I’d agree with you if the young person agreed to die suddenly at 30, or to never buy insurance. Barring that, since he will eventually be in the high risk pool he should also be obligated to pay when in the low risk pool.
If you are comparing insurance to a 419 scam it shows you don’t really understand what insurance is about. Do you have life insurance? If so, do you feel ripped off if you don’t die in a given year, but pay premiums anyway?
You may be confusing me with gonzomax. I don’t think insurance companies are in the business of denying claims. In the short run they may be more profitable by fighting against expensive treatments, but in the long run by accepting them they allow the increase in healthcare costs, which justifies an increase in premiums, which increases their absolute profits of not their percentage of profits. Why be a $500 million business and have everyone hate you for denying coverage when you can be a $1 billion business and have everyone love you for paying - even as the rates trickle up like the heat in the frying pan with the frog.
Insurance companies do seem to press to make a given treatment more efficient - as any new mother kicked out of the hospital after a day or two can tell you. That’s different from resisting expensive remedies that are effective - or which seem to be.
Neither of your links give any numbers about the number of young uninsured. I have seen numbers, from conservative writers, giving information about how a fairly large percentage of the uninsured are uninsured by choice, and are therefore not a problem. No time now to look it up, since I saw it in a newspaper. So, while lower rates for the young and healthy reduce the number of the young uninsured, there still seems to be a lot of them.
The factors are not really sick vs healthy, it is more the perception of the probability of getting sick. I would guess that anyone who has gone through an illness is much more likely to purchase health insurance. Even with low premiums the fact that a lot of young people don’t make a lot - and might be working for companies who don’t subsidize insurance - and the perception that they are not likely to become sick, and lack of responsibilities to others are good reasons for them to not purchase insurance. But the numbers are what really matter, and your links don’t have any.
The healthy subsidizing the sick is totally different from the government subsidizing the poor. Insurance is all about the lucky subsidizing the unlucky. The good and lucky driver pays premiums which go to the guy who gets in the accident. The life insurance customer who lives out the year subsidizes the guy who didn’t. And it is not actually a subsidy, since each person who is lucky this year may not be next year. That’s much more likely than high income tax payers needing Medicaid.
I don’t understand what you’re saying here. What stupid decisions am I making? Are you saying it’s not smart to try to buy health insurance if you’re young?
If “you need to force us to subsidise your cover” means that you don’t think it’s right to force people to buy health insurance, I am also uncomfortable with that. That’s why I have asked twice about the possibility that there could be a public option that is voluntary, which I’ve been informed is sort of what is in the current healthcare proposal. But, as I mentioned in the OP, it seems to me that we are already being forced to cover people with no insurance (sometimes referred to as the “hidden tax”). Many others here and in the Pit thread have explained this pretty clearly (one of the relatively few things I think I understand:p).
To the other posters in this thread, especially Sam Stone, Voyager, and athelas, much of what y’all are saying is going over my head, but I am hanging in here, reading what you’re writing and looking words up. Thank you all for this information.
A mini-hijack, but I need to know if it is appropriate to ask in this thread for clarification of a lot of things that I don’t understand and can’t figure out by myself. Or, is it preferred to PM posters to ask, “what does this thing you said mean?”
Just fulla questions, ain’t I?
This goes to something (I think) Sam Stone mentioned. Everybody in the US is in favor of UHC. If you ask how much they are willing to pay in increased taxes as a result, it is never close to enough.
It is highly unlikely to cost just a few more jingles.
Almost by definition, any system that covers the currently uninsured in the US is going to cost more, not less.
There are at least two kinds of folks in the ranks of the currently uninsured - those who can’t get coverage, and those who can’t afford coverage. So now you set up UHC, and both those kinds are covered. You now have to charge those who are already covered more. Because you need to cover the much higher costs of insuring the uninsurable, and because you need to subsidize the cost of covering those who cannot pay for it themselves.
Well, sure, but none of them are inherent in a UHC system. Preventative care? If preventative care was going to save so much money, the insurance companies would be saving at least as much - they push it pretty hard. But take obesity as an example - if I won’t lose weight to save on my own insurance premiums, why would I do it to save on my taxes?
Unless the government takes the next logical step and starts passing laws to reduce obesity. Or smoking. Or riding motorcycles without a helmet. Or riding bikes without a helmet. Or not washing your hands after using the toilet. Or…
People always talk about how poor people cannot afford coverage, so they wait until it is too late and then go to the emergency room. But there are other kinds of preventative care currently available either at no cost to the user, or heavily subsidized - vaccination, for instance. But vaccination rates are low in poor areas no matter if it is freely accessible or not. It is only when their children reach school age, when vaccination is required by law, that people get their children jabbed.
Not sure how you would swing that. You want people, who are currently not insured because they are healthy and don’t think they need insurance and/or it isn’t worth the money, to join a government program, even though they are healthy and don’t think they need insurance and/or it isn’t worth the money.
Think of it this way - small businesses might have a better chance at start-up if the government paid their rent as well. Health care is never free - nothing ever is. Having the government pay for one of the costs of doing business merely shifts that cost onto the taxpayer. It doesn’t reduce it at all. And if tax rates go high enough, that will have an equally stifling effect on new start ups.I’m not even beginning to grasp the issue of “rationing” or the ones related to malpractice yet.
[/QUOTE]
“Rationing” means doing what the big mean insurance companies do - deny care in order to save money. If the government does it, they will be just as bad as the insurance companies. If the government doesn’t do it, we won’t save the money.
The bottom line for me is that I have more confidence in an insurance exec saying No in order to keep his stockholders happy than a government official saying No and making his constituents unhappy.
Malpractice is another issue. If we limits damages for pain and suffering, for instance, we might save some money. But we can do that now, without involving UHC at all. My preference would be a system with a hard limit of $250,000 for pain and suffering, and (the key point) that neither plaintiff nor plaintiff’s attorney may collect any portion of punitive damages. Some other changes, too, but those are the ones that make the most immediate sense. As well as there being no chance whatever of them passing, with trial lawyers (like John “If She Don’t Cough, Fuck Her” Edwards) donating as much as they to Democratic coffers.
Regards,
Shodan
Just ask, as far as I am concerned. The posters you mention are very articulate, and at least two of them aren’t as big a asshole as I am. 
Sorry but you are wrong. When the health companies were testifying in front of congress ,many employees said that is exactly what they were paid to do. They were rewarded bonuses predicated by how much they were able to reject and get away with . They are in the business of fighting and denying care.
Very likely it isn’t, seen from a purely personal view. It is only smart if your savings in medical cost is greater than your payment to the insurer, less the amount you want to pay to reduce the risk that a bad illness or accident is going to bankrupt you. Say you would have to pay $2,000 a year for insurance, but expect to pay only $1,000 in medical bills. A big illness would cost you $100K. If you think you have a less than 1% chance of getting that illness, it pays for you not to get insurance. (I’m obviously simplifying things.)
One problem is that people are very bad at accurately predicting the probability of rare events, which is why people are more scared of flying than driving. Another problem is that $2,000 means more to you if you are making $30K a year than it does if you are making $100 K. So, it is often the case that the young person is right.
When the uninsured get emergency healthcare, and then cannot pay for it, the cost gets eaten by the hospital which then increases the fees we with insurance pay. As far as I can tell, the fear of the public option is not that it is going to be mandatory (which not even its opponents are claiming) but that the government which can’t do anything right is somehow going to outcompete private companies and force them out of business.
As for what he means by “cover” I can only guess is that you are not supposed to have the audacity to actually get sick and use more medical care than your insurance payments, and thus make our payments higher. The ideal seems to be the joke about group insurance, which doesn’t pay anything unless the whole group gets sick.
All I know is that I’ve paid a lot more in health insurance than I’ve gotten back in the past 30 years, and I think I’ve won. I’d much rather be healthy and pay than to be sick and receive.
My son-in-law did this job once, and he was looking for claims that looked fraudulent or unjustified. I’ve never gotten a legitimate claim turned down in 30 years. Not that there aren’t fly-by-night insurance companies. It seems the ones claiming they offer catastrophic coverage cheap have huge deductibles even after the stated one is met, and don’t pay for everything as claimed. And I’m sure there are cases of big companies incorrectly denying claims. But if that is their business model, I haven’t seen it.
Then you should have watched the reruns of the testimony. They did not represent flyby night operations. They were dealing with the biggest and most powerful.
Then you should have watched the reruns of the testimony. They did not represent flyby night operations. They were dealing with the biggest and most powerful.
This doctor who testified claimed denying was her job. She suffered guilt but made a fortune.
This is only a problem if you refuse to let the cost of insurance reflect the risk that it must pay out. If a young, healthy person only has to pay enough to cover a young, healthy person (plus the cost of administering the coverage), and an old person has to pay enough to cover an old person (plus the cost of administering the coverage), you remove the loophole and the disincentive for the young person to be a member.
I wasn’t, really. I am trying to explain that a failure to help someone (not subsidising someone else’s health insurance fees) is not the same as hurting someone (raising their fees).
I do not have life insurance.
I am saying it is only smart to buy health insurance when you’re young if you think it makes you better off. If it makes you better off, you don’t need my money to make it work, since it’s already working.
I would be fine with a public option that is voluntary, as long as it is funded by the users and not funded by everyone else.
Are you pro or anti-Medicare. Medicare in part takes taxes from the young to pay for the elderly, who for the most part aren’t contributing. If you are for this, how is this different from spreading the risk. If you are anti-Medicare, how do you expect the elderly to pay for their insurance?
The only good thing about Prop 13 was property tax relief for seniors. Spreading risk is just about the same.
Yes, I know. That was the point I was making in that paragraph, when I followed up with: “The problem is, as **Shodan **and others here have pointed out, that simply raising taxes is not enough (you’d have to tax the rich ‘til they become the poor to pay for it all).”
These and the many other points are excellent ones, which kind of underscore both the need for comprehensive reform, and the imperfection of reality when we must balance personal freedom against cost. You illustrate with an example here:
Two points I’d like to make here…one, there is no perfect solution. Us Americans have the freedom to be all tubby and smoky and to send our kids out without helmets, and laws that have been passed and may be passed in the future to protect others from having to pay for our stupid choices must be as minimal as possible in order to infringe on personal freedom no more than is necessary. But some infringement is necessary. One is not free to drive one’s car at 100 miles an hour through red lights and stop signs, not because society is trying to protect the silly driver, but because society is trying to protect the other drivers. This balancing act is ongoing and progressive, and we’d better continue to keep and eye on our government if we want a say in those choices.
The second point is related: “slippery slope” scenarios are always a possibility, but not necessarily a guarantee. Again, we’ve got to do our jobs and keep an eye on things, and not just evaluate and debate and write our congressfolks about the current reform, but do the same thing for the next proposed step and the one after that and…
I think this is a good illustration of a larger point, and that is that lots o people, for whatever reason, are not going to make careful, responsible decisions. I am not one of these who sees the sea of uninsured folks as either purely innocent and helpless victims nor as a bunch of lazy, selfish losers will live to suck the rest of us dry (see my “dirty fairies” metaphor in the Pit thread, if you want). That’s part of why I’m grateful that we are a democratic republic rather than a pure, “mob rule” democracy, because all of these issues are complex and we must do our best to work towards that balance of the freedom of the individual and the protection of the individual.
{Bracketed bit is my addition for clarification.} Well, the way I am trying to contribute is part of why I’ve been reading the ‘dope for years, and have finally started asking questions. A few of my friends and family have figured out that I like to learn about stuff, and since my disability has progressed to the point that I can’t do much else, they have started calling and emailing me and asking me to check stuff out. I am doing my best to educate myself about political issues and pass along what I’ve learned, and part of what people are asking me about is healthcare reform. So, if we had a voluntary public options, I would be willing (happy, even, since I want to contribute in some way) to volunteer to educate people about it and encourage young people to join.
I sometimes think that us Americans do have way too much of a sense of entitlement, expecting the “government” to do what we want, without educating ourselves to make good decisions about what we want and the doing our part to educate others. But I know that I am still pretty idealistic.
That doesn’t really answer my question, though, since rent is a practical need of the business, whereas providing healthcare for employees is a burden that we have sort of decided business should have. Mebbe that used to sort of work but my point is, mebbe it’s not working now, and it would be better, cheaper, and more efficient to break the link between your job and your healthcare.
Rationing and malpractice! I da scared! :eek:
Still not ready to wrap my mind around those issues yet, but hopefully as I keep plugging along at this I will be ready to learn about those factors, soon.
I often disagree with you, but I have enjoyed the particular flavor of your posts for many years now, and you have contributed to the slow erosion of my ignorance. It’s actually a bit of treat to have you and some of the others in this thread respond to me. A bit like meeting a celebrity.
Thanks, Shodan.
Thank you, Grumman. I think I understand better where you’re coming from now.
There are two things I would like to share with you. First is my understanding of how insurance works, which I remember learning about from a pretty cool Poly-Sci teacher of mine in high school. He explained to me that insurance is sort of gambling. He said, buying life insurance, for example, is saying to the company, “betcha I’m gonna die soon!” and the company saying, “betcha you don’t!” and setting certain odds on that occurring. So I suppose it is possible, that if you buy health insurance when you are young, you might spend a number of years paying in more than you “collect”. In that case, you have purchased two things; one, peace of mind, not having to worry that you will lose everything you’ve worked for if you get some terribly expensive illness or injury, and two, you have been responsible enough not to force the rest of us to assume that risk for you. Now, I don’t know what the situation is in Australia, but I am not comfortable, with the current problems with our healthcare system, in saying, “all y’all 46 million folks without insurance are being irresponsible! How dare you risk us having to pay for your unexpected disease or catastrophic injury!” because the truth is, at least a portion of that 46 million truly cannot get insurance (although, as many here have already pointed out, some of those folks don’t have insurance solely by choice).
The second thing is, if you don’t have health insurance (I don’t know if you do or don’t), then I am really worried about you! What if you get sick? What if you get hurt? Sure, if you have a heart attack, then you probably can’t be turned away from a hospital, but what if something happens to you like what happened to me!? I have progressive Multiple Sclerosis, which is not a life-threatening disease, but has no cure. There are treatments available for the various symptoms, though, and drugs that (in theory, at least) are slowing down the rate of my deterioration. Without insurance, I would have to spend every last dime of my assets just to minimize my suffering, and I’d be broke in no time (even though I am definately not poor).
Take care of yourself, sweetheart! I don’t want nothin’ bad to happen to you!:(
Thank you for this link, Gonzo. I don’t believe that every big insurance is fradulent or unethical in every transaction, but I also don’t believe for a minute that some companies don’t make a little of their money from unethical, if not necessarily illegal, policies. After all, if it’s not illegal, what’s to stop some companies from doing these things? What is the motivation to be honest, when they can make a little more in ways that are not easily revealed? A corporation is not an entity with a sense of morality, and the world has grown big and complicated enough that companies are able to hide their shenanigans pretty easily (look at all the credit default swaps and bad loans given AAA ratings).
I don’t want to eliminate all private insurance, however, nor do I want to strangle companies with regulation. It’s all a balancing act, and none of the answers are easy or simple.
This illustrates my belief that not every company is dishonest in every transaction. I suspect that the actual incidences of people being deceived or taken advantage of represent a very small, even miniscule percentage of customers (although I can’t begin to guess what that percentage might be). With all the trouble that I’ve gone through with my claims being routinely denied, my husband, covered by the same company, has had nary a problem. Broke his leg recently, paid the $250 copay when he got to the ER, and everything after was handled efficiently and without problems.
I think anecdotal evidence does have some small value; it reminds us that very little is all black and white.
The truth is, this is exactly what I’ve done, and I really do feel bad about it, at the same time I feel so grateful to be able to get the care I can. I live in a country where we have decided that it’s not ok for individuals to suffer and die just because they don’t have enough to pay full price (or at all) for the medical care they need. We have tried to solve this problem by having insurance for people to buy and subsidies for people who can’t or won’t buy insurance. I feel that it’s my responsibility to do what I can to give back, whether it’s to educate myself and help educate others about the choices that must be made, try to watch out for waste and fraud (public or private), pay what expenses I can cover myself, or volunteer in other areas.
But I never forget that people like you have given more taken less and people like me have given less (at least financially) and taken more. And to be honest, I can’t blame anyone in the first group for being a little pissed off about it. 
I’m truly happy to hear that you are healthy, and that you are aware of and appreciate that. Enjoy! Savor it!
Of course you are correct that there are no perfect solutions. The issue with government-funded UHC is that health involves issues that are very personal for people - life and death, sex, eating, things like that. And people often react very strongly to perceived interference in those kinds of issues.
The health commissioner of New York City was burned in effigy, for example, back in the 80s because he wanted to shut down the bath houses in NYC to prevent the spread of AIDS. I have heard proposals like taxes on fast food, to fight obesity.
This is one of the reasons why I would prefer a solution more in line with what Sam Stone (and, IIRC, Newt Gingrich) suggest. This would have catastrophic coverage, provided by government, but apart from that removing (to the extent possible) any third party payments. This would mean removing the tax deductibility of health care premiums, and generally having people pay their own way as much as possible. One of the major factors in health care inflation is that the ubiquity of third-party payors means that health care appears to be free. Paying my premiums is done by payroll deductions, and whether I go to the doctor for every sniffle and twinge or not at all does not affect the amount that I pay.
The other issue is that health care legislation is passed by legislators who are elected, but it is administered by bureaucrats, who are not. Add to that if I don’t like my insurance, I can switch. If I don’t like what the government does, I am SOL.
Employer-provided health insurance was, I believe, an artifact of the WWII era. There were wage freezes in place, and companies were looking around for a benefit they could offer instead of pay raises. And it caught on.
But you are correct, there isn’t any reason why businesses should be expected to provide insurance as part of their benefits, anymore than that the government should pay your rent. Historically, it could have been that businesses simply paid more and people bought their own insurance.
“Better, cheaper, and more efficient”? Well - better, maybe, depending on the system. Cheaper? I think almost by definition we would be spending more (overall) than less. As mentioned, we will be covering more people, and we would lose whatever downward pressure is exerted by those who have no insurance. More efficient? The federal government in particular is not famous for the efficiency of its programs. The nightmare is a health care system administered by the equivalent of the New Jersey Department of Motor Vehicles.
It could happen, but the government is motivated by factors different from the bottom line of cost-effectiveness. Witness the brouhaha over 48 hour maternal stays a few years back.
There is no medical reason, overall, that new mothers should ordinarily stay in the hospital for 48 hours. Statistically, letting them go home after 24 hours makes no difference to medical outcomes. And it is a hell of a lot cheaper to recover at home in your own bed than in the extremely expensive hospital with its enormous overhead. But the 48 hour stay is popular rather than efficient. Guess what? Legislation was passed to require insurance companies to pay for time in the hospital that is not medically necessary. Is that cheaper? No. Is it more efficient? Hell no. Is it better? I leave that question up to you.
The traditional saying is that Americans want a health care system that is three things -[ul][li]They want the best care in the world[]They want it available to everyone[]They want it at a reasonable cost[/ul]They can have, at most, any two of those three. [/li]
We already have the first. We are apparently lurching our way towards the second. Therefore by process of elimination…
If we want to hold costs down, it seems to me inescapable that we need to implement some kind of de facto rationing. This has to include not only the easy stuff, where we say “No, you can recover just as well at home as you can in the maternity ward - even the best hotel in town is cheaper than the hospital (and they have better food)” but also the hard cases. Hard cases, as in “No, I’m sorry - we are not going to treat your grandmother’s pneumonia.” or " No, the policy is that newborns weighing less than 2500 grams don’t get treatment." or “I know she is white, blonde and cute but that treatment is experimental and she hasn’t been accepted into the study,it costs $250,000 and it only works about 10% of the time. So no - she will get pain relievers, but no more.”
IYSWIM.
:Shodan preens like the worst peacock you ever met:
I suggest you start a dozen threads, all with verbiage like this addressed to anyone you want to talk with. I can almost guarantee you will be snowed under with responses from reasoned and articulate posters like Gruman and Voyager and athelas and Sam Stone.
All seriousness aside, you often get what you deserve. The tone of your posts is entirely reasonable and articulate, and set (IMO) the right atmosphere for rational discussion. If everyone conducted threads like this, GD would be filled to the brim with intelligent, respectful, enlightening debate.
So cut it out.
Regards,
Shodan
PS - 
We have the best care in the world? By whose standard. most measures show us about number 37 i n the world. We are number one on cost. Is that how you gage? We are sliding down in quality and results as we increase cost. It is ugly.