Health care isn't a "right"

[djkelly]

I'm not going to spend a lot of time  going over things I've said over and over before, but if you aren't familiar with insurance and billing and hospital admitting practices etc, and you are predisposed to be against any initiative championed by Democrats, you won't pay attention anyway.

I currently work in medical billing and I've dealt with plenty of my own medical billing issues so I found your descriptions interesting.

Hospitals, doctors offices and insurance companies spend a lot of money on personnel to deal with billing and claims. Patients all come in with different policies in terms of what is covered, deductibles and co-pays (what has already been met). 

In addition, insurance companies have to pay a sales staff, and often people in insurance sales continue to collect a commission off a policy as long as it is in force.  Companies pay for advertising and lobbyists. It's been proven that they also pay people to find reasons to dump customers.

It's been proven that a few companies have had their employees do this.  It hasn't been proven that most do.  It's also been proven that some people fill out fraudulent applications which is why they review them and look for errors.  In order to save money they don't review every application in detail because most people won't make a claim during their pre-existing condition waiting period.  A full review requires obtaining medical records from all doctors the patient has seen in a set amount of time so that's a lot of work for the insurance company and the doctors.  An insurance policy is a contract and both sides have to live up to it.  If insurance companies were routinely dumping people for no reason there would be lots of lawsuits being filed against them for breach of contract.

Medicare is usually accurate but then so are most private insurance companies.  Although Medicare is not routinely the faster payer out there.  Last year I spent about nine months working with numerous people at CIGNA, the contractor for our area,  to get half of our Medicare claims paid.  Having half your claims denied for nine months and not being able to find someone who knew enough to solve the problem for nine months does not inspire confidence in the system.  Especially when it was a change in their system that caused the problem.  It was only solved when I lucked out and got someone who had worked in both of the departments involved who went outside proper procedure and went to a supervisor in the other department.

For private insurance claims, every patient will have different policies that cover different procedures at different percentage rates.  Plus each company will have negotiated the reimbursement rate with that particular facility.

I've experienced every one of the situations you've listed either myself or at work.    While they do happen, the vast majority of the time claims are processed just fine with most companies.  Most offices will have a large number of patients with the same or similar policies and an established patient base that have been verified so it's not quite as confusing as it sounds.  The State Health Plan is very common as are other BCBS plans.  For routine procedures you quickly learn how those common plans are handled. 

I don't think doctors should bill patients until any claims questions are resolved.  Unfortunately with the push to automate so much of billing and claim processing, it's likely that many bills are never reviewed by a person before they're sent out.

You didn't mention the other headache of claims billing.  Some insurance companies use different codes and have nonstandard ways of filling out the standard claim form.  Yes, there is a standard claim form now.  Actually for me it's Medicare and one other company on the different codes and only Medicare on the non-standard claim form.

Some of the problems mentioned are caused by patients that don't give the doctor the correct information or don't correct information with their insurance company.  I usually verify new patients or any new insurance and most companies make this fairly easy. 

Generally doctors are part of networks and the networks negotiate reimbursement rates with the insurance companies, not the individual doctors.  They just have to decide if the rate offered by the company is enough or if they can risk losing patients with that insurance.  The larger the insurance company the lower the rate it can set.  Medicare generally has one of the lowest rates although there's not a lot of variation.  It's rare for a plan to pay a percentage of the actual bill.  Most companies have set fee schedules.  That's one reason it's so hard to get an accurate price.  Also, the current reimbursement method pays doctors for each separate procedure so it's hard to give an estimate ahead of time if you don't know what will be needed.

Medical billing is a headache and that's why some doctors are starting to not accept insurance if they have the type of practice that can manage it.  Medicare is not much different from the private companies so unless we truly went to a single payer system and did away with private insurance all together the proposed reforms don't help the situation at all.  While private insurance companies have their own networks, remember that not all doctors accept Medicare and even fewer accept Medicaid.

You'll read that administrative costs for private insurers are generally 20% or more and that Medicare's administrative costs are more like 3%.  Insurers have spent a lot of money paying their think tanks to attack the 3% figure, but they know that Medicare is more efficient and cost-effective.  That's why they are fighting as hard as they possibly can against a public option.

If you still believe this after all the discussions of why Medicare's efficiency claims are flawed we'll have to disagree on this one.  Of course if you assume that the think tanks are just saying that because they're being paid by the insurance companies instead of really thinking about what they're saying it's no wonder you feel that way.

If health coverage for everyone was included in how our taxes are figured, there would be no billing for premiums and no sales force and commissions to pay, no advertising staffing necessary. No lobbyists to pay.  The cost of products made in the US would not be burdened with the cost of health insurance, making our products more competitive globally.  Small businesses wouldn't be penalized for having smaller groups with smaller risk pools which makes makes their coverage more expensive. 

There'd be no choice of what kind of coverage best suits an individual's needs either.  Do you really think there'd be no more lobbyists?  The drug manufacturers, hospitals, medical equipment manufacturers, and trade groups for every health care specialty would be lobbying to make sure their interests were covered and paid for. Every disorder and disease would have it's advocacy group in Washington to fight for coverage.  Things wouldn't change much in terms of lobbying.  Of course now a lot of that lobbying goes on at the state level which is where coverage mandates are currently set.  With a single payer plan they would all move to Washington and people would no longer have the option to move to a state with lower insurance rates. 

Our products wouldn't be any more competitive globally because they'd include the cost of the additional taxes to cover that single payer health insurance instead of the cost of insurance.

You could solve the problem of small employers and individuals stuck in small risk pools by shifting the tax deduction for health insurance to individuals instead of to business.  It was the government that created the system of employer provided health insurance in the first place not industry or insurance companies.

The risk pool would be optimized because it would include all citizens.  The premiums of the young and healthy would help offset those of the elderly or chronically ill, without some insurers having an advantage of cherry-picking  more profitable customers and dumping older ones.

Of course the young and healthy who are just starting out and maybe trying to support a young and growing family might not appreciate paying higher premiums to subsidize the sickly, including those that have problems because they fail to take care of themselves.

If single payer worked like Medicare, everyone would have the same coverage.  Medicare would be billed and paid--no sweat over knowing the specifics for each individual's insurance coverage,  what is covered, who is primary and secondary insurer, no question of deductibles, no hassle over which procedures are covered and which aren't. 

hmm, everyone has the same coverage, so men have maternity benefits as well as 75 year old women.  No chance to pick and choose what types of coverage might suit you as an individual based on your lifestyle and health risks as well as ability to pay.  Patients will still have questions about what is or isn't covered.  Medicare doesn't cover everything and has a deductible so you'd still have that to deal with too.

A single payer system might solve some of the problems with today's billing and claim system but it would also have a lot of consequences I don't think are worth it.

[bobsyouruncle]

From The Risk Pool by Malcolm Gladwell:

...The labor movement believed that the safest and most efficient way to provide insurance against ill health or old age was to spread the costs and risks of benefits over the biggest and most diverse group possible. Walter Reuther, as Nelson Lichtenstein argues in his definitive biography, believed that risk ought to be broadly collectivized. Charlie Wilson, on the other hand, felt the way the business leaders of Toledo did: that collectivization was a threat to the free market and to the autonomy of business owners. In his view, companies themselves ought to assume the risks of providing insurance.

America’s private pension system is now in crisis. Over the past few years, American taxpayers have been put at risk of assuming tens of billions of dollars of pension liabilities from once profitable companies. Hundreds of thousands of retired steelworkers and airline employees have seen health-care benefits that were promised to them by their employers vanish. General Motors, the country’s largest automaker, is between forty and fifty billion dollars behind in the money it needs to fulfill its health-care and pension promises. This crisis is sometimes portrayed as the result of corporate America’s excessive generosity in making promises to its workers. But when it comes to retirement, health, disability, and unemployment benefits there is nothing exceptional about the United States: it is average among industrialized countries—more generous than Australia, Canada, Ireland, and Italy, just behind Finland and the United Kingdom, and on a par with the Netherlands and Denmark. The difference is that in most countries the government, or large groups of companies, provides pensions and health insurance. The United States, by contrast, has over the past fifty years followed the lead of Charlie Wilson and the bosses of Toledo and made individual companies responsible for the care of their retirees. It is this fact, as much as any other, that explains the current crisis. In 1950, Charlie Wilson was wrong, and Walter Reuther was right...


http://www.newyorker.com/archive/2006/08/28/060828fa_fact

Here's another irony.

A House of Representatives panel voted on Wednesday to approve a plan that would make health and medical malpractice insurance companies subject to antitrust laws.

The bill, which was introduced in both the House and Senate last month, would repeal an exemption granted in 1945 and make health and medical malpractice insurance companies subject to laws that forbid price fixing, bid rigging and dividing markets between them.

http://www.forbes.com/feeds/afx/2009/10/21/afx7027193.html

(A bipartisan version of this legislation was introduced in by Leahy in 2007.)

“A few industries have used their influence to obtain a special, statutory exemption from the antitrust laws, and the insurance industry is one of them,” said Leahy.  “In the markets for health insurance and medical malpractice insurance, patients and doctors are paying the price, as costs continue to increase at an alarming rate.  Insurers should not object to being subject to the same antitrust laws as everyone else.”

The two key provisions of the Health Insurance Industry Antitrust Enforcement Act will repeal the federal antitrust exemption for health insurance and medical malpractice insurance companies for flagrant antitrust violations, including price-fixing, bid rigging, and market allocations, and subject health insurers and medical malpractice insurers to the same good-competition laws that apply to virtually every other company doing business in the United States.

http://leahy.senate.gov/press/200909/091709a.html

Another irony here is that the McCarran-Ferguson Act put states in charge of regulating insurance companies, giving them exemption from federal anti-trust regulation.  So will this bring on a tea party since it would take authority away from the states although some of the same people keep saying that opening sales across state lines and addressing medical malpractice is all the health reform we need?

From 2007:
Employer-provided insurance continues to decline
"I don't think people realize" how easy it is to become uninsured, says Ruggiero, 41, who says she used to think "the only uninsured Americans were the homeless."

Three years ago, she and her husband, John, left jobs with health benefits in New York to move to Florida to strike out on their own: John as a real estate agent and Angela as an office manager for an financial planner. Neither job came with health insurance.

Then they learned how difficult it is to buy health insurance outside of employment, mainly because they both had some minor health conditions. They were hopeful about an "open enrollment" period allowed each year under Florida law. During that time, insurers must offer coverage to sole proprietors and may not exclude those with medical problems.

But for the Ruggieros, the cost of coverage was out of the question: $1,500 a month to cover the couple and their 11-year-old son, Jared. So they remained uninsured until last January. When the real estate market tanked, John took a job as a package handler for a shipping firm, a position he still holds part time because it provides his family with health insurance.

http://www.usatoday.com/money/industries/insurance/2007-11-12-social-net_N.htm

[bobsyouruncle]

 

It's been proven that a few companies have had their employees do this.  It hasn't been proven that most do.  It's also been proven that some people fill out fraudulent applications which is why they review them and look for errors.  In order to save money they don't review every application in detail because most people won't make a claim during their pre-existing condition waiting period.  A full review requires obtaining medical records from all doctors the patient has seen in a set amount of time so that's a lot of work for the insurance company and the doctors.  An insurance policy is a contract and both sides have to live up to it.  If insurance companies were routinely dumping people for no reason there would be lots of lawsuits being filed against them for breach of contract.

Right there you have made the case for why we need health care reform.  The current system in which pre-existing conditions are a reason for denying coverage leads to the expensive situation you describe above.  People need to have health insurance whether or not they have pre-exisiting conditions. 

If you are denied insurance for a pre-exisiting condition you are one hospitalization away from bankruptcy.  But then, even if you have insurance you still are vulnerable to medical bankruptcy.

Why do we as a country allow that?  We are the only industrialized nation that does. Every other industrialized country in the world--and some that aren't--manages to find a way to see that all citizens have access to health care without going bankrupt, and they all do it for  half (or less)as much as the US pays without covering everyone.

...You liberals have made insurance companies out to be some sort of boogeymen.  All of that is just a distraction from the fact that CLAIMS are the thing that has driven up costs.

Let me say that again for those of you that just don't seem to get it.  CLAIMS.

For those of you supporting the single payer option, or the public option, please explain to me how the government intends to deal with that...

dj-- I appreciate all the time and attention you put into posting so much information. What I was answering before was someone's question of how single payer would save money.  You know it would. You work in billing. If you also work in accounts receivable you know that the system we have now is not efficient or cost effective. 

The difference in how I feel is that I don't think there is any reason that people working together in our country can't work together to work out the most cost-effective way to cover everyone.

I think we should have long ago gotten past the idea that some people deserve health care and some don't. I think that people arguing against health care reform are not taking a close, realistic look at the problems of the system we have today.  I think they are allowing themselves to be scared into throwing up their hands and declaring that there is just nothing to be done that won't make things worse--then they do their darnedest to prove it true. 

We can do better than that if we care about other people as much as we care about ourselves and want for each other what we would want for ourselves and the people we love.  Most of us wouldn't deny medical care to our pets.

People on another thread were slamming Cuba, but Cuba cares for its citizens very cost effectively-- and in addition sends medical teams to help people in other countries.

***

No one approves of trying to defraud an insurance company,  but that's not what the rescission problem is about.

"Insurers NotCommitting to End Rescission"

The point is not that people who lie about a condition should have a contract cancelled–that is fraud. But it is also fraud to accept money in advance to provide a service–in this case healthcare–and then fail provide it when it is needed (ie, cancel sick people’s contracts). The fact that some people call this “maximizing shareholder value” is
stomach turning.
http://blogs.wsj.com/health/2009/06/17/insurers-not-committing-to-end-rescission/


The practice of canceling medical coverage after policyholders have become sick or injured has cost insurers millions of dollars in fines and settlements. Now, for the first time, a jury will weigh whether an insurer owes anything to a canceled policyholder.

The case pits a former Cypress man against the health insurer that dropped him after a disabling car accident. Steve Hailey, a former self-employed machinist, and Blue Shield of California will be directly affected by the outcome, but the case already has influenced how insurers in California handle these rescissions.
http://articles.latimes.com/2009/may/18/business/fi-rescind18

Blue Cross praised employees who dropped sick policyholders, lawmaker says
 By Lisa Girion
June 17, 2009

. . .The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said. . .

. . . The committee investigation uncovered several rescission practices that one lawmaker called egregious, including targeting every policyholder diagnosed with leukemia, breast cancer and 1,400 other serious illnesses. Such investigations involve scouring the policyholder's original application and years' worth of medical and pharmacy
records in search of any discrepancies.

http://articles.latimes.com/2009/jun/17/business/fi-rescind17

And from the Congressional Testimony of insurance industry "whistle blower," Wendell Potter:

...My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick — all so they can satisfy their Wall Street investors.

I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand — or even to obtain — information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world...

...The average family doesn't understand how Wall Street's dictates determine whether they will be offered coverage, whether they can keep it, and how much they'll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies' quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical "benefit ratio," as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.

To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they've failed to trim medical costs. I have seen an insurer's stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company's first-quarter medical loss ratio, which had increased from 77.9% to 79.4% a year later.

To help meet Wall Street's relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation's largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending. The Energy and Commerce Committee's investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.

They also dump small businesses whose employees' medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether — leaving workers uninsured. The practice is known in the industry as "purging." The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation...

http://www.pbs.org/moyers/journal/07102009/potter_testimony.html

[RJLeeb]

I think you completely missed my point Bobs.  I wasn't talking about the cost of processing claims, but the claims themselves.

Your stat about private insurance admin costs being above 20 percent isn't quite accurate.  The actual percentage is 16.7.

http://healthcare-economist.com/2006/07/27/medicares-true-administrative-costs/
Private Insurance on average has administrative costs of 16.7% (varying between 30% for individual policies to 12.5% for large group policies).  Yet these figures are inflated.  If we exclude taxes and profits, as well as sales commissions, then the total administrative costs decrease to 8.9% overall and 8.0% for large group policies.

So I've said this before and I'll say it again.  The government plan does very little, if anything meaningful, to combat the issue of rising healthcare claims.

Liberals keep pointing to government as the solution, but he government isn't focused on the problem.  In the end, it won't matter if healthcare is run by private industry or politicians.  Neither one is going to be able to keep the system going.

[Muddylaces]

oddly, those countries and health care workers do just fine.

Fine?  Is that what the goal is now.   I'm going to spend $200,000 on medical school so my kid can do fine?   "Honey, medical school is not for you.   Law School is where you want to be."

[Silk_Hope]

Liberals want everybody to be equal no matter how hard you work. Your kid would be better flipping burgers rather than spending the money at a med school, after all redistribution is a key to the socialist agenda.

[RJLeeb]

People on another thread were slamming Cuba, but Cuba cares for its citizens very cost effectively-- and in addition sends medical teams to help people in other countries.

If you actually believe that Cuba cares for its citizens, cost effectively or otherwise...

<a href="http://www.youtube.com/v/-x6yHrRq774&amp;rel=0" target="_blank">http://www.youtube.com/v/-x6yHrRq774&amp;rel=0</a>

The articles on the subject are numerous.  Here's another one:

http://www.latinamericanstudies.org/cuba/health-myth.htm

National Review
July 30 , 2007
To be sure, there is excellent health care on Cuba — just not for ordinary Cubans. Dr. Jaime Suchlicki of the University of Miami’s Institute for Cuban and Cuban-American Studies explains that there is not just one system, or even two: There are three. The first is for foreigners who come to Cuba specifically for medical care. This is known as “medical tourism.” The tourists pay in hard currency, which provides oxygen to the regime. And the facilities in which they are treated are First World: clean, well supplied, state-of-the-art.

The foreigners-only facilities do a big business in what you might call vanity treatments: Botox, liposuction, and breast implants. Remember, too, that there are many separate, or segregated, facilities on Cuba. People speak of “tourism apartheid.” For example, there are separate hotels, separate beaches, separate restaurants — separate everything. As you can well imagine, this causes widespread resentment in the general population.

The second health-care system is for Cuban elites — the Party, the military, official artists and writers, and so on. In the Soviet Union, these people were called the “nomenklatura.” And their system, like the one for medical tourists, is top-notch.

Then there is the real Cuban system, the one that ordinary people must use — and it is wretched. Testimony and documentation on the subject are vast. Hospitals and clinics are crumbling. Conditions are so unsanitary, patients may be better off at home, whatever home is. If they do have to go to the hospital, they must bring their own bedsheets, soap, towels, food, light bulbs — even toilet paper. And basic medications are scarce. In Sicko, even sophisticated medications are plentiful and cheap. In the real Cuba, finding an aspirin can be a chore. And an antibiotic will fetch a fortune on the black market.

A nurse spoke to Isabel Vincent of Canada’s National Post. “We have nothing,” said the nurse. “I haven’t seen aspirin in a Cuban store here for more than a year. If you have any pills in your purse, I’ll take them. Even if they have passed their expiry date.”

The equipment that doctors have to work with is either antiquated or nonexistent. Doctors have been known to reuse latex gloves — there is no choice. When they travel to the island, on errands of mercy, American doctors make sure to take as much equipment and as many supplies as they can carry. One told the Associated Press, “The [Cuban] doctors are pretty well trained, but they have nothing to work with. It’s like operating with knives and spoons.”

And doctors are not necessarily privileged citizens in Cuba. A doctor in exile told the Miami Herald that, in 2003, he earned what most doctors did: 575 pesos a month, or about 25 dollars. He had to sell pork out of his home to get by. And the chief of medical services for the whole of the Cuban military had to rent out his car as a taxi on weekends. “Everyone tries to survive,” he explained. (Of course, you can call a Cuban with a car privileged, whatever he does with it.)

So deplorable is the state of health care in Cuba that old-fashioned diseases are back with a vengeance. These include tuberculosis, leprosy, and typhoid fever. And dengue, another fever, is a particular menace. Indeed, an exiled doctor named Dessy Mendoza Rivero — a former political prisoner and a spectacularly brave man — wrote a book called ¡Dengue! La Epidemia Secreta de Fidel Castro.

[bobsyouruncle]

Liberals want everybody to be equal no matter how hard you work. Your kid would be better flipping burgers rather than spending the money at a med school, after all redistribution is a key to the socialist agenda.

[Silk_Hope]

Equal in rights not equal in wealth, wealth is achieved through accomplishment and hard work not sitting on their rear watching TV all day long. Each person is equal and entitled to 1 vote.

[bobsyouruncle]

Hey buddy, you just made a claim about liberals.

Liberals want everybody to be equal no matter how hard you work.

1. I was answering what you said, not what you may have meant to say.

2. Remember when I suggested you ask what people believe instead of telling them what they believe?  It's still a good idea.

Equal in rights not equal in wealth, wealth is achieved through accomplishment and hard work not sitting on their rear watching TV all day long. Each person is equal and entitled to 1 vote.

Did meant to say that liberals believe that everyone should have the same amount of money?

No they don't.  Being a liberal, I would be in a better position to know than you.

[Silk_Hope]

I have to tell you what Liberals think because yall are so blinded by the Pelosi KoolAid, sort of like being blinded by drinking wood alcohol.

If you truly believed in individuality you would not be worried about protecting everybody from evil corporations. Everybody in this world needs to take responsibility for themselves, their needs, wants and actions instead so many want the government to give, others to give and their reason is that others have and they are have nots.

Obama said that wealth needs to be given back to its rightful owners, who are the rightful owners?

[bobsyouruncle]

I have to tell you what Liberals think because yall are so blinded by the Pelosi KoolAid, sort of like being blinded by drinking wood alcohol.

If you truly believed in individuality you would not be worried about protecting everybody from evil corporations. Everybody in this world needs to take responsibility for themselves, their needs, wants and actions instead so many want the government to give, others to give and their reason is that others have and they are have nots.

Obama said that wealth needs to be given back to its rightful owners, who are the rightful owners?

Silk Hope,

Who wants to be protected  from evil corporations?  How many times must I repeat that insurance companies are just being successful at their job, which is maximizing profits.  Unfortunately, in order to do that they have adopted practices that create a problem for people who need health insurance but are aging, self-employed or have pre-existing conditions.

One way you take responsibility for yourself is to carry health insurance so that your family is not driven into bankruptcy by injury or illness.  Other people want to be able to take responsibility for themselves by carrying health insurance for the same reason.  If there is not a company which will sell them a policy, they have no way of taking care of their finances in the case of an expensive injury or illness.

Equally unfortunate is the fact that many policies have exclusions, gaps and caps on payments so that even people with health insurance are being forced into bankruptcy.

I don't understand why you think it is a bad for people to try and figure out solutions to this problem. I don't think it shows regard for individuals to let so many families fall into bankruptcy because one member got sick or hurt.

This has nothing to do with people sitting on their butts all day, watching television or doing anything else.  People over 65 can buy Medicare, and very poor people can qualify for Medicaid.  It's mostly older working people who are self-employed or working for a business that doesn't offer health insurance.

I think our discussions would be more productive if you connect yourself with the reality of what people here are saying instead of the fantasy of what you claim we are saying.


And from the Congressional Testimony of insurance industry "whistle blower," Wendell Potter:

...My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick — all so they can satisfy their Wall Street investors.

I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand — or even to obtain — information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world...

...The average family doesn't understand how Wall Street's dictates determine whether they will be offered coverage, whether they can keep it, and how much they'll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies' quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical "benefit ratio," as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.

To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they've failed to trim medical costs. I have seen an insurer's stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company's first-quarter medical loss ratio, which had increased from 77.9% to 79.4% a year later.

To help meet Wall Street's relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation's largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending. The Energy and Commerce Committee's investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.

They also dump small businesses whose employees' medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether — leaving workers uninsured. The practice is known in the industry as "purging." The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation...

http://www.pbs.org/moyers/journal/07102009/potter_testimony.html

[bobsyouruncle]

Hey Silk Hope.  Look who's rich!

17. Rep. Nancy Pelosi (D-Calif.)
$18.71 million

The Californian’s net worth rose nearly 16 percent in 2007, adding $2.5 million to her personal wealth.

Among her assets, Pelosi lists a Norden, Calif., town house valued at $1 million to $5 million and a real estate investment in Napa, Calif., worth at least $500,000.

In addition, her husband owns a commercial property in San Francisco valued at $5 million to $25 million. In 2006, the property was listed as worth $1 million to $5 million, so that property alone added $4 million to Pelosi’s net worth last year.

The couple also owns a vineyard in St. Helena, Calif., valued at $5 million to $25 million.

The Speaker’s husband also increased tenfold his holdings in Apple Computer Inc. stock to at least $5 million, up from a minimum of $500,000 in 2006.

Pelosi and her husband also owe mortgage debt on several of their properties, including the vineyard, totaling at least $8.75 million.

Other debts listed by Pelosi include lines of credit totaling at least $3.5 million

http://www.rollcall.com/features/Guide-to-Congress_2008/guide/28506-1.html?page=5

[RJLeeb]

No response to my comment about the actual claims being the issue at hand that the government isn't addressing or the ridiculous claim about healthcare in Cuba?

[RJLeeb]

I don't understand why you think it is a bad for people to try and figure out solutions to this problem.

Pardon me, but I don't think he's said anything of the sort.  As far as I can tell, he just disagrees with the left's "solutions". 

That being said, it looks like you're trying to read minds a bit yourself there Bobs. 

I wouldn't have even brought it up, but...

2. Remember when I suggested you ask what people believe instead of telling them what they believe?  It's still a good idea.

Physician heal thyself?

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