The problem with pre-ex

[Dene]

The fundamental problem with pre-existing conditions is this
question....who is going to pay for it?

Under ACA, those who choose to be covered pay for it. Problem with that
solution is that there are not enough healthy people in the risk pool to
adequately pay for the unhealthy. So premiums rise exponentially and
healthy people drop out or have heavily subsidized premiums, if their
income is low enough. Middle class self employed person gets hosed.

Previous system...the one Jimmy Kimmel laments about. Pre-ex are
underwritten, therefore only the healthy can acquire health insurance,
leaving those with pre-ex out or in expensive risk pools. It was a
ridiculous system. No one insurer could afford to be liberal with
underwriting standards or else they would inherit the unhealthy people,
exclusively.

So what is the answer? The Republican solution. Those who have current
insurance keep their insurance, regardless of pre-ex, and pay the same
rate. But...if you let the insurance lapse or choose to go without,
then become sick, then you are forced into a taxpayer supplemented,
state run risk pool, and pay higher premiums.

Essentially...it becomes a matter of personal responsibility.

But with the nanny state culture in full bloom on all channels, nobody
is emphasizing that caveat. It's "OMG....I have to pay more if I get sick."

Not true. You pay more if you are irresponsible before becoming sick.

[-hh]

Except ...

An infant born with a heart condition is immediately a "pre-existing" (through no
lifestyle choice fault of their own BS) and will never be able to buy their own policy
without getting slammed.

So how is this solved?


-hh

[Alan Baker]

Isn't it amazing how the very same people who insist every fetus is
sacred and must be protected have no interest whatsoever in protecting
that same sacred life after it is born?

[-hh]

Alan wrote:
> -hh wrote:
>> Except ...
>>
>> An infant born with a heart condition is immediately a "pre-existing" (through no
>> lifestyle choice fault of their own BS) and will never be able to buy their own policy
>> without getting slammed.
>>
>> So how is this solved?
>
>

> Isn't it amazing how the very same people who insist every fetus is
> sacred and must be protected have no interest whatsoever in protecting
> that same sacred life after it is born?

Well, there's that too. I simply find it amazing that supposed "business" centric
types can't even recognize a definitively non-sustainable business model.

In the meantime, I'm still waiting for the response to my prior query of
"Whose ox gets gored?" (I.e., ends up with less money).

-hh

[Carbon]

The 99%+. Meaning, everyone but stockholders in pharma, insurance, etc.

[Dene]

Good question. Birth, adoption, involuntary loss of coverage, etc.
would not be subject to underwriting. Where one gets into trouble is
being irresponsible and incur a lapse of coverage, typically not paying
a premium on time.

[Carbon]

On 05/03/2017 12:38 AM, Dene wrote:
> On 5/2/2017 7:28 PM, -hh wrote:
>
>> Except ...
>>
>> An infant born with a heart condition is immediately a "pre-existing"
>> (through no lifestyle choice fault of their own BS) and will never be
>> able to buy their own policy without getting slammed.
>>
>> So how is this solved?
>

> Good question. Birth, adoption, involuntary loss of coverage, etc.
> would not be subject to underwriting. Where one gets into trouble is
> being irresponsible and incur a lapse of coverage, typically not paying
> a premium on time.

Wouldn't it be great if there was a universal healthcare system that
provided decent healthcare for everyone? I wonder if there are other
first-world countries that have better, more affordable healthcare systems
like that?

https://goo.gl/zvV96T

[-hh]

Gosh, wouldn't a single payer system result in lower costs for the public too?
After all, you wouldn't have the inefficiency of multiple different (and incompatible)
billing management systems,many of which are deliberately whacked in order to
be inefficient so as to slow down payments to healthcare providers. Similarly,
there would be a bunch of CEO's and Boards each making up to $102M per year
in compensation that would end up getting cut out as redundant inefficiencies too...


<http://www.dailykos.com/story/2015/4/9/1376712/-UnitedHealthcare-myUHC-CEO-Stephen-Hemsley-took-home-66-million-in-2014-102-million-in-2010>

<http://www.beckershospitalreview.com/compensation-issues/healthcare-ceos-dominate-wsj-s-list-of-highest-paid-employees-at-nonprofits.html>

<https://www.bloomberg.com/news/articles/2017-01-06/the-highest-paid-u-s-executives-supervise-doctors-not-bankers>

<https://www.opensecrets.org/industries/summary.php?ind=H04++>
<https://www.opensecrets.org/industries/indus.php?ind=F09>
<https://www.opensecrets.org/industries/indus.php?ind=H03++>


-hh

[John B.]

The problem with the post-ACA pre-ex regime was that insurance cos.
would use any unreported pre-ex as an excuse to terminate coverage.
A cancer patient could be cut off if he failed to report that he was
allergic to cats.

[Dene]

The situation you John describes never happened to any client of mine.
Once a policy was rescinded, but only because the applicant failed to
disclose he had lung cancer.

[Dene]

It would be great if we were a country of 35 million like Canada. The
USA Federal government, specifically the CMS, can barely run a website.

[Dene]

On 5/3/2017 6:29 AM, Welcome to Trumpton wrote:

> Which in effect means that the people who can least afford it end up
> asked to pay more.

The people who can least afford get very generous subsidies. It's the
tax paying, middle class, self employed people who get hosed.

> Of course you can avoid this inequality by having just the one state
> run risk pool.
>

[-hh]

But this is still merely figuring out ways for the public to be
able to pay the ever-growing bill ... we've still not addressed
the much more fundamental basics of the total costs of healthcare,
which means that the only way for rates to go down overall is for
someone currently being paid to be paid less.

So whose ox is to be gored?

> > Of course you can avoid this inequality by having just the one state
> > run risk pool.

But why should the State effectively "give away" to private industry
the lower cost/risk clients for them to profit off of?

Is the basic idea here going to be that all of the private healthcare
companies who benefit from the State providing a healthier customer
pool...are going to pay the State for providing this service?

If not, why not?


-hh

[John B.]

My knowledge of this is admittedly anecdotal, but I read about
instances of it during the creation of Obamacare. I don't know
how widespread it was, but I think any successor to the ACA
should outlaw it. Also, I meant pre-ACA, not post-.

[John B.]

The U.S. government runs hundreds of websites. Nobody complains
about them.

[-hh]

From what I recall, the problem with the Healthcare.gov website
included that it was contracted out ... IIRC, to a Canadian company?


"The design of the website was overseen by the Centers for Medicare
and Medicaid Services and built by a number of federal contractors,
most prominently CGI Group of Canada."

<https://en.wikipedia.org/wiki/HealthCare.gov>

Yup, there it is.

Overall, it was just a messed-up project that got high visibility,
and it probably didn't help that each State invariably had their
own delays in providing information, interfaces, requirements, etc,
which made it hard to go from zero to hero in a single development
cycle.


-hh

[MNMikeW]

John B. wrote:

>>
>> It would be great if we were a country of 35 million like Canada. The
>> USA Federal government, specifically the CMS, can barely run a website.
>
> The U.S. government runs hundreds of websites. Nobody complains
> about them.

And just how exactly would you know that?

[Dene]

Tell that to those who use healthcare.gov to sign up for ObamaCare. Each week I am calling them, having them straighten out one glitch after another.

[John B.]

How would I know what? That no one complains about them? If
people complained about another government website to the
extent they complained about the ACA site, it would have
been in the press. I've used dozens of government websites
for one thing or another. A couple, like census.gov, are
complicated and hard to navigate, but I've never felt a
need to complain about any of them.

[John B.]

That's one site. The problems people have had with it are not
representative of other government sites.

[Dene]

It's representative of what would happen if CMS were the ones who ran a single payor system.

[Dene]

A healthier risk pool will result in lower premiums for all.

> Is the basic idea here going to be that all of the private healthcare
> companies who benefit from the State providing a healthier customer
> pool...are going to pay the State for providing this service?

In the old system, the insurers did support the risk pool with a premium tax.

[Alan Baker]

On 2017-05-03 4:01 PM, Moderate wrote:
> "John B." <john...@gmail.com> Wrote in message:

>>
>> The U.S. government runs hundreds of websites. Nobody complains
>> about them.
>>
>

> Baker does.

What websites have I supposedly complained about, doofus?

> You don't know who complains or how many. You just
> make bold statements based on nothing.
>

[Alan Baker]

Of course, what you neglect to mention is that a website to be the
portal for a single payer system would be much, much simpler...

[Alan Baker]

On 2017-05-03 6:12 PM, Moderate wrote:
> Alan Baker <alang...@telus.net> Wrote in message:

>>
>> What websites have I supposedly complained about, doofus?
>>
>

> You forgot. Whitehouse.gov where you Carbon were too stupid to
> understand how domain controllers work.
>
>

Quote it.

[Carbon]

Like my wife, my brother-in-law has dual US/Canadian citizenship. As a GP
he has practiced in both countries but has been in Canada for the past 15
years or so. He said at his US practice he and his ~8 partners had about
the same number of administration staff who dealt with all the paperwork,
fought with the insurance companies, etc. He's at a similar sized practice
in Canada, and he and his partners share one administration person who is
not full time. He described avoiding all the aggravation as a quality of
life issue, like having a five-minute commute vs an hour each way.

[Carbon]

Bullshit.

I lived in Canada for 35 years. There is way less hassle getting
healthcare there than here. For one thing, if everyone was on the same
plan there would be no need for CMS or any of that other crap. You get a
card, you see whatever doctor you want, and you never have to fight with
insurance companies.

Your average American has no clue how shitty and corrupt their system is.
And a lot of money is spent to ensure it stays that way.

[Dene]

It works in Canada because you have a small population and you are used
to pay horrific taxes.

[Alan Baker]

You are so full of it.

[Carbon]

And you're hoping population size is meaningful in some way when
calculating per capita healthcare costs?

[Carbon]

Fat chance.

[Dene]

> ...and greater profits for the insurers and other parasites who take
> money out of the system that could be going towards healthcare.
>
> How much money do insurers take out of the system each year
9% for admin. Rest goes to claims. This is mandated by ACA.

>
> Greg, this is your industry but you struggle to suggest anything which
> comes close to being fair, efficient and socially acceptable... except
> to a proportion of service users. Anyone can do that. That is why Trump
> thought it would be "so easy". He has no concept of the greater good.

The Republican solution is sound.

[Dene]

I'm saying that our Federal government cannot possibly manage the
healthcare of 330 million people.

Possibly on the state level, but you would have a smorgasbord of
efficiency and chaos.

[Alan Baker]

But won't be mandate under Trumpcare...

>
>>
>> Greg, this is your industry but you struggle to suggest anything which
>> comes close to being fair, efficient and socially acceptable... except
>> to a proportion of service users. Anyone can do that. That is why Trump
>> thought it would be "so easy". He has no concept of the greater good.
>
> The Republican solution is sound.

If it's so sound... ...why are they exempting themselves?

[Alan Baker]

It seems to work alright for Canadian Provinces...

[-hh]

An interesting claim, particularly considering that the Feds **already**
manage the healthcare for 44 (Medicare) + 70 Million (Medicaid & CHIP),
which is a third of the US Population.

... and if memory serves, while at a lower management overhead expense rate
than what the Private Healthcare systems cost - - so much for those claims
that private industry is always "more efficient", right?

> Possibly on the state level, but you would have a smorgasbord of
> efficiency and chaos.

Why possibly on the State level? Are you trying to suggest that
local municipalities somehow are inherently "better" at running large
organizations?

For example, you do realize that the National Institute of Justice (NIJ) has to
work with more than ~50 Law Enforcement Groups from the 50 States ... right?
FYI, if I recall correctly, the actual number is around 22,000.


-hh

[Carbon]

Bias unsupported by fact.

> Possibly on the state level, but you would have a smorgasbord of
> efficiency and chaos.

You're still not understanding how much simpler the administration would
be if everyone were on the same plan. And the economies of scale would be
much greater in America, and a smaller percentage of the population lives
in remote and expensive to service areas.

[-hh]

On Thursday, May 4, 2017 at 6:59:38 AM UTC-4, -hh wrote:
> On Thursday, May 4, 2017 at 1:09:38 AM UTC-4, Dene wrote:
> > On 5/3/2017 8:30 PM, Carbon wrote:
> > > On 05/03/2017 11:15 PM, Dene wrote:
> > >> On 5/3/2017 8:04 PM, Carbon wrote:
> > >>>
> > >>> Your average American has no clue how shitty and corrupt their system
> > >>> is. And a lot of money is spent to ensure it stays that way.
> > >>
> > >> It works in Canada because you have a small population and you
> > >> are used to pay horrific taxes.
> > >
> > > And you're hoping population size is meaningful in some way when
> > > calculating per capita healthcare costs?
> >
> > I'm saying that our Federal government cannot possibly manage the
> > healthcare of 330 million people.
>
> An interesting claim, particularly considering that the Feds **already**
> manage the healthcare for 44 (Medicare) + 70 Million (Medicaid & CHIP),
> which is a third of the US Population.

Oh, and add another 9.4 million on Tricare.

That raises the total to roughly 124M out of a current
population of 321M, which is 38%.

As such, having the Feds take over everything would only require
a bit more than a doubling the existing Federal infrastructure.

Plus the comparison on USA vs Canada on taxation isn't as simple
as it may appear, for the US rates do not include personal
healthcare insurance costs whereas the Canadian one does.

For example, for a notional US domestic healthcare expense rate of
$10K/pp-year, at a generic US gross income of $100K/year, that's a
hidden 10% "tax" handicapping offset that needs to be added to
the total expenses for Americans before comparing to Canada. Still
really want to claim that we're paying less overall in the USA?

> ... and if memory serves, while at a lower management overhead
> expense rate than what the Private Healthcare systems cost - - so
> much for those claims that private industry is always "more
> efficient", right?
>
>
> > Possibly on the state level, but you would have a smorgasbord
> > of efficiency and chaos.
>
> Why possibly on the State level? Are you trying to suggest that
> local municipalities somehow are inherently "better" at running
> large organizations?
>
> For example, you do realize that the National Institute of Justice
> (NIJ) has to work with more than ~50 Law Enforcement Groups from
> the 50 States ... right? FYI, if I recall correctly, the actual
> number is around 22,000.

Contemporary literature says "over 22K":

http://discoverpolicing.org/files/dp-brochure.pdf

That's a hell of a lot of little fiefdoms to wrangle...


-hh

[Dene]

On 5/4/2017 3:59 AM, -hh wrote:
> On Thursday, May 4, 2017 at 1:09:38 AM UTC-4, Dene wrote:
>> On 5/3/2017 8:30 PM, Carbon wrote:
>>> On 05/03/2017 11:15 PM, Dene wrote:
>>>> On 5/3/2017 8:04 PM, Carbon wrote:
>>>>>
>>>>> Your average American has no clue how shitty and corrupt their system
>>>>> is. And a lot of money is spent to ensure it stays that way.
>>>>
>>>> It works in Canada because you have a small population and you are used
>>>> to pay horrific taxes.
>>>
>>> And you're hoping population size is meaningful in some way when
>>> calculating per capita healthcare costs?
>>
>> I'm saying that our Federal government cannot possibly manage the
>> healthcare of 330 million people.
>
> An interesting claim, particularly considering that the Feds **already**
> manage the healthcare for 44 (Medicare) + 70 Million (Medicaid & CHIP),
> which is a third of the US Population.

The bulk of Medicare claims administration is handled by private
insurance companies via Advantage plans. Reason...private insurers are
more efficient than our bloated Federal govt.

Medicaid is administered by the states. Oregon's is quite mismanaged.
Long hold times. Delays with enrollment and receiving ID cards. I've
enrolled many and the majority become quite frustrated. This kind of
"service" does not happen in the private sector.

[-hh]

On Thursday, May 4, 2017 at 11:17:25 AM UTC-4, Dene wrote:
> On 5/4/2017 3:59 AM, -hh wrote:
> > On Thursday, May 4, 2017 at 1:09:38 AM UTC-4, Dene wrote:
> >> On 5/3/2017 8:30 PM, Carbon wrote:
> >>> On 05/03/2017 11:15 PM, Dene wrote:
> >>>> On 5/3/2017 8:04 PM, Carbon wrote:
> >>>>>
> >>>>> Your average American has no clue how shitty and corrupt their system
> >>>>> is. And a lot of money is spent to ensure it stays that way.
> >>>>
> >>>> It works in Canada because you have a small population and you are used
> >>>> to pay horrific taxes.
> >>>
> >>> And you're hoping population size is meaningful in some way when
> >>> calculating per capita healthcare costs?
> >>
> >> I'm saying that our Federal government cannot possibly manage the
> >> healthcare of 330 million people.
> >
> > An interesting claim, particularly considering that the Feds **already**
> > manage the healthcare for 44 (Medicare) + 70 Million (Medicaid & CHIP),
> > which is a third of the US Population.
>
> The bulk of Medicare claims administration is handled by private
> insurance companies via Advantage plans. Reason...private insurers are
> more efficient than our bloated Federal govt.

Unfortunately, the Fed's practice of contracting out does not
automatically mean that it is done solely due to efficiency:
there's been a lot of Congressional Mandates to do it even when
it ends up costing more.

Even so, how do the profits of these providers compare to
those in the rest of the market?

> Medicaid is administered by the states. Oregon's is quite mismanaged.
> Long hold times. Delays with enrollment and receiving ID cards. I've
> enrolled many and the majority become quite frustrated. This kind of
> "service" does not happen in the private sector.

Which serves my point about how there's nothing magical about
tossing it down to the States either.

In any case, the net overhead rates are still lower than the
non-Government private healthcare firms today, are they not?

For example, this one claims 1.3% vs 12%:

<http://www.politifact.com/truth-o-meter/statements/2011/may/30/barbara-boxer/barbara-boxer-says-medicare-overhead-far-lower-pri/>

And granted, this has been a subject of debate, such as by also
factoring in differences in detection of fraud, or how Agencies
have off-the-books institutional support but there's also been
a quiet "inflated markup" running through the private companies
claims too that's an expense that's been under the radar too...

"Contrary to claims made by John Goodman and Thomas Saving in
an earlier Health Affairs Blog post, non-partisan data from
the Congressional Budget Office (CBO) and the Center for Medicare
and Medicaid Services (CMS) demonstrate definitively that private
insurance is increasingly less efficient than Medicare."

<http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/>

In any case, there's also a fundamental difference in the basic
business models too: the private healthcare insurance companies
have a fundamental and irreconcilable conflict-of-interest between
optimizing their service to their customer recipients versus an
optimization of their profits to their stockholders: a Government
entity and/or a Mutual doesn't have this same contradiction.

-hh

[Dene]

If not for efficiency, why does Congress continue to mandate it?

> Even so, how do the profits of these providers compare to
> those in the rest of the market?

What?

>> Medicaid is administered by the states. Oregon's is quite mismanaged.
>> Long hold times. Delays with enrollment and receiving ID cards. I've
>> enrolled many and the majority become quite frustrated. This kind of
>> "service" does not happen in the private sector.
>
> Which serves my point about how there's nothing magical about
> tossing it down to the States either.

Single payor would be a disaster...even if the states ran it. Single
payor will never happen. Only a minority in our country trust the
government to that extent.

> In any case, the net overhead rates are still lower than the
> non-Government private healthcare firms today, are they not?
>
> For example, this one claims 1.3% vs 12%:
>
> <http://www.politifact.com/truth-o-meter/statements/2011/may/30/barbara-boxer/barbara-boxer-says-medicare-overhead-far-lower-pri/>
>
> And granted, this has been a subject of debate, such as by also
> factoring in differences in detection of fraud, or how Agencies
> have off-the-books institutional support but there's also been
> a quiet "inflated markup" running through the private companies
> claims too that's an expense that's been under the radar too...
>
> "Contrary to claims made by John Goodman and Thomas Saving in
> an earlier Health Affairs Blog post, non-partisan data from
> the Congressional Budget Office (CBO) and the Center for Medicare
> and Medicaid Services (CMS) demonstrate definitively that private
> insurance is increasingly less efficient than Medicare."
>
> <http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/>
>
> In any case, there's also a fundamental difference in the basic
> business models too: the private healthcare insurance companies
> have a fundamental and irreconcilable conflict-of-interest between
> optimizing their service to their customer recipients versus an
> optimization of their profits to their stockholders: a Government
> entity and/or a Mutual doesn't have this same contradiction.

Many health insurance companies...like Blue Cross...are non profit
entities.

[Alan Baker]

If only one could figure out what might cause politicians to do what is
best for private corporations rather than people...

>
>> Even so, how do the profits of these providers compare to
>> those in the rest of the market?
>
> What?
>
>>> Medicaid is administered by the states. Oregon's is quite mismanaged.
>>> Long hold times. Delays with enrollment and receiving ID cards. I've
>>> enrolled many and the majority become quite frustrated. This kind of
>>> "service" does not happen in the private sector.
>>
>> Which serves my point about how there's nothing magical about
>> tossing it down to the States either.
>
> Single payor would be a disaster...even if the states ran it. Single
> payor will never happen. Only a minority in our country trust the
> government to that extent.

Single payer exists all over the world...

...and it works.

[John B.]

Every developed country on earth except the US has
single-payer health insurance. You would be hard-
pressed to find a citizen of any of those countries
who would prefer to have a private-sector system. Do
you know of any Medicare beneficiaries who don't want
to be on Medicare?

[Dene]

Medicare recipients, who stay with original medicare are not happy
campers, if they incur a chronic or catastrophic event. Those who buy
an Advantage plan (the bulk of Medicare recipients) or a Medigap plan
are the happy campers.

They are also happy because the premium is lower. Reason...it's a trust
that they have been paying into for years.

Bottom line...Medicare is apples and oranges, compared to a single payor
system. It's reality vs. idealism.

[Dene]

On 5/2/2017 6:06 PM, Dene wrote:
> The fundamental problem with pre-existing conditions is this
> question....who is going to pay for it?
>
> Under ACA, those who choose to be covered pay for it. Problem with that
> solution is that there are not enough healthy people in the risk pool to
> adequately pay for the unhealthy. So premiums rise exponentially and
> healthy people drop out or have heavily subsidized premiums, if their
> income is low enough. Middle class self employed person gets hosed.
>
> Previous system...the one Jimmy Kimmel laments about. Pre-ex are
> underwritten, therefore only the healthy can acquire health insurance,
> leaving those with pre-ex out or in expensive risk pools. It was a
> ridiculous system. No one insurer could afford to be liberal with
> underwriting standards or else they would inherit the unhealthy people,
> exclusively.
>
> So what is the answer? The Republican solution. Those who have current
> insurance keep their insurance, regardless of pre-ex, and pay the same
> rate. But...if you let the insurance lapse or choose to go without,
> then become sick, then you are forced into a taxpayer supplemented,
> state run risk pool, and pay higher premiums.
>
> Essentially...it becomes a matter of personal responsibility.
>
> But with the nanny state culture in full bloom on all channels, nobody
> is emphasizing that caveat. It's "OMG....I have to pay more if I get
> sick."
>
> Not true. You pay more if you are irresponsible before becoming sick.

So the first step has been taken in replacing ACA. Hallelujah.
What I find most remarkable is this fact. With ACA clearly failing,
(e.g. Iowas), there is no Dem bills or movement to reform the existing
law. They have reduced themselves to becoming a party of no without any
fixes or solutions.

Americans are watching. The Dems are out of touch. Vision is needed.
Ask those who are honest about HRC's failed campaign.

[-hh]

Because private corporations make bigger political donations.

> > Even so, how do the profits of these providers compare to
> > those in the rest of the market?
>
> What?

Compare the respective profit margins. What do you find?

> >> Medicaid is administered by the states. Oregon's is quite mismanaged.
> >> Long hold times. Delays with enrollment and receiving ID cards. I've
> >> enrolled many and the majority become quite frustrated. This kind of
> >> "service" does not happen in the private sector.
> >
> > Which serves my point about how there's nothing magical about
> > tossing it down to the States either.
>
> Single payor would be a disaster...even if the states ran it.
> Single payor will never happen.

Single payor is probably the best chance we have to drive down
total system costs...but you're right, it probably will never
happen, because the Corporate interests who spend millions to
lobby Congress will be an influence in setting policy.

> Only a minority in our country trust the government to that extent.

But how much of the underlying reason for that distrust is because
of very deliberate and systematic sabotage of government institutions
by politically motivated entities?

> > In any case, the net overhead rates are still lower than the
> > non-Government private healthcare firms today, are they not?
> >
> > For example, this one claims 1.3% vs 12%:
> >
> > <http://www.politifact.com/truth-o-meter/statements/2011/may/30/barbara-boxer/barbara-boxer-says-medicare-overhead-far-lower-pri/>
> >
> > And granted, this has been a subject of debate, such as by also
> > factoring in differences in detection of fraud, or how Agencies
> > have off-the-books institutional support but there's also been
> > a quiet "inflated markup" running through the private companies
> > claims too that's an expense that's been under the radar too...
> >
> > "Contrary to claims made by John Goodman and Thomas Saving in
> > an earlier Health Affairs Blog post, non-partisan data from
> > the Congressional Budget Office (CBO) and the Center for Medicare
> > and Medicaid Services (CMS) demonstrate definitively that private
> > insurance is increasingly less efficient than Medicare."
> >
> > <http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/>
> >
> > In any case, there's also a fundamental difference in the basic
> > business models too: the private healthcare insurance companies
> > have a fundamental and irreconcilable conflict-of-interest between
> > optimizing their service to their customer recipients versus an
> > optimization of their profits to their stockholders: a Government
> > entity and/or a Mutual doesn't have this same contradiction.
>
> Many health insurance companies...like Blue Cross...are non profit
> entities.

Better check your fine print:

"In 1994, BCBS changed to allow its licensees to be for-profit
corporations.[3] During 2010, Health Care Service Corporation,
the parent company of BCBS in Texas, Oklahoma, New Mexico,
Montana and Illinois, nearly doubled its income to $1.09 billion
in 2010, and began four years of billion-dollar profits.[10]"

<https://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Association>

There's many different flavors & nuances of 'nonprofits' today.


<http://www.npr.org/templates/story/story.php?storyId=124807720>


-hh

[John B.]

How do you know there's no Dem bill? Are you aware of every
health-care-related bill that's been introduced in the House?
When one party controls the legislative process, the other
party's bills tend not to be considered. What we have now is
a bill that throws millions of people off of Medicaid and cuts
taxes for rich people and corporations. That's what you get
when you put a bunch of grey-haired, white, male conservatives
in charge of deciding what's best for everyone else. It's
not the Dems who are out of touch.

[John B.]

Let's not forget what Trump promised: a bill that would insure
more people, cost them less, and give them access to better
care and better coverage than Obamacare. Does this bill do
that? Absolutely not. It's an abomination.

[Dene]

On 5/4/2017 1:25 PM, John B. wrote:

>
> Let's not forget what Trump promised: a bill that would insure
> more people, cost them less, and give them access to better
> care and better coverage than Obamacare. Does this bill do
> that? Absolutely not. It's an abomination.

Results depends on the individual states but younger, healthier people
will definitely pay less, if they choose to participate (more about that
below). Boomers like me will pay more but that could be offset if we
have choices in what we buy...like no maternity, mental health, etc. I
have a $6000 deductible plan that I'm perfectly comfortable with. I can
afford the doctor visits and routine Rx. It's the hospital bill I want
insurance for.

A big factor is Medicaid reform, which is a key reason why ACA is
failing. With it's ridiculous expansion, too many young, healthy people
are on it instead of being part of a private insured risk pool. With
Medicaid being rolled back, insurance companies can compete for this
desired business...and they will.

The only hole in the plan is the elimination of the penalty. Too many
freeloaders will risk being uninsured and show up in the ER, leaving the
insured to foot their bill. The good news is that when they buy a plan,
they will be screened for their pre-existing condition, put into a
special pool, and pay alot more for coverage.

But...that is the fitting price for being a freeloader.

[Dene]

Name the bill, John.
What is your solution for what was announced in Iowa?

[Alan Baker]

Americans should watch.

The Republicans just voted for a bill that defines having had children
as a "pre-existing" condition...

...along with having been raped.

[John B.]

Try these: HR 707, HR 1589, HR 1064, HR 1621, HR 2336,
HR 676, HR 767. All health care alternatives, all introduced
by Democrats.

[Dene]

On 5/4/2017 10:35 PM, Welcome to Trumpton wrote:
> Dene wrote:
>

>> On 5/4/2017 1:25 PM, John B. wrote:
>>
>>>
>>> Let's not forget what Trump promised: a bill that would insure
>>> more people, cost them less, and give them access to better
>>> care and better coverage than Obamacare. Does this bill do
>>> that? Absolutely not. It's an abomination.
>>
>> Results depends on the individual states but younger, healthier
>> people will definitely pay less, if they choose to participate (more
>> about that below). Boomers like me will pay more but that could be
>> offset if we have choices in what we buy...like no maternity, mental
>> health, etc.
>

> I see why you might take the gamble on not getting pregnant but do you
> really think it should be the individuals choice not to pay towards
> mental health.

Yes...the ultimate purpose of any insurance is that it should cover what
I'm willing and unable to cover myself. I can self insured mental health.

You really haven't got your head around the whole
> national healthcare ideology. You think it's okay for people to just
> get cover for what they fear they will need as opposed to they might
> really need.

Amount of insurance is always a subjective decision. For example, the
amount of deductible, etc. We are grownups. We do not need a nanny
state to decide this.

The difference is tens of millions of people having
> inadequate care and either not getting the care they need or relying on
> a substandard charitable system to pick them up.

Who are these people...the poor who have Medicaid. The uninsured? Who?

> You are thinking like an insurance salesman not a healthcare provider.

Thank you!

[-hh]

On Friday, May 5, 2017 at 2:47:54 PM UTC-4, Dene wrote:
> On 5/4/2017 10:35 PM, Welcome to Trumpton wrote:
> > Dene wrote:
> >> On 5/4/2017 1:25 PM, John B. wrote:

> >> [...]

> >>>
> >>> Let's not forget what Trump promised: a bill that would insure
> >>> more people, cost them less, and give them access to better
> >>> care and better coverage than Obamacare. Does this bill do
> >>> that? Absolutely not. It's an abomination.
> >>
> >> Results depends on the individual states but younger, healthier
> >> people will definitely pay less, if they choose to participate (more
> >> about that below). Boomers like me will pay more but that could be
> >> offset if we have choices in what we buy...like no maternity, mental
> >> health, etc.
> >
> > I see why you might take the gamble on not getting pregnant but do you
> > really think it should be the individuals choice not to pay towards
> > mental health.
>
> Yes...the ultimate purpose of any insurance is that it should cover what
> I'm willing and unable to cover myself. I can self insured mental health.

FWIW, I think that mental health is a bad example, because by
definition, the subject of the need will impair the ability
to objectively self-assess the same.

> > You really haven't got your head around the whole
> > national healthcare ideology. You think it's okay for people to just
> > get cover for what they fear they will need as opposed to they might
> > really need.
>
> Amount of insurance is always a subjective decision. For example, the
> amount of deductible, etc. We are grownups. We do not need a nanny
> state to decide this.

A fair enough statement in principle ... but in reality, we
are all surrounded by thousands of "nanny" regulations, all
because we have learned that corporate self-interest cannot
be inherently trusted to be consistently in the public's
own interests.

FWIW, Industry has learned (well, some of them) that an external
entity setting standards is a good thing too, because it helps
to establish public standards when it comes to liability lawsuits.

The big problem with "nanny" in healthcare has been
that there's been ample historical examples of people
being deceived into buying really crappy policies which
don't really cover much of anything -- these are quite
frequently very complicated products and a lot can & does
get hidden in the fine print ... just look at the news on
Commercial Airlines throwing people off of flights this
past month for examples of the divergence between what
the public thinks they're getting and what the airline's
lawyers have hidden in the fine print.

> > The difference is tens of millions of people having
> > inadequate care and either not getting the care they
> > need or relying on a substandard charitable system to pick them up.
>
> Who are these people...the poor who have Medicaid. The uninsured? Who?

To a great degree, they're normal middle class folks
who get hit with a huge medical bill.

For example, its the #1 cause of personal bankruptcy in the USA
...and more:

"Even outside of bankruptcy, about 56 million adults — more
than 20 percent of the population between the ages of 19 and 64
— will still struggle with health-care-related bills this year,
according to NerdWallet Health."


<http://www.cnbc.com/id/100840148>


<http://www.consumerreports.org/personal-bankruptcy/how-the-aca-drove-down-personal-bankruptcy/>

FYI, here's current real world example from a family member.

It started two years ago when there was a medical emergency
and they supposedly gave the okay to call for a MediVac by
chopper. But bad weather resulted in the chopper never
being able to take off to make the flight (so a ground
ambulance was used instead).

Well, the MediVac company is demanding $60K (I kid you not)
and the Health Insurance carrier is refusing to pay because
the MediVac company never provided any service, so they're
trying to get the adult who allegedly gave the verbal consent
to pay.

Yes, the demand is for the full $60K cost of a MediVac flight,
even though they never left the ground...supposedly, this
provision was buried in "fine print" which was never provided.

So...are you going to simply roll over and pay the bill?

And even if you say 'yes', do you even have this amount
of free cash just laying around?

Yeah, maybe today, but how much did you really have back
when your kids were between, oh, say 5 - 15 years old?

Back then, I know I didn't have anything even close to that.

FWIW, another contemporary real world: a colleague has a
still-young child who's a cancer survivor (Neuroblastoma).

After both his & his wife's insurance policies ...

<< yes, they both work & were DOUBLE insured >>

... they have a "bit over" $100K in outstanding bills
that they're personally responsible for paying. They'll
get there, but 100% of the reason why is because they
happen to make $200K more than the US Household Median Income.

Now try to imagine how much worse of their situation would
have been had it been only one parent working...


-hh

[David Laville]

On Thu, 4 May 2017 08:29:03 -0400, Carbon
<nob...@nospam.tampabay.rr.com> wrote:

>>
>> I'm saying that our Federal government cannot possibly manage the
>> healthcare of 330 million people.
>
>Bias unsupported by fact.

You are clueless. The government can't manage the 9 million people
enrolled in VA health care system.

What is it that happened in your life that makes you think the
government is the solution to everything?

[David Laville]

On Wed, 3 May 2017 20:15:59 -0700, Dene <gds...@aol.com> wrote:

>On 5/3/2017 8:04 PM, Carbon wrote:

>> Your average American has no clue how shitty and corrupt their system is.
>> And a lot of money is spent to ensure it stays that way.
>
>It works in Canada because you have a small population and you are used
>to pay horrific taxes.

The average family in Canada pays close to $12,000 a year in taxes
that goes to healthcare yet left wing zombies like Carbon like to tell
us about the free healthcare that get.

http://tiny.cc/ut6yky

[David Laville]

On Wed, 3 May 2017 23:04:10 -0400, Carbon
<nob...@nospam.tampabay.rr.com> wrote:

>Bullshit.
>
>I lived in Canada for 35 years. There is way less hassle getting
>healthcare there than here. For one thing, if everyone was on the same
>plan there would be no need for CMS or any of that other crap. You get a
>card, you see whatever doctor you want, and you never have to fight with
>insurance companies.
>
>Your average American has no clue how shitty and corrupt their system is.
>And a lot of money is spent to ensure it stays that way.

The average insurance cost in Canada is $12,000 a year and $10,000 in
the United States. I'll give you the benefit of the doubt and say you
Canadians probably don't have a deductible but in the U.S. the average
is $4,300 dollars. So we're comparing $12,000 to $14,300, a $2,300
difference. The biggest difference is Canadians are coming to the
U.S. for healthcare because the waiting list is much shorter for
treatment, Americans aren't crossing the border into Canada for
treatment.

Tells us again how shitty and corrupt our system is, we can use the
laugh, clown.

[Alan Baker]

And yet our per capita health care costs are less than yours...

[Alan Baker]

Tell us how you laugh off that people die in your system for lack of the
ability to afford healthcare...

...or go bankrupt.

[Alan Baker]

On 2017-05-05 4:04 PM, Moderate wrote:
> Alan Baker <alang...@telus.net> Wrote in message:

> Canada has substandard care. Canucks who can afford it come to the US.
>

LOL!

Canadians don't die because they can't afford health care.

Canadians don't go bankrupt when they get diagnosed with something
catastrophic.

Is our system perfect? Hell, no.

Is it a thousand times better and more compassionate than yours? Damn right.

[Alan Baker]

On 2017-05-05 4:25 PM, Moderate wrote:
> Alan Baker <alang...@telus.net> Wrote in message:
>> On 2017-05-05 4:04 PM, Moderate wrote:
>>>>
>>>
>>> Canada has substandard care. Canucks who can afford it come to the US.
>>>
>>
>> LOL!
>>
>> Canadians don't die because they can't afford health care.
>

> They just die.

Nope. We live longer than Americans.

>
>> Canadians don't go bankrupt when they get diagnosed with something
>> catastrophic.
>

> Americans who purchased catastrophic care didn't either.
> Catastrophic care plans were $50 a month prior to
> Obamacare.

Cite, please...

[John B.]

On Friday, May 5, 2017 at 2:47:54 PM UTC-4, Dene wrote:

The poor wouldn't have Medicaid anymore if this atrocity of a health care
bill were to pass the Senate. Fortunately, we know it won't.

[John B.]

There is not one single Canadian who would trade their system for
ours.

[Alan Baker]

Oh, no, John. There are some few...

...sadly.

[Carbon]

The most telling stat is average life expectancy. It is significantly
higher in Canada (2.7 years of perfect health), due in large part to
universal healthcare.

https://goo.gl/mf8H

I've had many hapless idealogues lecture me about the horrors of the
Canadian healthcare system, though as far as I recall none of them had
ever been to Canada, and none had the first clue about its healthcare
system aside from the factless certainty that it must be evil.

[-hh]

David Laville wrote:

>Carbon wrote:
> >Your average American has no clue how shitty and corrupt their system is.
> >And a lot of money is spent to ensure it stays that way.
>
> The average insurance cost in Canada is $12,000 a year and $10,000 in
> the United States.

Got cite tattoos to back those up? My recollection is that the US is closer
to $10K per adult, not family. Perhaps you're only counting your copay and
neglecting your employer's portion?

>I'll give you the benefit of the doubt and say you Canadians probably
> don't have a deductible but in the U.S. the average is $4,300 dollars.
> So we're comparing $12,000 to $14,300, a $2,300 difference.

Closer.

> The biggest difference is Canadians are coming to the
> U.S. for healthcare because the waiting list is much shorter for
> treatment, Americans aren't crossing the border into Canada
> for treatment.

That story of Canadians coming south is so 1990's. Got a contemporary citation with numbers?

> Tells us again how shitty and corrupt our system is, we can use the
> laugh, clown.

It utterly is bad, largely because the patient isn't considered to be the customer. IIRC, we're paying
over $15K/yr. Amongst other personal examples, a well-travelled friend chooses to pay to have his
healthcare done outside of the USA, despite having healthcare benefits available to him in the States.


-hh

[-hh]

A quick update, since David has bailed:

<https://www.nytimes.com/2017/05/08/business/dealbook/09dealbook-sorkin-warren-buffett.html?em_pos=large&emc=edit_dk_20170508&nl=dealbook&nlid=17643344&ref=headline&te=1&_r=0>

Employer's portion: over $12K per year for a family of four. If the employee is paying half (including
company's, etc), then it's basically $25K/year.

Oh, and the Buffet article is quite interesting, too.

-hh

[David Laville]

Tell this to Mr. Shamblaw;

https://www.usnews.com/news/best-countries/articles/2016-08-03/canadians-increasingly-come-to-us-for-health-care

[David Laville]

On Fri, 5 May 2017 18:04:42 -0500 (CDT), Moderate <nos...@noemail.com>

wrote:

>Alan Baker <alang...@telus.net> Wrote in message:

>Canada has substandard care. Canucks who can afford it come to the US.

Notice how he left out "since Obamacare"?

[Alan Baker]

I left it out because it's not so.

It has been less expensive per capita than yours for a long time.

<http://kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/>

You lose.