JHZR2
Staff member
Originally Posted By: eljefino
But then who'll insure the sickos? Sometimes they get lumped into an assigned risk pool and shoved back into the hands of the insurers who initially balked at covering them. Other times they dump the lame for-profit coverage and go with a spouse's state-employee plan, which is, from my anecdotal overhearings, very fair. The actual cost of course just gets moved around on the books, never goes away.
First, any of the state/federal plans that Ive been exposed to are not run by a government entity. Look at the plans available, for example, to federal employees... Aetna, Amerihealth, etc. all the same that anyone else would get. For profit insrance companies. Its not like the state-employee plan should be any different (i.e. run by the state). Is it?
As for insuring the sickos, there are two classes.
One group is the flag waiving "its my body and its my right to destroy it" group. Very rights-centered to be able to smoke, eat excessively, not exercise, whatever. That's fine. I dont have an argument against those rights. But I also have a right to discriminate against them and not buy insurance if I dont want to. By doing this, my healthy dollars dont subsidize the pot that they are going to pull from. That's one side and one approach that Im not saying is right or wrong. What I am saying is for members of that group, its NOT my problem.
The other group is the bunch who for whatever reason came down with bad disease, maybe were born with issues, maybe an accident or something else caused them issues. It is sad to see them loose their insurance because they can't work, and yet if you somehow lumped them together, their costs would be statistically very high because they will be pulling more and more times per unit time because of conditions. Couple that with potentially spotty work history if they have bad issues and it is a horrible situation.
But these two groups are fundamentally different, IMO. And that is part of the problem. The first group is VERY large, the second group is relatively small.
The healthy population DOES buy insurance depending upon financial situation. They also have the option to pay on a cash basis. Sure, they arent pooling risk if they are self-paying, but does that matter? Isnt that their right? So long as they can only receive services up to the level they are able to negotiate to pay (and beyond that the doctor does it for free on risk), Im OK with that.
Im NOT OK with medical entities creating their own risk pool to ensure profits/paychecks by double charging. What I mean by that is that insured users pay into a plan to pool risk. They potentially pay into it in any one year far more than they get out. So they "overpay" there. Then they use the services of a doctor. The doctor charges multiple times over what they expect to get paid and need to as part of their cost structure to cover other losses in payment from unpaying or cash paying people. So the insurance pays more than the services are worth to cover the doctor's costs. This drives premiums as a whole up, so the policyholder is paying double for this.
Again, I think the cost structure and willingness to serve all are the biggest issues. Pay for a lot of these things is too high, and if the health system is going to serve all, they should do it on risk of getting zero, not overcharging the next paying schmuck that is coming in the door.
Or at least I think I think this.
But then who'll insure the sickos? Sometimes they get lumped into an assigned risk pool and shoved back into the hands of the insurers who initially balked at covering them. Other times they dump the lame for-profit coverage and go with a spouse's state-employee plan, which is, from my anecdotal overhearings, very fair. The actual cost of course just gets moved around on the books, never goes away.
First, any of the state/federal plans that Ive been exposed to are not run by a government entity. Look at the plans available, for example, to federal employees... Aetna, Amerihealth, etc. all the same that anyone else would get. For profit insrance companies. Its not like the state-employee plan should be any different (i.e. run by the state). Is it?
As for insuring the sickos, there are two classes.
One group is the flag waiving "its my body and its my right to destroy it" group. Very rights-centered to be able to smoke, eat excessively, not exercise, whatever. That's fine. I dont have an argument against those rights. But I also have a right to discriminate against them and not buy insurance if I dont want to. By doing this, my healthy dollars dont subsidize the pot that they are going to pull from. That's one side and one approach that Im not saying is right or wrong. What I am saying is for members of that group, its NOT my problem.
The other group is the bunch who for whatever reason came down with bad disease, maybe were born with issues, maybe an accident or something else caused them issues. It is sad to see them loose their insurance because they can't work, and yet if you somehow lumped them together, their costs would be statistically very high because they will be pulling more and more times per unit time because of conditions. Couple that with potentially spotty work history if they have bad issues and it is a horrible situation.
But these two groups are fundamentally different, IMO. And that is part of the problem. The first group is VERY large, the second group is relatively small.
The healthy population DOES buy insurance depending upon financial situation. They also have the option to pay on a cash basis. Sure, they arent pooling risk if they are self-paying, but does that matter? Isnt that their right? So long as they can only receive services up to the level they are able to negotiate to pay (and beyond that the doctor does it for free on risk), Im OK with that.
Im NOT OK with medical entities creating their own risk pool to ensure profits/paychecks by double charging. What I mean by that is that insured users pay into a plan to pool risk. They potentially pay into it in any one year far more than they get out. So they "overpay" there. Then they use the services of a doctor. The doctor charges multiple times over what they expect to get paid and need to as part of their cost structure to cover other losses in payment from unpaying or cash paying people. So the insurance pays more than the services are worth to cover the doctor's costs. This drives premiums as a whole up, so the policyholder is paying double for this.
Again, I think the cost structure and willingness to serve all are the biggest issues. Pay for a lot of these things is too high, and if the health system is going to serve all, they should do it on risk of getting zero, not overcharging the next paying schmuck that is coming in the door.
Or at least I think I think this.