Lets take a different look at heathcare.....

chase_gw

Would be very interested in understanding what the Republican solutions are to the American health care crisis.

Trump ran on " repeal and replace " he did neither . Replace wth what ?

Lots of knocks on the Democratic proposals...but what is the Republican alternative? Surely there is one given it is the number one issue with voters.

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elvis

I think Ann's thread may cover this, but you post OPs seldom, so you deserve a response. I'm as sincerely interested in the responses as you are, Chase.

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chase_gw

I didn't recall seeing any Republican alternatives to the healthcare issues in Ann' s thread.

The responses I'm interested in are from Republicans regarding their solutions for American healthcare issues. I saw none of that on the other thread....but yes I am truly interested.

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forreal

Wait, one only deserves a response if they seldom post OPs? How odd.

I've seem liberals criticized for posting too many OPs and criticized for not posting any/enough OPs. I didn't know it was important to tally how many OPs one posts to know whether they are worthy of a response.

--

I too would like to hear what it is they want. I suspect they don't ever answer this question because what they want is just more of 'I got mine and I'm not paying for yours'. Of course, they seem to miss the fact that they are already paying for others.

Perhaps someone will prove me wrong.

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elvis

Of course, they seem to miss the fact that they are already paying for others.

How could anyone "miss" that fact? We just don't intend to compound it. Reasonable alternatives will of course be entertained, no, welcomed.

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carolb_w_fl_coastal_9b(zone 9/10)

...but nothing constructive added?

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Becca Reese

Of course, they seem to miss the fact that they are already paying for others.

LOL, no we are acutely aware of how we honest, hard-working Americans are paying for all your Leftist entitlements.

And how you want to make us into a slave class and bleed us dry.


Maybe we should be "unwilling to work". I hear the pay's not too bad.

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sheesh(5b)

So please, tell us what you want!

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patriciae_gw(07)

So ,lets just keep driving down the road to ruin and no one will have health care except the one tenth of one percent. That sounds like a plan. Do we limit who can ride on our roads, cross our mutual bridges? Do people not recognize that a healthy public protects everyone? Just consider that untreated antibiotic resistant TB. It is an equal opportunity disease. Your status as a conservative is not going to protect you Becca.

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sheesh(5b)

Sorry, chase. You tried. Again.

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forreal

Huh, who knew I have leftist entitlements? Could someone tell me what they are? I seem to be missing out on something. Or, could it be that someone is not being honest? Could it be they are spreading false propaganda because it supports what they want to believe?

OK, so we have a conservative poster attacking me (and leftists) for my post, but still not a single word about what they actually want.

Like I said, when what you want is "I got mine and too bad for you" it's kinda hard to admit that.

Still looking forward to be proven wrong. Not holding my breath.

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Izzy Mn(4)

I remember Trump saying he was going to replace ACA with something far better. Haven't heard a peep about it since he was elected. So he really didn't have a plan, how surprising, not. Just a bunch of hot air and excuses.

And Melania says: I don't really care. Do you?

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chase_gw

As I suspected...no solutions..no ideas ...just criticism with no alternatives.

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sunflower_petal(5a)

They know what's wrong with Democrats' proposals but not what to have instead ....

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Rita / Bring Back Sophie 4 Real

Personally, I would like to see Medicare for all with the ability to pay for additional insurance that covers luxuries, like seeing doctors who have concierge type practices and such. I like single payer because it eliminates insurance companies, and gives the government vast purchasing power on behalf of healthcare consumers.

There are alternatives to the status quo or Canadian system. The whole world is not made up of only those two options. The Germans and Singaporeans have their own ways of ensuring everyone is covered equitably- and neither on of those systems is government managed, single payer like Medicare. Why is there never any discussion of what other countries do?

Singapore, from Wiki:

Healthcare in Singapore is supervised by the Ministry of Health of the Singapore Government. It largely consists of a government-run universal healthcare system with a significant private healthcare sector. In addition, financing of healthcare costs is done through a mixture of direct government subsidies, compulsory savings, national healthcare insurance, and cost sharing.

Singapore generally has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organization's ranking of the world's health systems in the year 2000.[1] Bloomberg ranked Singapore’s healthcare system the most efficient in the world in 2014.[2] The Economist Intelligence Unit placed Singapore 2nd out of 166 countries for health-care outcomes. [3] Bloomberg Global Health Index of 163 countries ranked Singapore the 4th healthiest country in the world and first in Asia.[4]

https://en.wikipedia.org/wiki/Healthcare_in_Singapore


Germany, from wiki:

Germany has a universal[1] multi-payer health care system paid for by a combination of statutory health insurance (Gesetzliche Krankenversicherung) officially called "sickness funds" (Krankenkassen) and private health insurance (Private Krankenversicherung), colloquially also called "(private) sickness funds".[2][3][4][5][6]

The turnover of the health sector was about US$368.78 billion (€287.3 billion) in 2010, equivalent to 11.6 percent of gross domestic product (GDP) and about US$4,505 (€3,510) per capita.[7] According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004.[8] In 2004 Germany ranked thirtieth in the world in life expectancy (78 years for men). It had a very low infant mortality rate (4.7 per 1,000 live births), and it was tied for eighth place in the number of practicing physicians, at 3.3 per 1,000 persons. In 2001 total spending on health amounted to 10.8 percent of gross domestic product.[9]

According to the Euro health consumer index, which placed it in 7th position in its 2015 survey, Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it.[10]

https://en.wikipedia.org/wiki/Healthcare_in_Germany

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heri cles

Nikki Haley wants to opt out of the ACA and Medicaid leaving tens of thousands without healthcare and others subject to the whims of private insurers who would be able to once again deny coverage for any reason or for no reason whatsoever.

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tryingtounderstand

How about, we on HT, create our own utopian system. Then send it into govt

My first premise Healthcare is a right, profit should not be made over one’s health or well being. A wage yes, a darned good wage absolutely, current salaries, yes absolutely. Millions and millions in profits no.

everyone should have ‘skin in the game’ yet not be so foreboding that health and well-being is affordable to only a select few. Quality healthcare care, means it is accessible, attainable and affordable.

Forego, current co pays, deductibles, and put them toward taxes, perhaps or universal system. Forego, advertising, cumbersome and complicated insurance company involvement. Hospitals, should not need to advertise their existence. Or advertise to get customers. It’s not amazon, after all. Perhaps develop a home care system, where individuals can be receiving at home or receive certain health care services at home, rather than in hospital.

in Canada, make more use of physician assistants and clinical nurse specialist. Govt should negotiate with healthcare providers, services, pharma etc

i May come up with other ideas...but for now, it’s all I have..

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

The first step is to find out why the USA has the biggest spend per capita on Healthcare in the world.

No nonsense, where is the money going?

Not a problem, if the USA is rated very highly over a big range of health issues!

No doubt, the Socialist Stuff will raise its ugly head. Great word "Socialism"! A dream word in the USA for politicians who want to do nothing!

I wonder which country would be rated as number 1 in care and cost in the world???? Probably one of the Northern European Countries?

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Chi

It's the most expensive because healthcare is a for-profit industry in the US. Health insurance companies and pharmaceutical companies make massive profits and have shareholders demanding more. This leads to crazy inflation for doctors and hospitals knowing they will only receive a fraction from the insurance companies. People without insurance have to pay those crazy fees, unless they can negotiate.

And for some reason, lobbying is completely legal in the US and these companies pay millions of dollars to politicians in exchange for favorable laws. Most people would call this bribery at the expense of the American people, yet somehow it is allowed and encouraged. There's corruption everywhere.

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numbersjunkie
Actually, the ACA put a cap on the profits insurance companies are allowed to keep. They must pay out 80-85 PCT of premiums for medical care, so they are limited to 15-20 PCT for administrative costs and profit.
Drug companies and hospital systems probably reap the biggest profits. I think the heath care workers are getting squeezed. And docs have to deal with the insurance companies, which have upteen different plans, rules, etc. A nightmare for them Im sure.
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chase_gw

It is somewhat baffling to me that the Republicans have no plan to address the problem given it's the number one issue with voters and will likely become even more important as 2020 approaches. My personal opinion is that , while some may have some ideas, they don' t have a cohesive strategy that they can get majority buy in too..

It's very much like immigration, lots of talk about reforming it but no agreement on the overall strategy.

Last term was the perfect opportunity to at lesst get a cohesive strategy passed but Ryan would not bring either immigration or healthcare to the floor He knew he couldn't get immigration reform passed by a majority of Republicans. Healthcare reform was a bit different......I don't think they viewd it as a priority. 2018 proved them wrong. 2020 will too.



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Izzy Mn(4)

Republicans don't have a plan because there is no plan on health care. Probably wants to go with third world version. No money upfront, no care. Mother's giving birth and dying on the front steps of hospital. That would cut health care costs.

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sunflower_petal(5a)

Republicans hope that Dems take over so that they can get it done and Republicans don't need to do any more work than crab about it.

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Izzy Mn(4)
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chisue

How many ills would be ended if we enacted laws limiting campaigning to a few months?

Information is disseminated instantly today. We do not need years for a Pony Express to get 'the word' to far flung voters. We only need enough time for presentations and challenges to rise to the fore and be debated *within a limited timeframe*.

Almost anyone could afford to run for almost any office.

How long is 'long enough', in your opinion? I'm thinking six months.

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Zalco/bring back Sophie!

Anything you create will have problems and require leadership to see through. We have no leadership. We only have people more angry with one another than interested in moving forward on issues.

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tryingtounderstand

I always wondered about the purpose or reasoning for the inordinant campaign time lengths. More work and focus could be done wifh respect to dealing with the country’s issues as opposed to focus on re elections.

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writersblock(9b/10a)

I always wondered about the purpose or reasoning for the inordinant campaign time lengths.

Oh, that's an easy one: $$$$$. Think of all the advertising dollars our current system generates.

Consider how much more is spent these days than back when the parties made back-room decisions about who would run and announced at the conventions in the summer before the election.

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tony jelly

Health care in the US is a clear indicator of inequality, as an old member of HT would say "follow the money," who stands to gain and who loses from a universal system? Those gaining (big time) from the way it now wants it to stay that way and the losers squandered their voice by voting for Trump.

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Fárbauti

The problem with healthcare in the US is the cost of care. Insurance carriers mostly pass that through since, as someone mentioned above, they have to spend 80% of their premium dollars on paying claims. Add administrative overhead to that and they're making maybe 10% profit. The insurance carriers are not the problem - the cost of medical care which generates 80% of the premium is the problem. If medical costs go down, insurance premiums go down as well.

Let's not forget that we're running trillion dollar deficits, and healthcare-related entitlements(Medicare/Medicaid) far exceed that. Healthcare is literally bankrupting this country. We need to start by asking why hospital care, supplies, equipment and
drugs cost so much more in the US than every other developed country. We then need to ask, should providers be tax-exempt when they make millions in profit?

I don't believe the free market can solve this one. The healthcare industry is essentially a monopoly with a captive audience - when you're on your death bed you have no choice but to pay whatever they're charging you. There is no need for government-run healthcare, but I think the government is going to have to step in and enforce a fee schedule based on an average of costs for the same procedure/drug/piece of equipment in other developed countries.

Once healthcare costs fall, the insurance premiums will also naturally fall on their own based on the 80%. Once that takes place, I'd like to see health insurance become real insurance. We now have the technology to create a system that is equitable. Coverage based on date of diagnosis, whoever is covering you at the time is on the hook until maximum medical improvement. This eliminates all the pre-existing condition issues - you either have coverage when you get diagnosed or you don't. If you do, your current carrier is on the hook for it forever, even if you switch insurance companies.If you get really sick, lose your job and can no longer pay your health insurance premium - no problem, you had coverage at the time of diagnosis you're covered. We would require centralized healthcare records. Doctors would be able to assign portions of the cost to various diagnostics - if you had something small complicated by diabetes, 90% goes to the diabetes diagnostic and the carrier responsible for that pays it. We would also be able to issue a modifier to each person, so that people who use their insurance a lot would get a 1.5 and pay 1.5 times the premium, while someone who is really healthy could get a 0.7 for example. This would need to be capped to say 3x, but it would make it fair and encourage younger people to sign up with lower costs.

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sunflower_petal(5a)

" The problem with healthcare in the US is the cost of care. Insurance carriers mostly pass that through since "

Don't fool yourself into thinking that the insurance business doesn't affect how much the care providers charge for their services. As an example, if a doctor charges $100 for a visit, $30 of that charge may be associated with hiring employees just to manage working with many different insurance companies.

Administration costs would go down if doctors didn't have to deal so much with insurance and I think that would be a bigger savings than just mandating a fee schedule would achieve.

" We would also be able to issue a modifier to each person, so that people who use their insurance a lot would get a 1.5 and pay 1.5 times the premium, while someone who is really healthy could get a 0.7 for example."

I think you need to reconsider that for diseases/conditions that a person has through no fault of their own. Why should someone with type 1 diabetes pay the same higher cost that a hypochondriac pays just because they both use their insurance 'a lot'? Or did I miss where you considered that?

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Fárbauti

As an example, if a doctor charges $100 for a visit, $30 of that charge
may be associated with hiring employees just to manage working with many
different insurance companies.

All billing is done electronically via EDI these days, using the exact same transaction set mandated by CMS/Medicare. The bill gets sent out and gets routed to the appropriate insurance carrier by the VAN/aggregator. The insurance carrier then replies with a status transaction indicating they received it, and then a payment transaction when the payment is issued or denied including the electronic EOR. Money comes in via ACH linking the payment to the EOR by transaction code. If money due from the insured, the provider bills the remainder to the insured. All this happens automatically without a person touching anything. Working with many different insurance companies is exactly the same as working with just one.

I think you need to reconsider that for diseases/conditions that a person has through no fault of their own.

No, I think if you're using say 5 times more than the average person in your age group in in benefits per year it's fair that you pay a little more. Regardless of reason.

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numbersjunkie

Agree with sunflower that the cost of medical care is higher than it needs to be because providers have to deal with all of the administrative differences of multiple insurance companies. Single payer would fix that. A uniform database/admin system would also go a long way, but the docs would still have to deal with all of the different plan designs/coverage. The available technology doesn't seem to be used as effectively as it could.

I disagree that there should be modifiers for each person. Modifiers by geographic areas are warranted and common. Once you start trying to make everyone pay their "fair share", the efficiency and fairness of the system falls apart and the spreading of risk that is the basis for "insurance" is lost.

I also disagree that we should have "the ability to pay for additional insurance that covers luxuries, like seeing doctors who have concierge type practices and such". I do agree that additional insurance could be used to cover elective procedures upgraded coverage (like lower copays). Concierge practices should not exist. If you are an exceptional provider, there should be other incentives provided to you by the system and not by allowing you to service only the rich folks. I think many of these practices were created to avoid having to deal with insurance company paperwork anyway, but I could be wrong.

Maybe the Medicare Part B system is a good place to start - collect more premiums from those who can afford to pay more. And/or provide only minimal or no co-pays for those who cant afford it. But the burden of determining who pays what should not be on the providers.

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Fárbauti

Agree with sunflower that the cost of medical care is higher than it
needs to be because providers have to deal with all of the
administrative differences of multiple insurance companies. Single payer
would fix that. A uniform database/admin system would also go a long
way, but the docs would still have to deal with all of the different
plan designs/coverage. The available technology doesn't seem to be used
as effectively as it could.

Sounds like single-payer propaganda you read on a left-wing site somewhere. It doesn't reflect reality. Technology is being used effectively and efficiently, and it's the exact same technology that would be used with single-payer Medicare.

Once you start trying to make everyone pay their "fair share", the
efficiency and fairness of the system falls apart and the spreading of
risk that is the basis for "insurance" is lost.

Seems to work fine for every other line of insurance, personal or commercial.

collect more premiums from those who can afford to pay more. And/or
provide only minimal or no co-pays for those who cant afford it.

All about wealth redistribution eh?

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purr mich 7_

Those 'modifiers' sure sound a lot like the so-called 'death panels'.

Subjective. Who gets to call one person a hypochondriac? Slippery slope, there.

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carolb_w_fl_coastal_9b(zone 9/10)

It seems quite clear the alternative plan that conservatives favor is no plan at all.

Sink or swim, Americans!

Just hold your breath when you get into crowded elevators, etc....

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numbersjunkie

I think if you're using say 5 times more than the average person in your age group in in benefits per year it's fair that you pay a little more. Regardless of reason.

Here's the problem I see with this. If its not your fault, why should you pay more? How much added cost will there there be to implement/enforce this type of premium structure? Is it worth it - especially if you only pay "a little bit" more? And then what happens when someone can't afford the extra charge - it either goes uncollected, or it causes undue hardship to the patient and family. If it goes unpaid or requires legal/administrative action in an attempt to collect, then it causes prices for everyone else to increase over time. I am a proponent of the KISS principle in this case.

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Fárbauti

Those 'modifiers' sure sound a lot like the so-called 'death panels'.

That's quite the exaggeration. It's no different than paying more for car insurance if you get a lot of speeding tickets. Or paying more for life insurance if you have certain diseases, or if you smoke. It makes it fair. And I would suggest it be capped so as to not make insurance unaffordable to those who need it most.

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sunflower_petal(5a)

"Once you start trying to make everyone pay their "fair share", the
efficiency and fairness of the system falls apart and the spreading of
risk that is the basis for "insurance" is lost.

Seems to work fine for every other line of insurance, personal or commercial."

I would argue that when it comes to whether you live or die, the playing field needs to be a little different compared to if you decide to live in a flood prone area, have a big house, or get a car with a fancy engine.


Type 1 diabetes patients can die if they have to choose between being able to afford what lets them live (like going for doctor visits more often than the rest of us or a type of insulin that lets them work instead of one that keeps them alive but not productive). I was just listening to a smartly dressed woman talking about how much better her life is now that she has an insulin pump (she has Type 1). I'm pretty sure the guy that has to work at McDonald's won't be getting that so his health condition will continue to require him to make some hard choices. I think a higher insurance rate will only continue to make life harder for him to pull himself up by his bootstraps.

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Fárbauti

Here's the problem I see with this. If its not your fault, why should you pay more?

Because you're using/benefiting from the system more, regardless of fault.

How much added cost will there there be to implement/enforce this type of premium structure?

Not much, it would be generated by the same entity which maintains health records. Heck of a lot less than the Obamacare website I can tell you that. Calculating if you're above/below average for your group is trivial.

Is it worth it - especially if you only pay "a little bit" more?

Yes. First of all it adds a sense of fairness, it rewards good life choices, and it also allows those who are young and don't have a lot of health issues to get in at a lower cost while still getting great coverage based on their record of good health.

And then what happens when someone can't afford the extra charg. If it goes unpaid or requires legal/administrative action in an
attempt to collect, then it causes prices for everyone else to increase
over time

No such thing as affording or paying the "extra charge", it's embedded in your insurance premium. That's your cost to get insured based on your medical history. Just like your car insurance, if you get tickets your premium simply comes out to more. There's not a separate "charge" for your speeding violations.

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numbersjunkie

Seems to work fine for every other line of insurance, personal or commercial. Well other lines of insurance aren't dealing with life and death for one thing. And in most cases, the risk for other lines can be managed to some degree by the policyholder.

All about wealth redistribution eh? No. It's about helping your fellow man who is is less fortunate than you are. If we pooled all the risk and spread it across all citizens in this great country in some reasonable manner, it wouldn't kill you. If we don't find a solution, many will continue to die.

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Izzy Mn(4)

Faurbti

I guess you've never spent hours going over bills denied by insurance. Calling insurance carrier over and over for 4 months trying to get them to pay what they should have. Being told over and over that it will be taken care of. Then getting a denial again, calling insurance, wash, rinse, repeat.

No the hospital won't help, they submitted claim. No Mr. Insurance that was not a triple billing for x-rays it was three x-rays in one day. This is just a small glimpse of the mess with insurance. The medical situation was only 18 days but took a year to get payments settled with insurance.

Then calls from Hospital and Drs offices saying if you don't pay this bill your child won't get the treatment they need if you are delinquent. But insurance should cover can you help me to get them to pay. No, we sent them the bills it's your problem, pay the bill or else.

Don't worry Mr/Mrs Doctor/Hospital billing office, my son died so we won't be bothering you anymore.

This is from my personal experience.


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sunflower_petal(5a)

I do support having the ability to buy premium insurance supplements for doctors with concierge service, or to pay for non-essential services like boob jobs not associated with medical conditions, etc.

As for people paying extra because they smoke or indulge in other unhealthy activities, I'd be looking for ideas on how other countries deal with that (and then deciding if their ideas worked or not).

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Fárbauti

Type 1 diabetes patients can die if they have to choose between being
able to afford what lets them live (like going for doctor visits more
often than the rest of us or a type of insulin that lets them work
instead of one that keeps them alive but not productive). [...] I think a higher insurance rate will only continue to make life
harder for him to pull himself up by his bootstraps.

My plan is great for such people, because it's actual insurance. You get diagnosed with diabetes? If you have coverage at that moment in time, your carrier is on the hook for your diabetes, forever. You can cancel your health insurance policy tomorrow and never pay a dime in premium again and have your diabetes covered.

Of course, you break your arm or something completely unrelated and you don't have coverage, you're on the hook for it.

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sunflower_petal(5a)

Izzy Mn, I'm so sorry.

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numbersjunkie

My plan is great for such people, because it's actual insurance. You get diagnosed with diabetes? If you have coverage at that moment in time, your carrier is on the hook for your diabetes, forever.

Who would ever be able to afford the premium for coverage that might end up having to provide lifetime care for a particular ailment/disease? How on earth would your doctor keep track of who to send the bills to if your claims would have to go to different companies for different ailments/services. What a nightmare!

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Fárbauti

Well other lines of insurance aren't dealing with life and death for one thing.

Sure they are. If you get in a car accident, your car insurance will be covering your medical bills up to your policy limits. If you get in an accident at work, your workers comp will be paying your medical bills, your salary, retrofitting your house to accommodate any resulting disabilities, and so on.

Calling insurance carrier over and over for 4 months trying to get them
to pay what they should have. Being told over and over that it will be
taken care of. Then getting a denial again, calling insurance, wash,
rinse, repeat.

My plan resolves all these issues. The question of coverage becomes a simple one - is the date of diagnostic or service between the policy effective date and the policy expiration date. If yes, pay bills. If no, no coverage, don't pay bills. No denials except for no coverage. I would suggest legislating a 30 days turnaround time for insurance carriers to get their bills paid.


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Fárbauti

Who would ever be able to afford the premium for coverage that might end
up having to provide lifetime care for a particular ailment/disease?

How is that any different than what happens now? You're just hopping from carrier to carrier. Insurance is the business of taking risk. They're good at it. Let them take risk.

How on earth would your doctor keep track of who to send the bills to if
your claims would have to go to different companies for different
ailments/services. What a nightmare!

Simple. You select the diagnosis code associated with the treatment you're providing. The system presents you with a list of existing conditions for your patient, or you select a new one. If you select multiple, you assign a percentage to each code. The bills go out to the insurance carriers known to provide coverage for those existing conditions, or to the current carrier if a new diagnosis code. If any issues, the carriers can subrogate against each other and work it out.

This is how car insurance works currently for example, you can file with your carrier and they subrogate against the insurance of the party at fault. Works just fine.

This is why I say, we now have the technology to make such a system work. Using paper it would be a nightmare. Using electronic records and EDI, it's a piece of cake.

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sheesh(5b)

And you think insurance carriers would accept your plan for permanent lifetime coverage? Right. No company would insure diabetes or cancer or any other chronic disease. What about transplant patients, heart disease patients, auto immune patients?

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sheesh(5b)

I'm curious, fárbauti. What is your expertise in this field of medical/health insurance? Are you in the field? Are you an accountant or auditor?

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numbersjunkie

Insurance is the business of taking risk. They're good at it. Let them take risk.

Good luck with finding one that will take that bet for a reasonable/affordable annual premium. Especially if they are prevented from individual medical underwriting.

Simple. You select the diagnosis code associated with the treatment you're providing. The system presents you with a list of existing conditions for your patient, or you select a new one. If you select multiple, you assign a percentage to each code. The bills go out to the insurance carriers known to provide coverage for those existing conditions, or to the current carrier if a new diagnosis code. If any issues, the carriers can subrogate against each other and work it out.

This sounds like a boom for the legal profession. And I'm guessing the poor patient would be stuck in the middle. Edited to add that providers will be stuck in the middle too!

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Fárbauti

And you think insurance carriers would accept your plan for permanent
lifetime coverage? Right. No company would insure diabetes or cancer or
any other chronic disease. What about transplant patients, heart disease
patients, auto immune patients?

Sure they would. I think they'd be happier than the current system, where they have to take in people from other carriers with pre-existing conditions - including diabetes, cancer etc - and pay for their healthcare costs. It's no different. Instead of having people with expensive pre-existing conditions come in every year, everyone is responsible for the people they took a risk on.

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catspat(aka)

No one controls they genes they receive, so it's not like "speeding tickets". Life, in general, is not "fair", anyway -- no such thing as perfect justice. Am I supposed to begrudge the cancer patient whose horrific disease (most are fundamentally genetic in origin) costs $1,000,000 to treat when I've only cost my insurer $10,000 during my entire lifetime, far less than the premiums I've paid? Nope -- I'm just happy that the cancer patient can get that kind of care and that I don't need it.

Life insurance providers accommodate good genes vs bad genes by setting their base prices based on the odds, in the form of actuarial tables. It's not "fair" to them when some lout with bad genes that took out one of their policies dies early of natural causes, but that's already been accounted for in how the policy premiums are set. To me, that seems the best way to set healthcare premiums, too -- based on the whole population being covered and the odds.

Otherwise, we go back to the old system (and one reason why my husband and I still kept working, after the election of Trump and a Republican Congress, to keep our employer-provided insurance, though we could have retired long ago) when those with pre-existing conditions, through no fault of their own, were unable to get real, affordable insurance. Just the conditions that could be excluded from coverage based on the pretext of existing high blood pressure (heart attack, stroke, kidney failure....) made any insurance policy that could be gotten nearly useless.

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tony jelly

Fairness: insurance companies balance the risk with their thumb on the scales.

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Fárbauti

Good luck with finding one that will take that bet for a
reasonable/affordable annual premium.

Well again, the premium is driven by healthcare costs, not by the insurance plan. 80% of the premium you pay has to be direct healthcare costs, by law. So affordability is going to come from dealing with the high cost of healthcare, not from the insurance system.

Especially if they are prevented
from individual medical underwriting.

The individual modifier alleviates that issue to some extent.

I'm curious, fárbauti. What is your expertise in this field of
medical/health insurance? Are you in the field? Are you an accountant or
auditor?

I am in the field of technology with strong experience relating to medical billing systems, billing procedures and processing of EDI transactions.

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Fárbauti

Just the conditions that could be excluded from coverage based on the
pretext of existing high blood pressure (heart attack, stroke, kidney
failure....) made any insurance policy that could be gotten nearly
useless.

If you hate all that, my plan deals with it by completely eliminating pre-existing conditions. If you have health insurance, and you get diagnosed with something, that something is covered by your current carrier until maximum medical improvement. If you change jobs, or insurance, your new carrier doesn't have to pay for it, so they can offer you decent rates.

And actually, if you have a serious illness, they may fight for your business and give you a great deal knowing they'll probably be passing on most of your costs to someone else while collecting the full premium.

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sheesh(5b)

Can you give us an example or suggestion about approximately how much a monthly premium for a family of four would cost under your plan?

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sunflower_petal(5a)

" my plan deals with it by completely eliminating pre-existing conditions."

Didn't ACA eliminate pre-existing conditions? How is your plan different?

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carolb_w_fl_coastal_9b(zone 9/10)

Send that plan to the White House pronto!

I am sure they would be interested in it.

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Fárbauti

Can you give us an example or suggestion about approximately how much a
monthly premium for a family of four would cost under your plan?

Exactly the same as it does now. The driver of premium is the cost of care, not the insurance plan. You're shuffling the same money around. We're not going to see affordable healthcare until we deal with the huge prices healthcare providers are charging compared to other developed countries. I suggested enforcing a fee schedule for medical procedures/equipment/drugs based on an average of costs in other developed countries, and heck give them an extra 20% since this is America. But the important thing to understand is, insurance is mostly just passing costs through. That's not where the issue lies.

Didn't ACA eliminate pre-existing conditions? How is your plan different?

It did not, they're still there, but carriers are no longer allowed to decline coverage based on that. People are still taking their existing conditions from carrier to carrier, and the new carrier has to pay for it. My plan eliminates pre-existing conditions by providing coverage based on date of diagnosis. If you get diabetes, your carrier at the time you get diagnosed will pay for it, forever. If you change jobs and get new insurance, the new carrier is not paying for it. If you break your arm they pay for that, but the diabetes stays with the carrier who was providing coverage when you got diagnosed.

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Fárbauti

Send that plan to the White House pronto!

What is is, potus@whitehouse.gov? I'll just send them the link to this forum.

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sunflower_petal(5a)

"If you get diabetes, your carrier at the time you get diagnosed will pay for it, forever. If you change jobs and get new insurance, the new carrier is not paying for it. If you break your arm they pay for that, but the diabetes stays with the carrier who was providing coverage when you got diagnosed."

Seems cumbersome, even with software.

ETA: But I totally like thinking outside the box and some piece of this might take us further down the road, so keep the discussion going.

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maifleur01

Using diabetes only as an example but it could be any other health issue. Diabetes can cause the body to develop other health issues some such as heart and lung issues. Simply stating that if someone has diabetes that the disease should be covered for the rest of their life is sound but who gets to decide if the other issues are caused by it or from things like a virus or simply growing older. There are many health issues that simply are unknow why they happen.

I agree that there should be a national health insurance that will cover both issues to stay healthy and cover common health problems. I also think that like in other countries people show have additional coverage to help pay for the extraordinary health issues.

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rob333 (zone 7a)

As I've stated ten billion times, I was in healthcare. For a score of years. Now that that is said, please know, I am very aware of how the system works: I don't understand what your focus is on the pre-ex stuff. Who cares which carrier pays for it? What does that matter in the overall scheme of all covered Americans? What would work better is, if everyone paid into the system. Utilization is an area that needs reform. Price gouging on drugs. But not pre-ex.


P.S. Chase, I told you many many years ago, the American public would never go for universal. Never. It's all about "choice". Ugh. I have no idea what the issue is that cheetohead is touting, but I do know most people are just so misinformed, you're only going to get soundbytes and justifications.

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patriciae_gw(07)

When you go to the doctor you aren't going to be diagnosed with a something. I can no longer get the something I was diagnosed with 30 years ago but I have multiple issues as a result of that former problem and much of that is from the medical care I received. Today I have another something and the care I get for that makes the previous problems I have worse. On top of that I have other totally unrelated somethings that are on going more or less. Because I have a knee problem does my former insurance have to pay for the problems I have with my other knee because I have favored the problem one putting more stress on my other joints and knee? That way lies madness. Coding, the thing the medical center and doctors office does before your bill hits the billing system would be a schizoid nightmare.

The entire world deals with this inequity of use with insurance pools. The larger the pool the more the cost is spread. Most people go through the whole of their lives with very little medical cost. Typically it is your last few years when the costs mount up. Those who don't fit this scenario are carried by all the healthy people. It is the reason that federal employees have pretty good insurance options at a reasonable cost. They represent a huge insurance pool. Maybe everyone should be able to buy into that?

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Fárbauti

I don't understand what your focus is on the pre-ex stuff.

It's not. I mentioned in my first post the problem is the cost of healthcare, not the insurance system. Insurance companies simply pass those costs along in your premium. If we get costs down to where premiums are manageable, we may not even need any changes to the insurance plans. The root of all evil is the high cost of care, equipment and drugs.

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chase_gw

Very interesting respectful duscussion. Hats off farbuti for expanding on her/ his ideas . At least they are real ideas not shallow platitudes.

In the end, the only way you get to affordable healthcare and affordable insurance is by regulating both to some degree . I agree with him/ her an unfettered free market system will never deliver the solutions required.

A robust duscussions on solutions is what is needed........ a solution exists.

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carolb_w_fl_coastal_9b(zone 9/10)

Nothing like reinventing the wheel, eh?

Way back in 2009, Stuff You Should Know looked at healthcare systems around the world, how they differ, how they're similar, etc.. As many others have suggested, we would do well to examine these other systems and learn from them, and build on, improve what we already have.

https://www.stuffyoushouldknow.com/podcasts/health-care-systems-around-the-world.htm

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palisades_

IMO, any healthcare plans from Democrats or Republicans will not work unless these are parts of the fixes:

1. Drug cost. Pricing regulations for the pharmaceutical industry

2. Insurance reform; prior authorizations, pre-existing conditions coverage

3. High service costs - Not all hospitals charge the same for the same procedure. Hospitals are buying up small MD practices, then charge patients twice as much or more on visits and lab fees because now they can add the additional hospital charge on to patient's bills.

4. Transparency from hospital billings with proper use of ICD billing codes. Patients should be aware in advance in most cases what the charges are.

5. Rural area hospitals/health centers need more funding and incentives to retain healthcare professionals, and to stay open to serve the population.

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elvis

It is the reason that federal employees have pretty good insurance options at a reasonable cost. They represent a huge insurance pool.

Not so fast. The employer pays between 80 and 90% of the premium for most federal employees (Postal is less, more like 76%). I have a family member who is an EEOC employee, she pays single plan $160/month. You do the math. The corruption goes all the way up.

ETA link https://fas.org/sgp/crs/misc/R43922.pdf

That's ^^^ The Congressional Research, it's safe.

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numbersjunkie
Elvis,. I was a federal employee and agree that health care costs are lower than for most employers, but maybe not so much less than other very large employers. I think that's part of deal when you accept federal employment. I was a professional employee and can tell you salaries in my job we're at least 20 PCT less than private sector. I'm not sure why you say the corruption goes way up. why/ how is that corruption?
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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

Bry911 has posted numerous times on this type of thread that Employers paying Health Insurance Premiums is a dumb system. I agree with him 100%.

I have health insurance with the one company and when I started working aged 15, joined up. It was part of the employment deal. I paid the premiums, but the one employer in my working life did cover unusual health expenses such as Physio.

So I paid and paid and never claimed much till old age.

When "universal" health cover arrived, there were all sort of strange options coming from my health Insurer. Options that needed Actuarial skills to work out the best deal. I opted for private hospital health cover.

To me, this business of employers paying health insurance premiums would be the most difficult thing to fix before the USA moves on to something better.

Here in Socialist Australia, the private system is alive and well.

Want to use the public system and are fairly well off?

No problem , but be aware that there are waiting times for non life threatening conditions and you would have to pay the medicare levy if your income is above $X.


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jlhug

Numbersjunkie, Medicare Part B premiums are income based. Married filing joint couples with incomes over $214,000 pay twice what a married filing joint couple with an income of less than $170,000 pays for Part B.

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chase_gw

Part of a solution could be employers paying a payroll tax into a universal healthcare option rather than handling health insurance for their employees. It breaks the tie to employment, lowers the cost for the employer and helps reduce the costs for the taxpayer.

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rob333 (zone 7a)

2. Insurance reform; prior authorizations, pre-existing conditions coverage


Here it is again. What do you think is wrong with pre-ex? How about we eliminate it. If you have an issue, regardless of how long you've had it, it gets covered.

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maifleur01

In this area for a long time the various government agencies, local, state, national, and a couple of international ones were the largest employers in the area. I worked as a temporary while looking for long term employment and apparently was good enough to have access to employee handbooks. Many of the companies actually had better benefits than what I found after starting to work for the federal government. While things have changed some of those companies still provide better benefits but it depends on the division that you work in.

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numbersjunkie

jlhig, yes I am aware of the income based premiums on Medicare B. That's why I suggested it as an example for a single payer plan - AKA Medicare for all. In other words, cost of coverage would be income based.

chase, I agree that would be a reasonable option in some cases. It could to be like SS tax, where employer pays part, employee pays part, and if you are not a W2 employee, you pay the full cost as part of your income tax. Family coverage would have to be part of the deal - so all children were covered.


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maifleur01

If you do not understand pre-existing conditions and the ramifications of them you probably do not understand what a pre-existing condition is. You probably have one or more from some injury or illness that you had perhaps when you were a baby but they just have not bothered you. Yet. Everyone has something that can cause problems years later that seemed to be minor at the time it happened.

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maifleur01

I can see that elvis has not looked at the regular federal vs postal employees insurance rates for quite some time if the comment about paying 76% as is believed by elvis. Postal employees pay less than federal employees for their health insurance if you look at the rates. As an example my plan if it was bi-weekly is $69.34 a postal worker bi-weekly is $57.55. I do not know what retired postal workers must pay because the monthly rates are not shown.

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rob333 (zone 7a)

mai, if you mean me, I totally understand what pre-ex is. We're NEVER going to get to universal coverage as long as this thought process exists. I know. Thinking outside of the box, get rid of a longstanding issue that benefits insurance carriers. But there you go. It's what I think. It's a part of the problem.

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numbersjunkie

rob, I read your post as saying we definitely need to get rid of pre-ex. I think you are dead on.


Many on the right seem to have a problem with this, and think everyone should pay their "fair share" (those with higher claims should pay more). It makes no sense to me, since anyone at any time could find themselves in a medical crisis that would bankrupt anyone. You can't predict who this might affect, and so you can't charge ahead of time. The costs are so high if it happens, you can't charge enough for it after it is known. Trying to make premiums reflect the risk leads us down a rabbit hole that is not productive.

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carolb_w_fl_coastal_9b(zone 9/10)

Many unfortunate people cannot afford to pay for ANY health care now.

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Stan Areted

So why can't many people pay for their own healthcare policies?

Has anyone asked the question?

The question WHY they don't have the money?

It is obvious why some don't--tragedy, deaths, unusual circumstances.

The fact is we wouldn't have so many people on the health dole if more people made better decisions and got jobs and bought their own health care policies.

It happens, you know.



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sunflower_petal(5a)

"The question WHY they don't have the money? "

Because they are paying for food, rent? Wages at the bottom haven't even kept up with inflation while healthcare costs have exceeded inflation.

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chase_gw

Stan ignores the fact that for many of us our basic lifestyle demands a supply of lower wage employees. We need restaurant workers, hotel employees, lawn care people, baby sitters, grocery shelf stockers, checkout clerks, department store clerks, parcel delivery...on and on. To pay them a wage that allows them to buy healthcare insurance, educate their kids and plan for retirement is fine me...is it fine by you?

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numbersjunkie

I agree with sunflower and chase and just want to add that think the question Stan asked is really beyond the scope of this healthcare discussion. It's not really a healthcare issue at all. Its a much bigger issue.


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Stan Areted

Oh yes, it's a much bigger issue.

I agree--it's COST of services and treatment that is the problem.

People used to barter for operations, paid in cash.

A doctor's visit was $30 to $40 just thirty years ago.

Government got involved and the costs are transferred to those who actually have money pay.

Too many people totally ignore their own health care situation and when they get sick, hurt, or have a very serious illness, they present themselves to hospitals that have to take them and treat them, very often with having no thought or plan in place.

This behavior is now commonplace and I doubt it can be reversed.

Socialism by neglect of responsibility.


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numbersjunkie

Too many people totally ignore their own health care situation and when they get sick, hurt, or have a very serious illness, they present themselves to hospitals that have to take them and treat them, very often with having no thought or plan in place.


Oh Stan, I'm so sorry not everyone is as perfect as you - no vices, no inherited heath issues, money in bank to cover any possible health emergency. You strictly follow the Mediterranean Diet, exercise regularly, avoid stress (except for hanging around here on this site). You never exceed the speed limit, get 8 hours of sleep every night (no more, no less). These other people, they let their health go to hell just to spite you! To hell with them!

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AnnKH

Part of a solution could be employers paying a payroll tax into a
universal healthcare option rather than handling health insurance for
their employees. It breaks the tie to employment, lowers the cost for
the employer and helps reduce the costs for the taxpayer.

Exactly! Everyone whines about where the money is going to come from for single-payer - we already have businesses paying billions of dollars in health insurance premiums for their employees. If those same funds were paid into a federal health care fund, eliminating the middleman of the insurance companies (and their profits), those funds could go a long way toward covering the costs of health care for everyone.

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patriciae_gw(07)

Part of Stans crisis is the difference between care today and care in the past. Cancer treatment is a good case in point. There was only surgery of a sort in the past for some sorts of cancer and that was that. Usually you died. Today you can live a surprising amount of the time if you can afford the improved surgical techniques and the Chemotherapy and today Biologic treatments that are literally life saving but Oligarch expensive. Medical intervention not even dreamed of fifty years ago saves lives daily but it costs. Do you only get to enjoy the benefits of care if Stan approves of you? Do you have to prove that your medical fiasco isn't your fault. People trying to convince insurance companies that their problem is not pre-existing haven had much success in the past so I don't think you can prove that having eaten French fries when you were ten did not cause your problem.

I had a friend when I was a child who was dying of kidney failure. This was before dialysis or Transplant. I assume she died. No one told me when she was moved away. When Dialysis became available shortly afterwards in the early 1960's it was so breathtakingly expensive that the federal government created a special medical system to cover it. Just for people with kidney failure. What happened to that sort of thinking?

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chisue

Yes, there have been HUGE advances in treatments for all kinds of medical problems. There was *nothing* for most blood cancers until about 15 years ago. My mother died of one 40 years ago. When I was diagnosed with (a different) one last year, I was astounded to see *a choice* of treatments to get me into 'remission', and another medication to keep me alive afterwards.

It is dscouraging to learn that my new oral med, Revlimid, will cost me $1300 a month under my Aetna Part D Medicare plan. (Retail is $22K.) My just-completed medication, administered in a hospital clinic, was 100% picked up by Part B Medicare. I still object strenuously to the pharmaceutical manufacturers charging astronomical retail amounts for these drugs. Both of mine have certainly earned back plenty of R&R expenses after more than ten years on the market. Evidently, rather than reduce retail, drug manufacturers have some programs to reduce what the patient must pay; I will be finding out about that in the next week. I can see why they don't want to reduce the retail when Medicare was willing to pay $10K a week for my first drug (Velcade). A *shame*.

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sunflower_petal(5a)

In addition to all that, consider the huge cost in medical malpractice and the many CYA procedures being done. Doctors are scared to death (meanwhile fewer of us are dying because of their malpractice so that's a plus).

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tryingtounderstand

“Too many people totally ignore their own health care situation and when they get sick, hurt, or have a very serious illness, they present themselves to hospitals that have to take them and treat them, very often with having no thought or plan in place.” For arguments’ sake, some of this is true. But to cover all those without health care insurance as ‘neglectful, irresponsible etc. Is not accurate.

Hence, the question? Is healthcare an innate right or privilege?

Not everyone is born physically or mentally healthy. Do these individuals not have the right to quality healthcare care services? What if your employer based plan is not enough to cover catastrophic health care for your entire family, ex. Case if horrifc MVA. Or other serious health issues, faced by different members in the same family.

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

"Socialism by neglect of responsibility."

More like caught in a poverty trap!

Not a big winner in the Genetic Lottery? Then it is bit difficult to afford Health Insurance on Minimum wage type Job income.

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Rita / Bring Back Sophie 4 Real

The amount of money that health care costs our economy is what it is, as they say. By organizing the way we spend it more rationally, the total number can only go down. An increase in taxes is a no-brainer if that money is offset by a savings in insurance payments by us and our employers (hint, our employers do not gift us this benefit, we pay for it too with decreased wages and lowered headcount/hiring.)

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floral_uk z.8/9 SW UK

I think that numbersjunkie's article overemphasises the importance of private health insurance in the U.K. Although advertising has conned a small minority of people into buying it, it has many drawbacks. It is expensive, does not cover chronic conditions like diabetes or difficult conditions like cancer and it gets costlier as one gets older. Whenever anything unexpected arises in a private facility you will be returned to the NHS to sort it out. Private facilities often lack the resources to deal with complications. They'll call an (NHS) ambulance and you'll be sent back to the NHS system pronto. Basically all private insurance gets you is a fancier room and perhaps quicker treatment for things like straightforward elective surgery.

A friend of mine was diagnosed with pancreatic cancer before Christmas. She was receiving chemo within a week and her latest scan shows progress. I cannot begin to imagine having to wrestle with insurance whilst undergoing that kind of stress. I don't have cancer and have never needed hospital treatment, other than for producing the kids, but I am proud to know that my taxes and national insurance contributed to my friend's care and to the care of anyone else in my country who has the misfortune to fall ill, from the drunk on the street corner to the Prime Minister. The unfeeling 'I'm alright and if you're not it's your fault' attitude appals me.

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marquest(PA zone 6)

How many pre-ex could be covered if we cut the executives.

-------------


Health insurance CEO earned $342.6M in 2017

Most CEOs in the insurance industry earn higher incomes working for larger companies. For example, CEOs in some of the largest insurance companies -- Cigna, Humana, Health Systems, Aetna and Wellpoint -- earned average incomes of $10.9 million, according to the latest data from Creators Syndicate. The $10.9 million average includes both salaries, benefits and stock options for these top insurance company executives.

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bry911

How many pre-ex could be covered if we cut the executives.

A very small amount. Notice your article says, "The $10.9 million average includes both salaries, benefits and stock options for these top insurance company executives." Stock options, which account for more than 80% of executive pay at insurance companies, are not paid out of revenues. They are bonuses paid from shareholders to executives, thus are not collected from customers.

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