Supreme Court Healthcare Mandate Decision

[JeffL]

And this is why, if we stay with a private insurer system, health insurance will need to be treated/regulated like a public utility--there's no way around it.

Yep. Even with the reform bill, we basically are still leaving most of our healthcare decisions in the hands of companies where the decision makers, at every level, are rewarded for making the most money, not providing the best care. Knowing that the person who is making the decisions is someone who will get promoted and a nice big bonus check if they make the decision that makes their company the most money, or that they may be fired if they make the decisions that DON'T make the most money for the company, is no way to have health care decisions made.

And the insurance companies have enough money that I doubt we'll see their power taken away any time soon.

[Zak Gordon]

And this is why, if we stay with a private insurer system, health insurance will need to be treated/regulated like a public utility--there's no way around it.

I find it very bizarre this whole allergy to 'public' held options in the usa. I completely get that people would prefer to pay less tax, we all want that, but in particular the notion that public ownership = communism (which is a very strong bed-rock of opinion, across the usa political divide of left and right even) or some such, is....well....almost 'irrational' from a european(uk) perspective.

Your american, you love america right (hey even i love america!) and what it stands for, the history around your foundation. That solidarity of thought and action to liberate yourselves from the evil (and it really was an evil in many aspects) heavy hand of british imperial rule.

Well ALL public ownership is, is kind of like what you all did to join up, act as one and found the american ideal and your country. That was public ownership for the common good if you like. Your country, as an idea and put into practice is just an act of public ownership. You did it for the benefit of all americans, it was noble and good.

Communism (in practice) is very different from that.

If any system in a country should be in public ownership, it has to be the health care system. If you don't look out for one another, no-one else will, especialy not corporations that need to make profit before all other concerns. So yeah it is freaky to see the many normal, regular americans go on tv to say public health care is teh evil. Like what?!

If you took half of what you spend on your military (this link always boggles my mind!):

http://en.wikipedia.org/wiki/List_of...y_expenditures

You'd still be outspending China by x3 AND you could maybe move up the ranks in terms of health and quality of life for all american citizens. But probably suggesting that makes me a communist?

[wahoo]

Wouldn't they get cheaper as more people joined them to avoid the mandate?

Sure. The more people you have joining will help control costs. The younger, cheaper plans are going to go up in cost b/c of the age band restrictions and the minimum benefit package is more than was originally forecast.

[Houngan]

Is there anything that the GOP dislikes about Obama that can't be directly tied back to Reagan?

http://www.salon.com/2012/07/05/reag...hcare_mandate/

I hadn't realized he was the one that signed the emergency room mandate into law.

[Papageno]

Zak, for the record I completely agree that it's irrational.

Also, to wahoo and others--never forget that those supercheap catastrophic only individual health insurance plans for healthy 20-somethings are mostly there as long as those people don't actually, you know, make claims. At which point they find some reason to say "oh, you didn't point out on your app that you stubbed your toe when you were 12 so here are your premiums and you were never insured with us. Good luck paying that multi-10's thousands hospital bill!"

[G-Man]

JeffL and Papageno's posts made me think of something. Why do people solely blame insurance companies for engaging in such sharp practices? Aren't insurance consumers partly at fault too? I mean if an insurance company ever decided to abandon all the practices that people decry they would basically be driven out of business in short order because their costs would be so much greater than the competition for seemingly similar insurance products. The dominance of price as a factor people consider when choosing insurance products is really the heart of the problem if you ask me. It is not that different from what has happened with the economy class airline market.

[Tin Wisdom]

JeffL and Papageno's posts made me think of something. Why do people solely blame insurance companies for engaging in such sharp practices? Aren't insurance consumers partly at fault too?

Partially. Most Americans don't actually get much of a choice in who their healthcare insurance provider is: you get whomever your company has picked. Sure, there are some (huge) companies that give you a choice of two or maybe three staggeringly similar plans, but usually when you join a company you are joining a specific plan. You can petition your company management to change providers if you have enough sway, I guess. In theory your company will pick its plan with an eye towards attracting the best employees... but unless you are in a field where specialists are sparse and competitively fought-over, cost is going to be the single biggest factor for the company.

So the the airline analogy is pretty apt: in theory there are a slew of airlines to choose from... but if you want to get to El Paso, you're pretty much going to fly US Air.

[JeffL]

JeffL and Papageno's posts made me think of something. Why do people solely blame insurance companies for engaging in such sharp practices? Aren't insurance consumers partly at fault too? I mean if an insurance company ever decided to abandon all the practices that people decry they would basically be driven out of business in short order because their costs would be so much greater than the competition for seemingly similar insurance products. The dominance of price as a factor people consider when choosing insurance products is really the heart of the problem if you ask me. It is not that different from what has happened with the economy class airline market.

Not aimed at you, but the impact and cruelty of these actions takes them beyond just cash flow control.

When you take a woman who has paid her premiums for 20 years, gets breast cancer, and deny payment for her (very expensive) treatment because she literally did not put on her app, 20 years ago, she had acne treatment, even when the doctor who treated her calls the insurance company and tells them it was freaking acne and had nothing to do with her cancer and PLEASE fulfill your obligations to her, as she can't pay these on her own - that goes beyond costs management.

That's a LOT different from the economy class airline market.

[Zak Gordon]

.................. That's a LOT different from the economy class airline market.

AbsoF-inglutely! I completely see this and my heart goes out to people that get gamed by that system currently. Again i'll bang my drum and say that for petes sake (is that sampras?) just cut your stupidly high military spending a little and filter that into some kind of ethical health management. It's a normal, kind, christian, rational, first-world thing to do.

You wont suddenly become the weakest nation in the world, or even close, you'll still be no.1 death-merchants (by a long way) AND have some ethical health care. Call/write your representative now.

[Murbella]

JeffL and Papageno's posts made me think of something. Why do people solely blame insurance companies for engaging in such sharp practices? Aren't insurance consumers partly at fault too? I mean if an insurance company ever decided to abandon all the practices that people decry they would basically be driven out of business in short order because their costs would be so much greater than the competition for seemingly similar insurance products. The dominance of price as a factor people consider when choosing insurance products is really the heart of the problem if you ask me. It is not that different from what has happened with the economy class airline market.

Because the practices they made part of their standard operating procedures were morally wrong and should/would have been illegal in any other context.

For example, i am currently waiting to get out of my cell phone contract. If i was an insurance company, i could make note that Tmobile didn't tell me that they don't have service on the moon and then use that to not only get out of the contract, but also get all of my money back.

If health insurance companies can't remain profitable without committing fraud against their customers, fuck them and fuck the people who run them. All the more reason to transition to a modern health care system that is more efficient.

How can anyone defend a business model that says a company should take money for a service and then when they are required to provide that service, that their customer has been paying for for many years, try to find a way out of it?

[Jason McCullough]

I don't think individuals who go without insurance to "save money" are all that different from for-profit insurance companies denying treatment.

Both are doing it for money. Both don't have any other choice. The individual would have to make extreme sacrifices to their lifestyle to afford the insurance; the insurance company would go out of business if it wasn't as big a (legal) dick as all the other insurance companies.

In cases where the companies violate the law or regulations, sure, but that's a minority of what makes the insurance system so awful.

[Houngan]

I don't think individuals who go without insurance to "save money" are all that different from for-profit insurance companies denying treatment.

Both are doing it for money. Both don't have any other choice. The individual would have to make extreme sacrifices to their lifestyle to afford the insurance; the insurance company would go out of business if it wasn't as big a (legal) dick as all the other insurance companies.

In cases where the companies violate the law or regulations, sure, but that's a minority of what makes the insurance system so awful.

Eh, I have to slide the other way on that, I would think that the vast majority of those going without insurance are already paying for luxuries like cellphones and cable TV. If you're truly impoverished then Medicaid is there to help but most people that voluntarily choose to go without healthcare are making that decision on a priority basis rather than a "I can feed myself and put a roof over my head, next up: health insurance!"

[Jason McCullough]

I think you're underestimating how unbelievably expensive the private non-employer insurance market is.

[Houngan]

I think you're underestimating how unbelievably expensive the private non-employer insurance market is.

I wonder about that. I checked a couple of years ago when I thought I might need bridge coverage while transitioning from contractor to permanent. It was only around 80$ for catastrophe (I want to say $5000 deductible?) per month. Everyone always says that insurance costs some crazy $300/month but I've never seen that since I've always worked.

Just out of curiosity I went to a Travelocity-like insurance aggregator site. Looks like that's the going rate for a $5000 plan, between $65 and $85 a month. Granted these are not good plans, and in no way come close to my work plan, but catastrophe insurance can be had for less than a smartphone plan or non-premium cable. You can get a decent plan ($2500 deductible, no coinsurance) for $120/month or so. So Smartphone AND cable.

I think the real problem is that healthcare is so ridiculously expensive that some people make a wager, since the deductible will wipe them out anyway. If you hit the deductible you're wiped out, if you have an actual catastrophe you're out of work and your shitty job won't cover you so you're wiped out, or you have just enough healthcare that you can still work but the 10-30% coinsurance wipes you out. Might as well go broke and abuse the emergency room until you get on Medicaid.

America, fuck yeah.

[Jason McCullough]

You personally can, as a healthy non-smoker 20 something male, but what if you have a wife and 2 kids? What if you have any pre-existing conditions whatsoever? Those guys are just shit out of luck.

[Houngan]

You personally can, as a healthy non-smoker 20 something male, but what if you have a wife and 2 kids? What if you have any pre-existing conditions whatsoever? Those guys are just shit out of luck.

Sure, provided they land in the hazy area between Medicaid and a good job with benefits. I think you know I'm fully behind the PPACA and would even like to see it extended into single payer care, but there are a lot of folks that make shitty decisions regarding their entertainment/lifestyle dollars vs. their healthcare dollars.

[Alistair]

Minimal insurance (emergency plus an annual check up) for my wife and me is $400+. COBRA continuation of my former big company package was $900.

Would you mind linking to the $65 version so I can compare?

[Houngan]

Minimal insurance (emergency plus an annual check up) for my wife and me is $400+. COBRA continuation of my former big company package was $900.

Would you mind linking to the $65 version so I can compare?

Just Google catastrophic health insurance.

[Enidigm]

I just took out two policies on myself (group and individual) and AFLAC. Because they coordinate benefits the coverage should overlap; ie, 80% of one, and 85% of remaining 20%, plus AFLAC kicking on in the event of a catastrophic health issue.

Catastrophic insurance is relatively affordable but also symptomatic of the complete breakdown of the heath care system for underinsured individuals. In a sense, it's insurance for the person who never goes to the doctor, ever, until they're in a car wreck. It's the completely abandonment of preventative care.

[Alistair]

Just Google catastrophic health insurance.

Using eHealthInsurance, for me (41 in New York) it's $182, or $415 if I add my wife. Just a data point.

[Houngan]

Interesting, I guess it's hugely location-dependent.

[Strollen]

Interesting, I guess it's hugely location-dependent.

It is hugely dependent on location. On my early retire forum a large proportion of the people have purchased individual policies. We were comparing rates and it is all over the map. From the $75 high deductible for people in their 30s to $1300/month for families in their 50s. Pre-existing conditions are a big factor, but it was surprising that common things like high cholesterol can double insurance cost. Geography plays a huge role and it seems impossible to figure out why. For instance MO is down right cheap <$100 even for 40+ year olds, families for $150. On other hand much of east coast like MD families (typically a couple + teenage kid) were often paying $1000. A high cost state like NY was expensive but so was a low cost state like SC. One thing that does seem to be universal is that COBRA is almost always more expensive than finding your own coverage.

I pay $285/month for Kaiser in Hawaii it went up a lot 30% when I hit 50, but if you are under 40 you can get a high deductible plan for under $100 from the Blue Cross provider in the state. Now Hawaii is one of the healthier states in the union, but also one of the most expensive so it is hard to understand why insurance here is cheaper than say OR. I don't find the money I pay for insurance to be outrageous, it is roughly twice my internet+cable+ phone bill.

What is crazy is the bills associated with most medical treatments. Two friends had heart surgeries recently a guy in his early 60s his bill was over $200K, and woman in her mid 70s her bill was over $600K. Blue Cross picked up the tab for guy and medicare for the woman. What would be fascinating to find out is how much actual money was transferred from one organization to another I suspect it was $.25 on the dollar at most.


Overall medical cost in this country are astonishingly random and variable. It is like some 8 year kids designed an RPG and instead of calculating for damage for a sword as Str/3+ Random(8-15), used Str*Random(100) + Random(1000) and then wondered why players bitched.

[JeffL]

I don't think individuals who go without insurance to "save money" are all that different from for-profit insurance companies denying treatment.

Both are doing it for money. Both don't have any other choice. The individual would have to make extreme sacrifices to their lifestyle to afford the insurance; the insurance company would go out of business if it wasn't as big a (legal) dick as all the other insurance companies.

Bullcrap.

If insurance companies want to raise rates, fine. They need to charge the rates they need to be able to survive and pay their CEOs and officers their million dollar bonuses.

But they are not "required" to tell a person with cancer, who has paid their premiums for decades, "Oh, sorry, you are out of luck - we discovered you didn't put down that you had an ingrown toenail cut out in 5th grade. So we aren't going to cover your cancer treatments. Sorry!"

There is abso-f**cking-lutely NO reason they "have" to do that to stay in business.

[Jason McCullough]

But they are not "required" to tell a person with cancer, who has paid their premiums for decades, "Oh, sorry, you are out of luck - we discovered you didn't put down that you had an ingrown toenail cut out in 5th grade. So we aren't going to cover your cancer treatments. Sorry!"

There is abso-f**cking-lutely NO reason they "have" to do that to stay in business.

If they don't, they'll get all the sick people as they move to the insurer that isn't an asshole. Then they'll either go bankrupt in a spiral of increasing premiums and influx of sick patients, or there'll be a hostile takeover that brings them back in line with the median dickery/profit margin.

Don't hate the player, hate the game.

[JeffL]

If they don't, they'll get all the sick people as they move to the insurer that isn't an asshole. Then they'll either go bankrupt in a spiral of increasing premiums and influx of sick patients, or there'll be a hostile takeover that brings them back in line with the median dickery/profit margin.

Don't hate the player, hate the game.

Jason, read what you are saying. It's one thing to deny covering someone because of conditions, it's another to come up with slimy reasons to deny coverage for which the person is paying with BS reasons.

Don't get into "I said it, now I have to defend it mode!"

[Zak Gordon]

If they don't, they'll get all the sick people as they move to the insurer that isn't an asshole. Then they'll either go bankrupt in a spiral of increasing premiums and influx of sick patients, or there'll be a hostile takeover that brings them back in line with the median dickery/profit margin.

Don't hate the player, hate the game.

And that right there is a 100% reason to get away from that system of health-care. So don't be fearful of change imho. You really need it to avoid all that bullshit.

[Tin Wisdom]

Minimal insurance (emergency plus an annual check up) for my wife and me is $400+. COBRA continuation of my former big company package was $900.

My data is a little older (like 7 years), but similar. My COBRA was $950/month until I found a nice high-deductible family plan for a couple hundred a month.

But responsibly, it was really closer to $400 month since it was a Healthcare Saving Account plan. The plan's cost with just under $200 for my non-smoking self, wife, and two kids. But to fund it, I had $200 more per month put into the HSA so that I'd have enough to cover doctor's visits and whatnot. In about 18 months I had fully-funded the deductible amount ($2500), so from then on it would only pull the extra $200 out if we had "room" in the HSA. Since all the funds that go into the HSA are pre-tax it made my paperwork a little messier at the end of the year, but most of the companies make it pretty easy nowadays.

[Jason McCullough]

Jason, read what you are saying. It's one thing to deny covering someone because of conditions, it's another to come up with slimy reasons to deny coverage for which the person is paying with BS reasons.

Don't get into "I said it, now I have to defend it mode!"

I didn't say it was right, dude. But given the shitty system we have, the only health care companies that can stay in business in the US are assholes.

[Strollen]

I didn't say it was right, dude. But given the shitty system we have, the only health care companies that can stay in business in the US are assholes.

It certainly helps the bottom line to be an asshole in the business. However, Kaiser, many but certainly not all Blue Cross affiliates are not for profit organization, along with various religious oriented health providers. They don't necessarily have incentive to deny benefits.

[Scuzz]

Blue Shield is a non-profit. They actually twice last year returned money because their profits were too large. Not every company is full of assholes. However they cannot control costs outside their reach.