08-20-2012, 08:49 AM
Since everyone who thinks the law might help is a schmuck, I guess its okay to use the term dumbshit to describe people like yourself who are so ignorant of the insurance industry that you think the major health insurers are also in the casualty insurance business. A few casualty insurers are in the health insurance business in a relatively minor way. Federated Mutual and (I think) Aetna come to mind. But none of the big healthcare players are in the casualty business. They're not about to get into anything with real risk involved, as that goes totally against their business model as a parasite that simply sucks money out of the system as it passes thru their hands. In fact, most casualty insurers who were in the health insurance market in the past were eventually driven out of the market by "the Blues" who, for the most part operated as non-profits, with all the tax advantages inherent in that status, until the for profit casualty insurers moved out of health insurance, and only then did they decide to become for profit operations so they could operate with very little competition and rake in billions in profit without the government scrutiny that comes with operating as a non-profit.
Originally Posted by Newman109
08-20-2012, 09:11 AM
Muncher, I should have mentioned, that at the time all this happened to my wife, I was not on medicare, she was. I was still employed at that time and under 65. The insurance was provided by my employer and it cost $350/mo. to add a spouse to the insurance. She was four years older than me. Medicare stated that our private insurance would be her primary insurance, and medicare would be secondary. The $480,000 was the amount that my health insurance paid to providers according to the invoices that I have and added up. Yes there was a 30 day limit at the convalescent hospital and they released her after the 30th day. I don't know how much her medicare paid during all of this. I paid her part A&B. When I retired, I kept the insurance that my employer provided, and I pay monthly what it costs the company each month for the employees. It is now almost $640/mo. My wife passed about four years ago, so I just have the $100/mo. A&B and the monthly cost of the insurance is just for me. Sorry for the confusion.
I edited my previous post to read this:
On edit: How will single payer affect us retired persons. I pay for the private health care, I can't really afford it, I am just squeaking by. I have never been late on any of my monthly debts but there are no luxuries. I would really like to spend the money I spend on health insurance to go fishing and on other things. I have this feeling that if I go to the hospital with only medicare I might not receive the same level of care that I would with what I have now. I'm not really against single payer but will it cost more or less than I am paying now and will I get the same level of care that my wife received during her hospital stay.
08-20-2012, 09:21 AM
57% of americans have some form of employer "sponsored" health care- which ranges from people who get full coverage as a benefit, to Walmart employees who can choose to pay $15 per pay period for a very basic policy.
Originally Posted by MichaelP
and, around 25% of americans currently have "socialist" single payer insurance.
08-20-2012, 09:33 AM
Whatever dude. It will eventually be single payer the way we're going.
Originally Posted by metlmunchr
You want government scrutiny? Looks like you have it with Obama.
Last edited by Newman109; 08-20-2012 at 03:22 PM.
08-20-2012, 09:50 AM
08-20-2012, 11:36 AM
No, we won't get jack shit.
Originally Posted by Nick
Romney will win and the conservafucks will retake the senate. Then it will be game over. Rich people and big corps will get way richer and the rest of us will get our ass holes pounded. They'll have to cut entitlements to make up for the debt that Obama ran up. It will all be blackies fault. They'll be left with no choice.... gotta lower taxes on zillionairs and make the rest of us pay. Oh, and don't forget they'll have to deregulate the banks more so their Jew overlords will continue to fund their campaigns.
08-20-2012, 11:47 AM
I wonder if the insurance company coughed up the entire amount.
Originally Posted by Nick
My sister recently had surgery. The bills came to just under $40,000.
The insurance company agreed to pay $3,500 and the hospital took it. Not sure where the rest of the charges went.
The medical community has to take some blame as they seem to inflate the bill, then agree to a lower amount.
I'll bet dollars to donuts that this has to do with profit/loss statements and writing off losses for end of the year taxes due to our convoluted tax code.
On number two, some of these filers might be "married filing jointly" so counting returns is kind of skewing your numbers.
I do get your point.
For myself (joint return) I could pay $20,000 per year and come out ahead if everything was paid for, IE: no deductible coming out of my pocket.
Since this would be pre-tax money I would come out ahead.
An advantage would be that I would be more inclined to visit the doctor, hopefully finding something bad early when the cost to fix it would be lower.
My guess is that this is one big driver of our high cost per person, nobody goes to the doctor until it is too late under our system.
I hear this from my friends and relatives in other countries. A small problem or pain and you go see somebody, here we wait until you can't live with the pain or can't breathe.
We need a way to change this to get our costs down.
I just lost my mother last weekend and maybe it could not have been stopped but she was feeling discomfort last year.
By the time she went in it was probably too late but even then they did not do the needed tests to know what the problem was (bloodwork says it's just muscle pain..).
Weird system we have, evidently there is a limit on when you can do a MRI and there is also a limit on how much of the body you can scan in one test.
First day in the hospital, "we can stop or at least slow this, 5+ years".
Third day, "let's test some more", now 1-2 years.
Each day, "hmmm, somethings not right", more images and more bad news.
One week and they give you the big story and then give you the real bad news. Two days and it is over.
We start out at 5 years or more and in 5 days the "professionals" buy a clue and say 2 weeks or less.
I have no grasp as to why more work was not done from the beginning letting us know what was going on.
It does turn out that the MRI machines are not actually owned by the hospital but by a group of doctors and they charge back to the hospital for each scan.
For some strange reason I suspect "profit" motives here.
Don't even get me started on the incompetent RN who sat for 15 minutes trying to get through the basic menus on the IV machine while the family sat there as he punched away at buttons getting one alarm code after another. If one of my employees was "guessing" like this on one of my machines he'd be sweeping floors and cleaning coolant tanks.
Five minutes after he leaves the room the alarm goes off again. My little sister goes out in the hallway and asks him if he can turn the alarms off.
At this point I go out of sight of the family and ream him the same as I would one of my guys. He calls for help, then someone else comes in and resets the unit and it starts working.
Between this and overhearing conversations between doctors during working hours about their new car or high buck vacations I have lost faith in our system to care for people.
The chase for the almighty buck seems to have invaded our system both on the patient and care side.
I know there are good doctors out there but at this point I have the same respect for a MD as I do for the engineer who spends his whole day on the internet checking the value of his stock portfolio.
(Yes, I'm a little wound up about our system.... deep breath, deep breath, count to 10.....Rant mode off)
08-20-2012, 12:01 PM
"I've been buying auto insurance since I was 18. I'm now 66. I've never filed a claim. I've lost all my premium payments to the insurance companies and gotten nothing in return. Or some would have you believe. What I actually got in return is security."
I think car insurance is a bit of a different boondoggle. A cautionary tale follows:
About ten years ago, my wife rear-ended another car down the street. I did not see what
happened, but it was clearly her fault.
A few months went by, and our insurance company, which of course had paid the claim
of the other car owner, did cancel our insurance.
Holy cow, says I.
I did inform my wife that she would have to do the legwork to get insurance for our car
again, figuring it would be some kind of assigned risk pool, and we'd be on the hook for
five years that way, with substantial financial penalty.
A few days later, she calls me and says, "all set. "
Turns out she got the same level of coverage, for LESS MONEY than we had been
paying (policy was in place before the crash, about ten years) and the new insurance
company was clearly informed of the crash.
What this says is, our rates had been slowly, steadily jacked up over the years. We were
paying way too much and never thought to shop around.
My suggestion to folks, DP included, is to consider changing insurance companies every five
years or so for vehicle insurance. Keep 'em honest.
08-20-2012, 12:30 PM
I Googled around looking for pros and cons of NHS.
In one link I came across this summation that I think expresses the whole thing well:
"Overall, I think the piece of mind the NHS provides outweighs the private healthcare system."
In countries where the standard of living is comparable to the USA I think most Americans will find that getting ill and needing treatment where there is a NHS doesn't give the same concerns as it does in the USA. You certainly won't need an understanding insurance company or bank manager.
I mentioned several posts ago that I had to get a MRS. Been done and the result is in. I now have it in writing that my head is normal
Turned out it was a skin irritation (giving me a headache) that some special oil cured and which I took. My doctor just wanted to be sure it wasn't anything else.
Last edited by Gordon B. Clarke; 08-20-2012 at 02:23 PM.
Reason: pos to pros
08-20-2012, 01:11 PM
Bob, Sorry to hear of your loss and the circumstances around it.
Originally Posted by CarbideBob
08-20-2012, 01:26 PM
You raise a good point, for which there is an answer.
Originally Posted by MichaelP
The percentage of health insurance paid by companies varies all over the place. Some don't cover anything. Others have generous plans. However, the generosity is subsidized by the 100% tax break they get for providing insurance. In an average circumstance, the employee will pay some of their costs through payroll deductions, the employee will pay still more through deductibles, the company will pay a significant chunk, and much of that will be subsidized by the US government. Trace it all back to its roots and consumers (typically 75% of our economy) are currently paying the majority and would continue to do so under most future possible scenarios.
It's important, as you suggest, to separate a discussion of reality (the current ACA law) and possible future scenarios; including having a public option (slightly likely) and single payer (very remotely likely). Under ACA there are incentives for more companies to provide insurance. What's likely to happen, IMO, is that most large companies will continue their practices of offering insurance to remain competitive on fringe benefits; that some small companies will add insurance, that others will drop insurance, that WalMart will still suck in regard to insurance; and that overall not much will change with one exception. That exception is the insurance exchanges, which will allow small companies and individuals a shot at getting competitive rates.
PS -- As for your "blood sucking imperialistic pigs," I spend a fair amount of time in my local "progressive" community explaining why the corporate form of organization is a tremendous invention and, properly regulated, a force for good. Surprisingly, many more of these far left liberals end up understanding that notion, than the far right here understand that government, carefully watched, can also be a force for good.
PPS -- Wish I didn't have to follow the above post -- and on-edit, since deleted
Last edited by PeteM; 08-20-2012 at 04:38 PM.
08-20-2012, 01:52 PM
Kind of a made up issue, IMO. Direct payment is far less expensive than sending out paper bills, writing checks, stamping envelopes, opening envelopes, manually crediting payers, dealing with late or lost payments, and the like. Having direct payments should be seen as a cost-saving measure, of the sort we desperately need.
Originally Posted by Newman109
The average person already has several suppliers using direct payments. In my case that included a mortgage loan, my new Medicare part, my new private medical insurance supplement, my old insurance policy, etc. My wife wants all our bills paid direct. Practically every private company, right down to magazine subscriptions, wants some sort of electronic payment.
The bottom line is that today's consumers need to have passed at least 5th grade maths to properly manage their funds. Their greater risk from allowing direct payments would be signing up with a crappy cellphone company, with unpredictable overcharges.
Last edited by PeteM; 08-20-2012 at 05:26 PM.
Reason: missing a space between two words
08-20-2012, 02:14 PM
Originally Posted by PeteM
Pete, coming from the right side of the isle, I must confess to the truth of that statement.
But I'd single out this snippet from the above:
Who do you propose should be doing the watching and how?
government, carefully watched, can also be a force for good.
I agree with the bold letter quote you've posted.
I also make it clear that I would shed no tear for any insurance companies in the healthcare field.
What I would say tough is that regardless of NHS or private heath coverage, we apparently all have the very same problem, some of us just don't know it yet.
Just google the following:
"country" health care deficit
Where you can substitute "country" with the name of each and every European or North American countries you know of.
I believe you will conclude that pretty soon it won't matter who pays for healthcare unless we figure out how to get the actual costs under control.
I've said it before and say it now again. My problem with Obamacare is that right off the bat it made a deal with pharmaceuticals and removed tort reform from the table.
Without those, the Affordable Care Act cannot use the word "Affordable", hence the short name "Obamacare".
08-20-2012, 03:15 PM
"Who do you propose should be doing the watching and how?"
1) google 'separation of powers' or 'checks and balances.' Our government has three parts and they all work
differently. There's a reason for this.
2) often taxpayers have the job of watching the henhouse. There is a chance to
vote new foxes in now and again.
Don't like yer congrescritter? Fire 'em and hire a new one.
decision has thrown a bit of a monkey wrench into the works. As one famous
candidate said, "corporations are people too!"
Want more of that, vote for him come november.
08-20-2012, 03:54 PM
Some interesting numbers can be found here: How Much Money Do Insurance Companies Make? A Primer - NYTimes.com
Apparently, contrary to our beliefs, insurance companies don't make 20-30% profits. It's more like 5% or so. They spend about 85% of the premium money to cover the healthcare expences. About 10% go to their operating expenses (from the salaries to the paper clips), and 5% is what we call profit. Nothing spectacular.
Yes, we lose 15% of our premiums to have them redistributed to us, but I doubt that all this job (that only sounds simple) can be done significantly less expensively, yet efficiently.
08-20-2012, 04:50 PM
That would be us, the voters, aided by a free press. If we started paying attention to real issues, demanded honest metrics for the quality and cost-efficiency of government services, and rewarded the good guys and threw out bums each electoral cycle we'd be in pretty good shape.
Originally Posted by SeymourDumore
There have actually been a few steps in the right direction. Many states have stopped or reduced gerrymandering. Sensible term limits are also in place for many offices; long enough for people to have an impact and short enough to make it harder for politicians to have dynasties. The GAO does a pretty good job of providing metrics in many areas. For all its excesses, the Web does allow a careful citizen the opportunity to dig into an issue. In its small way, even this forum and its more responsible respondents is a plus. We also have somewhat disinterested observers, such as BBC or the Economist, paying attention to our issues. Smaller nations don't have that luxury.
As for steps in the wrong direction, I'd cite two things. First, the idea that winning at all costs is more important than serving the American people. That one has come and gone over the years. Folks like Carl Rove have brought it back more recently. Second, the huge infusion of PAC money, now shielded from public scrutiny by the Citizens United decision. The average voter is being "played" by special interests and media channels only to happy to stir the pot (e.g. Fox "News" and MSNBC).
08-20-2012, 04:58 PM
Originally Posted by PeteM
Hate to be cynical, but is that something new we can do now?
What happened to the bums we did throw out?
08-20-2012, 05:14 PM
The typical "medical loss ratio" across the medical insurance industry is around 20%, not the 15% cited in the one year WellPoint example. The insurance industry counts it as a "loss" whenever they actually pay health claims. That strange language is a hint to the culture. As folks like Jim Rozen point out, many insurance companies historically had even higher medical loss ratios. Recent law in some states, and most recently in the ACA limits it to 20%. My own Blue Cross subsidiary had to return a bit of money this year because they made more than 20%. Anyhow, the main point here is that insurance companies are converging to the 20% figure, the maximum now allowed by law.
Originally Posted by MichaelP
Now, a couple of things to keep in mind. First thing is that the role of an insurance company is to collect money, then pay it out, and do a bit to deter fraud along the way. This is essentially the same function provided by a money changer, PayPal, Visa, American Express, etc. Those (credit card, etc.) companies manage to collect money from all sorts of people, many of them poor risks or even crooks and then pay it through billions of transactions. They spend a lot of money to deter fraud as well. They do all this for about 3% off the top. Arguably they have a tougher job, since medical insurance companies collect money in big chunks, direct from pay checks, and pay it back in big chunks, to hospitals and doctors. There are far fewer transactions to track, with much lower risks of not being paid on the front end. They face similar issues in deterring fraud on the back end. So, the first thing to remember is that this 20% collected for profit, overhead, etc. is about 17% too much. The final proof of it is all the many nations, as well as Medicare, which manage to do the job for around 3%.
If we look at where the 20% goes, you're right that all of it doesn't show up in profits payable to shareholders:
- A big chunk goes to private jets, gold foiled china, and executive perks.
- Another big chunk - many billions - goes into systems and procedures designed to lock doctors and hospitals into their network.
- Still another big chunk goes to billing offices designed as much to deny and delay claims as process them. Most physicians I know complain bitterly about the hoops they have to jump through to get paid; and it also adds to their own overheads to process and reprocess claims.
- Then there are the huge salaries paid to medical insurance execs, for a job that should get paid much more than an Associate Prof. of Accounting or Risk Management at a mid tier school. In a truly free market, they might be paid as much as professional Frisbee players.
- We can then add the billions each company spends on PR, lobbying, PAC money and the like to maintain their plush position.
- Last of all there is profit. One should note that the average manufacturing company makes about 5% (these days, lucky to break even). The article notes profits of 10-15% in recent years for the insurance companies.
08-20-2012, 05:39 PM
08-20-2012, 06:16 PM
It's always dangerous to offer advice, even when asked. But, here goes . . .
Originally Posted by SeymourDumore
I'll assume, from your frequent and usually thoughtful posts, that you tend to vote Republican? If so, here's something to try: vote for at least Democrat in the upcoming election.
I've split the ticket in every election for the past four decades. There's never been in case, IMO, when one party had all the best candidates.
Seriously, start with a list of issues. Truly figure out where the candidates stand. Knowing you'll be voting for at least one (gulp) Democrat will demand a serious look at the candidates.
I'd humbly offer the same idea to anyone (there are a number of candidates on this forum) who likely votes a straight Democrat ticket: understand the issues, do a fair amount of homework, and vote for at least one Republican in the coming election. If we can't cross the aisle, why should our representatives?