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Old 09-10-2008, 01:05 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,241,378 times
Reputation: 908

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This is a heated and hot topic and has been in the past

I would like to hear your experience with the health care system. . all positive and negatives. What sacrafices have you made in order to afford health care for you and your family (if you purchase for yourself).

If you have health care through your employer do you feel it's adequate and what is your contribution? What kind of plan do you have.. deductables, lifetime caps etc.

If you purchase insurance for yourself what state are you in, what challenges have you faced in purchasing the insurance (denial, etc) and if you were able to purchase at a pretty "cheap" price what does that plan come with (what is the lifetime/yearly max, out of pocket etc) What percentage of your income goes to your monthly health insurance premiums.

If you are for or against a universal health plan , elaborate why. Do you think the current healthcare system is just fine or is it broken and why?


For example.
I currently live in NY State. I'm a Juvenile Diabetic for the past 18 years. I am self employed with a "small business". For myself and my son the insurance is now $856/month. I pay a copay to my regular Dr. of $25 and specialist $40. Prescription Generic drugs are $10 but non generic I pay I think like 50% ? (Just had to get augmentin for my son and it cost me $65.) I have a deductable, I believe of about $750 a year. Lifetime caps are high as well as yearly caps. Husband is NOT insured because we couldn't afford the family (we are currently parent & child plan) as it would have put us over $1,000. NY is a state that can not deny health insurance coverage for pre-existing conditions.

Moving to PA. Shopped around the web and was contacted by a Mini- Med type plan. Sounded good.. you get 10 Dr. Visits a year picked up by the insurance portion of the plan. $500 /day for hospitals.. and drugs at a discount. After the 10 visits a year you get the "discounted" Dr. Rate, which they say is about $50 a visit. Guaranteed issue and $309/month for a family. BUT.. here's the big BUT.. lifetime caps are extremely low. Someone like myself would max out pretty quickly ($25K lifetime max) It is NOT major medical.

Found Blue Cross Blue Shield. They offer a guaranteed issue plan.. for myself alone with a $750 deductable is $333/month. Covered 80% after deductable. Yearly max is 1mil lifetime 5 mil. My husband and child can go on a medically underwritten program with no deductable for $230/month coverage of 90% and copays of $10/20 for generic/brands. Basically it will cost us as a family approx $550/month.

I am for a Universal system of some sort. I believe it works in other sections of the world. I particularly like the model that UK has where private and tax system work together, which significantly lowers the private health insurance premiums as they are more of a supplemental insurance for added piece of mind. I believe that contributing with a tax strictly for health insurance opens us up to being the biggest "pool" of insured which would drive down costs of premiums. Streamlining to one payer system would eliminate a lot of adminstrative waste on both the Dr's side and the insurance side of the equation. It would also elminate the excess we pay for with insurance, including their "lobbying" costs on the part of the insurance companies.

I do believe that this should ONLY be offered to American Citizens. Illegals are still recieving treatments for their care regardless as they do go to emergency rooms and must be treated when they enter, however they will not have access to preventative care and ongoing care. All working citizens who pay taxes will be contributing. The health care is not free as it is paid for out of our income in an income tax. The only "free" healthcare will be those that are poor, which they are already receiving healthcare for free with the medicaid program.

I do not believe that families .. wether they are a minority number or a majority number (not refering to race.. but the argument that the millions uninsured is not the majority), should have to go without proper healthcare. It should be affordable to all and accesable to all. While for a Universal healthcare, I don't expect it to be "free" but I certainl do not expect it to be out of reach for many working class citizens. Insurance should not be tied to a job, no one should HAVE to work for someone else in order to have proper coverage.

I do not believe our current system is working and it is failing miserably. I do not trust "free markets" in this regard, as I do not want decisions dictated by a companies profit margin. I'd rather have my decisions in the hands of the doctor who will determine what the best care for my situation is, not wether this "care" will diminish a companies earning potential.

What are all your thoughts?

Last edited by TristansMommy; 09-10-2008 at 02:18 PM..
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Old 09-10-2008, 01:08 PM
 
Location: Montrose, CA
3,031 posts, read 8,021,422 times
Reputation: 1927
Quote:
Originally Posted by TristansMommy View Post
I currently live in NY State. I'm a Juvenile Diabetic for the past 18 years. I am self employed with a "small business" . I do not have employees.. but in order to get a lower premium I pretty much said that I do have employees to get into a small business grouping. For myself and my son the insurance is now $856/month.
That could be considered to be insurance fraud, you know.
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Old 09-10-2008, 01:27 PM
 
Location: Moon Over Palmettos
5,975 posts, read 17,540,063 times
Reputation: 5005
"All working citizens who pay taxes will be contributing."

Please explain what you mean by this:
1. Who pays for healthcare for unemployed people, be it temporary or permanent, involuntary or voluntary?
2. Citizens - would legal resident aliens be covered? If employed, they pay taxes, though they are not citizens.
3. Who Pay Taxes - there are some people who by virtue of their tax bracket and tax returns not only get all the taxes they paid back but get earned income credit back. Are they included in your population of "citizens who pay taxes"? Are they not effectively not paying taxes since they get all of it (and some) back?
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Old 09-10-2008, 01:51 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,241,378 times
Reputation: 908
Quote:
Originally Posted by bibit612 View Post
"All working citizens who pay taxes will be contributing."

Please explain what you mean by this:
1. Who pays for healthcare for unemployed people, be it temporary or permanent, involuntary or voluntary?

Health care would essentially follow you. If you find yourself temporarily unemployed that no you wouldn't be paying into the system for that time, as you have no income to pay taxes on. Of course, if you are someone that doesn't live on the welfare system you will seek other employment and be right back on that wagon again. The permanently unemployed or those collecting disability , under our current system, are receiving care through the welfare system of medicaid already, which are paid for through our paychecks now, so no one will be esentially getting something that isn't given out already. Unless you fear that suddenly working people are going to stop working and spiral themselves into poverty? I don't see that happening
2. Citizens - would legal resident aliens be covered? If employed, they pay taxes, though they are not citizens.
hmm. well I'm not really sure about this one. I think that they should have some sort of coverage should something catastrophic happen, but not the same access as the rest of us. Similar to SS where they pay the SS taxes in their checks but I believe, unless I"m mistaken, that they do not collect on those taxes. BUt.. on the other hand, they are contributing to the system and should therefore be afforded the same benefits as long as they are
3. Who Pay Taxes - there are some people who by virtue of their tax bracket and tax returns not only get all the taxes they paid back but get earned income credit back. Are they included in your population of "citizens who pay taxes"? Are they not effectively not paying taxes since they get all of it (and some) back?
Those who don't make enough money to pay taxes are already getting healthcare through medicaid because they fall in an income class that allows them to qualify. Just because a person gets a portion of the taxes they paid in back at the end of the year doesn't mean that they didn't pay any taxes, btw.. it just means that according to the tax code after they write off certain things they get money back because they overpaid. Nothing will esentially be changed by that.. again... if they are making below a certain income they are already getting medicaid that the rest of us are paying for ON TOP of our own insurance preimums.
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Old 09-10-2008, 02:24 PM
 
Location: Texas
43,376 posts, read 52,297,745 times
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Health insurance does not have to be tied to a job; you can purchase it from various brokers who do the big names and some other smaller private companies, as well.

I have always had a good experience with my health care, but since I think that my health is the most important thing in my life, it gets priority when I make my budget (before mortgage, car payment, reproducing, etc), right there with food and water.
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Old 09-10-2008, 02:25 PM
 
Location: Southeast
4,296 posts, read 6,253,210 times
Reputation: 1445
A very complicated and troubling issue.

For starters, I receive 96% healthcare coverage from my employer, but just for emergencies I take out a little bit of my money each month and stick it in an separate account. That way if I ever run into trouble, I can use that (not just medical emergencies).

As for universal coverage. I say no. Here in the US we have far too many illegals and unemployed individuals for it to cover everyone. Plus, have you even seen how the universal system works in Socialized countries? If you aren't about to drop dead be prepared to wait weeks or months to even get into the doctors office.

Worst of all, you get focus on smokers, drinkers, the obese, poor dieters, people who don't exercise, etc. all singled out for not trying to be healthier, and a waste of taxpayer dollars. Plus with a free system you get what you pay for; If you pay nothing expect the same quality in return.

Instead of making everything free, we should instead invest in more free clinics and county hospitals. Or at the very least if a universal system comes in, allow people to opt out of the system.
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Old 09-10-2008, 02:29 PM
 
Location: Texas
43,376 posts, read 52,297,745 times
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Agreed. Many people don't realize that in countries with socialized medicine, you often get dinged for having unhealthy life habits.

I don't get why we'd want govt-run healthcare. Do they run anything else particularly well?
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Old 09-10-2008, 02:36 PM
 
Location: State of Being
35,885 posts, read 66,941,592 times
Reputation: 22369
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.
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Old 09-10-2008, 02:39 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,241,378 times
Reputation: 908
Quote:
Originally Posted by Frankie117 View Post
A very complicated and troubling issue.

For starters, I receive 96% healthcare coverage from my employer, but just for emergencies I take out a little bit of my money each month and stick it in an separate account. That way if I ever run into trouble, I can use that (not just medical emergencies).

As for universal coverage. I say no. Here in the US we have far too many illegals and unemployed individuals for it to cover everyone. Plus, have you even seen how the universal system works in Socialized countries? If you aren't about to drop dead be prepared to wait weeks or months to even get into the doctors office.

Worst of all, you get focus on smokers, drinkers, the obese, poor dieters, people who don't exercise, etc. all singled out for not trying to be healthier, and a waste of taxpayer dollars. Plus with a free system you get what you pay for; If you pay nothing expect the same quality in return.

Instead of making everything free, we should instead invest in more free clinics and county hospitals. Or at the very least if a universal system comes in, allow people to opt out of the system.
Some good points..

Here's a question for you. First, you referred to it as "free". I don't know why people refer to it as free. If you are paying INTO a system it's not free

For example..I have insurance, I pay a monthly premium so that I can go to the Dr. and NOT have to pay beyond my copay. So you may say that I am recieving "free" healthcare becasue I"m not paying the Dr. .. but. .. that's not true because I pay a monthly "preumium". Well take away the word monthly premium and put in "tax paid out of income" and it's the same principle.

I wouldn't be opposed to people opting out of the system. People can opt out of the SS system too (I didn't know that till another poster said they opted out) however, I feel that if anyone were to opt out of the system than they should prove that they would financially be able to pay for their medical needs upfront should the need arise. Those that opt out would in essence be leaving themselves uninsured. If illness or injury occurs and they don't have health insurance than what happens if they go to a hospital or Dr. and can't pay their bill? THey will default on that hospital bill and in order to make up for the losses they would have to raise the cost to the rest of us to compensate. Either that or they will end up on a medicaid, medicare system anyway if they end up spiraling economically as a result then end up using a system they "opted" out of.

I did mention an option for purchasing supplemental private insurance if you fear that the Universal is not adequate or would be lacking in an area.. say wanting a private hospital room etc. .. or if you wanted to visit a Dr. that only operated through private insurance. Those premiums, however, would be fairly cheap as I think they would have a harder time attracting business as most would have all they need through a UHC.. something that has occurred in England with the two systems working side by side.

My mother in law is from a socialized country. She discovered here while we were getting her glasses, that she has cataracts and will require surgery. When she goes home for two months she will visit her Dr. and have the surgery before returning here. I have an idea of how it works, and I've heard from other posters who have straddled both systems the differences.. benefits and negatives.

As for the illegals, etc. they wouldn't be covered under UHC.. and currently are uncovered here in this country. There status, I do not think , wouldn't change from what it is today. They do , however, receive treatments when they enter a county facility or free clinic.
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Old 09-10-2008, 02:49 PM
 
Location: Pennsylvania, USA
5,217 posts, read 4,241,378 times
Reputation: 908
Quote:
Originally Posted by stan4 View Post
Agreed. Many people don't realize that in countries with socialized medicine, you often get dinged for having unhealthy life habits.
hey Stan,
A lot of raised an argument to a UHC in the past about paying for "other's poor lifestyle choices" as a reason to oppose a UHC.

I'm not about someone dictating to another how to live their life. There are some instances of diseases that are unpreventable.. like my Juvenile Diabetes NOT brought on by any poor lifestyle choices.. but there are problems that do arise for those individuals who .. munch on horrible foods and allow themselves to get unhealthy and obese as a result. (there are instances of obesity, however that are NOT caused by lifestyle choices). Smokers too run the risk of cancer.

In a private health care system people do get dinged for their poor lifestyle choices already.. for example, you can be turned down for insurance if you are overweight (it depends on laws in each state) or forced into a guaranteed issue plan with a higher premium if you have been denied from a medically underwritten plan. Worse yet, those that have no control over their conditions are forced into a plan that is more expensive as a guaranteed issue.

I don't think pinging people for their poor lifestyle choices would neccesarily be a bad thing. It might hold people more accountable for their own health. In the current system an unhealthy person doesn't feel the financial effects of their poor health choices because they are not paying the premiums if they are covered by their employer. If they effect is felt differently for them they would then have to make smarter choices to avoid the consequences financially of those poor choices.

I wouldn't even be opposed to having to answer to how well I manage my diabetes in a UHC system and being pinged if I am not managing it properly with my physicians etc.

It might actually make America a lot healthier as a result
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