health insurance bill

[2manyrocks]

Most people seem to like the fact that the health care bill disallows the use of pre-existing conditions to deny coverage. I think it would be fair to say that most think this is the best part of the bill.
l.

One negative effect is that those who are uninsurable because of effects of past drug abuse or other moral hazard behaviors can now be covered by insurance, and the insurance companies have to find ways to pass the costs of their medical treatment onto the "pool."

 

[canoetrpr]

One negative effect is that those who are uninsurable because of effects of past drug abuse or other moral hazard behaviors can now be covered by insurance, and the insurance companies have to find ways to pass the costs of their medical treatment onto the "pool."

Very true. That said, I don't think the numbers are as nearly as large as lots of other preexisting conditions - hypertension, acid reflux, back pain etc. that are really beyond most of our control and tend to affect many many of us as we age.

The problem with leaving any loophole for the insurer is that it being a private enterprise whose goal is to make a profit, will do its best to find a way to get out of paying for eventual health problems that may even be remotely related to whatever the pre-existing condition / past drug use / moral hazard was. The insurance companies are not daemons. They are simply businesses and do what businesses do best and try to make a the most for their shareholders.

Just my $0.02 CND (and it is worth quite a bit these days!)

 

[2manyrocks]

Does anyone know the number of truly "uninsurables" in the 30 million that are supposedly going to be added or have any idea of what it will actually cost to provide their medical care?

Aren't the uninsurable those at the ends of the statistical bell curve for which there aren't that many in number, but for whom the costs of treatment are, by conventional thought, unaffordable. But with malpractice being what it is, and now having access to insurance, now healthcare providers are going to have to do whatever it takes to provide healthcare at whatever it costs?

If I have a health plan that has comparatively low rates now because the insurance company has done a good job of screening risks, what happens to my rates when the insurance company can't screen risks any longer? Will I be able to afford insurance coverage?

What if my insurance company, because of its low rates, has an influx of coverage it can't deny that results in a disproportionate number of claims and expense causing it to become insolvent? What happened to the coverage I've been paying for? What do I do then?

If I am a large employer in the US and I'm faced with increasing employee costs, including increasing health care costs, why shouldn't I outsource manufacturing to China where I don't have to pay for them?

 

[dave1949]

If I have a health plan that has comparatively low rates now because the insurance company has done a good job of screening risks, what happens to my rates when the insurance company can't screen risks any longer? Will I be able to afford insurance coverage?

What happens now to the people who are screened out? They get treated for the most part. Except, since they were screened out, they didn't pay any insurance cost like you did. It gets paid for somehow by all taxpayers and/or insurance rate payers.

Your question is based on the assumption that a person should enjoy low insurance costs if their risks are low. How far are you willing to take that in principle? For example, a low risk man and his low risk wife can bear very high risk children. Then what? Or, you may be exposed to something that causes a chronic condition years after the fact, how is your risk determined? Do we kick you to curb now that you are a poor risk?

The fact that companies off-shore when possible is just a race to the bottom, that hasn't changed. They don't have a lot left to move to China by now, do they? The real irony is the Indian radiologist who reads your X-ray/MRI/etc. remotely from his office in India.

Dave.

 

[canoetrpr]

2manyrocks, I found this excellent breakdown of who the uninsured are. It dosen't completely answer your question completely bit it is worth reading. The article is written by a former Bush staffer who has some detailed background into some of this data.

This seems to suggest (at least to me) that only a portion of the uninsured are may even be in the category of 'uninsurable'. I'd say that the 10 or so % that are below 300% of the poverty level are simply cannot afford it. 300% of the poverty level is still not a very high number so there may well be a lot in the 10% that are over the 300% of the poverty level may not be able to afford health insurance either.

Your point is perfectly valid about a possible rise in premiums to cover those with preexisting conditions that are not covered today. I suspect that many of these are insured but exempt from coverage for certain things. I think the counterpoint is that the mandate for everyone to have cover (including those that are healthy) will offset the increased cost of providing coverage for preexisting conditions.

I think it will simply take some time to figure out how premiums are affected by this new reality.

On the China thing, there is more than just healthcare that is causing the movement of manufacturing jobs there. It is certainly a non trivial part of it. Over time, I expect the Chinese will have to start providing social services (they are already seeing the pressure) like social security and health care. The beef I have about the Chinese is that their markets are no where near open to us as ours are to them. Additionally the fixed and undervalued yuan is causing significant distortions in the trade balance.

 

[Dennisfly]

So, the bill hires over 15000 new IRS agents and auditors and not one doctor. It puts student loans under government control and puts private student loan companies out of business. Read the bill. This is what it says. How does this relate to health care?

It doesn't speak at all to tort reform or allowing competition across state boundries, both of which would significantly lower costs.

This is not about health care. It is about government control and wealth redistribution. Wake up people!!!

 

[dave1949]

So, the bill hires over 15000 new IRS agents and auditors and not one doctor. It puts student loans under government control and puts private student loan companies out of business. Read the bill. This is what it says. How does this relate to health care?

It doesn't speak at all to tort reform or allowing competition across state boundries, both of which would significantly lower costs.

This is not about health care. It is about government control and wealth redistribution. Wake up people!!!

Those private student loan companies are making loans guaranteed by the US taxpayer at no risk to the loan company. It's good work if you can get it.
Dave.

 

[LostInTheWoods]

Lost, you are a gentleman to debate/discuss with.

Likewise.

Too many people get lost in all the rhetoric and are unwilling to debate the actual issues.

Unfortunately, that is the standard and not the exception. As you likely know, we have two main political parties here. Bad and Worse. Even the party we have which one would most associate with Peace, Love, and Happiness is rife with intolerance and insular thought. All the more galling because they loudly proclaim their progressiveness. All's peachy unless, of course, you're not toeing the party line. Its opposition tends to be little better.

We have a very very different health care system in Canada from what you have in America. It is completely a single payer system, otherwise known as 'socialist'

I could handle socialism. Or communism. Or any of the other -isms. If I thought they worked as well as CAPITAL-ism and democracy. They tend to look great on paper, but fail (often miserably) in practice. Yes, I know the -isms are already at work in the USA, and have been for a very long time. We are not a true democracy, and that's OK with me. So long as we keep what works, and jettison what doesn't.

Most people seem to like the fact that the health care bill disallows the use of pre-existing conditions to deny coverage. I think it would be fair to say that most think this is the best part of the bill.

The requirement to purchase healthcare (individual mandate) is least liked as it takes away the freedom for one to have the individual freedom to decide whether they would like to have it or not.

What I don't think has been communicated effectively is that you cannot have one without the other...

Some would argue that alone is reason enough not to pass this bill. I don't necessarily count myself in that group, but it does trouble me.

If insurance companies are no longer allowed to deny coverage for pre-existing conditions, then there is no point for any one to get insurance until they actually get sick enough to need it. It is much cheaper to pay for regular doctors visits, the odd treatment and so on. When you need insurance is when you have a condition that is going to cost a lot of money.

Besides, there are ways I think you could work around that problem. You could make it available only in "blocks" of time. You want in, great, but you're locked in for 5 years at a time. So no getting that bypass surgery, and then cancelling your plan. Smarter folks than I could probably think of even more workarounds to this problem.

Each province administers its own public health insurance system. Doctors, X ray clinics, pathology labs etc. are private operations which simply bill the province's health insurance when you need their services. In Ontario, the public insurance is called OHIP (Ontario Health Insurance Plan).

"Administers?" Smells like beurocracy. Which begets waste, increases hassle, runs up cost, and generally upsets my digestive tract. From my experience, the things "administered" by the government have been poor cousins to their closest "real world" counterparts. Poor in respest to their effectiveness, not necessarily cost. Perhaps they have been more successful in Canada?

Do you have any means of independent confirmation that the Canadian system has been successful at delievering on its promises? That the populace, as a whole is happy or unhappy with healthcare there?

One very key difference between our systems is that in Canada you cannot as a patient decide to go see a specialist. You must be referred by your family doctor. Consequently, in Canada the ratio of of GPs to specialists is 3:1

Some plans here are the same. Or at least, have been in the past. Required a visit to your primary care provider as a "doorkeeper" before you could see a specialist. The downside is it might actually increase the overall cost in some cases. For example, if you have a hernia, who else would fix it other than a surgeon. Yet, you still must see the primary provider for "clearance" to see the surgeon.

Do you have any information as to whether the physicians there are happy with their chosen career and the system of healthcare?

 

[canoetrpr]

"Administers?" Smells like beurocracy. Which begets waste, increases hassle, runs up cost, and generally upsets my digestive tract. From my experience, the things "administered" by the government have been poor cousins to their closest "real world" counterparts. Poor in respest to their effectiveness, not necessarily cost. Perhaps they have been more successful in Canada?

Do you have any means of independent confirmation that the Canadian system has been successful at delievering on its promises? That the populace, as a whole is happy or unhappy with healthcare there?

OHIP is fairly straightfoward. You go to a health care provider (doctor, hospital, E.R.), they bill OHIP directly. OHIP pays the bill. You don't have to be pre-approved for procedures that your doctor GP/specialist asks for. In that sense, it is not bureaucratic. I frankly don't know what the experience is at the doctor's end. The bureaucracy might well show up at their end of the experience.

OHIP openly lists what is covered and what is not. You are free to purchase additional insurance for things above the basic healthcare that OHIP provides, or pay for it e.g. no chiropractic care is provided, if you are hospitalized, basic OHIP care is for a ward room that you share etc. etc. OHIP sets rates of remuneration for procedures and visits. On balance, our doctors make a lot less money than your doctors. A good friend of mine is an accountant. He has about 10 GPs that are his clients. He says on average they make $300000 per year. Specialists make $800000 to $1000000 a year. Based on these figures, I would say they are not underpaid.

Yes there are wait times for things. My wife just had an MRI done on her knee. It was three weeks after the doctor asked for it. It was not an emergency. I don't consider it unreasonable. If you needed one for in case of an emergency, you would get one right away. I have been in hospital for a 4 week stretch. Hospital care was good - not excellent but it was good. On average, a really good private insurance plan in the USA would be far better than being treated in the single payer system. However our system is designed to provide a basic level of care to everyone. If you can afford more, you can pay the extra for a private room, etc. What you can't pay extra for is to jump the queue - that is determined by urgency of the situation.

We do have pockets of pretty serious problems. In some areas, there is a shortage of GPs and so people don't have a family doctor and have to go into a walk in clinic.

On the plus side, basic coverage exists for everyone. If you need heart surgery, you get it. If you want a tummy tuck - then its on your tab .

Here is an interesting link to a poll done by gallup on satisfaction with the health care systems in the USA, UK and Canada. Of course not all is evident from a single poll but I thought it made interesting reading.

Anecdotally, you would be hard pressed to find too many people here that that would want something fundamentally different than the publically funded system we have. It is very much cherished. We don't have to give health coverage a second thought when it comes to changing jobs or considering to become self employed, or if you lose a job. At times it works against us as it can become a bit of a religion as well and can prevent reasonable debate about how best to have health care delivered. On balance, I would say it is a relatively decent system that does need improvements. I would like to see an approach that is more customer oriented. I don't like the fact that the nurse staff are unionized and thus the best ones get pay raises equal to the worst. I'd like to see more private delivery of health care through the public system i.e. more for-profit hospitals, MRI clincs etc. There is nothing that prevents this as X Ray, Ultra sound clinics are privately run but the bill is sent to OHIP and OHIP pays for them so long as your doctor asked for the procedure. I'd like to see hospitals compete with each other and I believe that they will do this best if they are for profit institutions. The funding rates can continue to be set by OHIP. Procedures can still be paid for by the public insurance plan.

Neither system is perfect.

 

[wingerT]

Just look at Massachusetts, there was an article in the paper that i have on April 11th, we are in for one wild ride in the years to come, it was in the commentary section, by rich lowry of the national review. I hope i'm not around by then.