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-   -   What does the health insurance industry add to the equation? (http://www.peachparts.com/shopforum/off-topic-discussion/257012-what-does-health-insurance-industry-add-equation.html)

mgburg 07-19-2009 01:12 PM

Quote:

Originally Posted by tbomachines (Post 2249951)
... mgburg: your friends are probably in the insurance biz, not HEALTH insurance biz.

They were in both...not all, but both systems were being covered...and the stories were pretty much the same...did I see any of the paperwork? Nope. Could their stories have been a beer-induced-bit-of-bravodo "I've got one for you..." type of story? Maybe.

And maybe, things have changed a bit for the better since the early 80s...but then, again... :rolleyes:

Quote:

Originally Posted by tbomachines (Post 2249951)
... if insurance companies started approving every claim that was outside of the plan coverage, they would lose billions of dollars. 90% of resubmitted claims for appeal are settled after a call to the providers, who VERY often have bad billers/coders (anyone else see those commercials on TV advertising a "great career" in billing/coding?:rolleyes:). That is a huge expense labor-wise, and mostly infuriates the customers. Since you'd see it in the claim, blame is placed solely on the insurance company when it isn't proper (just one example).

I'm not arguing that part...it's the stuff they are suppose to pay for, but they come back at you with "...our doctors have determined that you don't need that procedure...blah, blah, blah..." in hopes you'll give up. No doctors are seen and they wouldn't be able to pick you out of a line-up because they've never had you as a patient...you're a number on a form...

Quote:

Originally Posted by tbomachines (Post 2249951)
IMHO someone who pays out the butt for health insurance (and face it we all do, those who have it) should at least know exactly what they are buying.

It's the stuff you are pre-qualified for, then a few months later you get the bill for the whole procedure 'cause of the imaginary doctors (see above) have determined you didn't need the procedure to begin with...that's the BS-part I've personally dealt with...

Quote:

Originally Posted by tbomachines (Post 2249951)
Overall profit margins are in the vicinity of <1% for many of the better HI companies. ...

Yep, those new buildings along the interstate freeways just showed up the other day...that's probably why the highway is called a "freeway"...buildings just pop up out of nowhere and you're free to move right in and put your shingle on the side of the building facing the "freeway" - it's a wonderful plan and it works beatifully in America... :rolleyes:

Listen, some companies are struggling...but you don't advertize on TV 'cause the air-time is just there for the taking...you don't pay your executives disportionate salaries 'cause you have a death-wish for dark alleys...you're making money and you're happy to do it...it's a dirty job...but if you aren't doing it...you'd want to be doing it...'cause you don't want someone else to do it and have all the fun...I know...I know...trite, but accurate...

BTW, how much do mothers go for on the open market right now? :confused: :eek: :D ;)

mgburg 07-19-2009 01:15 PM

Quote:

Originally Posted by Matt L (Post 2250388)
How much of your paycheck now goes for health care? Don't forget to add your employer's contribution to the total.

BINGO! And it will only go up... :thumbup1:

jlomon 07-19-2009 01:25 PM

Quote:

Originally Posted by mgburg (Post 2250363)
I'm assuming from your comments that you are with the Canadian Health Care System (CHCS)...how's that working out for you? Or...haven't you had to go through the meat-grinder yet? If not, congratulations on you, and yours, good health.

Quote:

Originally Posted by mgburg (Post 2250363)
We will end up with the Canadian-style, where we'll have to "take-a-number" and sit around waiting for a phone call to confirm when we can get in...if we're even eligible for the service to begin with.

Again, you display your ignorance of our system with these two quotes. I've used the system succesfully my entire life - from being born to regular checkups, childhood pnueumonia, annual physicals and full neurological screening and testing for multiple sclerosis. I have family members who have all used the system succesfully for a wide variety of care, ranging from the mundane to the catastrophic. There is no "meat-grinder". There is no "take a number and wait for a phonecall". If I want to see my doctor I call and book an appointment. If her schedule is too full to see me when I want to be seen, I go to a walk-in clinic and get treated by a doctor in the order I arrived. If I am injured I go to the hospital emergency room and yes there is a triage system that means people with worse injuries move to the front of the line, which makes sense to me. If you need treatment you get treatment, it is as simple as that. There is no claims process where someone needs to decide if your life is worth saving, or if the procedure you require is outside your level of coverage. There is no need to continually resubmit denied claims (while your health and financial situations worsen) in the hope that this will be the time you sneak the claim in past the insurance company. Our doctors and nurses are every bit as good and highly trained as yours, which is why so many of your hosptials and other healthcare services actively recruit up here for nurses and doctors.

I could honestly care less what type of health care your country opts to provide or not provide for its citizens. You have your social contract and we have ours. I just get angry when blatantly misinformed opinions, such as yours, are seen as factual representations of our health care system.

Matt L 07-19-2009 01:29 PM

Quote:

Originally Posted by mgburg (Post 2250404)
BINGO! And it will only go up... :thumbup1:

It is fine with me if it goes up, as long as I can continue to be covered if I get laid off or have to take a lower-paying job for a while. Have you checked the prices of individual policies lately, that is, if they'll even sell to you? Or the extreme cost of a COBRA plan, which only lasts for a limited time?

I can't see why employers (other than health-insurance companies) aren't clamoring for such a thing. If I were to open a business, providing health insurance would be difficult and time consuming.

mgburg 07-19-2009 01:45 PM

Quote:

Originally Posted by cmac2012 (Post 2250054)
It kills me the way opponents of public health care go on and on about rationing - as if there's not rationing going on now. ... Under any system there's going to be rationing. There's no way each and every person in the nation, or on earth, is going to get a $half million in medical care each year for the last several years of their life. Or that chronic street drunks are going to be ushered to the front of the liver transplant waiting list so they can "enjoy" a few more years of inebriation. ... But I read of too many stories of people receiving expensive procedures that they don't need primarily because it's profitable to the medical community to give them those procedures. Or because they're trying to head off any and all malpractice suit possibilities. ... The indigent in our nation rarely get any preventative care or counseling, instead they show up at ERs with advanced conditions either expensive or impossible to treat. ... I'm thinking that some sort of two tiered system is inevitable in any implementation of publicly funded health care. The upper income level folks are simply not going to stand in line with indigents for medical care nor should they have to. Many, most prosperous people are prosperous for a reason and should have the right to purchase more speedy and deluxe medical care than is available to lower income people. ... Perhaps we could require doctors who are trained in state funded facilities to devote the first 10 or so years of their practice to public health facilities. Then they could move on to higher paid positions treating the more affluent. Or faster relief from student loans could be a lure for working in public health facilities. ... But this business of putting health care primarily on the backs of employers gives too much power to large employers IMO. And it makes us less competitive with Canada, Britain, and France (for starters) for some companies who have options on where to base their manuf. facilities. And forces people to stay in jobs that may not be in their best interest owing to fear at losing health insurance.

You're right about the two situations...not only is there the inequities within the insurance industry itself...the medical profession needs to have a "prostate examination" of itself and rid itself of the cancer of greed among the hospitals and servicing institutions...when a scam is found, MAJOR LEGAL ACTION needs to take place with criminal penalties instituted harshly...throw enough crooked doctors in prison and we could pretty much do away with contracted services there...make the doctor the prison doctor...and you know he couldn't slack off...or he'd end up doing a personal shiv-endectomy on himself in the back of his cell or office...and you'd also have a few less doctors medicating themselves too...or you'd find out that they'd be practicing proctology a bit more than normal in order to get their daily fixes... :eek:

As for a two-tied approach...it's still costing money from a segment of society that can go "mobile" if it wants...therefore, no more (or significantly less) population to be taxed if they no longer are in the US...and the result will be that the resposible parties to pay for it will be where it will trickle down on those below to carry the weight of EVERYONE, including those that don't contribute to the system the way it is now...

All the while, that "third tier" that no one is talking about is still getting its healthcare because they aren't contributing to Social Security, or any of the other "mandated" programs that the regular Joes have to pay for...the government worker and the gang of 545...

"All in or nothing!"

If not, the program they'll come up with isn't "Universal" at all...it's the scraps from the table... :sad:

mgburg 07-19-2009 01:58 PM

Quote:

Originally Posted by jlomon (Post 2250409)
Again, you display your ignorance of our system with these two quotes. I've used the system succesfully my entire life - from being born to regular checkups, childhood pnueumonia, annual physicals and full neurological screening and testing for multiple sclerosis. I have family members who have all used the system succesfully for a wide variety of care, ranging from the mundane to the catastrophic. There is no "meat-grinder". There is no "take a number and wait for a phonecall". If I want to see my doctor I call and book an appointment. If her schedule is too full to see me when I want to be seen, I go to a walk-in clinic and get treated by a doctor in the order I arrived. If I am injured I go to the hospital emergency room and yes there is a triage system that means people with worse injuries move to the front of the line, which makes sense to me. If you need treatment you get treatment, it is as simple as that. There is no claims process where someone needs to decide if your life is worth saving, or if the procedure you require is outside your level of coverage. There is no need to continually resubmit denied claims (while your health and financial situations worsen) in the hope that this will be the time you sneak the claim in past the insurance company. Our doctors and nurses are every bit as good and highly trained as yours, which is why so many of your hosptials and other healthcare services actively recruit up here for nurses and doctors. ... I could honestly care less what type of health care your country opts to provide or not provide for its citizens. You have your social contract and we have ours. I just get angry when blatantly misinformed opinions, such as yours, are seen as factual representations of our health care system.

Fine...you're one of the first that actually has an anecdotal tale to tell concerning real-first-person experiences with the Canadian system...Thank you for that...and if anyone is taking anything I say on this forum as FACT...we're in a world of hurt...just the stuff that's happened to me is fact...the rest is an OPINION...and that's it...I can be swayed...but it takes some hard evidence to do it...but you have a fairly "mild" and non-confrontational way of doing it...it just took a bit to get it out of you... :D ;)

But, I do want to know...how is the system paid for? Direct taxes from your paycheck? Are government-subsidized folks required to do "co-pays" or how does that work?

It's one thing that everyone is treated the same...but somehow, we know that EVERYONE isn't contributing "their fair share" to the system...how does that work? :confused:

tankdriver 07-19-2009 02:01 PM

Quote:

Originally Posted by Fitz (Post 2250347)
The USPS is FUBAR. How many rate increases lately, and still they are closing post offices and laying off workers.

And this is not related to e-mail, cellphones, texts, online bill pay at all? Come on man. The USPS is usually cheaper than FedEx or UPS for consumer mailing. People just use it less. If you can point to actual poor management as a cause for USPS for rate increases, I'd like to see it. The fact that a stamp costs 43cents is only indicative of inefficiency if you can show the post office takes in as much business as it used to, but has somehow increased cost above normal inflation.

mgburg 07-19-2009 02:13 PM

Quote:

Originally Posted by Matt L (Post 2250414)
It is fine with me if it goes up, as long as I can continue to be covered if I get laid off or have to take a lower-paying job for a while. Have you checked the prices of individual policies lately, that is, if they'll even sell to you? Or the extreme cost of a COBRA plan, which only lasts for a limited time?

Yep, they suck. For work, COBRA would be: $350/month, single - $480/month, married - $600/month, family... I looked at an individual policy a few years back, when I was considering going "contractor" - over $1,000/month for family coverage...deductibles, if I remember correctly were somewhere around $5,000/year...

I like my yob! :cool:

Quote:

Originally Posted by Matt L (Post 2250414)
I can't see why employers (other than health-insurance companies) aren't clamoring for such a thing. If I were to open a business, providing health insurance would be difficult and time consuming.

It's the additional taxes that will be heaped on them..."O" thinks that big businesses have a stash of cash laying around, just waiting for government to tap into...

The problem is..."O" and Congress aren't thinking past the first premium payment...THERE IS NO BUDGETARY PLANNING IN ANY OF THE STAGES OF THIS LEGISLATION.

They're thinking that if someone, somewhere, waves a magic wand, the money tree to green-up and everything will be better...

HELLO!!!!

Everyone's 401(k) plan has been reduced to something in the 175(f-) category...that 30-hour/week MickeyDs stint just aint covering the mortgage payment along with the windshield-washer job down on the street-corner outside the bank building...and the taxpayer is going to have to learn a newer method of new math come tax-time when it comes to filling out the new 1040 to figure out "his share" of the new healthcare plan...

Oh yah...I just WANT to open my own business, just like you...

Hello, underground economy...good bye open lifestyle... :rolleyes:

tankdriver 07-19-2009 02:18 PM

Quote:

Originally Posted by mgburg (Post 2250437)
It's one thing that everyone is treated the same...but somehow, we know that EVERYONE isn't contributing "their fair share" to the system...how does that work? :confused:

Can you tell me of any system of any kind that exists in which fairness not only exists, but everyone thinks that is so? Even democracy is not fair. Certainly our current health care system is not fair. Fairness isn't possible in it.


As long as a civilized society has people in it with differing amounts of money, fairness is inapplicable. Members of that society make a judgment of what standards exist in living in that society. Society makes that judgment as a whole. Like child labor.

Unless you advocate communism, you are agreeing to participate in a society that would rather be unfair than to fetter the human spirit. There are going to be things that benefit some and things that hurt some.

mgburg 07-19-2009 02:32 PM

Quote:

Originally Posted by tankdriver (Post 2250455)
Can you tell me of any system of any kind that exists in which fairness not only exists, but everyone thinks that is so? Even democracy is not fair. Certainly our current health care system is not fair. Fairness isn't possible in it. ... As long as a civilized society has people in it with differing amounts of money, fairness is inapplicable. Members of that society make a judgment of what standards exist in living in that society. Society makes that judgment as a whole. Like child labor. ... Unless you advocate communism, you are agreeing to participate in a society that would rather be unfair than to fetter the human spirit. There are going to be things that benefit some and things that hurt some.

If you're proposing something to replace another item...the least I'd expect from the the proponent is the fact that all in inequities of the old system should be brought down, leveled out and we all start from square one with a level playing field...

That's not happening here...

The person NOT IN GOVERNMENT, but is paying the government (taxes) is the one expected to pay for the new system...and the old system of the Government's Healthcare...and the military's too (you don't expect our military to be part of this "new" system do you?)...

So, what's "fair" there? The Government is the 3rd tier no one is talking about...or including...the way they're set up, they don't need to worry about copays or the like...it's in their contracts and union deals...the military...that's a 4th tier...

What I'm tired of hearing about is the Government saying "Do as I say, but not as I do."

When do WE get the brass-balls back and let our Government know that WE are their bosses...not the other way around...

The closest I've seen that happen is when Reagan fired the Air-traffic controllers...

Many lawyers got rich on that, but the end result was the American Public spoke and it happened...

We're too tongue-tied to do that now...and I believe that may be our undoing as a Republic... :sad:

Fitz 07-19-2009 02:49 PM

Quote:

Originally Posted by tankdriver (Post 2250440)
And this is not related to e-mail, cellphones, texts, online bill pay at all? Come on man. The USPS is usually cheaper than FedEx or UPS for consumer mailing. People just use it less. If you can point to actual poor management as a cause for USPS for rate increases, I'd like to see it. The fact that a stamp costs 43cents is only indicative of inefficiency if you can show the post office takes in as much business as it used to, but has somehow increased cost above normal inflation.

And how will raising rates and closing post offices help them to compete against private carriers and other forms of communication?

Matt L 07-19-2009 03:32 PM

Quote:

Originally Posted by mgburg (Post 2250451)
It's the additional taxes that will be heaped on them..."O" thinks that big businesses have a stash of cash laying around, just waiting for government to tap into...

I would prefer that I would be taxed to support it, and not the business directly (except as part of their overall income taxes, if they pay any).

Hatterasguy 07-19-2009 05:04 PM

Quote:

Originally Posted by tankdriver (Post 2250282)
National Defense


I'll raise you medicare.:D

tankdriver 07-19-2009 05:37 PM

Quote:

Originally Posted by mgburg (Post 2250467)
If you're proposing something to replace another item...the least I'd expect from the the proponent is the fact that all in inequities of the old system should be brought down, leveled out and we all start from square one with a level playing field...

That's not happening here...

Now who's being unfair? You have inequities in the current system and you're fine with that, but in a new system there can be no inequities? If the least you expect is utopia, how can you possibly think what we've got is good enough? Never mind the fact that it's impossible to please everyone, but we're not pleasing many people now.

Quote:

The person NOT IN GOVERNMENT, but is paying the government (taxes) is the one expected to pay for the new system...and the old system of the Government's Healthcare...and the military's too (you don't expect our military to be part of this "new" system do you?)...
Every person who pays taxes pays for what the government does. Not every person can be in the government. I fail to see a problem here. The alternative is anarchy.
I expect if there is a new system it will apply to everyone, military or not.

Quote:

So, what's "fair" there? The Government is the 3rd tier no one is talking about...or including...the way they're set up, they don't need to worry about copays or the like...it's in their contracts and union deals...the military...that's a 4th tier...
Details. The devil's in them and they're important. But they can be hashed out, traded upon, compromised on, eliminated, or accepted.

Quote:

When do WE get the brass-balls back and let our Government know that WE are their bosses...not the other way around...

The closest I've seen that happen is when Reagan fired the Air-traffic controllers...

Many lawyers got rich on that, but the end result was the American Public spoke and it happened...
Not the portion of the public who were air traffic controllers. Certainly wasn't fair to them. They spoke and got stomped on by the government.

As far as letting the government know who the bosses are, the people let the Rep Congress know how they felt. They let John McCain and Barack Obama know how they felt.
If you want an active citizenry taking part in its governance, I am right beside you. But let's not pretend that the government is somehow absconding with the public's control of it. People still exert their will, but the fact that they don't routinely exert it is their problem, independent of government action.

tankdriver 07-19-2009 05:37 PM

Quote:

Originally Posted by Fitz (Post 2250473)
And how will raising rates and closing post offices help them to compete against private carriers and other forms of communication?

Same way closing dealerships helps GM and Chrysler.


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