from curlcoat:
We already have Medicaid for those people who simply don’t have the money to get insurance or health care on their own. Then we have all of these people, usually dubbed the working poor, who have made their own choices on what to buy that doesn’t include insurance. So we are supposed to create this new government money hole to provide cheap insurance to people who have already chosen not to pay for it at full price because they wanted to buy other things.
How do you know that all of the working poor are choosing to buy things other than insurance?
How do you know that their income allows them to buy anything beyond rent, utilities, phone, and clothes?
Nice try, but no points. Health care dollars spent are not the same as health insurance premiums paid. Your cite is health care dollars paid after after premiums, so the 30% overhead still stands.
As a preliminary issue, you talk about the cost of a treatment; that may even make sense in the way the UK system works currently - they’re forever experimenting with idea for creating markets - but other UHC systems wouldn’t price the work. Instead, they provide what service they can with the resources provided - we’re talking about committed staff who believe in the system and are dedicated. They make things work when, if they were corporate employees, they might go home. Btw, having hugely committed staff is by far the most undervalued aspect of UHC - I mean committed to the idea. I can’t tell you how important that is.
Next, the kind of bureaucracy you associate with the treatment doesn’t exist to my knowledge; once diagnosed you go through the process from one appointment to the next consultation to the next treatment. That’s it - no one at that level is concerned with budgets, it is just a process in which you move between appointments, etc (if budgets stagnate or worse, I suppose the gap between appointments would increase, unless it was urgent).
As a general point, I’m sure you understand medical professionals make life and death decisions routinely. What I would say is if someone does not get appropriate *and timely *treatment, as in any other area of business, the hospital is exposed to legal action.
In the end, stuff that needs to be done gets done - sometimes because the staff have gone beyond their duty - but it generally works, hence the decent life expectancy, child mortality, etc, rates.
None taken. I think I’ll pop on over to that thread and snoop around, see if I can learn something. Google wasn’t all that helpful wrt how the Yurpeens handle that.
Well aren’t you the little dipshit. I’ve done more than complain (you say whine, I say complain), and I’ve done more than call UHC about it. I went to a higher authority: the people who pay them on my behalf (you should appreciate the entirely capitalistic tactic, which, by the way, works). Maybe you think I would have gotten better results going to the insurance commissioner right off the bat, and maybe you’re even right, but implying I’ve somehow failed to “take responsibility” is idiotic. It’s just more of your favorite pastime of blaming people for anything unfortunate that comes their way.
Cause if I was responsible I’d be able to pay my mortgage (I can) and make my car payments (don’t have any) and I’d have acquired health coverage (I did) and I’d only have babies I could afford (I can) and that whose births were covered by my insurance plan (they are), and even considering all that, it’s still my fault that UHC decided to try to play games and deny claims that they are obligated to pay, because I’m not diligent enough to have the insurance commissioner on speed dial. Right?
I hear filing a complaint with the government works like magic. I appreciate your opening my eyes to this.
Ahem. Where does it say that those are health care dollars after premiums? Let’s read the entire paragraph together, shall we?
Unfortunately the reference provided goes to a pdf that doesn’t exist (#28 if you want to try yourself), so I can’t find any source data. But at least I’ve shown something to bolster my point. The Forbes article further does.
Still awaiting your cites proving that 30% is admin costs, wasted money that will not also have to be spent for UHC.
Still waiting…
still…
If you can prove that, I’ll concede your point. Again, prove it please. No Kos/HuffPo/Pravda/etc. 30% is wasted dollars, right?
Wellpoint of California was, indeed, the first for-profit Blue company. When I started working for BCBS there were something like 120 primary licenses. When I was laid off in 2007 it was down to 39. Basically, the for-profits started buying each other, until only two remained in 2007. They still operate under state names - so, for example, BCBS of Indiana, Ohio, and several other states are all owned by the same primary licensee, but are known still as “XXX of Ohio” and “XXX of Indiana” and so forth. This gives the appearance of more for-profits than actually exist. Only two primary licensees are for-profit. The vast majority are still not-for-profit, whether you believe it or not.
And that is as far as I’m going to with this hijack of yours. I do not want to side track this thread any further with a history of the Blue Cross Blue Shield empire.
I see you don’t understand that universal, single payer health care is NOT an absence of coverage but rather an extension of coverage to everyone in the country. It wouldn’t take years to effect this change if the country actually wanted to make the change.
Your statement is utterly and completely ridiculous. BCBS covers 1/3 of the US. You are stupid enough to think all those policies are identical to each other? You’re grasping at straws rather than admit you were flat-out wrong.
I might concede you earned your RETIREMENT SS - you DID NOT earn the money you get for being disabled prior to retirement age. That is above and beyond the usual benefit.
Yes. It is a government benefit paid for by taxes. It is a form of welfare. Unlike you, however, I don’t find the word “welfare” inherently evil.
Right. I don’t have kids. I’m screwed in regards to welfare in many ways.
Again - you assume anyone receiving any form of government assistance must have been irresponsible rather than unfortunate. Except for yourself, of course - you’re the special exception snowflake.
No.
People spend 20-30 years paying off a house - now THAT is expensive.
Yes, we allow people to take out loans to enable to obtains items they can’t pay for all at once. Provided the loans are paid back why is this a problem? Don’t take on more debt than you can afford to pay back.
Or are you seriously saying no one should buy anything except by paying for it entirely up front? If that’s the case… why do you have a mortgage?
If the government hadn’t taken that money from me, I could have put it in a proper retirement fund, rather than having them piss it away as they have, so that I have to listen to people in here whining that they are paying my SSDI.
I imagine that is true of most everyone who gets social security benefits. There are many people who get them without having paid in at all.
Snort. I didn’t demand gratitude from the folks that were on SS while I was working, if for no other reason than that is a ridiculous thing to expect.
The same exact thing that happened when he was laid off in early 2008. We paid COBRA for nine months, until he got another job. We’ll get Medicare when we have to, but not one minute earlier. I am not even accepting the free Part A that they automatically signed me up for.
Not at all, it is the young folks that don’t think they should pay into insurance until they get sick. My stance is that I am tired of paying for other people’s choices. People have sick babies all the time, so why is it a surprise when another one is born? And then why is it the responsibility of people other than the parents to pay for it/see that it gets paid for? Having a healthy baby is expensive enough and we already have way too many people having babies they can’t afford, so having to pay for a sick one that doesn’t appear to be viable is just too much.
:rolleyes: You are advocating starving disabled people to death? Disabled people are unable to enjoy their earned retirement benefits? Way to be a bigot.
My attitude is that we have created a society of people who think they can have whatever they want as soon as they want it, and when their house of cards falls down they expect someone else to take care of it. We cannot afford to continue to do that for much longer, unless your idea of a perfect society is everyone as the same level of poverty.
Good lord, you guys will try to inject Jesus into everything, won’t you?
I seem to remember quite a few wondering why they would continue the pregnancy knowing that the baby would be born with severe problems and most likely not have anything approaching a normal life. It’s a moot question anyway since it has become impossible for people to avoid giving birth to suffering after a certain period of time.
It has nothing to do with me. Almost all of the people that scream for a UH in the US either don’t know or chose to ignore the fact that government funded health care will still be working with a finite amount of money.
I have no idea what you are talking about, but I will say I am not “pro-health-insurance-industry”. Which you would know if you paid attention to what I post, not what folks like Broomstick pretend I say.
I didn’t say anything about “all” of the working poor. Aside from that, every last example here and all of my own personal experiences have supported my belief that there is a large, growing section of our population that go forth and do whatever they want with little concern as to what they will do should they have some sort of emergency. There are two families of these folks living right across the street from me even. All they need is to lose one wage earner, or have one of the five or six kids get some severe health problem, and they will lose the house they couldn’t afford, the SUVs they had to have and everything else.
Yeah, a few more data points for you. This is in socialist hellhole Finland, by the way.
my 89-year-old fully demented grandmother died last spring when they decided to take her off life support. DEATH PANEL! Of course, said death panel was composed of my father and three aunts who negotiated long and hard with the doctors, who informed them that they would keep my grandmother alive for as long as possible if that’s what they wanted. They decided it wasn’t.
my 84-year-old grandfather died about a week later on the operating table. His body never really fully recovered from a bad bout of influenza he had had about a year earlier, and his systems gave out when they were trying to remove a bowel obstruction. 84 years old. Extremely weak. Bowel obstruction. They still attempted to save his life.
I’ve brought up my brother in other threads. Born with a full bilateral cleft lip and palate, gone through 7 operations so far, the last one just before Christmas of this year. Also, he regularly sees a psychologist, speech therapist, physiotherapist and specialized orthodontist. This 12 years of care so far has cost my parents 30€ per hospital night. Everything else is paid for.
the preemie situation mentioned in this thread: in Finland, the cut-off age for treatment of micropreemies is, I think, 22 weeks. Anything further along than that gets treated to the full capability of the staff, depending on the situation and discussions with the parents. Mikko Hallman, a professor at Oulu University Teaching Hospital, says:
in the GD thread, someone mentioned dentistry (in a sort of “hur hur Brits have bad teeth” way). I had braces for four years because my canine teeth came in before the milk teeth had a chance to fall out and they grew in all wonky. This was covered fully by the government since I was a school kid. Had I gotten braces as an adult, I could have gotten them at a private practice and the Social Insurance Institution of Finland (KELA) would have reimbursed me.
So, there’s a few insights onto how health care is in Finland. Did you know, our men have a life expectancy 7 years lower than women? Women in Finland are expected to live 82 years, the men only 75. We drink a lot of alcohol as a people, we eat quite unhealthy foods, people get drunk and stab each other. And then they get taken to the hospital and treated. And then, maybe, they leave the hospital and go get drunk again and get stabbed and brought back and treated again. And yes, it’s frustrating. But we do it, because they’re people, and that’s what you do with people in a civilized society. That’s the general point of view here.
Our health care spending per capita in 2006 was US$ 4,031, by the way. Y’all’s was US$7,439 according to the Office of the Actuary. We treat everybody. shrug
In America, many feel the poor do not deserve health care. They are poor because they are just not as good a person as the wealthy. If they had gone to the right schools, picked the right profession and saved properly, they would not be such a drain on public monies. Errors start when you choose to be born poor. It is a bad choice and you should pay for it. We have many educated, professionals losing their jobs. They just did not choose wisely.
Our insurance companies are spending mega-millions of insurance revenue in fighting health care reform. They are fighting their customers over coverage and denying care. But they can afford to spend 1.5 million dollars a day lobbying the senators and congressmen.
I think there is something funny about this story. I know insurance companies do some evil things, but I have never heard of a case of an insurance company giving express approval for something and then turning around and not covering it.
In my opinion, there are two likely scenarious which occurred here:
The hospital is out of state. Many insurance plans require you to only see doctors in your home state unless you have to go to the emergency room. Perhaps this couple could not get the needed care in their own state and believe that as a result, the insurance company should cover out of state care. This argument makes sense but an insurance company is unlikely to go along with it. Those are not the terms it agreed to.
The couple assumed this care was covered. Perhaps the insurers coverage manual made it sound like this care would be covered. Coverage manuals tend to contradict themselves constantly and are almost impossible to read. What’s odd about this story is that, in my experience, the insurance holder is not the last stop in determining whether something is covered. One of the first things which occur when you attend a hospital is the hospital gets ahold of your insurance card. They are going to know immediately what is covered and not covered. If there is a question, they get to the bottom of it. They want to be paid.
The idea that this couple was told that they could attend this specialty hospital and it would be covered by insurance only to later be told that none of it would be covered does not add up.
Adds up fine to me. I called my insurer last year to ask if (essentially routine) testing for sexually transmitted diseases would be covered.
The helpful person on the other end asked which specific diseases, so I threw out HIV/AIDS, hepatitis, herpes, gonorrhea, chlamidya, and hepatitis.
She did not know, and referred me to the coverage manual. Having already reviewed said publication, I told her that it did not appear to offer the answers I sought. She expressed dismay and said she was unable to provide further assistance. So, I asked to be transferred to somebody who could. She sent me to a supervisor, who gave me the same answer. I asked if he could transfer me to somebody who knew. He said no, but “[they]'ll call you back”.
They called back. They asked if I knew the billing codes for these procedures. I obtained same from my physician, and called back.
They still didn’t know.
Their advice was, essentially, “go have it done, and you’ll find out if it was covered when you get your statement”.
I wish I was joking.
It was covered, and I’m clean as a whistle, in case you’re wondering.
Anyway, the point is that any system so arcane that insurers cannot define or even offer the practical terms of *their own policies *is one in which any stupid shit can happen. It’s not like I was a prospective customer or something - I had been a policyholder for over two years at that point.
I used to get “prior authorization” from insurance companies for surgeries done by the doctors I used to work for. They make a VERY emphatic point of the disclaimer “Coverage is not a guarantee of benefits” and are very explicit in saying that even if they give you “prior authorization”, if something happens that is in anyway different than the exact scenario you give them when you call (because, of course, medicine/surgery is predictable and changes never happen during surgery), that they can still turn around and deny coverage.
There ain’t no guarantees from an insurance company. None.
Another little data point about how the parents could have been given the idea they were covered:
I was on vacation on Maui last winter and got an eye infection due to a chronic problem I have. Being the dutiful drone that I am I called the number on the back of my insurance card to get a local referral. I was given two names and numbers. The first was located on Molokai, I would have had to fly to get there. The second phone rang and rang and no one ever picked up (at 10 am on a weekday) and there was no message machine. I called back the insurance company, explained the situation and asked if I could get approval to go to local Dr. XYZ who was out of network but could see me in a timely manner. The insurance guy said he could do that.
So I go to Dr. XYZ, he fixes me up and I submit the insurance documents. Surprise, surprise the claim is denied. I call the insurance company back and politely (really) describe the situation and ask why the claim was denied. The woman puts me on hold for a long time to review the situation and comes back and tells me that yes, they have a record of my calling for permission and yes their guy said he could approve my going out of network however he never said he would approve it. Therefore, claim denied. Unfucking believable. The woman I was talking to seemed to think it was as big a load of bullshit as I did and suggested I file a request for review.
Long story short, my secondary insurance company picked up almost the whole tab except for about $10 bucks above my co-payment so it wasn’t worth my time to fight the denial.
I am totally in favor of UHC.
Finally, I am embarrassed by many of my fellow Americans who so vehemently oppose UHC because they think so poorly of both our government and many of our fellow citizens. The ones who’s arguments seem to boil down to we can’t have UHC because the government will fuck it up and/or many Americans don’t deserve health care because they’ve made bad personal choices and/or many Americans will take advantage of the system. What a shitty country they live in.
RNATB, my brain hurts from even trying to think about dealing with bureaucracy like that just to have some simple tests done. Ouch.
The idea of not wanting your fellow citizens to have healthcare because you don’t want to pay for it - some day, some way, everyone ends up needing healthcare. I’m paying for the healthcare of older, sicker people now, but someday I’ll become one of them. I guess it’s two different ways of looking at things.
I am on Medicare. It serves quite well. I don’t use it much, just a 6 month checkup and renewal of prescriptions. Not all Medicare users are beating the system to death.
They send me Emails telling me what preventative tests I qualify for. They know keeping me healthy longer will save them money. They can not just deny coverage. They have a financial interest in keeping me healthy. Insurance companies do not worry. They will deny enough customers coverage that they will guarantee great profits.