[stupendousman]

I'm surprised no one has mentioned the federal court's ruling on Obamacare.

I could be wrong, but I'm going to guess that even if Obama presses the Supremes, that they aren't going to turn over the federal court's decision, and we've ended up with a lot of wasted time and money on a scheme that most of America really didn't want.

Obama needs positive news, and the recent ruling wasn't it, by a long shot.

Unless the Supremes intercede (doubtful), the congressional Republicans who have been trying to vote the plan out the past month or so are going to appear prescient, instead of being the partisan time wasters their opponents have sought to portray them as. "If only they'd voted with us when they had the chance," will be the refrain you'll hear, and they will be right.

So what's going to happen? The Supremes to the rescue? Start over with no forced by-in? Delay until after 2012?

[olePigeon]

Originally Posted by stupendousman 

I'm surprised no one has mentioned the federal court's ruling on Obamacare.

Certainly interesting. You also have to remember that two Federal judges have upheld the bill, and the one other that ruled against it, only ruled on part of it -- requiring Americans to purchase health care.

This is the first judge to completely overturn the bill. I agree with the 3rd judge, actually. There's nothing inherently unconstitutional about the rest of the bill except for the requirement to force people to purchase health care, and even that decision is a little dubious.

Originally Posted by stupendousman 

...and we've ended up with a lot of wasted time and money on a scheme that most of America really didn't want.

Recent polls after the judge's decision show 58% against, 42% in favor. Previously it was pretty evenly divided. How is that "most" of America?

[BadKosh]

It just shows how ignorant many are as to the US Constitutions LIMITS on what congress can do. Did you actually read the judges findings or its this just more liberal BS you are repeating from Maddow et al? I doubt you poll numbers as well.

[turtle777]

Originally Posted by olePigeon 

This is the first judge to completely overturn the bill.

It's a logical consequence. The bill was missing a severability clause, which was intentionally left out by the Democrats.

This is what the judge wrote:

Because the individual mandate is unconstitutional and not severable, the entire act must be declared void

It makes sense in this context: the individual mandate is pivotal for the Health Care Bill. Without it, the whole thing falls into pieces.

-t

[SpaceMonkey]

Originally Posted by BadKosh 

It just shows how ignorant many are as to the US Constitutions LIMITS on what congress can do. Did you actually read the judges findings or its this just more liberal BS you are repeating from Maddow et al? I doubt you poll numbers as well.

More from the My Interpretation is Always Right side of the MacNN house. The fact of the matter is that we now have four district courts whose rulings on the subject are in conflict. If you are prepared to accept this FL judge's ruling on the basis of his Constitutionally-mandated authority of review, then you must also be prepared to accept the conflicting decisions. This will not be a case of the Supreme Court coming "to the rescue," as stupendousman put it. Rather, this will inevitably be ruled decisively by the Supreme Court precisely because the rulings at the lower level are conflicted both ways.

[Big Mac]

Originally Posted by BadKosh 

It just shows how ignorant many are as to the US Constitutions LIMITS on what congress can do.

Many Democrats in Congress think that anything Congress chooses to do is automatically constitutional.

I love the fact that the administration argued that the individual mandate wasn't a tax while they were fighting for passage because the reconciliation maneuver required them to lie about it not being a tax. But when they marched into court to defend the legislation, they argued it was indeed a tax given that they couldn't justify a requirement to buy something except by classifying it as part of Congress's power to tax. Amazing.

I really wish we'd see it struck down by more than 5 to 4 by the Supreme Court, but we all know that's how it will turn out because the leftist bloc on the Court is blindly partisan.

[SpaceMonkey]

Originally Posted by Big Mac 

I really wish we'd see it struck down by more than 5 to 4 by the Supreme Court, but we all know that's how it will turn out because the leftist bloc on the Court is blindly partisan.

Come on. The righty side of the Court isn't partisan too? I predict this will be 5-4 in the other direction because the SC is not prepared to overturn 8+ decades of New Deal-era precedent, no matter what their preferred reading of the Constitution is.

[olePigeon]

Originally Posted by BadKosh 

Did you actually read the judges findings...

Yes.

Originally Posted by BadKosh 

...or its this just more liberal BS you are repeating from Maddow et al?

I stated that I found the ruling interesting and that I agree, at least in part, with the decision. Somehow you construed that as liberal BS.

Originally Posted by BadKosh 

I doubt you poll numbers as well.

Not everyone can count to 100, so I won't hold that against you. Incidentally, the polls are taken from Rasmussen.

[OAW]

Something tells me the fate of the Individual Mandate is going to be decided by Justice Kennedy.

OAW

[olePigeon]

Originally Posted by turtle777 

It makes sense in this context: the individual mandate is pivotal for the Health Care Bill. Without it, the whole thing falls into pieces.

I'd rather they keep the pre-existing conditions exemption and extended health care for dependents, that's the only part of the health care bill I'd really like to see stay. Denying people coverage even when they can afford it is practically criminal.

[Shaddim]

Originally Posted by olePigeon 

I'd rather they keep the pre-existing conditions exemption and extended health care for dependents, that's the only part of the health care bill I'd really like to see stay. Denying people coverage even when they can afford it is practically criminal.

I agree 100%, well said.

[Big Mac]

It's interesting that the judge ruled on the fact that the legislation didn't include a severability clause. I don't know if that's a standard thing to omit in Congressional legislation, but almost every contract you pick up will have such a clause that allows a part to be severed if found illegal while the rest of the contract remains in force.

[BadKosh]

It was not put in because if part was removed it wouldn't pay for itself as promised.

[Big Mac]

But it won't pay for itself as promised regardless, and I can't imagine any Democrat really believed their own propaganda that it ever would result in savings.

[mduell]

I particularly enjoyed page 46.

Eat your broccoli.

[stupendousman]

Originally Posted by SpaceMonkey 

Come on. The righty side of the Court isn't partisan too? I predict this will be 5-4 in the other direction because the SC is not prepared to overturn 8+ decades of New Deal-era precedent, no matter what their preferred reading of the Constitution is.

I don't think that it would require them to repeal anything in regards to "New Deal-ear" legislation, that is unless there where laws that Congress passed that forced people to spend their money on things they chose not to, just to remain out of legal jeopardy without there being any kind of real Constitutional mandate to back it up.

I'm guessing it would be pretty easy to squash this new precedent, and not have a single person think it would effect any other social program put in effect for the past hundred years.

[SpaceMonkey]

Originally Posted by stupendousman 

I don't think that it would require them to repeal anything in regards to "New Deal-ear" legislation, that is unless there where laws that Congress passed that forced people to spend their money on things they chose not to, just to remain out of legal jeopardy without there being any kind of real Constitutional mandate to back it up.

Arguably, the original Social Security legislation. See Steward Machine Company v. Davis (1937).

[BadKosh]

Its a shame the Democrats made such a mess out of ObamaCare, didn't bother to read it, and now are back pedaling. They wasted their only chance.

[smacintush]

Originally Posted by olePigeon 

I'd rather they keep the pre-existing conditions exemption and extended health care for dependents, that's the only part of the health care bill I'd really like to see stay.

Great. How exactly will this do ANYTHING to help control costs?

Denying people coverage even when they can afford it is practically criminal.

Based on what? In what other industry does this logic fly? It's pretty unfair that I can't wreck my car BEFORE I go and get insurance to pay for the damage, or wait until a tree falls on my house before before I get homeowners insurance.

Those provisions fail on a moral as well as a practical level…and they don't even touch the real problem which is the whole third party payer system itself. All it does is drive up costs, invite more stupid government intervention, and create a distance between the cost and the receiver of services.

[turtle777]

Originally Posted by olePigeon 

Denying people coverage even when they can afford it is practically criminal.

Ok, devil's advocate: is that *REALLY* happening ?

Someone being denied buying insurance at rates that would reflect the true risk of the individual ?

The whole "denying coverage" is really "denying subsidized coverage", where someone with a pre-existing condition gets a rate so low that it would not cover the expected expenses, and therefore, has to be cross-subsidized by someone else (other clients or the gubmint).

Can you fault the insurance company saying "no" to cross-subsidized rates, where it's guaranteed that other insurance members will have to pick up the tab for someone expecting a low rate ?

-t

[ebuddy]

Originally Posted by olePigeon 

I'd rather they keep the pre-existing conditions exemption and extended health care for dependents, that's the only part of the health care bill I'd really like to see stay. Denying people coverage even when they can afford it is practically criminal.

There are companies who accept pre-existing conditions by charging a higher premium. The problem is State-by-State regulations tweaking the remainder of the insurance products and causing problems trying to access the wealth of insurers and their packages across the country. There is nothing of this bill that can't be replaced by something much more succinct and sensible.

*As an aside; who here really considers a 26-year old a dependent? You're going on 30 years old son, time to quit playing World of Warcraft and find a job with bennies.

[ebuddy]

Originally Posted by smacintush 

Great. How exactly will this do ANYTHING to help control costs?

As you know of course it doesn't control costs and was never intended to.

[Athens]

Originally Posted by Big Mac 

But it won't pay for itself as promised regardless, and I can't imagine any Democrat really believed their own propaganda that it ever would result in savings.

At best Obamacare is going to cost a ton more money on top of whats being spent now with little benefits for those he is trying to protect.

No country can support multiple healthcare systems. Either make it all private with rules for the industry to make sure every one is treated fair and remove Medicare and other forms of public medical or remove the private medical and make it all public. Having both is a colossal waste of money. Insurance companies cherry pick the healthy while leaving the sick to the public system. Insurance companies get rich while the public purse pays for uninsureable people with no help from healthy peoples contributions.

[mduell]

Originally Posted by turtle777 

Ok, devil's advocate: is that *REALLY* happening ?

Someone being denied buying insurance at rates that would reflect the true risk of the individual ?

The whole "denying coverage" is really "denying subsidized coverage", where someone with a pre-existing condition gets a rate so low that it would not cover the expected expenses, and therefore, has to be cross-subsidized by someone else (other clients or the gubmint).

Yes; I knew someone who could not get quotes from any of the major insurance companies. In hindsight the breakeven premium would have been about $250k/yr.

There may have been some smaller company that would be willing to take them, but the path of least resistance was to go on Medicare (which I guess you become eligible for if insurance declines to quote you).

[ebuddy]

Originally Posted by mduell 

Yes; I knew someone who could not get quotes from any of the major insurance companies. In hindsight the breakeven premium would have been about $250k/yr.

Without prying too much mduell, can you offer some additional details such as the State your acquaintance is in and the condition he/she is fighting?

There may have been some smaller company that would be willing to take them, but the path of least resistance was to go on Medicare (which I guess you become eligible for if insurance declines to quote you).

The path of least resistance? Not that it relates to your acquaintance, but I'm sure a great many are getting up to their alarm clocks every morning wondering if there's a path of lesser resistance. This type of arrangement is costly. Like turtle777 said, it's going to come from somewhere and I'll add that someone is going to have to go without something. Again, without regard to your acquaintance necessarily; I'd rather get this whole "self-empowerment" thing underway now so that we can maintain these decisions as opposed to watching us riot 5-10 years from now when things are pulled back by the giver.

[smacintush]

Oh, since we are talking anecdotes here…when my son had cancer we changed insurance twice and it wasn't a problem.

[mduell]

Originally Posted by ebuddy 

Without prying too much mduell, can you offer some additional details such as the State your acquaintance is in and the condition he/she is fighting?

New Jersey (permanent) / Massachusetts (current at the time)
Cancer at 16, relapse at 18, I met at about 20 (when uninsurable), relapsed and died at 21.

By path of least resistance I mean it was easier to get on Medicare than continue to hunt for private insurance.

[ebuddy]

Originally Posted by mduell 

New Jersey (permanent) / Massachusetts (current at the time)
Cancer at 16, relapse at 18, I met at about 20 (when uninsurable), relapsed and died at 21.

By path of least resistance I mean it was easier to get on Medicare than continue to hunt for private insurance.

I'm sorry to hear that your friend did not pull through mduell.

In discussions like these, almost invariably a cancer situation is brought forth. Not only is there no other disease for which so many resources are available in the US be it the American Cancer Society which can connect you to assistance ranging from lodging to food + care including travel expenses or the United Way, Social Security, etc... , but statistically there is literally no better health care system than ours for cancer treatment and survival rates. Now to the specifics; In Massachusetts for example, since 2006 all are required to obtain a state-government-regulated minimum level of healthcare insurance coverage and a public "connector authority" governs the distribution of this insurance to the people of Massachusetts. I'm guessing this was prior to 2006? Employer-coverages are generally group plans and singular conditions are not considered for deniability. Was he self-employed? Humana and others offer health insurance coverage for pre-existing conditions including cancer and there are multi-plans available which are essentially a coop of numerous insurers that cover everything from doctors visits and related prescriptions to blood tests and surgery for cancer. The critical component of this type of coverage is maintaining the premium because if you get dropped for non-payment of premium with this pre-existing condition, your chances of picking up with another insurer are... well extremely difficult. These plans range from $175 to $440 per month for individuals. The accessibility of these plans is of course contingent upon state laws and regulations which is something I'd like to see changed, but there are fee-for-service plans and managed care plans with a wide range of packages including catastrophic care clauses which require either a larger premium/lower deductible or a smaller premium/larger deductible and can often be tailored to meet specific needs and are available in some variety in every state.

In short, sometimes the path of least resistance does not serve anyone's best interest and may soon create a condition that no one will be capable of addressing. By cramming those who don't need this level of coverage into the system, we exhaust its resources for those like your friend; the exception to the rule, who will need it.

[Cold Warrior]

The individual mandate seems so critical that a judge would've voided the rest of the act, with or without a severability clause.

If it's struck down, we still need a great deal of reform. I hope that would lead to joint efforts.

[Athens]

I think the US needs to do the reform slow and in baby steps. One reform at a time.

Step 1)

Remove all pre existing conditions as a basis for coverage and cost to coverage. Insurance companies become mandated to treat every one equally regardless of any past medical history. Pricing to be same for every one as well. Some one with a previous heart attack gets the same price as some one who has never had a heart attack. Remove usage charges and co-pays and deductibles or make it standard across the board with all insurance companies. Those who make below a certain level of income can apply for government subsidies.

Step 2)

Remove all government run systems like medicare for the old and vets. Replace that with a government subsidy through private insurance. No government hospitals or clinics instead some one who qualifies for what would have been medicare instead picks what ever insurance company they want and the government pays the premiums.

Step 3)

Create a mandatory coverage schedule that applies to all companies offering health insurance. Set minimums of coverage that is the same across the board. Medically necessary procedures and care for acceptable quality of life to remove part of the administrative BS. If a person has a condition such as cancer and the treatment is listed in the mandatory coverage a hospital can begin treatment right away and bill the insurance company with out first waiting for approval. The only thing the hospital and doctors need to do is check that the person has valid medical insurance. The insurance company would be required to pay for anything in that schedule.

Step 4)

Require the care industry and the insurance industry to negotiate a price schedule for the majority of procedures which gets re-negotiated every 5 years to ensure standards in pricing. This would be to prevent hospitals from gouging the insurance companies.

Elective, cosmetic surgeries or non medically necessary tests and procedures would be up to the insurance companies to cover or not at what ever price they want. Same goes for doctors and hospitals with pricing on doing those out of schedule procedures.

Insurance companies and Hospitals would bitch but it would provide the best results for access to care, coverage of care and getting costs under control while maintaining a free market in health insurance and care.

[ebuddy]

Originally Posted by Athens 

I think the US needs to do the reform slow and in baby steps. One reform at a time.
Step 1)

Remove all pre existing conditions as a basis for coverage and cost to coverage. Insurance companies become mandated to treat every one equally regardless of any past medical history. Pricing to be same for every one as well. Some one with a previous heart attack gets the same price as some one who has never had a heart attack. Remove usage charges and co-pays and deductibles or make it standard across the board with all insurance companies. Those who make below a certain level of income can apply for government subsidies.

For the majority of the insured, this is how it works already. I pay the same as everyone else in my company for the same coverage. Some of us have heart conditions and some of us don't. Some of us smoke and some of us don't. This is the benefit of group-rate insurance. Increase portability of insurance by allowing across-state access so that smaller companies can band together under larger group-policies which spreads out risk and gives smaller companies the same group benefits as larger corporations and unions. Co-pays and deductibles are features that keep the cost of healthcare coverage down and people should be able to opt into "more skin in the game" if they wish in order to curb the monthly expense of unnecessary coverages. By removing these features and charging everyone the same, you're essentially advocating a change that would charge everyone the same - at a higher rate.

Step 2)

Remove all government run systems like medicare for the old and vets. Replace that with a government subsidy through private insurance. No government hospitals or clinics instead some one who qualifies for what would have been medicare instead picks what ever insurance company they want and the government pays the premiums.

There is no baby-step to this provision and it would never garner enough votes. A sound place to start would be to encourage the use of HSAs and compatible plans that give people "more skin in the game" by giving employers the opportunity of contributing to the HSA and in fact the government itself could contribute to this HSA for those who are means-tested to require help. HSA surpluses could be rolled into the next plan-year with incentives for saving on health care expenses encouraging people to shop their care more aggressively putting hospitals and clinics in the position of competing for this business.

Step 3)

Create a mandatory coverage schedule that applies to all companies offering health insurance. Set minimums of coverage that is the same across the board. Medically necessary procedures and care for acceptable quality of life to remove part of the administrative BS. If a person has a condition such as cancer and the treatment is listed in the mandatory coverage a hospital can begin treatment right away and bill the insurance company with out first waiting for approval. The only thing the hospital and doctors need to do is check that the person has valid medical insurance. The insurance company would be required to pay for anything in that schedule.

These variances in health care products and pricing are one of the primary factors that keep coverage costs down across the board. When you start tweaking mandatory minimums, you screw with the actuarial methods of risk management and increase costs for all. Most of these ideas are "sock it to the insurance company" ideals that do zero for the actual cost of health care and IMO buys into the myth that the health insurers are what are causing the problems. Health insurance companies profit on average, 3.3% which ranks them 88th of 215 industries for profit margin. Charges are what they are because people aren't paying attention to how much of their health care is paid by someone else and aren't shopping their care. i.e. they have little "skin in the game". People are always more careful with their own money than they are with someone else's money. Again, most pool their risk with others in larger group plans in which the coverages are outlined in exhaustive detail. You go to the clinic, you present your insurance ID, you get help for your problem, they bill the insurance company, and then they bill you for the co-pays and deductibles. By far the largest administrative burden on health care professionals is the paperwork involved with government-sponsored insurances such as Medicare and Medicaid. Of course, there are some valuable systems modernization provisions in Obamacare that should be preserved in some form or fashion in whatever health care reform occurs in the US.

Step 4)

Require the care industry and the insurance industry to negotiate a price schedule for the majority of procedures which gets re-negotiated every 5 years to ensure standards in pricing. This would be to prevent hospitals from gouging the insurance companies.

This is generally performed on a state-by-state basis and most states employ some type of "price-point" service for determining what those costs are by State. I'd be happy if we could control/schedule the costs between Medicare, Medicaid, and VA for the equipment and/or medications used and related costs let alone the medical procedures themselves.

Elective, cosmetic surgeries or non medically necessary tests and procedures would be up to the insurance companies to cover or not at what ever price they want. Same goes for doctors and hospitals with pricing on doing those out of schedule procedures.

This is a good point. Too often States will have their own ideals on what should and should not be covered and insurers of that State must play by their rules. Imagine if your auto insurance was expected to pick up oil changes, windshield washer fluid, new tires every 3 years, and keeping gas in it and how this would affect the cost of your auto insurance, but in fact this is what we find with some of the bizarre minimum coverage requirements from state to state. By increasing portability and chartering health care Insurance companies with host states, you not only have more insurers competing against one another, but you'll have states competing against one another for charters. Instead of having the choice of 6 large insurers in your state, you'd have the choice of several hundred. By ensuring that hospitals and clinics and insurers do not have a captive audience, but enticing customers with coverages and pricing advantages, you can ensure a more fickle consumer and a more competitive environment reducing costs across the board. Again, giving people more "skin in the game" and giving them more choices which also increases accessibility across the board.

Hospitals would bitch but it would provide the best results for access to care, coverage of care and getting costs under control while maintaining a free market in health insurance and care.

I don't think we need to create an environment where anyone's "bitching" necessarily. I think there are much less contentious solutions that encourage competition, increase accessibility, shift the paradigm from entitlement to empowerment, and reduce costs for all.

[Athens]

Originally Posted by ebuddy 

For the majority of the insured, this is how it works already. I pay the same as everyone else in my company for the same coverage. Some of us have heart conditions and some of us don't. Some of us smoke and some of us don't. This is the benefit of group-rate insurance. Increase portability of insurance by allowing across-state access so that smaller companies can band together under larger group-policies which spreads out risk and gives smaller companies the same group benefits as larger corporations and unions. Co-pays and deductibles are features that keep the cost of healthcare coverage down and people should be able to opt into "more skin in the game" if they wish in order to curb the monthly expense of unnecessary coverages. By removing these features and charging everyone the same, you're essentially advocating a change that would charge everyone the same - at a higher rate.

This is good for those on group plans but what about individuals who have coverage for themselves only or the small independent business owner. Some where in the overall system people are being rejected out right for conditions they already have or are paying more for coverage. Otherwise it wouldn't be a issue coming up so often. On to the Co-pays and deductibles, I understand the principle for the use of them to ensure people don't abuse the system and the insurance company with non medically needed procedures and tests. What about changes that make it so doctor ordered tests are exempt from co-pays and deductibles while those that are requested the doctor does not think are needed are subject to them. Here is the problem I see with co-pays and deductibles which can cost the system much more money then it saves. If there is a attached cost to getting checked for any issue which might seem minor, a end user is not going to spend the money on getting checked. I know if it costs me $50.00 every time I want to go see a doctor and also will be paying a small fee for every lab test the doctor orders up, I will be waiting until what ever minor issue I have turns into something I can't put off any longer. The extra costs in this is what kind of care is required to cure the problem from waiting to long. IE say a woman feels something isn't right with her breast. With no co-pays or deductibles she would most likely schedule a appointment with a doctor and have it checked out. If a tumor is found it will thus be treated right away. Now put in co-pays and deductibles she might wait. It could be a year before she starts having pain in the breast and by the time she checks it out, she could either have terminal cancer from waiting to long or require much more expensive care to deal with the problem. The other outcome is its nothing and a little bit of money was wasted on a doctor checkup and some lab tests. So I see two valid sides to this issue. One with no co-pays that result in excessive use of doctors and lab tests. One with co-pays that result in issues being caught early being easier and cheaper to treat. I think the half way point for this is if a doctor thinks its medically necessary to order tests and follow up visits for something, then co-pays and deductibles don't apply. For the person who visits 5 different doctors trying to find one that will order up tests that are not necessary the insurance company can ding them for the co-pay and deductible based on the fact other doctors said it was not needed.

There is no baby-step to this provision and it would never garner enough votes. A sound place to start would be to encourage the use of HSAs and compatible plans that give people "more skin in the game" by giving employers the opportunity of contributing to the HSA and in fact the government itself could contribute to this HSA for those who are means-tested to require help. HSA surpluses could be rolled into the next plan-year with incentives for saving on health care expenses encouraging people to shop their care more aggressively putting hospitals and clinics in the position of competing for this business.

Could you go into more detail about this. I don't know what a HSA is. Is it a Health Spending Account? The reason I suggested dropping Medicare, Medicad, VA and using the regular insurance industry to cover those that currently qualify for those services is because of the massive amount of money it takes to run those services a long side of the private sector. I just did a bit more research into medicare and wow its bloody complicated. Honestly I wouldn't know where to begin on getting personal health insurance. PPO, PSO, HMO, PFFS, MSA, MA, PD and MA-PD, Medigap and the list goes on. The one thing I don't like is this in-network stuff. If you go to the wrong hospital or doctor your coverage differs greatly as do the costs.

These variances in health care products and pricing are one of the primary factors that keep coverage costs down across the board. When you start tweaking mandatory minimums, you screw with the actuarial methods of risk management and increase costs for all. Most of these ideas are "sock it to the insurance company" ideals that do zero for the actual cost of health care and IMO buys into the myth that the health insurers are what are causing the problems. Health insurance companies profit on average, 3.3% which ranks them 88th of 215 industries for profit margin. Charges are what they are because people aren't paying attention to how much of their health care is paid by someone else and aren't shopping their care. i.e. they have little "skin in the game". People are always more careful with their own money than they are with someone else's money. Again, most pool their risk with others in larger group plans in which the coverages are outlined in exhaustive detail. You go to the clinic, you present your insurance ID, you get help for your problem, they bill the insurance company, and then they bill you for the co-pays and deductibles. By far the largest administrative burden on health care professionals is the paperwork involved with government-sponsored insurances such as Medicare and Medicaid. Of course, there are some valuable systems modernization provisions in Obamacare that should be preserved in some form or fashion in whatever health care reform occurs in the US.

I would argue its not just the government insurance systems like Medicare. The amount of paperwork and administration to deal with all the different insurance companies and coverage all contribute to the costs. The system is complex which requires a lot of extra staff to deal with that which ad's costs. If a doctor has to employ half a dozen people just to deal with insurance, coverage his prices are going to be that much more expensive to cover those costs.

I don't think we need to create an environment where anyone's "bitching" necessarily. I think there are much less contentious solutions that encourage competition, increase accessibility, shift the paradigm from entitlement to empowerment, and reduce costs for all.

No matter what is changed some one is going to bitch. Either the hospitals, the insurance companies or the patients. I can't see any changes that wont affect one of those groups both in a good way and in a bad way.

[ebuddy]

Originally Posted by Athens 

This is good for those on group plans but what about individuals who have coverage for themselves only or the small independent business owner. Some where in the overall system people are being rejected out right for conditions they already have or are paying more for coverage. Otherwise it wouldn't be a issue coming up so often.

It is a problem, but like so many issues becomes politicized for an agenda. There may be dirt in the bathtub, but too often busy-bodies with a short attention span in Washington want to remove the bathtub and subfloor to address it. Again, in regards to smaller businesses and the self-employed; increase portability by allowing across-state access so that smaller companies can band together under larger group-policies which spreads out risk, reduces cost, and gives smaller companies the same group benefits as larger corporations and unions.

On to the Co-pays and deductibles, I understand the principle for the use of them to ensure people don't abuse the system and the insurance company with non medically needed procedures and tests. What about changes that make it so doctor ordered tests are exempt from co-pays and deductibles while those that are requested the doctor does not think are needed are subject to them. Here is the problem I see with co-pays and deductibles which can cost the system much more money then it saves. If there is a attached cost to getting checked for any issue which might seem minor, a end user is not going to spend the money on getting checked. I know if it costs me $50.00 every time I want to go see a doctor and also will be paying a small fee for every lab test the doctor orders up, I will be waiting until what ever minor issue I have turns into something I can't put off any longer. The extra costs in this is what kind of care is required to cure the problem from waiting to long. IE say a woman feels something isn't right with her breast. With no co-pays or deductibles she would most likely schedule a appointment with a doctor and have it checked out. If a tumor is found it will thus be treated right away. Now put in co-pays and deductibles she might wait. It could be a year before she starts having pain in the breast and by the time she checks it out, she could either have terminal cancer from waiting to long or require much more expensive care to deal with the problem. The other outcome is its nothing and a little bit of money was wasted on a doctor checkup and some lab tests. So I see two valid sides to this issue. One with no co-pays that result in excessive use of doctors and lab tests. One with co-pays that result in issues being caught early being easier and cheaper to treat. I think the half way point for this is if a doctor thinks its medically necessary to order tests and follow up visits for something, then co-pays and deductibles don't apply. For the person who visits 5 different doctors trying to find one that will order up tests that are not necessary the insurance company can ding them for the co-pay and deductible based on the fact other doctors said it was not needed.

Copays and deductibles are risk-management tools used by insurance companies to maintain lower premiums. For every copay and deductible you remove, premiums will have to be increased to cover the increase in claims against the insurer. Plus, we're already faced with a situation where tests and exams are performed unnecessarily due to policies that have not only incentivized them in some cases, but have created what's referred to as a moral hazard; a situation in which consumers aren't scrutinizing or shopping their care as aggressively as they should because they aren't paying for it. If you remove copays and deductibles for doctor-recommended exams, you may create a similar situation in which providers will simply recommend unnecessary testing.

You made the statement; "I know if it costs me $50.00 every time I want to go see a doctor and also will be paying a small fee for every lab test the doctor orders up, I will be waiting until what ever minor issue I have turns into something I can't put off any longer." and used a mammogram as the example.
My first question is; how often do you see a doctor or get lab tests? The average copay for an insured woman to get a mammogram for example is $10-$35, in many cases is covered entirely by the insurer, and there are a wealth of outlets that provide free breast exams. While there are disagreements, the National Cancer Institute recommends you get a mammogram every 1-2 years after the age of 40. When you mandate higher levels of coverage for all in order to cover examples like these, you increase the cost of premiums for all. I think you'll find that most people aren't sweating the $10-$35 copays. For most, regular doctor visits and lab tests are not necessary and can create an environment where people are seeking care more than is necessary. There are some who seem to believe you can never see a doctor too often and I have a hard time with that. By empowering individuals with the decision to scrutinize their own care by watching their own dollars, we can hedge against placing that decision with someone else who may not be as in touch with our needs. Insurance plans should be flexible enough so that shoppers can pick and choose which coverage-types are best for them which may include paying higher copays or deductibles.

Could you go into more detail about this. I don't know what a HSA is. Is it a Health Spending Account?

An HSA is a Health Savings Account with tax advantages and can work much like an IRA. A company may contribute to your HSA and in fact even the government can contribute in cases that are means-tested. Per a study published in the American Journal of Medicine, the average out-of-pocket medical expenses leading to bankruptcy were $17,943 for a family, but here's the rub; we spend nearly $5400/year per household on entertainment and eating out, nearly $3300 in new vehicle purchases/year, and $16,920/year keeping up with the Jones' square footage of living space. If the average household were to curb their spending by half on eating out and entertainment and just a third on their homes, they'd have $11,500 of savings per year... in just one year. This doesn't even include drinking or smoking. I think our priorities are skewed. We spend wastefully, then decry a healthcare crisis with our hands out for help. We absolutely, positively have to begin helping ourselves and without a little skin in the game, we're just not going to do it. HSAs and compatible plans would go a long way toward addressing this problem.

The reason I suggested dropping Medicare, Medicad, VA and using the regular insurance industry to cover those that currently qualify for those services is because of the massive amount of money it takes to run those services a long side of the private sector. I just did a bit more research into medicare and wow its bloody complicated. Honestly I wouldn't know where to begin on getting personal health insurance. PPO, PSO, HMO, PFFS, MSA, MA, PD and MA-PD, Medigap and the list goes on. The one thing I don't like is this in-network stuff. If you go to the wrong hospital or doctor your coverage differs greatly as do the costs.

It can make a difference, but in most cases it's pretty negligible. Providers make arrangements with insurers to predict their own bottom line and ensure steady clientele. I'd like to see this arrangement change so that providers ensure clientele by competing with the quality and cost of their care. That culture will only change with more fickle consumers.

I would argue its not just the government insurance systems like Medicare. The amount of paperwork and administration to deal with all the different insurance companies and coverage all contribute to the costs. The system is complex which requires a lot of extra staff to deal with that which ad's costs. If a doctor has to employ half a dozen people just to deal with insurance, coverage his prices are going to be that much more expensive to cover those costs.

Certainly the administrative burden is a consideration and Obamacare does have some decent provisions for modernization that should be preserved in any reform as mentioned earlier.

[BadKosh]

We sure don't need all the administrative infrastructure and the associated costs(taxes).

[Athens]

Originally Posted by ebuddy 

You made the statement; "I know if it costs me $50.00 every time I want to go see a doctor and also will be paying a small fee for every lab test the doctor orders up, I will be waiting until what ever minor issue I have turns into something I can't put off any longer." and used a mammogram as the example.
My first question is; how often do you see a doctor or get lab tests?

On average once every few years. Middle of last year though I had developed a odd pain in my neck. It felt like the artery was constricted or was being pressed against. So that resulted in 4 doctor visits, a specialists, a ultrasound and a CT scan , 8 vials of blood for tests over the course of a month.

I have had to go to the ER at the hospital a few times over the years just because of what ever it was that was affecting me happened after hours or on the weekends when its hard to find any clinics open, and my family doctor is only available from 9-5 Monday to Friday. One was a bad reaction to new medications I was taking and one was a infection that got really bad I couldn't wait a couple more days to see my doctor so got the prescriptions from the hospital. I consider myself a low user of the system.

[Athens]

Oh I also wanted to comment on the part about what families spend one. You pointed out $3000 spent on entertainment and whatever number spend on eating out and other items. The difference between that and a big medical bill is the fact that you are comparing cumulative costs over a period of a year to a large single cost which most families couldn't absorb in one shoot. I think a simple solution to the medical costs would be making all bills related to medical interest free. If you end up owing $40 000 for a heart procedure, if the debt was interest free, its actually manageable vs $40 000 plus interest which could take years to pay off. I have always had a issue with Interest on any form of non loan debt. If anything the bigger issue is families saving period not just for medical debts but for any unexpected issue. Sudden car repair need, loss of job, health, natural disaster or family disaster. Medical bankruptcies is just a symptom of a bigger problem of families not saving.

I don't know the inner details of the US tax system. So I don't know if there is anything setup for encouraging saving. In Canada we have this thing called RSPs, registered saving plans. The incentive is to put money into these comes from the fact that it counts against your income for taxes. Side effect is you are penalized if you use them early before retirement with the exception of borrowing against your own RSP's for education or home ownership. Point is, its a effective tool to reduce income tax to lower tax brackets by deferring income that would have been taxed at a high bracket to a income at retirement at a lower bracket , eligibility for some subsides and credits. For example of how its useful with one subsidy, a family of 5 would have Medical premiums of $1452 a year if income is over $30 000. If you can bring your taxable income level down to $20 000 you qualify for 100% medical subsidies. A lot of Canadians operate home based businesses or work independently on the side for tax write offs. Some one making $30 000 of taxable income (after lots of creative accounting and deductions) could save a further $1452 by putting away $10 000 into RRSPS thus qualifying for 100% medical subsidies as the taxable income was now $20 000. No income tax is paid on that $10 000 either until its taking out later or used as a down payment for a house which does not need to be paid back for a decade.

Last stats I read about saving rates, more Canadians put away more money then Americans but we have also been seeing the same decline in the numbers of people saving and the amounts being saved over the last couple decades like the US so we have the same trend going on with people not saving. I live pay-check to pay-check so I haven't been putting anything aside for a while now. Seems this is the trend for most of us these days.

[ebuddy]

Athens; the annual expenditures cited are accumulated costs over one year and yes, a major medical expense can occur all at once, but the point of saving every year is that you don't have the all-at-once expense every year. I illustrated that for many situations, just one year of moderate spending discipline could in fact address a major all-at-once medical expense. Two years of moderate spending discipline in my example would cover well more than the average out-of-pocket medical expenses leading to bankruptcy claims.

[Athens]

Originally Posted by ebuddy 

Athens; the annual expenditures cited are accumulated costs over one year and yes, a major medical expense can occur all at once, but the point of saving every year is that you don't have the all-at-once expense every year. I illustrated that for many situations, just one year of moderate spending discipline could in fact address a major all-at-once medical expense. Two years of moderate spending discipline in my example would cover well more than the average out-of-pocket medical expenses leading to bankruptcy claims.

I totally agree. The trend is pay check to pay check. My generation and parents generation never learned the importance of saving. On top of that many businesses thrive on people spending everything they have and actively encourages and baits people to live like this. Our system of economics is morphing into a system to setup failure. Starts at home and in school not learning the importances of money and credit. Continues on into adult hood with pay check to pay check spending. I cringe at the thought of 30+ years from now when people hit old age and have no savings.

With that said though a single major medical event can also wipe out the entire savings of a family on one go to. Additional some medical events can cost so much that even a decent savings size might not be enough and still lead to bankruptcy. Im not trying to defend those that cheat out by using bankruptcy. We just have a lot of failure points. Personal economics, society and business incentives, general loss of perspective, lacking rules and laws on bankruptcy and you have a nice perfect storm. Spend to much, get into debt, have a medical condition and lose it all to start the cycle again.