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  #1  
Old 09-19-2008, 10:37 PM
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Default Health Care

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Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.
John McCain - this month's edition of http://www.contingencies.org/ - you can see a preview in pdf form at http://www.contingencies.org/septoct08/mccain.pdf
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  #2  
Old 09-19-2008, 10:42 PM
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Oh sweet Jesus....
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  #3  
Old 09-20-2008, 12:07 AM
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i admit i don't understand the health care system. i get coverage thru my employer, and they have 2 choices: a for-profit providor (Blue Cross) and a not-for-profit providor (Kaiser). i have insanely cheap coverage ($50/month for family), though it doubled from last year, and will double again the next two years. It's still less than what my brother pays for his coverage thru his employer (over $400/month for family coverage). i know we have a few in the medical profession here on the board, can you elucidate the system for my uneducated self?
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Old 09-20-2008, 12:49 AM
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Default Well,

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Originally Posted by Frenzy
i know we have a few in the medical profession here on the board, can you elucidate the system for my uneducated self?
no.
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Old 09-20-2008, 12:55 AM
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no.
ouch.
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  #6  
Old 09-20-2008, 01:06 AM
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I'm sure Yuri will fill us in.
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  #7  
Old 09-20-2008, 01:29 AM
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Hawaii is the only state in the nation with mandated health care coverage for employees who work more than 20 hours per week. It was passed back in 1976, and I found out today that there is a special exemption from ERISA (federal) that Hawaii had to have, or we wouldn't have the coverage. Ain't that interesting? We had to have a SPECIAL EXEMPTION FROM ERISA, signed by Ronald Reagan, so that most employees in Hawaii would have health care coverage. Our government amazes me, sometimes.

The law allows employers to recover up to 50% of the premium from the employee, but it's capped at 1.5% of the employee's earnings -- so most employers don't even bother charging.

My company has the full package -- major medical, dental, drug and vision -- at a cost per employee of slightly less than $400 per month. We offer plans through either Kaiser (HMO) or HMSA/Blue Cross. I find it fascinating that the Carpenter's union (which two of our employees are members of) charges us around $3.50 per hour worked for Health Care coverage -- which, assuming a 40-hour week, comes to over $600 per month.

The plans can cover dependents -- but my bosses draw the line at paying for them -- you want to cover your six kids, you pay for it. The employee, however, is free -- which isn't really all that bad a deal.
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  #8  
Old 09-20-2008, 09:03 AM
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Well, I don't really like a lot of government regulations on much, but health care is one area where I think that government regulations have the ability to really provide some good benefits. Not in the form of federal-run health care, etc, which we already have and it just doesn't work, but in the manner that they could provide mechanisms and incentives to the market that would make health care more affordable.

It all amounts to causality and consequences, and no one in the political race this year really has a clue.

Interesting information about Hawaii, Tru!
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Old 09-20-2008, 02:06 PM
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Originally Posted by Bryan Blaire
Well, I don't really like a lot of government regulations on much, but health care is one area where I think that government regulations have the ability to really provide some good benefits. Not in the form of federal-run health care, etc, which we already have and it just doesn't work, but in the manner that they could provide mechanisms and incentives to the market that would make health care more affordable.
Are you talking about Medicare? Why do you say it doesn't work?
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Old 09-20-2008, 02:39 PM
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Have you had to actually file a claim and get it paid through Medicare? Have you seen the actual budget they operate on vs. how much they end up paying out for medical expenses? Have you been called by a doctor's office for four months when they are trying to get paid because Medicare hasn't paid them? After trying to deal with them for my grandmother vs. dealing with my insurance company: Medicare doesn't work.

The Medicare system is not a good system, and does have a lot of corruption inherent within the system, etc. The prescription expansion pretty much serves as yet another government hand out to the pharmaceutical industry (not a lot different than a good deal of all health care systems in the US anyway). Considering that Medicare was considered as a basis for a national health care system to cover everyone, I'll vote No, thanks.
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Old 09-20-2008, 02:45 PM
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Quote:
Originally Posted by Bryan Blaire
Have you had to actually file a claim and get it paid through Medicare? Have you seen the actual budget they operate on vs. how much they end up paying out for medical expenses? Have you been called by a doctor's office for four months when they are trying to get paid because Medicare hasn't paid them? After trying to deal with them for my grandmother vs. dealing with my insurance company: Medicare doesn't work.
Don't take it out on me, I was just asking a question. I was planning on speaking to my wife about it when she gets home from work. She works with Medicare on a daily basis, and from what she's described it doesn't sound too bad.

But again, I was just asking your opinion, not for a rant about how I'm not qualified to understand it.
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Old 09-20-2008, 02:51 PM
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I wasn't trying to take it out on you or rant. Those were actual questions, in addition to my irritation at Medicare. I'm not saying you can't understand it, but much of the above is things that I've had to personally deal with. Personal mileage may vary. I haven't met anyone in Texas really happy with the Medicare system versus what service they can get from private insurance.

I honestly don't know what the problem is, because some doctors' offices seem to get paid well and smoothly, while others get the shaft. Some places are required to turn in certain other forms for claims, while other locations (sometimes with the same doctor working at another location) do not have to turn in those forms. It also seems to depend on which bureaucrat you are having to work with, and how bad that person's day has already been, etc.

To some extent, because I work for the gov't, I am inherently suspicious of any government systems (especially ones that have to be created/expanded) because I already see just how bad the great majority of the government agencies really are. It's just a bad, bad, bad return on tax payer investment.
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  #13  
Old 09-20-2008, 03:41 PM
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Quote:
Originally Posted by Frenzy
i know we have a few in the medical profession here on the board, can you elucidate the system for my uneducated self?
::soapbox::

I am not in the medical profession, I am in the insurance industry...I help companies plan, compare and implement their benefit packages...so i have no carrier affiliations here. You could say I am the one who works as the watchdog for companies VERSUS the carriers.

National healthcare will add to the destruction of our economy and bog us down more than ever in red tape. Just my opinion, and that could change if someone comes up with a decent plan. Neither McCain or Obama will solve this, but they could START as process.

FYI, non for profit means nothing in healthcare. Just longer meetings in the annual budgeting to figure out where to spread (or hide) the money next time. Again, just my opinion.

If you think tax code is hard, try getting an explanation of medical self funding by Blue Cross or how the Rx rebates and discounts work. I play bullshit bingo with Rx reps, they usually know less than I do and can NEVER explain their projected costs to me the first time without me poking holes in the numbers.

Taking state control from these issues will again cause more red tape and constant struggles for power which only leads to people getting sicker and dying faster. Corporation continue to drive out the small competitors who can ACTUALLY MANAGE health care.

The uneducated population contributes to the problem. Anyone know how much an actual doctor visit costs? Most see $10 office visit and move on. Rx is worse. I bet you all pass by gas stations in favor of a .10 savings at the next corner, but not one of you negotiates with your doctor on his costs. Do you compare hospital rankings, services and pricing? Do you check your Rx for cost vs. suitability? (some of you do, if you have a brand name copay on your plan).

High deductible health plans will be the future, and I would recommend you ask your employers about them. If you have one PUT THE MAXIMUM AMOUNT YOU CAN in the health savings account every single, bloody year, 'cause Medicare ain't gonna take care most of you once you hit 67 and the folks doing this will be the ones to live the longer, healthier, happier lives. Otherwise, go the way of Walt Disney.

Best of luck. McCain can't recall how many houses he owns, I am sure not trusting him (and his mega-rich wifey) to plan my medical future.

If you wan't statistics of costs, let me know. I do that every day and would be happy to share.

$600 a month for family medical coverage is likely less than 50% of the actual (premium) cost btw. I have seen two sets of preemie twins in my career, both almost bankrupted the companies. If you have family medical coverage, thank your employer and hope you keep your job.
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  #14  
Old 09-20-2008, 10:38 PM
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Default Part of the problem, Bryan, is

Quote:
Originally Posted by Bryan Blaire
I haven't met anyone in Texas really happy with the Medicare system versus what service they can get from private insurance.
that Medicare/Aid is run by the states. So indeed, your mileage varies a lot. Second big problem is, Medicare/Aid claims can go straight to the doc and are painlessly paid, or they may go to the doc's preferred provider organization, in which case there may be much pain. In my Very Large Integrated Health Care System, patients enrolled as Medicare/Aid patients don't even see the process; it simply happens in the bureaucracy and all is taken care of. Finally, those government programs tend to go as cheaply as possible on repayment. So unless you're willing to run a Medicare/Aid fraud shop, you're gonna lose money on those folks. Cost of doing business. Which brings me to a final point. Fee for service docs operate a lot like I do as a researcher. I will put together a study proposal, calculate the budget I need to do the work, then my institution adds in something called 'indirect costs'. This is intended to cover the cost of doing business - the building, the lights, the janitors, the admin staff - that kind of thing. It runs anywhere from 45% to 90% of the 'direct' budget. My institution charges an extra 64% in indirects on top of my original budget. Where this is like a medical office is that many fee-for-service docs will tack an extra amount on their fees for insured or wealthy patients, to cover the cost of doing business- in their case, the uninsured or the Medicaid/Care patients.

It really does work, Bryan, in that poor people and old people are a lot healthier than they were before this, although I won't argue your description of Medicare Part D, the prescription thingy. The whole package is something Eisenhower tried to do, and that resulted in the American Medical Association inventing the term "socialized medicine" to combat him.
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Old 09-21-2008, 10:24 AM
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It is imperative that access to healthcare be equal. Health Insurance be affordable and that all parties: patients, providers and insurers are treated fairly. No one should be without coverage and the level of coverage should not determine the level of treatment (and I mean both where underinsured do not get the care they need and the well-insured get treatments that aren't of value). I used to have a post saved in my bloglines about a mother's struggle with her very young child's illness due to poor medical coverage. That is an atrocity that we need to prevent.
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Old 09-21-2008, 01:05 PM
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Tana, out of curiosity, what is a "treatment not of any value"?

You mentioned it in reference to well-insured.
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Old 09-21-2008, 01:11 PM
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Quote:
Originally Posted by Davian93
Tana, out of curiosity, what is a "treatment not of any value"?

You mentioned it in reference to well-insured.
I think that sometimes doctors will order tests with a higher profit margin when a less expensive one will work as well.
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Old 09-21-2008, 01:14 PM
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Quote:
Originally Posted by tanaww
I think that sometimes doctors will order tests with a higher profit margin when a less expensive one will work as well.
I could see that. I could also see them not ordering necessary tests because of cost if they knew the subject didnt have the insurance to pay for it.
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Old 09-21-2008, 01:23 PM
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Quote:
Tanaww said:

That is an atrocity that we need to prevent.
I'll only agree with that, Tanaww, if I'm allowed to charge everyone else for IVF if Gil and I need it to conceive. I don't recall any parents asking me for their approval to have a child so that I could prepare my hand-out for them just in case they have a kid with a medical issue. That's a parent's responsibility and the risk they take when having a kid.
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Old 09-21-2008, 02:02 PM
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Hawaii plans are oh so easy to build!!! I love pulling down those templates punching in a few numbers and then its good to go


One thing you guys have to understand about Healthcare is that there are two funding arangements to it. Fully Insured and ASO (Self-Funded)

Fully Insured is where the company elects to have (I'll use UnitedHealthcare since thats where I work) UHC pay all their medical bills. Said company the chooses which plan and coverages that they want. THe better the plan the higher the premiums obviously. The problem that has arisen is that medical bills have risen so much that premiums have sky rocketed. Gone are the days of copays and 100% coverage unlesss you work for the government or the State. I'm not taking all the blame off healthcare insurance providers, but they do need to be able to make money in order to stay in business. Fully Insured has to follow all the state mandates for coverage. Each state madates different coverages for different things....Let me =just take this oppurtunity to say, if you want the most coverage for the most things head down to Texas and work for a smaller company Texas plans are a bitch to implement...90 pages of mandates.

ASO (Self-funded) is where the company you work for actually pays all the bills themselves. They decide what they want to cover and at what rate. Basically UHC is just the middle man and gets all the paperwork done. Generally its the really big companies that do this because it is more cost benficial for them. They gamble that it will be cheaper to pay for the hospital bills then the premiums to the insurance company. A small company would be better off paying premiums then having to pay a million bucks for someones cancer treatments, but larger companies are generally better off paying for the cancer treatment then paying the insurance premiums. Make sense? ASO funded groups do not have to follow mandates unless they choose to...and I belive they can charge the members whatever premium they decide...not 100% on that but I believe its the case. Usually ASO plans are what we would call crappy coverage because the companies you work for want to pay as little as possible. You cant blame the Insurance Industry on that one, you can blame the CEO who would rather have his 5 million dollar bonus then lower insurance rates and healthcare costs for all the little peons that work for him.


I don't know if that gives you and inside look or not, but thats how the plans work.
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