Health Care initiatives in the world of the unemployed

sc4ram wrote:http://fltimes.com/articles/2009/12/31/news/doc4b3a3e34cf762654032433.txt

It seems this article says more for the need for healthcare reform, rather than against it, and regardless of what any particular bill in Congress may or may not do.

Medicare Advantage plans are going up, just as ALL insurance premiums have been going up and up, regardless of Congressional action all along. It seems the germane information in this article points to how the insurance companies are gouging their customers and luring them with cheap perks that don't amount to the same more important provisions in regular Medicare. So we're supposed to be upset that people may be losing expensive but minimally useful benefits? I'd like to see my insurance dollars put to better use than wild parties, thank you very much.

Happy New Year Nancy-

Thanks for reading my post. I wish Grandmom hadnt invoked her right to remain silent on this subject, since she worked in insurance billing she could probably provide some realism for us all.

Contrary to popular belief, everything Ive posted here hasnt been anti-health care reform. Ive tried to post a lot of information along with some conclusions.

I would argue with your conclusion from the article. (you have managed again to put me in a position of defending a unpolular entity) Your post implies the popoular mis belief that if only insurance companies profits and saleries were elimanated that all of the perceived issues with our health care system would be fixed.
In a earlier post I showed some data that indicated health insurance companies were on the low end of the scale for corporate profitability. Executive saleries (as in most corporations) are fractoins of percent of revenue to the company.

Yes the article lists the usual gripe about multi-million dollar retreats at resorts (I believe the resort itself might be worth multi million dollars, but I doubt that amount was paid for a Corporate retreat, my former corporation had such outings and they cost a lot less than that). All corporations reward top performers, generally speaking I dont have a issue with it (it is a private business after all, )

I concluded from the article that most participants werent concerned about 2010 enrollment changes to their Med Advantage (ref that only 10% of inquiries had a concern) , but there was rightly uncertainly as to the future under the proposed Health Care reform legislation . (So much concern that Sen Bill Nelson grandfathered everybody in Medicare Advantage in Florida and exempted them from it being eliminated under the Senate bill, while much of the rest of the country and future retirees in Fla will have to do without) . So I must assume that the thoughtful Sen Nelson (a former insurance Comissioner in Fla btw) doesnt believe that Med Advantage is simply a profit vehicle for the Insurance Companies.

The figures listed are unfairly compared to Medicare expendetures, Medicare obviously has much less administrative overhead (and even with that feature its on the verge of bankruptcy) , and it shows, I posted earlier on this thread the 60 Minutes report on Medicare fraud in south Florida which was estimated at some huge dollar amount and was valued at a larger amount of fraud than organized crime . Medicare has little or no mechanisms for safeguarding against fraud. Health Insurance Companies (for all of their faults) do scrutinize their claim payments a lot more carefully, in my view securing a profit from that is not bad.

So there we are, I guess the article is in the eye of the beholder.

HNY

sc4ram--And Happy New Year to you too!

Now--I don't see how you could conclude from the article that "most participants werent concerned about 2010 enrollment changes to their Med Advantage (ref that only 10% of inquiries had a concern) , but there was rightly uncertainly as to the future under the proposed Health Care reform legislation," when they actually said exactly the opposite in more than one sentence! They said those polled were not concerned about upcoming reform legislation (expecially since it doesn't go into effect til 2014), but rather were concerned with specific details of the renewal plans they have coming up right away.

But unfortunately I can't quote that article, since it appears to have "gone subscription" and I can't use that link anymore. On top of that, the way the article was written was a bit scatter-shot, so this whole debate about what was meant could be entirely moot.

I give you credit for posting a lot of information, not just opinions. But I have to counter your assumption that "the popoular mis-belief that if only insurance companies profits and saleries were elimanated that all of the perceived issues with our health care system would be fixed." Personally I don't know a soul who thinks that, and I know a lot of people involved in the push for health care reform. I have to say that an objection I have to some of what you've posted (and I admit I haven't read all of it here) is that it appears to be from the perspective of someone who doesn't really need to use the health care system all that much. And, unlike grandmom, and myself, in some respects you're making judgments based on data from a sampling of one--yourself.

I've had to deal with just about every corner of the health care system in this country from every angle since I was a child, and it would take me so many pages of blogging to write up all that's wrong with it that it's not worth my time, since others have chronicled these matters already, along with the millions that have been affected adversely because of it.

And let's not get into a dialogue about the "greatest health care in the world" in this country. We do have great health care--for those who have access, for those who can afford to go where they want, and when you can find the right places to go. And it is grotesquely wasteful for more reasons than Medicare waste.

In fact, blaming Medicare for the fraud practiced against it is like blaming the police for crime waves. A good fix for that fraud was recently proposed, and I have to say it was from our new Republican Senator in Florida, with whom I disagree on other matters, but on this he had a great idea. It has to do with having accountability for the charges be more directly overseen by the actual patient. With all the mutual hatred in Congress these days it's probably doubtful he will get it passed, but I hope he gets heard on it at least.

As for your comments "Executive saleries (as in most corporations) are fractoins of percent of revenue to the company" and "All corporations reward top performers, generally speaking I dont have a issue with it (it is a private business after all, ) "--I DO have a problem with it. First of all, a fraction of a percent of billions is still millions, and that doesn't even include the millions in bonuses and stock options on top of all that.

As a philosophical point, I'm above average in IQ, yet I would never consider any labor I could possibly do to be worth multi-millions in comparison to the hard work done by a minimum wage laborer, no matter what my position. That's a fantasy developed rather cleverly in the population, especially in this country, over several decades--the idea that this is ok human behaviour and attitude. The disparity between our rewards for corporate Type A behavior and that of our European counterparts is astonishing, and we can even include the British House of Lords in that thinking! To deregulate monopolies and multi-nationals to the degree we have done to allow this degree of disparity in rewards for actual work (these execs are not all geniuses, for god's sake, most are either born into it or driven to it by sheer ambition), and especially to reward in some cases the kind of criminal behavior exhibited by these people is simply not a reasonale way for our species to be sustainable on this planet. It's counter-productive to the extreme.

That's the philosophical point, which not all would agree on. But even if we all didn't care who made what billions by what methods (cutting benefits, cutting policies, raising rates beyond usability, etc.), the sheer destructiveness to our country to be "taking the money and running" at a time when our country is in deep, deep sh--t, is what I consider, actually, treason.

Doctors, hospitals, drug companies, labs, and all kinds of medical providers are all private companies (some non-profit); I have absolutely no problem with them being private companies. They provide services; they make products. Insurers, on the other hand, are a different animal. They are selling risk avoidance. What they are selling is the restriction of something in order to pay totally non-medical people to make a profit. Think about it. It makes sense to insure against a fire, or a flood, or a robbery, or a hurricane, or even a gambling loss. Those are loss events. But insurers are betting against providing for health. They are using a model that normally would insure against loss events to insure against someone getting sick, as if that were a good model for health care in general, specifically preventive health care and health maintenance, as opposed to treating the disaster. THAT is the business model, there's no getting around it. The less they can spend on health, the more they have for non-health related profit. Unlike a hospital or doctor's office, they don't plan to re-invest the money in more health providing facilities or more education in health matters. But the insurer invests in what--more markets, to earn more non health-providing profits. It's essentially a leech industry on health care. (Health care administration and bookkeeping does not need to be done by insurers.) At a time when we are going to go BROKE in not that many years in this country and a big chunk of that is for health care, it is simply not a good health care model to be using any dollars for health care on anyone's non-health related profits!

I won't "ban" myself from debating this topic, but don't be surprised if I don't post very often. I suppose this may sound arrogant, but I really don't feel the need to debate something that I've lived through myself for decades and know pretty thoroughly the situation. From the perspective of many who cannot access health care, especially those without jobs and who have pre-existing conditions, the excessive wrangling in Congress has resulted in a bill that neither side likes. It's a crap bill, but I suppose the process has to start somewhere, and I hope they keep changing the legislation after this, even after it passes, to create something that might work before it's too late. And it already is too late for many of us.

The chances of my getting a job with benefits at this point are virtually zilch. Costs of private plans (the ones that actually cover anything) are completely prohibitive. The fact that Congress couldn't even agree to start the pre-existing condition provision until 2014, couldn't even agree (Lieberman) on an extension of Medicare, couldn't even agree on cheaper drugs from Canada or any real restrictions on the drug companies, and those previous factors mean that I will essentially have no health coverage whatsoever until I get to Medicare age in 4 years, and I have medical conditions that cannot go without treatment. So from my and many others perspective, this debate appears to be between those who do have access to health care and don't want to risk changing even one tiny little iota of it for the sake of anybody else and those 50+ million who have nothing at all.

And yours will change also, not because of any reform bill, whether or not it passes, but because the companies just want to keep their level of profit and costs of the providers are continually going up because of all the OTHER factors that I haven't even mentioned here. And don't be surprised if when you start really needing that private plan that it either starts to skyrocket in price or else tries to wiggle out of providing what you need in ever more clever ways. Of course you might be lucky, you might be safeguarded a little bit by some of the measures in this current bill, in which case you would be among the lucky few.

Wow Nancy-

Thanks for putting the effort into that post. I guess we'll have to agree to disagree on this one. Your post didnt read as arrogant but Im might respectfully suggest that it could be interpeted as slightly close minded. I welcome your comments on this as you have obviously used the System more than I have. Im sorry that you feel you have been taken advantage of by the system. I can understand that if your coverage has been interupted and you have pre-existing conditions that it is difficult or impossible to obtain affordable coverage before medicare. Our representatives in both parties agree with you on that one.

You are right that the Ins Cos are incentivized to payout less not more. (but there is a positive aspect in that they get ripped off a lot less ) . I would question your view that I either have, been or will be screwed by a Health insurance company. You are right that the most serious thing Ive used my coverage for is outpatient stuff. But objective opinion surveys consistantly indicate that ~85% of people are content with their Health Care in the US . (that doesnt sound like a 24/7 operation screw-job by the insurance companies to me. )

Be careful on Executive pay, if they can restrict what the CEO of a private company makes, they can regulate what you and I get paid, I'll trust the market on that one.

I think we do have the best health care (which is why forgieners from Saudi sheeks to Canadians fleeing the restrictions of their government run health care come to the US to get treated). I am not naive enough to think it is perfect, and I have been,miffed and irritated with rejected claims and then they mysteriously resolve themselves after they have been resubmitted multiple times (by the invisible army of administrators trading paper) . I brought this up to our Benefits Admin at my former company and they ignored me (in my former biz if we exhibited that type of customer service or one of our suppliers did, somebody would of been fired) . I also strongly believe that if they allowed insurance companies to bid on policies interstate, limit lawsuits and provide tax incentives (as they have for employers) coverage would be cheaper. [Id be for selling coverage on EBAY]

If somebody has no access to health care thru no fault of their own Im not opposed to helping them with assistance funded by the taxpayer, but it shouldnt be a trillion dollar government take over boondoggle. This gem that they passed in the Senate is full of bought votes, and we all know when it comes time to renew the "Doctor fix" that Congress will not have the discipline to maintain the Medicare cuts, which means more debt and more taxes (this thing may literally desolve into a Chinese health care plan because they are financing it) . I drive a 20 year old car and live in small house and have not practiced a "whoever dies with the most toys wins" strategy, and when I needed to continue my health care coverage when I got laid off (I have a pre-existing conditon) I could afford to do it . [Im not saying you did the opposite but many have and wonder why they cant maintian their coverage when things go bad]

Health care coverage has gotton more expensive (as have a lot of other things) . When I was a kid in my small hometown in the late 1960s a office visit to our family doctor was $6 and a housecall was $8. That is a great Leave it to Beaver memory, the only problem was If I woke up one morning with a excruiating back pain , my great family doctor (who served in Europe in WWII with Eisenhower) didnt have access to a MRI to evaluate what the problem was (because MRIs hadnt been invented yet). Frankly Im happy to pay more for 21st century medicine.

There are a gazillion other ways to approach this without a government take over. In your case, in a free insurance market like I described above with lower premiums perhaps you could of maintained your coverage. If your case is more complicated than that I would have no problem with the government issueing you a Debit card for medical expenses (I'll bet that would be cheaper than a Trillion dollars) . The government could establish a high risk insurance pool for people like yourself . But no, in the middle of close to record unemployment in a generation these rocket scientists in Washington decided to spend a year on health "reform" that does nothing to improve a functioning system that has 85% satisfaction in the country.

Again, if somebody cant access the health care system I think we should find ways to help them (are you not eligible for Medicade?) but I object that if somebody doesnt have health care that the government should negatively impact me to provide it to them. Whats next, a governent controlled Dental Plan for everyone? We could make the same arguments for that, that have been made on behalf of Health Care Reform. (I can hear it now "Cash for Crowns" lol)

Too bad you and I werent in charge of this, we could probably solve it efficiently.

Have a good evening

I'll post only a few comments in reply. We will obviously have to agree to disagree on most of this subject because you will never agree to the basic premise that for-profit insurance has no place in health care.

But don't be fooled by that bandied about 85% figure that Republicans like to quote; the opposite side can easily quote the polls and statistics that show almost the same proportion want a public option. The problem with any poll or survey is in how the questions are asked. When I had health coverage, I would have had to answer that same question with a grudging yes, but at the same time worrying about the others who did not even have access to the coverage I had at the time. The surveys that ask if you are happy with your coverage cannot be answered by those that simply don't have coverage; that seems to be conveniently ignored in those reports. Statistics can be used to show whatever a lobbyist wants. The big issue is not the overall grade for American health care; the issue is the delivery system, which can't be conveniently discounted when it comes to that final grade, otherwise the report is totally dishonest.

You keep using the phrase "government takeover." Please--don't. There's no more government takeover in the proposed Medicare expansion (which would have saved me, and possibly my life) than there is in Social Security or Medicare that we now have.

And I maintained private insurance for decades--through employment, unemployment, self-employment, and even while going to school. That's a lot of why at the start of 2009 I had run out of funds to keep paying for ever more expensive health insurance. And don't worry about me and "toys"--I never bought anything over 50 bucks in my life without agonizing over it. Some people just get more breaks in life than others. I expect disparities in access to comfort, but I don't expect disparities in access to life in a sane society. Any insinuation on your part that those who didn't manage to wind up in a situation where they could afford to continue their private coverage due to mismanagement of funds implies a closed mind on your own part.

And obviously our representatives on both sides didn't agree enough about pre-existing conditions to start that clause right away. Gee, I wonder who convinced them to wait til 2014.

I guess one thing I would agree with you on is that in spite of our vast differences, you and I could probably have sat down and come up with a better compromise in legislation than the entire Congress did in all these months. As far as I'm concerned the Republicans fought so hard at every single turn to avoid some mythical "government takeover" that there was nowhere to go for most Democrats. And the Dems are not blame free either, having sold out a ton of bucks to lobbyists and other pressures to use the bill to get some kind of share of a pie.

Dear Nancy-

I wasnt implying that you didnt have health care because you are living like Eva Gabor. (which is why I specifically said i wasnt directing that comment at you ) I more visualized the guy comming out of Wal-Mart in the $40K SUV that has a book full of payments left, loading his new big flat screen TV in the back that he bought on his credit card, saying "the high price of health insurance is killing him". (A real example of my former boss comes to mind, who is now out of a job, who had bought 2 houses, new vehicles for himself, his wife and each of his 2 children(4 total) and whos wife decided she didnt want to work anymore. He is maintaining his health care coverage for now via the Cobra assistance, but obviously had to downsize his personal life a bit in his post employment world)

Ive said multiple times if somebody cant truly afford to get access to health care we should find a way to help them. (Unfortunately this proposed legislation doesnt do the job, which is why Ive posted information on it).

In my view Medicare IS government run health care , they set the rates and collect taxes for it which we have all paid into (and must I say again it is broken, I would respectfully submit that a plan to bring a whole bunch more beneficaries into it would seem nuts to me.) Yes, most people on Medicare love it, including my mother (which is why people went bonkers when these refrom bills cut $500B out of it).

The contraption that was just passed in the Senate mandates all kinds of new regulations for the dastardly Insurance companies (yet they couldnt bring themselves to revoke the Ins Cos anti-trust exemption or force them to compete across state lines) . This pending law regulates everything to what levels of coverage they offer and forces them to offer it to everybody. If thats not enough. someone minding their own business and is happy without health insurance, this Senate bill forces them to buy insurance. (I havent looked closely but I assume that the mandate provision doesnt take effect until 2014). Can you imagine if all of us on this board were forced to buy insurance this year? What a joke, I doubt its even constitutional.

If you have a life threatening condition and you dont have any insurance, this pending legislation isnt going to help you (unfortunately ) . You obviously know your situation better than I do, is Medicade assistance not a option for you? The State of Florida certainly spends enough money on it, I would hope it could provide some relief to you.

I obviously wish you the best, and hope there is some solution for you. (Unfortuantely it is not in the current Health Care Legislation )

http://news.yahoo.com/s/ap/20100109/ap_on_bi_ge/us_health_care_overhaul

sc4ram wrote:

... is Medicade assistance not a option for you? The State of Florida certainly spends enough money on it, I would hope it could provide some relief to you.

There is widespread mythology (so this is not aimed just at you, but at the general public) about who can get access to Medicaid and how these state-run programs will or will not catch people who fall through the cracks of any health care system, whether now or with any new legislation.

Medicaid is NOT that easy to get, especially if you are single or with only grown children. For anyone in that category, which includes literally millions of seniors over 50 who have no option to get help from families long gone or otherwise unable to help in this recession, the income threshholds are so low that only those who perhaps live with supportive families, those who are disabled and get other benefits, or those who have no mortgage or rent to pay, or else can somehow live in some kind of subsistence level conditions (like under a bridge), can manage to get Medicaid. This cuts out just about any of us middle class and upwards people who worked all our lives and have used up all our savings just to survive this downturn, became unemployed prior to the Cobra subsidy start date, and yet still have to pay the usual basic-level rents (or mortgages) and expenses that go along with living in Florida in areas where there might be any possibility of finding work.

States vary in how they administer Medicaid. If I were in Massachusetts I would get help, but not in Florida or many other states. There is limited access to other county-funded programs here, but it is limited and depends entirely on income and what zip code you happen to live in. As soon as I start making enough without unemployment benefits to actually survive at a basic level month to month, I will no longer be eligible even for this kind of help.

I haven't studied all the thousands of pages of either health care bill, but I do know that no changes take effect til 2014, leaving all of us in the above-mentioned category SOL essentially until then or until Medicare kicks in. And now even if I got a good job with benefits (ha!), I would still come up against the pre-existing conditions rules of insurance companies that would make it almost impossible to get treated for anything for who knows how long.

I can mention one really bad example of the irony of this system in Ohio, probably this is repeated all over the country--a woman who posts regularly on the Open Congress forums who has admitted that her situation is almost impossible as far as health care is concerned. She has worked professionally for years, by no means a stereotype of a "welfare mom," but is now divorced and has a teenage daughter who has a brain tumor, a condition that obviously requires expensive treatment that she couldn't possibly afford if she didn't get Medicaid. She also is seriously visually handicapped and lives in a remote area where jobs are even more scarce than in the cities, and obviously has no reason to try to sell her home and move to Cleveland or some such foolishness. She is currently unemployed (at least officially, she does odd jobs and rents out some property), so because of that AND the fact that she has underage children, she can get Medicaid for her daughter and ALSO full medical and dental coverage for herself!

She has admitted that she doesn't really WANT to find a job, at least not a job without benefits (which might not even cover her daughter if she got them), since then she would no longer qualify for Medicaid.

(Further ridiculous irony comes from the fact that this woman, who in many ways deserves a tremendous amount of sympathy for the situation with her daughter, somehow manages to ridicule others on the board who have nowhere near the safety nets in place that she has, but then human nature is not always logical, and that's outside of my point here.)

Any idea that there is equity in a system that rewards more than is warranted those who fall within a certain really unfair set of guidelines and leaves others out in the cold completely is unfounded. And any who really think that they are not being already taxed in a multitude of ways for this inequity are really not aware of how the system works, and how it affects everything from the deficit to the cost of a box of tissues in a hospital.

And, icing on the crap cake, most who don't qualify for Medicaid also don't qualify for food stamps.

Hi Nancy-

Sorry to hear that Medicade is not the answer for you . (I obviously dont know much about the Medicade program)

I havent read in detail the multi thousand page Senate Health Care bill , but I have read reports that part of it includes increasing the eligibliity for Medicare. (This is why several senators had to be "incentivized" to vote for it by the promise of more Fed Medicade money being flowed to his or her state to underwrite the cost for a increased amount of subscribers. Its a big deal for the states as it will cost most of them more money in the out years (which means more of a burden on the state taxpayer)

The NYT editorial (link below) delves into this a bit. (If you dont have a ID and password with the NYT it may ask you to fill out a profile for one at no charge) . If its a problem let me know and I'll post the text for you .

http://www.nytimes.com/2010/01/10/opinion/10sun1.html?ref=opinion

source: Bankrate.com Jan 11, 2010

Tip 10: Keep an Eye on Health Care

President Barack Obama had hoped that health care reform would be resolved by now. But look for this debate to continue into the early part of 2010. If or when lawmakers reach an agreement, you'll need to pay attention to what modifications might take effect.

Many changes, such as an increase in the amount of medical expenses necessary to deduct them, wouldn't show up for several years. Others, however, are on a fast track. For example, the proposal to limit flexible spending account contributions to $2,500 a year would take effect in 2011. If that change comes to pass, you'll need to account for it in 2010 as you make decisions about your company health care benefits

sc4ram wrote:http://www.nytimes.com/2010/01/04/health/policy/04health.html

Just one more resounding reason why health care should have no connection with your employer.

sc4ram wrote:

...I havent read in detail the multi thousand page Senate Health Care bill , but I have read reports that part of it includes increasing the eligibliity for Medicare...
The NYT editorial (link below) delves into this a bit...

http://www.nytimes.com/2010/01/10/opinion/10sun1.html?ref=opinion

Unless you meant to say Medicaid instead of Medicare, that move to expand Medicare was squashed single-handedly by our illustrious Senator Lieberman in a stunning swoop of single-senator power within just a few days in the last week of the Senate debates before the vote.

And those new guidelines for Medicaid listed in that NYT article do absolutely nothing for most "poor, childless adults." If one is a "poor, childless adult," by definition that person does not have the ability to move in with or get care from their own family. 150% of poverty level is less than $17000 per year. The only single adults I know who could possibly survive on that, especially those who have to continue to work and have to live near a major city to do so, are those who are either rent or mortgage-free, or else are simply homeless.

This entire mess, and I do mean mess, could have been avoided with a single-payer system from the get-go. But what we (might) have, as the result of so much Republican opposition and paranoia, combined with Democratic old guard wrangling, is a system that not only doesn't give universal coverage, but doesn't cut costs as much as we need to, and will continue to lumber our businesses with insurance costs at a time when that burden of health care expense should be taken out of their hands entirely so the economy can move forward in a global marketplace.