lealdragon

Well many would argue that: why should they (fit, healthy people, or maybe people who use predominately alternative healing modalities) have to share the cost of others who have horrible diets, are obese, don't exercise, etc.

Bay

leal,

I think you just made your case for why a healthy family of 5 (parents in 30s) would take their chances rather than buy insurance. At $700 per month, plus a likely $1000 deductible and $25 co-pay, they'd need to spend about $9,500+ out of pocket every year before seeing any benefit to purchasing your insurance. Its the risk-sharing that makes that premium prohibitive for many.

kluge

So what happens when a person who is "uninsurable" gets sick? And what does that mean to a system where companies and consumers can choose not to "share the risk" with those who they think are likely to need medical care?

Bay

mini,

If you are seriously interested in making a change, you should inquire about coverage for your wife, as it may not be as scarce as you think. My H has changed jobs 7 times in our marriage, and each time the new medical insurance benefit covered our entire family, no questions asked.

mini

You are very lucky! (and, in fact, in our state high-risk insurance pool, one of about 7 in the nation, I can in fact acquire insurance, but the pay increase I'd need to have would have to be very substantial.)

The principle of cost-sharing, rather than risk-sharing, is one that every other western democracy except the U.S. has adopted. We have cost-sharing in Social Security. Of course, for the past 70 years, African-American males with a life expectancy below age 65, have been supporting nice white woman who die at 82. (The so-called crisis in Social Security is a direct result of the beginnings of mitigation of the racial subsidy.) Why should I pay Social Security (and Medicare!) for all those old ladies when I don't expect to live that long?

Risk sharing (and with it, the 19-33% rake off to the private insurance companies) would be considered downright silly anywhere else but in the U.S. Deadly too. Deadly to people with insurance as well as to people without it, as it provides incentives to skimp on quality (and they do).

jclay2

I don't really know the answer to the risk vs. cost sharing problem. However, I think that we should at least establish that government should be out of any healthcare programs. Remember, the cost will always be higher if someone else is paying the bill.

mini

"However, I think that we should at least establish that government should be out of any healthcare programs."

Why? Medicare has 3% overhead; private insurance a 19-33% rakeoff. My state employee "single-payor" self-ensured option costs one-third that of the private options (because of the elimination of underwriting and profit), allows me to use all licensed providers, allows me to see another doctor/provider if I don't like either the wait time or quality of another, and has a board of consumers and physicians setting the package of reimbursable services. And no governmental entity actually provides any of the care - physicians get to compete head-to-head on the basis of quality.

The Republican CEO of Aetna, one of the largest health insurers in America, says the average wait time for cancer surgery here is now longer than the wait time for elective surgery in Canada. (And that assumes that one has insurance.)

jclay2

Mini, why do you assume the only way to instill a communitave good willed program is through the government. If you have a bunch of people who are passionate about such programs, don't you think the program would be cheaper and more efficient if it was run privatly rather than through a beurocratic system. Take a program like Social Security for example. If there was some charity that ran it instead of the government, don't you think the charity would receive a much higher rate of return on your money. I sure do and I believe you do to.


Also, I would like to see REAL medicare cost. That means include the TAXES that go into Medicare.

jclay2

Oh mini, if you are so keen on a government takeover, why don't you check this out YouTube - A Short Course in Brain Surgery

fendergirl

i think you have to be careful with lumping all insurance firms in together. I recently watched Sicko for the first time and I know it mostly talked about HMO's, but not all companies are like that.

I work for an insurance company and our employee insurance on ourselves that we have is alright.

We get a 30/month break on the premium we pay by certifying that we are a non smoker - or a 30/month break on the premium if you are a smoker and agree to participate in a quit smoking program. we also get a 20/month break on the premium for taking a health survey online which gives you feedback on how to improve certain areas of your life.


And as far as medicare is concerned... it's not free and a lot of doctors are beginning to not accept it. You still pay on average 96 bucks a month (more premium if you make more money, and chances are most of us make more then somebody who is retired and on medicare, so our premiums would be more as well), and in the event you go in the hospital you have a 1024 deductible (2008), and the deductible in the beginning of the year is 135 (in 2008)... plus you still pay 20% on most charges.

We just recently got a contract with an insurance company at work and the "basis" of their contract (from my understanding and what I remember of it) is that they will get compensated based on the level of care they deliver to the insured customers.

lealdragon

Thanks for pointing that out, fendergirl. There seems to be a myth that Medicare is 'free.' Not.

lealdragon

Did you pay for car insurance last year? How much was your annual premium?

Did you have a car accident last year?

No?

Was that $$ all wasted, then?

What about the year before that?

How many years have you been paying for car insurance, with no wrecks?

Is all that $$ wasted?

I find it amazing that people are willing to pay for car insurance for 'just in case' so they'll have some cash to replace their vehicle, which is, for the average person, maybe $15-25k (not quite enough to cause bankruptcy, for most people), but they are not willing to pay for health insurance for 'just in case' when catastrophic accidents or illnesses can sometimes run in the hundreds of thousands of dollars, being the #1 cause of bankruptcy in this country.

Your question displays the mentality that one is supposed to 'gain' from health insurance - come out ahead. But, in actuality, health insurance was designed to operate much like car insurance - like any insurance - protect against a catastrophic incident that could be devastating financially.

It's only because insurance companies have 'sweetened the deal' by covering x # of doc visits, etc. that has perpetuated the myth that the purpose of health insurance is to pay your petty little doc bills for flu shots, annual checkups, etc.

Those little doc visits might be an inconvenience but they don't cause one to go bankrupt.

My company offers a catastrophic-only option for those who would prefer to take their chances on the little stuff but not be devastated on the big stuff.

The premiums are usually about less than half that of a full-blown plan, with very low (or no) deductibles.

I don't sell it very often; most people want the full-blown plan. They're usually willing to pay more, much more, so they don't have to hassle with a $100 doc visit.

But, people do have choices.

fendergirl

We have a catastrophic plan that we offer too which doesn't cover doctors visits or prescriptions and the monthly premium too is about half of it's full coverage equivalent.

I get a lot of elderly customers who cancel us to go with other plans and I'm always like "They'll be back next year" when they realize what they just lost.

I get people all the time who throw a fit about the cost of their insurance in relation to what they get out of it and 99.9 percent of the time I come back with how "Insurance is for protection and by that as example I pay x amount of dollars per year on my car insurance and have never needed to make a claim, knock on wood"

Opie ofMaybery2

"At $700 per month, plus a likely $1000 deductible and $25 co-pay, they'd need to spend about $9,500+ out of pocket every year before seeing any benefit to purchasing your insurance. Its the risk-sharing that makes that premium prohibitive for many."

But, no one really, honestly explains how that is going to be different under a single payor. There still be that cost, that risk, it doesn't go away it shifts. That doesn't change single payor or 20 payor. It will still cost.. It will not be cheap or free, everybody still will be paid.

"and, in fact, in our state high-risk insurance pool"

And MINI what you aren't disclosing here is the WA high risk pool is for individual coverage, not group. Small group 2-50 is guaranteed issue. They can't ask, they can't say no. I write it all the time only a couple national players try to underwrite by age band or ask health questions.

So mini, in WA if you want to go to work for someone else YOU and Your Wife will be covered in 99.9% of the cases. In fact if you want to start your own business and have both you and your wife work (w-2) I'd be happy to send you the group application for both the blues as they ask no health questions that would make them say no and since you are currently covered, you can wingwalk with no preexisting in WA...

The high risk pool is for people who are buying individual coverage that have major health conditions PRIOR to seeking coverage. If you've owned coverage in WA, you can change coverage in WA...


the elephant in the room folks, is not who runs it, but how do we pay for it? Healthcare still has a cost, a significant cost no matter the number of players. What drives health care costs is simply claims...

Rate increases at least in WA have to be approved by the OIC (office of insurance commissioner) before they can be passed to the public. In other words they have to show a financial need to raise rates for this market. Believe it or not, sometimes they are told no....

Until we figure out how to get people to improve their personal health with things they will actually DO, no matter who delivers it, the cost will continue to rise, it's simple math....

Dumping the CEO's while I would take great, great pleasure in personally, will not stop people from getting sick either by accident or lifestyle. The simple refusal to address the root cause of COST (claims volume) with any vivable solution, any national program of improving the general health of the population.... it isn't going to matter who at the end of the day calls the shots. They will either need to raise revenues (taxes or premiums both are the same basic thing==money) or reduce service or increase self insurance (deductibles)

This is why I don't buy respectfully to the UHC folks, they don't address the cause, they only want to squeeze the pimple that forms (CEO's) rather than treat the problem. While it gives mommentary pleasure to pop that zit, it doesn't mean tomorrow you won't have five more...

lealdragon

Opie: Well said!