Republicans and democrats don't understand each other

[Jeremy Roussak]

Self insurance is different as there is not an underwriting profit involved.   In your example the insurer makes a profit on your premium.  In our case we eliminate that profit along with some over head.   We design a plan that does not turn a profit but maintains a reserve to assure a break even point.  It is just a different approach,

What nonsense. Are you seriously suggesting that your insurer (for losses above your self-selected excess of $250k) makes no profit from the premium you pay?

Jeremy

[Jeremy Roussak]

Jeremy, in spite of the long post, you remain fundamentally wrong.

Mere assertion is inadequate, Slobodan. Explain why you have formed that view.

Jeremy

[Rob C]

This is simply not true.

Robert, it doesn't have to be. It comes as part of the catechism and mindset. If you have ever had a religious discussion with somebody totally subscibed to any of the regular faiths you get the same revelation: no matter what awkward points you raise they will be ignored or countered by the reddest of herrings.

Regarding the Brexit debacle: various times the reasons for and against, and problems associated with it have been written out and can be referrenced, but different versions of the same questions keep getting asked, repeatedly. If it tells me anything, it's that it's become a waste of time and energy trying to answer, because nothing gets taken onboard and digested - if it is even scanned.

Life is just too short for talking to oneself.

[Martin Kristiansen]

Two sets of robber barons. Or two sets of warlords. Or two tribal chiefs. Or two medieval kings. Or two opposing groups of financial elites and out come the peasants with their pitch forks prepared to defend their particular psychopath to the death.

 Some things are apparently eternal.

[Rob C]

Two sets of robber barons. Or two sets of warlords. Or two tribal chiefs. Or two medieval kings. Or two opposing groups of financial elites and out come the peasants with their pitch forks prepared to defend their particular psychopath to the death.

 Some things are apparently eternal.

And probably because they had little choice. Refusal to fight for the head honcho meant slow death and the inevitable forfeiture of female family members and animals, were you lucky enough to own a goat.

These days, it's a tad more subtle, but the payment for votes still comes through the "promises" rather than in the fulfillment.

[Alan Goldhammer]

I already see it here in America.  Since I retired and now have Medicare.  Medicare is our government provided  health insurance if you're over 65 and no longer work or have private insurance.   There are many doctors of higher quality and experience that I cannot use because they do not accept Medicare.  They've opted out.  So because I can no longer afford to pay them out of pocket, I cannot use them. I must use other more inferior doctors that accept Medicare. If I was still younger, I would have private health insurance that would still cover these doctors.

This is absolutely not true.  My internist has never accepted private insurance and one is only guaranteed full coverage if the doctor is in the particular plan.  If you go outside the plan you have increased co-pays or could even be responsible for the full amount.  We experienced this some years ago when my wife had emergency gall bladder surgery.  The hospital assigned a doctor who was out of plan and we were not paying close enough attention.  We were on the hook for the full surgical fee!!!

[Alan Goldhammer]

What nonsense. Are you seriously suggesting that your insurer (for losses above your self-selected excess of $250k) makes no profit from the premium you pay?

Jeremy

Both of us seem to be dancing on the head of our respective pins.  The model that I described is one of controlling up front costs and eliminating of the profit of the primary underwriter as I already described.  That you seem not to grasp this concept is your problem.  Of course the reinsurer that covers the stop loss has a profit built in and that premium might be readjusted from year to year depending on claims that are filed.  We still have significant savings in this model compared to one that would contract directly with the primary insurer for full coverage.  You are entitled to not like this explanation but the animus is better parked by the side of the road.

[RSL]

Shame on you, Jeremy, for not grasping the concept. 

[Alan Klein]

Alan, I have given you the information necessary for you to form a view on the case which was the subject of your original comment. You have plainly not bothered to read the judgments. Quoting an incorrect view, which misrepresents the facts, does nothing to advance your argument.

The quoted text is simply wrong, yes. As I have clearly indicated, and as is obvious to anyone who is prepared to depart from preconceptions and educate himself on the detail, the case had nothing to do with the state taking a view on life, which you persist in confusing with medical opinion. The "state"'s involvement was simply to adjudicate, by a means long-established, between the views of the medical profession and those of the parents. The first emphasised sentence above displays a complete lack of understanding of the issues, which can have been acquired only because the author, like you, has not troubled to acquaint himself with the actual facts but, again like you, is using the case to advance his prejudice against what he perceives as "socialised medicine". It is wrong. Not arguably wrong, or possibly wrong; just wrong.

The answer to your question, which I have emphasised above, is quite simply yes. If you blind yourself to the facts, the opinions you derive from them are worse than worthless; they are harmful.

Jeremy

Jeremy, I don't live in GB.  So I'm not familiar with the day-to-day issues regarding this case.   I'm taking the article as telling the truth.  But even if there are untruths in it does not change the fact that government control of our medical care can hurt our rights to make free choices about that care.  Obama lied when he said Obamacare would not cause you to change your doctors.  In the end, a single payer system must make choices since there is not an ever supply of funding to pay for everything.  So government's choices may not comport with the individual's choice so they have lost their freedom to decide.  If you have a disease, and the government says that because of your old age, the government will not fund care, you're screwed.  Unless you're very rich and can pay out of pocket or you can afford to fly to America for the care.  With private insurance, you have more options and more free choices. 

Look how Brexit is affecting national health care, a government controlled system.   Brits overseas, ex-pats, might lose health care once Brexit goes into effect.  Had there been private health care, individuals would still be able to decide what kind and how much care their insurance policies handles.   They lost their freedom to decide how to live by turning their lives over to the care of bureaucrats in government who care little about them.  I would rather keep important decisions about my life in my hands.  I just don't trust the government.  That extends to making end-of-life decisions.  When you go in for serious surgery in the US, the hospital asks you to sign or not sign a DNR (Do Not Resuscitate).  If you sign it, and you have major failure let's say of breathing or your heart during or after the procedure, the hospital will not take extraordinary measures to keep you alive.  They will let nature takes it's course.  If you don't sign it, they are obligated by law to take all measures to keep you alive even if you have to be put in a induced coma state.  There's no telling what government may decide once they take over fully.  That's what makes the British kid's story so important.  It represents a transfer of power to the state about our personal freedoms to make choices.

[Alan Klein]

This is absolutely not true.  My internist has never accepted private insurance and one is only guaranteed full coverage if the doctor is in the particular plan.  If you go outside the plan you have increased co-pays or could even be responsible for the full amount.  We experienced this some years ago when my wife had emergency gall bladder surgery.  The hospital assigned a doctor who was out of plan and we were not paying close enough attention.  We were on the hook for the full surgical fee!!!

I'm sorry you got caught paying the fee.  It happened to me once under Medicare.  I used a doctor who had opted out. I had to pay his entire fee.  Even my out-of-network plan refused to pick up any payments.  The rule is if your primary (Medicare in my case) does not pay anything, your secondary and tertiary private plans will not pay anything either.  So now the  the first question I ask before making an doctor's appointment or when I went in for surgery was, "Do you accept Medicare?"  I learned my lesson.

Before I got old and went on Medicare, my out-of-network private plans worked for me as follows.  If the doctor was in the primary plan, then the plan paid him fully (a lower amount that he agreed with to be in the plan).  I was only responsible for a small annual deductible.  However, if the doctor was out of network, this same private primary plan would pay him let's say 30% of his fee equal to what he would have gotten if he was in the plan.  However, my secondary plan would kick in and pay him 90% of the 70% balance.  In effect, I would be paying less than 10% out-of-pocket for out-of-network doctors. 

[faberryman]

So government's choices may not comport with the individual's choice so they have lost their freedom to decide.

Actually, the only thing you have lost is your ability to chose and to have someone else pay for it. Even private insurance will not pay for treatments and procedures it deems not medically necessary. Denials of coverage happen all the time. That's why hospitals won't do procedures without precertification from the insurance company that it will pay for it. No coverage, no money, no procedure, except in an emergency.

[Alan Goldhammer]

Before I got old and went on Medicare, my out-of-network private plans worked for me as follows.  If the doctor was in the primary plan, then the plan paid him fully (a lower amount that he agreed with to be in the plan).  I was only responsible for a small annual deductible.  However, if the doctor was out of network, this same private primary plan would pay him let's say 30% of his fee equal to what he would have gotten if he was in the plan.  However, my secondary plan would kick in and pay him 90% of the 70% balance.  In effect, I would be paying less than 10% out-of-pocket for out-of-network doctors.

If I read you correctly, you had two medical insurance plans when you were working?  This is pretty unusual; we only had one plan which my employer offered.  I know from my work with the non-profit that I previously described that out of plan doctor fees vary all over the place.  Some HMOs require you ONLY to use their doctors unless you are traveling outside the area that the HMO covers.

[Alan Goldhammer]

Actually, the only thing you have lost is your ability to chose and to have someone else pay for it. Even private insurance will not pay for treatments and procedures it deems not medically necessary. Denials of coverage happen all the time. That's why hospitals won't do expensive procedures without precertification from the insurance company that it will pay for it.

It's also common for both doctors and hospitals to require you to sign a document that you guarantee to pay the bill in the event coverage is denied.  I'm will to wager that most people do not understand what they are signing.

[Alan Klein]

Actually, the only thing you have lost is your ability to chose and to have someone else pay for it. Even private insurance will not pay for treatments and procedures it deems not medically necessary. Denials of coverage happen all the time. That's why hospitals won't do procedures without precertification from the insurance company that it will pay for it. No coverage, no money, no procedure, except in an emergency.

But with private plans, you get to choose.  It's like automobiles.  Not every car has all the safety features.  But you have a choice of which safety features you want by buying the car you want.  One of my cars has a backup camera; the other doesn't.  Once you go to a single payer government plan, you have no choices.  You get what the government provides - take it or leave it. 

[faberryman]

But with private plans, you get to choose.

No private insurance plan will pay for treatments and procedures which it deems not medically necessary.

[Alan Klein]

If I read you correctly, you had two medical insurance plans when you were working?  This is pretty unusual; we only had one plan which my employer offered.  I know from my work with the non-profit that I previously described that out of plan doctor fees vary all over the place.  Some HMOs require you ONLY to use their doctors unless you are traveling outside the area that the HMO covers.

Yes, I was very fortunate working my last job for the NYC government. 

[Alan Klein]

No private insurance plan will pay for treatments and procedures which it deems not medically necessary.

Not all cars provide all the safety feature either.  But you get to choose which car and safety features you want.  With government health care, there are no choices unless you're rich and can pay out-of-pocket. 

[Rob C]

All this incredible minefield of potential fiscal annihilation, and you still turn the collective nose up at the very idea of a national, free-at-point-of-use service! I never would have imagined that dogma and the painful effects of it could still stand between you and the simple solution: a little social sense of collective responsibility and something for the common good.

But no, government is out to destroy you. Government is so dumb that it doesn't understand that when it destroys you it has destroyed itself. Heysoos, your pool of possible politician candidates must be even worse -  and even more thick - than ours! Who would have imagined that possible? But isn't there something written on those stone tablets to the effect that you ultimately get what you deserve?
 
Just watched ex-PM John Major in a good interview on, broadly, the next Tory PM and Brexit. At last a man who can tell it like it is - even if it is only because, as he says, he is out of politics. What a shame Alan didn't get a chance to hear him - not that I expect it would have helped him much. But anyway, as Major said, in a choice between party or country, country must come first. That would never translate, dear me no!

A shame so many good people have become so disenchanted with party and, in some cases, country.

[faberryman]

But with private plans, you get to choose.

Assuming you have a choice and can afford to pay the premiums for the insurance plan you choose.

[JoeKitchen]

All this incredible minefield of potential fiscal annihilation, and you still turn the collective nose up at the very idea of a national, free-at-point-of-use service! I never would have imagined that dogma and the painful effects of it could still stand between you and the simple solution: a little social sense of collective responsibility and something for the common good.

But no, government is out to destroy you. Government is so dumb that it doesn't understand that when it destroys you it has destroyed itself. Heysoos, your pool of possible politician candidates must be even worse -  and even more thick - than ours! Who would have imagined that possible? But isn't there something written on those stone tablets to the effect that you ultimately get what you deserve?
 
Just watched ex-PM John Major in a good interview on, broadly, the next Tory PM and Brexit. At last a man who can tell it like it is - even if it is only because, as he says, he is out of politics. What a shame Alan didn't get a chance to hear him - not that I expect it would have helped him much. But anyway, as Major said, in a choice between party or country, country must come first. That would never translate, dear me no!

A shame so many good people have become so disenchanted with party and, in some cases, country.