Gov. Role in Health Care Question

[Gadawg73]

Just curious as to what people here will say about this. Do you think the government should pass legislation to prevent the following example below from happening, and if so what, and if not why not?

I know someone, who's in his mid/late 30s, immigrated here (legally), has held the same job steadily, recently became a US citizen, married a US citizen here, and just had a baby. He's a prime example of somebody coming here for a better life-and an example of the American dream. Did everything the right way. He's a hard worker, and has health insurance for his family through his employer.

His newborn baby however has many medical problems-and needs very expensive medical attention, or will die. The health insurance company has already alerted the company he works for that he's no longer able to stay on the policy.

I think there's something very wrong with this scenario-and it can happen to ANYBODY. I think America can do better for our citizens than this.

edit: to be fair they're not dropping him, but just charging a ridiculous amount, knowing full well he, and the other employees cannot afford it. Adding edit here, rather than my post.

You must be under the impression that under Obamacare, his child would receive every possible treatment and care necessary to keep him alive. Where did you ever get that idea? His baby still won't get it -it isn't cost effective under Obamacare and in order to keep costs down, it requires making health care decisions based on cost effectiveness. NOT on whether it is in the patient's best interests and not based on the mutual decision between doctor and patient about they think is best.

I'm constantly amazed at what people THINK is in that bill -who THINK they support it because they THINK it means they get something for nothing -or at least get a whole lot more for a whole lot less. No you don't. Its impossible and in fact will only make health care even MORE expensive! The hard truth is you will get a whole lot LESS for a whole lot more money. When it comes to running industries, government is NEVER more efficient than the private sector, NEVER makes better use of resources than the private sector and in fact only entrenches even MORE waste, fraud and corruption. When you become a fan of making health care a government run operation what you are really being asked to do is sacrifice the quality of your care and possibly even sacrifice some years of your life expectancy -under the LYING ASS pretense it is the only way to provide health care to those who can't afford it. (This is the very same government that blindly paid $300 for HAMMERS and $500 for TOILET SEATS because of the mindless, unquestioning bureaucratic mentality -but OH SURE, I can count on my health care service improving if government is calling the shots! ROFL!) Of course they are never up front and TELL you that is what you will be sacrificing because that would be a no sale, wouldn't it? Instead they couch it in a bunch of touchy feely stories about how some man has been denied medical treatment for his baby who will die without it -insinuating that under a government system that baby would be treated. But in reality that baby would be denied treatment even faster than private insurance companies declined to pay for it. Because it isn't a cost effective use of resources.

Cost effective use of resources are to pay for an abortion for a 20 year old so she can get back to work and pay taxes and not be at home with a new baby. Cost effectiveness is getting a mammogram to detect breast cancer -but restricting treatment for any cancer discovered to those under 50 because that age group will still spend enough years paying into the system if returned to health while the older women will just be a drain on it even after being returned to health -therefore the sooner the older ones kick the bucket, the better. Cost effectiveness is paying for a child's vaccine -but denying a brain damaged child life saving surgery because that child is never going to be paying into the system no matter what and will always be a drain on it. Improving the quality of life is no longer even part of the equation under a government run system -it becomes all about cost effective use of resources. In the UK people are routinely denied hip replacement surgery because of their age and that cut off age is lowered year after year -which means confining younger and younger people to a wheelchair FOR THE REST OF THEIR LIVES -even though expected to live another 20 years. Oh wait -except if you confine someone to a wheelchair, it actually shortens their life expectancy, taking more years off their life the earlier they end up in a wheelchair -so denying someone a hip replacement at a younger age actually means confining that person to a wheelchair for the same number of years as denying a hip replacement to an older person -and both end up being in one about the same length of time -which to the liberal and socialist mentality actually sounds FAIR to them! See how nicely that worked out after all to deny even younger people a hip replacement? For government of course, not the individual. The individual is not only denied his mobility for the rest of his life and turned into a cripple dependent on others -but the decision was made knowing full well it also meant depriving the individual of years of his life on top of it! A win-win for government! YOU will consume the service and you will foot the bill for it too, big time. But since you aren't paying for it DIRECTLY, YOU don't get to call the shots about what treatment is available to you. Under private insurance companies that is only partially true -but when government takes it over, your ability to make health care decisions amounts to whether you want a return appointment in March 2 years from now or April 2 years from now. YOU won't even be told treatment exists for your condition if you don't fall in the category eligible for it -you will be told there is nothing that can be done for you at all. NOT that there is a treatment for it but YOU can't have it. You won't be in a position to make fully informed decisions because you won't be the one making those decisions anyway. A faceless bureaucracy will be and that faceless bureaucracy is unmoved by the sad stories of a man's child in need of life saving treatment -only if it is cost effective use of resources will that child get it. Which means if this man's child is unlikely to lead a normal life even after that treatment -that child will not only never get that treatment at all, his father will never be told any treatment for it even exists and instead be told there is nothing that can be medically done for his baby and that he WILL die.

In the UK after years of reducing the mortality rates for all sorts of diseases and conditions -have now swung back the other way. Women diagnosed with breast cancer are now MORE likely to die of it than they were 15 years ago. In fact people with ANY type of cancer are more likely to die of it than they were 15 years ago. People who have strokes are now MORE likely to die of it than they were 15 years ago. People with diabetes are now MORE likely to die of complications of the disease than they were 15 years ago. People with high blood pressure are now MORE likely to die of complications related to the condition than they used to. And on the bright side? Getting a doctor's appointment in the UK no longer takes an average of 6-8 weeks as it does here -something Americans constantly bitch about. Instead it takes an average of 18-24 MONTHS -which goes a long way in explaining the change in mortality rates. Plenty of time for a mild condition to become more serious and a serious condition to become a critical condition resistant treatment and a critical condition to become a terminal one. With government run health care there is NO option but to sacrifice the quality of your health care and possibly even your life expectancy. Government is THE worst institution to be in charge of a nation's health care system. As flawed as people may believe our own to be, it is still THE best in the world where 90% of all medical advancements originate HERE. For a reason. Destroy it in the name of pretending there is such a thing as a free lunch and it will cause a setback for our entire species. Not just Americans, but the species itself which has benefited as the result of the medical advances that were only achieved under THIS system. Under our system hospitals and doctors can and do offer up their services for free in hard luck cases -all the time. But they are FORBIDDEN from doing so under a government run system. So the notion that this man's child would suddenly become eligible for this life saving surgery if ONLY government were running the show is fantasy -and a dangerous one at that because when government takes over the health care system, it will INEVITABLY end up increasing human suffering, not decreasing it.

Obamacare is not a government run system. Obamacare is mandatory PRIVATE HEALTH INSURANCE that everyone must buy.
Where do you get your information?

 

[MaggieMae]

Just curious as to what people here will say about this. Do you think the government should pass legislation to prevent the following example below from happening, and if so what, and if not why not?

I know someone, who's in his mid/late 30s, immigrated here (legally), has held the same job steadily, recently became a US citizen, married a US citizen here, and just had a baby. He's a prime example of somebody coming here for a better life-and an example of the American dream. Did everything the right way. He's a hard worker, and has health insurance for his family through his employer.

His newborn baby however has many medical problems-and needs very expensive medical attention, or will die. The health insurance company has already alerted the company he works for that he's no longer able to stay on the policy.

I think there's something very wrong with this scenario-and it can happen to ANYBODY. I think America can do better for our citizens than this.

edit: to be fair they're not dropping him, but just charging a ridiculous amount, knowing full well he, and the other employees cannot afford it. Adding edit here, rather than my post.

I'm not sure anyone actually answered your question (can't remember, frankly), but the child would probably be covered under Medicaid or one of the child health programs run by the state as part of the Medicaid program. Although "Obamacare" will provide near universal access to health insurance in 2014, it does not expand the services available for the long term care needs of people with disabilities or long term chronic diseases. It is still the case that these types of services are available only through private resources or Medicaid.

You would be wise to just contact your local state social services office for the most accurate answers to your questions.

 

[Greenbeard]

This is the kind of thing that needs to be done. The whole insurance piece is a swindle.

The linchpin of safety net health care in the United States is Medicaid funding. Which makes up about 46% of spending in the law over the first decade. Reimbursing providers--including those at community health centers--for health services rendered is a pretty large piece of the puzzle.

However, the rules were intended to force the private sector out. Insurance is based on risk which can be calculated. That is why there are lifetime caps in many policies and why folks with pre-existing conditions find it difficult to buy insurance.

By removing caps and forcing insurance companies to insure all at the same rates, this denies the reality of the economics of the health care industry.

It institutes a new model, which is why it adds constructs like an individual mandate and risk adjustment between insurance plans. Believe it or not, it wasn't so long ago that the idea of reforming insurance markets to compel competition on price and quality instead of on risk profiles was popular even in conservative circles. That has nothing to do with forcing the private sector out, it has to do with reshaping the incentives under which those payers operate.

If Obama Care is so great how come so many people/States/Unions etc are getting waivers so they don't have to get it?

States still have to "get it." What certain states are requesting and receiving now is a phase-in of a particular insurance market regulation that sets a medical loss ratio (i.e. a minimum percentage of premium revenue that should go toward health care). That doesn't impact anything else going on in the insurance markets in those states.

You must be under the impression that under Obamacare, his child would receive every possible treatment and care necessary to keep him alive. Where did you ever get that idea? His baby still won't get it -it isn't cost effective under Obamacare and in order to keep costs down, it requires making health care decisions based on cost effectiveness. NOT on whether it is in the patient's best interests and not based on the mutual decision between doctor and patient about they think is best.

Where does it require that?

 

[lehr]

Government pays 75% of all prescription costs now and Medicare is all paid for by government and that is blank check health care.
And it would be GOP that passed Gramps Dope Plan.

role of government in healthcare is ---- die early !

 

[Gadawg73]

With your experience in doing this, did the bidding companies ever ask for the demographics of your population? Experience ratings? Your goals for coverage? The important components to be included in the plans to be defined?

All of these questions are definers of the costs that the insurer will incur. If your population is generally young, less than 35 and they all currently carry family insurance, pregnancy and the possible problems with delivery, pre and post natal care are definite considerations.

The premiums for the group are identical within categories. If one member of the group is diagnosed with cancer and has 10 operations in one year and is in the ICU for ten months, everyone's premiums will rise next year and they will be identical within categories.

Insurance companies do nothing more than figure the odds.

All the employees had to fill out a standard form detailing their personal situations, as if applying for personal health insurance, and those were turned over to the insurance companies under consideration. We (as the employer) could also decide whether or not we wanted them to include an estimate for pregnancy care, and as I recall we said yes but only bare bones, i.e., limited to non-emergency regular doctor visits and no coverage for the actual hospitalization.

Ironically, we did have a situation where one employee had horrendous medical/surgical expenses involving her situation with scoliosis. She decided she wanted to have the spine straightening operation where they drive a metal rod through the spine and she had to be in a full back cast for an entire year while it fused. The costs were through the roof, just for that one employee. We had a lock on the premiums, though, but you can bet the insurer wanted to either raise the rates when the contract was up or drop us. That's when I went shopping. That year, I found an insurer (Prudential) whose rate estimates were very close to what we'd been paying, plus they would add preventive dental insurance for an additional $10 a month per person and dependent, but everyone had to agree to take both. You can really design your own plan, or at least you could 20 years ago.

I had group insurance from United Healthcare a few years ago. Our company had about 40 employees. I don't remember all the details but United lumped our employees in with a number of other companies so the insurance pool was quite large. So if there was a huge medical expense, the cost was spread over a large pool which protected our premiums somewhat. The plans seemed expensive and there were very few options.

My sister is retired ATT, 25 years. She now has United Health Care.
I would rather do business with the mafia.
She had cancer in 2002, was off for 2 years and had SS disability for 6 months.
She beat the cancer.
She went back to work in 2005 and worked another 4 1/2 years before retiring for good.
4 months ago she was diagnosed with another totally different cancer.
United Health Care has DENIED ALL CLAIMS, like they do on ALL large claims. The reason they stall? They are trying to force my sister on Medicare and she is only 60!
They claim that since she drew SS disability in 2002 then the taxpayers, NOT THEM, should pay for everything.
They are crooks. I vote Republican since 1972 but know that market forces are not at work in the health care market in America now. Administrative costs eat up 40% of the insurance premiums, commisions are 20% and that leaves 40 cents on the dollar for SUPPOSED claims.
We need a single payer system and now. Group health insurance paidby employer or anyone other than the consumer has ruined the American insurance market.
Does your car insurance pay for tires, brakes and oil change? Of course not.
Does your employer pay for your home owner's insurance covering paint, new carpet and maintenance?
Of course not. Anyone that believes market forces are at work in the health insurance industry knows nothing about free enterprise.

 

[dblack]

We have irrational expectations of health insurance. We're trying to get it to do something it simply can't. Insurance is a hedge against risk. It makes absolutely no sense as a primary means of funding health care. Try to use it as such is fueling health care inflation, and causing us much frustration as we face our delusion.

If we want health care to remain a free market service, we have to limit our use of insurance to catastrophic coverage and pay for as much as possible out of pocket, like we do everything else. That is the only way it will work short of socializing it entirely.

If we don't want to be responsible for paying for our own health care, then we have to socialize. If we're going to do that, we need to do it in such a way that it's not yet another target for corporatism and decentralize as much as we possibly can. If making health care a basic right is the goal (ultimately, I think this is a mistake, but ...) then we should do it as locally as possible - something like what we've done with primary and secondary public education.

What I see driving the health care crisis is several generations of people inculcated with the notion that all of us can, and should, have the best health care available. It doesn't take much reasoning to see how that is can never happen. Each and everyone one of us is going to face a point where there won't be enough health care to save us. It won't matter whether we're relying on government, or insurance companies or our own savings, it will happen. You can't make that go away by passing legislation.

 

[Two Thumbs]

Just curious as to what people here will say about this. Do you think the government should pass legislation to prevent the following example below from happening, and if so what, and if not why not?

I know someone, who's in his mid/late 30s, immigrated here (legally), has held the same job steadily, recently became a US citizen, married a US citizen here, and just had a baby. He's a prime example of somebody coming here for a better life-and an example of the American dream. Did everything the right way. He's a hard worker, and has health insurance for his family through his employer.

His newborn baby however has many medical problems-and needs very expensive medical attention, or will die. The health insurance company has already alerted the company he works for that he's no longer able to stay on the policy.

I think there's something very wrong with this scenario-and it can happen to ANYBODY. I think America can do better for our citizens than this.

edit: to be fair they're not dropping him, but just charging a ridiculous amount, knowing full well he, and the other employees cannot afford it. Adding edit here, rather than my post.

Thanks for correcting your lie. Most of us know that a single person can not be dropped from an employers ins. And those of us that do know that, also know that the ins co. did not increase ins just b/c of the baby.

Your dishonesty or ignorance is profound.