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Old 09-10-2008, 04:40 PM
 
Location: Montrose, CA
3,031 posts, read 7,865,223 times
Reputation: 1925

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Quote:
Originally Posted by anifani821 View Post

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 healthcare premiums themselves are affected by a lot of factors.

For instance, health insurance fraud in the United States costs Americans an estimated $80 billion a year, or nearly $950 for each family (Source: Iowa Fraud Bureau)
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Old 09-10-2008, 04:47 PM
 
Location: somewhere
4,264 posts, read 7,931,569 times
Reputation: 3129
My husband is a federal employee so our insurance is really good.

We have BCBS Federal and we pay $290 a month for the family. Our deductible is $600. We pay $15 per visit except for the kids well child. Anything other than the office visit is paid at either 90% or 85% depending on the service. We pay nothing for accidents. It provides alittle dental but not much. We have United Concordia for our dental and it costs us about $971 a year. The only drawback is that despite the fact our 23 yr old is still in college and our dependent, last year she got kicked off of our insurance because of her age, so now we spend an additional $107 a month on her insurance. Overall I know we are really lucky to have such good coverage.
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Old 09-10-2008, 04:52 PM
 
Location: State of Being
35,885 posts, read 65,265,344 times
Reputation: 22271
Quote:
Originally Posted by SuSuSushi View Post
...and healthcare premiums themselves are affected by a lot of factors.

For instance, health insurance fraud in the United States costs Americans an estimated $80 billion a year, or nearly $950 for each family (Source: Iowa Fraud Bureau)
Fraud and waste are appalling! We could make a difference in the cost of healthcare if each person would report it when they know fraud exists. Sadly, I see people trying to "beat the system" all around me!

Let's don't forget . . . fraud also goes on when illegible people apply for disability (when they do not deserve it) and that spills over into other government programs. You get qualified for one and then it is a domino effect . . . disability . . . food stamps. . . Section 8 housing . . . healthcare . . . it goes on and on.

And let's not forget nursing homes. How many people do you know who have deliberately said . . . I have to switch around accounts and make it appear my mother has no assets so she can qualify for medicaid and a nursing home? I sure have heard it! In fact, I will be surprised if anyone over 45 or so has not heard that kind of discussion in their own families!!!! Well, that is fraud! If you have assets, you should be paying. Medicaid is not FREE!! And when the dollars go to Grandma's nursing home bill when she actually had $150,000 socked away . .. then that is taking $$ away from others, such as those school aged children w/ cystic fibrosis . . . or the baby w/ a congenital heart defect but whose parents are underemployed.

Also, when we all start talking about UHC, please remember - all sorts of restrictions will be put on access. For example, do you think it would be fair for your neighbor to have a daughter who is comatose and in a vegetative state, and costing taxpayers $3,000 a day, to get that care free when they live in a $600,000 house and have $500,000 in retirement plans socked away? HECK NO. I sure don't. There will be caps on services just like there are caps NOW on insurance policies (usually $1 M).
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Old 09-10-2008, 04:57 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,112,847 times
Reputation: 908
Quote:
Originally Posted by anifani821 View Post
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.
I see what you are saying..

My problem is that in health insurance there is a conflict of interest. The health insurance purpose is to turn a profit for their shareholders, etc. BUt. it is in direct conflict with what is in teh best interest of the patient or the customer because if something does occur they do not like to pay out.

It is documented that insurance companies try to find means to deny a claim/ coverage. Often the default is denied on a lot of things in hopes that the person denied won't fight it.

So.. what is "reasonable" income for a company to make? What is a reasonable expense the company should incurr. For example, a lot of our premiums go to pay for their lobbying in Washington. There is also excessive administration costs. And then there is the profit margin.

Remove the "we need to make a profit" from the insurance system and you remove a conflict of interest.

BTW.. i was denied for a medical piece of equipment and went through one appeal, then an outside appeal. During all those appeals, which too adminstrative time/money, the insurance company ended up striking a deal with the suppliers on some level and I was approved. A week later I got the external appeal review in which 3 out of 4 doctors sided with me and my doctor on the equipment I was looking to get covered. Just think about the adminstration fees , etc that were paid in denying and then needing to go through the claim process for something they should have just approved in the first place.

There are two sides to the coin here. On the one side we place our health decisoins NOT in the hands of the doctors but adminstrators at the health insurance companies whos job it is to watch the companies bottom line. On the other side we have those that fear health decisions being left in the hands of the government.

But.. if a UHC could be achieved with leaving the decisions to the people it should be left to, the Doctors.. I feel that it could truly work.
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Old 09-10-2008, 04:59 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,112,847 times
Reputation: 908
Quote:
Originally Posted by ajzjmsmom View Post
My husband is a federal employee so our insurance is really good.

We have BCBS Federal and we pay $290 a month for the family. Our deductible is $600. We pay $15 per visit except for the kids well child. Anything other than the office visit is paid at either 90% or 85% depending on the service. We pay nothing for accidents. It provides alittle dental but not much. We have United Concordia for our dental and it costs us about $971 a year. The only drawback is that despite the fact our 23 yr old is still in college and our dependent, last year she got kicked off of our insurance because of her age, so now we spend an additional $107 a month on her insurance. Overall I know we are really lucky to have such good coverage.

Now why can't coverage like that be opened to all!! That would be acceptable!
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Old 09-10-2008, 05:17 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,112,847 times
Reputation: 908
I really don't know what the answers are.

All I know for sure is that the current system is just not working and needs to be completely overhauled

No one should go bankrupt in getting healthcare

Less waste administratively needs to happen by somehow mainstreaming the system ( I believe all these different contracts and keeping things straight causes a lot of admin overhead for doctors)

I don't know how to combat insurance fraud: ie; overbilling or billing for procedures not needed.

On the nursing home note ; There are legal ways that you are allowed to remove money from bank accounts. For example, funerals may be pre-paid, family members may be gifted etc. Hiding is different from the legal methods. My grandmother had a sizeable amount of money to take care of her needs. She didn't own a home because about 8 years earlier she sold it , helped convert my parents home into a mother /daughter so that they could live with us (she couldn't live onher own anymore out of fear she'd burn her house down, etc.).

Even with her sizeable money she had left after we pre-paid and she gave her grandchildren a monetary gift (it really wasn't much at all) that money was gone in a matter of 2 months in the nursing home because the cost was so high. She was from the depression era so she was always worried about her "money" that no longer existed but we told her that it did exactly what it needed to and that was to take care of her in her old age. I was greatful for the medicaid system because my grandma got all she needed that she wouldn't otherwise have gotten had she not had medicaid kick in after her money was gone.
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Old 09-10-2008, 05:25 PM
 
Location: CO
1,599 posts, read 3,006,263 times
Reputation: 488
I too, and a small business owner who pays for insurance for a family of three - myself, my wife and my daughter. We're in Colorado and companies out here can and do deny insurance based on preexisting conditions (I have acid reflux). I was denied twice and was limited to only a couple choices in the end. The one we chose was the best of the worst, and is terrible compared to the good coverage we had out in California. We pay nearly $7k per year for medical insurance and cannot afford dental at the moment. Our insurance mainly just covers catastrophic injuries and illnesses.

I hear all of the negatives about a universal system, but why couldn't there be two systems? One that will benefit those who are seemingly content with the current system and one for those who can't afford or are denied coverage in the current system? Allow people to go with what works best for them and their families.

I want the same opportunity to have great coverage at a reasonable price that Congress has. And I think everyone should have that same opportunity. But I can also see that those who are happy with their coverage won't want to change the system if it means it will cost them more. That's understandable. So how do we meet in the middle?
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Old 09-10-2008, 06:17 PM
 
Location: Sometimes Maryland, sometimes NoVA. Depends on the day of the week
1,501 posts, read 10,540,276 times
Reputation: 1091
Federal health insurance is pretty good, and there are lots of affordable options, but it has its issues. My coverage was better and cheaper (to me) when I worked for GE than while working for the feds. But I know that compared to many people, I have it good.

It is stories like this that really get me upset about health insurance in America: UnitedHealth’s McGuire to pay $30M to settle class-action suit - The Business Journal of Milwaukee:
Other stories I have read suggest that the CEO of UnitedHealth makes over $100million/year. (one link: Healthcare Economist · United Health CEO earned $124.8 million in 2005).
I realize that not everyone agrees with me, but I really don't understand how it can be morally and ethically OK for the insurance companies, hospitals, etc to make a profit off of the misfortune of others. Just because there is an opportunity to make money does not mean you should. I would love to hear from the side the does believe in profiting for misfortune.

My personal investment in this issue is that I had cancer in my 20s and am now essentially uninsurable on the open market. I was diagnosed just before I planned to return to school for my PhD, so that did not happen as I could not lose my insurance. Despite my frustrations with federal employment at times, I won't leave until we have a reasonably UHC option.
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Old 09-10-2008, 06:21 PM
 
Location: So. Dak.
13,495 posts, read 33,431,409 times
Reputation: 15044
IMHO, we shouldn't have to "meet in the middle". It seems that we have enough money to wage war (may not totally uncalled for, but still....), feed people in other countries AND give medical care to non-citizens and people in other parts of the world. Surely our government could figure out a way that every single one of us could have healthcare. It doesn't matter if we have to pay into it~we really don't deserve to have it handed to us. But each and every one of us deserve to at least have basic medical care.

And this is from someone who has good medical insurance through her employer. I have pre-existing conditions and if anything ever happened that I couldn't have group insurance~no one would accept me. I would have to go with South Dakota State Health insurance. I didn't know it even existed until about five years ago. We were talking to someone who was on it and even back then, his premium was 900 per month. It's a high risk pool.
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Old 09-10-2008, 06:27 PM
 
Location: Moon Over Palmettos
5,975 posts, read 17,144,848 times
Reputation: 4989
Quote:
Originally Posted by rubytue View Post
I realize that not everyone agrees with me, but I really don't understand how it can be morally and ethically OK for the insurance companies, hospitals, etc to make a profit off of the misfortune of others. Just because there is an opportunity to make money does not mean you should. I would love to hear from the side the does believe in profiting for misfortune.

My personal investment in this issue is that I had cancer in my 20s and am now essentially uninsurable on the open market. I was diagnosed just before I planned to return to school for my PhD, so that did not happen as I could not lose my insurance. Despite my frustrations with federal employment at times, I won't leave until we have a reasonably UHC option.
I am sorry that you had cancer. I did too, just last December. Inspite of that, I believe that insurance companies, like any company in business, has to make a profit. And by its very nature, insurance companies provide the safety net for misfortunes of everybody. Just because the health insurance companies are in the limelight lately, it does not mean that companies like State Farm, Allstate, or life insurance companies don't make a profit. One catastrophe is enough to wipe the solvency of insurance companies leaving many more uninsured people who can't get coverage. Imagine just a few companies who operate in rural New Mexico for example. If insurance companies shut down because they can't make a profit, how will claims be paid. One has to understand how insurance works in the first place...that premiums are created to make reserves in anticipation of future claims. The fact that the claims cannot be predicted with any accuracy, premiums become an estimate. In good times, what has been collected is invested in the open market, to take care of large claims when they come, because the cash inflow may be exceeded by an outflow. It is a very very complex system and solutions are not easy. Throw the Feds in there and taxation turns it into a nightmare. Do we need it to be affordable? YES! Do we need it to be accessible? YES! I am just getting a little weary of reading the "bad insurance company" as the source of evil in all this.
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