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"Mandatory end of life Counseling" and other Health Care Reform woes

Started by July 24, 2009 08:35 PM
863 comments, last by nobodynews 15 years, 1 month ago
Quote: Original post by Eelco
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?

Neither one of those terms is as narrowly defined as you would like to portray them. The concept of insurance is similar, in many respects, to a co-operative: participants pool their resources into a shared fund so that any one of them may draw an amount greater than he individually would otherwise be able to gather. Calling insurance a "fund" is not a completely out-of-bounds usage.

Quote: '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?

Temporary loss of coverage is a technicality because coverage is tied to employment, and even the ability to transfer coverage is limited by law. The point is not absurd hypothetical analogies to car insurance, but whether you'd like your auto insurance to be tied to your job, too. Nobody is talking about "retroactive insurance."

Quote: 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.

In the case cited, care was refused. And the reason care is being refused is precisely because the question of who foots the bill is open, in large part because our HMOs will jump through rings of fire to avoid paying to cover claims by fully-paid up subscribers.

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

The contract never skips on emergency care. It's always the loopholes, the bureaucratic procedures and the arbitrary "company policies" that deny it when it's actually needed - after it has been paid for.
Don't you guys have mutual insurances? Historically, these are less rapacious than your standard private insurance company. Are are their core values been eroded by deregulation and corporate greed?

We're been insured by a mutual for complementary health cover (yes, you need some even in France), car insurance, home insurance, life insurance, ect... and they've been brilliant.

Everything is better with Metal.

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Quote: Original post by Oluseyi
Quote: Original post by Eelco
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?

Neither one of those terms is as narrowly defined as you would like to portray them. The concept of insurance is similar, in many respects, to a co-operative: participants pool their resources into a shared fund so that any one of them may draw an amount greater than he individually would otherwise be able to gather.

You are confusing insurance with savings, exactly like i said.
Quote:
Calling insurance a "fund" is not a completely out-of-bounds usage.

Calling equity into the picture is.

Quote:
Quote: '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?

Temporary loss of coverage is a technicality because coverage is tied to employment, and even the ability to transfer coverage is limited by law. The point is not absurd hypothetical analogies to car insurance, but whether you'd like your auto insurance to be tied to your job, too. Nobody is talking about "retroactive insurance."

We agree on the tying to your job part.

'Absurd hypothetical'.. Care to elaborate on that? Im comparing apples with apples: insurance with insurance. How is your dismissive attitude towards a coverage gap NOT equivalent to a plea for allowing retroactive insurance?

Quote:
Quote: 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.

In the case cited, care was refused. And the reason care is being refused is precisely because the question of who foots the bill is open, in large part because our HMOs will jump through rings of fire to avoid paying to cover claims by fully-paid up subscribers.

Technically, you didnt cite anything.

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

The contract never skips on emergency care. It's always the loopholes, the bureaucratic procedures and the arbitrary "company policies" that deny it when it's actually needed - after it has been paid for.

Appeals to 'company policies' are no excuse for a breach of contract tantamount to murder. If that were allowed to pass as a matter of routine, you should be pleading for an overhaul of your legal system. But i think a more likely explanation of the widespead circulation of such stories, is that you are not the only person with a disrepancy between what insurance is and what youd want it to be.
Quote: Original post by oliii
Don't you guys have mutual insurances? Historically, these are less rapacious than your standard private insurance company. Are are their core values been eroded by deregulation and corporate greed?

We're been insured by a mutual for complementary health cover (yes, you need some even in France), car insurance, home insurance, life insurance, ect... and they've been brilliant.


Yes, we have mutual insurances but not for health care (afaik). Most people get their health insurance through their employer as a job benefit, so they don't think about buying additional health insurance.

Here's more about the current cost: Challenge to Health Bill: Selling Reform

Quote:
...
Our health care system is engineered, deliberately or not, to resist change. The people who pay for it — you and I — often don’t realize that they’re paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with.
...
The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average.

We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.

In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical.

One thing we don’t get is better health than other rich countries, whether it’s Canada, France, Japan or many others. In some categories, like emergency room care, this country seems to do better. In others, like chronic-disease care, it seems to do worse. “The fact that we spend all this money and don’t have better outcomes than other countries is a sign of how poorly we’re doing,” says Dr. Alan Garber of Stanford University. “We should be doing way better.”
...


I disagree with the description of that $6,500 as a tax. Calling it that suggests the money ends up with the government rather than in the pockets of insurance company fat cats. It's more like a shipping fee or a toll or a tribute to a feudal lord.

"I thought what I'd do was, I'd pretend I was one of those deaf-mutes." - the Laughing Man
Quote: Original post by Eelco
<stuff>

I will no longer be responding to you. You have no interest in a discussion of improving the system. Congratulations. "You win at the internets."
How about we treat health insurance like car insurance? Take it away from employers and allow the companies to compete just like geico and allstate. Offer better plans for better prices.. Prices would drop at least..

Let the employers use the money they would using to pay for employee insurance and put it in their paycheck so that employees can choose their plan.

[Edited by - Chris Reynolds on July 27, 2009 8:36:13 PM]
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Quote: Original post by Chris Reynolds
How about we treat health insurance like car insurance? Take it away from employers and allow the companies to compete just like geico and allstate. Offer better plans for better prices.. Prices would drop at least..

Prices won't drop. It'll be better because coverage won't be tied to employment, so that's an absolute no-brainer good idea. But prices won't drop significantly because of the things that increase the cost of healthcare provision:
  1. liability insurance;

  2. state restrictions - not all providers are available in all areas, reducing competition;

  3. medical record-keeping;

  4. drug costs

It's a good first step, but we need more.

Quote: Let the employers use the money they would using to pay for employee insurance and put it in their paycheck so that employees can choose their plan.

In theory that works. In practice, well... Let's say your employer is a small business with 50 employees. In purchasing health insurance - typically at a fixed level for all employees - for 50 people and their dependents, do you think your employer would obtain a discount over you purchasing individually?

Which is not to say I disagree. On the contrary, I completely agree: I think employers should pay salaries and individuals should be free to purchase as much or as little health insurance as they need. But we still have to do something to lower the costs of healthcare and improve our return on investment as a nation.
One little historical note about how health care insurance became tied to employment. Wages were capped during WWII. So to entice better employees, employers offered health insurance as a benefit in lieu of greater wages. The arrangement worked well enough and stuck, even though Truman tried and failed to establish a single payer system in 1948.

One more thing, with regard to the car insurance model. Private insurance failed to cover every car here in California, so the state had to step in and offer a basic liability package for motorists too poor to afford private coverage. It's not free, but it's cheaper. And it's not available to everyone, only to those who qualify.
"I thought what I'd do was, I'd pretend I was one of those deaf-mutes." - the Laughing Man
Quote: Original post by LessBread
One more thing, with regard to the car insurance model. Private insurance failed to cover every car here in California, so the state had to step in and offer a basic liability package for motorists too poor to afford private coverage. It's not free, but it's cheaper. And it's not available to everyone, only to those who qualify.


IMO, if you can't afford to insure your car, you shouldn't have bought the car in the first place. OTOH, IMO, hardly anyone should own a car anyway. :)
Quote: Original post by Zahlman
Quote: Original post by LessBread
One more thing, with regard to the car insurance model. Private insurance failed to cover every car here in California, so the state had to step in and offer a basic liability package for motorists too poor to afford private coverage. It's not free, but it's cheaper. And it's not available to everyone, only to those who qualify.


IMO, if you can't afford to insure your car, you shouldn't have bought the car in the first place. OTOH, IMO, hardly anyone should own a car anyway. :)


A fine philosophy, but not really practical, at least in Southern California. Maybe if you live near San Fran. the public transport is a little better, and things are closer together, but I cant speak to that personally.

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