US Medical Insurance: How Much Choice?

[Loren Pechtel]

Yeah, what the hell is wrong with that guy, thinking he should be able to insure his wife and kids as well? His wife needs to get out of the house and get a job, so she can pay for her own insurance, and the kids, well fuck them, if it's to expensive to put them on the insurance plan, imagine daycare plus insurance. Those little rugrats can go get jobs as well. Problem solved, and now the insurance premium will only be about $1,000!

The point is the deductible being shown is the family deductible but it's one sick person--the relevant number is the individual deductible.

The relevant number is the amount that one person has to pay in order to insure all of those in his family who are relying on that person to provide insurance for them.

The number I am calling deceptive is the deductible. That's not what they're going to actually end up paying.

 

[Loren Pechtel]

You are also paying more for your health insurance in USA than you would be in your share of taxes to cover UHC.

For Her Head Cold, Insurer Coughed Up $25,865

"She may not be paying anything on this particular claim," says Richelle Marting, a lawyer who specializes in medical billing at the Forbes Law Group in Overland Park, Kan., who looked into this case for NPR. "But overall, if the group's claims and costs rise, all the employees and spouses paying into the health plan may eventually be paying for the cost of this."

Marting says this is a common problem for insurance companies. Most claims processing is completely automated, she says. "There's never a human set of eyes that look at the bill and decide whether or not it gets paid."

Kasdan did pay her usual $25 copay for the office visit and a $9.61 fee to LabCorp for a separate set of lab tests.

The best way to attempt to cure criminal behavior like this is transparency. If you don't know what something costs you're fucked before you even start.

Transparency isn't going to be much help, the dirty dealing wasn't exactly hidden. The problem is they are allowed to get away with it. Hopefully the insurance company will at least remove him from their network for this.

I have long proposed a simple solution that would have prevented this abuse: Networks apply to facilities, not individuals. By working in an office you are bound by any network agreements it has. Likewise, it applies to any third parties they involve. No generic warnings about possible out-of-network issues, anything out of network must be exactly spelled out.

 

[Jolly_Penguin]

No. Fixing them would mean making them provide adequate coverage. Show that we can trust the government to do it before we al jump on board.

The private companies have shown again and again that they can't. Wouldn't you rather put your trust in a group of people whose goal is your health and re-election instead of their own profit? It boggles my mind that people would prefer a for profit insurance company over government. I keep hearing "I don't want the government between me and my doctor". But they do want a for profit insurance company whose goal is profit rather than their health?

 

[laughing dog]

Sure, you can dream up UHC systems that would work. What I'm saying is fix what we have before expanding them.

Why do you think the two - expanding and fixing - are mutually exclusive?

Show that you can do it right first?

Want to ride the next Boeing launch to space given they couldn't even get the clock right on this one? (Which probably means the software is full of serious flaws as the clock error is also the time the system was powered up before launch--which most likely means they mixed up the up time with the mission time.)

I see, you have no logical reason. You simply do not believe it can be done.

 

[KeepTalking]

The relevant number is the amount that one person has to pay in order to insure all of those in his family who are relying on that person to provide insurance for them.

The number I am calling deceptive is the deductible. That's not what they're going to actually end up paying.

Is it? Well, let's look at the post that started this side discussion:

I know a single woman, breast cancer survivor. Her premium is just over $2000 with a $6000 deductible. Silver level plan.

And subsidies are based on income. Debt has nothing to do with it.

Look at the screenshots. Family plan. And if you're not getting subsidies you're making enough you can afford those premiums.

It sure looks like you were talking about premiums to me.

 

[Loren Pechtel]

No. Fixing them would mean making them provide adequate coverage. Show that we can trust the government to do it before we al jump on board.

The private companies have shown again and again that they can't. Wouldn't you rather put your trust in a group of people whose goal is your health and re-election instead of their own profit? It boggles my mind that people would prefer a for profit insurance company over government. I keep hearing "I don't want the government between me and my doctor". But they do want a for profit insurance company whose goal is profit rather than their health?

They seem to be doing a decent job of it with the ACA. We could use some tweaks to the system but the basic idea is working.

 

[Loren Pechtel]

Show that you can do it right first?

Want to ride the next Boeing launch to space given they couldn't even get the clock right on this one? (Which probably means the software is full of serious flaws as the clock error is also the time the system was powered up before launch--which most likely means they mixed up the up time with the mission time.)

I see, you have no logical reason. You simply do not believe it can be done.

I am not saying it can't be done. I'm saying prove you can do it before we all rely on it.

 

[Loren Pechtel]

Is it? Well, let's look at the post that started this side discussion:

I know a single woman, breast cancer survivor. Her premium is just over $2000 with a $6000 deductible. Silver level plan.

And subsidies are based on income. Debt has nothing to do with it.

Look at the screenshots. Family plan. And if you're not getting subsidies you're making enough you can afford those premiums.

It sure looks like you were talking about premiums to me.

Separate but related issue.

 

[laughing dog]

Show that you can do it right first?

Want to ride the next Boeing launch to space given they couldn't even get the clock right on this one? (Which probably means the software is full of serious flaws as the clock error is also the time the system was powered up before launch--which most likely means they mixed up the up time with the mission time.)

I see, you have no logical reason. You simply do not believe it can be done.

I am not saying it can't be done. I'm saying prove you can do it before we all rely on it.

No need to confirm that your belief is your belief unfounded on facts.

 

[Jolly_Penguin]

For Her Head Cold, Insurer Coughed Up $25,865



The best way to attempt to cure criminal behavior like this is transparency. If you don't know what something costs you're fucked before you even start.

Transparency isn't going to be much help, the dirty dealing wasn't exactly hidden. The problem is they are allowed to get away with it. Hopefully the insurance company will at least remove him from their network for this.

I have long proposed a simple solution that would have prevented this abuse: Networks apply to facilities, not individuals. By working in an office you are bound by any network agreements it has. Likewise, it applies to any third parties they involve. No generic warnings about possible out-of-network issues, anything out of network must be exactly spelled out.

A much simpler solution would be to do away with networks, and insurance companies. Why should you have to check who is "in network"? That's such a weird concept to those of use who have UHC. I can go to any hospital, any doctor, any walk in clinic and know they will take my OHIP card, and I will only pay for gas and possibly parking.

 

[lpetrich]

A much simpler solution would be to do away with networks, and insurance companies. Why should you have to check who is "in network"? That's such a weird concept to those of use who have UHC. I can go to any hospital, any doctor, any walk in clinic and know they will take my OHIP card, and I will only pay for gas and possibly parking.

This network business strikes me as a scam. It seems to me a way of the insurance companies to pose as being subject to some outside organization's dictates rather than publicly accept responsibility for being selective about which doctors they support.

Conservatives brag about how much they believe in personal responsibility, but their exemption of medical-insurance companies is telling.

 

[Loren Pechtel]

A much simpler solution would be to do away with networks, and insurance companies. Why should you have to check who is "in network"? That's such a weird concept to those of use who have UHC. I can go to any hospital, any doctor, any walk in clinic and know they will take my OHIP card, and I will only pay for gas and possibly parking.

This means you have no choice in the quality of service. Monopolies almost always provide bad service. Furthermore, it means the government gets to simply dictate how much the doctor will be paid. Our track record on that down here isn't very good--there have been cases of states actually setting negative prices (we'll pay you $100 to do something that will consume $110 of supplies) and plenty of cases of setting rates far below what's reasonable.

 

[Loren Pechtel]

A much simpler solution would be to do away with networks, and insurance companies. Why should you have to check who is "in network"? That's such a weird concept to those of use who have UHC. I can go to any hospital, any doctor, any walk in clinic and know they will take my OHIP card, and I will only pay for gas and possibly parking.

This network business strikes me as a scam. It seems to me a way of the insurance companies to pose as being subject to some outside organization's dictates rather than publicly accept responsibility for being selective about which doctors they support.

Conservatives brag about how much they believe in personal responsibility, but their exemption of medical-insurance companies is telling.

Huh? The insurance companies don't say the networks are externally imposed. Networks are doctors that agree to the price list and the like the insurance demands and don't have too many patient complaints. Unfortunately, they also tend to look at how much treatment the doctor provides without considering the patients--they have a legitimate interest in weeding out the ones that overtreat but there have been cases of doctors with two offices and having one accepted, one rejected--the one being rejected was in a lower class area with less healthy patients.

 

[T.G.G. Moogly]

A much simpler solution would be to do away with networks, and insurance companies. Why should you have to check who is "in network"? That's such a weird concept to those of use who have UHC. I can go to any hospital, any doctor, any walk in clinic and know they will take my OHIP card, and I will only pay for gas and possibly parking.

This network business strikes me as a scam. It seems to me a way of the insurance companies to pose as being subject to some outside organization's dictates rather than publicly accept responsibility for being selective about which doctors they support.

Conservatives brag about how much they believe in personal responsibility, but their exemption of medical-insurance companies is telling.

Huh? The insurance companies don't say the networks are externally imposed. Networks are doctors that agree to the price list and the like the insurance demands and don't have too many patient complaints. Unfortunately, they also tend to look at how much treatment the doctor provides without considering the patients--they have a legitimate interest in weeding out the ones that overtreat but there have been cases of doctors with two offices and having one accepted, one rejected--the one being rejected was in a lower class area with less healthy patients.

In my experience the doctors that prescribe the most are preferred. Do you have any examples of doctors running into problems by over-prescribing tests, meds, etc.?

 

[lpetrich]

Why I suspect that "in the network" is a scam is that it's expressed like that and not like "in our list". Something that makes it seem like it's not the decision of the insurance companies, while "in the list" would be in an insurance company's list of doctors that accept its insurance.

 

[T.G.G. Moogly]

Today in the mail I received a flier from my insurer enticing me to sign up for and participate in a wellness event. If I sign up and participate I will receive 25 dollars in a gift certificate. I don't know why they do these things except that in some way it must be profitable.

Are they required to do these thing by some regulation? Are they really trying to make people healthier, which has been disproven using this method? Do they just want data that they can sell? Are they looking for sick people that they can make money from? Is it a marketing ploy to get more business?

I ask because it seems everything would cost less for everybody if they just insured and treated people and didn't try to "entertain" them. Before retiring I received these type correspondences a couple times a week. Should they be spending money hiring staff at minimum wages to tell me it's allergy season and how to stay healthy around pets? This isn't insurance.

But maybe I'm just an old-fashioned stick in the mud.

 

[Canard DuJour]

No country as large as the US has single payer. In fact, only 20 countries have single payer and most of them are small. It's unreasonable for politicians to simply promise M4A, when that actually happening is close to impossible.

Why would that be some kind of consideration? Yes, you have ten times the population of Canada, but you also have ten times the population of Canada so there's that many more people paying into the system. The concept behind it scales up easily.

In fact one of the main advantages of single payer UHC is economy of scale.

 

[Loren Pechtel]

Today in the mail I received a flier from my insurer enticing me to sign up for and participate in a wellness event. If I sign up and participate I will receive 25 dollars in a gift certificate. I don't know why they do these things except that in some way it must be profitable.

Are they required to do these thing by some regulation? Are they really trying to make people healthier, which has been disproven using this method? Do they just want data that they can sell? Are they looking for sick people that they can make money from? Is it a marketing ploy to get more business?

I ask because it seems everything would cost less for everybody if they just insured and treated people and didn't try to "entertain" them. Before retiring I received these type correspondences a couple times a week. Should they be spending money hiring staff at minimum wages to tell me it's allergy season and how to stay healthy around pets? This isn't insurance.

But maybe I'm just an old-fashioned stick in the mud.

It's about getting you to do healthy things.

I'm a little annoyed with my insurance over this--they have sent me multiple things about getting $20 for gym check-ins. Hey, how about my "gym"--how about the same credit for check-ins at trailheads. (Admittedly, a bit problematic as the majority of trailheads don't have cell service, the app would have to remember and send the data later.)

 

[T.G.G. Moogly]

Today in the mail I received a flier from my insurer enticing me to sign up for and participate in a wellness event. If I sign up and participate I will receive 25 dollars in a gift certificate. I don't know why they do these things except that in some way it must be profitable.

Are they required to do these thing by some regulation? Are they really trying to make people healthier, which has been disproven using this method? Do they just want data that they can sell? Are they looking for sick people that they can make money from? Is it a marketing ploy to get more business?

I ask because it seems everything would cost less for everybody if they just insured and treated people and didn't try to "entertain" them. Before retiring I received these type correspondences a couple times a week. Should they be spending money hiring staff at minimum wages to tell me it's allergy season and how to stay healthy around pets? This isn't insurance.

But maybe I'm just an old-fashioned stick in the mud.

It's about getting you to do healthy things.

I'm a little annoyed with my insurance over this--they have sent me multiple things about getting $20 for gym check-ins. Hey, how about my "gym"--how about the same credit for check-ins at trailheads. (Admittedly, a bit problematic as the majority of trailheads don't have cell service, the app would have to remember and send the data later.)

Sounds more like they have a business/profit agreement with the gym but need the numbers to collect.

 

[southernhybrid]

In recent years, many insurance companies give money or other rewards for those who workout on a regular basis. Medicare Advantage Plans and Medicare supplements do the same thing. It's called "Silver Sneakers". Yeah. I hate that label too. There is a huge amount of recent evidence that regular exercise leads to better health outcomes. So, sure, you can say it's the insurance companies attempt to lower their costs but why would anyone not like being able to join a gym or exercise group if their insurance company paid for it. Nobody is being forced to workout, but all of us should have get regular exercise if we want to decrease our risks of certain diseases.

Has anyone even addressed how they think Medicare premiums and copays would be vanished under an M4A program? That's' one of my biggest complaints.