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Author Topic: It's Medical INSURANCE and Medical care COST, not Healthcare !!!  (Read 318 times)
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Ice Pilot2
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« on: March 22, 2017, 09:17:06 AM »

There are people, on this board, with well thought out and well articulated positions on just about every major issue facing our country.  On all sides.   With that being said, I write this post.

Why the hell has buying Health INSURANCE and the COST of healthcare, in general, been changed, in the public eye, to the term "Healthcare" ?

The word insurance is rarely used in any discussion of The Affordable Care Act  (Obama Care) or even in any plan to repeal and/or replace it.  Including this latest ugly child being championed by President Trump. They all fall far short of addressing the core issue, that in my humble opinion is the skyrocketing cost of INSURANCE and Healthcare services.

I wanted The ACA to go away.  I wanted to see the markets open up where companies could compete and perhaps that would drive INSURANCE PREMIUMS down.  But driving the premiums down is not anywhere near the real issue.  Even if premiums go down, the mighty INSURANCE Companies raise deductibles, increase Co-Insurance, and add more and more limits on how and what they will pay for.  Hey, it's the cost of care stoopied, that cannot be controlled by the insurance company. It is not the insurance folks that are at fault, Physicians are at fault.  Nope, not their fault it is the attorneys that continue to bring lawsuits.  Nope, it's the evil Big Pharma driving up profit to satiate shareholders.  Nope, it's the for profit companies that own and deliver so much of our healthcare.  etc. etc. etc.

For many of us between 55-65, we are squeezed in an impossible situation.   We were downsized from good jobs that had provided health insurance (when we were young and rarely needed to seek healthcare).   Now so many of us are working for jobs that are paying much less and do not have any "benefits".  It is what it is.   Health Insurance premiums are calculated based on age and sex so the cost to us on ANY marketplace is very high.   The wife and I have Health insurance premiums now that, on a monthly basis,  are higher than any mortgage we ever had. (in both percentage of income and actual dollars)    And as mentioned before, we still have the honor of paying $5,000 before the insurance company pays a damn penny.  

Last time I checked Blue Cross and Blue Shield of NC was doing pretty well.   Take a look at their sprawling employee campus in Durham.  Check out their executive's compensation.  

Sorry, I could go on and on and probably not say much that would dazzle Pi, or Yip,  or 1911, or Rabbit, or Silk, or Mud, or JF,  or even make Foggy ask me to go around the world with him.   It just sucks to be part of a demographic that is rarely mentioned and often dismissed in the great  "Health Insurance" debates of the past decade or so.  

Some questions that come to mind;

1- What percentage of a person's income is considered unreasonable to pay for Health Insurance?  
2- Should we just continue to go down this path whereby the wealthy have little concern about the issue because they get the care they need/want?
3- Surely, we should continue to provide full coverage to very poor people so they can obtain care?
4- Ignore the burden this is placing on hardworking tax paying Americans that have never taken anything out of the "system" and are not eligible for any consideration now due to being over a dollar limit on a chart?

I see this going the way of Dental Care in the U.S. -   We all have access to world class dental care.  However, not everyone can obtain services due to financial reasons. We see evidence of that in peoples smiles.   Regarding medical healthcare, we all have access to world class medical care.  However, more and more people are postponing treatment, or even skipping treatment due to financial issues.  We will see more and more evidence of this at funerals.

« Last Edit: March 22, 2017, 01:31:56 PM by Ice Pilot2 » Logged
1911A
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« Reply #1 on: March 22, 2017, 11:37:06 AM »

I'd like you to know I've nodded my head in agreement with your posts on more than one occasion.

Having said that, let me further pick the nit you started.  It ain't health insurance either, it's medical insurance, right?

What if you (and your wife) could pay that $5000 for a year's worth of catastrophic coverage and put some money away every paycheck into a Health Savings Account (HSA, and again with the "health") to use for your regular and routine medical expenses; anything not spent per annum gets rolled over into the following year.
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« Reply #2 on: March 22, 2017, 11:53:14 AM »

Quote
Regarding medical healthcare, we all have access to world class medical care.  However, more and more people are postponing treatment, or even skipping treatment due to financial issues.  We will see more and more evidence of this at funerals.

I am one of these people, I have a good company medical insurance policy but the nickel and diming deductibles eat up the costs. IMO so many of the recommended  procedures are just a way for the doctors to make money. Oh, and if you do not call to set up an appointment for a referral the doctor offices go crazy.

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Ice Pilot2
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« Reply #3 on: March 22, 2017, 01:31:17 PM »

 It ain't health insurance either, it's medical insurance, right?

What if you (and your wife) could pay that $5000 for a year's worth of catastrophic coverage and put some money away every paycheck into a Health Savings Account (HSA, and again with the "health") to use for your regular and routine medical expenses; anything not spent per annum gets rolled over into the following year.

You are correct!   So, after even more review, my revised question is;   Why is the conversation focused on the phrase "Healthcare"  instead of Medical Insurance premiums and/or Medical services costs?

Oh, and we do the HSA too, but, we both have acquired some long term issues that now require annual tests and specialist visits.  So, each year we end up spending $15,000 on the insurance, then have to fork out the deductible, and that is not even the end.  Then there is that relatively new term to me, Co-Insurance, that does not go away until the plan year maximums have been satisfied.   It's a lot of fun.
« Last Edit: March 22, 2017, 01:33:31 PM by Ice Pilot2 » Logged
1911A
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« Reply #4 on: March 22, 2017, 01:42:15 PM »

I know, we here have the same issue with premiums, co-insurance and deductibles.  It sucketh.

I recently heard a Doc (out of Kentucky, I think) talking about his practice, and others he's helped set up, that have multiple doctors on staff, charge $50 a month for adults, $10 per child, with no limit on visits.  IIRC, he's also got lab services, and he's negotiated with the pharmaceutical companies on price, so he dispenses on site as well.

I sincerely hope this type of practice works and, if so, spreads.
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« Reply #5 on: April 11, 2017, 03:52:57 PM »

Pointing the finger at insurance companies is oversimplifying the problem.  Reforming them, or requiring them to do certain things, is not the solution.  That's precisely what the ACA did when it dictated plan provisions and you see how that turned out.

There are many issues that need to be solved.  And though I'm not pretending to have the answers, we first have to agree on the cost drivers for healthcare.

1. Many people that use healthcare do not pay for it.  That leaves others to pick up the tab.  Insurance companies and providers (such as hospitals) have to spread that cost to the paying customers.

2. Insurance companies have allied with state legislatures to put rules in place to reduce competition in their respective areas.  This makes it very difficult for other insurance companies to establish networks and compete with incumbents.  In NC, there are 3 primary insurance companies.  The Department of Insurance in NC sets the rules.  Insurance companies lobby to have certain rules make and/or changed to block competition.  NC is not alone in this, and this is also why you don't have Kaiser or California creating their own networks here in NC.  That lack of competition is also what enables insurance companies to charge what they do.

3. BCBSNC is a not-for-profit.  They aren't a "non-profit".  Those are not really the same thing, as not-for-profits are still able to have profits.  In some ways, those profits are necessary.  Flu season alone has an impact on their financials.  Supposedly, they keep some funds in reserve for unforeseen disasters and outbreaks.  So you don't want BCBSNC to have $14.90 in their bank account.  They need some in reserve.  Again, doesn't mean they aren't making a profit, because they certainly are.

4. When you mention frivolous lawsuits, greedy providers, etc., and then dismiss them in favor of insurance carriers being the culprit, that's not acknowledging the effect those things have.  They certainly do have an effect, as anyone who has read their billing detail from a hospital stay is aware.  Again, this occurs because hospitals are trying to distribute the costs to paying customers. 

5. Healthcare costs are rising due to some major shifts in demographics.  That includes the Baby Boomers, of course.  People are simply living longer because healthcare is better.  But those technological advances have costs associated with them.

6. Yes, big pharma is an issue.  They run much of the world behind closed doors.  If you look back at mass shootings, you'll note that hardly anyone brings up the dangers of selective serotonin reuptake inhibitors, or SSRIs.  It is amazing how many of those criminals were on SSRIs or had recently discontinued their use.  Yet, we hardly ever heard about that fact in the news.  Instead, we hear about gun control.  Why?  Because big pharma wields a lot more power than just about any other industry out there.  They have considerable influence over Congress and that's precisely why prescription drugs are so much cheaper in other countries such as Canada.  There's an unholy alliance between big pharma and the USFDA.  The result: you and I pay a lot more than we should for prescription drugs.

7. You're asking questions, which is good.  Unfortunately I think some of those are the wrong questions.  Percentage of income is largely irrelevant.  Should the price of a good or service I buy be based on a percentage of my income?  Most people would say "no" when it comes to just about anything outside of healthcare.  Should a rich person who needs a Z pack pay $15k for it to offset an unhealthy poor person who can't pay anything for all the care they require?  If that doesn't sound right to you it shouldn't.  That's almost the system we have now.

The wealthy will always have little concern about any issue because they are wealthy.  They will also always be able to receive better care than a poor person.  The same hold true in every single society that allows people to get wealthy in the first place.  The only places that doesn't happen is in communist countries, but then it isn't the wealthy that get favored.  It's the political elites.  But truth be told, they seem to live a lifestyle that is the same as a wealthy person too.  

Do we, instead of tolerating some disparity in service, reduce everyone to a much lower quality of care?  That's what many people have been asking for.  Those people ran out and voted for Bernie Sanders.  

Should we continue to provide coverage to poor people?  Well, when did we ever stop?  If a person comes into a hospital and needs immediate attention, is the hospital not obligated to provide care?  Of course they are.  Granted, it might have been reduced from a cost perspective via preventative care.  Or it could have simply been a gun shot.  The liberal answer to that scenario is to save the taxpayers money by having them pay for an abortion today so that bullet wounds and prison stays don't have to be paid for tomorrow.

We could go the route of Canada.  And then we'd have horror stories about people having to wait two months for an MRI.  We find ourselves in this predicament because of our consumption of healthcare.  That's probably the biggest factor of all, and it goes beyond greed on the part of insurance carriers and providers.  We over medicate our children and ourselves.  We eat too much.  We smoke.  We're depressed.  All those things have a consequence, and that consequence is higher healthcare cost.

All the things like HSAs and the like are designed to get the consumer to put some skin in the game so that they will be responsible for their healthcare usage.  Of course it also provides a tax free way to pay for those expenses.  The only way to hold people responsible is for them to feel the financial pinch.  

That also happens to be the premise on which the ACA was built.  One of the biggest problems is that we're fundamentally dysfunctional when it comes to how we consume healthcare.  It is overly simplistic to just blame it on the insurance carriers.  They aren't even 20% of the problem.
« Last Edit: April 11, 2017, 04:09:34 PM by Pi » Logged

There are two ways to conquer and enslave a country. One is by the sword. The other is by debt. - John Adams
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