"Health Insurance Isn't All It's Cracked Up to Be"

[NHB_MMA]

It is amazing that Stossel is still on ABC and some of his pieces are pretty entertaining, but he gets ridiculous with some stuff too. This is the guy that talks about how gasoline prices of last year where a bargain in 1981 dollars (a Limbaugh line) as if that means anything in terms of what sharp price increases will do to an economy. In this article, he makes some good points, but some of his points are flawed too.

"Nearly eight in 10 favor a federal requirement that all employers offer insurance to their full-time workers. Nearly two-thirds favor such a requirement for part-time employees as well."

Of course this is going to be a popular notion because, for better or worse, a large percentage of our population has become accustomed to having their healthcare paid for.

Employer paid health insurance isn't free. It just means we get insurance instead of higher salaries.

Of course. But you'll never convince me if we went to a system of buying it ourselves that most companies would pay the difference in salary. If the average cost is 8K per family, many companies would say "We're giving you a healthcare credit of 3K since the laws have changed" and pocket 5K. Hell, the cheap SOBs I've been working for would pay absolutely nothing and see how many people would stay. You'll not convince me the consumer would not take a hit on this one.

People have gotten so used to having "other" people pay for most of our health care that we routinely ask for insurance with low or no deductibles. This is another bad idea.

As for deductibles, both at my current job and the job I'm moving to the HMOs with low deductibles cost less than the traditional plans with high deductibles, although they ARE true traditional plans with the ability to use any doctor. I don't know anyone that chose the more expensive plan. No one has "filled his shopping cart with lobster and filet mignon" when it comes to the healthcare choices I've seen".

Suppose car insurance worked that way. Every time you got a little dent or the paint faded, or every time you buy gas or change the oil, you'd fill out endless forms and wait for reimbursement from your insurance company. Gas prices would quickly rise because service stations would know that you no longer care about the price. You'd become more wasteful: jackrabbit starts, speeding, wasting gas. Who cares? You are only paying 20 percent or less of the bill.

That's a good point. I do think people use doctor visits and rely on prescriptions for routine minor sicknesses far more than they used to.

In the few areas where there are free markets in health care — such as cosmetic medicine and Lasik eye surgery — customer service is great, and prices continue to drop.

True, but I know I can't afford Lasik and many others cannot either. With Lasik we're just talking about one procedure. How could we expect most people to realistically pay for every medical procedure this way? So Lasik has dropped from about 5K to less than 2K. If that 250K long-term hospitalization drops down to 100K, it's still 100K that almost no one could afford to pay.

This is not to say that we don't need insurance. We need it to protect us against financial catastrophes that could result from a stroke or heart attack. That's why health savings accounts, which cover smaller out-of-pocket health expenditures, are paired with high-deductible catastrophic insurance.

I agree with the concept, but I don't think people are ready to accept 5K-10K deductibles that some set up with HSAs. Would it be a good start to move to 1K-2.5K deductibles?

In other terrifying news from the poll: "Three-quarters like the idea of expanding Medicare, the government program that covers retirees."

That is bad. We've been expanding Medicare at a time when it's in financial trouble.

As far as the cause of higher health costs, the public's biggest suspicion is profiteering by drug and insurance companies — 50 percent call this one of the single biggest factors.

It IS a concern to a point, but most people beat it to death. But the actual costs of lawsuits are often overexaggerated too.

Finally, the worst news on the poll is that "56 percent support a shift to universal coverage."

I don't want universal coverage, but I could deal with it as long as we have an option to purchase supplemental coverage. I don't now if there has been a noticeable difference yet, but I imagine the Canadian system will improve now that the government has allowed private supplemental coverage to compete. Again, it's not what I want to see happen.

The ABC poll says that while most people want universal coverage, "far fewer, ranging from 15 to 26 percent, think such coverage would actually improve the quality or cost of their own care, the availability of treatment, or their choice of doctors or hospitals. Indeed by 2-1, people think universal coverage would make the quality of their own care worse, and by better than 2-1 think it would worsen their choice of doctors or hospitals."

No doubt it would. People just feel sorry for folks like my one friend that had no health insurance (he was financially struggling as a diner owner and was uninsurable--healthwise) and ran up a 90K hospital bill when he got accidentally shot during a hunting trip and had to eventually file bankruptcy.

 

[James]

Employer paid health insurance isn't free. It just means we get insurance instead of higher salaries.

Of course. But you'll never convince me if we went to a system of buying it ourselves that most companies would pay the difference in salary. If the average cost is 8K per family, many companies would say "We're giving you a healthcare credit of 3K since the laws have changed" and pocket 5K. Hell, the cheap SOBs I've been working for would pay absolutely nothing and see how many people would stay. You'll not convince me the consumer would not take a hit on this one.

I suppose your not a student nor a believer of free markets, lazaire affair economy?

 

[midwestbroker]

I am a Stossel fan since he takes a different view of a lot of issues. I think that we need that, rather then the doom and gloom of most media. If you get all your information from one source, how do you know it is right?

But most people hear 1/8th of the story, and it must be true since I heard it on the news. Then go to the kitchen, open a 2 liter of coke, eat a hoho, and have a cig while they complain about healthcare costs.

They spend more time taking care of their cars then they do themselves. Oil change every 3K miles. Walk everyday, heck no! American Idol is on!

 

[NHB_MMA]

I suppose your not a student nor a believer of free markets, lazaire affair economy?

To a point. The world has changed considerably since our forefathers hopped off the Mayflower with almost nothing to their names, fortune enough to survive the voyage. Am I a capitalist? Absolutely. Do I favor reasonable measures to keep the capitalist system from a situation where some people will screw others? Absolutely, because some will.

What is a free market? Is it a free market when an American worker has to compete against somebody working in unsafe conditions in a third-world country getting paid 25 cents per hour? If it is, then why stop there? Maybe we could go beyond having everything we buy being produced in China and Vietnam. We could start opening commerce with North Korea. Think about it. We send over a little money to Kim Jong Il and he can feed his troops and maybe he'll quite down on the nuclear thing for now. At the same time, now instead of our shirts and hats being made for 25 cents per hour, they can be made for absolutely nothing--by political prisoners. When the family run hardware store has to close the doors, but the dancing yellow smile shows another "rollback" on prices it all makes sense. I mean, where does it end? I'm waiting for the day when some of the worst corporations figure out how to get past the racial issue and lobby for repealing the 13th Amendment. Maybe folks like myself that try the American dream and fail can provide free labor for the fat cats for having to file bankruptcy? Here I sit typing on this computer and to think--I could be in debtors prison making shoes for you all. :wink:

 

[NHB_MMA]

Back to the health insurance issue, now that I just had my fun for the day.

If you were to put the consumer back in control of healthcare costs, the only sensible way to do it would be to make large pools of risks that a person could choose from. Individual health plans have their own pitfalls. Look at many of the exclusions in an individual health plan.

When I purchase my own hospitalization plan right out of college, under the questions about sports and activities, I disclosed that I played recreational ice hockey. I got a call from underwriting asking all kinds of questions about it and when I explained that it was a non-checking league, they finally put it through. If I were playing in a men's league that was full-contact like people can find in Detroit, Toronto and other hockey cities, I would have been declined for coverage. I used to have a neighbor that would race motocross on weekends throughout high school and college. He would have been declined for coverage. If I were 10-15 years younger, I would be actively studying MMA for health and fitness if not competition at some level--and, again, most individual health plans wouldn't touch me.

The beauty of group health insurance, from a consumer standpoint, is the inability for those plans to deny many claims the individual plans can in fact deny. Most individual plans have a clause that says they won't pay if I'm injured doing anything illegal. When I sold for NASE years ago, agents would look at the client and say "Now, you can't rob any banks and expect us to pay for your injuries". Cute, but how far will the individual companies take this? In PA, it's illegal to posess or detonate fireworks, but I have had some backyard firework shows over the years. If something would have happened and I lost a finger, my group coverage would have to pay for those expenses, but individual medical would likely deny the claims. Individual medical generally excludes paying any claims while under the influence of alcohol or non-prescribed drugs. What standard do they use? If I trip on the church steps after a communion, are the worst of the companies going to say I was injured after drinking wine? Do they use the legal standard of .08, which was recently lowered from .10 (for better or worse)? Minors have a BAC of .02 instead of the .08 for legal intoxication, for no other purpose than trying to nail them with additional legal penalties. So if I have a kid that drinks a very small amount of alchol and is clearly NOT "intoxicated" but coincidentally gets injured, am I liability for the medical bills? Last, the biggest pitfall I see is the maternity benefits typically being separate from the main policy. This is fine in some situations and it's fine if the client totally understands it, but it leaves no coverage at all for the teenage daughter that gets "knocked up" and we all know this sometimes happens. You mean I have to take care of some kid in my house when I thought I was through with changing diapers and burping babies and pay another 10K to 15K or more in medical bills? :x

John has often pointed out some pitfalls of group insurance, such as you're at the mercy of your employer when it comes to the design of the plan, it can be changed at any time, and it costs more. But that's pretty much where it ends. Group plans beat individual all day long when it comes to claims paying. This doesn't mean I wouldn't sell individual. Individual is cheaper and can be customized and is a wonderful product, providing it fits the needs of the individual and the consumer understands the limitations and exclusions such as I mentioned.

The whole point is that if we want to put consumers back in charge of healthcare, group plans are the model. Consumers should be able to choose from HMO style coverage, HSA plans, POS, etc. and make the choice with their dollars. The answer is not to trust employers to pay their employees more and then have everyone scrambling for an individual Golden Rule, Unicare, or Assurant plan, even though that would be some serious $$$ for guys like John and STI and many others here.

 

[midwestbroker]

Ok, we have gone way over the top here.

The wine in church example is a bad one. That is like saying if you eat one of Grandma's rum balls you are going to get a DUI. If you blow your fingers off on the 4th you are on your own. I do not want my premium going up becuase you cannot judge a fuse (if we were in the same pool). There should be a "we do not cover the following procedures be cause of your lack of intelligence" section.

 

[Golddoor]

Back to the health insurance issue, now that I just had my fun for the day.

plan.If you were to put the consumer back in control of healthcare costs, the only sensible way to do it would be to make large pools of risks that a person could choose from. Individual health plans have their own pitfalls. Look at many of the exclusions in an individual health

When I purchase my own hospitalization plan right out of college, under the questions about sports and activities, I disclosed that I played recreational ice hockey. I got a call from underwriting asking all kinds of questions about it and when I explained that it was a non-checking league, they finally put it through. If I were playing in a men's league that was full-contact like people can find in Detroit, Toronto and other hockey cities, I would have been declined for coverage. I used to have a neighbor that would race motocross on weekends throughout high school and college. He would have been declined for coverage. If I were 10-15 years younger, I would be actively studying MMA for health and fitness if not competition at some level--and, again, most individual health plans wouldn't touch me.

quote]



Hey Bro,

You actually admitted that you played hockey on an app? Even if you had an injury you could just say that you wasn't playing when you applied for insurance but you have started playing since. If there is no exclusion for sports related activities then they cant deny payment. I have raced Motocross professionally and I also train and compete in JuJitsu,Kickboxing and wrestling. Insururers nightmare huh? I have had both group and individual health coverage for this whole time with no issues. One would not even mention the fact that they do any type of physical sport or activity when applying for coverage. I quit counting the injuries I have received from both of these sports a long time ago. But when I get injured, I also don't tell that its from any of these types of activities. I either claim I got hurt falling from a bicycle or I have even said that I fell off a porch and a ladder. Works for me!!

Golddoor

 

[arnguy]

I believe NHB_MMA made a convincing argument for group coverage when and if available. But Golddoor appears to be condoning omission of important facts or even worse falsifying claim information. That's not a good role model for a professional insurance agent. For shame, Golddoor! Furthermore, in PA all health apps must contain a fraud clause which can be used to prosecute the applicant for any false statements (assuming, of course, they can be so proven).

 

[Golddoor]

I believe NHB_MMA made a convincing argument for group coverage when and if available. But Golddoor appears to be condoning omission of important facts or even worse falsifying claim information. That's not a good role model for a professional insurance agent. For shame, Golddoor! Furthermore, in PA all health apps must contain a fraud clause which can be used to prosecute the applicant for any false statements (assuming, of course, they can be so proven).

:lol: OHHHH SHAME ON ME@!!!! LOL

And I never falsified any claim info. I told that to the Docs at the emergency room so thats what they put on the claim and med records. not me!!!!! GET IT????? :?

"assuming, of course, they can be so proven"
Yea good luck!!

 

[NHB_MMA]

The wine in church example is a bad one. That is like saying if you eat one of Grandma's rum balls you are going to get a DUI.

Yes, that was admittedly an exaggeration. I cannot imagine a company actually trying to get out of the church communion thing, but the point of the exaggeration is that there might be times when SOME companies would look for anything they could to keep from paying out.

I do not want my premium going up becuase you cannot judge a fuse (if we were in the same pool). There should be a "we do not cover the following procedures be cause of your lack of intelligence" section.

Accidents happen, regarding fuses. That's why the tell you to NEVER hold it and throw it, even though I've done it with regular firecrackers on occasion. I have seen some fuses burn far faster than normal.

All I'm saying is it's a risk to the consumer that does such thing and never thinks about how it might impact any potential injuries. The "hazardous activities" clause is much more potentially damaging. Individual policies have their place and they are great for a large number of people. I know many folks, particularly as they get into their 30's, 40's and beyond, that will never do anything more hazardous than watch the National Geographic channel for an evening. But for the younger, athletic, daring, or spontaneous kind of person this can be a legitimate pitfall of individual policies.

Again, the whole point is just that we cannot trust employers to pay extra salary and all go running for individual policies. True group insurance plans would have to remain for consumer shopping to ever be successful.