A health care anecdote

[Norman Bernstein]

It's not unusual that insurance companies would prefer that simpler and less expensive treatments be tried, before the more expensive ones are initiated... it's one method of holding the rising costs of health care down.

When I began to have trouble with my shoulder, the insurance company insisted on a period of physical therapy BEFORE resorting to an MRI, which made some sense.... the PT is comparatively cheap, while an MRI is expensive. However, when PT simply made my shoulder worse, they authorized the MRI, and the subsequent surgery (AND more PT afterwards). All of this was fine with me.

However, it doesn't always work to the benefit of the patient.

My new granddaughter, within a few days of birth, began to show evidence of a gastro-esophageal reflux problem. The best solution, according to the doctors, was a switch to smaller, more frequent feedings, as well as a switch to a special formula, available only by prescription, which is quite expensive.

The insurance company's judgment: the infant should attempt to be fed with three OTHER formulas, all far less expensive, first..... before they would authorize payment for the expensive stuff. In other words, they wanted the child to be the subject of a 'medical experiment' of sorts. Considering the fact that the symptoms of her problem were stopping breathing for 10-20 seconds at a time, this seemed damned unreasonable. My daughter is paying for the expensive formula, out of pocket, which could cost up to $6000 in the first year.

For all the talk of how the 'government' would get between a patient and their doctor with the AHCA, it seems that nobody realizes that this already occurs, and has been occurring for quite a while. Doctors all over the country tailor their treatment to the constraints of an insurance company's decisions about 'appropriate care'.

Would it be better, with the AHCA? Probably not a great deal. Would it be worse? I doubt it.

[David W Pratt]

Normally, good medicine involves a diagnosis (MRI) prior to therapy,
alternative diagnosis (which should be ruled out) would be a tracheo-esohageal fistula (remember Donald Sutherland mangling the pronunciation in the movie M.A.S.H.)

[Norman Bernstein]

This is what happens when we relinquish control of our routine health care to insurance companies. Under a high deductible/low premium policy, this crucial decision would have been made by the parents, not by the insurance company.

Hmmm.. you figure you're capable of diagnosing your own health status, and recommending the appropriate treatment?

[wardd]

This is what happens when we relinquish control of our routine health care to insurance companies. Under a high deductible/low premium policy, this crucial decision would have been made by the parents, not by the insurance company.

and they still would have wound up with $6000 out of pocket

[wardd]

Huhh? This comment bears no relationship to my post.

you bear little relationship to reality

[Norman Bernstein]

Well, let's use a clearer example.... loosely based on my own experience.

Approaching the dock, you jump off to tie on the stern line.... but as you land, your knee simply crumbles... the pain is intense, and you nearly pass out, but manage to maintain consciousness. You attempt to get up, but your knee feels like it's made of rubber... you can't put ANY weight on it, whatsoever. Your wife calls the maria office, and they send a couple of guys down with a golf cart, who help to tie up the boat (but not until you've smashed your starboard bow nav light, and put a $500 gouge in the yacht next to you). They then take you to the parking lot with the golf cart, and you get driven by your wife to the local hospital.

At the hospital, you wait 2 hours (you're not as emergent as other patients), and then you get an x-ray to rule out broken bones, a couple of Motrin to suppress the swelling, a pair of crutches, and a leg brace.... and are told to see an orthopedist. If you were insured, you might pay a $50 or $100 co-pay, but since you have high-deductible insurance, the bill is $750.... credit cards accepted, and since you don't carry that much cash, you put it on the card.

A week later, you get to see the orthopedist. The office visit is $275, and the inevitable MRI is $1500.... you're now $2525 in the hole. The results of the MRI: you've torn your ACL. You have a choice: you can hobble around on crutches for the rest of your life.... or you can have the surgery.... perhaps $12,000... for which, you'll expend the remainder of your $5000 deductible.

Except that you've already charged up $2525, money that you didn't happen to have, on $50,000 per year in gross income. You're not poor enough for government assistance with the premiums you're already paying, or with the high deductible.... but you can't hobble on crutches the rest of your life. So, you 'card' the rest of the deductible, at 29.99% interest, and start figuring out what ELSE you and your family have to sacrifice.....

...and you hope like hell that you don't have any other medical emergencies next year.

[wardd]

..and they would save $6000 in premiums every year of their lives that they don't have extraordinary health care events. The math is stone cold simple. You want it to cost more? Run it through a third party. You'll eventually pay the bill, AND the profit. Insurance should only be used to pay for that which is too costly to pay for ourselves.

unless there was a serious accident or ilness

[wardd]

I guess you and Norman expect to have accidents or serious illness every year of your lives. The rest of us who know better will happily pocket the savings of not over insuring ourselves. People with low deductible policies are paying for that yearly disaster whether they have it or not.

The math is stone cold simple, but it's clear that neither of you have put pencil to paper to learn it for yourselves.

you could save even more with no insurance and the country could solve the debt by collecting no taxes

[Norman Bernstein]

I guess you and Norman expect to have accidents or serious illness every year of your lives.

I don't expect that... but I'm wise enough to know that many millions of people do NOT have the assets to withstand the hit of a high deductible, should catastrophe occur... and many more, if faced with a high deductible policy, will 'self treat' to save the out of pocket expense, with the inevitable result that they'll get sicker, and require MORE health care resources, eventually.

Your 'economics' makes the assumption that people with high deductible plans will be saving and investing the difference in cost. YOU may indeed do that, but half the population lives paycheck to paycheck. When it comes to either putting that $500 in the bank every month, or paying for the rent and groceries, the choice will be obvious. THAT is what make high-deductible plans a really, really BAD solution.

[Vince Brennan]

Sorry, but this is how we perpetuate the cycle of poverty and a struggling middle class that doesn't understand why it can't make ends meet. We assume people incapable, ALL people according to the thinking currently coming out of Washington, of doing wise things for themselves. Your thinking says that we must wrest this control away from the individual because people cannot be trusted, even if it takes thousands more out of their pockets every year of their lives. They are too stupid to do the right thing for themselves, so a far more costly solution will be forced on them. Balderdash.

Sorry, but I totally reject this line of thinking. This is elitist snobbery of the worst kind. This makes people poor. It makes them ignorant of economic basics. It makes them confused and dependent. When we expect so little of people, little is what we will get.

Hmmmm. Last name, "Roberts" by any chance?

[Norman Bernstein]

Sorry, but this is how we perpetuate the cycle of poverty and a struggling middle class that doesn't understand why it can't make ends meet. We assume people incapable, ALL people according to the thinking currently coming out of Washington, of doing wise things for themselves. Your thinking says that we must wrest this control away from the individual because people cannot be trusted, even if it takes thousands more out of their pockets every year of their lives. They are too stupid to do the right thing for themselves, so a far more costly solution will be forced on them. Balderdash..

Great ideology, but bad pragmatism.

This is the classic conservative line, blaming people for being poor. The reason that millions of people can't follow your line of thinking is that they can't.... and survive. Your assumption that people of ANY income level can follow your notion of personal responsibility is a far worst form of snobbish elitism.

What would you have them do? Skip a rent payment? Work three minimum wage jobs? Not buy clothes for their children? Sorry, but there are MILLIONS of people who live from paycheck to paycheck.... barely hanging on. Expecting them to drop their standard of living, as modest as it may be, to be able to set aside enough money to cover a high deductible is simply unrealistic.... all that does is give you an excuse to castigate them for lacking personal responsibility... when they don't have the assets to exercise personal responsibility, by YOUR definition.

It doesn't sound like you have a clue as to how hard it is to raise a family on just a few tens of thousands of dollars per year.

[Norman Bernstein]

They're poor, in part, because so many have no faith in them.

Captured for historical preservation.

Whew!

[wardd]

Ridiculous assumption. Your way takes many thousands of dollars out of their pockets, because you believe them to be incapable of acting as you would. Nanny statism at its worst. They're poor, in part, because so many have no faith in them.

what does my having faith is someone have to do with their conduct

i don't have any faith in you does that mean you're off to hades in a hand basket?

[leikec]

Captured for historical preservation.

Whew!

It is simply amazing. "He" (or "she", or "it") and his ilk are always arguing that poor people don't pay their fair share of income taxes, and that the Bush tax cuts were unfairly weighted toward middle and lower income people at the expense of the wealthy, but now the "nanny state" is picking their pockets....

So apparently "we" should leave "them" alone so "they" can succeed, but "we" also should be taxing the crap out of "them" at the same time, so the "rich" can get a break.

I think "he" (or "she", or "it") erases posts so the track record of inconsistency and befuddlement is expunged from the record...

Jeff C

[wardd]

Wow. If you don't understand that......

are you saying i control the destiny of the world?

[wardd]

"unfairly weighted toward middle and lower income people at the expense of the wealthy"? Really? "Unfair"? "at the expense of the wealthy"? I've said nothing of the sort.

What I have done, repeatedly, and to a nearly deaf audience, is correct the oft repeated lie that that Bush tax cuts were "for the wealthy", when in fact the wealthy got a smaller percentage cut than did the lower brackets, and that the vast majority, over 80%, of the "cost" of those cuts accrued to the lower and middle brackets. Why do you think the Democrats recently renewed those cuts? As a favor to the rich? This is not a matter of perspective or debate. These are cold, hard numbers, and is no comment on "fairness" one way or the other.

If you are comfortable basing your thinking on disinformation, than have it it. You've been corrected. What you do with that information is up to you.

here are cold hard numbers, the average income of myself and bill gates makes us very wealthy

[B_B]

... You want it to cost more? Run it through a third party. You'll eventually pay the bill, AND the profit. Insurance should only be used to pay for that which is too costly to pay for ourselves.

You make no sense - you say the problem is insurance and you say the solution is insurance?

I completely agree that one of the main issues with the US healthcare system is the overhead and profit absorbed by insurance companies. To then proffer as the preferred solution that everyone just needs a different insurance policy run by the same guys who're the problem now, is, to my mind, absurd.

[Norman Bernstein]

The solution is not NO insurance...it's LESS insurance. And insurance that's chosen by patients, not by employers.

If you continue to rely on an insurance company (low deductible policy) to pay for routine care, you will continue to allow insurance companies to make routine choices, like what brand of baby formula a new mother buys, or whether or not you can take the drug your doctor prescribes. A high deductible policy takes the insurance companies OUT of the loop with MOST medical transactions, and saves the policy holder thousands, year in and year out.

Brilliant... Just brilliant.

The one place where health insurance works (unintentionally) to the consumers advantage is when insurance companies negotiate for lower prices on both drugs and procedures.... And you are suggesting that it's better for consumers to pay retail prices for those things?

Are you aware of the spreads between retail, and negotiated prices on these things?

Big pharma must love you.

[wardd]

The solution is not NO insurance...it's LESS insurance. And insurance that's chosen by patients, not by employers.

If you continue to rely on an insurance company (low deductible policy) to pay for routine care, you will continue to allow insurance companies to make routine choices, like what brand of baby formula a new mother buys, or whether or not you can take the drug your doctor prescribes. A high deductible policy takes the insurance companies OUT of the loop with MOST medical transactions, and saves the policy holder thousands, year in and year out.

Why is this hard to understand?

what's troubling is you understand it

[B_B]

The solution is not NO insurance...it's LESS insurance. And insurance that's chosen by patients, not by employers.

If you continue to rely on an insurance company (low deductible policy) to pay for routine care, you will continue to allow insurance companies to make routine choices, like what brand of baby formula a new mother buys, or whether or not you can take the drug your doctor prescribes. A high deductible policy takes the insurance companies OUT of the loop with MOST medical transactions, and saves the policy holder thousands, year in and year out.

Why is this hard to understand?

Why is it hard for you to understand that what you're suggesting still leaves the insurance companies, the bit you blame for the problems in the healthcare system, in charge of a significant slice of the system you say is broken.

If you think insurance companies will sit idly by as their premiums dwindle (in your scenario) then you've got another think coming. They'd rather make 4% profit on 20% of GDP than they would 20% profit on 4% of GDP. As, I'm sure, would you. Bigger pie and all.

Being that their mandate is to make profit (once mutual insurance companies disappeared there was no mandate to serve the policy holders, only the shareholders) they'll find ways to make profit.

The solution is to remove private industry from most of the healthcare system, and to strictly regulate those parts where private industry is allowed to exist.

[Horace]

The solution is to remove private industry from most of the healthcare system, and to strictly regulate those parts where private industry is allowed to exist.

But that's not what 0bamatax does, now, is it?

[Norman Bernstein]

If we lessen our demand for the insurance product by taking on higher deductibles, the insurance companies will be weakened, most of their claim activity gone, and the cost of their products will decline. That's how markets work....supply and demand. They do compete with one another, you know. Company "A" can't simply decide to raise prices and expect to hang on to their customers. Company "B" will then lower prices and garner all the business. That's how a consumer driven market works.

Beyond our own bad habits of relying on insurance to pay for routine and minor issues, insurance companies have no hook to keep us ensnared into buying excessive helpings of their products....unless the government forces us to. That is precisely what the AHCA does. It destroys the natural market forces that keep costs in line. It forces everyone to do that which you are railing against.

Too bad that's not how it works in practice. FEW people actually shop for health insurance; the vast majority take what their employers offer, and many employers, being corporations, are very happy to consider their bottom line, rather than the health of their employees.... Especially in these days of large layoffs.

Of the few people who might be in a position to shop for health insurance, they are frightened to death. No problem, if they are 25 years old and healthy.... But a 50 year old might not be accepted at ANY price. If nothing else, the AHCA resolves that issue. Not a problem for you, maybe.... But certainly a problem for me and MY family.

[2MeterTroll]

typical libertarian BS.
we must all save for the catastrophe.. Brilliant, till you take a look at where folks try to invest, housing is usually a first one, well there goes the house for one torn knee, then we have 401K; there goes the 401K for the heart surgery, then stocks, there goes the whole portfolio for one cancer treatment. If you are lucky you get cancer first so all of your investments go at the same time.

basic health care will not make folks poorer it will most likely allow them to make more money because they are not chronically sick from malnutrition or some untreated infection/condition. course like all the ryndians you view those not in your economic scale as flawed in some way. Expecting Everyone to be money grubbing self serving asshats. Then using your belief in that system to justify using all the public services you can qualify for. Very much like the old dame herself a hypocrite to the end.

Insurance; no matter how limited you make the involvement will adapt and you will end up paying about the same as full anyways. look at countries with single payer health care, the insurance companies arent hurting a bit. they simply move charges around till it balances out.
Personally i think insurance is the biggest scam ever devised; the math doesn't balance out in any way when you take the bulk of the population has maybe one serious condition in there lives that takes far less money then the insurance will ever pay out.

your way of thinking is what makes the libertarians/republicans a laughing stock.

Sorry, but this is how we perpetuate the cycle of poverty and a struggling middle class that doesn't understand why it can't make ends meet. We assume people incapable, ALL people according to the thinking currently coming out of Washington, of doing wise things for themselves. Your thinking says that we must wrest this control away from the individual because people cannot be trusted, even if it takes thousands more out of their pockets every year of their lives. They are too stupid to do the right thing for themselves, so a far more costly solution will be forced on them. Balderdash.

Sorry, but I totally reject this line of thinking. This is elitist snobbery of the worst kind. This makes people poor. It makes them ignorant of economic basics. It makes them confused and dependent. When we expect so little of people, little is what we will get.

[Norman Bernstein]

What do you know about how it works in practice? You're the guy who thinks negotiated prices don't kick in until after the deductible is met. (post #30) You obviously have no clue.

And you're the guy who thinks that insurance companies don't make money on those negotiations, or spend wasted money on paperwork and overhead, each time you spend out of pocket on a 'negotiated price'. Each time you submit your insurance card and pay that negotiated price, a cash register at the insurance company goes 'cha~Ching'.... The overhead of that transaction is part of the cost of your premium.

But it is irrelevant to the main issue. High deductible insurance policies have only one purpose in life: to encourage people to avoid medical expenses... Even when they are critically needed. It is rationing by wealth.

[B_B]

...They do compete with one another, you know. Company "A" can't simply decide to raise prices and expect to hang on to their customers. Company "B" will then lower prices and garner all the business. That's how a consumer driven market works.

In a perfect classroom setting, sure. What really happens, now, is companies compete in price for customers (big print) and deny service for profit (small print). If you think that will change with your model, I don't see it.

..."The solution is to remove private industry from most of the healthcare system, and to strictly regulate those parts where private industry is allowed to exist." This is almost exactly my position, unless you are including care providers as part of the private industry you'd do away with....yet you think we are at odds. Odd, that.

I do include care providers in this estimation - why is profit a bad thing when it comes to paying for service, but not for providing service?

[TomF]

I suspect that one impact of high deductable insurance is indeed reduced contact with a primary care provider, at least for people in low to middle income ranges. They'd save health care interventions for when a major event occurred ... and quite possibly restrict their participation in routine preventive or chronic care. In the longer term, that would have an impact on mortality/morbidity.

It is possible that earlier mortality could save in overall health costs in an ultimate sense - because later detection and earlier mortality would each reduce the window for actually receiving care.

[Norman Bernstein]

I suspect that one impact of high deductable insurance is indeed reduced contact with a primary care provider, at least for people in low to middle income ranges. They'd save health care interventions for when a major event occurred ... and quite possibly restrict their participation in routine preventive or chronic care. In the longer term, that would have an impact on mortality/morbidity.

It is possible that earlier mortality could save in overall health costs in an ultimate sense - because later detection and earlier mortality would each reduce the window for actually receiving care.

Bingo... Yes, it does have a payoff....just not for it's victims.

[Norman Bernstein]

In my model I pay for nearly all of my own care out of pocket enroute to meeting that high deductible that cuts my premiums in half. I will not deny my own claims!

Your perspective makes great sense... For YOU.

Unfortunately, YOU are not a prototypical model for everyone in the country. You MIGHT be a prototypical model for a libertarian, however.

[B_B]

In my model I pay for nearly all of my own care out of pocket enroute to meeting that high deductible that cuts my premiums in half. I will not deny my own claims!

Yes, the little itty bitty claims. What if you need triple bypass (>$50,000) or get hit by a car and need lifetime of care (what was that thing you said we all needed, insurance?) - I'm sure for that they'd be very happy to just pay it all out and wish you well...you need more good thoughts and positive kharma than I'd imagined!

[TomF]

More misinformation. Many high deductible policies pay for "wellness care" to the tune of 100% with no deductible. Some go so far as to require those visits as a condition of the insurance contract.

If so, bully for them.

As a Canadian guy, I'm not aware of how widespread "wellness care" provisions are in mass-market American insurance plans - although I am aware of some insurers who reduce their rates for people who can demonstrate that they're taking their wellness seriously. For which I've given kudos before.

How common are these 100% no-deductable wellness provisions? Are they industry-standard with high-deductable policies? How broadly or narrowly are the "wellness" provisions defined?

[2MeterTroll]

ya right flawed; hey judge do you walk with crutches? if you dont you have no freaking clue. High deductible will cost the same as full does now if the majority goes to high deductible. its called making money. in your paper world it may work to your inferred rules of economics; in the real world it works on where we can fleece the public profit curves.

the economics are not clear and you are a deluded if you imagine they are and that the market will not adapt. lets take air lines for instance; what do you suppose coasts more a direct ticket or one with lots of stops? look it up you pay more for layovers than you do for a direct ticket. it invalidates you assumptions in one stroke. business does not function logically because consumers do not function logically.

Your economic understanding is deeply flawed. There's no way the cost of insurance would remain "the same as full anyways" if the demand for the product were to decline. The AHCA creates MORE demand for the insurance product. Demand is what enables the high prices.

Furthermore, your countless sophomoric insults aside, this is not a discussion of the merits of single payer health care. It is a discussion of the relative merits of high deductible insurance policies vs low deductible policies. Most people who have low deductible do so because they are forced on them by an employer who doesn't give a rip. People who do their own shopping know better. The economics are clear. The low deductible policy is a HUGE part of the runaway cost problem. The AHCA moves us further in the wrong direction.

[Norman Bernstein]

More misinformation. Many high deductible policies pay for "wellness care" to the tune of 100% with no deductible. Some go so far as to require those visits as a condition of the insurance contract.

BFD... One checkup per year... That satisfies the 'wellness care' PowerPoint bullet.

Hint: that isn't where the problems lie.

[TomF]

My comment about financial disincentived to see primary care docs, particularly among low and middle income groups, reflects widely understood public health epidemiolical work across Eastern and Western europe, latin america, and Australasia, as well as North America. Consistently, socioeconomic status is onee of the most prominent barriers to primary care, and has been the subject of more focus by more health providers, researchers, and agencies than you've any idea.

If in America now insurers offering high deductable policies now as a matter of course offer wellness and/or primary care at no deductable,with 100% coverage, that's big news.

Is it true? Is this routine industry practice now in the US?

[hanleyclifford]

Question: would medicare be described as a high deductible policy?

[Norman Bernstein]

My comment about financial disincentived to see primary care docs, particularly among low and middle income groups, reflects widely understood public health epidemiolical work across Eastern and Western europe, latin america, and Australasia, as well as North America. Consistently, socioeconomic status is onee of the most prominent barriers to primary care, and has been the subject of more focus by more health providers, researchers, and agencies than you've any idea.

If in America now insurers offering high deductable policies now as a matter of course offer wellness and/or primary care at no deductable,with 100% coverage, that's big news.

Is it true? Is this routine industry practice now in the US?

If wellness care is defined as a single annual physical of a healthy patient, then I believe it is indeed true.

I don't think I'd describe that as 'health care', though.... No more than guaranteed access to an emergency room is health care.

[Norman Bernstein]

Question: would medicare be described as a high deductible policy?

No, but it has substantial gaps in cost coverage. Most Medicare eligible people buy supplemental policies to cover the gap between what Medicare covers, and what it doesn't.... Medicare is NOT complete health care.

[TomF]

Best practices in wellness and preventive care go well beyond that - various screening regimes, immunization schedules etc. Primary care includes a helluva lot more too, including most chronic disease management.

These are typically where the gaps are respecting socio-economic status, even in countries *with* universal care.

[B_B]

Huh? Insurance companies pay for triple bypass surgeries every day. Again, and please read my posts more carefully...it appears that you are not, I am not arguing for NO insurance. I am arguing for higher deductibles to put the routine choices and the certainty of payment back into the hands of the consumer, along with massive cash savings, all the while getting care that is decided by doctors and patients, not by insurance companies.

It appears it is you who is having trouble comprehending - I can play this game too - please read my posts more carefully

The issue at play is the profit motive in denying payment. They make claims difficult no matter what the cost of the service - and the incentive to do so will remain no matter what the policy in place is. As a matter of fact, the incentive to deny claims, to make claims difficult to get, will only increase if they have larger claims to pay.

Additionally the incentive for insurers to be nosy about the care you're getting will remain no matter the policy - i.e. they will not butt out of the medical decisions which they are paying for just because they have fewer claims to process...they'll have additional incentive to get nosy about the cost of care because the number of claims will be reduced but the per claim expense will greatly increase.

[Norman Bernstein]

The only possible exception to these economic rules comes when we are forced to buy more insurance than we think wise, be it by an employer, or by the government. That is precisely what the AHCA does. It dances with the devil.

Does the AHCA accept your high deductible insurance as meeting the requirements of the mandate?

Then what in hell are you bitching about, other than the fact the you seem to think that what is appropriate for YOU, in YOUR judgment, should apply to everyone else?

[B_B]

That's why you want to not make so many claims. When you pay for most of your own health care enroute to meeting that big deductible, the big bad insurance company has no opportunity to deny the claims if there are no claims.

The size of the deductible bears no relationship on the likelihood of a company trying to deny a claim for major care.

Come on, surely you get this, right?

I get that you keep saying it.

If they (insurance companies) exist they'll have an incentive to minimize payouts. It doesn't matter if it's a $500 claim or a $500,000 claim, they're interested in minimizing payouts. If they only get $500,000 claims then they'll only quibble about those.

Their role will remain the same (take money from people, pay themselves, their lawyers, and their stockholders, pay out the absolute minimum they can get away with), just the size and number of claims will be different.

Surely this concept isn't hard to grasp?

I don't think I've linked any of what I've said to the size of deductibles (reading comprehension again )

[Norman Bernstein]

OK, I give up. I'm wasting time arguing with people who simply aren't able to understand what's being said.

Have a nice day.

Translation: 'They don't agree with me, so, by definition, they must be idiots'

[B_B]

OK, I give up. I'm wasting time arguing with people who simply aren't able to understand what's being said.

Have a nice day.

Ha! I feel the same way. But I soldier on...

How about I paraphrase what you're saying and you paraphrase what I'm saying...let's see who's closest?

You believe that by limiting the role of insurance companies to high deductible policies - i.e. large claims - that insurance companies will lower premiums and the overall cost of healthcare will be reduced because for most medical transactions there won't be a third party paying for it's overhead and it's shareholders profits, and because that overhead will be reduced overall.

Close enough in a nutshell?

Your turn.

[Horace]

Too bad that's not how it works in practice. FEW people actually shop for health insurance; the vast majority take what their employers offer, and many employers, being corporations, are very happy to consider their bottom line, rather than the health of their employees.... Especially in these days of large layoffs.

Of the few people who might be in a position to shop for health insurance, they are frightened to death. No problem, if they are 25 years old and healthy.... But a 50 year old might not be accepted at ANY price. If nothing else, the AHCA resolves that issue. Not a problem for you, maybe.... But certainly a problem for me and MY family.

This thread started with a personal anecdote, so perhaps it's time to insert another. I'm one of those "few people" who "actually shop for health insurance"--or more correctly, who use an independent agent to help me make choices. After a 15-year stint trying to maintain a pretty comprehensive small-group plan, with a continual struggle to keep adequate group membership--employees preferred to transfer to their spouse's newly-acquired large-group or state plans, primarily because of dental benefits, even though I paid most of their premiums--I eventually had to give it up and switch to an individual family plan.

I have been fortunate enough--"glass half full"--to be far ahead of the game as far as premiums paid versus benefits received using high deductible policies, and never have had the first problem with an insurer. I seem to have had the same experience The Judge appears to be claiming: greatly reduced premiums, with the savings dedicated to a rainy-day fund for paying expenses, such as insurance premiums (including other insurances), out-of-pocket expenses, etc., in case of illness. There has even been limited dental insurance with these policies.

Norm, below is a chart showing pre-age-65 insurance coverages by type. Do you have a typical description of who's in that 16% uninsured category, and why?

Also, I'm not quite sure what you are trying to say here: "[M]any employers, being corporations, are very happy to consider their bottom line, rather than the health of their employees.... Especially in these days of large layoffs."





Share by insurance coverage type,
for those under 65 years of age

[skipper68]

I'm glad to hear there WAS a solution to the problem. A sick baby is such a very scary issue.

[wardd]

In my model I pay for nearly all of my own care out of pocket enroute to meeting that high deductible that cuts my premiums in half. I will not deny my own claims!

but your insurance will try to deny your big claims

[Norman Bernstein]

I have been fortunate enough--"glass half full"--to be far ahead of the game as far as premiums paid versus benefits received using high deductible policies, and never have had the first problem with an insurer. I seem to have had the same experience The Judge appears to be claiming: greatly reduced premiums, with the savings dedicated to a rainy-day fund for paying expenses, such as insurance premiums (including other insurances), out-of-pocket expenses, etc., in case of illness. There has even been limited dental insurance with these policies.

Horace, you said it succinctly, in your very first words: you've been 'fortunate'.

My point is simple: not everyone is fortunate. People of very modest means just might be able to recover from some single, short lived catastrophic medical problem... But what of the people who have chronic illnesses, not so bad that they can't work or need to be institutionalized, but those who will need far more than the one annual physical? Consider my wife ( as long as we are indulging in anecdotes )..... She has Parkinson's disease. She is highly functional, holds down a job, but also needs the care of 4 or 5 different doctors, undergoes many periodic tests, and takes a basket full of drugs each day. Clearly, a 'high deductible' insurance policy would be an exceptionally bad choice... And shopping for a policy is out of the question, since she would be denied by every insurer, were it not for the AHCA.

What did she do wrong to deserve that fate? We paid our health insurance premiums for 38 years, and didn't abuse the coverage. What would the 'private enterprise, free market' have for us?

Norm, below is a chart showing pre-age-65 insurance coverages by type. Do you have a typical description of who's in that 16% uninsured category, and why?

I can't read the graph, on my iPad... The resolution is too low.

Also, I'm not quite sure what you are trying to say here: "[M]any employers, being corporations, are very happy to consider their bottom line, rather than the health of their employees.... Especially in these days of large layoffs."

Many large companies are reducing their health insurance contributions, an limiting employee options and coverage.

This isn't universally true. My former employer was very fair about it. They established a dollar cost level for each employee, and offered a half dozen different plans... Plans costing more than than the amount could be subsidized by the employee, and plans costing less than the amount resulted in a cash refund.

This was back in 1992 though .. . . . Not sure what they do now.

[2MeterTroll]

ya ya ya Tell me another one Judge. We are not arguing the inner workings of insurance companies we are talking about the deaths of millions because you think you know where the problem lies.
sorry mate i dont want to live in a world where i condemn to death and homelessness over half the population of any country.

It's not a paper world. It's the real world. Nearly every market plays by the basic economic rules of supply/demand, excepting health care. Why do you suppose that is? Do you believe there is something inherently different about health care that makes it immune to the rules? Currently there is...that health care is not paid for like everything else. It's paid for primarily by third parties whose inner working are invisible and inaccessible to its consumers. It's paid for by group policies that are forced on people who don't realize how much they cost and who don't bother to understand them because they have no say in whether or not they buy these policies anyway.

High deductible will NOT come to cost "the same as full does now" as you claim. There is absolutely no way. High deductible wrests control away from the insurance companies you decry and puts it back into YOUR hands. It eliminates the vast majority of claims. It pushes insurance partway out the door and makes them less a player in routine health care, leaving them to deal with disaster coverage, which is how we otherwise use insurance. Do you have home owners insurance to paint your house? Why not?

The only possible exception to these economic rules comes when we are forced to buy more insurance than we think wise, be it by an employer, or by the government. That is precisely what the AHCA does. It dances with the devil.

[wardd]

the problem with the judge is he may actually believe there is such a thing as a free market

[2MeterTroll]

oh ya i forget that one needs to fight with you so you can justify yourself. Tell you what you keep pretending you know how the world works and I will continue living in the real one.

ROFL! What a lightweight. Come back when you have something substantive to say...so far it's been just these childish little spit wads you manage to hack up. If you want to talk about policy, law, or the math and economics behind the issue, then you should prepare yourself for the discussion before you stagger in and make a fool of yourself.

Oops, too late,

[Dave Wright]

Something to think about in between the bickering:

"Perhaps the most counter-intuitive finding is that higher spending does not necessarilylead to better access to health care (see box), or better quality of care. Patientoutcomes can actually suffer, because having more physicians involved increasesthe likelihood of mistakes (too many cooks spoil the soup), and because hospitals

are dangerous places to be if you do not absolutely need to be there."

http://www.dartmouthatlas.org/downlo...ief_022709.pdf