WHY health care needed reform

[Bern80]

if so why be so afraid to present your best example for the whole world to see?????

No, no he claims he alraady explained why free market principles won't work.......except there is no post in this thread that actually provides such an explanation......

It's pretty simple Bern. It is something that any person with an adult mind should be able to not only understand, but figure out on his own.

The whole basis of a 'free market' is the buyer has leverage, i.e. he/she can take his/her business elsewhere. That works perfectly fine when the stakes are things (cars or TV sets etc). But a person's health is not a 'thing', and the consumer's stake is their very life. An unhappy consumer can go buys a different car or TV. If a person has a life threatening illness and is denied coverage for treatment, WHAT leverage does that person have...take their business elsewhere IN ANOTHER LIFE?

I guess if your serious about looking at the above scenario we'd have to look at some details. First off, why is coverage being denied? Is it because the plan doesn't cover the needed treatment or because the insurance company is being shady? Or do we just want to assume there is no possible chance any insurance provider is going to pay the cost of treatment?

 

[bill5]

I applaud your determination, but it should be clear by now that attempts to get through are pointless.

Naw. He's actually making an effort. he actually managed to form a semblance of a counter argument... a place to actually begin a debate. Far more than I can say for you. If I didn't know better, given your obtuseness, weaseling, lying and general lack of maturity I'd say this is Jake Starkey's new account.

First idiocy, now childish attacks and the pot/kettle thing. What a surprise.

I made the effort. You ignored what I and others said. Now you're surprised I don't re-re-repeat myself? Whatever.

 

[Bfgrn]

No, no he claims he alraady explained why free market principles won't work.......except there is no post in this thread that actually provides such an explanation......

It's pretty simple Bern. It is something that any person with an adult mind should be able to not only understand, but figure out on his own.

The whole basis of a 'free market' is the buyer has leverage, i.e. he/she can take his/her business elsewhere. That works perfectly fine when the stakes are things (cars or TV sets etc). But a person's health is not a 'thing', and the consumer's stake is their very life. An unhappy consumer can go buys a different car or TV. If a person has a life threatening illness and is denied coverage for treatment, WHAT leverage does that person have...take their business elsewhere IN ANOTHER LIFE?

I guess if your serious about looking at the above scenario we'd have to look at some details. First off, why is coverage being denied? Is it because the plan doesn't cover the needed treatment or because the insurance company is being shady? Or do we just want to assume there is no possible chance any insurance provider is going to pay the cost of treatment?

You really need to watch the half hour interview with Wendell Potter in the OP.

 

[Bern80]

I applaud your determination, but it should be clear by now that attempts to get through are pointless.

Naw. He's actually making an effort. he actually managed to form a semblance of a counter argument... a place to actually begin a debate. Far more than I can say for you. If I didn't know better, given your obtuseness, weaseling, lying and general lack of maturity I'd say this is Jake Starkey's new account.

First idiocy, now childish attacks and the pot/kettle thing. What a surprise.

I made the effort. You ignored what I and others said. Now you're surprised I don't re-re-repeat myself? Whatever.

No bill. You did not. You never answered the question even once. There aren't many posts in this thread to go through and no where did I see an answer to the question I asked, which was essentially why free market principles won't help to bring the cost of health care down. If you did, feel free to simply copy and paste. Any other response to this is simply proof that you're a liar.

 

[Bern80]

It's pretty simple Bern. It is something that any person with an adult mind should be able to not only understand, but figure out on his own.

The whole basis of a 'free market' is the buyer has leverage, i.e. he/she can take his/her business elsewhere. That works perfectly fine when the stakes are things (cars or TV sets etc). But a person's health is not a 'thing', and the consumer's stake is their very life. An unhappy consumer can go buys a different car or TV. If a person has a life threatening illness and is denied coverage for treatment, WHAT leverage does that person have...take their business elsewhere IN ANOTHER LIFE?

I guess if your serious about looking at the above scenario we'd have to look at some details. First off, why is coverage being denied? Is it because the plan doesn't cover the needed treatment or because the insurance company is being shady? Or do we just want to assume there is no possible chance any insurance provider is going to pay the cost of treatment?

You really need to watch the half hour interview with Wendell Potter in the OP.

I did watch it. What it has to do with a person's options once denied coverage I have no idea. We can't even go that far because you won't answer why, in this hypothetical scenario, the person was denied. That would require you to acknowledge that just having insurance doesn't mean any and all health care costs are going to be covered by your plan.

 

[Brutus]

If a person has a life threatening illness and is denied coverage for treatment, WHAT leverage does that person have...take their business elsewhere IN ANOTHER LIFE?

that would be the rare exception of course. Capitalism makes it possible for people to afford critical things like food, clothing, and shelter whereas under socialism people starved to death in the 10's of millions . In a truly capitalist system very few would need to be subsidized.

A liberal is a liberal because he lacks the IQ to understand capitalism.

 

[bill5]

Or English, apparently.

 

[saveliberty]

Healthcare was not reformed, it was hijacked by Democratic terrorists.

 

[bill5]

Well it's about time. Finally someone comes along to digress yet another thread here into a wingnut cat fight! YAAAAAAAAAYYYY The left sucks! No wait the right sucks! Bush! Obama! Tea Party! There's my opinion and the wrong one! My side is always right! Yours is always wrong! blah! etc! blah!

 

[saveliberty]

A reform would have addressed accessibility across state lines for coverage and tort reform. This bill simply applied accounting tricks and lead time on a plan doomed from the start. Then violating our Constitutional right to choose if we buy a product. Pardon my shorthand.

 

[Bfgrn]

I guess if your serious about looking at the above scenario we'd have to look at some details. First off, why is coverage being denied? Is it because the plan doesn't cover the needed treatment or because the insurance company is being shady? Or do we just want to assume there is no possible chance any insurance provider is going to pay the cost of treatment?

You really need to watch the half hour interview with Wendell Potter in the OP.

I did watch it. What it has to do with a person's options once denied coverage I have no idea. We can't even go that far because you won't answer why, in this hypothetical scenario, the person was denied. That would require you to acknowledge that just having insurance doesn't mean any and all health care costs are going to be covered by your plan.

I can believe anyone could watch that interview and not see that the for profit insurance cartels are the root of our problems.

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

WENDELL POTTER: That's right. Exactly right.

BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

WENDELL POTTER: Exactly right. They--

BILL MOYERS: Where does it go?

WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.

 

[Bern80]

You really need to watch the half hour interview with Wendell Potter in the OP.

I did watch it. What it has to do with a person's options once denied coverage I have no idea. We can't even go that far because you won't answer why, in this hypothetical scenario, the person was denied. That would require you to acknowledge that just having insurance doesn't mean any and all health care costs are going to be covered by your plan.

I can believe anyone could watch that interview and not see that the for profit insurance cartels are the root of our problems.

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

WENDELL POTTER: That's right. Exactly right.

BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

WENDELL POTTER: Exactly right. They--

BILL MOYERS: Where does it go?

WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.

I'm in no way defending the insurance companies, Bf. In fact if you read back you will see where I addressed the actual conversation above and the beneficial steps that some insurance companies are taking. I can give you a perfect example of how when financies directly impact the actual consumer costs go down and quality goes up. Our employer provided insurace plan is providing not just free health screenings at our offices for the next couple weeks they are actually giving people $100 to attend them. How many people do you suppose started taking a real interest in their overall health for a moment? Why do suppose an insurance company would offer something like that? Perhaps to improve that medical loss ratio Potter talks about? Now I agree that not all insurance companies are saints, but fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.

Getting back to our hypothetical it is again important to know why the person was denied coverage. Again there is no health insurance plan that covers everything. Believe it or not some claims are legitimately denied and if your complaint is the isurance companies should never deny anything and that everything ought to be covered, that is a bit of a different conversation. Insurance claims can legitimately be denied Bf. To believe that your insurance plan is supposed to cover any and every medical expense is to live in a fairy tale land. Getting back to reality you need to stop being consumer with the 'evil' insurance companies and start tackling this issue from purely a financial perspective. There will always be cases where sometimes the financia responsibility of some health care service will fall to the consumer. Maybe their denied coverage for certain treatment, maybe there insurance has run out, who knows. The real question is what should a person and/or we as a society do when health care costs exceed what a person can reasonably expect to pay. Isn't that the real question here?

 

[Greenbeard]

That fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.

Haven't you simply been advocating for insurance plans with higher deductibles on average?

 

[Bfgrn]

I did watch it. What it has to do with a person's options once denied coverage I have no idea. We can't even go that far because you won't answer why, in this hypothetical scenario, the person was denied. That would require you to acknowledge that just having insurance doesn't mean any and all health care costs are going to be covered by your plan.

I can believe anyone could watch that interview and not see that the for profit insurance cartels are the root of our problems.

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

WENDELL POTTER: That's right. Exactly right.

BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

WENDELL POTTER: Exactly right. They--

BILL MOYERS: Where does it go?

WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.

I'm in no way defending the insurance companies, Bf. In fact if you read back you will see where I addressed the actual conversation above and the beneficial steps that some insurance companies are taking. I can give you a perfect example of how when financies directly impact the actual consumer costs go down and quality goes up. Our employer provided insurace plan is providing not just free health screenings at our offices for the next couple weeks they are actually giving people $100 to attend them. How many people do you suppose started taking a real interest in their overall health for a moment? Why do suppose an insurance company would offer something like that? Perhaps to improve that medical loss ratio Potter talks about? Now I agree that not all insurance companies are saints, but fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.

Getting back to our hypothetical it is again important to know why the person was denied coverage. Again there is no health insurance plan that covers everything. Believe it or not some claims are legitimately denied and if your complaint is the isurance companies should never deny anything and that everything ought to be covered, that is a bit of a different conversation. Insurance claims can legitimately be denied Bf. To believe that your insurance plan is supposed to cover any and every medical expense is to live in a fairy tale land. Getting back to reality you need to stop being consumer with the 'evil' insurance companies and start tackling this issue from purely a financial perspective. There will always be cases where sometimes the financia responsibility of some health care service will fall to the consumer. Maybe their denied coverage for certain treatment, maybe there insurance has run out, who knows. The real question is what should a person and/or we as a society do when health care costs exceed what a person can reasonably expect to pay. Isn't that the real question here?

The problem with insurance cartels is much greater and much more anti-patient outcome than you either realize or acknowledge.

Wall Street investors whose ONLY concern is profit margins should not be controlling that industry.


Coverage Denied: How the Current Health Insurance System Leaves Millions Behind

“Pre-Existing Conditions” Affect Millions of Americans

A large proportion of Americans have health conditions that insurance companies can qualify as “pre-existing conditions.”

A pre-existing condition is a medical condition that existed before someone applies for or enrolls in a new health insurance policy. It can be something as prevalent as heart disease – which affects one in three adults1 – or something as life-changing as cancer, which affects 11 million Americans.2

But a pre-existing condition does not have to be a serious disease like cancer or heart disease. Even relatively minor conditions like hay fever, asthma, or previous sports injuries can trigger high premiums or denials of coverage.3

Unattainable Health Coverage

Insurance discrimination based on pre-existing conditions makes adequate health insurance unavailable to millions of Americans.

In 45 states across the country, insurance companies can discriminate against people based on their pre-existing conditions when they try to purchase health insurance directly from insurance companies in the individual insurance market.4 Insurers can deny them coverage, charge higher premiums, and/or refuse to cover that particular medical condition.

A recent national survey estimated that 12.6 million non-elderly adults5 – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years.6

In another survey, one in 10 people with cancer said they could not obtain health coverage, and six percent said they lost their coverage, because of being diagnosed with the disease.7

It is still legal in nine states for insurers to reject applicants who are survivors of domestic violence, citing the history of domestic violence as a pre-existing condition.8

Even when offering coverage, insurers can exclude whole categories of illnesses related to a pre-existing condition. For example, someone with a pre-existing condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage.9

Losing Coverage When You Need It Most

Thousands of Americans also lose health insurance each year through a practice called rescission.

When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire. In most states’ individual insurance market, insurance companies can retroactively cancel the entire policy if any condition was missed – even if the medical condition is unrelated, and even if the person was not aware of the condition at the time. Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition.10

A recent Congressional investigation into this practice found nearly 20,000 rescissions from three large insurers over five years, saving them $300 million in medical claims11 – $300 million that instead had to come out of the pockets of people who thought they were insured, or became bad debt for health care providers.

At least one insurance company has been found to evaluate employee performance based in part on the amount of money an employee saved the company through rescissions.12 Simply put, these insurance company employees are encouraged to revoke sick people’s health coverage.

More

 

[dblack]

That fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.

Haven't you simply been advocating for insurance plans with higher deductibles on average?

No. It's an one example of the kinds of alternatives people might explore. We're advocating for the freedom to make those kinds of choices without asking the government (or the regulators, or the vested interests in the health insurance industry) for permission.

 

[Greenbeard]

That fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.

Haven't you simply been advocating for insurance plans with higher deductibles on average?

No. It's an one example of the kinds of alternatives people might explore. We're advocating for the freedom to make those kinds of choices without asking the government (or the regulators, or the vested interests in the health insurance industry) for permission.

You don't need to ask permission for a high-deductible plan.

What are the other alternatives on the agenda?

 

[dblack]

The problem with insurance cartels is much greater and much more anti-patient outcome than you either realize or acknowledge. ...

The cartelization of the insurance industry IS the problem. The health insurance cartel is built on government regulation. Which is why it's so painful to watch our leaders selling people on the idea that the solution is even more.

 

[dblack]

You don't need to ask permission for a high-deductible plan.

What are the other alternatives on the agenda?

They're infinite. That's the point. From what I've read, catastrophic plans will not count as sufficient coverage - but it's all up to the regulators and their lobbyists eh? The point is, what we're arguing for isn't a specific plan of action, it's the freedom to find our own solutions rather than have the vested interests choose them for us.

 

[Bern80]

That fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.

Haven't you simply been advocating for insurance plans with higher deductibles on average?

Hadn't thought of it like that, but that would be one way of introducing such concepts.

 

[Bfgrn]

The problem with insurance cartels is much greater and much more anti-patient outcome than you either realize or acknowledge. ...

The cartelization of the insurance industry IS the problem. The health insurance cartel is built on government regulation. Which is why it's so painful to watch our leaders selling people on the idea that the solution is even more.

Please provide the government 'regulations' that have cartelization of the insurance industry.

Are you saying that if the government just leaves the cartels alone, they will will become good actors and no longer put profits before patients?


The first thing to understand is the difference between the natural person and the fictitious person called a corporation. They differ in the purpose for which they are created, in the strength which they possess, and in the restraints under which they act. Man is the handiwork of God and was placed upon earth to carry out a Divine purpose; the corporation is the handiwork of man and created to carry out a money-making policy. There is comparatively little difference in the strength of men; a corporation may be one hundred, one thousand, or even one million times stronger than the average man. Man acts under the restraints of conscience, and is influenced also by a belief in a future life. A corporation has no soul and cares nothing about the hereafter.
—William Jennings Bryan, 1912 Ohio Constitutional Convention