Isn't the purpose of any insurance company primarily to enhance the wealth of its stockholders (as is the purpose of any capitalist-minded company - which is as it should be, imo) by providing a product or service that people want to purchase? The service, in this instance, is a promise to pay your medical bills (within constraints of your contractual arrangement) in exchange for you paying premiums even when you don't necessarily need any medical attention.
The problem I have with them heretofore is that none of the contracts that were offered were a pure example of their premise. IOW, they would promise to pay 'up to X' or would pay only if you never had a chance of a 'Catastrophic Illness'. Their business models, predicated on the need to return as much capital as possible to the equity investor (again, totally reasonable), made them actually not very good at managing risk over time for the consumer.
I agree completely that what we have now is a cluster . That's before the ACA.
Insurance was, classically, more akin to catastrophic coverage today. Not alot of options and cost-effective.
It wasn't intended to cover the day to day expenses. But by putting more inputs into the model, there's more opportunities for:
A) Acturarial gains.
B) SKU (Item) markup.
ACA just feeds the beast.
I take celebrex for my ankle that exploded and my insurance charges a $65 co-pay on name brand drugs. I have been begrudgingly paying it. Just for grins the other day I googled "buy celebrex" and found out I can pay cash for it and it costs $42.50.
Humana.
I would like a system where I know or will reasonably know what my bill will be before I go to a doctor or to a hospital. The bill does nothing to make receiving medical care more transparent. Imagin the compe ion if we could choose which hosoital to go to knowing that one will charge me $15.00 to take my tempature even though I simply broke my leg and another one would not do that at all because I simply broke my leg and there is no real need to take my tempature.
Touche!I'm sure it is. You specified conservatives with the implied qualifier that the reader of the post was your population.
I qualified.
Be careful with Celebrex, CC.
I took it for ten years (high dosage prescribed by my rheumatologist) for my Rheumatoid Arthritis. Great result in that I felt great and it allowed me to continue sports activities that I would have had to give up long before.
Problem is: It utterly destroyed my stomach lining.
So it is a trade-off, but I always wonder if my doc had kept me on a lower dose if I might have done as well but been able to tolerate it longer.
Zantac is now my friend.
It's going to be up to the states to actually do oversight on the rates as well as setup the exchanges but that is the mechanism where the cost controls are supposed to come from.
If a state implements rate controls through their insurance departments like they already do with liability coverage then it will have the opposite effect of feeding the beast. It's going to be a state by state thing. FWIW, the TIC used to be pretty good at telling insurers to off and come back with new rate tables.
Have you ever asked a nurse what the cost of a service is before? next time try it cause they do not know what the billings are. I have had friends that have tried to find out and they are intentionally left in the dark.
Even when you check out and sign for services rendered those clerks do not know.
This is a flaw of the system, IMO. I agree with elbamba
I think it's what happened to the system because "insurance pays"... unfortunately, we've entrenched the insurance system even further without basic cost things like that. In the meantime, those paying out of pocket get ed without lube.
Not a fan of the bill, and I'd rather have single-payer, but the following bits from ACA are intended to reduce costs:
Seems like some good things?1. Expand the pool to include more healthy people through the individual mandate; this provides insurance companies more money to be able to cover folks with pre-existing conditions at lower cost.
2. Mandate the minimum medical loss ratios. This means that the insurance company can use only 15% or so for administration and profit. Payments to providers must account for 85% or so of the costs of premiums.
3. Subsidize state high-risk pools. This provides insurance coverage for folks with pre-existing conditions who cannot afford private insurance.
4. Benchmark costs to Medicare standard prices. This provides insurance companies with a measure to try to beat in order to claim that private insurance outperforms government plans.
5. Require preventive care to be without charge to the patient. This encourages patients to get preventive care, reducing the long-term cost by improving their health.
6. Cover primary care. This reduces the load on emergency rooms and uses less expensive procedures for treatment before conditions get out of hand.
7. Have a healthcare quality board that review medical research and reports on improvements to best practices so that physicians in one part of the country can benefit from improvements in other parts of the country.
8. Subsidize rural clinics to bring primary care closer to rural populations, reducing the incidences of catastrophic health problems.
who's going to be wiping your ass in five years when you're in an old folks home?
I get free health insurance at my job. Any full time employee gets that for himself or herself. Pay is less but benefits are good.
Those who find jobs without that benefit can NOW stay on their parents' work insurance to age 26. at my work that currently costs $200 per month.
There's no such thing as "free health insurance". It might be that your employer decided to pay fully for the premium, but that's hardly the norm.
Depending where you look, there's about 40 million to 60 million Americans that are either uninsured and underinsured. About half of the non-business bankruptcies filed nowadays involve a person with a serious health problem.
Health insurance tied to employment has always been a terrible idea, IMO. If you happen to be unable to work for over 3 months for some kind of medical condition, you can lose your job and your coverage, exactly when you need it the most.
Count me in the boat of people that would prefer a single-payer system.
That is what the progressives in the Dem party wanted all along....Obama gave up too much for his bill when he gave up on single-payer....this is a ty compromise bill....the mandate was necessary for this law to have any teeth at all...Count me in the boat of people that would prefer a single-payer system.
that is what Aflack is for MOFO.....Health insurance tied to employment has always been a terrible idea, IMO. If you happen to be unable to work for over 3 months for some kind of medical condition, you can lose your job and your coverage, exactly when you need it the most.
yOU WILL BE, SINCE IT'S THE ONLY PLACE THAT WILL HIRE YOU.
This is one way to control corporations and their political influence through citizens united...corporations have bought our political system... it is totally corrupt...maybe this is why John Roberts decided to side with the less wing-nut justices....his court has handed over the government to corporations and against the will of the people...Mandate the minimum medical loss ratios. This means that the insurance company can use only 15% or so for administration and profit. Payments to providers must account for 85% or so of the costs of premiums.
must be opposite day
dIDN'T REALIZE i HAD MY CAPS LOCK ON. tHAT'S ALL.
LOL...
Did it again.
I've been entering some things in a database, and it's easier with my caps on. Just forgetting to switch over for the few minutes I check in here.
It's bull . I actually did ask one time. Had a severe pain in my neck that moved up into my head. Did some Googling and was convinced it was meningitis. It was late so went to one of those Care Now places. I was pretty sure my insurance wouldn't cover it so I told the girl at the counter that my insurance wasn't going to cover it so what's the estimated cost. She says it should be around $200 which would cover all the normal tests. But she also said she would try to run it on the insurance and took my card anyway. When I got out, I went to pay and she tells me "great news, it went through on the insurance". Great.
Then a few weeks later, I get a bill in the mail saying that my insurance would not cover it and the charge was almost $900. They charged me $180 for a pulse ox which 1) is ridiculous and 2) which they never ran in the first place. Also, the doctor literally spent only about 10 minutes with me.
I called to complain and they said that you get a convenience discount if you pay at the time of service. I explained that I was willing to pay at the time of service and they eventually referred me somewhere else. They eventually let me get away with paying around $350 because they said there was no way nurse at the front couldn't' have known what tests they were going to run when she gave the estimate.
"Good" in the sense that more people will be given access to more care, but that's not the same "good" as costs coming down. Most of these items involve tangible spending up front based on the premise that we'll get that money back via intangible savings on the back end. Once you filter those potential back end savings through the giant government bureaucracy that's going to be required to implement this all, I don't see much of a reason to be optimistic that this bill will do much of anything to slow down the growth in healthcare costs. We haven't done anything to remove cost from the system, all we've done is change who and how the burden of those costs is beared.
1. Expand the pool to include more healthy people through the individual mandate; this provides insurance companies more money to be able to cover folks with pre-existing conditions at lower cost.
2. Mandate the minimum medical loss ratios. This means that the insurance company can use only 15% or so for administration and profit. Payments to providers must account for 85% or so of the costs of premiums.
3. Subsidize state high-risk pools. This provides insurance coverage for folks with pre-existing conditions who cannot afford private insurance.
4. Benchmark costs to Medicare standard prices. This provides insurance companies with a measure to try to beat in order to claim that private insurance outperforms government plans.
5. Require preventive care to be without charge to the patient. This encourages patients to get preventive care, reducing the long-term cost by improving their health.
6. Cover primary care. This reduces the load on emergency rooms and uses less expensive procedures for treatment before conditions get out of hand.
7. Have a healthcare quality board that review medical research and reports on improvements to best practices so that physicians in one part of the country can benefit from improvements in other parts of the country.
8. Subsidize rural clinics to bring primary care closer to rural populations, reducing the incidences of catastrophic health problems.
"We have done anything to remove cost from the system"
"cost" is the health care system's revenue. And they own more than enough legislators to preseve their revenues while increasing them annually, for no additional benefit or care level, while lying about why they MUST raise costs.
Obviously I am talking about it being free to me. My employer pays the full premium. It is one of the things I like about my job.
I spent 7 years having to pay for my own insurance. The costs of a catastrophic policy were awful but I went without a lot of things to pay for it. I would welcome a single payer system, but in the meantime I chose my job partially for the health insurance benefits, not only for me but my kid.
There are currently 1 users browsing this thread. (0 members and 1 guests)
Posting Permissions
Reply With Quote
