20th January, 2017

[Alan Goldhammer]

So are they pay much  less because someone else...the taxpayers...is picking up the a big part of the tab via subsidies?   I am required to pay the full price myself.  I can only speak for myself.  My priemums are 2k a month for my wife and myself, and I'm forced onto the marketplace with only one company to choose from.  It wa not this way pre Obamacare and the plans were better and cheaper.  What I'm paying for is mostly useless with over 10 deductibles and 14k out of pocket.  Obamacare is worthless.  Ymmv.

But you are seeing the exact same thing happening with corporate plans as well as Medicare.  $2K a month seems to be a lot to pay but maybe because of the geographical region you live in that's the way it is.  You have to remember that regardless of Obamacare lots of insurers are restricting the regions they underwrite in.  My daughter was covered by Aetna when she lived in Philadelphia but was not covered when she moved to Oakland in September because Aetna doesn't write individual policies there.  She asked what she should do if she needed to see a doctor and Aetna said to go to the ER as that was all Aetna would cover.  Great money saving advice.  She had a month transition before she was eligible for Kaiser Permanente.

Wait until you go on Medicare and you will see the same thing happening.  I'm looking for a new internist and two practices I called are not accepting Medicare patients.  I told them I had excellent secondary coverage through our local BlueCross company but that did not matter.  also, don't think Medicare is free.  My wife and I will be paying about $13K this coming year for Medicare and our secondary insurance.  It's a little on the low side as I have a discount as the secondary policy is provided by my former employer as a retirement benefit.  Fortunately, we have investment income that lives us financially in good shape.  I cannot figure out how anyone who relies only on Social Security can live.

My comments about Obamacare were simple, it worked for my two daughters who are free lancers.

[john beardsworth]

Politics, sex, and religion are highly personal and subjective topics. There's enough divisiveness to go around and then some. So, why not save it for the "rantitorial" section? As far as LuLa goes, doesn't that seem like the best place to editorialize and or argue?

Coffee corner: A forum for open discussion of both photographic and non-photographic topics of a general nature.
It is assumed (and required) that posters conduct themselves in a civil and adult manner.

Rantatorials: Discussions about Kevin & Michael's Rantatorials.

[Christopher Sanderson]

Coffee corner: ....
It is assumed (and required) that posters conduct themselves in a civil and adult manner.

Rantatorials: Discussions about Kevin & Michael's Rantatorials.

Correct indeed. Civil discussion on a topic such as this is encouraged - but generally frowned upon in other fora here.

[Rob C]

Reading the premiums you guys pay for health insurance in the USA makes me think that either you all earn millions, or some sectors are being severely overpaid!

It's nothing like as high as that in Spain - not enough folks could afford it to make it a viable business - and the private services are excellent. As are the state ones, once you get into a hospital. The problem is a shortage of staff doing early tests etc. which results in long waiting times for a first visit, and even a routine repeat one. But if they ambulance you in, you are in fairly good hands.

Best staying healthy!

Frankly, I am in favour of a better tax revenue distribution scheme than seems prevalent. Car-tax money should be spent on roads, and health should have a clear label on it when the tax for it is being raised. In the UK the national health system is a bit of a holy cow - and I understand that. People would be far more inclined to go along with higher taxation to fund it if they were convinced the money raised would go where it was supposed to be going, and not vanish funding all manner of hairbrained political exercises in vote-catching. A national health system is a wonderful thing which grants every citizen the right to survival in the face of health disasters, a right not dependent on how much money you can make.

I don't think any marriage between state and private medicine will ever be 'fair': the private part is obliged to make as much money as it possibly can - it's in the nature of business to have to do that; there is no other choice for it if it is to prosper and survive. I simply feel that some things just deserve to be out of the profit sphere of influence.

Rob

[Craig Lamson]

But you are seeing the exact same thing happening with corporate plans as well as Medicare.  $2K a month seems to be a lot to pay but maybe because of the geographical region you live in that's the way it is.  You have to remember that regardless of Obamacare lots of insurers are restricting the regions they underwrite in.  My daughter was covered by Aetna when she lived in Philadelphia but was not covered when she moved to Oakland in September because Aetna doesn't write individual policies there.  She asked what she should do if she needed to see a doctor and Aetna said to go to the ER as that was all Aetna would cover.  Great money saving advice.  She had a month transition before she was eligible for Kaiser Permanente.

Wait until you go on Medicare and you will see the same thing happening.  I'm looking for a new internist and two practices I called are not accepting Medicare patients.  I told them I had excellent secondary coverage through our local BlueCross company but that did not matter.  also, don't think Medicare is free.  My wife and I will be paying about $13K this coming year for Medicare and our secondary insurance.  It's a little on the low side as I have a discount as the secondary policy is provided by my former employer as a retirement benefit.  Fortunately, we have investment income that lives us financially in good shape.  I cannot figure out how anyone who relies only on Social Security can live.

My comments about Obamacare were simple, it worked for my two daughters who are free lancers.

Yet you failed to answer the very simple question I asked.  Do your daughters get government assistance with the cost of their insurance?

Prices are raising among all insurers due the restrictions required by Obamacare.  For example I am forced to pay for pregnancy coverage even though we will never use it.  I must pay for colonoscopy coverage that I will never be able to use.  (Trust me on that one, it's impossible). Children's dental and vision...never use those.  Drug abuse rehab.  Nope.  Keep 26 year old children on my policy, nope.  There is more.  I am not alone. 

http://www.cnsnews.com/news/article/susan-jones/rand-paul-were-going-legalize-sale-inexpensive-insurance

[Craig Lamson]

Reading the premiums you guys pay for health insurance in the USA makes me think that either you all earn millions, or some sectors are being severely overpaid!

It's nothing like as high as that in Spain - not enough folks could afford it to make it a viable business - and the private services are excellent. As are the state ones, once you get into a hospital. The problem is a shortage of staff doing early tests etc. which results in long waiting times for a first visit, and even a routine repeat one. But if they ambulance you in, you are in fairly good hands.

Best staying healthy!

Frankly, I am in favour of a better tax revenue distribution scheme than seems prevalent. Car-tax money should be spent on roads, and health should have a clear label on it when the tax for it is being raised. In the UK the national health system is a bit of a holy cow - and I understand that. People would be far more inclined to go along with higher taxation to fund it if they were convinced the money raised would go where it was supposed to be going, and not vanish funding all manner of hairbrained political exercises in vote-catching. A national health system is a wonderful thing which grants every citizen the right to survival in the face of health disasters, a right not dependent on how much money you can make.

I don't think any marriage between state and private medicine will ever be 'fair': the private part is obliged to make as much money as it possibly can - it's in the nature of business to have to do that; there is no other choice for it if it is to prosper and survive. I simply feel that some things just deserve to be out of the profit sphere of influence.

Rob

I don't make millions and I'm not overpaid, but this is just one of the costs of being self employed.  Back when I left a corporate job in 1999 and my wife left hers to work with me, our heath insurance costs were $300 a month.  By the time Obamacare started we were at $1200 a month.  Now it's 2k and the deductibles have gone from $1000 to $5300.  Even worse its no longer 80/20 but 60/40.   

[Alan Goldhammer]

Yet you failed to answer the very simple question I asked.  Do your daughters get government assistance with the cost of their insurance?

Prices are raising among all insurers due the restrictions required by Obamacare.  For example I am forced to pay for pregnancy coverage even though we will never use it.  I must pay for colonoscopy coverage that I will never be able to use.  (Trust me on that one, it's impossible). Children's dental and vision...never use those.  Drug abuse rehab.  Nope.  Keep 26 year old children on my policy, nope.  There is more.  I am not alone. 

http://www.cnsnews.com/news/article/susan-jones/rand-paul-were-going-legalize-sale-inexpensive-insurance

Neither daughter received any subsidy to purchase their policy.  Yes, you are not alone regarding some of the things you write about.  However, do you want to return to the old days where everything was risk based, pre-existing conditions were the rule of the day, and women paid more than men for health insurance.  That's fine, let's go back to medical underwriting and you will soon see people who can't get stuff covered or they have to pay very high premiums.  BTW, pregnancy coverage is a drop in the bucket.  the only time things add up is if the baby is born premature and in those cases costs can be very high (I know from experience).  Colonoscopies also are pretty inexpensive these days.  Big cost drivers for insurance are Rx drug and complicated care the last two or three years of life.

[Craig Lamson]

Neither daughter received any subsidy to purchase their policy.  Yes, you are not alone regarding some of the things you write about.  However, do you want to return to the old days where everything was risk based, pre-existing conditions were the rule of the day, and women paid more than men for health insurance.  That's fine, let's go back to medical underwriting and you will soon see people who can't get stuff covered or they have to pay very high premiums.  BTW, pregnancy coverage is a drop in the bucket.  the only time things add up is if the baby is born premature and in those cases costs can be very high (I know from experience).  Colonoscopies also are pretty inexpensive these days.  Big cost drivers for insurance are Rx drug and complicated care the last two or three years of life.

Thank you.  And yes I would gladly go backwards.  What we have now is not working.

[Alan Goldhammer]

Thank you.  And yes I would gladly go backwards.  What we have now is not working.

When I was still working in the pharmaceutical industry I was tracking the whole healthcare reform issue (started doing so in about 1990 when Dr. Paul Ellwood convened the first Jackson Hole meeting).  I was not a fan of Obamacare as it really is a Kludge to try to make something work for the widest number of people.  We currently have a very inequitable healthcare system where those who have nice employer-based insurance do well at the expense of everyone else.  As I noted in an earlier post, even Medicare is not perfect. You have a 20% co-pay on doctor visits and can be on the hook if the doctor charges more than Medicare reimburses.  Rx drugs cost more than they should and so on.

My belief is that we need some form of national health insurance that covers every one.  I don't particularly care if it is run by the government the way Medicare is or if it relies on the private insurance market with vouchers to everyone for the purchase of insurance.  the status quo continues to be unacceptable.

[Rob C]

I don't make millions and I'm not overpaid, but this is just one of the costs of being self employed.  Back when I left a corporate job in 1999 and my wife left hers to work with me, our heath insurance costs were $300 a month.  By the time Obamacare started we were at $1200 a month.  Now it's 2k and the deductibles have gone from $1000 to $5300.  Even worse its no longer 80/20 but 60/40.

I'm not suggesting that you are overpaid - I have no idea what you earn; what I'm suggesting is that somebody down the line is making a helluva lot of money out of health insurance, or they wouldn't be in the business. Seems to me that there's a huge moral issue here going unfaced. Maybe Mr Trump really will cut some of the fat there, as well as with Messrs Boeing.

The whole issue about percentages is a weakness in the system: you shouldn't have to pay any part of it directly; those sorts of expenses are far better paid as part of income tax, as they are under a state system. The Brit concept of 'free at point of delivery' doesn't suggest nobody pays anything at all: it's not magic money - taxation provides it. It's spread over everybody, and everybody is entitled to its benefits. The guys making money out of illness and misfortune are the insurance guys and the medics. But at least the medics spend years of their lives learning and doing something for humanity; in my view, medical insurance companies just suck the easy blood. Yes, I got help out of mine, at high annual monetary cost, but I only went with them because at the time I took it up (a policy) a state system wasn't available to me. With Brexit, God knows where I'm gonna find myself in that area at the end of the negotiations. Myself, and many millions more. Interesting times.

Rob

[jeremyrh]

With Brexit, God knows where I'm gonna find myself in that area at the end of the negotiations. Myself, and many millions more. Interesting times.

Rob

I suspect that, like me, you will end up as collateral damage in our countrymen's xenophobic impulse to blame the forriners for their plight.

[DeanChriss]

...
My belief is that we need some form of national health insurance that covers every one.  I don't particularly care if it is run by the government the way Medicare is or if it relies on the private insurance market with vouchers to everyone for the purchase of insurance.  the status quo continues to be unacceptable.

Absolutely.

[Rob C]

Absolutely.

I think you really have to remove the private insurance element from the public sphere. The twain cannot function in harmony because the private will always seek all ways by which to drive up costs and exploit the situation to profit. It's its raison d'être.

Beyond medicine, I would expand that public ownership to transport and to the provision of electricity and gas. The single factor that stops me ever voting for the left, however, is the certainty in my head that the moment such a well-intentioned grand plan were implemented, these unions that exist within those sectors would flex their muscle for political objectives and reduce everything to greater chaos than we see at present. In other words, the objective is noble but the implementation releases the devil in man. Again, it would be people who destroy the greater good. I stretch my faith to exclude the medical profession from that, though recent UK actions do slightly undermine my faith...

Rob

P.S.

An example of what happens when business and medicine mingle:

http://www.heraldscotland.com/news/15040143.Hospitals_pay_more_than___1500_a_shift_to_some_agency_nurses/?ref=ebln

[Craig Lamson]

Absolutely.

The government makes a mess of everything.  No thanks.  Take a look at the pile of I.O.U's in a filing cabinet in Ohio that is what's left of the Social Security fund. 

More open commerce, not less is the answer. 

[Rob C]

The government makes a mess of everything.  No thanks.  Take a look at the pile of I.O.U's in a filing cabinet in Ohio that is what's left of the Social Security fund. 

More open commerce, not less is the answer.

Commerce is great; health is not commerce. Bad management is bad management, it happens in all walks of enterprise.

No idea how it was done in Ohio, but on anything but a truly national level and scale, it's never going to work: the first problem is health tourism, state to state. It's already a well-established problem within the European arrangement, but should/could have been avoided by obvious limits of applicability.

In the UK the huge problems in public health funding exist because of the nebulous manner in which funding is allocated; as with roads - another troubled area of spending - there should be clear sources from whence will come funding. Education is another service plagued by funding mystery. Hiding and throwing all tax revenues into a communal pot prevents the public appreciating (and knowing) where their money goes; shown that it goes to health, when raised for that specific purpose, would, I'm sure, encourage a lot of people to accept a reasonable charge via their taxation levels. It's when taxpayers suspect that their money goes to finance absurd projects, that are of no purpose other than to encourage votes from strident minority groups next time around, that resentment begins and essential services become deprived of resources better spent on those essentials that do not include the arts, minority language public broadcasting, etc. etc.  If the time comes when the nation has too much money, then think about the peripherals of life, the entertainments, the ego-trippers.

Transparency of spending, of the raising of what for use where, will either silence those who suspect the worst of governments or create a society where the public really, and democratically, can determine the direction of its future well-being.

Basic life-support comes first.

Rob

[Craig Lamson]

Commerce is great; health is not commerce. Bad management is bad management, it happens in all walks of enterprise.

No idea how it was done in Ohio, but on anything but a truly national level and scale, it's never going to work: the first problem is health tourism, state to state. It's already a well-established problem within the European arrangement, but should/could have been avoided by obvious limits of applicability.

In the UK the huge problems in public health funding exist because of the nebulous manner in which funding is allocated; as with roads - another troubled area of spending - there should be clear sources from whence will come funding. Education is another service plagued by funding mystery. Hiding and throwing all tax revenues into a communal pot prevents the public appreciating (and knowing) where their money goes; shown that it goes to health, when raised for that specific purpose, would, I'm sure, encourage a lot of people to accept a reasonable charge via their taxation levels. It's when taxpayers suspect that their money goes to finance absurd projects, that are of no purpose other than to encourage votes from strident minority groups next time around, that resentment begins and essential services become deprived of resources better spent on those essentials that do not include the arts, minority language public broadcasting, etc. etc.  If the time comes when the nation has too much money, then think about the peripherals of life, the entertainments, the ego-trippers.

Transparency of spending, of the raising of what for use where, will either silence those who suspect the worst of governments or create a society where the public really, and democratically, can determine the direction of its future well-being.

Basic life-support comes first.

Rob

I know you are not an American so some of this is confusing.  Social Security, simply put i the government run retirement we are all requried to fund via income taxes ( its actuall FICA tax but that even add more co9nfusion)   The problem is tha tover the decades, GOVERNMENT has raided this fund and used the money for other things, leaivng behind a huge pile of IOU's in that filing cabinet in Ohio.  Now we are using borrowed money instead and the system is broke.  Medicare, our grovenment run insurance for Seniors ( again that we have paid for via those FICA taxes) is not in any better shape. To add insult to injury many DR's will not accept patients who have medicare coverage.  The goverment screws everything up.

And Healthcare really is commerce.  Dr's build a practice and are right to expect a profit for the time and money spent learning their trade and building their practice.  Hospitals are right to expect a profit atfer speand vast sums of mony creating the facitity, outfitting it, staffing it and maintaining it. all to provide a very valuable service to people who need it.  Drug companoes are als entitled to a profit, for the products they produce.   There is a trend in the US for medical facilities that operate on a cash only basis, no insurance will be taken.  They list the price of their services openly, so the consummer can tell upfront what his care will cost.  The point here is a that this is commerce.  The consummer gets to choose.  And in many cases gie teh very high deductabke that need to be met before an insurance company pays, it is often a far better deal for the consumer for many procedures.

I'm not a big fan of the government being involved in this part of my life.  And I would like more market driven choices.  Your mileage may vary.

[Bart_van_der_Wolf]

And Healthcare really is commerce.

And that's the root of your problem in a nutshell.

Cheers,
Bart

[Craig Lamson]

And that's the root of your problem in a nutshell.

Cheers,
Bart

No Bart. that will be the salvation when true commerce is in place.

[DeanChriss]

...the private will always seek all ways by which to drive up costs and exploit the situation to profit. It's its raison d'être.

I have to agree. For-profit health insurance has a built-in conflict of interest. It's all about maximizing profit and minimizing loss so there is a very strong incentive to deny claims and provide the cheapest possible treatments. That's in direct conflict with maximizing patient care and good outcomes.

[JoeKitchen]

I have to agree. For-profit health insurance has a built-in conflict of interest. It's all about maximizing profit and minimizing loss so there is a very strong incentive to deny claims and provide the cheapest possible treatments. That's in direct conflict with maximizing patient care and good outcomes.

I was recently in Cuba, and something that struck me is many of the buildings are crumbling and collapsing.  When it comes down to it, the real reason is self policing never works. 

You see, they built the rain gutters within the walls of the buildings directly connecting to the sewers.  Aesthetically very nice, unless you don't perform regular maintenance, then they get clogged, crack, water seeps into the wall, erosion takes over and so on. 

Since the government took over in 59, no real maintenance has taken place, no self policing is happening and now a new building collapses every 3 or 4 months. 

Regardless if a private industry says it can self police or if the government takes over and says it can self-police, you should be worried. 

This is the same reason why the recent NYC free-lancers law made me laugh.  Essentially, now, if you bill a client in NYC and they don't pay within 30 days, you can sue them for it along with reasonable legal fees.  First off, if you conducted business properly, you would not run into situation enough for it to matter.  Second, I did a project for the city and it took over 90 days to get paid; does this law not apply to them? 

Anyway, if government takes over health care, we will need to rely on self policing by the government on the government.  I can't say this will lead to problems, but history surely suggests it would. 

Having a private industry being policed by government always seems to be the better alternative.  It's just a question of how intense should the policing be.