Healthcare reform

[flaja]

I would like to get everybody’s input on this. It is not something that I necessarily agree with or something that I would necessarily accept in practice. But it is something that I am willing to discuss for the sake of trying to find solutions to a pressing national societal problem.

Any healthcare system must:

1. Preserve competition among providers for insurance policies, healthcare products and healthcare services in order to lower prices.

2. Preserve the profit motive to fund R&D of new medical products.

Taxes to consider:
Television sets

Cable and satellite TV services (based on the number of channels and number of receivers)

CD/MP3/IPOD players

DVD players

Video cassette recorders

Video cassette players

Pre-recorded video tapes

Digital video recorders

Pre-recorded CDs, DVDs, cassette tapes and MP3 recordings

Entertainment themed software

Computers

Video game systems

Video game disks, cartridges et cetera

Automobiles for personal use (proportional to the number of autos owned by a household)

Tobacco products (in addition to whatever taxes now exist)

Alcohol products (in addition to whatever taxes now exist)

Packaged process foods based on calories

Restaurant foods based on calories

Payroll tax on people who are not enrolled in the healthcare system

Internet service providers not used exclusively for business

Progressive tariff on products imported from the People’s Republic of China based on the amount of products imported, i.e., the more you import the higher your tariff rate

Corporate stock owned by non-U.S. citizens or companies not owned by U.S. citizens

Real estate owned by non-U.S. citizens or companies not owned by U.S. citizens

Credit card debt

Consumer finance loans

Sale of contracts for the future sale of gold, silver, crude petroleum, refined petroleum products, agricultural products based on the value of the contracts

Sale of corporate stock that has been owned for less than 1 year



Requirements:

Impose price limitations on all medical products that are otherwise sold over-the-counter (adhesive bandages that Wal-Mart can sell for a penny a piece shouldn’t cost $5 just because it is sold by a hospital or doctor)

End all subsidies, insurance programs and disaster aid to tobacco farmers

Create a nutrition education program for grades 1-8

Fund daily PE programs for grades 1-8

Revamp the school lunch program to avoid high-calorie/low nutrition meals

Ban advertising of prescription medications

Prohibit the sale of soft drinks at all public schools

Restrict the products that can be purchased by food stamps to insure that recipients maintain a nutritious diet

Basic plan:
The plan will provide 3 levels of coverage.

Basic coverage will be offered everyone and will include a yearly health assessment examination and routine vaccinations as well as coverage for minor incidental medical needs (illness and injury).

Anyone who is enrolled in the basic coverage plan will be required to enroll in the chronic and catastrophic plans as well.

The chronic coverage plan will include things like pregnancy, diabetes and hypertension.

The catastrophic coverage plan will cover things like cancer, heart disease and paralysis.


How the plan works:

Doctors and insurance companies will create a standardized set of health assessment criteria that will determine a person’s overall health and the likelihood that he will need certain types and amounts of medical care during the next year based on the person’s age, gender, family history, lifestyle et cetera. A person’s health assessment will be expressed as a numerical score.

Each year all interested insurance companies will submit bids for premiums to cover each possible health assessment score for each level of coverage (routine, chronic and catastrophic). The bids for each health assessment score will be averaged to determine the national average.

Persons who are enrolled in the plan will receive a voucher equal to the average premium for an insurance policy to provide routine health care. Each enrolled person will use the voucher to purchase a routine health care insurance policy from one of the participating insurance companies. If the person purchases a policy that cost more than the national average, he must pay the difference. If he purchases a policy that cost less than the national average, he may apply the difference towards his purchase price for the chronic health care insurance policy that he must buy.

Each year’s health assessment score will be converted to a percent chance that he will need chronic medical care during the next year. Each enrolled person will receive a voucher equal to: [100% of the average premium] – [(percent chance of need) x (100% of average premium)]. This way the more burden a person puts on the healthcare system the more he pays in insurance premium. Each enrolled person must use the voucher to purchase a chronic health care insurance policy from one of the participating insurance companies. If the person purchases a policy that cost more than the national average, he must pay the difference. If he purchases a policy that cost less than the national average, he may apply the difference towards his purchase price for the catastrophic health care insurance policy that he must buy.

Each year’s health assessment score will be converted to a percent chance that he will need catastrophic medical care during the next year. Each enrolled person will receive a voucher equal to: [100% of the average premium] – [(percent chance of need) x (100% of average premium)]. Each enrolled person must use the voucher to purchase a catastrophic health care insurance policy from one of the participating insurance companies. If the person purchases a policy that cost more than the national average, he must pay the difference. If he purchases a policy that cost less than the national average, he may apply the difference towards alternative treatments or lifestyle modification programs.

Each year a national average cost will be calculated for medical products and services (doctors’ visits, lab work, hospitalization, prescription medications, diagnostic tests and procedures, medical supplies). These averages must be published and provided to each person who is enrolled in the program. Persons who are enrolled in the program may obtain medical services and products from any participating provider. Insurance companies will pay the average cost. If the person uses a provider whose price is greater than the average, the person must pay the difference. If the person uses a provider whose price is lower than the average, he will receive a voucher for the difference that he may apply to his out-of-pocket costs for medical products and services or apply them to alternative treatments or lifestyle modification programs or apply towards the next year’s insurance premiums.

[JohnDoe]

fla
there is alot to digest there....i still haven't finished reading it all....it could take a day or two to really sharp shoot :) it!

I commend you on making an effort and see some things in there that do seem like they need to be done to help the situation....

offhand i don't agree with the higher taxes on what you mentioned.... higher taxes will not solve our problems....

Another thing that might get in the way of another idea you had with allowing insurance companies to compete in order to lower the costs, what actually is stopping that "competition" now from taking place? I am not certain, but i know it ain't happening because prices don't ever go down or on sale to meet the competitions.... :D

and also on this point system thing and all that crap....it won't work, unless you want people that have inherited health problems pay out the ying yang for insurance which is unfair imo, though maybe there is a way to give you a bonus for offering a dietician's advise and seminars to your employees for a discount with the insurance company....

besides it is not the healthy that need insurance now is it? It is the sick, or those in accidents.... but the insurance business does not work if only the sick are insured...they lose. They need the healthy to be paying for insurance in order to cover the elderly and sick...this is how insurance works, and they NEED many more healthy people paying for health insurance in order to afford the payment of the sic's medical care at a profit....

anyway...i kinda stopped in the middle of your point system paragraph and thought i would let you know what i thought so far and that i would like to go over this in depth and discuss it in full.... :D

jd

[flaja]

offhand i don't agree with the higher taxes on what you mentioned.... higher taxes will not solve our problems....

If you notice, I’ve put most of the new taxes on things that contribute to lifestyles that increase our collective need for medical care- namely obesity, smoking and drinking. I wouldn’t expect to fund a healthcare program with revenue from these taxes, but I would hope that the taxes would encourage people to make lifestyle changes that will lead to better health and thus fewer visits to the doctor.

Taxes on things like consumer debt, foreign ownership of American assets and imports will deal with issues that threaten our economic and national security. If we do need more revenue for healthcare, then we should create a tax system that can solve as many other problems as possible.


Another thing that might get in the way of another idea you had with allowing insurance companies to compete in order to lower the costs, what actually is stopping that "competition" now from taking place? I am not certain, but i know it ain't happening because prices don't ever go down or on sale to meet the competitions.... :D

I wish I knew the answer to this. The best explanation I can give is that the healthcare industry is a seller’s market because anyone who needs medical care doesn’t want to go without it regardless of the cost and America has such a socialist entitlement mentality that medical providers and insurance companies know that they can charge whatever they want to charge because eventually the government will end up paying for everything.


and also on this point system thing and all that crap....it won't work, unless you want people that have inherited health problems pay out the ying yang for insurance which is unfair imo, though maybe there is a way to give you a bonus for offering a dietician's advise and seminars to your employees for a discount with the insurance company....

Why should people who put a greater demand on the healthcare industry not have to pay more for healthcare? Why should healthy people have to subsidize the costs of people who make no effort to be healthy?


besides it is not the healthy that need insurance now is it?

They don’t need routine medical care to stay healthy? They have absolutely no chance of ever being severely injured or come down with cancer? But their overall good health will be reflected in lower healthcare premiums.

[Dilloduck]

If you notice, I’ve put most of the new taxes on things that contribute to lifestyles that increase our collective need for medical care- namely obesity, smoking and drinking. I wouldn’t expect to fund a healthcare program with revenue from these taxes, but I would hope that the taxes would encourage people to make lifestyle changes that will lead to better health and thus fewer visits to the doctor.

Our collective need ??? Why should I pay for anyone's healthcare but my own. Furthermore---why should I have to have my own ?

[flaja]

Our collective need ??? Why should I pay for anyone's healthcare but my own. Furthermore---why should I have to have my own ?


Yes our collective need. In any industry both the suppliers and consumers are cumulative. What you have to pay for a product depends on how many suppliers for that product and how many other consumers of that product interact in the market place. The amount of a product that you can supply or demand will influence the market price that everybody else has to deal with.

Note: there is nothing in my plan that mandates that consumers take part. The most my plan does is encourage people to take part.

[Dilloduck]

Yes our collective need. In any industry both the suppliers and consumers are cumulative. What you have to pay for a product depends on how many suppliers for that product and how many other consumers of that product interact in the market place. The amount of a product that you can supply or demand will influence the market price that everybody else has to deal with.

Note: there is nothing in my plan that mandates that consumers take part. The most my plan does is encourage people to take part.

What you buy depends on what you think you need. Health services can charge whatever they want as long as people need it. Captive consumers.

[flaja]

What you buy depends on what you think you need. Health services can charge whatever they want as long as people need it. Captive consumers.


Even though the healthcare industry is a sellers’ market, there is still a supply and demand component. People who demand higher amounts of healthcare due to their unhealthy lifestyles, raise the price for the rest of us.

[Dilloduck]

Even though the healthcare industry is a sellers’ market, there is still a supply and demand component. People who demand higher amounts of healthcare due to their unhealthy lifestyles, raise the price for the rest of us.

Why don't you just go straight for euthanasia ? Cheaper.

[flaja]

Why don't you just go straight for euthanasia ? Cheaper.


I see that you are not interested in having a serious discussion, so I won’t waste any more time replying to you.

[manu1959]

Even though the healthcare industry is a sellers’ market, there is still a supply and demand component. People who demand higher amounts of healthcare due to their unhealthy lifestyles, raise the price for the rest of us.

what about health freak hypochondriacs ..... i about genetically inferior people with birth defects.....or just stupid people….

[flaja]

what about health freak hypochondriacs ..... i about genetically inferior people with birth defects.....or just stupid people….


Hypochondriacs do have legitimate medical problems albeit mental rather than physical ones. So they should be treated as mental health patients under the chronic portion of this plan- assuming that doctors who give routine care can be trained well enough to recognize the patient’s mental health problems.

People with birth defects would get treatment under the chronic or catastrophic portion of the plan depending on the severity of their condition.

And stupid people are the ones who believe the country doesn't have a problem with healthcare.

[Dilloduck]

Hypochondriacs do have legitimate medical problems albeit mental rather than physical ones. So they should be treated as mental health patients under the chronic portion of this plan- assuming that doctors who give routine care can be trained well enough to recognize the patient’s mental health problems.

People with birth defects would get treatment under the chronic or catastrophic portion of the plan depending on the severity of their condition.

And stupid people are the ones who believe the country doesn't have a problem with healthcare.

Is it that our country has a problem with healthcare or that people have a problem affording it ?

[flaja]

Is it that our country has a problem with healthcare or that people have a problem affording it ?


Both. The typical American lifestyle increases our need for healthcare and this extra demand contributes to high costs, which many Americans cannot afford.

[manu1959]

Hypochondriacs do have legitimate medical problems albeit mental rather than physical ones. So they should be treated as mental health patients under the chronic portion of this plan- assuming that doctors who give routine care can be trained well enough to recognize the patient’s mental health problems.

People with birth defects would get treatment under the chronic or catastrophic portion of the plan depending on the severity of their condition.

And stupid people are the ones who believe the country doesn't have a problem with healthcare.


are you saying people with unhealthy life styles do not have legitimate medical problems.....

define healthy lifestyle......how do you enforce it....you know if each person paid for their own medical servcies you wouldn't care what anyone does....

[manu1959]

Both. The typical American lifestyle increases our need for healthcare and this extra demand contributes to high costs, which many Americans cannot afford.

you know i drive an expensive car drink exensive wine and buy expenisve food.....does that make what you buy more exensive?

[glockmail]

you know i drive an expensive car drink exensive wine and buy expenisve food.....does that make what you buy more exensive? More money is spent on collecting taxes than on health care. Why is it Democrats don't support the Fair Tax?

[Mr. P]

My Health care solution.

No new taxes or government involvement in the health care insurance provider process.

Problem:

Reasonable people know they need health care insurance. Many simply can’t afford it.

Currently insurance providers are hand picking those they will insure. These are the least risk, healthiest folks in the population. How are they doing it? With premiums, by adjusting premiums for every individual they can effectively eliminate those they will not profit from. At the same time, eliminating so many from coverage results in higher premiums for those who are covered. The insurance industry has become no more that a premium collector from a select group instead of being an insurance provider. Don’t believe it? If you have individual insurance vs group insurance and are unfortunate enough to make a major claim, when your new term comes up for renewal, watch how fast they either don’t renew, or price your premium so high you just walk away. Sure you can get a new policy but it will be priced to reflect your history, and that pre-exiting condition, excluded for at least 12 months. They will however be happy to accept your monthly premium payment, if you can afford it.

High premiums are the major obstacle to obtaining decent or any health care coverage at all. So how do we solve this problem and not affect the profit of the insurance providers?


Solution:

I see what may be the only reasonable solution. One I may be able to support: regulation.

For the most part I oppose regulation; however, I see it working positively in the public utilities arena. People are offered a utility product which like health insurance we all need, electric, gas. The price is regulated here by the PSC (Public Service Commission).
They set the rate or maximum rate that can be charged. If the utility company needs to raise rates do to costs or expansion they must present their case to the PSC for approval before doing so. The PSC works to adjust rates, if necessary, that benefit both the public and the utility company. Utility companies are profitable under this system/ process.

The country would be divided into regions, Southeast, Northeast etc.

Any company providing health insurance in a region would be required to provide a basic health care coverage plan (Standard for the entire country) to anyone in that region.

The national standard would be developed by a national group composed of an insurance commissioner from each region. Premiums would be determined by the regional Insurance commission. Regional commissions would be made up of the state insurance commissioners from each state within that region.
Premiums would be set by region based on overall risk in that region.
.
Reasonable and customary charges would be set by region, similar to what is done now.


Maintenance of Profit and Coverage:

I see an increase, or at the least, the same profit for insurance companies by increasing their customer base thus spreading the risk across a region (think group coverage).

Supplement participating companies with current alcohol/ tobacco taxes collected regionally. Make these taxes fluid, easily shared with other regions if needed.

Further reduce risk with a customer deposit, similar to utilities now, with a maximum cap.

Well that’s my general idea. It seems reasonable to me and I think it would work with little federal government involvement, which means little federal control.

[JohnDoe]

More money is spent on collecting taxes than on health care. Why is it Democrats don't support the Fair Tax?


I am not quite certain on that lean and mean, just think about it....

I think medicare costs are the 3rd largest expense in our government which is escentially "healthcare and prescription" expense for the seniors. Also, think about all of the healthcare expence the government spends on Veterans or Military Retires, and all of the expense our gvt pays for health care policies for our entire workforce of the federal gvt...including all postal workers, FAA, pentegon, active duty military and their families and then add in every one in congress and all of their employees, and then on top of all of that add in what the federal government spends on research and development on Health Purposes and that grant money given, like adult stem cell research and also some on embryonic, and so many others on the lines that i mentioned like SCHIP paying healthcare for children and their mothers and Medicaid paying healthcare for the poorest among us, and FINALLY, the money our federal gvt credits to all of the businesses paying for a portion of their employees health care expense, tax write offs we give to them and the tax write offs we give to individuals with their healthcare expenses over 7% of their salaries....

I would bet healthcare already adds up to the biggest expense of our federal government ALREADY....if you get in to the nitty gritty of it....

It truely is an important if not the most important domestic crisis we have... and gvt spending crisis and family busting crisis, and employer financial busting crisis, and life or death crisis, and on top of that, the number one reason for individual filed bankruptcy in our Nation.

This is why i differ with other Democrats and a universal plan, at least not yet, it will bankrupt us to go in to some kind of universal plan, even if held in the private sector, could bankrupt us as a Nation if we do not face the critical issues with healthcare costs today, and WHY they keep rising, and WHAT, if anything, CAN be done about it....sometimes the simplist of things like streamling the overhead or billing system could give significant reductions in our cost, something like a 25% reduction in costs.... and like you mentioned once, allow more competition within states could reduce costs a little, and also promoting a healthy lifestyle by corporations with their employees could reduce healthcare costs to the employer,

and also allowing the free market to work with the medicare pill bill----allow bulk price negotiations as any business would expect when purchasing in bulk and also allow us to purchase from any country we want...there is no reason for americans to burden the entire costs of the R & D on medicines the whole world benefits from...this is inherrently unfair and making Americans spend 10 times more for their medications than many other countries in the world buying the same ones.

We could force the Pharma industry's hand by making them restructure these costs and prorate them throughout the world instead of all on us...?



It really hits alot of areas of concern imho!

jd

[flaja]

are you saying people with unhealthy life styles do not have legitimate medical problems.....

Are you paying any attention at all to what I am saying? I have never said that people with unhealthy lifestyles have no legitimate medical needs. What I have said is such people put greater than normal demand on the healthcare industry, and this extra demand raises the prices for everyone.


define healthy lifestyle......how do you enforce it....you know if each person paid for their own medical servcies you wouldn't care what anyone does....

Mostly maintaining a proper nutritious diet and getting regular exercise. Making junk food more expensive by taxing it would go a long way towards fixing the diet problem. Making PE mandatory for all students in public schools would help with the exercise issue.

And regardless of whether or not everyone paid for their own medical care, people with unhealthy lifestyles create health problems for themselves, but when they demand extra medical services, they raise the cost of healthcare for everyone else.

[flaja]

you know i drive an expensive car drink exensive wine and buy expenisve food.....does that make what you buy more exensive?

Depends on whether or not you are a drunk and whether or not the expensive food makes you obese either by its nutritional quality or the quantity you eat.

And I do support more stringent gas mileage requirements for SUVs. Part of the reason why gas prices are so high is that SUVs and large pickup trucks don't get good mileage.

[flaja]

Currently insurance providers are hand picking those they will insure. These are the least risk, healthiest folks in the population. How are they doing it? With premiums, by adjusting premiums for every individual they can effectively eliminate those they will not profit from. At the same time, eliminating so many from coverage results in higher premiums for those who are covered.

How so? If an insurance company will only write a policy for people that won’t need healthcare thereby insuring a certain level of profit, how does refusing to write policies that will reduce profit raise premiums? If writing a policy means guaranteed profit, why would the cost of the policy have to be so high? How do people who can’t get a policy raise the premiums of people that can get a policy even though they likely won’t use it to get healthcare?


If you have individual insurance vs group insurance and are unfortunate enough to make a major claim, when your new term comes up for renewal, watch how fast they either don’t renew, or price your premium so high you just walk away.

If someone who has group insurance has an existing medical condition (one that requires prolonged care like cancer, hypertension or even pregnancy) the insurer cannot refuse to renew the policy according to federal law. They may be able to raise the group premium (but they’d likely do that anyway), but they cannot cancel a policy that someone in a group is collecting on. And at the same time the organization that is “providing” the policy (likely an employer) cannot change policies as long as someone is the group is collecting on the existing one because you cannot leave someone in a group without coverage.


Sure you can get a new policy but it will be priced to reflect your history, and that pre-exiting condition, excluded for at least 12 months. They will however be happy to accept your monthly premium payment, if you can afford it.

People who have all of their medical costs paid for by the government don’t care how much medical care they use because it doesn’t cost them anything.

People who have a group policy through an employer may not be paying all of their own premium (depending on the policy and the employer) so they too have no reason to care about how much healthcare they use.

In both cases the healthcare recipient has no financial reason to worry about his lifestyle, and lifestyle is our biggest healthcare problem.


High premiums are the major obstacle to obtaining decent or any health care coverage at all. So how do we solve this problem and not affect the profit of the insurance providers?

There are certain industries that should be not-for-profit. Insurance (all kinds) is one. You get insurance so you will have money when you need it. But the insurer has a financial incentive to find ways and reasons to not pay you the money that you are owed.


For the most part I oppose regulation; however, I see it working positively in the public utilities arena. People are offered a utility product which like health insurance we all need, electric, gas. The price is regulated here by the PSC (Public Service Commission).
They set the rate or maximum rate that can be charged.

Where I live this simply means whatever the utility wants to charge since it is a government agency.


Any company providing health insurance in a region would be required to provide a basic health care coverage plan (Standard for the entire country) to anyone in that region.

The national standard would be developed by a national group composed of an insurance commissioner from each region.

Shouldn’t medical professionals have some say in this? Insurance companies will always look out for what is best for their profit margin, not what is actually needed by medical patients.


Premiums would be determined by the regional Insurance commission. Regional commissions would be made up of the state insurance commissioners from each state within that region.

So you’d have representatives from a for-profit industry in collusion with the government?

[flaja]

Also, think about all of the healthcare expence the government spends on Veterans or Military Retires, and all of the expense our gvt pays for health care policies for our entire workforce of the federal gvt...

I recently looked into the program that buys health insurance for non-military federal employees. In 2005 the average premium was something like $385 per person covered (total costs to the government to buy premiums / number of people covered).

[JohnDoe]

I recently looked into the program that buys health insurance for non-military federal employees. In 2005 the average premium was something like $385 per person covered (total costs to the government to buy premiums / number of people covered)."premiums" are usually paid monthly...am i to presume the average MONTHLY payment per person covered is $385 a month by our gvt, and then the employee also pays a small portion, monthly?

That's alot of money to be spending on healthcare for all of their employees!

jd

[Dilloduck]

are you saying people with unhealthy life styles do not have legitimate medical problems.....

define healthy lifestyle......how do you enforce it....you know if each person paid for their own medical servcies you wouldn't care what anyone does....

Tax chairs because people don't get enough exercise--and sofas. :laugh2:

[Mr. P]

How so? If an insurance company will only write a policy for people that won’t need healthcare thereby insuring a certain level of profit, how does refusing to write policies that will reduce profit raise premiums? More policies will not necessarily mean less profit. If profit is set at X then premiums must be structured to achieve X. More policies mean more premiums. Many of those will never make claims. If the policies are writen to eliminate abuse it's not a problemIf writing a policy means guaranteed profit, why would the cost of the policy have to be so high?See above. How do people who can’t get a policy raise the premiums of people that can get a policy even though they likely won’t use it to get healthcare?See above.



If someone who has group insurance has an existing medical condition (one that requires prolonged care like cancer, hypertension or even pregnancy) the insurer cannot refuse to renew the policy according to federal law.Did you see I said "individual coverage" They may be able to raise the group premium (but they’d likely do that anyway), but they cannot cancel a policy that someone in a group is collecting on. And at the same time the organization that is “providing” the policy (likely an employer) cannot change policies as long as someone is the group is collecting on the existing one because you cannot leave someone in a group without coverage.



People who have all of their medical costs paid for by the government don’t care how much medical care they use because it doesn’t cost them anything.
This is not what I propose.
People who have a group policy through an employer may not be paying all of their own premium (depending on the policy and the employer) so they too have no reason to care about how much healthcare they use.
For me this is about making insurance affordable not dictating lifestyle
In both cases the healthcare recipient has no financial reason to worry about his lifestyle, and lifestyle is our biggest healthcare problem. I disagree.



There are certain industries that should be not-for-profit. Insurance (all kinds) is one. You get insurance so you will have money when you need it. But the insurer has a financial incentive to find ways and reasons to not pay you the money that you are owed. Profit motive is an issue.



Where I live this simply means whatever the utility wants to charge since it is a government agency.Your utility is government owned?



Shouldn’t medical professionals have some say in this? Insurance companies will always look out for what is best for their profit margin, not what is actually needed by medical patients.They should and do have a say. Treatment protocol should never be driven by insurance companies.HMOs tried to dictate treatments. I believe they have made major adjustments over the years. I can't say for sure. I'd never have one because of that practice.



So you’d have representatives from a for-profit industry in collusion with the government? our state insurance commissioner is elected. Yours isn't?..

[flaja]

"premiums" are usually paid monthly...am i to presume the average MONTHLY payment per person covered is $385 a month by our gvt, and then the employee also pays a small portion, monthly?

That's alot of money to be spending on healthcare for all of their employees!

jd


The figures I had were for the government’s yearly cost, but I don’t think that $385 was the total yearly premium per person because the beneficiaries pay part of the cost of the premiums themselves. I was looking for average premium per beneficiary so I’d have some idea what the average costs for my plan would be. I couldn’t find anything for the private sector and I don’t know how good government figures would be- does the government get cut-rate because of the number of people involved, or is the government paying through the nose because that’s what the government usually does?

[flaja]

More policies will not necessarily mean less profit. If profit is set at X then premiums must be structured to achieve X. More policies mean more premiums. Many of those will never make claims. If the policies are writen to eliminate abuse it's not a problem

More policies that are likely to be collected on do mean less profit. If a company will only write policies on people that likely won’t collect on them, then the company’s price need not be very high to insure a high profit margin.

Suppose a company wants to make $100 in profit, it has 100 customers and it can earn a 4% annual return on its investments.

The company would have to invest $2500 to earn its $100 profit. Now suppose that half of the customers will definitely make a claim and each claim will cost the company $25 each and 10% of the other half will make a claim that costs $25 each. The company would have to earn $1375 (55 claims x $25 each) to meet its costs and then $100 more for its profit. At 4% annually the company would have to invest $36875. With 100 customers each premium would be $368.75.

Now suppose the company refuses to write a policy for the 50 people that would definitely make a claim against it. This would bring its costs down to $125 (5 claims x $25 each). Then to make $100 in profit the company would have to invest $5625. This would make the premiums for the 50 healthy people only $112.50.

The more people who will likely make a claim you cover, the higher the cost of premiums because the premiums would have to factor in the money that will be lost in paying claims.

However, people that are chronically unhealthy will raise everyone’s cost for the simple fact that their extra demand raises market prices. Insurance companies will have to price their policies accordingly even for healthy people on the off chance that a healthy person may make a claim and the insurance company will have to pay the market price to provide care to the covered person. But other than that, refusing to write policies for the unhealthy wouldn’t affect the premium costs for the healthy.


Did you see I said "individual coverage"

I was merely expanding on what you were saying. Group policies are not always what they are cracked up to be. You don’t necessarily have lower costs simply because you have group rates. And the law is pretty much the same when an employer offers insurance as individual policies. An employer cannot cover one worker and not all workers who do similar work, nor give one worker a policy that is not comparable to what is provided to another worker.


People who have all of their medical costs paid for by the government don’t care how much medical care they use because it doesn’t cost them anything.
This is not what I propose.

Then what happens if the cost per individual in your plan is not significantly lower than the costs we have now? Millions of people cannot afford insurance now, so what guarantee does your plan offer that they will be able to afford insurance under your plan? Remember, just because a utility is heavily regulated by the government doesn’t mean that consumer costs are low.


For me this is about making insurance affordable not dictating lifestyle

So changing lifestyles that contribute to heart disease and lung disease and cancer won’t lower medical costs and thus insurance premiums? I think your plan is missing half the equation.


In both cases the healthcare recipient has no financial reason to worry about his lifestyle, and lifestyle is our biggest healthcare problem. I disagree.

How so? If something is free, people aren’t inclined to waste it? Last year my neighbor (who doesn’t work and whose income is from welfare and child-support from men she never married) took her 2 year old daughter to the emergency room simply because the child had a slight fever and vomited once. Needless to say my neighbor gets free medical care from the government.


Your utility is government owned?

Unfortunately, yes. Historically our light and water bills have been some of the lowest in the country- much lower than what people downstate pay to Florida Power and Light. But in the last decade our bills have gone through the roof to make up for the infrastructure that hasn’t kept up with our suburbanization. The fact that the utility’s managers have been getting bonus after bonus lately hasn’t helped either.


Treatment protocol should never be driven by insurance companies.

But far too often they are. A few years ago my mother’s insurance company denied her medication that her doctor had prescribed. She was told to have the doctor write a prescription for a cheaper drug.


our state insurance commissioner is elected. Yours isn't?

I couldn’t say right off if Florida even has an insurance commissioner. If we do its not an elected post since I’ve never seen the post on any state election ballot.

But even if insurance commissioners are elected they are not immune from industry pressure. The insurance lobby can likely out-fund anyone who wants to challenge an incumbent that the lobby owns.

[Dilloduck]

More policies that are likely to be collected on do mean less profit. If a company will only write policies on people that likely won’t collect on them, then the company’s price need not be very high to insure a high profit margin.

Suppose a company wants to make $100 in profit, it has 100 customers and it can earn a 4% annual return on its investments.

The company would have to invest $2500 to earn its $100 profit. Now suppose that half of the customers will definitely make a claim and each claim will cost the company $25 each and 10% of the other half will make a claim that costs $25 each. The company would have to earn $1375 (55 claims x $25 each) to meet its costs and then $100 more for its profit. At 4% annually the company would have to invest $36875. With 100 customers each premium would be $368.75.

Now suppose the company refuses to write a policy for the 50 people that would definitely make a claim against it. This would bring its costs down to $125 (5 claims x $25 each). Then to make $100 in profit the company would have to invest $5625. This would make the premiums for the 50 healthy people only $112.50.

The more people who will likely make a claim you cover, the higher the cost of premiums because the premiums would have to factor in the money that will be lost in paying claims.

However, people that are chronically unhealthy will raise everyone’s cost for the simple fact that their extra demand raises market prices. Insurance companies will have to price their policies accordingly even for healthy people on the off chance that a healthy person may make a claim and the insurance company will have to pay the market price to provide care to the covered person. But other than that, refusing to write policies for the unhealthy wouldn’t affect the premium costs for the healthy.



I was merely expanding on what you were saying. Group policies are not always what they are cracked up to be. You don’t necessarily have lower costs simply because you have group rates. And the law is pretty much the same when an employer offers insurance as individual policies. An employer cannot cover one worker and not all workers who do similar work, nor give one worker a policy that is not comparable to what is provided to another worker.



Then what happens if the cost per individual in your plan is not significantly lower than the costs we have now? Millions of people cannot afford insurance now, so what guarantee does your plan offer that they will be able to afford insurance under your plan? Remember, just because a utility is heavily regulated by the government doesn’t mean that consumer costs are low.



So changing lifestyles that contribute to heart disease and lung disease and cancer won’t lower medical costs and thus insurance premiums? I think your plan is missing half the equation.



How so? If something is free, people aren’t inclined to waste it? Last year my neighbor (who doesn’t work and whose income is from welfare and child-support from men she never married) took her 2 year old daughter to the emergency room simply because the child had a slight fever and vomited once. Needless to say my neighbor gets free medical care from the government.



Unfortunately, yes. Historically our light and water bills have been some of the lowest in the country- much lower than what people downstate pay to Florida Power and Light. But in the last decade our bills have gone through the roof to make up for the infrastructure that hasn’t kept up with our suburbanization. The fact that the utility’s managers have been getting bonus after bonus lately hasn’t helped either.



But far too often they are. A few years ago my mother’s insurance company denied her medication that her doctor had prescribed. She was told to have the doctor write a prescription for a cheaper drug.



I couldn’t say right off if Florida even has an insurance commissioner. If we do its not an elected post since I’ve never seen the post on any state election ballot.

But even if insurance commissioners are elected they are not immune from industry pressure. The insurance lobby can likely out-fund anyone who wants to challenge an incumbent that the lobby owns.

Cut the middle man out of the deal and save bundles. Whatever happened to the concept of just paying the service provider ?

[Mr. P]

Cut the middle man out of the deal and save bundles. Whatever happened to the concept of just paying the service provider ?
That would be nice. But then a Doc would need to charge only what the market could bear, sending their income into a nose dive. Same with the drug and other suppliers. It would weed out those interested in healing from those who are only in for the money. We can dream though.

[Dilloduck]

That would be nice. But then a Doc would need to charge only what the market could bear, sending their income into a nose dive. Same with the drug and other suppliers. It would weed out those interested in healing from those who are only in for the money. We can dream though.

What---they can't handle the competition ?? Insurance always seemed like a scam to me anyway.----Give me some money and I'll take care of your problems----ya right !! :laugh2:

[flaja]

Cut the middle man out of the deal and save bundles. Whatever happened to the concept of just paying the service provider ?

Because very few people can afford the cost of major medical care. My mother spent 4 days in the hospital over Thanksgiving last year. She went in through the ER because that was the best way to get the tests that her doctor said she needed. And even without having the surgery that she needed her total bill was something like $50,000. Could you afford such a bill?

[flaja]

That would be nice. But then a Doc would need to charge only what the market could bear, sending their income into a nose dive. Same with the drug and other suppliers. It would weed out those interested in healing from those who are only in for the money. We can dream though.


If all of the doctors who are in the business for the money were to leave the business, how overworked would the remaining doctors be? If you needed to see such a doctor, how long a wait would you have?

[Mr. P]

What---they can't handle the competition ?? Insurance always seemed like a scam to me anyway.----Give me some money and I'll take care of your problems----ya right !! :laugh2:

Can't disagree, that's the biggest reason I could support regulation of coverage and premium cost.

[Mr. P]

If all of the doctors who are in the business for the money were to leave the business, how overworked would the remaining doctors be? If you needed to see such a doctor, how long a wait would you have?

Ask Canada. I think their system is similar to what you proposed. That being pretty socialist.

How long have you dealt with insurance companies.

BTW...Fla does have an insurance commissioner.

[Dilloduck]

Because very few people can afford the cost of major medical care. My mother spent 4 days in the hospital over Thanksgiving last year. She went in through the ER because that was the best way to get the tests that her doctor said she needed. And even without having the surgery that she needed her total bill was something like $50,000. Could you afford such a bill?

so other people should all join together and pay her bill ?

[flaja]

Ask Canada. I think their system is similar to what you proposed. That being pretty socialist.

How long have you dealt with insurance companies.

BTW...Fla does have an insurance commissioner.


I don’t know anything specific about Canada’s system. But how would my plan not preserve the profit motive and competition among insurance companies and medical care providers?

My mother spent the last 13 years of her working life as the comptroller of a private country club. She had to deal with insurance matters all of the time for about 100-150 employees. I likely know as much, if not more, about the insurance industry as anyone who doesn’t work in the insurance industry directly does.

[Dilloduck]

I don’t know anything specific about Canada’s system. But how would my plan not preserve the profit motive and competition among insurance companies and medical care providers?

My mother spent the last 13 years of her working life as the comptroller of a private country club. She had to deal with insurance matters all of the time for about 100-150 employees. I likely know as much, if not more, about the insurance industry as anyone who doesn’t work in the insurance industry directly does.

So how do insurance companies stay afloat with the price of health care shooting so high ? They dump the sick. It's a scam.

[Mr. P]

I don’t know anything specific about Canada’s system. But how would my plan not preserve the profit motive and competition among insurance companies and medical care providers?

My mother spent the last 13 years of her working life as the comptroller of a private country club. She had to deal with insurance matters all of the time for about 100-150 employees. I likely know as much, if not more, about the insurance industry as anyone who doesn’t work in the insurance industry directly does.

How long have you dealt with insurance companies?

There seems to be a great deal you don't know. That being the case, what makes you think your approach will work?

[flaja]

So how do insurance companies stay afloat with the price of health care shooting so high ? They dump the sick. It's a scam.

That's just it: they don't all stay afloat. They stop writing policies and beg the government for a bailout. And this isn't limited to health insurance. Florida has a real problem with home insurance companies leaving the state since we've had so many hurricanes in the past decade.

[flaja]

How long have you dealt with insurance companies?

There seems to be a great deal you don't know. That being the case, what makes you think your approach will work?

What makes you such an expert in insurance? Do you work in the industry?

[Mr. P]

How long have you dealt with insurance companies?

There seems to be a great deal you don't know. That being the case, what makes you think your approach will work?


What makes you such an expert in insurance? Do you work in the industry?

I'm not an insurance expert, never said I was.

Now can you answer the questions?

[PostmodernProphet]

the health care crisis.....is it that some people don't have insurance, or is it that any kind of health care costs a shitload of money.....

my son went into the emergency room because of a shooting pain in his neck.....they decided he needed an MRI.....he was there a total of 5 hours and the bill that went to the insurance company was over $4k.....after the insurance company got done with it the bill was $1300.....only $500 of it was the deductible, the other $800 was defined by the insurance company as (loosely paraphrased) shit they shouldn't have charged him for.......so, do you think that's a good average?.....$125 per hour in shit they shouldn't charge for times every person who walks into the hospital?.......

[Dilloduck]

That's just it: they don't all stay afloat. They stop writing policies and beg the government for a bailout. And this isn't limited to health insurance. Florida has a real problem with home insurance companies leaving the state since we've had so many hurricanes in the past decade.

Why are they writing policies when they don't have the bucks to cover losses by their clients who are paying for protection ?

[flaja]

I'm not an insurance expert, never said I was.

Now can you answer the questions?

If you are not any kind of expert in the insurance industry, why are you questioning my understanding of how that industry works?

[flaja]

Why are they writing policies when they don't have the bucks to cover losses by their clients who are paying for protection ?


Likely because the law doesn’t keep a good enough watch on how they do business.

[Dilloduck]

Likely because the law doesn’t keep a good enough watch on how they do business.

It's tough to regulate a ponzi scheme.

[Mr. P]

If you are not any kind of expert in the insurance industry, why are you questioning my understanding of how that industry works?

I'm not questioning the obvious. It's apparent you have little background, experience or understanding of the insurance or health care industry.

It's painfully clear that your proposal is for nothing more than socialized medical care coupled with social engineering. I oppose both. So for now, our time is over.

[flaja]

I'm not questioning the obvious. It's apparent you have little background, experience or understanding of the insurance or health care industry.

It's painfully clear that your proposal is for nothing more than socialized medical care coupled with social engineering. I oppose both. So for now, our time is over.

If you don’t have any more experience than I do with the insurance industry, how do you know enough to know that my understanding of that industry is faulty? Just what has your experience been?