Ending For-Profit Health Insurance

[20thStDad]

This is an interesting conversation, I hear a lot of ideas I like. I'm with the one about the government putting some regulations and oversight on things. The insurance companies just keep increasing costs and being dropped by health providers, it's not getting any better.

I don't know if I would use the UK as any good example - the people I've talked to about it say it's horrible, they still spend a ton on private insurance and their options for care are crap. So many go out of the country to do things, according to the few I've talked to.

[TheNiche]

Not anymore. Many posters on this board are getting ready to vote a United Steel Workers member into the Vice President's house. Now, unions are good.

Are you trying to be funny or serious?

[Overseas]

what makes Australia any different than what the USA has now......with the exception that people in the USA end up with an unenforceable blemish on their credit record that will not prevent them from getting credit for any consumer good they wish

also as for the tort reform not getting rid of bad doctors.....it seems lil johnny edwards and his lawsuits did not get rid of them either.....it just made insurance more expensive for all the good doctors

We do have something similar in the US - also called Medicare. Everyone over 65 has insurance provided to them. If you want more services, you can get more - if you pay. But if you can't afford extras, you won't be denied health coverage. There is more a focus on cost containment in the Australian Medicare, which is why, if you feel it necessary, it is possible (and in fact encouraged) to also obtain private insurance.

Why should someone who earns $15,000 a year - say, a farm worker - be condemned to die from a disease because they can't afford insurance? So either we as a society think their life isn't worth anything, or we do something about it. Considering we are currently starting to bankrupt ourselves with our current system, and don't even cover everyone, I'd say we have a serious issue that we need to address. Alas, we have a political climate that seems to think dicussing Paris Hilton and moose hunting is a valid way to decide the future of the nation.

[Overseas]

This is an interesting conversation, I hear a lot of ideas I like. I'm with the one about the government putting some regulations and oversight on things. The insurance companies just keep increasing costs and being dropped by health providers, it's not getting any better.

I don't know if I would use the UK as any good example - the people I've talked to about it say it's horrible, they still spend a ton on private insurance and their options for care are crap. So many go out of the country to do things, according to the few I've talked to.

Just to clarify - I wasn't necessarily holding the UK out as a good system. On a macro-economic level, it may be - they seem to get more bang for the buck, so to speak, based on a comparison of results (life expectancy, survival rates) etc. versus money spent. But they also have a large number of horror stories, wait lists are a serious problem, and certain areas you definitely don't want to just rely on the NHS (cancer has long been a real weakness).

Such a system is wholly unsuited to the US. But I do think it interesting that the seemingly most efficient health care system in the developed world (based on return on the dollar) is the one that is the most socialized.

[RedScare]

Are you trying to be funny or serious?

What's funny about it? The VP acceptance speech giver proudly announced her husband's membership in the USW. In fact, according to John McCain, she was a union member herself. Since you are posting the campaign sticker in your sig, one must assume that you support her and her husband's union membership.

[Subdude]

I don't know if I would use the UK as any good example - the people I've talked to about it say it's horrible, they still spend a ton on private insurance and their options for care are crap. So many go out of the country to do things, according to the few I've talked to.

I would agree that there are a lot of complaints about delivery and execution, but the overall concept of a national health service has always been popular. It is considered the keystone social benefit. No politician would ever advocate a US-style privatized system that is tied to employment.

[RedScare]

I would agree that there are a lot of complaints about delivery and execution, but the overall concept of a national health service has always been popular. It is considered the keystone social benefit. No politician would ever advocate a US-style privatized system that is tied to employment.

Germany's system is similar to that. But, unlike the US, Germany has strict rules on what the employers are required to offer, and what the insurance must cover, rules that I believe would improve our patchwork system.

[TheNiche]

Since you are posting the campaign sticker in your sig, one must assume that you support her and her husband's union membership.

Not only is that ridiculously illogical, but you might want to actually read the sig. I don't really expect McCain to be a good president but I'm voting for him anyway. If I only voted for politicians I believed in, I wouldn't vote nearly at all.

As for Palin, that she's touting any kind of connection to a union as something to be proud of is disgusting to me, personally. I dislike her immensely and my fingers are crossed that McCain remains in good health.

[HTX]

"The insurance companies may be wonderfully efficient but the hospitals and doctor's offices who deal with these companies are forced to waste huge amounts of time and money conforming to differing requirements of HUNDREDS of different insurance carriers.

It wouldn't be a bad idea for the government to step in and make all the insurance carriers and all the providers adopt a single standard. That would eliminate a lot of waste right there."

To a large degree the Government has already standardized health care through the use of DRG and CPT coding. Initially designed to reign in Medicare and Medicad's soaring costs the system is now used by the entire industry to determine reimbursement for any diagnostic and or treatment. The problem is with the bewildering number of insurance companies and plans. Think HMO/PPO, in network out of network, as examples.

A few years ago there was an effort to pass "any willing provider" laws. If for instance Humana had a negotiated deal to pay all of the doctors in their network $500.00 for a heart transplant or wart removal and a doctor not in the network was willing to do it for that price they would pay the claim. The insurance companies were dead set against it and used their lobby to quash it. It's that carving up of the providers by the insurance companies that create the headaches in physicians offices but simplify the paperwork for the insurance company. It's is really pretty much the same at the hospital level.

[jm1fd]

To a large degree the Government has already standardized health care through the use of DRG and CPT coding. Initially designed to reign in Medicare and Medicad's soaring costs the system is now used by the entire industry to determine reimbursement for any diagnostic and or treatment. The problem is with the bewildering number of insurance companies and plans. Think HMO/PPO, in network out of network, as examples.

A few years ago there was an effort to pass "any willing provider" laws. If for instance Humana had a negotiated deal to pay all of the doctors in their network $500.00 for a heart transplant or wart removal and a doctor not in the network was willing to do it for that price they would pay the claim. The insurance companies were dead set against it and used their lobby to quash it. It's that carving up of the providers by the insurance companies that create the headaches in physicians offices but simplify the paperwork for the insurance company. It's is really pretty much the same at the hospital level.

Standardized coding is a step in the right direction, but doesn't even come close to simplifying things. As you've said there are a gazillion different plans from any one insurer, and myriad different requirements for determining if something is covered or not, what the copay is, etc. Moreover, most insurers don't even have online systems for providers to query to determine what is or is not covered, and what the copay might be. They have to pick up the phone and call the insurance company and ask a human, and a lot of times they'll get different answers depending on who they talk to. If the insurers do happen to have an online system for this then the interface requirements are different for every company, and usually the information isn't 100% up to date. In this day and age that is inexcusable.

[Overseas]

Standardized coding is a step in the right direction, but doesn't even come close to simplifying things. As you've said there are a gazillion different plans from any one insurer, and myriad different requirements for determining if something is covered or not, what the copay is, etc. Moreover, most insurers don't even have online systems for providers to query to determine what is or is not covered, and what the copay might be. They have to pick up the phone and call the insurance company and ask a human, and a lot of times they'll get different answers depending on who they talk to. If the insurers do happen to have an online system for this then the interface requirements are different for every company, and usually the information isn't 100% up to date. In this day and age that is inexcusable.

Not to harp on about Australia, but when I go into a health care provider for a service that isn't covered by Medicare (the gov't insurance) - for instance, buying eye glasses, or a therpeutic massage, I hand them my private insurance card, they put in into a machine similar to one used for a credit card, and it automatically pays the provider what my policy will pay, and I just have to pay the difference. All the insurers are on the same IT system, and it is all automated.

So they can automate it all, and make it all interchangeable. I agree it is inexcusable.