New subject - moral hazard and pre existing conditions

[evmori]

OK. I blew out my knee playing street hockey in 10th grade. It hurts every day. If I want to get it cleaned up, it wouldn't be covered?

 

Both of my kids were born deaf. Does that mean none of their hearing tests or hearing aids should be covered?

[TheScout]

This all sounds nice. But how are we going to pay for it? All the proposals involve more debt.

 

If tort reform is a state issue. So is this anyway. Where is health mentioned in the Constituion? If you make up something about general welfare you can do the same thing for tort reform.

[GernBlansten]

Taxes. That's how every 1st world country with universal health care pays for it. Instead of paying a for profit health insurance company, you pay taxes. Instead of your employer paying for a group plan, they pay you your salary plus the amount they would have paid for the benefits. You pay the taxes. The taxes should equal the cost of the program. No debt. Unless you want to follow the tax break and spend policies of the last 8 years of course.

[packsaddle]

"Only way to make it work is if yeh require everyone to pay in and thereby truly distribute the risk without any demographic skimming."

Yes. This is a rational approach of shared risk and shared cost in a mutually-supportive community of people who care.

An alternative of 'every man for himself' is also a rational approach.

However, only one of those alternatives involves no further public debt or expense. To answer the question posed by TheScout, WE will not pay for the alternative that DOES involve public expense and debt. THAT payment will be deferred to young people and those yet unborn. Unfair, you say? Tough luck. If you don't like it vote for responsible government. Oops, you're too young to vote? Oh well, that's just tough luck then.

The inevitable end of all this is that we are going to have an 'every-man-for-himself' approach to everything. Obama and his strategy can only delay this. Might as well learn to love it.

 

Or to put this in a different light, I wonder what Jesus would do?

 

AnniePoo, turn on your sarcasm filter right now. Shame on you for putting a personal face on the issue...for softening hardened hearts and enabling empathy and sympathy in others. How are we supposed to solve this problem if you innocent sick people keep getting in the way?

[scoutldr]

Just like WE are now paying for the "Great Society" that our parents voted for. Social Security, Medicare, Medicaid...what's the diff? Nobody asked ME if I agreed with Medicare. And I DON'T agree with a lot of it...especially the waste and fraud part. And as Big Gov gets deeper and deeper into our lives, it will only get worse. The whole thing is a grand scale Ponzi scheme...the same thing they put Madoff in jail for.

 

Let all the taxpayers keep their money and buy what they need. How's that for "choice and competition". Costs will come down if there is really a choice...but when the healthcare industry knows that Medicare will pay XXX for a procedure, guess what...that's what they will "accept", even if it could be done cheaper. You can bet your bottom dollar that I wouldn't have 4 walkers in my shed if the patient had to pay for them. But the Govt pays for them, so what the hey..."sure, I'll take another one."

 

PS: WWJD? I would hope He'd just cure everyone.(This message has been edited by scoutldr)

[TheScout]

"Taxes. That's how every 1st world country with universal health care pays for it. Instead of paying a for profit health insurance company, you pay taxes. Instead of your employer paying for a group plan, they pay you your salary plus the amount they would have paid for the benefits. You pay the taxes. The taxes should equal the cost of the program. No debt. Unless you want to follow the tax break and spend policies of the last 8 years of course."

 

But of course this will never happen. If we could just raise taxes to make our debt go away, why do we have any debt?

[CalicoPenn]

Tort reform? 30 states have tort reform - we already know the results - it hasn't made a lick of difference. Indiana has tort reform, Illinois doesn't. If one listens to the right wingers in Illinois, this state is the absolute worst when it comes to lawsuit abuse - if you want to sue, sue in Illinois. Yet malpractice insurance costs are essentially the same in Indiana (which has tort reform) and Illinois (which doesn't). So are health insurance rates. Even if tort reform worked, it would result in savings of aprroximately 1 to 3 percent. Not a very significant savings.

 

Fraud and waste in Medicare? Sure, there's no doubt that there is - there's fraud and waste in just about everything. Heck, even the BSA is not immune - you might recall the scandal concerning inflated membership numbers that hit some councils - and I'll bet every single one of us could point to something Council does that we'd consider wasteful. But - the administrative costs for Medicare is about 3%. For private insurance, the administrative costs run 20 to 30%. Put another way, for every $100 Medicare spends on health care, $3 goes towards administration, $97 goes towards health care. For every $100 private insurance spends on health care, $20-$30 dollars is spent on administration - $80 to $70 dollars is spent on health care - who is being wasteful.

 

Pre-existing conditions should not be a barrier to obtaining affordable health care. Pre-existing conditions, if properly (in the medical sense) managed, don't necessarily result in more expenses than is paid out for someone without a pre-existing condition. Someone like me, with a chronic lung disease (not caused by smoking, or anything I've done), is going to be visiting doctors a bit more often, is more likely to get an annual flu shot, and to have more preventive care than someone who doesn't have a pre-existing condition. Sure, it may cost my insurance plan a few hundred dollars per year, but in the long run, I may end up costing my insurance company less than the guy without a pre-existing condition who has a sudden heart attack, or the guy who slips and breaks his arm while playing soccer.

 

So why don't health care providers want to cover people with pre-existing conditions? Because it's a regular source of expense - we are more likely to visit the doctor regularly, and get that flu shot, and take advantage of preventative care - and that's a drain on profits. They prefer the guy who might have a sudden heart attack, because they're gambling the guy won't (and the odds favor the house), and this guy is less likely to get anything more than an annual check-up - maybe. How many of us went to the doctor on an annual basis in our 20's and 30's? How many of us in our 40's, who believe ourselves to be healthy, get an annual check-up. Not as many as we are led to believe (let's face it, people lie to pollsters, we tell them what we think they want to hear - if some stranger calls on the phone and asks if you visit a doctor for an annual check-up, most people will answer yes, even if they don't, because we don't want to be faced with potential disapproval, even from people we don't know). Pre-existing conditions are a drain on profits - sudden conditions are not (and once you've had that heart attack - you now have a pre-existing condition).

 

Pre-existing conditions are also not cut and dry - most of us can list heart attack, cancer, diabetes as pre-existing conditions. How many of us recoil at the thought that being a victim of demostice violence is a pre-existing condition? Most of us I imagine, yet there are States that allow insurance companies to call domestic violence a pre-existing condition. There are States that allow rape to be considered a pre-existing condition. Do we really want to get into morality?

[packsaddle]

The area of health care automatically has a component of morality. Maybe, as scoutldr suggests, we can just depend on miracles. Personally, I have my doubts about faith healing but I admit...if everyone who objected to public health would just adopt that approach and reject everything else, I think the problem would be resolved fairly quickly.

[Beavah]

Yah, KC, if yeh really want tort reform, go with a 100% government health care system and exercise sovereign immunity!

 

I think there are some decent arguments to be made for discouragin' frivolous cases in tort law. Has to be done in a way that still protects the fellow whose doc amputates his leg instead of his appendix. Those ambulance-chasers we all complain about serve a purpose, eh? There are over 50,000 deaths in da U.S. each year that the medical industry itself attributes to medical error. If it happens to your family, yeh don't want tort reform, eh?

 

What often gets lost in da discussion of malpractice impacts is the impacts of the billing system. Malpractice worries are attributed to a lot of "unnecessary tests". I've looked at it, and I don't think I believe it. I think da real thing driving unnecessary tests is that in our current system, docs get paid for each procedure, and each separate visit. So our current insurance scheme incentivizes lots of testing and brief visits to discuss tests. It does it so well that it's drivin' docs out of general practice (where they might want to talk to a patient) and into specialties (where they can perform lots of procedures).

 

I think that's the bigger issue.

 

The medical system I still don't know enough to know how to fix it. It does seem to me that there's merit to McCain's notion of moving away from employer-sponsored health insurance, eh? Make it portable for people. Make it so that health costs don't sink American manufacturers. Make it so that gold-plated health coverage is off da table in union bargaining and such. But to do that, we have to make it universal, and we have to eliminate da demographic skimming. And it sure would be nice to fix da billing issue.

 

B

 

(This message has been edited by Beavah)

[skeptic]

Another related thing to "pre existing" is family history. How many insurers either will not cover, or charge greater fees if you have a history of any number of things, such heart problems, diabetes, or cancer? All of these things are somewhere in my family's history, most directly in line with me. Yet, so far, I have not been unfortunate as to have them. The cholesterol thing though raised its head years ago. If I did not have V.A., I would have been in serious "choice" land. If I had family dependent on me, then it would really have been a problem. Once I lost my insurance after being downsized, due to yearly exorbitant increases, I had no where to go, as I was (am) under-employed. So, the government plan was my salvation; but it has many drawbacks, and as I get older it concerns me a bit. Now, I also have Medicare, but it is not free by any means.

 

From my perspective, any type of tort reform should include some kind of limit on the actual penalty amount. Part of the problem is with ridiculous jury decisions. Even in the most severe cases, more than a few million dollars, even in today's money, is enough or more. So, when they tack on an extra $50-$100 million or more, it simply keeps rates for coverage way too high. And in a large percentage of cases, even a million is over-kill. There need to be penalties, but only high enough to cover the reality of the injury, and to make the parties responsible adopt changes to avoid additional similar awards; but not so high as to bankrupt them, or increase every one's cost through inflated rates. Of course, they also would need to include severe penalties for "frivolous" suits.

 

[sandspur]

We have confused two different provisions of the proposals now before congress (as, frankly have some of our economically ignorant congressmen/women)

 

1. A requirement that insurance companies must cover pre-existing conditions. OK by itself. If rates can be adjusted.

2. A requirement that companies cannot charge different groups/people different rates.

 

Combine the two, and it means if you are an insurer you MUST cover the guy who needs expensive, lifelong care but you CANNOT charge him any more than you do the healthy 20-year-old.

 

Only way that works is if the healthy guy pays more.

 

Like the friendly Allstate guy says shouldnt you get a break for your good driving record? Nope. Not if we have to cover the guy with a record of major claims and cannot charge him any more than we charge you.

 

And yes, I know that auto claims may be your fault while health may not be, but economically it is the same as far as payments and rates go.

 

So rather than focus on the problem (how to cover about 5% of the population who cannot afford health insurance, or have expensive pre-existing conditions but cannot get coverage) we seem to be bent on a nationalized system for everyone. Why not create a government-backed insurer of last resort to cover those folks who need it? I suspect because congress wants to control the system and create a new class of folks dependent on congress.

(This message has been edited by Sandspur)

[Eamonn]

From what I have read and seen on the news. It seems to me that just about everyone seems to agree that when it comes to health care here in the USA, there is a need for change.

 

Right now one of the main reasons I'm toddling off to work everyday is to ensure that myself and HWMBO has the coverage we need.

I didn't have much choice in the plan that I was offered, in fact my choices were take it, don't take it and if you take it you have the choice of a HMO or a PPO.

Some of my co-workers with many years service in don't pay anything for their insurance. I pay 1/2% of my gross, it should be 1% but we have a silly Get Healthy Plan, which entails answering a bunch of questions on line and results in the discount.

The State has it that if your spouse works anyplace that offers insurance, they have to use that plan, but can be on the State Workers Plan as secondary insurance.

OJ was also on my plan, while he was a full time student.

He however decided that he wants to be a Para-Medic.

In order to reach his goal he has to work as a EMT.

He is working as an EMT.

He is working some very strange shifts and some very long days. Most weeks he works about 50 hours. As do most of the other EMT's.

But the company he works for doesn't hire any of its workers as full time workers. As part-timers they are not even offered the choice of buying health insurance through a company plan.

He isn't earning that much, a little over $10.00 an hour. Not enough to be able to afford his own plan.

Meanwhile he is out there lifting some very heavy loads, working 16 hour shifts.

Who is to say that at sometime, somehow he isn't going to do himself some type of harm?

Sure he will be covered by Workman's comp. Insurance. But a bad back isn't an easy fix and can last a lifetime.

 

I'm not sure how to make it work.

But I do believe that everyone and I mean everyone needs to be covered by a health insurance plan.

Right now the people with no insurance are a burden on us all. They tend to use the local ER as a Doctors office. The Hospitals have no choice but to treat these people and these people for one reason or another (Some just can't afford to pay) don't pay. This raises the costs that the hospitals have to pass on to us all.

Allowing people to wait until they become really sick, before they buy insurance? Is just a daffy idea. Which will end up costing everyone more.

Allowing employers to not offer insurance, by saying that everyone is a part-timer. Is just wrong.

Even more wrong when the employer makes money from billing health insurance plans.

Eamonn.

(Sorry about the rant!)

[sandspur]

Eamonn:

I agree your son seems to have a raw deal. And I agree there is a problem nationally.

 

But, as someone who is generally of a libertarian bent, I must point out that your son is not without choices.

 

Is your sons employer the only one around? Even in this economy?

 

If they are the only employer of EMTs in the area, does he have to work in that local or can he get a better deal elsewhere with a better employer?

 

Is there a medical-related field he can get a job in that has a better employer?

 

In other words, your sons employer may be a Grinch, but does your son have to take it? The only way the Grinch gets away with it is if he can.

 

And best of luck to your son. Truly!

 

[GernBlansten]

Unfortunately Sandspur,

that scenario is repeated millions of times in America.

Entry level positions are ripe with being part-time. Employers design them to reduce employment costs. Employers don't have to provide benefits for part time labor and they like it that way. Walmart is a master at this.

 

You can shop around for a better offer when you have some unique skill that employers value, some experience. But for entry level folk, you all have the same skill set and if you won't want the job, there's a stack of resumes on his desk of people who will do it.

 

So OJ joins the ranks of the chronically uninsured, not by choice or precondition, but by design. Hopefully, he will gain enough experience to get a full time job that offers benefits. Until then, he needs to be careful. And lucky.

[scoutldr]

I think if I were being asked to work 50 hrs a week and being called part-time, I'd have a chat with the Labor Department...and the union. THere are laws about that.