Health care victory

[jAQUAN]

Just had another baby check up this morning. Wanted to thank you all for paying for it.

[hanratty21]

I have not seen any raises in my healthcare costs as of yet beyond the normal inflation of a few dollars a week

Agreed. Based on the additional taxes in that article, I didn't expect my rates to go up...just my taxes.

[silverx2]

Just had another baby check up this morning. Wanted to thank you all for paying for it.

it was either pay for the checkup or send the child support payments...

[jAQUAN]

<golf clap/>

[FlashLackey]

Sounds fishy to me. It will be interesting to hear if other FK members have the same experience. Could your health care provider be taking the opportunity to practice a bit of gouging?

I don't think it takes Alan Greenspan to understand that if you require insurance companies to cover things that they previously did not, they will raise rates to cover the additional cost.

It's only going to get worse when the government controlled margin kicks in.

Same thing happened to me a couple of months ago.
Neither my case nor FL's has anything to do with what's in the healthcare bill.
Nothing in the bill is affecting the insurance companies yet and all of the major provisions don't go into affect for years.

A slew of provisions that are substantial to insurance companies do go into effect this year.

Even if they didn't, rate increases now could have everything to do with provisions that kick in later. Their current model isn't designed to support the additional expenses that this legislation requires. They have to have the funds available to cover policy holders. If the expenses for those policy holders goes up, they need to have increased the pool of funds to draw from.

This just highlights why we needed healthcare reform in the first place.
Healthcare costs have been increasing 10% every year, and if FL thought he could keep avoiding that by putting his head in the sand then I guess it's his wake-up call.

Nothing in the health care reform prevents insurance companies from raising costs. In fact, the major changes encourage insurance companies to raise rates more.

I would be happy to have 10% increases back over the Obamacare 50% hike I just received.

I have not seen any raises in my healthcare costs as of yet beyond the normal inflation of a few dollars a week

Is your health care paid for by an employer?

[silverx2]

Is your health care paid for by an employer?

it is part of a company provided plan, but i pay for it.

[FlashLackey]

it is part of a company provided plan, but i pay for it.

Most likely, there is a significant portion of the cost that your company pays for that doesn't appear on your check (which they get a huge tax break on).

As a group plan, your company has more leverage than an individual policy holder to negotiate. Of course my rate went up before yours.

This is an ongoing problem that wasn't addressed at all by the health care bill. Individual policy holders have been paying disproportionately high rates compared to employer provided plans because they can't leverage the value of a larger group of policy holders (plus the subsidy money companies get).

[Loyal Rogue]

I guess that the whole selling across state lines and forcing millions of new customers to pay billions more in new premiums has no place in the equation of someone suffering from "Obama Derangement Syndrome".

"It's all Obama's fault because the insurance industry would never gouge me or deny a legitimate claim just to make a profit."

[FlashLackey]

Selling across state lines doesn't help anyone if you are also mandated to sell an identical product at the same margin.

One of the reasons premiums were going up is that states were using insurance mandates for political gain, pandering to interest groups. Requiring providers to cover things that most people would prefer not covered in return for a lower price (ie. fertility treatment, substance abuse treatment, sex changes, etc.).

If someone has a legitimate claim that is denied by the insurance companies, that is illegal. It's a law enforcement issue rather than a health care one. Don't confuse legitimate claims with types of coverage. There are lots of people that would rather pay a lower price for health care if they can rule out certain coverage for themselves like sex change operations.

Government mandated coverages is like forcing people that don't live near water threats to pay for flood insurance or making a person pay for business liability insurance just in case they someday start a business.

[hanratty21]

...if they can rule out certain coverage for themselves like human caterpillar operations...

fixed.

[Loyal Rogue]

If someone has a legitimate claim that is denied by the insurance companies, that is illegal. It's a law enforcement issue rather than a health care one. Don't confuse legitimate claims with types of coverage.

Obviously you've never looked into the business practice of denying claims or else you would know what I was talking about.

Remember all the healthcare reform scaretalk of "death panels"?
That is the actual business model of what goes on in our current insurance industry.
Bonuses are given based on denial of claims and are termed "medical savings".

One tactic used to deny claims is if a policyholder is extremely sick and needs continued expensive treatments it is common to classify the treatment as "experimental" and therefor not covered.

The mantra of heath insurance claim reviewers is the three D's... Delay, Deny, Defend.
Delay paying a claim as long as possible, then deny the claim with an excuse, finally defend the denial in court against the lawsuit if the patient survives that long.
As in most court cases, the winner is the one with the most money.

Here is one whistleblower testifying to congress: http://www.youtube.com/watch?v=DoqpPwvUoP0

[silverx2]

Loyal rogue that is an outlandish claim! if something like that were true surely there would have been some sort of story in the new paper, or a best selling novel later turned into an award winning movie which im sure would star an up and coming actor, someone of matt damons caliber..

now if only such a movie had been made..

hmm...

http://www.imdb.com/title/tt0119978/plotsummary

or maybe some sort of columns about what to do if you get denied and how to fight back:
http://www.cnbc.com/id/36178055


basically when having health insurance is a requirement(massachusetts by law), and the health insurance industry is a for profit industry, the companies will do everything in their power to squeeze every cent out of you, and do everything they can to prevent you from getting any of that money back in the form of bills being paid.

what we need is a non-profit solution, but that will never happen because of the greed our nation has been building a foundation on.

[Frets]

Well that was the single payer provision. Too bad the republicans and Nancy Pelosi did everything they could to yank it.

[Jeff2A]

I don't think it takes Alan Greenspan to understand that if you require insurance companies to cover things that they previously did not, they will raise rates to cover the additional cost.

Also doesn't take a genius to realize that if you tax pharmaceutical companies that those costs will also be passed on to private insurance companies.

Interesting dynamic appearing there - the taxes (at something like $40B) vs 30 million or so new potential customers, I don't think that industry knows if this plan will help or hurt them, but it's pretty clear that the costs per pill are going to go up, up, up.

[FlashLackey]

Remember all the healthcare reform scaretalk of "death panels"?
That is the actual business model of what goes on in our current insurance industry.
Bonuses are given based on denial of claims and are termed "medical savings".

A claim cannot legally be denied if it is for something that is legitimately covered by a persons insurance policy. Law enforcement matter. Not health care.

Giving a bonus to an employee for making sure that they aren't paying for things that they were never obligated to pay for seems like a legitimate business practice to me.

In countries with single-payer systems that have to ration health care, there are panels that review patients on a case by case basis to determine where they should be in line for a treatment or whether they should receive it at all. In that sense, "death panels" are very real and are a genuinely scary prospect.

One tactic used to deny claims is if a policyholder is extremely sick and needs continued expensive treatments it is common to classify the treatment as "experimental" and therefor not covered.

If a persons insurance policy does not cover experimental treatments and the treatment they seek is indeed experimental, that person has no right to expect the insurance company to pay for it.

An insurance company could not refuse payment to one client by saying that the treatment is experimental while funding other patients seeking the same treatment. If they did, it would be a slam dunk case and pay-day for the defrauded client.

Loyal rogue that is an outlandish claim! if something like that were true surely there would have been some sort of story in the new paper, or a best selling novel later turned into an award winning movie which im sure would star an up and coming actor, someone of matt damons caliber..

Matt Damon? Caliber...?

That aside, do you believe everything you see in the movies?

what we need is a non-profit solution, but that will never happen because of the greed our nation has been building a foundation on.

A non-profit solution like the United States Postal Service? Which government run, non-profit solution would it be most similar to?

Also doesn't take a genius to realize that if you tax pharmaceutical companies that those costs will also be passed on to private insurance companies.

Interesting dynamic appearing there - the taxes (at something like $40B) vs 30 million or so new potential customers, I don't think that industry knows if this plan will help or hurt them, but it's pretty clear that the costs per pill are going to go up, up, up.

Now we're cooking with gas (clean of course).

Indeed. I think that not understanding how business works is at the root of a lot of misunderstanding about national policy. Do they even teach economics in public schools any more?

[silverx2]

A non-profit solution like the United States Postal Service? Which government run, non-profit solution would it be most similar to?

the USPS is failing because there are better and easier solutions now then there were back before the internet. if i want to send someone some funny pictures i can instantly send them via the internet, and save myself a trip to the post office and the cost of a stamp, and the cost of developing film.

The last time i checked, then i needed to go get a physical or surgery i couldn't do that yet via the internet.

looks at other health care systems around the world there are some that are way better then ours, but people are not making billions of dollars in profits off of them so they will never happen here.


As for Matt Damon, yes i think the Oscar winning actor is very good at what he does, show me one movie he has been bad in.

[Jeff2A]

As in most court cases, the winner is the one with the most money.

That's very, very wrong. In most court cases, the winner is the won who is right. In some court cases, the winner is the one who has the money to find a loophole.

Courts take a very dim view on big companies burying small parties in legal paperwork. It happens, and it sucks, but it's not enough to win the case alone. If one side has merit and the other does not, the side with merit will win.

Don't believe me? Look at all the big companies that settle stupid claims with tiny plaintiffs because they don't want to have to go to court and lose.

[Jeff2A]

what we need is a non-profit solution, but that will never happen because of the greed our nation has been building a foundation on.

The last thing we need is a non-profit solution, because the greed is what makes US healthcare the driving force in innovation.

MRI.
CT Scan.
ACE Inhibitors.
Statins.
Coronary artery bypass surgery.
SSRIs.
Cataract Extraction.
Eye lens replacements.
Knee replacements.

All of these developments came from the greedy researchers in the US, out to make a buck for their own family, and the end result is better technology for the entire world. Since 1975, more Nobel Prize in medicine/physiology winners have come from the US than all other countries combined, and it's not a coincidence (nor is it a mistake) that there was a tremendous profit potential for the people doing the research.

Even though it makes for interesting movies, people don't work 80 hour weeks for academic stipends or for the love of their fellow man. They work 80 hour weeks because they know they have a potential to make life changing, retire-at-35 type money. Those 80 hour weeks in the lab working on unproven technologies are what create the breakthroughs that save lives.

[Loyal Rogue]

The last thing we need is a non-profit solution, because the greed is what makes US healthcare the driving force in medical bankruptcy.

Fixed.

Even though it makes for interesting movies, people don't work 80 hour weeks for academic stipends or for the love of their fellow man. They work 80 hour weeks because they know they have a potential to make life changing, retire-at-35 type money. Those 80 hour weeks in the lab working on unproven technologies are what create the breakthroughs that save lives.

While I'm sure there is some merit in the idea behind what you say, the reality is that most of our medical innovation comes from non-profit university researchers funded by the government.
The National Institutes of Health (NIH) is the single biggest source of medical research funding not only in the US, but in the entire world.

Most of the for-profit companies don't produce any of the ground-breaking innovations because, contrary to what you believe, that is not where the profit is.
The real profit is in producing "me to" drugs that are just molecular knock-offs of existing drugs (E.g. Nexium and Prilosec) so that they can file another exclusive patent to lock in profits for 5 more years.

[Loyal Rogue]

That's very, very wrong. In most court cases, the winner is the won who is right. In some court cases, the winner is the one who has the money to find a loophole.

Courts take a very dim view on big companies burying small parties in legal paperwork. It happens, and it sucks, but it's not enough to win the case alone. If one side has merit and the other does not, the side with merit will win.

Unfortunately in the real world large, corporations like insurance companies do win cases of basic claim denial just by bankrupting the other side through a long drawn out court process.

Most people who are in that position are already in financial trouble and cannot afford the attorney fees for a courtfight in the first place.

Don't believe me? Look at all the big companies that settle stupid claims with tiny plaintiffs because they don't want to have to go to court and lose.

That is completely different than what we are discussing.
A major negligence payday case will get taken up by an ambulance-chaser on contingency in a heartbeat.
Everyday claim denial cases do not.