Originally Posted by LawnGuyLandSparky

Great...

So, let's hear your ideas!

Originally Posted by EDC

Yes, the fact is that it IS their fault, and their responsibility.

It most certainly isn't MY fault, yet socialists like you expect me to pay for them.

Tell you what, if you think they should be helped, why don't you and the other like minded people contribute?

You would never do that on your own, would you? You'd only tell OTHER PEOPLE that they should do it.

Originally Posted by LawnGuyLandSparky

I don't want them in charge of it, I want them to set standards and regulating it.

Originally Posted by BryanMD

There IS a role for private health insurance companies.
There IS a role for a national backstop coverage system.
Mostly though there is a NEED to shift responsibility back to individuals.

Less of Government and Less of Private Insurance.
Two sides of the same nannyism coin.

What does that leave us with?
With the three basic categories of care:

1) The first category is the 80% that constitutes everyone’s day to day use of medical services which should be paid for out of pocket (by most of us) on a fee for service basis to the provider we choose.

And yes, people with a specific condition can expect to pay more for that
basic care than people who don't have that specific condition.

This largish number can be broken down by age and gender and medical specialty but however many subcategories might result what they all have in common is still too similar to warrant detailing those distinctions at this juncture.

There are very few of us who don’t have the same basic recurring sequence of annual professional visits. Some of these are twice a year and others perhaps only once every three years (eg: Dentist vs Optometrist). But whatever our particular pattern, it is indeed a pattern and therefore it can be planned and budgeted for.

This practical reality is the best argument against having insurance company involvement in these common transactions and private relationships with our doctors at all.

For those without that pattern we may need to foster creating facilities and staff that will serve them. And for the rest some protocols for transparent fee structures by these providers will need to be established and some regulation of standards of care along with specific expectations for examinations and clinical tests.

Whether our tastes or resources would send us to the health clinic at the University Medical School or allow us to be pampered by the posh Park Avenue private practice we remain the best arbiters of how much we should spend to get the care we need.



This self-direction and sense of personal responsibility warrants cultivation and should extend to those things we are willing to do (or not) to mitigate what degree of care and services we will have to pay for. Diet, exercise, and smoking are examples of the choices we make. Hopefully when we bear the direct cost of those choices we will do better with them than we have in the past.


2) The second category is the 10% that will occasionally crop up beyond those routine year to year expenses that we can mitigate the budget impact of by having some backstop insurance (or a HSA) which we also pay for on our own. Most of us will use this similarly to how we use high deductible homeowner or auto insurance and for much the same reasons.

No one can anticipate every possible eventuality. Periodic changes in our basic physical condition may present at any time either as diagnostic work related to some previously undetected chronic condition or as a single injury incident.

Everyone knows that such events happen without warning and that we need to be prepared to meet the financial responsibility of that medical challenge. The healthcare savings account (HSA) or backstop medical insurance plan does this until we are able to absorb that expense otherwise and adjust our budget to include this.

These HSA’s tied into an insurance policy also function as a security measure for institutional providers (Hospitals etc) that incurred charges will be paid.

This shift of nearly total financial responsibility to the individual (or family) is balanced by the shift of nearly all tax deductions related to that same individual; as well as ordering all funds previously paid by their employer as benefits being changed to straight wages instead.

Those who had decent coverage before under an employers plan will continue to be able to afford decent coverage into the future and probably for less in direct costs.

The total of these tax-deductible out of pocket expenses for most individuals and families should be less, in many cases considerably less than what is currently paid by or on behalf of them for a comparable quality of service.

Reasons for the savings will vary but the obvious common business practices of lowering the operating overhead of every provider and initiating actual competition between them for your business will be the primary factors. These medical services can be sourced very frugally or very expensively. Kia or Cadillac is your choice.

Your costs should be what YOU choose to spend for the quality that YOU value.




3) The third category is the 10% that NO ONE can reasonably expect to afford
or in most instances to even insure against privately. These catastrophic and
traumatic bankrupting expenses are the perfect category for and reasonable
limit to a government plan with a tax supported 100% actuarial base.

Despite all the rhetoric in the news there are very few working Americans who will be affected by medical treatment that would personally bankrupt them. Some other insurance like workman’s comp or auto liability is far more likely to be responsible.

That said, the collective risk of illness or injury is still quite real and as medical science marches on ever more conditions will have ever more expensive medications and procedures available to treat them and diagnostics used to rule out or define the less serious. This very well documented expense risk is the largest problem with private insurance carriers as they know can’t afford to actually pay for the level of risk their subscribers represent.

When an incident or a diagnosis presents itself it is quite clear to the medical professionals involved and one more document they manage will be to initiate the expansion of coverage to the affected individual.

Expand the existing and generally well functioning Medicare to cover these catastrophic, traumatic and similar bankruptingly expensive disease treatments that worry everyone so deeply. The intention being to take this entire category of medical practice and their costs off the table as a concern to individuals.

Achieve the 100% actuarial base needed to spread this universal risk to universal funding through the same tax supported means we already have in place.

When the employer paid private insurance was shifted to straight wages (as described above) those funds then get assessed with both the employer and the employee paying a modest percentage of that amount in additional FICA withholding. You’ll never even miss it.

The people who never had employer provided insurance and their employers will see the additional deduction. But, as this group are those who represent the largest of unpaid mandates in the current model… it’s hard to feel great sympathy for them now having to pay a modest contribution toward the social compact.

Accommodating the needs of people with known and expensive to treat conditions remain the problem they are today as they directly represent the largest year to year expense and the largest risk of that growing beyond the merely expensive and into the realm of the bankruptingly expensive. Hiding these costs under multiple layers of administrators and deep inside actuarial pools doesn’t help anyone.


As a society we expect these people to do all they can reasonably do for themselves before they ask society for assistance; but once that threshold is crossed that social compact will be there to give that assistance.

In successive years it is entirely reasonable to expect that this category of expense will require greater funding. Balanced against the overhead and operating efficiency savings in described above it may seem modest enough to just accept.

The alternative will be to review and amend standards of care for savings.

4) If we are truly honest we can add a fourth category: Terminal care.
Stop pretending that anyone gets out alive by refusing to flog and abuse
our elderly and other terminal loved ones and still call it medicine.

Most terminal care expenses are covered under Medicare (the elderly) but it still warrants it’s own category because of how it distorts every other cost statistic. It especially distorts when pointless treatments are used because the misguided emotionality and guilt of survivors mistakenly insist on them.

Originally Posted by LawnGuyLandSparky

I feel there are hundreds of thousands of jobs in this country that do not pay enough for anyone to afford healthcare, so, step one is to mandate employer coverage or an employer healthcare compensation bill. ALL jobs should pay enough to afford anyone a healthcare policy.

Originally Posted by LawnGuyLandSparky

#2 would be to not allow insurers to cherrypick customers - all must offer the same policies that cover the same base plan under the same rules so they can all compete on the same level playing field.

Originally Posted by LawnGuyLandSparky

Medical histories should be as irrelevant as "assigned risk" is to car insurers.

Originally Posted by LawnGuyLandSparky

#3 would be wether large or small, all companies pay the same per employee / family plan and group discounts are illegal - no reason an employer with 2,000 employees should pay less for coverage per employee than an employer with 20 employees.

Originally Posted by LawnGuyLandSparky

Any ORIGINAL thoughts?

http://www.bigbrassblog.com/index.ph...hive=2009-11-8

Originally Posted by Dnkldorf

They need to fix what they got going on first, before expanding the idea.

We're talking about them not taking care of 10% of it's population now, and this minority group, just happen to be the finest people to ever wear fatigues.

How is slamming a larger plan, for everyone, somehow a good thing that HAS to be done right now or the world will end?

Originally Posted by BryanMD

hey how about that!
That guy is from Baltimore too.

hmmm

Originally Posted by LawnGuyLandSparky

Because universal healthcare (if done right) is a long time coming. We are the ONLY 1st world nation without it. Why?

Originally Posted by Dnkldorf

If this happens, Insurance rates will sky-rocket. End user costs will go up. Those costs have to be passed on to your customer. Every business you buy anything from, will have to be more expensive. In the end, you'll pay more for everything, and so will businesses. Health insurance are the winners, you and me are losers.

Originally Posted by BryanMD

hey how about that!
That guy is from Baltimore too.

hmmm

Originally Posted by LawnGuyLandSparky

The more people who participate in this risk pool the cheaper it becomes for everyone.

I agree....

When someone buys insurance and is known to have an already pre-existing condition, often an insurer will not cover any treatment or complications that arise in the future due to this condition, if they allow coverage at all.

I have said this very thing earlier....it is happening in my own house hold this very minute....


You're an insurer. Here you have one company with 2000 employees. There you have 1000 employers with 2 employees each. HOW, statistically, is it costing the insurer more to cover the 2000 employees from one company than the 2000 employees of 1000 companies???

Originally Posted by Shado

...a group is a group is a group.

Just throw a bunch of independant policies or folks into a group randomly and it would still be the same as a larger business policy...

Originally Posted by LawnGuyLandSparky

You're an insurer. Here you have one company with 2000 employees. There you have 1000 employers with 2 employees each. HOW, statistically, is it costing the insurer more to cover the 2000 employees from one company than the 2000 employees of 1000 companies???

Originally Posted by amptech

This is a common misconception held by folks who do not understand statistics, demographics and ratios.

Insurance companies look at a group policy from a risk-management/assessment perspective. If you have 2 companies each with 1000 workers in their groups that does not mean their risk assessments will be identical. One c ompany may be relatively new and have a workforce with a mean age of 26-34. Their risk assessment would be lower than an older, well established company whose workforce mean age is 46-54. In other words, the younger group will likely pay more premiums before benefits paid become significant. The "larger the group, the cheaper the rate" theory goes to crap in real life when the numbers reach a certain point. Take an extended family for example. We'll say this family, including inlaws, siblings, children and parents numbers 25 people. Of these 25 family members, statistically one will contract some form of cancer. That is 4% of the "group" who requires treatment. Now expand the group to include the total population of the community of 25,000 people. Statistically, 2250 people out of 25,000 will contract some form of cancer. Now you are talking about 9% of the "group". Ratios, where people are concerned, do not remain constant as the numbers increase. There are too many factors that change. It works the same with production. If 100 workers produce 1000 tons of product in 8 hours do you thing 110 workers will produce 1100 tons? Not likely. Depending on the product, facility, and equipment the output may be 1500 tons or 1050 tons. It may be less than the 1000 tons if the original situation doesn't accomodate a 10% increase in the workforce.
There is a reason people who have had multiple auto accidents or DWI arrests pay more for auto insurance just like there is a reason that a 26 year old non-smoker, non-drinker who works in sales can buy life insurance cheaper than a 26 year old non-smoker, non-drinker who works in a coal mine. The risks are not close to being equal.

Originally Posted by Shado

Boy...you sure know how to put a damper on a dream for many folks needing HI.......

Originally Posted by amptech

Not at all. I just don't believe the answer is in going to the extreme, either government take-over or the complicated corrupt hodge-podge that they were working on...

Originally Posted by amptech

Their current system is barely sustainable with a little more than 10% of our population.

Originally Posted by JayH

I don't understand this statement. Are you saying Canada cannot pay for its' system?

If so, you have to support that statement with facts, otherwise it is just parroting misinformation.