Register | Sign In


Understanding through Discussion


EvC Forum active members: 65 (9162 total)
3 online now:
Newest Member: popoi
Post Volume: Total: 915,817 Year: 3,074/9,624 Month: 919/1,588 Week: 102/223 Day: 0/13 Hour: 0/0


Thread  Details

Email This Thread
Newer Topic | Older Topic
  
Author Topic:   WHY MANDATES ARE MANDATORY
dwise1
Member
Posts: 5930
Joined: 05-02-2006
Member Rating: 5.8


(1)
Message 3 of 58 (825453)
12-15-2017 1:24 AM
Reply to: Message 1 by AnswersInGenitals
12-14-2017 5:49 PM


I really wish that there were a legislative rule that required a legislature to learn something about what they are about to write laws about.
The Republican side of Congress is abysmally ignorant of the very basics of how insurance works, but then so is the White House.
Yes! For insurance to work you need a large enough group of insured to spread out the costs. To add to your explanation of the need for sheer numbers, we also have that insurance premiums are also based on other factors, namely teh risk that each insured party presents. As the press pointed out back when [voice=Lewis Black]Trump was playing his sadistic games and trying to mind-fuck us all[/voice] by hinting back and forth about funding or not funding the subsidies to the insurance companies for low-income people, insurance companies are really great at dealing with risk because that is their stock-in-trade (ie, that is what keeps their little actuarial hearts beating and happy), they cannot deal with uncertainty such as what Trump was torturing them and the entire country with.
In order to cover and pay for those who need medical treatment, insurance companies need as broad a base of insured people as possible. As you rightly point out, every other form of insurance does that. In California, if a traffic cop pulls you over, you also need to show him proof of car insurance.
But now to a pet peeve of mine, a health insurance nightmare I very nearly had to live. In their infinite ignorance, Trump and other Repugnicans keep offering this idea of letting you buy health insurance from another state where it's cheaper. Of course there's the trivial matter that their premiums are based on local state law and local actuarial tables, both of which would have to be massively recalibrated to account for people from anywhere in the country, the end-result of which would most likely be that their previous cost advantage would evaporate.
But the real problem with that should be apparent to anybody with any kind of medical insurance who has ever bothered to actually read their doctor's bill. I've almost always been in a PPO plan. My network doctor lists all the procedures (ICD-9 codes -- I once worked on a database project for medical therapists of all kinds, where I learned about the ICD-9 codes for everything and anything a doctor will treat or do) and the cost of each procedure. Then there's the amount that the insurance paid for that procedure, followed by a "PPO Write-off" of the remaining amount, excluding a percentage of the original cost that your doctor can still charge you for. So (pulling these numbers out of my rectum, though they are representative) you have a $400 procedure for which the insurance only pays $115, leaving $285 out of which you are charged $12 and your doctor posts a "PPO Write-off" of $273 -- I assume that they can use that as a business loss or the like, so they're doing alright. As long as you only deal with a network provider, all you would be on the hook for would be $12. But if you go out-of-network, to my knowledge your insurance will still only pay $115 and leave you on the hook for the remaining $285.
Now for the fun part. Those local state insurance plans make use of those provider networks. The insurance plan adds a provider (eg, a doctor) to their network which throws business their way. In return, the provider accepts their greatly reduced payments, tax write-offs, etc. The keyword there is local.
This is my real-life true story. Our company used to be a division of a larger company, but then we were spun off and sold to another company. That other company welcomed us, all very nice and proper, part of which included that we employees were all covered under their medical insurance plan. Wonderful, wonderful, thank you, thank you, but ... wait ... what? We are in Southern California and our parent company is on Long Island. The whole thing actually got to the point where every single employee in SoCal received the booklets of the medical plan and all the providers in the plan. Every single provider who was in the plan's network was in or within n miles of New York City. About 3000 miles away from Southern California. So then, to stay in-network, you would need to commute all the way across the country for each and every medical appointment. The alternative was to always go out-of-network in which case you were on the hook for whatever the insurance did not pay for, which would not be insignificant. The moment we became aware of the problem, we notified our local management and they immediately acted to resolve the problem, such that our corporate owners allowed us to negotiate locally for our medical benefits.
The point of all this is that Republican alternatives are unworkable bullshit. To add insult to injury, now they are coming up with smaller negotiating associations (somebody who knows more, please add to the discussion here) against whom there are many lawsuits because they are basically scams who do not pay for forthcoming benefits.

This message is a reply to:
 Message 1 by AnswersInGenitals, posted 12-14-2017 5:49 PM AnswersInGenitals has not replied

  
dwise1
Member
Posts: 5930
Joined: 05-02-2006
Member Rating: 5.8


(1)
Message 14 of 58 (825632)
12-16-2017 3:30 PM
Reply to: Message 9 by New Cat's Eye
12-15-2017 4:49 PM


Percy writes:
But it *does* need a solution. If not the federal government, who?
The entities that make up the system.
Yes, the health insurance companies. The very ones who created the problems. And whom the ACA had to bring on board, resulting in many unpleasant surprises.
Obviously, that does not work. We need a solution to this problem. Suggestions, please? Workable suggestions!
Percy writes:
People can run through their life savings treating a serious disease, then they die. Read Need an Organ? It Helps to Be Rich.
Sure, and people also spend a lot of money on newborns with congenital heart defects so they can suffer for a few months before they die.
Consider a personal history. When you retire, the last thing you want to still have are mortgage payments (though rent is now just as expensive). I am just now retiring and my condo is paid off. But that could have not happened.
8 years ago I needed emergency abdominal surgery. The total bill from the hospital was something like $65,000. Then three years later I needed angioplasty which cost about $81,000. Fortunately, we caught that condition before an actual heart attack, so that I ducked all the additional cost that would have created, not to mention all the follow-up treatment for months or years to follow.
So within the span of three years I racked up $146,000 in medical costs and had gotten off cheap. That's just $50,000 less than my mortgage was, so effectively that would have been a second mortgage I would have had to pay off. Except I had medical insurance, so my out-of-pocket expenses were less than $500. But if I hadn't had medical insurance, then I would be very deeply in financial hurt right now.
That's the reality being faced by millions of Americans who do not have medical insurance. Financial ruin or just die. Though just dying is a problem, because that takes a lot of time during which you are unable to work, so your family still suffers financial ruin.
Oh, sure, emergency rooms cannot turn you away, but that's no solution but rather contributes to the problems. Many poor are left having to use the ER for all their medical care, which not only overcrowds the ERs, but also causes the hospitals incur extra costs which they cannot collect from those patients. So they have to pass those costs onto the paying patients, which causes medical costs to go up. Also, they don't and can't provide the preventative treatment that people need to keep small problems from become major ones, so those poor people go in already in bad shape. And after saving that person's life at great expense to the hospital and to society, that patient cannot receive the follow-up treatment he needs and so he ends up in the ER again and again, all while he cannot provide for his family.
The drain on society alone is inconscionable. And it is at the root of the entire problem. The economics of healthcare in the US is insane.
Sure, and people also spend a lot of money on newborns with congenital heart defects so they can suffer for a few months before they die.
Oh, sorry, I didn't recognize you. You're on one of the GOP's death panels deciding who will live and who will die. Must be really easy work, since the decision is always for them to die.

This message is a reply to:
 Message 9 by New Cat's Eye, posted 12-15-2017 4:49 PM New Cat's Eye has not replied

  
dwise1
Member
Posts: 5930
Joined: 05-02-2006
Member Rating: 5.8


Message 15 of 58 (825634)
12-16-2017 3:37 PM
Reply to: Message 4 by Percy
12-15-2017 9:52 AM


Re: A Story for the Season
This isn't a story about insurance mandates but about love and commitment, with the importance of insurance the centerpiece. Read it. You won't regret it, especially at this most joyous time of year.
A fellow chief had a similar story. He was separated from his wife and had been for about 20 years (my memory of the exact number is hazy, but it had been a very long time). It was a fairly bitter separation and yet he refused to divorce her. The reason was that she had a serious chronic condition that if left untreated would kill her. If he were to divorce her, then she would have lost medical coverage under his insurance at work, so by not divorcing her he was keeping her covered. He didn't care one bit about her personally, but he didn't want his son to think that he had killed his son's mother.

This message is a reply to:
 Message 4 by Percy, posted 12-15-2017 9:52 AM Percy has seen this message but not replied

  
dwise1
Member
Posts: 5930
Joined: 05-02-2006
Member Rating: 5.8


(1)
Message 16 of 58 (825638)
12-16-2017 4:36 PM
Reply to: Message 7 by New Cat's Eye
12-15-2017 2:59 PM


I agree that everyone ought to have access to healthcare, but we already have that because hospitals don't turn people away. It's just not affordable.
Well, one way to make healthcare affordable would be to make medical insurance affordable. Given how insurance works, how would we accomplish that goal?
We could pass arbitrary laws and regulations that limit the premiums that insurance companies could charge while completely ignoring the economics of insurance. That would result in the insurance companies leaving the market for more lucrative things to insure, such that then nobody could get medical insurance. That wouldn't work.
What would work would be to work with the economics of insurance.
Provide medical insurance companies with a large enough population paying premiums and you can bring everybody's premiums down -- that is after all the most basic idea behind insurance to begin with.
So then, how to do that? We could require everybody to have medical insurance, but then you are adamantly opposed to that idea. OK, so then what's the solution? How do you propose that we enlarge the insurance base enough to bring everybody's premiums down to a sane level?
Here's a wild thought: a Mormon solution. The Mormons had chosen Boy Scouts of America, Inc, as the youth program for their boys. As of around 1990 (it may have changed a bit in the meantime) every single Mormon boy was enrolled in BSA from the earliest age until they aged out at 18. No exceptions. Every single boy was to make Eagle by age 14 at which point he went into the church's sports programs -- even though he was no longer active in Scouting, he was still automatically enrolled in BSA. To my knowledge, it was the Mormon Church that paid every boy's enrollment fee of $7 per year. One of the unfortunate side-effects was that the Mormon Church enjoyed great influence in dictating BSA policy, especially in BSA's religious discrimination actions in the 90's.
So, one possible solution would be for the government to automatically enroll every citizen in medical insurance and to pay for those who couldn't afford it. Of course, that would require the use of tax money, which I'm rather certain you would object to.
So, do you have any better suggestions? Workable suggestions? Ones which do not involve just letting them die lingering deaths?
... because hospitals don't turn people away.
In another message, I already discussed that as have others in this topic. It does not work! And it also contributes greatly to our insanely high cost of medical care. And it completely fails to provide the kind of medical care (preventative and follow-up) that people actually need.
I think that's a systemic problem and not something that needs a federal government solution.
Yes, it is indeed a systematic problem. So how do we solve it?
It was created by the free market, so the free market cannot offer a solution.
Local and state governments can try to do something, but their resources are limited and what would result would be a patchwork. It is a fact of modern life that people move about the country, usually trying to follow where the jobs are, so there will be many cases of someone moving from a place with coverage to a new place without coverage, which is no kind of solution.
In the face of such a patchwork (such as Percy's COBRA story in Message 13), there has to be something to coordinate everything. Since you rule out the federal government, what do you suggest should step in in its place?
The other night I met a girl who's engaged to someone in Northern Ireland. When she was laid off and extremely worried about medical insurance and not being able to afford it, he couldn't understand why she'd be so worried. When he discovered how much more he could earn here, he was ready to move until he learned about the absolutely insane housing and health-care costs here that would eat up all his extra earnings in an instant. On the radio I heard of a couple moving from the USA to the UK and their medical insurance costs went from $500 a month (it was a few thousand dollars per month before he went onto Medicare) to a little over $200 per year. As for the level of care and having to wait? The girl's Irish fianc's father or uncle was diagnosed with cancer; the very next day he was on chemo-therapy.
So then just what is the solution? We need a solution. You do not like the ones offered so far. So what do you suggest as an alternative. Remember, it must be both workable and not something which has already been proven to not work.

This message is a reply to:
 Message 7 by New Cat's Eye, posted 12-15-2017 2:59 PM New Cat's Eye has not replied

Replies to this message:
 Message 17 by Rrhain, posted 12-16-2017 9:49 PM dwise1 has not replied
 Message 19 by RAZD, posted 12-17-2017 10:47 AM dwise1 has replied

  
dwise1
Member
Posts: 5930
Joined: 05-02-2006
Member Rating: 5.8


Message 20 of 58 (825721)
12-17-2017 1:32 PM
Reply to: Message 19 by RAZD
12-17-2017 10:47 AM


Make them non-profit services.
Or have them operate under a government contract, which I think would be far easier than to dictate that they become non-profits. My statement referred to letting free market forces operate and determine what would happen. Requiring them to become non-profits would require strong government intervention in the form of new laws.
As a military retiree I have medical benefits under TriCare and, since I turned 65, under Medicare and TriCare combined (Medicare is my primary, TriCare my secondary/supplemental and my pharmaceuticals plan) Documentation I've received has at times named regular insurance companies as managing the plans.
In addition, for a wide range of public services we have government contractors, so having some insurance companies operate as government contractors either in whole or in part would not be far-fetched. Of course, with those contracts would come a lot of regulating which would cause an epidemic of leg injuries due to GOPista knee-jerk reactions.
But if we just leave everything up to the laissez-faire free market, as soon as being in the medical insurance market is no longer profitable, companies will leave that market. Evidence of this can be seen in the companies leaving or threatening to leave the ACA exchanges because Trump kept threatening to not pay his bills (which has always been his primary business practice) -- I lost track; has Trump actually stopped paying those subsidies?
Nobody should make a profit off pain, suffering and disease.
No, they shouldn't. But capitalism unchecked cares absolutely nothing for what's right or wrong, but only whether they can squeeze out the maximum amount of profit.
How could anybody actually work to profit from misery? Except for the obvious sociopaths who rise to the top, the normals working for them will continue to do their job since their bosses have the responsibility. Netflix still has Experimenter, an independent bio-flic about Stanley Milgram and his infamous 1961 experiments in which normal people were willing to administer lethal electrical shocks to another person so long as the experimenter assume all responsibility. Watch for the elephant in the room.

This message is a reply to:
 Message 19 by RAZD, posted 12-17-2017 10:47 AM RAZD has seen this message but not replied

  
dwise1
Member
Posts: 5930
Joined: 05-02-2006
Member Rating: 5.8


(1)
Message 23 of 58 (825848)
12-18-2017 11:54 AM
Reply to: Message 22 by New Cat's Eye
12-18-2017 10:49 AM


Percy writes:
Well, if that's the kind of society you wish to live in,
I don't wish it, but it is what it is.
Well if you don't want it to be that way, then why keep it that way? Why insist on keeping it that way when anybody tries to change it for the better?

This message is a reply to:
 Message 22 by New Cat's Eye, posted 12-18-2017 10:49 AM New Cat's Eye has not replied

  
Newer Topic | Older Topic
Jump to:


Copyright 2001-2023 by EvC Forum, All Rights Reserved

™ Version 4.2
Innovative software from Qwixotic © 2024