The rising cost of health insurance.

[Coito ergo sum]

Yep. Like Mrs. Lak's cousin in the UK, diagnosed with bowel cancer about 6 months ago. Had to wait for 3 months to get "funding" for an MRI. When she finally got it, shit, it had spread. Now, they did get her into surgery fairly quickly (10 more weeks but who's counting). Only had to take her vagina, cervix, ovaries, large intestine, rectum and a few other bits an bobs. She gets to shit in a bag forever, never have sex again, and very likely die but that's OK, because, you know, sometimes bad things happen to good people. Not the fault of the system, no, it's the most fair and egalitarian system ever devised.

No question, single payer is the way to go.

We supposed to take your word for all that?

I have a cousin in the US who's husband had a good job, and full company health insurance. Got sick, couldn't work, health cover ran out, the whole family is chipping in to pay huge sums up front for his health care. It's lucky there were TEN kids in that family.

Sounds dubious, since if he is out of work and earning zero income with 10 kids, he'd apply for Medicaid and be fully covered, and get food stamp assistance for food. Something in your description is not correct, because he'd have no problem getting free coverage unless he really wasn't as destitute as you're suggesting. 60 Million Americans have Medicaid coverage. That represents 20% of the population.

[mistermack]

Yep. Like Mrs. Lak's cousin in the UK, diagnosed with bowel cancer about 6 months ago. Had to wait for 3 months to get "funding" for an MRI. When she finally got it, shit, it had spread. Now, they did get her into surgery fairly quickly (10 more weeks but who's counting). Only had to take her vagina, cervix, ovaries, large intestine, rectum and a few other bits an bobs. She gets to shit in a bag forever, never have sex again, and very likely die but that's OK, because, you know, sometimes bad things happen to good people. Not the fault of the system, no, it's the most fair and egalitarian system ever devised.

No question, single payer is the way to go.

We supposed to take your word for all that?

I have a cousin in the US who's husband had a good job, and full company health insurance. Got sick, couldn't work, health cover ran out, the whole family is chipping in to pay huge sums up front for his health care. It's lucky there were TEN kids in that family.

Sounds dubious, since if he is out of work and earning zero income with 10 kids, he'd apply for Medicaid and be fully covered, and get food stamp assistance for food. Something in your description is not correct, because he'd have no problem getting free coverage unless he really wasn't as destitute as you're suggesting. 60 Million Americans have Medicaid coverage. That represents 20% of the population.

God you're dumb. There were ten kids in my cousin's family.

[hadespussercats]

Yep. Like Mrs. Lak's cousin in the UK, diagnosed with bowel cancer about 6 months ago. Had to wait for 3 months to get "funding" for an MRI. When she finally got it, shit, it had spread. Now, they did get her into surgery fairly quickly (10 more weeks but who's counting). Only had to take her vagina, cervix, ovaries, large intestine, rectum and a few other bits an bobs. She gets to shit in a bag forever, never have sex again, and very likely die but that's OK, because, you know, sometimes bad things happen to good people. Not the fault of the system, no, it's the most fair and egalitarian system ever devised.

No question, single payer is the way to go.

We supposed to take your word for all that?

I have a cousin in the US who's husband had a good job, and full company health insurance. Got sick, couldn't work, health cover ran out, the whole family is chipping in to pay huge sums up front for his health care. It's lucky there were TEN kids in that family.

Sounds dubious, since if he is out of work and earning zero income with 10 kids, he'd apply for Medicaid and be fully covered, and get food stamp assistance for food. Something in your description is not correct, because he'd have no problem getting free coverage unless he really wasn't as destitute as you're suggesting. 60 Million Americans have Medicaid coverage. That represents 20% of the population.

God you're dumb. There were ten kids in my cousin's family.

I think he isn't realizing the ten kids are the ones earning money to help pay for the dad's health care ( i.e.-- They're not little kids anymore. )

[Coito ergo sum]

God you're dumb. There were ten kids in my cousin's family.

So? If the question is whether he is covered, then being unemployed and not earning any money would seem, at first blush, to qualify him for full coverage under Medicaid.

If the question is whether the kids are covered, they'd also have coverage availability under Medicaid and SCHIP.

Do you think there isn't a safety net in the US?

[Coito ergo sum]

I think he isn't realizing the ten kids are the ones earning money to help pay for the dad's health care ( i.e.-- They're not little kids anymore. )

If they are adult children then their income isn't counted as income of their parents. So, it doesn't impact eligibility for Medicaid.

[laklak]

Could have too many assets to qualify. He should have COBRA'd his employer insurance.

[laklak]

Here's another one, anecdotal as it may be. Mrs. Lak is obviously a statistical outlier, as she's had three friends get cancer in the last 3 years. I posted about her cousin. Then there's her best friend from uni, who lives in Nottingham. She had all sorts of gastric issues and was sick for over two years. NHS finally got her an MRI and - surprise! - rectal cancer. They got her on chemo relatively quickly, within 3 months. Then they did a bowel resection and colostomy. Now they're going in again and taking more. She won't make it.

The last friend is a Danish woman who immigrated to the States. She was having "female issues" and was diagnosed with ovarian cancer. She had an MRI that week, surgery a week later and is now 2 years cancer free. She had health insurance.

Now, maybe the two in the UK are unusual, I don't know. I do know that Mrs. Lak worked for the NHS when we lived there and she always said that if either of us got cancer or needed heart surgery we were going to the states. She was quite happy with the way the NHS handles day-to-day medical issues and how they try to keep geriatric patients in their own homes, she loved the way she was not circumscribed by costs when she prescribed a therapy regime or ordered special equipment like a stair lift or electric wheelchair. She's very UNHAPPY with the way our system handles those issues.

So it's a mixed bag, saying one is shit and the other is perfect is simply silly.

[Seth]

So given that 45-50 million Americans are uninsured, what do they do?

Take care of themselves and pay for their medical care in cash, a la carte, like I do, at a SUBSTANTIAL (about 40%) discount off the prime insurance rate. I'm uninsured because I WANT to be uninsured. It's way cheaper. It would be more than four times as expensive for me to have insurance, and I'd be paying that even if I didn't ever need to use the policy. As it is, I take care of myself, manage my own medical care, stay informed and go in once a year to get my prescriptions renewed and have an appointment when it's absolutely necessary for me to do so. My monthly medical bills are quite small as compared to what I had to pay for insurance when I still had it under COBRA after quitting my job with the state.

I don't want insurance, and I don't want to pay for YOUR medical care or insurance either. You're on your own.

I certainly hope you never end up with cancer or need extensive surgery. Unless you have quite a chuck of change sitting around, you'd be screwed. That's why it's called 'insurance'.

Me too. But you see I "self insure." I've been socking away all the money I'd have paid in insurance premiums in a bank account for years now and have quite a little medical nest-egg built up. If health insurance were, in fact, insurance I might feel differently, but it's not, it's actually pre-paid health care and rather than encouraging people to take care of themselves so as to avoid a hike in insurance premiums caused by making a claim, our system encourages people to NOT take care of themselves and to over-consume health care resources for the pettiest and niggling of reasons.

The vast majority of people with a "health maintenance organization" account pay hundreds to thousands of dollars a month for "coverage" that is, in fact, like buying a permanent subscription to the health club. They are paying for the services to be available to them on call whether they use them or not. Worse, because they pay for them, they feel (rightfully) free to avail themselves of the services for things that in the days before health insurance people would simply learn to self-treat and/or endure.

In the past, medical care was much more affordable because there was a free market for actual health care that created competition between health care providers that kept prices down, and the costs naturally drove consumers to try to reduce the amount of service they required, which resulted in the supply for health care closely following the actual demand for health care, which also acts to keep prices competitive.

Now, however, the "insurance" company has merged with the care provider and the "insurance" purchased creates a predictable and regular revenue stream for the "insurer" that creates predictable profit margins because the customer pays monthly whether or not they use the service. Since the consumer only rarely actually chooses which "insurer" covers him (it's most often determined by the employer, who by federal law must provide HMO coverage if they have more than 50 employees) he cannot shop the free market to find a cheaper, better alternative source for medical care. It then becomes a tension between the employer, who want's to pay as little as possible for his employees and the "insurer" who wants to charge as much as possible to maximize profits.

This model, in and of itself, would not be bad except for government intervention that skews the market.

The government requires the employer to provide HMO coverage, but does not allow the employer to choose what services will and will not be covered in order to reduce his costs. Government dictates not only what must be covered, but also artificially limits the pool of potential "insurers" in each state, forbidding the business owner from going outside the state to find an "insurer" that offers a better more competitive product.

For the HMO, it naturally tries to limit the amount of service it's obligated to provide as a way of limiting its exposure in what can be a very expensive "insurance" calculus. Most actual insurance covers a specific object against specific perils for a specific price that obligates the insurer to pay a specific amount in the event of loss. This allows the insurer to calculate potential losses against revenue, thus largely making profits predictable based on actuarial analysis. If you insure your car or home, the premium is based in part on the potential maximum payout the insurer will have to cover in the event of loss.

But that's not a calculation that can be made about medical care. Obviously, medical care for an individual is highly unpredictable and can range from zero to enormous amounts of money for serious disease treatment. Because there is no fixed maximum payout, health care insurers usually impose a lifetime limit on the policy to ensure they can maintain profitability even in the worst case scenario where one or more individuals uses much more of the product (service) than was expected.

This also forces providers to charge much more for the coverage because they have to make assumptions about how many people will not make use of the services versus those who will use exorbitant amounts of the service. TANNSTAFL. HMO's aren't charity organizations and they have to make a profit to stay in business.

But again government steps in to regulate the HMO industry using a "fairness" argument by mandating that all policies cover specific perils (illnesses) whether or not the covered individual wants or will ever make use of those services. In Colorado, for example, the government requirement that ALL health care policies cover ALL female gynecological issues, including cancer, pregnancy and (with Obamacare) contraception, a male who buys a policy is paying more for his coverage because for reasons of "non descrimination" he's being required to subsidize the health care needs of women, whose plumbing is simply more complicated than that of the male of the species.

The same occurs with mandatory mental health and drug rehab coverage, which the vast majority of people never need or use, but are required to pay for anyway.

Add to this the practice of the HMO client over-using the services for minor issues that could be handled at home at low or no cost and you have over-consumption of the available HMO resources, shortages in supplies and demands for more staff. All these high demands force the actual cost of the health care up because the price of the service fluctuates with the demand, and this applies to the lower tier internal operations of the HMO like buying gauze and rubber gloves. If there is high demand for such supplies, the price naturally goes up, and so does the cost of providing the care, which causes an increase in the cost of the premium for coverage.

What you end up with is a self-perpetuating, ever spiraling inflation of health care "insurance" costs precisely because the mechanisms of the free market that normally act to keep prices balanced with demand are skewed by the government and the system itself. So the cost of health care insurance keeps going up, and due to government regulation, the number of willing providers keeps getting smaller because there is no profit to be had, and companies just shut down rather than lose money.

The addition of juvenile psychiatric care as a mandatory benefit in Colorado resulted directly in the loss of at least three HMO providers, who simply shut down their Colorado operations rather than face the potential losses that the mandate produced.

Combined with the illegality of consumers going out of state to buy HMO coverage, which is also a government mandate, the system leaves the actual consumers (the employees) with no choices and a perfectly good reason to maximize their use of the HMO system, since they're paying through the nose just to participate.

Of course, one of the prime intents of Obamacare is to deliberately control, restrict and manipulate the market for health care insurance to make it unprofitable for HMOs to operate, thereby driving them out of business. By doing this through health care mandates and gross overregulation at the federal level, Obama and the Progressive can get what they ACTUALLY want, which is pure government-run, government-provided socialized medicine.

The argument will be that because all the HMO organizations are going out of business (due to a deliberate and calculated plan of raising their costs beyond profitability through regulation and mandates), the President will be justified in declaring a "health care emergency" and imposing socialized medicine by executive regulatory fiat, or perhaps by persuading Congress to make it law.

Now, if health care insurance were actually insurance, and the government kept it's nose out of the private sector's business dealings, the actual cost of health care would be significantly reduced because a) the actual consumer would have market power to force providers to compete with one another; b) the costs of health care would be imposed directly on the consumer rather than being washed through the employer, which would stimulate economy on the part of consumers (there's nothing like having to pay out of pocket for each visit to make one carefully review the actual need to get care...something I know and practice all the time) so that the demand for services and supplies would drop and the markets for those lower-tier medical services and products would become more competitive, again reducing the actual costs of care.

A health care insurance policy in a free market environment would look substantially different from HMO coverage of today. The consumer would be free to buy his health care a la carte when needed and thereby free to negotiate the best price directly with the actual provider, rather than "hiring" the HMO to "negotiate" with itself about how much the care is going to cost. Or, if the consumer wants the peace of mind of paying a regular "insurance" installment for specified coverage of specified perils, he can shop nationwide for an insurer.

That way, each consumer can decide what level of risk they are willing to take and what type and amount of coverage they need, and insurers can decide what to charge based on the actuarial risks involved with that individual, just as is the case in life insurance.

Thus, I, a diabetic who cannot get independent health care "insurance" today without government subsidies and mandates (like Obamacare's pre-existing condition regulations) could negotiate with an insurance provider for a traumatic injury catastrophic health care policy that would only cover trauma-related injuries or illnesses where the costs of treatment exceed some threshold amount that I determine I can afford to cover myself. Yes, this leaves me not covered for non-trauma medical care for illness or disease, but that's a choice I get to make based on my analysis of my medical health and potential future needs. In choosing my coverage with great specificity (a woman for example could choose ONLY pregnancy-related medical care, while a man could choose ONLY coverage for male cancer like testicular cancer) I have the opportunity to reduce my medical care costs to fit with my income and not be forced to buy a bunch of coverage I don't need or want. As in car insurance, where I can choose liability only, collision, or comprehensive, depending on what my budget allows and my risks of loss are, a la carte health care insurance would substantially reduce the costs to the consumer, who need only buy that coverage they need or want.

Or, as I do, a consumer can eschew "insurance" altogether, put money aside for medical care (it's called "saving", and unfamiliar concept in the world today) and negotiate directly with individual health care PROVIDERS for the required or desired services, paying in cash to get a substantial (in my case about 40%) discount.

In my case the ideal situation is for me to be able to search nation wide for a catastrophic care policy that kicks in where my savings account ends (which is more than $100,000 right now) and that will offer me a known maximum amount of coverage for those perils I choose to cover. That would make my insurance highly affordable.

[Seth]

Here's another one, anecdotal as it may be. Mrs. Lak is obviously a statistical outlier, as she's had three friends get cancer in the last 3 years. I posted about her cousin. Then there's her best friend from uni, who lives in Nottingham. She had all sorts of gastric issues and was sick for over two years. NHS finally got her an MRI and - surprise! - rectal cancer. They got her on chemo relatively quickly, within 3 months. Then they did a bowel resection and colostomy. Now they're going in again and taking more. She won't make it.

The last friend is a Danish woman who immigrated to the States. She was having "female issues" and was diagnosed with ovarian cancer. She had an MRI that week, surgery a week later and is now 2 years cancer free. She had health insurance.

Now, maybe the two in the UK are unusual, I don't know. I do know that Mrs. Lak worked for the NHS when we lived there and she always said that if either of us got cancer or needed heart surgery we were going to the states. She was quite happy with the way the NHS handles day-to-day medical issues and how they try to keep geriatric patients in their own homes, she loved the way she was not circumscribed by costs when she prescribed a therapy regime or ordered special equipment like a stair lift or electric wheelchair. She's very UNHAPPY with the way our system handles those issues.

So it's a mixed bag, saying one is shit and the other is perfect is simply silly.

My fiancee was having serious mental health issues as well as a host of odd illnesses and her doctor finally convinced her to get a pap smear because sometimes this is symptomatic of cancer.

She discovered she had early stage cervical cancer.

Caught early, cervical cancer is relatively easy to cure. I paid cash for service, got immediate care for her (in literally days) and ended up paying only about $6500 for the whole thing BECAUSE I paid cash and negotiated the cost directly with the clinic. She's cancer-free now only because we acted very, very quickly, which we could do because we were free to select the doctor and clinic that could do the job in the necessary window of time, something that you don't get to do in the NHS. The doctors said that had she gone another year without detecting the cancer, it would have involved major surgery and chemo and would have cost more than a hundred thousand dollars.

If she'd been in the UK, there's no telling how long she would have had to wait to get diagnosed and sent for a pap smear, or how long to get a pap smear, or how long to get the outpatient surgical procedure (essentially electrocuting and shaving her cervix free of cancer) itself. Most likely, by the time she got the recommendation for a pap smear, if some NHS shrink ever actually put two and two together and she hadn't first died of pylonephritis due to delayed medical care (which in her case is what triggered the pap smear), and then if she'd actually been able to get the outpatient procedure done in time to stop the cancer before it spread, which is unlikely in the NHS, she'd likely have died from being denied or delayed a hysterectomy and chemo because it was deemed "too expensive" for the NHS to bother with or simply because her treatment was delayed too long.

And that $6500 represents less than SIX MONTHS of health care "insurance" coverage. If I'd been paying for HMO coverage I'd have paid probably $15,000 or more in insurance premiums for $6500 worth of service.

Screw socialized medicine. When I need medical care, I want it, I want it NOW, and I want to choose whose going to give it to me, and I'm willing to pay for that convenience and expertise.

[Seth]

Jesus, free healthcare isn't really that hard.

Just work out the insurance premium for a nation, budget for it, then collect it in taxes.

The end.

Except of course you can't do that because each person has different and changing medical needs which are entirely unpredictable and change quickly, and therefore central planning will ALWAYS fail to allocate resources properly, leading (as it does in the UK and elsewhere) to shortages, surpluses, waste, fraud, sub-standard care, denied care, delayed care, unavailable care and all the myriad other ills suffered by every single socialized medical care plan on the planet.

Doesn't work. Never has, never will, and it inevitably leads to national bankruptcy, as it's doing in the UK right now.

How is that different from the situation with private insurance, though?

See my post above for the reason. In short, it's the free market that keeps costs down and care available.

[laklak]

Best thing about Obamacare is I can drop my insurance and pay the piddly fine, which is one fuck of a lot less than the insurance premiums. I see the doc maybe once a year and I have never even met my insurance deductible. Then when I get sick I'll go buy insurance, because they can't discriminate based on pre-existing conditions. Sounds like a winner to me.

[Seth]

Yep. Like Mrs. Lak's cousin in the UK, diagnosed with bowel cancer about 6 months ago. Had to wait for 3 months to get "funding" for an MRI. When she finally got it, shit, it had spread. Now, they did get her into surgery fairly quickly (10 more weeks but who's counting). Only had to take her vagina, cervix, ovaries, large intestine, rectum and a few other bits an bobs. She gets to shit in a bag forever, never have sex again, and very likely die but that's OK, because, you know, sometimes bad things happen to good people. Not the fault of the system, no, it's the most fair and egalitarian system ever devised.

No question, single payer is the way to go.

We supposed to take your word for all that?

I have a cousin in the US who's husband had a good job, and full company health insurance. Got sick, couldn't work, health cover ran out, the whole family is chipping in to pay huge sums up front for his health care. It's lucky there were TEN kids in that family.

Sounds dubious, since if he is out of work and earning zero income with 10 kids, he'd apply for Medicaid and be fully covered, and get food stamp assistance for food. Something in your description is not correct, because he'd have no problem getting free coverage unless he really wasn't as destitute as you're suggesting. 60 Million Americans have Medicaid coverage. That represents 20% of the population.

Besides, there's always bankruptcy or the obvious alternative: suicide. What responsible father of 10 would selfishly choose to burden his entire family with a lifetime of crushing debt just so he can survive a few more years?

Buy a life insurance policy early, keep it in force, and then when such a situation arises, do the right thing and blow your brains out with your legally owned handgun and save your family from penury and poverty.

Quit being so selfish and self-centered.

[Seth]

Best thing about Obamacare is I can drop my insurance and pay the piddly fine, which is one fuck of a lot less than the insurance premiums. I see the doc maybe once a year and I have never even met my insurance deductible. Then when I get sick I'll go buy insurance, because they can't discriminate based on pre-existing conditions. Sounds like a winner to me.

Yup. For me, because I'm "unemployed" (and "retired") it'll cost all of $90 (presuming that I ever file an income tax return again, which I plan not to do), and I can probably get a poverty waiver to eliminate even that cost. And when I get sick, I'll do exactly the same thing.

To paraphrase H.L. Mencken, Socialism is the theory that the common people know what they want, and deserve to get it good and hard.

I'm going to stick it to the socialists good and hard in every way I possibly can...while sitting on top of a big pile of cash from the ranch sale NOT kept in a bank.

[Gerald McGrew]

So it's a mixed bag, saying one is shit and the other is perfect is simply silly.

But that doesn't preclude us from examining the data and concluding one system is better than the other. No need to invoke any fallacies of false dilemma.

http://en.wikipedia.org/wiki/False_dilemma

[ronmcd]

If she'd been in the UK, there's no telling how long she would have had to wait to get diagnosed and sent for a pap smear, or how long to get a pap smear, or how long to get the outpatient surgical procedure (essentially electrocuting and shaving her cervix free of cancer) itself. Most likely, by the time she got the recommendation for a pap smear, if some NHS shrink ever actually put two and two together and she hadn't first died of pylonephritis due to delayed medical care (which in her case is what triggered the pap smear), and then if she'd actually been able to get the outpatient procedure done in time to stop the cancer before it spread, which is unlikely in the NHS, she'd likely have died from being denied or delayed a hysterectomy and chemo because it was deemed "too expensive" for the NHS to bother with or simply because her treatment was delayed too long.

Hmm, I think you've been misinformed about the NHS. Pap smear tests are free and routine. A few years ago my girlfriend at the time went for her regular pap test on the NHS, she was 30 I think at the time, she was quickly called back to the hospital for followup checks and after quick outpatient treatment she was fine, but had her checkups increased in regularity. One of my relatives died of cancer, but I can tell you now it was not due to the speed of or quality of NHS treatment, it was down to him ignoring his symptoms for a year and then he was already in serious trouble. Once diagnosed he quickly had tests, specialists working out his treatment, and over the next couple of years they tried everything and did their absolute best for him, various operations, drugs, chemo, etc.

Don't believe the anti NHS myths Seth, or worse make up new ones, or perhaps worse still believe that individual incidents highlighted by the anti NHS brigade are the norm. Bad things happen in any healthcare system, but generally the NHS is hugely popular with the people who use it. The biggest danger to the NHS in England is the Conservative government, who are categorically NOT "reforming" the NHS because of money. That is their cover for all the massive ideological changes they are imposing on UK in every policy area, many changes they did NOT have in their manifesto for the 2010 election. They have no mandate. In Scotland our NHS is under financial pressure too, every part of UK and every area of the economy is under financial pressure, but unlike in England it is not being reformed/privatised. Thank fuck. But me ... and most in Scotland (and likely England if given the choice) prefer spending money on health rather than, oh, I dont know, nukes? Illegal wars?

The NHS was created after the war at a time when it could NOT be afforded ... but it was, and it's something to be valued.

Oh, and in UK you can still go private if you want, and have the money.