be confused with a savings plan. You, not me.

In what way is a savings plan an alternative to health insurance? I get the vague feeling - due to your imprecision in reference to "savings plans" - that you are arguing that health insurance is not something where an individual makes contributions that yield equity and can then be withdrawn from or cashed out as a direct function of those contributions, that you are disparaging the notion that having paid for "all these years" should entitle an insured individual to any coverage at all. Is that what you mean? If not, could you clarify?

The complaint is not against an insurance company, which seems to be your first misperception. The complaint is against a system in which you pay your insurance premiums but your provider can elect to refuse care for any number of reasons, including claiming your condition to be "preexisting." That is the true crux of the matter that you're missing here: the couple got health insurance again when the husband secured a new job, but the new insurance company is denying her coverage due to her cancer being a "preexisting condition."

You're also probably unaware of the limitations of US COBRA provisions - such as limiting coverage to 18 months, meaning that if your employer provided health insurance and you lost your job and you remain out of work for more than 18 months, even if you are paying the COBRA premiums out of pocket, you forfeit whatever credit/equity you have in the insurance fund. Again, a structural flaw in the system.

I agree, having health insurance tied to employment is a horrible approach, but that's what we have and that's what we're criticizing. That is, we criticize:

1. tying health insurance to employment, such that losing your job results in loss of coverage, or even changing jobs can temporarily leave you uninsured as many employers only begin to provide benefits after 90 days.


2. a system in which an individual pays for health insurance for years, but because the insurance is tied to the employer rather than the individual, the equity that should have been earned within the insurance fund does not follow the individual and is not available when the individual gets into trouble.


3. a system that permits an insurer to accept your money and then refuse you coverage for any number of reasons, including the claim that your condition is "preexisting." Raise my premiums. Classify me as "high-risk," but don't tell me that I can't get coverage - after you've accepted my money, or my employer's money on my behalf - because I'm already sick.

It is also important to note that there are numerous examples that do not include loss of employment or interruption of coverage, yet result in people being denied coverage. There are instances in which treatment is denied due to an explicit and advance refusal to pay by the insurer because the individual is at an out-of-network facility. I don't think that policy should be formulated on the basis of anecdotes, but I do think anecdotes should inform us of tragedies that we do not want to occur under our redesigned system.

I can't see what any of this has to do with savings plans.

Quote: Original post by Eelco
Why would you want to couple either your insurance or savings to your employer?

Americans who have insurance are most likely insured through their employer (paying up to half of the premium in most cases), using the insurance company of their employers choice. If you lose employment, or switch jobs, you lose this insurance, and have to use whatever insurance your new employer has. You can go out and buy an individual plan, but the cost of these plans are fairly expensive, and if for some reason you miss a payment (loss of job, etc), you lose it. Also, let's say you are wealthy, and can afford an individual plan. If you move, you will most likely lose this coverage, since most insurance companies only work with hospitals in their region.

Quote: Original post by Eelco
Why youd want to added volatility of tying your insurance contract to your job contract, is beyond me.

Again, this is how the our current system works, which is why we're (I believe the majority of Americans anyway) are looking to improve it.

You've basically pointed out the major flaws we have in the system.

Quote: Original post by HostileExpanse

Quote: Original post by LessBread
Here's is the press release announcing the results of that study: First-of-Its Kind Study: Medicare for All (Single-Payer) Reform Would Be Major Stimulus for Economy with 2.6 Million New Jobs, $317 Billion in Business Revenue, $100 Billion in Wages.

Interesting. Going to see if I can find this study.

That page links directly to the study, right beneath the "Single Payer Job Recovery" graphic.

Continuing forward with the issue of health care as a right, it seems clear to me that Congress is more interested in establishing a right to profit for health insurance corporations than it is in keeping Americans healthy. Bill Moyers spelled this out last week: Bill Moyers' Journal, July 17, 2009.

Quote:
...
Many of the folks in Regina Benjamin's bayou town are so poor that sometimes she's paid with a pint of oysters or a couple of fish. She buys medicine for her patients out of her own pocket, and she makes house calls.

Now meet H. Edward Hanway, the Chairman and CEO of Cigna, the country's fourth largest insurance company. At the beginning of the year, Cigna blamed hard economic times when it announced the layoff of 1,100 employees. But it reported first quarter profits of $208 million on revenues of $4 billion. Mr. Hanway has announced his retirement at the end of the year, and the living will be easy, financially at least. He made $11.4 million dollars in 2008, according to the Associated Press, and some years more than that.

That's a lot of oysters, although he lags behind Ron Williams, the CEO of Aetna Insurance, who made more than $17 million dollars last year, or John Hammergren, the head of McKesson, the biggest health care company in the world. His compensation was nearly $30 million.

Here's the difference. To Dr. Regina Benjamin, health care is a service, helping people in need with grace and compassion. To Ed Hanway and his highly paid friends, it's big business, a commodity to be sold to those who can afford it. And woe to anyone who gets between them and the profits they reap from sick people.
...

Quote: Original post by Oluseyi

Quote: Original post by Eelco
Im not saying they should have gotten a savings plan instead of insurance. Im saying that the complaint 'they paid all these years, then they broke their contract, and then when they got into trouble they got nothing for all their years of payment' is not a valid complaint to level against an insurance company. Thats how insurance works, and i repeat: you seem to be confused with a savings plan. You, not me.

In what way is a savings plan an alternative to health insurance?

Im not saying they should have gotten a savings plan instead of insurance.

Quote:
I get the vague feeling - due to your imprecision in reference to "savings plans" - that you are arguing that health insurance is not something where an individual makes contributions that yield equity and can then be withdrawn from or cashed out as a direct function of those contributions, that you are disparaging the notion that having paid for "all these years" should entitle an insured individual to any coverage at all. Is that what you mean? If not, could you clarify?

They are entitled to the coverage specified in their contract, as long as it isnt broken.

Quote:
The complaint is not against an insurance company, which seems to be your first misperception. The complaint is against a system in which you pay your insurance premiums but your provider can elect to refuse care for any number of reasons, including claiming your condition to be "preexisting." That is the true crux of the matter that you're missing here: the couple got health insurance again when the husband secured a new job, but the new insurance company is denying her coverage due to her cancer being a "preexisting condition."

Preexisting conditions are a sensitive issue, but you wouldnt have that problem if you didnt have coverage gap.

Quote:
You're also probably unaware of the limitations of US COBRA provisions - such as limiting coverage to 18 months, meaning that if your employer provided health insurance and you lost your job and you remain out of work for more than 18 months, even if you are paying the COBRA premiums out of pocket, you forfeit whatever credit/equity you have in the insurance fund. Again, a structural flaw in the system.

Now youve made it explicit: you are confusing insurance and a savings plan. Perhaps through no fault of your own, perhaps thats the way of things in the US, but in that case: do you agree that bundling savings and insurance under one contract is retarded?

Quote:
It is also important to note that there are numerous examples that do not include loss of employment or interruption of coverage, yet result in people being denied coverage. There are instances in which treatment is denied due to an explicit and advance refusal to pay by the insurer because the individual is at an out-of-network facility. I don't think that policy should be formulated on the basis of anecdotes, but I do think anecdotes should inform us of tragedies that we do not want to occur under our redesigned system.

Does the facility not request your insurance card? The responsibility should be with them, id say. If they give you treatment, knowing you arnt insured there, without explicit consent: fuck them.

Quote: I can't see what any of this has to do with savings plans.

Then appearently you dont know what a savings plan is, even though you yourself are talking about one.
you forfeit whatever credit/equity you have in the insurance fund

Quote: Original post by Eelco

Quote:
You're also probably unaware of the limitations of US COBRA provisions - such as limiting coverage to 18 months, meaning that if your employer provided health insurance and you lost your job and you remain out of work for more than 18 months, even if you are paying the COBRA premiums out of pocket, you forfeit whatever credit/equity you have in the insurance fund. Again, a structural flaw in the system.

Now youve made it explicit: you are confusing insurance and a savings plan. Perhaps through no fault of your own, perhaps thats the way of things in the US, but in that case: do you agree that bundling savings and insurance under one contract is retarded?

... apparently you dont know what a savings plan is, even though you yourself are talking about one.
you forfeit whatever credit/equity you have in the insurance fund

I suspected this was going to be your counter, and I was right.

While one does not literally earn a "credit" or "equity" from insurance, a history of paying premiums without claims is what makes an insurance customer a "good" customer. What is essentially being decried is an individual having been a good, low-risk customer and contributed to their insurance fund but now needing to make a claim and losing their insurance as a consequence. In some cases this loss is explained by a technicality such as temporary loss of coverage or change in providers, typically because coverage is tied to employment, but this is one area where we agree: coverage should not be tied to employment.

Nobody is talking about a savings plan. Nobody is confused. Well, maybe except you.

Quote: Does the facility not request your insurance card? The responsibility should be with them, id say. If they give you treatment, knowing you arnt insured there, without explicit consent: fuck them.

A mother's little child is hurt at a playground. Emergency services are called, and the on-site paramedics determine that this is a life-threatening situation. The child is rushed to the nearest hospital, arriving in time for doctors to have a good chance at saving her life. The facility asks if the mother is insured, which she is, and they ask for her insurance card. Because of the extent of the injury to the child, they call the insurer to determine coverage - if the insurer will pay. The insurer completely balks because the hospital is not in its coverage network, and insists the mother transfer the critically injured child to another hospital. The mother, being a mother, is pleading for these medical professionals to treat her child, but they refuse. The child dies.

This is okay to you?

This isn't a hypothetical situation.

Quote: Original post by Eelco
Preexisting conditions are a sensitive issue, but you wouldnt have that problem if you didnt have coverage gap.

I think everyone understands the situation. Its not an academic failure to understand you loose coverage you don't get covered. Its simply saying that the loss of coverage gives you the screws. And in the example situation one didn't break their contract it was broken for them. No matter how it plays out there will be an UNAVOIDABLE loss and gap in coverage, because the original policy is no longer valid for the individual. He will have to get new insurance which will most likely be something totally different from an alternate vendor. 2 seconds of paperwork shuffling is enough to qualify you as a new client with pre-existing conditions. Its unavoidable which means its a flaw and a hole that should be plugged. It is being said coverage shouldn't be lost.

There will be a loss of coverage no matter what due to what you have insisted is a flaw in the system. Yet instead of embracing it as a flaw you are insistent that somehow people have no right to feel burned or jaded over said flaw. You sound for and against the scenario all at the same time. People aren't complaining because they don't academically understand, they complain because its a frustrating reality too many people have to deal with that can actually result in death.

Quote: Original post by Oluseyi

Quote: Original post by Eelco

Quote:
You're also probably unaware of the limitations of US COBRA provisions - such as limiting coverage to 18 months, meaning that if your employer provided health insurance and you lost your job and you remain out of work for more than 18 months, even if you are paying the COBRA premiums out of pocket, you forfeit whatever credit/equity you have in the insurance fund. Again, a structural flaw in the system.

Now youve made it explicit: you are confusing insurance and a savings plan. Perhaps through no fault of your own, perhaps thats the way of things in the US, but in that case: do you agree that bundling savings and insurance under one contract is retarded?

... apparently you dont know what a savings plan is, even though you yourself are talking about one.
you forfeit whatever credit/equity you have in the insurance fund

I suspected this was going to be your counter, and I was right.

Thats not a great feat, considering that 'equity' and 'fund' are well defined terms. Am i to understand you are misapplying them on purpose? Care to explain that?

Quote: Nobody is talking about a savings plan. Nobody is confused. Well, maybe except you.

Yes, i am. Congratulations.

Quote:
While one does not literally earn a "credit" or "equity" from insurance, a history of paying premiums without claims is what makes an insurance customer a "good" customer. What is essentially being decried is an individual having been a good, low-risk customer and contributed to their insurance fund but now needing to make a claim and losing their insurance as a consequence. In some cases this loss is explained by a technicality such as temporary loss of coverage or change in providers, typically because coverage is tied to employment, but this is one area where we agree: coverage should not be tied to employment.

'temporary loss of coverage' is not a technicality. Do you expect to be able to take your crashed car to an insurer and get it insured retroactively? If that were a possibility, do you think anyone would buy insurance?

What would happen, is that the price of insurance would come to match the price of emergency care. Plus overhead. To allow for retroactive insurance, is to outlaw insurance.

Quote:

Quote: Does the facility not request your insurance card? The responsibility should be with them, id say. If they give you treatment, knowing you arnt insured there, without explicit consent: fuck them.

A mother's little child is hurt at a playground. Emergency services are called, and the on-site paramedics determine that this is a life-threatening situation. The child is rushed to the nearest hospital, arriving in time for doctors to have a good chance at saving her life. The facility asks if the mother is insured, which she is, and they ask for her insurance card. Because of the extent of the injury to the child, they call the insurer to determine coverage - if the insurer will pay. The insurer completely balks because the hospital is not in its coverage network, and insists the mother transfer the critically injured child to another hospital. The mother, being a mother, is pleading for these medical professionals to treat her child, but they refuse. The child dies.

This is okay to you?

This isn't a hypothetical situation.

Like i said, i think the case for nationalizing emergency care is strong.

It is my understanding that this is already the case though; that US hospitals are not allowed to refuse emergency care. Which is a rather fucked solution, as it leaves the questions as for whom to foot the bill completely open.

An insurance company making deals for non-emergency care is fine with me, but i wouldnt take a contract that skips on emergency care.