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#Post#: 14294--------------------------------------------------
A great Republican idea...You‘ll be healthier if we take away yo
ur healthcare
By: SHL Date: April 11, 2019, 10:46 pm
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This is one of those „only in the USA“ stories that‘s too crazy
to be believed, but is real.
HTML https://prospect.org/article/another-gop-brainstorm-youll-be-healthier-if-we-take-away-your-health-care-struck-down-court
#Post#: 14568--------------------------------------------------
Re: A great Republican idea...You‘ll be healthier if we take awa
y your healthcare
By: MartinSR Date: April 20, 2019, 1:52 am
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I'm not sure if I understood this article well. It's probably
because I know nothing about the US health system. The
impression I got after reading it is that (at least in a few
states) you have to work to benefit from the health insurance.
And losing your job or getting the disease which is considered
incurable and prevents you from doing your job, results in
losing your health insurance. As I said I don't know your
healthcare system, so I don't know what are the options (if any)
for those who are no longer eligible for the health insurance.
I may say as I see it in my country (at least what I'm aware
of).
Here you have to pay the health insurance - it's rather small
amount of money every month, so even people with the smallest
possible income can pay it. It is normally payed by your
employer or by yourself (In case you are self-employed). If
you're diagnosed as unable to do any work the social security
pays it for you (But you have to follow their rules to not lose
it). When you lose your job, you have to register as unemployed
- you get a small amount of money during the next few months and
you are insured (But again - you have to follow their rules and
not refuse if they find a job for you). The children are insured
by default.
Our major problem with this insurance system is that the amount
of money entering it is rather small and the insurance covers
theoretically everything you can think of (As long as it is
saving life or health, so things like plastic surgery are
covered only in very specific cases). So when your doctor orders
a specialist procedure for you, they put you on the waiting
list. For some types of procedures you may wait even 10 years or
longer. For example when you are ordered to have a brain CT scan
because of returning headaches - you wait 3 to 9 months. I was
put on the list for the knee arthroscopy once and the estimated
date was after 3 years or so (they called me after 2 years, but
I was no longer interested, because my knee was much better -
so the system worked perfectly in my case).
Of course there are other options. You can always pay for the
procedure to have it earlier. Many people use other shortcut.
They go to the hospital waiting room or Emergency ward. The
doctor there has to examine you, before he decides is it
emergency or not (And sometimes he needs additional procedures
like CT scans to be sure about it - he isn't interested in
meeting the lawyer in case he refused the patient). So you have
your CT instantly instead of in a couple of months. You must be
only prepared to wait several hours in the waiting room because
there are many people interested in this form of healthcare.
And here we get another negative side - seriously ill patients
are waiting together with those who try to go around the normal
queue... And we have cases of the death in a waiting room from
time to time...
#Post#: 14584--------------------------------------------------
Re: A great Republican idea...You‘ll be healthier if we take awa
y your healthcare
By: NealC Date: April 20, 2019, 9:20 am
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It is a tough issue, and will only get tougher as our population
ages. There is no silver bullet to fix it all, it has to be a
dynamic compromise between wait time (rationing), Doctor
salaries, tort reform (what lawyers can sue for), cost, and even
health care panels (better known in the US as "Death Panels").
I would like to see a truly free enterprise based system loosed
in the US to create solutions between insurance companies,
doctors and hospitals. We have not seen that yet, and I think
it can work. If we can't make it work, then I am open to a
government based plan.
The current situation in the US, which is neither truly free or
truly government is a 'worst of both worlds' hybrid
Frankenstein's monster.
#Post#: 14617--------------------------------------------------
Re: A great Republican idea...You‘ll be healthier if we take awa
y your healthcare
By: SHL Date: April 20, 2019, 6:19 pm
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Like Neal said, the US system as it now exists is a Frankenstein
monster. It costs twice or more than twice what the same thing
in other countries with nationalized systems costs and many are
left Uninsured in addition.
The thing about the US system is it grew to become extremely
complex, not by design, but by a complex number of historical
reasons. The vast majority have access to some sort of
healthcare (I could look up the numbers of uninsured but it`s
all online for the interested. It`s not like people are dying in
the streets- the rich wouldn’t like that anyway. It wouldn`t
make the streets look too pretty). It`s just that we devised
over the years multiple ways of paying for this through various
insurance sources and it`s a jumbled mess.
Keep in mind, the problem with insurance, as a general rule, is
that when you add insurance to the cost of any commodity, you
automatically inflate the price of that service. That´s why
healthcare costs are out of control in the US. And I don`t think
this is the kind of thing private insurance will fix. The theory
behind the competition model is simple enough: add more doctors,
more medical facilities, more insurers to the mix, and the
competition will bring the price down because people will lower
their prices to beat the competition. This works fine in some
service areas, selling computers, or tomatoes, but not all. In
healthcare and with auto insurance rates it doesn`t seem to work
too well. But, in non-insurable services it works great. (Think
of the airline industry. Deregulation in the late 70s caused
airfares to plummet. Flying anywhere now is cheaper than it ever
was, and it costs no more in the US to fly than anywhere else in
the world.)
But healthcare isn`t like that.
Here, employers all have to have workers compensation insurance.
That´s for on-the-job employee injuries. That covers healthcare,
and work disability costs and even permanent disability. So,
that`s one source of healthcare insurance. Car insurance is
another. Then we have military service coverage for people
actively in military service and their dependents; coverage for
those retired from the military, and those who were in it for
awhile but didn`t serve 20 years. Those two are separate
government operated systems. Then there is government sponsored
coverage for the older folks, age 65+, called Medicare. But it`s
not entirely free for all, and is complex in terms of what
additional payments have to go along with it. Some pay
$500/month out of pocket for it. Some pay nothing, like my mom.
She`s 91 and is double-covered by both the military system
(because my dad was a retired colonel in the Air Force) and
Medicare. So, for her, with blended health insurance together,
her double coverage, she pays nothing for healthcare, just like
in Norway. She doesn`t like the military coverage so elects the
private hospitals and doctors, but it`s still all free for her.
That`s because the military pays a premium to Medicare for her.
See, it`s highly complex.
Then there`s government health insurance coverage for the very
poor called Medicaid- not to be confused with MediCARE, they are
totally different. It`s only for the very poor, usually
unemployed but not always within certain guidelines- again more
complexity. (I can`t recall if it`s available for individuals or
only individuals with a child(ren)). It´s medicaid that was the
subject of the article. Two states wanted to make people do some
work, the very poor who could qualify for it, but were NOT sick,
just to earn it, and that is what the court invalidated. The
title of the story is misleading in this respect.
Then there is private insurance systems of a variety of sort
paid partly by employers and party through deductions from
paychecks by workers. They are highly variable in what they
cover and what co-pays are applied. Again, extraordinarily
complicated.
Again, as Neal said, it really is a Frankenstein monster of
sorts. It we had a national healthplan covering everybody, we
wouldn’t need workers compensation, or car insurance to pay for
anything other than property damage (because the national health
insurance would cover all injuries), and you would need a much
smaller military healthcare system only for people actively
enlisted and overseas. You wouldn`t need Medicare or Medicaid
either. So, it`s finding a way of unraveling all this
complexity that`s a huge part of the problem.
So, it is the biggest mess the US has at the moment, I`d say, at
the social level.
#Post#: 14621--------------------------------------------------
Re: A great Republican idea...You‘ll be healthier if we take awa
y your healthcare
By: NealC Date: April 20, 2019, 7:04 pm
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I disagree with your point that it does not work with Auto
Insurance, the insurance model works wonderfully there. Auto
insurance is so tied to actuarial tables now, you can call up
any number of companies tell them the make, model of your car
and the state you live in and get a quote in minutes. Geico is
a cash machine for Warren Buffett, a guaranteed rate of return.
We will know we have conquered the beast in health insurance
when you can make a similar call to an insurance company, choose
the services you want, and get a quote in minutes. I would love
to see if a private plan could work, because of my general
hatred for government and my belief in their horrible
inefficiency. But it would take far more will and leadership
than is currently available in Washington.
#Post#: 14622--------------------------------------------------
Re: A great Republican idea...You‘ll be healthier if we take awa
y your healthcare
By: SHL Date: April 20, 2019, 8:01 pm
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[quote author=NealC link=topic=963.msg14621#msg14621
date=1555805069]
I disagree with your point that it does not work with Auto
Insurance, the insurance model works wonderfully there. Auto
insurance is so tied to actuarial tables now, you can call up
any number of companies tell them the make, model of your car
and the state you live in and get a quote in minutes. Geico is
a cash machine for Warren Buffett, a guaranteed rate of return.
We will know we have conquered the beast in health insurance
when you can make a similar call to an insurance company, choose
the services you want, and get a quote in minutes. I would love
to see if a private plan could work, because of my general
hatred for government and my belief in their horrible
inefficiency. But it would take far more will and leadership
than is currently available in Washington.
[/quote]
Car insurance is based on risk tables, yes, as health insurance.
But, the differences are enormous. I only cited auto insurance
as one of many sources that pays medical bills under certain
conditions (car accidents). I`m not aware of any studies on it,
but car insurance rates are usually pretty low and fairly
stable. That`s because people often go their entire lives and
never make a car insurance claim. But, how many people can get
away with never going to the doctor in their entire lives?
Nobody.
The principle of insurance inflating the costs of services is
easily proved. Why are University tuition rates through the
moon? Because of the student loan program and government
insurance guaranteeing against defaults. Without the government
insurance backing it up, it would be very hard to get loans for
school (how many lenders are going to hand out unsecured loans
to people of $150,000? Ah, probably none, except to people who
don`t need them anyway, like millionaires. It´s just too risky).
I did personal injury law (yep, that bottom-feeder ambulance
chasing type) for 10 years in the 90s working for some older
guy. Everyday, he`d have a stack of anywhere from 10-20 cases on
his desk and spend the day on the phone with the insurance
companies settling the cases-all car accident cases. They
usually settled for between $10,000 and $20,000 a piece at the
time, with him keeping a fee of 1/3. Now, down the street, about
mile from us, was the courthouse, where these sorts of cases had
to be filed and, if necessary, tried. The court had never in its
entire 25 or 30 year history ever have a jury award more than
$4,000 on ANY case it ever had had. Yet, we were settling these
cases down the street for 4 times that amount or more everyday.
Why was that? I asked the old man once about it, and said I
thought it was curious. Being the wise old gent that he was, he
just sat me down one day and said, „Steve, it`s just insurance.
You know that. Whenever you add insurance to the value of any
commodity or service, you just automatically inflate its value.“
True. The insurance companies found it more cost effective to
pay $15,000 to us, than to spend $15,000 on attorney fees and
have their insured drivers (who would surely be unhappy) being
dragged into court defending a case they all knew they`d win
anyway. It was just made good business sense.
Has competition driven the costs down? Maybe a little, but I
rather doubt it.
But, health insurance, by contrast, is a monster of epic size
and proportion compared to car insurance. And far more expense
and complex.
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