Health Care Debate

[Hazir]

A friend of mine has retired some time ago. He would like to go abroad to volunteer to teach poor children, but now is finding out that he actually can't afford to volunteer. He's covered by both Medicare and Medigap (?) neither of which will cover him outside of the US (which is sort of surprising to hear for a EU citizen to start with. So he decided to try for a private insurance, and sure enough there were private policies on offer. He'd be prepared to pay the $5,000 to $6,500 a year out of his own pocket, but recently found out that they don't cover pre-existing conditions for a period of 2 years. Which means that he, a man at age 67, won't be covered for anything related to high blood pressure (effectively that pretty much leaves him uncovered).

End of story; he'll have to give up his plans since his health insurance is keeping him hostage. And that's an American who actually has coverage.

[GGT]

The US has the best health care system IN THE WORLD.

I don't know anything about Medicare portability, but millions of seniors travel abroad for months at a time. Can't imagine their Medicare wouldn't be their coverage as tourists. Was your friend thinking of changing residency or something like that?

And yes, the private insurance maze is fubar. One option outside Medicare is to buy the major medical (80/20) and supplement it with a catastrophic high-risk policy (covering his pre-existings) until the two year exclusion expires.

But if he actually USES the high-risk policy, the purpose for which it's intended....he won't be able to get rid of the exclusion! The utilization reviewers will turn any little thing into a condition secondary to his hypertension. Even heart burn.

Go go USA #1!

[agamemnus]

Ooh, found another juicy thing after reading through a few more posts here...

Again, just like subsidizing the young over the old, why should the country subsidize those who CHOOSE to be sick (ie: fat, smokers) ? If we instead set up rules to control these behaviors to bring down the costs the insurance companies will charge the government for these people, then that just results in more bureaucracy. Oh, and it won't be efficient bureaucracy, so you'll anyway find many fatsos and smokers covered by government insurance with no penalties.

[Hazir]

The US has the best health care system IN THE WORLD.

I don't know anything about Medicare portability, but millions of seniors travel abroad for months at a time. Can't imagine their Medicare wouldn't be their coverage as tourists. Was your friend thinking of changing residency or something like that?

And yes, the private insurance maze is fubar. One option outside Medicare is to buy the major medical (80/20) and supplement it with a catastrophic high-risk policy (covering his pre-existings) until the two year exclusion expires.

But if he actually USES the high-risk policy, the purpose for which it's intended....he won't be able to get rid of the exclusion! The utilization reviewers will turn any little thing into a condition secondary to his hypertension. Even heart burn.

Go go USA #1!

He explained he can stay up to 60 days out of the country without losing his medicare coverage. I wonder if he could do this by simply flying back and forth after every 60 day period. He'd have to fly about 5 times a year, but that would still not look too bad compared to the premiums for health insurance.

[GGT]

Ooh, found another juicy thing after reading through a few more posts here...

Again, just like subsidizing the young over the old, why should the country subsidize those who CHOOSE to be sick (ie: fat, smokers) ? If we instead set up rules to control these behaviors to bring down the costs the insurance companies will charge the government for these people, then that just results in more bureaucracy. Oh, and it won't be efficient bureaucracy, so you'll anyway find many fatsos and smokers covered by government insurance with no penalties.

what?

[agamemnus]

what?

I'm saying that there are two alternatives to a market-based solution. One is to subsidize people with whatever insurance plan/company anyone wants. Clearly, that's impossibly costly. The other is to set up limits and scrutinize insurance plans/companies that people choose to make sure they aren't picking an insurance plan that is unjustifiably expensive.. that scrutiny will be done by bureaucrats, and it will be wasteful thus won't work well.

Just look at the Massachusetts subdivisions for free health insurance (I'm not even discussing the cost here...). There are many groups, some inexplicably receiving fewer insurance benefits than others. (the division is mostly based on politics; unemployed mothers get way more insurance than unemployed singles I believe) This will be extended under a national insurance/health-care subsidy to many more groups of people.

[Being]

I'm saying that there are two alternatives to a market-based solution. One is to subsidize people with whatever insurance plan/company anyone wants. Clearly, that's impossibly costly. The other is to set up limits and scrutinize insurance plans/companies that people choose to make sure they aren't picking an insurance plan that is unjustifiably expensive.. that scrutiny will be done by bureaucrats, and it will be wasteful and won't work well.

Just look at the Massachusetts subdivisions for free health insurance. There are many groups, some inexplicably receiving less insurance than others. (the division is mostly based on politics; unemployed mothers get way more insurance than unemployed singles) This will be extended under a national insurance/health-care subsidy to many more groups of people.

You're still making small pools and they can't compete with a large one.

[GGT]

I'm saying that there are two alternatives to a market-based solution. One is to subsidize people with whatever insurance plan/company anyone wants. Clearly, that's impossibly costly. The other is to set up limits and scrutinize insurance plans/companies that people choose to make sure they aren't picking an insurance plan that is unjustifiably expensive.. that scrutiny will be done by bureaucrats, and it will be wasteful thus won't work well.

That's supposed to explain this?--

Again, just like subsidizing the young over the old, why should the country subsidize those who CHOOSE to be sick (ie: fat, smokers) ? If we instead set up rules to control these behaviors to bring down the costs the insurance companies will charge the government for these people, then that just results in more bureaucracy. Oh, and it won't be efficient bureaucracy, so you'll anyway find many fatsos and smokers covered by government insurance with no penalties.

what the hell?

Just look at the Massachusetts subdivisions for free health insurance (I'm not even discussing the cost here...). There are many groups, some inexplicably receiving fewer insurance benefits than others. (the division is mostly based on politics; unemployed mothers get way more insurance than unemployed singles I believe) This will be extended under a national insurance/health-care subsidy to many more groups of people.

Mothers would need more coverage for their dependent kids, unless the kids are covered some other way.

Mass. has its own mandate, set up by Republican Romney. Sen Brown was elected partly b/c he tapped into state residents saying hey wait, we already have "everyone" covered by insurance, we don't want to participate with federal stuff. Politics, yes.


There are more than two alternatives as you suggest. It doesn't have to be a decision between subsidies (tax payer money) vs bureaucratic red tape (inefficiency). It's interesting to see Republicans talk about Choice, Costs, Behaviors, and Rules....as decided by Insurance companies (or even employers). That's somehow "better" than any government agency doing the same?

Whatever happened to Care decided between patient and physician? Third parties are in control, that's what's real. Insurance as payer and gov't as regulator. Any solution will have to be a hybrid that includes them, plus the consumer and provider.

You can use this as an opportunity to rant about fatties, smokers, welfare mothers, illegal imm'grants, grannies, Big Brother (or whatever you complained about earlier), but how will that solve any of our problems to just exclude those groups you don't like?

[ar81]

Buffett: Economy on mend, health care big problem

[GGT]

Double post to share this article-opinion:

http://online.wsj.com/article/SB1000...LEFTTopOpinion

In Indiana's HSA, the state deposits $2,750 per year into an account controlled by the employee, out of which he pays all his health bills. Indiana covers the premium for the plan. The intent is that participants will become more cost-conscious and careful about overpayment or overutilization.

Unused funds in the account—to date some $30 million or about $2,000 per employee and growing fast—are the worker's permanent property. For the very small number of employees (about 6% last year) who use their entire account balance, the state shares further health costs up to an out-of-pocket maximum of $8,000, after which the employee is completely protected.

1) State cash subsidy
2) State subsidy of premiums
3) $8,000 'deductible' for 100% coverage

Not bad, eh? We can manage our sick office visits and wellness screenings, plus meds, for under $2,750. If we use it up--OOP up to 8K--state takes care of our bills. And this guy is saying HSA like this are a good idea.....?

I should tell my sister in Indiana about this. Self-employed with non-subsidized HSA and major medical policy with $10,000 deductible.

[ImAnOgre]

the GIANT problem of the lardass who eats 20lbs of fried chicken and smokes two packs of cigarettes per day.

i have a brilliant idea how about we sponsor 1. gastric bypass surgeries 2. programmes to help people quit smoking ???

So now you want me to pay for someone’s surgery too? OMFG. Perhaps if someone makes decisions to change their habits then they wouldn’t need the surgery in the first place. And quitting smoking, how many free programs are already out there.

btw what the hell was ogre talking about with his snide remark about generosity with other people's money??? is he suggesting that i don't pay taxes, or that i won't be paying more taxes the more i earn?? that sounds crazy

It wasn’t snide at all, you want me to pay more money to taxes so people can continue their lifestyle choices that increase their health insurance cost. Quite simple. You’re a smart person, you should understand that. You say I should pay more… in addition to you. I on the other hand don’t want to pay for someone else’s poor lifestyle choices.

Hope it works out for you. Means you won't be drinking beer anymore...?

When I found out that I was a diabetic, I made some lifestyle changes. I quit smoking (after smoking well over 10 years), I lost 50 pounds. I started eating healthy. Everyday, instead of McDonalds or Wendys for lunch I have a SmartOnes for lunch. I’m getting a lot more exercise. So much so that according to my Doctor, if I keep this up I’ll never need insulin and can remain diet controlled for the rest of my life.

So… lifestyle changes.

So you're in favor of SCHIPs, WIC and foodstamps? And allowing children on parents' insurance policies until age 21? Maybe public-funded college too?

I love the idea of public funding college, however I kind of like what we have now in Georgia with the Hope Scholarship. You keep a B average or better in college, and you college is paid for by Lottery dollars. Am I favor of WIC and foodstamps…. Not like they are used now because there is way too much fraud with these programs. The number of times I’ve seen someone using foodstamps while buying beer is amazing.

But then again, perhaps the cost to investigate the fraud will outweigh the benefits…

I don’t know that much about it to make an informed decision.

They're in your insurance pool, they're your neighbors, they share the road and the health system, the dumbasses. Your utopian society can't separate individuals from the group, no matter how hard you try.

Sure we can, and we can charge the dumbasses more. They do it for life insuranace…. Do you smoke? Life insurance cost more. If you make choices in your life that cost more, you should pay more. I have no problems with someone who smokes. Let them, but they also need to pay more for the stupid decision to smoke.

Based on that, your employer should kick you out of their group insurance, since your diabetes "punishes" everyone in the pool. To be consistent about it, you should be buying your own individual policy, paying a much higher premium, full fee cash OOP for every office visit, market price for every medication.

If my employer wished to kick me out of the pool, that is their right. However, when I was hired, part of my contract with my employer was that I receive health insurance as a benefit of my employment. If they wish to kick me out of said pool, that is their right, but then they breach the contract.

Maybe your employer should do away with their insurance benefit altogether, so that cost won't trickle down to the consumer in higher airline tickets? Why should we have to pay higher prices to fly, when it's padded with your benefits and not simply work performance/value? I like how you can be 'charitable' with my money, when it goes into your pocket.

You don’t have to fly. You can drive, or take a boat. But if you wish to fly, and CHOOSE to do so, you have to pay. I’m not making you fly, I’m not taking money away from you by force (as the government does with taxes).

I was shrewd enough to negotiate a contract with my employer that benefits us both. I kick ass at my job, and they pay me a pretty nice wage.

If my employer chose to do away with health insurance, then they can. I also have the choice to leave and work somewhere else.

Are you saying an airline shouldn’t hire anybody so you can fly for free? Laughable!!

[GGT]

No, Ogre, I'm not saying that at all. Using your own logic to poke holes in that logic didn't work out too well tho.

Trying to get you to admit Personal Choice and Responsibility, while nifty lofty goals, can't ever be separated from other groups we're connected with. Not totally. Just take your case study and apply it to a self-employed or contract worker. Or someone who got laid off. Or anyone who can't afford the doctor (and testing and follow-up and meds) that were available to you, but they also don't qualify for subsidy.

Step outside your Individualism for a moment. Try on new glasses, the world might look a bit more complicated than "I don't wanna pay for anyone and don't take my hard-earned money!"

[Ziggy Stardust]

When I found out that I was a diabetic, I made some lifestyle changes. I quit smoking (after smoking well over 10 years)

So it took a diagnosis of diabetes to make you change your "dumbass behavior" (your words)? So that gives you the right to call others dumbasses right?

Do you smoke? Life insurance cost more

Yes it does actually. I pay quite a lot more than my girlfriend who already has kidney problems. Added to that I pay taxes on what I smoke.

[GGT]

<Smokers do pay more in insurance premiums>

Ogre, why not put your ideology to a real life test? Try shopping and applying for health insurance on "the open market". You'll have to list your diabetes as a pre-existing condition, even if it's managed and not insulin-dependent. Then come back and tell us what kind of coverage you can find, how much the premiums are, what your deductible is; will you go with an HMO/PPO, 80/20 major medical, a CAT plan, HSA and everything cash OOP? How much would COBRA cost for you to continue your employer-subsidized plan, and what would you do when that expires?

[EyeKhan]

<Smokers do pay more in insurance premiums>

Ogre, why not put your ideology to a real life test? Try shopping and applying for health insurance on "the open market". You'll have to list your diabetes as a pre-existing condition, even if it's managed and not insulin-dependent. Then come back and tell us what kind of coverage you can find, how much the premiums are, what your deductible is; will you go with an HMO/PPO, 80/20 major medical, a CAT plan, HSA and everything cash OOP? How much would COBRA cost for you to continue your employer-subsidized plan, and what would you do when that expires?

One problem you illustrate is that everyone thinks they want more control and more choices and more information and blah blah blah. I don't. I want the coverage I need when I need it and I don't want to have to think about it at all. My life's too complex as it is - I don't have the time, energy or brain-power to become savvy in the insurance market. I'll just end up fucking it up and getting ripped off.

Same damn thing happened with 401k investments. More options, more choices, more plans, a hundred different ways to invest your money. Study found that the more options employees were given, the more likely they were to not participate. People don't need more complexity - they need something simple that works.

[GGT]

People don't need more complexity - they need something simple that works.

Ah, but that's part of the debate. One side says consumers want to be in charge, have more choices, make their own decisions. The other side says it's too complicated and messy, let's help the consumer out.

We don't mind others telling us what's best, bargaining on our behalf, doing our homework, or helping out with costs. As long as it's OUR employer doing that for US (and we think it works) nobody blinks an eye, but mention public servants or big corporations like WalMart and everyone hyperventilates.

[Aimless]

ogre is dumb because he doesn't realise that gastric bypass is currently the most effective intervention for improving the health of the very obese, far superior to lifestyle choices. he is also silly for forgetting that obesity is frequently established in childhood or youth. finally he may be having a bad day because he 1. forgot to point out that he, unlike very many other fat people, is fairly well-off financially and in terms of job-security, and doesn't have kids etc and 2. forgot that just because something is free doesn't mean it's good. didn't we recently read about an unusually successful desmoking intervention relying on cash incentives???

how he can be so hard on others when he himself was at least 50 lbs overfat baffles me. no, wait, it doesn't... it's the whole self-made man nonsense in another form isn't it

[GGT]

Live Free or Die. Give Me Liberty or Give Me Death. Don't Tread On Me.

There's a pattern design that only works to a point.

[agamemnus]

GGT: ER, it's going to take me some time to respond to your post, if I get around to it.

I'll just address Being's comment for now:

You're still making small pools and they can't compete with a large one.

What do you mean by "compete"? A set of smaller more targeted pools is more efficient than one huge pool because the targeted pool distributes costs and prices effectively. But this isn't exactly praise for a government insurance subsidy plan-- just an observation.

[GGT]

GGT: ER, it's going to take me some time to respond to your post, if I get around to it.

I'll just address Being's comment for now:

What do you mean by "compete"? A set of smaller more targeted pools is more efficient than one huge pool because the targeted pool distributes costs and prices effectively. But this isn't exactly praise for a government insurance subsidy plan-- just an observation.

No problem Aggie. The devil is in the details, a model has to work with all variables or it's just a Band-Aid.

Someone should do comparison analysis of Switzerland, even tho they're tiny. They supposedly have healthcare via subsidized insurance "for everyone", with ~70+ main private insurers, while the US has less than 20.

[ImAnOgre]

So it took a diagnosis of diabetes to make you change your "dumbass behavior" (your words)? So that gives you the right to call others dumbasses right?
Yes it does actually. I pay quite a lot more than my girlfriend who already has kidney problems. Added to that I pay taxes on what I smoke.

You should know me well enough by now to know that I have no problem at all condeming my own actions. I was a dumbass for smoking, drinking heavily, overeating, Hell, even dating a stripper could be conisdered stupid.

[Being]

GGT: ER, it's going to take me some time to respond to your post, if I get around to it.

I'll just address Being's comment for now:

What do you mean by "compete"? A set of smaller more targeted pools is more efficient than one huge pool because the targeted pool distributes costs and prices effectively. But this isn't exactly praise for a government insurance subsidy plan-- just an observation.

From a business standpoint the pool should be comprised of people who pay and don't file claims. That maximizes profit without incurring risk. From an insurance standpoint the pool should include everybody because that minimizes the risk. Insurance as a business is a game that can't be won, AIG.

[ImAnOgre]

ogre is dumb because he doesn't realise that gastric bypass is currently the most effective intervention for improving the health of the very obese, far superior to lifestyle choices.

What part of I don’t want to pay for other people’s life style choices doesn’t make sense to you? Are you that obtuse? You want me to pay for people to have surgery, because they eat way too much?

I was just at Quiznos, got me a Turkey Sandwich. The lady beside me, who easily weighed twice my weight, orders a large Steak and Cheese, with everything.

I’m so glad that in your little utopia you want me to pay for to have surgery because the uber fattening sandwich she had was tasty. Not only would she have spent less, but it would have been more healthy for her to eat a turkey sandwich.

I should have gotten a picture, she could have been one of Baxter’s babes.

he is also silly for forgetting that obesity is frequently established in childhood or youth. finally he may be having a bad day because he 1. forgot to point out that he, unlike very many other fat people, is fairly well-off financially and in terms of job-security, and doesn't have kids etc and 2. forgot that just because something is free doesn't mean it's good. didn't we recently read about an unusually successful desmoking intervention relying on cash incentives???

I’m where I’m at now because of choice I make, to this very day!!!

We’ve had this conversation before, and I guess I can’t condemn you for not remembering everything about me, but I’m where I’m at because of choices I made as adult. I was homeless, living out of my car. This wasn’t that long ago (shortly before I got to the company where I now work) I righted my own life. Others can easily do the same.

If you want to smoke, fine by me, just don’t expect me to pay for it. If you can’t afford to smoke, don’t. If you can’t afford to eat healthy, at least exercise…. And as far as your really dumb idea that some people aren’t well off financially, they can go walking to exercise for free.

These same people who aren’t in dire straits financially would rather spend money on cigarettes, then spending on it their kids??? WTF!!! And not only do you want to support them, you want to spend MY money doing it by increasing my taxes.

God love ya Minxie poo, but there is no way in hell I can support that crap.

how he can be so hard on others when he himself was at least 50 lbs overfat baffles me. no, wait, it doesn't... it's the whole self-made man nonsense in another form isn't it

Pretty much. As has been pointed out many times on these forums, I’m not that smart, I’m not that educated, yet I’m able to use what few skills I have to get where I am at.

What’s wrong with a little self motivation. If you reward poor behavior it leads to more poor behavior.

[ImAnOgre]

<Smokers do pay more in insurance premiums>

Ogre, why not put your ideology to a real life test? Try shopping and applying for health insurance on "the open market". You'll have to list your diabetes as a pre-existing condition, even if it's managed and not insulin-dependent. Then come back and tell us what kind of coverage you can find, how much the premiums are, what your deductible is; will you go with an HMO/PPO, 80/20 major medical, a CAT plan, HSA and everything cash OOP? How much would COBRA cost for you to continue your employer-subsidized plan, and what would you do when that expires?

I want smokers to pay more. You obviously don't see my point. Don't reward bad behavior.

[ImAnOgre]

One problem you illustrate is that everyone thinks they want more control and more choices and more information and blah blah blah. I don't. I want the coverage I need when I need it and I don't want to have to think about it at all. My life's too complex as it is - I don't have the time, energy or brain-power to become savvy in the insurance market. I'll just end up fucking it up and getting ripped off.

Same damn thing happened with 401k investments. More options, more choices, more plans, a hundred different ways to invest your money. Study found that the more options employees were given, the more likely they were to not participate. People don't need more complexity - they need something simple that works.

I'll be happy to give you advice for free on your 401k. In the financial community, when people ask you how is your portfolio doing, they mean in comparison to the S&P500. So, why do you try to 'guess' what is doing well, when you can just simply pick a fund that mimics the S&P500. Typically, these funds are the lowest cost both intial cost, and cost to keep the fund running.

Anything else is a gamble (even the S&P is a gamble, just not as big a gamble).

[GGT]

<Smokers already pay more. In sin taxes, insurance premiums, and oh yeah, earlier deaths.>

Ogre, how far would you have gotten to that Quizno's without public roads? Did you also bemoan the SUV drivers or gas guzzlers along the way, or our oil crazed society? How would you have learned about your lifestyle choices being "bad" without the internet and electricity? How well could you have diagnosed your medical problems without your big employer (that flies people all over the globe) and your employer subsidized health care insurance helping to pay for your physician?

edit for the "and another thing!" comment. How far do you think you'd be without our US gov't having "subsidized" the airline industry....or our Treasury or Fed Res manipulating our dollar...or others having discretionary income to spend on flying around the world for vacations?

[Being]

Some people just don't get revenue shift. It's about money.

[LittleFuzzy]

how he can be so hard on others when he himself was at least 50 lbs overfat baffles me. no, wait, it doesn't... it's the whole self-made man nonsense in another form isn't it

Sounds more like valuing personal anecdotal experience more than impersonal and unfamiliar general statistics. Everyone ends up doing that to some degree.

[GGT]

Sounds more like valuing personal anecdotal experience more than impersonal and unfamiliar general statistics. Everyone ends up doing that to some degree.

He's doing both. He pulled himself up by his own bootstraps dontchaknow. Why can't everyone else do that, without taking money from his pocket?

[Aimless]

you know, if you pay for her surgery chances are she won't be ABLE to eat any more über-fattening sandwiches! it's awesome!

i bet you caught some lucky breaks man

if you didn't then you're an exceptional case and well done on your self-improvement but don't be so stupid as to assume that, just because you managed, everyone else can as well.

i mentioned kids because it's not easy losing any significant amount of weight all on your own with no guidance and no support when you're working your ass off, have to drive everywhere, and have kids to worry about as well.