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Old 09-10-2008, 02:51 PM
 
Location: Lake Arlington Heights, IL
5,481 posts, read 10,057,369 times
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A while back, NPR did a series on Universal coverage in different countries. Netherlands really resonated. If I remember correctly, federal law stipulates everyone must purchase health care insurance. The government also stipulates that insurer cannot decline and must accept those with pre-exisiting conditions and cannot charge higher premiums for those with pre-exisiting conditions. There is government aid for those who do not have the income to purchase. So the government embraces price control but otherwise steps out of the administration of the plans. The insurers need to profit from law of averages instead of maximizing profits on every single client.
I also would love to see Congress lose their health insurance and have to pay for insurance out of pocket through the private sector. I have a hunch they would quickly find ways to lower the costs of health insurance for many or make universal coverage work.
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Old 09-10-2008, 02:52 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,112,847 times
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Quote:
Originally Posted by anifani821 View Post
My point in my earlier post is that we already have universal healthcare - Medicaid, Medicare, CHIPs, etc. The problem is that the working poor cannot qualify for it.

The simple solution is not to create yet another government healthcare plan, but rather work w/ the insurance industry to offer plans that would have lower premiums and allow easier access by the working poor.

In other words, then TristansMommy would not have been put in the position she is now. Is she asking for a hand out? NO. But a more reasonable premium w/ decent coverage would definitely be meaningful in her life.

Do you feel that working with the industry is really feasable when their operation purpose is for profit, rather than better healthcare coverage? If so, how?
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Old 09-10-2008, 02:52 PM
 
Location: Connecticut
427 posts, read 1,210,779 times
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I had no health care form the age of 18 until I was 21 and started working for a loarge comapny, they pay a little over half for my insurance, and I luckily don't have to pay to much. However my deductables are pretty high. I probably would not have health care if it was not thru my company, Because of my asthma, which I have had since I was a child, and Migrains, I had a lot of trouble finding health care, that I could afford.

My parents however have it worse, My mother has issues from a car accident 20 years ago and because of it she was constantly denied insurance, and my dad has Diabetes, and had a heart attact a few years ago, they were finally able to get insurance thru the company that my dad sub-contracts from, but they pay about $1000 a month, with no deductable up to 4k.

We do however have foster kids that have free insurance from the state, and it is a total pain to get them app. with doctors, because no one wants to take the insurance. Especially orthodontists. It's been really hard findinh one for my foster sister, she been waiting for over 6 mons. and finally had to take her spacer out herself because it was half falling out.
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Old 09-10-2008, 03:08 PM
 
Location: State of Being
35,885 posts, read 65,265,344 times
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Quote:
Originally Posted by TristansMommy View Post
Do you feel that working with the industry is really feasable when their operation purpose is for profit, rather than better healthcare coverage? If so, how?
It is all the same industry. Third party administrators can handle private insurance or Medicare, Medicaid . . .

Insurance is regulated by the state and federal governments. All the government has to do is put out bids - and then decide wh/ companies (i.e. Kaiser, BC/BS) get the contracts.

If your state - any state - wanted coverage w/in the state that met certain criteria - all they have to do make it so.

That is what people don't understand.

In my state, for ex., NC - if our insurance commissioner decided that BC/BS had to offer open PPO plans for people aged 25-50, let's say, and that the minimum coverage would be xx, and the maximum premium would be xx, and the deductibles would be xx for Plan A, and xx for Plan B, etc. they could make it happen. BC/BS may say - well we can't meet that - your per member, per month price is too low . . . there could be negotiation to see what is reasonable . . . bids could be put out to see what other company would come closer to meeting their criteria, etc.

Insurance companies have contracts w/ hospitals, imaging centers, docs, etc. wh/ is all determined by the terms of your policy.

So if the state wanted to make it happen, they could do it right now.
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Old 09-10-2008, 03:12 PM
 
Location: State of Being
35,885 posts, read 65,265,344 times
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Actually, Massachusetts has done this - a form of it - anyway.
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Old 09-10-2008, 03:26 PM
 
Location: Lake Arlington Heights, IL
5,481 posts, read 10,057,369 times
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Quote:
It is all the same industry. Third party administrators can handle private insurance or Medicare, Medicaid . . .

Insurance is regulated by the state and federal governments. All the government has to do is put out bids - and then decide wh/ companies (i.e. Kaiser, BC/BS) get the contracts.

If your state - any state - wanted coverage w/in the state that met certain criteria - all they have to do make it so.

That is what people don't understand.

In my state, for ex., NC - if our insurance commissioner decided that BC/BS had to offer open PPO plans for people aged 25-50, let's say, and that the minimum coverage would be xx, and the maximum premium would be xx, and the deductibles would be xx for Plan A, and xx for Plan B, etc. they could make it happen. BC/BS may say - well we can't meet that - your per member, per month price is too low . . . there could be negotiation to see what is reasonable . . . bids could be put out to see what other company would come closer to meeting their criteria, etc.

Insurance companies have contracts w/ hospitals, imaging centers, docs, etc. wh/ is all determined by the terms of your policy.

So if the state wanted to make it happen, they could do it right now.
So what keeps the federal government from doing this?
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Old 09-10-2008, 03:28 PM
 
Location: State of Being
35,885 posts, read 65,265,344 times
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Let me use an example for anyone who may be confused by what I have written.

We will use your family physician as the example. In any given day, your FP may see 20 different patients, each w/ various types of insurance (or some who are self-pay).

Medicare, Medicaid . . . BC/BS . . . etc. So the doc has a fee schedule for each type of insurance. Your co-pay may be $35 w/ one insurance . . . and $50 w/ another . . . and $15 w/ yet another.

Let's say every person came in w/ the same problem - strep throat.

Every person there may be charged something different.

Does that mean anyone got different treatment? No. It only means that the physician practice (or if owned by a hospital - then the hospital or corporation that owns the hospital) has different contracts w/ different insurance companies. In addition, each patient may have differing versions of a policy, even w/in the same company. So my BC/BS policy may have a $5000 deductible and yours may have a $1500 deductible . . . my copay may be $50 and yours may be $15 . . .etc.

But it gets more complicated. The contracts can specify how much your procedure will cost. So the doc may charge the Medicare patient $75, you $77 and me $85.

Cutting the cost of healthcare is not as simple as getting universal coverage! It is a multi-faceted system. Cost and charges vary, depending on contracts

And for the poor guy w/ no insurance - he gets charged THE MOST!!! Yep, crazy isn't it. B/c the self-pay patient has no contract that has been negotiated for him - he gets charged the full amount. So that poor guy may be charged $150 for what the rest of you got for about 1/2 that price.

Pharmaceuticals are handled the same way! So my Advair may cost me $50, yours cost you $35 and your neighbor w/o insurance- he may be paying $80.

So this is no easy task to address.

Last edited by brokensky; 09-10-2008 at 03:40 PM.. Reason: typo
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Old 09-10-2008, 03:30 PM
 
Location: State of Being
35,885 posts, read 65,265,344 times
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Quote:
Originally Posted by cubssoxfan View Post
so what keeps the federal government from doing this?
Congress.

Oh - forgot the important part - Congress, yes, and the Lobbyists who help bankroll their re-election campaigns.

Last edited by brokensky; 09-10-2008 at 03:33 PM.. Reason: added info
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Old 09-10-2008, 03:52 PM
 
Location: Lake Arlington Heights, IL
5,481 posts, read 10,057,369 times
Reputation: 2784
The doctors sometimes get screwed too. My BIL was OB/GYN. Between the $25 reimbursement he got from one insurance co. to deliver a baby, to the malpractice insurance cost to the liability lasting until the child turned 18- it was too much.
First he stopped accepting insurance and did direct bill with patients only. Then sold his practice, got a Master Degree and now is Chief Operating Officer in a hospital (or something close to that)
I still wonder why the Dutch model couldn't work in the US.
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Old 09-10-2008, 04:29 PM
 
Location: State of Being
35,885 posts, read 65,265,344 times
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Quote:
Originally Posted by cubssoxfan View Post
The doctors sometimes get screwed too. My BIL was OB/GYN. Between the $25 reimbursement he got from one insurance co. to deliver a baby, to the malpractice insurance cost to the liability lasting until the child turned 18- it was too much.
First he stopped accepting insurance and did direct bill with patients only. Then sold his practice, got a Master Degree and now is Chief Operating Officer in a hospital (or something close to that)
I still wonder why the Dutch model couldn't work in the US.
Yes - docs can get screwed as well - wh/ is why many of them refuse to accept Medicaid patients - and why many OBs have left their practices.

Okay . . . the Dutch system. I don't know, CUBS. Their performance indicators are behind ours. The last source I saw (and indeed, it may be outdated) placed the Netherlands at #17, behind the US system. Now, that is on performance.

Our system may be expensive and even inequitable when it comes to access to care (cost, not proximity) . . . but our performance is at the top. Our system provides excellent healthcare to our citizens . . . but can bankrupt us (even w/ healthcare insurance!!!) at the same time.
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