Health Insurance Discussion

[momisery]

I will not blame peop;le for having what I would like to have, Lindsay. We all need affordable healthcare, and good paying jobs. Perhaps the good paying jobs would allow us to shop for healthcare on our own and that would make it more affordable? But you simply can not take peoples company pensions and healthcare away or make it cost more drop their incomes and then suddenly decide they can pay for their healthcare costs too... Totally dumb to think our nation could work that way. We will all be in the poor house if all we can afford to buy is healthcare and save for retirement. What would we all need to work for since no one would be buying anything? So, Lindsay, I am glad you have coverage!

[lindsay2181]

I'm not completely understanding your post....I didn't state anything to do with the recent healthcare reform issues. Just posted about my own personal experience with insurance.

[OhioFiler]

I will not blame peop;le for having what I would like to have, Lindsay. We all need affordable healthcare, and good paying jobs. Perhaps the good paying jobs would allow us to shop for healthcare on our own and that would make it more affordable? But you simply can not take peoples company pensions and healthcare away or make it cost more drop their incomes and then suddenly decide they can pay for their healthcare costs too... Totally dumb to think our nation could work that way. We will all be in the poor house if all we can afford to buy is healthcare and save for retirement. What would we all need to work for since no one would be buying anything? So, Lindsay, I am glad you have coverage!

Nanny states always fail.

If you don't like your lot in life, change it. Why is it the responsibility of the taxpayers to ensure you have everything you want?

[TooMuchCredit]

Nanny states always fail.

Which ones have failed? Specific examples please :-)

I think there has to be a balance. Pure capitalism is bad as is pure socialism. Adding universal healthcare - be it government run or not will not turn us into a complete socialist society. European countries, Japan, Australia, all have large and healthy free markets.

I don't necessarily think universal healthcare is in the same "nanny state" category as welfare, unemployment, and social security/gov't pension benefits. It's more of a moral/humanitarian service.

[momisery]

If I don't like my lot??? Really??? There is nothing wrong with my lot except there are no jobs for people and no way to pay for healthcare. What should we do to exactly here die? Big business allowed this to get out of control and now they want to toss it back on our laps, and we have no control at all. Business could have negotiated, but they decided not too. Nanny states? Really? I think we have bailed out businesses and continue to give them TAX breaks to ship jobs overseas. So, your idea to fix this is?????

[JRScott]

Which ones have failed? Specific examples please :-)

I think there has to be a balance. Pure capitalism is bad as is pure socialism. Adding universal healthcare - be it government run or not will not turn us into a complete socialist society. European countries, Japan, Australia, all have large and healthy free markets.

I don't necessarily think universal healthcare is in the same "nanny state" category as welfare, unemployment, and social security/gov't pension benefits. It's more of a moral/humanitarian service.

Pretty soon all of them, but the most recent major failure would be the Union of Soviet Socialist Republic......last I checked its not on the map anymore .

However the debt to GDP of all western countries is approaching dangerous levels, not just the United States. We aren't really to far from an 1870s style global economic collapse. (That was worse than the Great Depression for those that don't study history). The problem is everyone of the western countries have for years promised goods and services and not set aside sufficient monies to cover them, as such each has tremendous unfunded liabilities that they can never meet which means at some point services will have to be cut due to lack of funding when finally someone turns the pipe off. Take the United States for instance. If you took the federal unfunded liabilities they total 106 trillion dollars right now, all private and business assets in the United States current are only 74 trillion dollars. Its a hole you can never recover from yet politicians want to pass even more such liabilities. This doesn't even include the states, local, personal and corporate debt.

[TooMuchCredit]

Pretty soon all of them, but the most recent major failure would be the Union of Soviet Socialist Republic......last I checked its not on the map anymore .

The USSR was a COMMUNIST state. Big difference. A Socialist state is not necessarily the same. You actually can have a Socialist Democracy - and more than in name only - Communist countries liked to put "Democratic" in their names. And even the extreme of adopting government run single payer health care would not equate us with the USSR. The UK has single payer, yet they are far from being equated with the USSR.

However the debt to GDP of all western countries is approaching dangerous levels, not just the United States. We aren't really to far from an 1870s style global economic collapse. (That was worse than the Great Depression for those that don't study history). The problem is everyone of the western countries have for years promised goods and services and not set aside sufficient monies to cover them, as such each has tremendous unfunded liabilities that they can never meet which means at some point services will have to be cut due to lack of funding when finally someone turns the pipe off. Take the United States for instance. If you took the federal unfunded liabilities they total 106 trillion dollars right now, all private and business assets in the United States current are only 74 trillion dollars. Its a hole you can never recover from yet politicians want to pass even more such liabilities. This doesn't even include the states, local, personal and corporate debt.

Yes, the debt load is a problem, but according to the argument, we aren't socialist now, and we're in the debt hole too like the others we are labeling socialist.

If we are paying 50% more that other countries that cover everyone, we should be able to rework the system so that we cover everyone here without any increase in costs.

[JRScott]

Communism by definition is a nanny state .

We are paying so much because of the lack of tort reform.

There are doctors, many of them that pay 1/3rd to 1/2 of their income just in medical malpractice insurance.

In addition they order tests that are not really needed to avoid lawsuits as a result of the sue happy public. They also avoid other drugs and treatments where a company might be in litigation even if the drug/treatment is more effective than other such lines.

Thus if you want real health care reform you have to have tort reform, without it you have a coat where someone stripped out the lining and you are in the middle of a snowstorm. Basically meant to make you feel better but you'll still freeze to death.

[WhatMoney]

Tort reform is the healthcare debate's frivolous sideshow

We are paying so much because of the lack of tort reform.

Tort reform is the healthcare debate's frivolous sideshow

Any issue featuring so many interest groups cantering about on hobbyhorses is an issue where the truth goes to die. So let's try a shot of reality.

Every circus needs a sideshow, which must be why every time the issue of rising medical costs gets debated, politicians start clamoring for "tort reform."

You know the argument: Disgruntled patients, goaded on by unscrupulous lawyers, file frivolous malpractice lawsuits and walk off with millions of dollars in undeserved awards granted by teary-eyed jurors. Doctors respond by practicing "defensive medicine," ordering lots of unnecessary tests to cover their behinds. Bingo! Medical costs hit the stratosphere.

Sen. Johnny Isakson (R-Ga.) boiled this view down to its essentials in a recent Republican weekly radio address, calling for the elimination of "frivolous lawsuits against doctors and hospitals."

Tort reform has lots of fans. The public's on board because it's easy to hate lawyers. Doctors and hospitals love it because they hate to get sued. Insurance companies love it because the less money they pay out to plaintiffs, the more they get to keep. Republicans love it because trial lawyers give three-quarters of their political donations to Democrats. And Democrats pay it lip service because they're afraid to look like lawyer lovers.

Any issue featuring so many interest groups cantering about on hobbyhorses is an issue where the truth goes to die. So let's try to resuscitate the patient with a shot of reality.

First: "Frivolous" litigation. Lawyers define frivolous lawsuits as those that, from first to last, don't have a leg to stand on. Just because a lawsuit ends up a loser doesn't mean it's frivolous.

That's especially true of malpractice cases, which can bristle with complexity. Often the only way to know if an injury resulted from professional error is to use a lawsuit to pry loose the facts.

"It can be hard to tell until late in the litigation if there's really no claim," Michelle Mello, an expert on malpractice at Harvard's School of Public Health, told me. An extensive study she helped conduct of malpractice case files showed that frivolous cases, as usually defined, are rare -- and those that do get brought usually don't yield a payment to the plaintiff.

The obverse is a bigger problem -- injury cases where the victim doesn't get a dime. These often involve lower-income or unemployed patients, says David M. Studdert, Mello's research partner, now at the University of Melbourne, Australia.

The truth is that medical liability isn't a big driver of health costs overall. Studdert estimates the cost of malpractice litigation, in court and through defensive medicine, at roughly 2% to 3% of all U.S. healthcare spending -- in other words, no more than $50 billion out of a total annual bill of $1.7 trillion. (You'll hear estimates as high as $200 billion from outfits like the American Medical Assn., which is the antithesis of an objective source.)

It's fair to say that some reform is needed in our tort system. The trick is to make sure that the benefits of any changes go to the right people -- the patients. That hasn't been the result of the preferred remedy for malpractice lawsuits, which is to hit trial lawyers in the pocketbook. Cap their fees or jury awards (of which they customarily take a percentage), the theory goes, and they'll knock off the ambulance-chasing.

This model of tort reform comes, alas, from California. In 1975, a sharp run-up in doctors' premiums stampeded the Legislature into enacting draconian limits on malpractice cases. Under the Medical Injury Compensation Reform Act, or MICRA, noneconomic damages -- that's "pain and suffering" -- were capped at $250,000. Lawyers' fees were also limited. Many other states followed with similar laws.

Who got helped by MICRA? Not consumers. California's healthcare costs aren't measurably lower than other states'. In fact, they're measurably higher.

Not the victims of medical error, at least not fairly: A Rand Corp. study in 2004 found that the cap fell disproportionately on "those with small economic losses but great damage to the plaintiff's quality of life."

Women were big losers, possibly because their claims often result from obstetrics and gynecology procedures that affect fertility or sexual lifestyle, conditions which aren't amenable to economic analysis. Such patients find it hard to even bring cases, for lawyers know the long odds of winning a judgment big enough to cover costs.

Doctors and hospitals? Premiums in California continued to rise sharply for 10 years after MICRA. Rates finally plateaued in the late '80s, but the reason may have been 1988's Proposition 103, which rolled back casualty insurance rates.

By the way, the MICRA cap isn't indexed to inflation. So even if $250,000 was the right limit in 1975, it's the equivalent of only about $62,000 now.

MICRA's big winners are insurers. The average loss ratio for California malpractice carriers last year -- the portion of their premiums they paid out or reserved for claims -- was 16.43%, according to the state Department of Insurance. In other words, they paid out less than 17 cents of every dollar they took in.

How great a business is malpractice insurance nationwide? At American Physicians Capital (an insurer active in the Midwest), claims were falling so fast in 2007 that its chief executive publicly compared his underemployed claims managers to "the Maytag repairman." The next time you find yourself nodding in assent while some politician carries on about tort reform, remember that its benefits will go to characters like this.

That doesn't mean that no changes are needed, only that there are many ways to counter defensive medicine and the costs and inequities of the U.S. litigation system without shutting the courtroom door to malpractice cases.

Clearer professional guidelines for diagnostic imaging would give doctors legal cover for skipping an MRI or CAT scan that isn't clinically indicated. Creating special courts or appointing judges to specialize in malpractice cases would help deserving victims get compensated without the grotesque overhead of full-scale trials. So would a "no-fault" system to compensate those with medical injuries regardless of their source, paired with an objective process for disciplining error-prone doctors or hospitals.

Some of these options are being tried around the country, and are promising. But none of them has the pizazz of railing about lawyers and "frivolous" lawsuits.

October 01, 2009 MICHAEL HILTZIK Copyright 2009 Los Angeles Times
http://articles.latimes.com/2009/oct...ss/fi-hiltzik1

[justbroke]

Alas, an RCA (root cause analysis) will show that the root cause of a problem, is usually a "small percentage" of the snowball effect it causes. You can quote me on that.

[momisery]

Tort reform does not help. Missouri has it and our healthcare is expensive. There is an area in Texas that passed it two years ago and healthcare costs have skyrocketed. Court fees are a small fraction. The CEO of healthnet makes 122,000.00 PER DAY and that is based on a 365 day year, not the actual days he works. I would say the real reason our care is up is right there, salaries of CEO's.

[justbroke]

Then what's the cause of skyrocketing healthcare costs? I think it's a combination of things. I think you have to look at all those causes and deal with each one. I don't think it's tort reform alone, but everything from billing to tort reform. We use more designer drugs... ahem... pharmaceutical drugs than I care to even mention. Please I just want honesty on where the cost problems are. I don't think my Doctor's problem is un-collectability. Most medical offices now expect payment before service is rendered! They check your insurance first in my dentist's office, and demand as much as $500 down-payment for any restorative/cosmetic care done! They are very happy to get a "medical" line of credit for you, while you wait. So, all the costs can't be from lack of paying or lack of insurance.

Billing, Third Party "anything" (all "insurance" as third party "payers"), Education Expenses (Loan Payoffs), Private Medical Clinics, Niche Medical Practices, Pharmaceuticals, Torts... Xanax (just because I need something at the end of the alphabet). Someone explain to me why an anesthesiologist needs to make $300K a year? Explain to me why my doctor, for an office visit to refill prescriptions and just take my BP and temperature, charges my insurance $90, only to get $36 as the "negotiated" price? I think I was in the office for 10 minutes, and saw the "physician assistant" for 2 minutes.

I really don't care anymore, to tell you the truth. I pay $627/month for my plan for a family of 4. It's a very good plan. Routine office visits are included. Labs, X-rays, testing are all included. Specialist is a co-pay of 20%. It's still expensive at $7,524/year. Dental covers almost everything and prescription drugs via mail-in are usually 90-day supply for less than $5 on all my medications. Alas, do I use $7,524/year in services? No. But, if I need it... it's there.

We purchase insurance in case something happens. If something doesn't happen... shouldn't we get our money back?

[momisery]

Mine plan costs 250.00 per month and it will go up this year. It has a deducatable of 1100 and total out of pocket 10500 this year I think, and least I am close. My drug plan is a joke medco, mail order. At the end of the year that is a lot out of my pocket with hubby laid off. And if you have to use it it really is expensive.

I think we have to take the middle man back out of it. We can't afford to pay insurance companies executive salaries. And education needs to be cheaper and we need to get the AMA to offer more schools to cut the incomes on doctors too. Sorry, that may make some angry, but everyone else has their wages cut in todays world. We have too many lawyers that don't seem to see the black and white right and wrong that needs to change.

I work in banking with high income people and a good number are DRS. Here in my LITTLE town one guy makes 900,000 per year. Another one makes a salary of 450,000 with 300,000 in bonus... and our wages her are at 29,000 when the median average is 41000. Meaning that they want the world even when they can live cheap, open up offices cheap, and we have tort reform in MO.

My father lost his first wife in child birth. He worked in a factory at the time and managed to pay that bill off, pay for the funeral, raise 7 kids, marry a new wife and saved up to buy a farm in 5 years tops on factory wages. We bought a new car every three years and we had things my grand parents did not have just as the grand parents had things their grandparents didn't have. So, the rant about cells phones, computers, and cable tv seems silly to me. We always have more that is the American way. Per the labor dept our wages on the working class have been falling in purchasing power since the early sixties. And I believe that is a fact since we pay for homes, cars, and belongings now on credit for longer terms all the time. We have not noticed how much of our income has disapeared because we had credit. So, where did it go? My own feelings are that higher income people are making much more. for example, and this is document that a CEO use to make 41 times more than we do, now it is 480 times more.. so our lost incomes went to them. The stock market is no longer about investing it is about beting on performance and that has cost us, the working class in higher energy prices.
We can fix it, but doing it without going public option will result in a lot of people doing without healthcare and they will die sooner that way. I don't know how we can get those people at the top to see that the current system does not work because we can't afford it. And if we have to pay more and more for healthcare other purchases can not be made which will cripple our economy. Our economy, like it or not, if 67% driven by people being consumers. If we stop buying everything will slow down. I think if you paid people that get out there and work and allow them to spend that money they will bargin, but they can't afford itr at the current costs of healthcare. It is a sort of box canyon..

[JRScott]

Tort reform does not help. Missouri has it and our healthcare is expensive. There is an area in Texas that passed it two years ago and healthcare costs have skyrocketed. Court fees are a small fraction. The CEO of healthnet makes 122,000.00 PER DAY and that is based on a 365 day year, not the actual days he works. I would say the real reason our care is up is right there, salaries of CEO's.

[nc73]

Just copy the UK NHS and all will be solved. I work for the National Health Service and I think it can work in the states. I'm just really pissed that once I move back in the next 2 months I will be without insurance until I find work.