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We don't need to reinvent the wheel. We can benchmark against other systems and use what will work best for us. Australia has a good system as does Germany and a lot of other countries. The ACA was a train wreck from the start. They had a super majority and wasted it.
Right, it will only require a president and majority in each house of congress who are willing to thumb their noses at the insurance industry and their lobbyists for a system like what they have in the rest of the developed world.
I'm sure there will be an initial burst of care demand, due to previous unmet needs, but it should level out as time goes on and people are born into it. The economy should also improve, due to relieving the burden of employers subsidizing health care, which will balance the increase in taxes. I doubt the system will be "gamed" under UHC; when Obamacare was introduced, aggressive enforcement of Medicare fraud was undertaken and saved the system millions as a result. I don't think shady providers are stupid enough to try that again.
The initial burst in addition. And yes I think it will all improve economies, especially local.
Gaming isn't fraud. When docs learn the new rules, more stuff will get done. As so much is left undone.
A more UHC system is bound to reduce docs reimbursements per encounter. They (we, as I'm a doc) will buck and try to maintain the income that they desire.
Single payer might cost less per patient encounter. But we will see many more encounters.
Much in medicine is left undone for all sorts of reasons. And with more UHC, more will get done. Much of this will be on the positive side, and some on the negative side if abused. But when the HC cost and access issues are eased, more will get done. People/patients will opt to take care of previously lesser medical concerns. And docs might game the system by doing more.
Of course demand will go up as more people have access to healthcare. What's wrong with that?
Better than having less demand and more people dying as a result because they can't afford healthcare. Of course, our Wall Street profit-based system doesn't care much if you live or die. The priority is to make money not saving lives.
As part of my compensation when I work, I receive employer sponsored health insurance. My employer pays part of the premium that would otherwise come to me in the form of wages or other benefits, or kept by him to invest as he saw fit, to a for profit insurance company that is publicly traded on Wall Street.
I also pay part of the insurance premium, using my wages that I would otherwise spend, donate or invest elsewhere. My employer must offer this benefit in order to remain competitive in terms of attracting competent employees. It is even mandated to a certain degree, depending on your state and the size of your company.
Now, why should we be forced to buy this product from a for-profit corporation that in turn does business with huge for-profit hospital corporations, and restricts my use of practitioners to their contracted panels?
Can anyone please explain to me why the public option in Obamacare, where my employer could have paid premiums into a Medicare for everyone type system instead of subsidizing some other CEOs multi million dollar salary, was shot down?
You don't understand how a self-funded employer sponsored healthcare Plan actually works. You're not alone. If more Americans had a basic understanding of this process, the healthcare debate might be very different.
Most Americans are completely clueless when it comes to their "insurance." I've worked in the industry for 25 years primarily with self-funded employer sponsored Plans and am an appeals supervisor at a major "insurance company."
Most Americans are enrolled in self-funded, employer sponsored health care plans (at least 60%) vs fully insured Plans.
When you are enrolled in a self-funded employer sponsored Plan, what this means is your employer actually funds all of the employee claims (sometimes with assistance from a reinsurance policy) for catastrophic claims. The money to pay all employee claims comes FROM your employer not the "insurance company." Insurance company is also not the correct terminology for self-funded employer sponsored Plan.
What your self-funded employer does is hire a third party administrator or TPA (Aetna, Blue Cross, Cigna, insert random TPA name here) to process employee medical/dental/vision claims, provide customer service and process appeals. The TPA works for your employer, just like you do. The TPA gets a monthly fee to administer the Plan for your employer. The TPA gets access to your employer's bank account to cut the checks to providers. The TPA gets paid to make you think the "insurance company" is really the bad guy and disguise the fact your employer is really the one calling all the shots.
Surprise!!!! Your employer is really the bad guy, not the mean old "insurance company." Your employer actually determines what benefits, exclusions and types of Plan they are going to offer. Many write their own Plan documents. So if you went from a great PPO Plan to a crappy high deductible health Plan -- your employer did that to save THEIR money. Your employer is the one that chooses which PPO network they are going to use because it saves them money.
Why do employers choose to be self-funded? Control. They call all the shots and have final decision making authority if they have retained Fiduciary duty (which most do). They also can avoid compliance with state insurance laws which differ from state to state. This is helpful for large employers with locations in different states. Self-Funded ERISA (Employee Retirement Income Security Act)Plans are subject to Federal law. Plans do not have to comply with state laws. Some self-funded Plans retained grandfather status when Obamacare came out and they do not have to comply with healthcare reform requirements such as offering external review or preventative services. ERISA prevents you and your doctor from suing for punitive damages if your claims or medical treatment is denied. You can only sue for the cost of your claim. Guess who you get to sue in Federal Court??? The Plan sponsor -- your employer. Not many people want to do that.... ERISA is stacked heavily in favor of the employer. There are tax benefits of being self-funded and savings a group can achieve versus buying a fully insured Plan from the insurance company.
I've always found it very interesting that Americans are kept in the dark about how their insurance really works and claim funding. Personally, I think it is no accident and ignorance is what keeps the current ineffective system in place.
Of course demand will go up as more people have access to healthcare. What's wrong with that?
Better than having less demand and more people dying as a result because they can't afford healthcare. Of course, our Wall Street profit-based system doesn't care much if you live or die. The priority is to making money not saving lives.
Greater demand causes supply to go up. Economics 101.
But the astronomical cost of medical school doesn't help to expand the supply.
$200,000 average cost to go to medical school in the US vs $50,000 in Canada and Europe.
That is on top of the $100,000 or more you paid for your US undergrad degree.
This is crazy. Why does your problem now become my problem? I have nothing to do with you getting sick. Had I caused your illness, I should be liable, but I didn't.
Who pays the bills isn't the issue. The real question is why is healthcare so prohibitive expensive compared to any other nation on the planet?
Duh, the more profit the better!!! It will bring more competition and drive down the price more quickly.
Economics 101.
Not with all the patent abuse rife in the industry. Good luck trying to create a new pharmaceutical company to compete with the big boys. They'll litigate any new potential competition out of business.
Very interesting. So in addition to having to deal with dozens of different insurance companies all with their own rules, providers are also forced to deal with hundreds of different companies each with their own set of rules and policies. Jesus Christ.
Employer-based health insurance has to be the dumbest thing ever invented.
Quote:
Originally Posted by Angie682
You don't understand how a self-funded employer sponsored healthcare Plan actually works. You're not alone. If more Americans had a basic understanding of this process, the healthcare debate might be very different.
Most Americans are completely clueless when it comes to their "insurance." I've worked in the industry for 25 years primarily with self-funded employer sponsored Plans and am an appeals supervisor at a major "insurance company."
Most Americans are enrolled in self-funded, employer sponsored health care plans (at least 60%) vs fully insured Plans.
When you are enrolled in a self-funded employer sponsored Plan, what this means is your employer actually funds all of the employee claims (sometimes with assistance from a reinsurance policy) for catastrophic claims. The money to pay all employee claims comes FROM your employer not the "insurance company." Insurance company is also not the correct terminology for self-funded employer sponsored Plan.
What your self-funded employer does is hire a third party administrator or TPA (Aetna, Blue Cross, Cigna, insert random TPA name here) to process employee medical/dental/vision claims, provide customer service and process appeals. The TPA works for your employer, just like you do. The TPA gets a monthly fee to administer the Plan for your employer. The TPA gets access to your employer's bank account to cut the checks to providers. The TPA gets paid to make you think the "insurance company" is really the bad guy and disguise the fact your employer is really the one calling all the shots.
Surprise!!!! Your employer is really the bad guy, not the mean old "insurance company." Your employer actually determines what benefits, exclusions and types of Plan they are going to offer. Many write their own Plan documents. So if you went from a great PPO Plan to a crappy high deductible health Plan -- your employer did that to save THEIR money. Your employer is the one that chooses which PPO network they are going to use because it saves them money.
Why do employers choose to be self-funded? Control. They call all the shots and have final decision making authority if they have retained Fiduciary duty (which most do). They also can avoid compliance with state insurance laws which differ from state to state. This is helpful for large employers with locations in different states. Self-Funded ERISA (Employee Retirement Income Security Act)Plans are subject to Federal law. Plans do not have to comply with state laws. Some self-funded Plans retained grandfather status when Obamacare came out and they do not have to comply with healthcare reform requirements such as offering external review or preventative services. ERISA prevents you and your doctor from suing for punitive damages if your claims or medical treatment is denied. You can only sue for the cost of your claim. Guess who you get to sue in Federal Court??? The Plan sponsor -- your employer. Not many people want to do that.... ERISA is stacked heavily in favor of the employer. There are tax benefits of being self-funded and savings a group can achieve versus buying a fully insured Plan from the insurance company.
I've always found it very interesting that Americans are kept in the dark about how their insurance really works and claim funding. Personally, I think it is no accident and ignorance is what keeps the current ineffective system in place.
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