Going without health insurance

[JHZR2]

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.

 

[Cutehumor]

I must point out if the surgeon cut the fungus mass out of my lung right away. I would have been out of the hospital in a week. but instead I was in the hospital for 25 days. because when I first went in, they did two bronchoscopies, the surgeon put a ballon down my lung which was surgery number one, two days of radiation to try to stop the bleeding, gave me two blood transfusions, then almost a week of being in the ICU on the ventilator. However, I developed pneumonia in both of my lungs, oxygen level dropped to the 70%, heart rate in the 160s. Then they told my wife that they had to take the fungus mass out of my lung or I would die. If they took my lung mass out when I first went to the hospital, I would not have had all my complications. I asked how come they didn't take the fungus mass out of my lung ASAP. I was on the ventilator the whole time with no voice. instead, I was told by my mother in law "they were trying to save your lung". I almost died, it makes me feel like they were trying to milk my insurance money.

 

[rjundi]

Hospitals are mandated to take anyone from the uninsured to fully insured. They cannot reject anyone care.

You definitely get a lower level of care without insurance. However you do not get denied life saving procedures. The hospitals must charge insurance at higher rates to cover their losses to remain viable. How much they lose is where a hospital is located and local population. Its a vicious circle too. They release the non-insured much quicker and then they come back emergently and expensively.

This is simply how the medical industry is setup currently. My wife has been working in this industry for 20 years and currently at one that has many non-paying "customers".

 

[JHZR2]

Originally Posted By: rjundi
Hospitals are mandated to take anyone from the uninsured to fully insured. They cannot reject anyone care.


Isnt that what Doctors swear to under the Hippocratic oath? Isnt that part of their assumption of fair treatment? They agreed to it, not me. Thus it is risk on them, not costs shifted from me to the next guy so the doctor can maintain their boat and summer house on my dime.

I didnt take any oath or enter into that field.

 

[mechanicx]

Originally Posted By: JHZR2
Originally Posted By: Cutehumor
After several bronchoscopies, blood tests, x-rays, ct scans, radiation, being on the ventilator in ICU for two weeks, hospital for a total of 25 days, three surgeries, I rang up almost $750k in medical bills and that was all IN NETWORK!!!


What gets me is the $750k. Where I work, burdened rate for a professional engineering expert in a field is about $230k/man year. Its down to about $200k for a standard worker and $180k for a technician or equivalent. Let's take worst-case scenario, $4600 per man week. You were in the hospital the equivalent of five work weeks...Is the hospital really claiming that you had 32 full time equivalents working on you?

Of course there is some rental cost for the facilities. What can it really be? I can rent a nice hotel room in an big city for about $250/night. Sure there are other gadgets, so the cost of the room is say, $1000/night. So I guess youre paying $725k in labor? Maybe 30 full time equivalent people?

No hospital Ive ever been in dedicates one full time person to you, even in an ICU.

And there lies my dissatisfaction. Youre paying for the equivalent of 32 doctorate-level technical experts in any other field... working FULL time on a problem.

Something just doesnt align there, wrt costs, and that is where the discussion needs to be pointed, IMO.

At the same time, insurance for profit to me is a ridiculous thing. Why? Because if you are basing something upon probabilities and actuarial tables, then there should be zero variability from vendor to vendor unless one is taking more risk (bad) or less profit (good or bad depending upon the angle). But the probabilities and risk really dont change. I fear for profit insurance because they can allow/disallow payments based upon their profit structure, which is just a dirty way of doing things. Not advocating government care per se, just expressing my dislike of insurance systems in general.

Someone is making a LOT of money in this - a disproportionate amount. That may or may not be OK, but my gut is that not much of what is typically done is that advanced or comlex in the medical field that a trained monkey couldnt perform it... yet we are paying rates as if the world's top genius and only qualified individual are doing it.


I agree with you. What the healthcare industry charges for services provided is the fundamenttal problem. It's why you have to have insurance in the first place. And insurance encourages the cost to inflate out of control. No one without insurance would or could pay the cost they charge. Then insurance becomes too expensive. The solution then becomes rationing care and picking and choosing who gets what care (This can be both a good thing and a very bad thing). So along comes someone who payed into the healthcare insurance all their life, rarely used it, but now needs a procedure. Behind the scenes the insurance company can deny coverage. The person goes on to die. They payed into a system and got nothing useful out of it. The problem is excessive cost. Which means you end up getting less and paying more. I don't know what the solution is, but since healthcare is primarily paid for through insurance, it is not really free market and maybe it should be more regulated.

 

[eljefino]

Originally Posted By: JHZR2
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?


Maybe not but since the state is a "nonprofit" and has critical mass buying power, the benefits they negotiate are somewhat better. Of those I know who have their choice between a state plan and a private sector one, the state plan usually wins.

(OT but this could also relate to public sector unions existing and there being relatively few private sector ones in my region.)

 

[JHZR2]

Originally Posted By: eljefino

Maybe not but since the state is a "nonprofit" and has critical mass buying power, the benefits they negotiate are somewhat better. Of those I know who have their choice between a state plan and a private sector one, the state plan usually wins.

(OT but this could also relate to public sector unions existing and there being relatively few private sector ones in my region.)


But a critical mass buying power is kind of an irrelevant thing. It is a situation of convenience, nothing else. It is exactly why they seemed to be pushing for a while for a marketplace of some sort where small businesses could pool together to obtain better rates.

To the company, they see the pool as ALL customers, not payees from group X, Y and Z... At least they derive their profits in that way. I dont see why a lumped costing scheme wouldnt/isnt in place as-is across all potential insureds that could select their policy. The company's performance would then be as much related to how well they did wooing a body of people in as anything else.

 

[Vikas]

As I said before, now that one in five's livelihood is dependent upon health industry (the 18% of GDP), there is zero chance that health care costs are going to go down in this country. The entrenched interests are just too high.

Besides, the only real way to cut the costs will be with the death panels. Come up with a number which is tied to retirement age and once you are older than the "death age", government no longer pays for your health. I am sure actuaries can give us that number.

For all I know, Paul Ryan might have already stole my "modest proposal"

- Vikas

 

[crinkles]

Originally Posted By: JHZR2
Originally Posted By: Cutehumor
After several bronchoscopies, blood tests, x-rays, ct scans, radiation, being on the ventilator in ICU for two weeks, hospital for a total of 25 days, three surgeries, I rang up almost $750k in medical bills and that was all IN NETWORK!!!


What gets me is the $750k. Where I work, burdened rate for a professional engineering expert in a field is about $230k/man year. Its down to about $200k for a standard worker and $180k for a technician or equivalent. Let's take worst-case scenario, $4600 per man week. You were in the hospital the equivalent of five work weeks...Is the hospital really claiming that you had 32 full time equivalents working on you?

Of course there is some rental cost for the facilities. What can it really be? I can rent a nice hotel room in an big city for about $250/night. Sure there are other gadgets, so the cost of the room is say, $1000/night. So I guess youre paying $725k in labor? Maybe 30 full time equivalent people?

No hospital Ive ever been in dedicates one full time person to you, even in an ICU.

And there lies my dissatisfaction. Youre paying for the equivalent of 32 doctorate-level technical experts in any other field... working FULL time on a problem.

Something just doesnt align there, wrt costs, and that is where the discussion needs to be pointed, IMO.

At the same time, insurance for profit to me is a ridiculous thing. Why? Because if you are basing something upon probabilities and actuarial tables, then there should be zero variability from vendor to vendor unless one is taking more risk (bad) or less profit (good or bad depending upon the angle). But the probabilities and risk really dont change. I fear for profit insurance because they can allow/disallow payments based upon their profit structure, which is just a dirty way of doing things. Not advocating government care per se, just expressing my dislike of insurance systems in general.

Someone is making a LOT of money in this - a disproportionate amount. That may or may not be OK, but my gut is that not much of what is typically done is that advanced or comlex in the medical field that a trained monkey couldnt perform it... yet we are paying rates as if the world's top genius and only qualified individual are doing it.


Very well put. Someone is trying to get one over someone else along the line. The true cost of doign things is not reflected in the price.

Down here, the banks tried it on, and are now dropping charges left and right in fear of class action lawsuits.

They charged $35 fee for overdrawn accounts. However, the law states they can only claim the true cost of the inconvenience to them. Some folks started a class action suit against them; trey dropped the charge to $5 only.

 

[mechanicx]

Originally Posted By: Vikas
As I said before, now that one in five's livelihood is dependent upon health industry (the 18% of GDP), there is zero chance that health care costs are going to go down in this country. The entrenched interests are just too high.

Besides, the only real way to cut the costs will be with the death panels. Come up with a number which is tied to retirement age and once you are older than the "death age", government no longer pays for your health. I am sure actuaries can give us that number.




+1. But the very reason they have these "panels" to decide who is worth getting what treatment is because the healthcare industry is charging too much. They'll only pay up to a certain amount. Which may not be enough to cover anything or procedures really useful to the patient. You're paying more to get less. How about paying less so you get more?

A lot of these people turning 65 may find that their health insurance they payed into all their life isn't going to get them much if they need it. My concern is these decision aren't being made on bone fide medical reasoning as much as the whims and the result of the Dr. and insurance coming to an agreement on payment.

 

[Mr Nice]

kb01,

I know a guy that his dad has bone cancer and has no health insurance and goes to the county hospital for all his medical needs and treatment. Sure the guy has been paying into the systems for many years so I don't feel bad if it costs the county half a million to treat this guy.

If you can't afford health coverage don't hesitate to use what you have paid into for many years.

OT: when I worked in healthcare for a decade and saw prison inmates get free open heart surgery and the best treatment you would get if you had the very best health insurance at the county hospital.

 

[Spector]

Currently paying 1963/month until I get on Medicare, wife is uninsurable and basically high risk. Problem is to go bare one would face bankruptcy with a major illness. She had cancer 6 years ago and they still consider her uninsurable. So, we pay, another month and mine goes down but she will be around 1000/month for another year. Another cancer bout and it is easily 100,000 and health care providers will deal on elective stuff but emergency medicine etc they got you.

Health ins companies should all be non profit and their executives need to have the same poor coverage they offer the public for the same high price.

 

[tonycarguy]

Originally Posted By: Cutehumor
I'm 33 years old and I was perfectly healthy. I wasn't even on one medication. Back on 9/11, I woke up and starting coughing up blood. it got so bad that pure red blood was pouring out my nose when I coughed. After several bronchoscopies, blood tests, x-rays, ct scans, radiation, being on the ventilator in ICU for two weeks, hospital for a total of 25 days, three surgeries, I rang up almost $750k in medical bills and that was all IN NETWORK!!! I had a fungus mass the size of a fist in my right lung that was causing my pulmonary artery to bleed. So 60% of my right lung is gone.


Your post is a contradiction, because how could you be "perfectly healthy" and develop a huge foreign living organism in your lung? Severe lung fungal infections are uncommon and happen in people with compromised immune systems. So to say you were "perfectly healthy" seems inaccurate.

Anyway, using this example of why health insurance is necessary is akin to the lottery winner saying that everyone should play the lottery because they won $10M after buying a $1 ticket. How many people put in $10,000 in insurance premiums and get back $750,000? Obviously very few or the insurer would be out of business. Most are like me, putting in tens of thousands and getting back maybe 1/10 of it.

Insurance companies are casinos. They set the odds in their favor. I don't understand why people say the lottery is for fools who can't do math but at the same time say insurance is a good thing. The math is the same.

 

[eljefino]

What if someone is considering doing the legwork to invent a new drug. They crunch the numbers and consider the risks of it being a dud after clinical trials and all the hoops. They know foreign sales will be okay but with capped prices, no profit center. They have to charge $1000 a pill. (There are some miracle antidotes for snake bites and antifreeze posioning that cost many figures.)

If someone has to decide if they're going to go forward with all the research and development, they are, at that point, a death panel, because in the future their decision or indecision will cost lives. It's just not personal, face-to-face yet because it's dealing in the theoretical. A "death panel" could be coldly rigged to give "points" to a geezer: 100 points for every year of age over 72, 500 points for dormant cancer, 500 points for history of smoking, blah blah. Get 1000 points and "we'll make you comfortable." I'm not suggesting this, but it's as cold as the math that insurance actuaries use.

So they come out with the whiz bang cure, it's cheap overseas, and the US bears the burden, because insurance is written to cover what's "medically necessary."

 

[defektes]

Originally Posted By: Drew99GT
Originally Posted By: onebigunion

We must pass it to see whats in it!

mine went up 75/mo thanks to it, in a month. And if I go without I get taxed!

Anyways, go with the insurance, all it takes is a broken bone, diabetes, cancer, or any other unforseen illness to bankrupt you, and hurt you and your family in the long run.

 

[PandaBear]

Death panel are everywhere. Non profit doesn't means the ins or care providers will be nice to you and give you a break on price. Look at Sutter Health, they are a non profit but they buy up and merge so many hospital together and raise prices so much, the end result is health ins cost go up even bigger than the so call reform.

Oh, for those of you who complains that a bill pass that increases your rate $30 or $75 a month, have you consider how much it cost if you are dropped due to "pre existing condition"? You are currently rolling your dice in the existing system the existing system is a pseudo sense of security. Good luck not needing to use your insurance or not getting dropped when you need to. Or have a 3rd world country citizenship on the side just in case...

Are you feeling lucky?

Medicine R&D cost is high, that's why most of the new drugs are just slightly different variety of the current drug binding to the same receptors rather than something that works via a completely new pathway. My mother in law's doctor prescribe her a drug that cost $300 a month for stomach problem and my wife looked at it, and found that it is just like that, a mirror image opposite molecule of the same drug that has patent expired and generic available. We forced the doctor to prescribe that generic instead, what a croak.

So, with all the new drugs profit at stake, drug cos have to spend most of their effort on getting the same drug approved for new application, new cancers, new treatment, new everything, instead of funding exploration of uncertain result in treatment. So now you get 200 new ways to have something that works 50% better but cost you 50 times more than before, and we are surprised that our cost goes up so much. This wouldn't happen if the doctors, insurance, patient have the incentive to pay for the best deal that works "good enough" rather than the "slightly better" drug at unobtainable cost.

 

[Cutehumor]

Originally Posted By: tonycarguy

/quote]

Your post is a contradiction, because how could you be "perfectly healthy" and develop a huge foreign living organism in your lung? Severe lung fungal infections are uncommon and happen in people with compromised immune systems. So to say you were "perfectly healthy" seems inaccurate.

Anyway, using this example of why health insurance is necessary is akin to the lottery winner saying that everyone should play the lottery because they won $10M after buying a $1 ticket. How many people put in $10,000 in insurance premiums and get back $750,000? Obviously very few or the insurer would be out of business. Most are like me, putting in tens of thousands and getting back maybe 1/10 of it.

Insurance companies are casinos. They set the odds in their favor. I don't understand why people say the lottery is for fools who can't do math but at the same time say insurance is a good thing. The math is the same.


you can spin it either way. but someone who never was in the hospital, on medications, or hardly ever was sick. I describe as perfectly healthy. Most people just can't believe that I didn't have chest pain, fevers, or shortness of breath with a fungal mass the size of a fist in my chest. Your analogy of the lottery isn't a good one. how many people go bankrupt playing the lottery and how many of those people go bankrupt without health insurance when they get sick?

 

[Cristobal]

I know this thing is getting into politics. But we need access to medical care that is affordable for Americans. If not, this country will devolve into a place where you are rich or dirt poor, with no middle class. Personally, I do not want to ever see that.

We need tort reform to make it affordable, and a carrot-and-stick approach for medical providers, the law profession, and insurers to make it work. Just trashing insurers by reflex will not work--if they were making money so easily, why not start your own insurance carrier?

There are also guys who want to terminate Medicare and the Social Security system out there. If they get away with such unfairness, tens of millions, perhaps half, of Americans will be pauperized.

We also need to shut out certain people who in the course of their lives have cobntributed nothing to this society. You can guess on your own who they are.

 

[eljefino]

In a chicken and egg thing, how would you compensate someone who's disfigured from a medical procedure, let's not even call it a mistake (as it takes resources to judge it as one), and can't work?

If we had an all inclusive welfare system that "just paid" and didn't involve tons of lawyers laying blame, it would be like the dream of "no fault auto insurance." Of course most "no fault" insurance has enough loopholes to keep the lawyers busy. Then since someone got welfare they wouldn't have to sue doctors for money to survive on, and we wouldn't have expert witness doctors working for lawyers proving how other doctors screwed up.

Go to a doctor and complain of wrist pain, first thing he'll do is try to get you to blame your work, because he can go after workers comp, which pays better than regular insurance. If you get hurt in a car wreck there's a third policy for that and they'll all duke out who's responsible.

It's like it's part of the American way for someone, through some sin, to get what's coming to them, and we want to pin that blame with an absolute level of laser precision.

 

[Shannow]

Don't ask for tort reform, as you just might get it.

Oz got it, now the doctors can cripple you up to 10% (will ber increasing) before compensation kicks in. And compensation is limited to actuals, no hardship, pain and suffering...they leave a try of tools in you in surgery, their only obligation is to take it out.

And what savings did we get out of it ?

Increases in premiums of "only" 7-10% p.a.