Health Insurance

Parent Cafe
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<p>To my inattention, we claimed DS on our 1040 for 2006. On reviewing his tax forms for Canada, I discovered that he had a mandatory health insurance of $400/4 months. I haven’t seen his TA wage statement this year, but I would imagine that he is still paying the Canadian insurance and we are still paying in the company’s family plan-hence my comment we should have cut him out in 2006. He will be definitely on his own for 2007 tax year. </p>

<p>So Canada’s health premium is about the same what he will be enrolling in the US. However, the US plan will have a high deductible and limited out-of-network pay. I’ve investigated travel insurance but the coverage is limited and just as expensive as the unrestricted US coverage. I am still considering travel insurance if he uses HSA to pay for the premiums. </p>

<p>Since he will be a contractor, I imagine he could call health ins. premiums a deductible expense. (?). More tax consideration-ugh.</p>

62

<p>“National health care in other countries is not free to us citizens in most places. they bill and they bill hard…”</p>

<p>“Well, maybe I’m wrong or maybe there’s a bit more to your story detail wise?” </p>

<p>Hi Opie - We are US citizens but were residing in the UK at the time. Your first statement quoted above indicated as US citizens we would be billed - not so. My daughter even had a HOUSE call after discharge from the hospital. We did actually have private insurance but our local GP was horrified that we would consider a private hospital - not enough funding for adequate technology apparently!</p>

63

<p>BTW - Son in Canada does have private insurance but went directly to a hospital - not the student health service. He was treated - no questions asked.</p>

64

<p>"We are US citizens but were residing in the UK at the time. Your first statement quoted above indicated as US citizens we would be billed - not so. "</p>

<p>While you were residing did you pay taxes to the UK? Were you working there? The stuff I pulled came straight off the us gov advisory site. Are they wrong? </p>

<p>“Son in Canada does have private insurance but went directly to a hospital - not the student health service. He was treated - no questions asked.”</p>

<p>While rugging up in canada, I bit my lip off making a tackle. I was told go to the hospital and don’t tell em you’re american or they’ll charge you up the wazzu. So two hours back to the states and 47 stitches later, a new lower lip.</p>

<p>Again, I would err to caution if it were me…</p>

65

<p>Fundingfather, we are going to be paying large healthcare costs for life with a cancer survivor son. As he will be if the system remains as it is. Also with elderly parents and all of our kids I don’t expect our costs to lower regardless of the type of system we get. It’s those who are not as fortunate that I know that really concern me. And for us if something should happen to my husband since our insurance has always been work based. But due to circumstances, we had three different health coverages this year, and therefore had three deductibles to meet. And we met them. We still had to pay due to out of network costs, reasonable and customary costs. I daresay we paid more out of pocket this year than from insurance, or close anyways. </p>

<p>On a personal basis because we can afford it and because we know how to get immediate and excellent care, (we, being our family), we are in a whole different situation from those who are not so well situated. That will always be the case–even in countries with socialized medicine, there are those who are at the front of the line, and who can pay for private care rather than wait 10 weeks for the appointment. But there are too many here that cannot get care if it is not a life threatening condition; actually even if it is, if it is not an immediately life threatening condition. Also with the managed care, many here in the US are already stuck with the waiting periods. My son had a frightening looking cyst early this year. To get through to a surgeon for a biopsy under the prescribed course of action would have taken me months under our network. I line cut and paid out of pocket for an immediate biopsy (prior bad experiene makes me paranoid about lumps). But I paid for it. While waiting for surgery, I spoke with the family next in line for the surgeon. They had waited weeks to get a neuroblastoma tumor removed from their child. I nearly vomited, knowing the implications of this. Unexcusable, in my book. And they had to go to their congressman and an attorney to get this particular surgeon approved. Their insurance wanted a general pediatric surgeon to do the operation when he had done maybe 4 of that sort of tumor in the last several years. I know too many cancer kids on medicaid because they ran out of insurance or it does not cover what they need. At least they can get the medicaid. If it were the parent, it would really be a problem.</p>

<p>I believe todays WSJ features a medical insurance catastrophe. In my opinion, it was good news. At least the patient has a treatable condition, can just file bankruptcy and start again. If he truly had a serious medical condition yet needing care, he would be in trouble.</p>

66

<p>Hi Opie -
I have no dog in this fight, just relating my experience and I would certainly not give or take much advice from an internet forum on such an important matter.</p>

<p>“While you were residing did you pay taxes to the UK? Were you working there?”
Yes, my husband was working in the UK at the time. We paid both US and UK taxes so we did make our contribution to “free national healthcare”. Son is only a student in Canada so is not paying taxes there.</p>

<p>“Again, I would err to caution if it were me…”<br>
I totally agree. As I mentioned in my earlier posts, we carried our own private insurance in all instances…just weren’t asked to use it.</p>

67

<p>Opie–give me a break, i was not complaining about what a doctor makes. The one I know, by the way, spent a good amount of time shoveling coal on ships, but that’s another story. And quit medicine to be a teacher, also another story.</p>

<p>The POINT I was making, is that all the time and administrating that doctors and staff do to negotiate the different plans and make sure their patients can get the care they need is money leaking out of the health care system–it’s phenomenally inefficient.</p>

<p>Please do not assume everyone argues for what’s best for their own sake. I and my H are capable of seeing the big picture–he was never in medicine for the money, any more than he is in teaching for the money–both careers came from a desire to do some good. But, in doing so, it became very clear a to him how hurtful our present healthcare system is to many, many people.
This has nothing to do with personal gain, as hard as it might be for you to fathom that.</p>

68

<p>“hard as it might be for you to fathom that.”</p>

<p>you know, I am trying to be as nice as possible but you keep needling me… is that necessary for your arguement?</p>

69

<p>“While you were residing did you pay taxes to the UK? Were you working there?”
Yes, my husband was working in the UK at the time. We paid both US and UK taxes so we did make our contribution to “free national healthcare”. Son is only a student in Canada so is not paying taxes there.
"</p>

<p>No dogfight with anybody here… but that is the thing at some point you pay for it. It’s not free and the use of the word free shouldn’t be used. A single payor system still collects money either taxes or premiums… A single payor doesn’t have competition, doesn’t have to do better… as we press towards a single payor type system with giant regional players (the anthem, aetnas, united healthcares) we see bigger carriers providing lesser services.</p>

70

<p>You know really, it dawned on me while I read someones personal message to me that we already have national healthcare. </p>

<p>Ask yourself this… who really controls the healthcare delivery and service system in America? </p>

<p>With a simple vote we can mandate a service, require a policy to have a feature. We can make hospitals doctors work a more normal schedule, no 48 hour shifts… I mean we require truckers to pull over and sleep… but we don’t require the surgeon who operates on us to be rested? </p>

<p>We have government run healthcare right now… at any time and in any state legislature can make the rules of the game up… They do control how health care is delivered…right now…they control what health care costs. Rate increases have to be approved by your OIC…They have to show the government the need to raise rates. It is not a free enterprize system, it is controlled right now by our government… think about it… </p>

<p>The problem for whomever does it is simply cost… what is it going to cost? </p>

<p>And please don’t tell me 20% off the top for administration, that is intelligent stupidity… you will still need and have to pay for administration and processing claims. Claims will still occur (with more frequency) in your magical single system… admin costs will likely go up… more claims more people to process… Yes, claims will still need to be filled and processed no matter how many one or dozens of provides exist…</p>

71

<p>"You know really, it dawned on me while I read someones personal message to me that we already have national healthcare. </p>

<p>Ask yourself this… who really controls the healthcare delivery and service system in America? </p>

<p>With a simple vote we can mandate a service, require a policy to have a feature. We can make hospitals doctors work a more normal schedule, no 48 hour shifts… I mean we require truckers to pull over and sleep… but we don’t require the surgeon who operates on us to be rested? </p>

<p>We have government run healthcare right now… at any time and in any state legislature can make the rules of the game up… They do control how health care is delivered…right now…they control what health care costs. Rate increases have to be approved by your OIC…They have to show the government the need to raise rates. It is not a free enterprize system, it is controlled right now by our government… think about it…"</p>

<p>Following this logic, we don’t have a free enterprise system in anything in this country.</p>

<p>"And please don’t tell me 20% off the top for administration, that is intelligent stupidity… "</p>

<p>Looking at administration costs and wondering if there are better ways to provide health care in this country is intellectual stupidity?</p>

<p>I better write that down so I don’t forget. ;)</p>

72

<p>My really oldman, made more $, and gave better care, with less help and less hours when he was a public servant, than he made while in private practice. </p>

<p>Yes, opie, we already have universal care. The current system is rigged to keep people employed and to make a profit. There will be some who cannot afford insurance and will be granted welfare and bankruptcy. The system will automatically raise insurance owners premiums and taxes to accommodate welfare. </p>

<p>In the case of DS, having insurance, is a way to protect his assets and avoid bankruptcy - not to having access to health care.</p>

73

<p>One example of administrative inefficiency: Person had surgery to implant teeth that were missing because of a birth defect. Should the claim be paid under his medical plan or under his dental plan? One month spent between patient, health insurer, employer’s benefits manager discussing this.</p>

<p>Another example of administrative inefficiency: Person has coverage under two plans. One plan covers the procedure at 100% of the discounted rate, other plan covers it at 80% of the billed rate. Takes a month for each plan to determine what they really owe. Patient never understands how the determination was made.</p>

<p>Another example of administrative inefficiency: Patient has surgery at an in-network hospital with an in-network surgeon. Anesthesiologist, whom patient doesn’t choose, is out-of-network. Anesthesiologist’s charges are cut back to “reasonable and customary”; anesthesiologist bills patient for the difference; patient appeals to insurer to have anesthesiologst deemed in network since he wasn’t chosen and “came with” the hospital. Insurer always winds up paying the billed charges as if they were in-network. Total time taken to resolve: 4 hours. </p>

<p>If we had a single-payor plan, none of these questions or issues would arise. Think of the administrative simplicity!!</p>

74

<p>I have no beef with the pay levels for insurance co execs. Why should they be paid less than those in comparable businesses? It’s no less of a headache. Though I am no lover of health insurance companies (and that is an understatement) when I am not in battle with them and thinking objectively, I understand it is the system and not the company employees. Since the companies are run as a business, it is not in their best interest to easily pay claims. Much as I hate government intervention, when health becomes a universal right, there should be oversight so that it is administered consistently. The govt is already heavily involved with the old folks and medicare, those under a certain financial threshhold with medicaid, and for many kids whose needs outstrip their parents insurance , again with medicaid. It makes no sense to me that on medicaid, certain processes are approved whereas a working family who is kind of stuck with what the job gives as health care can be denied up the whazoo for all sorts of things. And if they hit the life time maximum, they can really be screwed. I have seen this happen in my world too much. The purpose is not to drive families to bankruptcy and into medicaid. There is simply too little for too many Americans. And if a medical catastrophe hits, it is very possible for most American to lose it all. We are talking about lives here.</p>

75

<p>Opie, I have replied as I have to your needling (I shouldn’t, I know). Each of your posts asserts the writer is incompetent or doesn’t know their facts. Such as </p>

<p>

</p>

<p>Or contiinually telling posters they’re not giving you the whole story, like you know better. you like those kinds of passive aggressive confrontational tactics. But you are right, I’ve got better things to do then get drawn in.</p>

76

<p>"Looking at administration costs and wondering if there are better ways to provide health care in this country is intellectual stupidity?</p>

<p>I better write that down so I don’t "</p>

<p>Actually I stand by that because just about everybody here claims that cost will go away which simply is BS… When someone cites 20% admin cost that means 80% goes out the door down stream to someone else… in the same way your bills are paid… you get a check and turn around and give it others…</p>

<p>How a carrier makes it’s profit is to take that admin cost and squeeze the hell out of it… That admin cost mainly is paying the people who will process claims and answer the phones and so on… it’s called a payroll and it won’t go away under a single payor system, it will actually increase as the government isn’t universally known for it’s efficent behavior… This is why I call it intellectual stupidity… because a normally smart person suspends logic and decides in this one particular case it will be better, cheaper and more efficent…just like all other government systems from fema, the VA and so on… What makes you disbelieve what’s already in front of you?</p>

77

<p>“One example of administrative inefficiency: Person had surgery to implant teeth that were missing because of a birth defect. Should the claim be paid under his medical plan or under his dental plan? One month spent between patient, health insurer, employer’s benefits manager discussing this”</p>

<p>medical necessity vs. cosmetic why would that question change with a single payor? </p>

<p>“Another example of administrative inefficiency: Person has coverage under two plans. One plan covers the procedure at 100% of the discounted rate, other plan covers it at 80% of the billed rate. Takes a month for each plan to determine what they really owe. Patient never understands how the determination was made.”</p>

<p>Patient needs to simply READ his/her benefit booklet, It is pretty clear. And if that’s too hard, call your OIC and ask. They set the rules, they can tell you… For example in WA, you automatically get the better benefit of the two, even if your primary coverage is the lesser benefit. It’s a law… </p>

<p>During that month, what actually happens to the patient? Does he/she lose their home, taken to collection? Is this really a problem? </p>

<p>"Another example of administrative inefficiency: Patient has surgery at an in-network hospital with an in-network surgeon. Anesthesiologist, whom patient doesn’t choose, is out-of-network. Anesthesiologist’s charges are cut back to “reasonable and customary”; anesthesiologist bills patient for the difference; patient appeals to insurer to have anesthesiologst deemed in network since he wasn’t chosen and “came with” the hospital. Insurer always winds up paying the billed charges as if they were in-network. Total time taken to resolve: 4 hours. "</p>

<p>Elective surgery, should have been part of the preop procedures… 4 hours? really? Normally it takes about 15 minutes, if that. </p>

<p>Of the three things you mention here, the last is one that has real service issues? If it honestly takes 4 hours, contact your HR and complain. Let them know the service problems… usually a business picks by rates… the only way they know differently is by feedback. </p>

<p>However, in all of these I think you to are making the common mistake of assuming the govt will never say NO in healthcare delivery… in your first example, should the government pay for cosmetic? If yes, get ready for boob jobs to cover america… if not, then wouldn’t a single payor have to look and determine medical vs. cosmetic? And if the gov decides it’s cosmetic, who do you complain to?</p>

78

<p>You know Opie, there is this belief that the the private sector is more efficent and does everything better than the public sector.</p>

<p>I think that belief is intellectually stupid.</p>

<p>Look at what Enron did for the energy business.
Look at the banks. Many of them would be toast today if it wasn’t for the government saving their tushes.
Look at the brokerage houses.
Look at Countrywide Credit and other mortgage companies.
Look at our auto companies.
Look at our airlines.
Look at Tenet Healthcare.
Look at Ambac and MBIA.
Look at farm subsidies. </p>

<p>Do you know where the stock market would have ended up in 1987 without the government stepping in? You do know that almost every major firm on the street was broke. At the firm that had my money, somebody from the Fed was there everyday for 3 months trying to sort things out.
I bet you didn’t read that in the papers.</p>

<p>What about the savings and loan crisis? LTCM? The Russian crisis? The Mexico Peso crisis?</p>

<p>I’m not going to waste anymore of my time. </p>

<p>Sometimes the public sector can do a good job.
Sometimes we have a public good and the private sector doesn’t meet that need well.</p>

<p>“Actually I stand by that because just about everybody here claims that cost will go away which simply is BS…”</p>

<p>The cost is not going away, but it may be less under a different system.
Nobody believes the cost is going away. Pooof. Vanished.</p>

79

<p>“There is simply too little for too many Americans.”</p>

<p>That is the crux of the problem. We want far more than we can realistically provide. We can’t settle on what basic healthcare is, I’ve seen it before. One person’s necessary health care provision is another person’s wasted spending. Do we include chiro, reproductive, abortive, erectile disfunction, cosmetic, natural pathic, etc… in BASIC healthcare?</p>

<p>Depending on who you talk to? </p>

<p>Then when we decide what is Basic healthcare, what will it cost? Everything you add in has a cost. </p>

<p>That’s just the truth of the matter… what ever system you choose will cost, it will be far from free… </p>

<p>It is folly to sit here and claim it will be peaches and sunshine… for the simplest reason of we can’t agree on what basic IS…</p>

80

<p>“but it may be less under a different system”</p>

<p>Show me. </p>

<p>Show me how it will cost less… Show me the math. Without reducing benefits. </p>

<p>Also in ALL OF YOUR EXAMPLES OF PRIVATE FAILURES… wasn’t there somewhere else to go? </p>

<p>What happens when a single payor fails? you just pay more in taxes, you can’t go elsewhere…can you?</p>