What are your thoughts about health care insurance? Should a healthy person with substantial financial resources be forced to participate in a health care insurance plan to provide additional money in the pool of premiums from which medical claims are paid?

Good question, Matt? I am against unnecessary rules and regulations and feel too many of our personal choices are already being eliminated; therefore, I do not feel some one should be forced to carry medical insurance. But I can't imagine anyone not wanting to carry coverage as one medical incident would cover the expense of the premium. If one can afford the premiums, it would seem a no brainer to carry med ins.

You make a very good point, Kathy. I was thinking about charities and things like company annual United Appeal drives where employees are encouraged (and often coerced) to contribute for the benefit of needy and less fortunate people. United Appeal has had a history of paying its executives and high-level employees (usually Republicans) very high salaries for very little work. Years ago I volunteered to head a local United Appeal drive, I was paid nothing for many hours of work. When I looked at the records for what I and my committee collected in donations, I found that most of the money came from the average factory and office worker, who were mostly Democrats. Very little money was collected from owners of small businesses and wealthy people, who I later learned were mostly Republicans. Does politics have something to do with donations to charitable organizations like the United Appeal, the Red Cross, etc.? Does politics have something to do with health care insurance companies and health care providers? It seems like it.

Matt, I don't think being a Dem or Repub has anything to do with charitable contributions. Income levels and type of job, people you come in contact with and church affiliation might be more of an influence.
I, having all my kids holding graduate degrees and being PhD.engineers and MDs, find that how hard they had to scrimp and save to get where they are is more of an influence. Takes a lot of money to go through college these days. Many of today's college grads have no patience for the cry babies and those not willing to work hard towards their goals. People wanting a handout bugs them.

Again, when discussing charitable donations, I want to make my own decisions. I was employed by a large ins company for 30 yrs...and for 25 of those yrs the employees were strong armed to give their "fair share" to the United Way. They kind of loosened up a bit after the big United Way embezzelment. I always resented those tactics. I don't like being forced to do anything and United Way split the $ with some causes I would never financially support. In retrospect, I think it was all a political ruse in order that the company would look good on paper and get a plaque to hang if they got 100% participation.

Another problem: when looking into a cause to support is to determine the actual amount of $ that goes to the overhead (salaries, etc) vs. the amount going to the stated cause.

I want to retain my freedom to choose how I spend my charitable donations.

Tom, I disagree with you regarding the state of our economy. There has been an increase in food prices, shipping charges etc because of the price of oil. I don't believe the unemployment figures as I believe a lot of people have fallen by the wayside of the statistics. However, I do not believe the government's bail out program is going to accomplish what the politians hope. John Q Public is going to apply the money towards outstanding bills and the necessities such as food and medicine. And where is this excess $ coming from?

Tom (Tom):
"I leaned towards the Dems views when a lot younger and gradually began to move towards a more conservative view."

Hmmm, sounds kinda familiar:

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Quote:

"Any 20 year-old who isn't a liberal doesn't have a heart, and any 40 year-old who isn't a conservative doesn't have a brain."

-Winston Churchill

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Tom makes some very good points however biased in favor of academical and egalitarian views of the U.S. economy and related subjects. His children's education and achievements are not unique in the Midwest.

There is no doubt that politics plays a role in how the health insurance business is run; that has been made quite clear by recent years exposure of the health insurance companies lobbyists activities in Washington D.C. and in midwestern state capitals.

I agree with Kathy P that firms should not be able to pressure employees to donate to a cause that the upper brass have determined is good. When pressured at my college to give to United Way I just told the "collectors" I don't want to give to certain agencies and will give directly myself. They left me alone. My corporate experience from years ago was the same as Kathy P's. Strong arm tactics.
The comment on prices of food, etc., rising is reflected in the inflation rate once the cost of oil and gas has been removed. And while we think things have jumped it isn't as bad as we are coerced to believe in the media.
When watching the TV news listen for the key words. Could, might, would, etc.
Unemployment is a regional thing. The national statistic does not show the problem in Michigan or California or such.
Economies always fluctuate. They are called business cycles. Good time followed by bad times.
Can't be stopped nor can/has anyone ever predicted when the changes will occur. Most data is after the fact and thus problems don't catch our eye until they are well on their way.
Enough

You must be careful to not get me started on leading, coincidental, and lagging indicators of the economy. Using these indicators is how economists try to determine where we are going. There aren't very many gurus like Alan Greenspan or Milton Freidman these days. Very independent of politics.
Even Greenspan used to make Reagan worry but he couldn't make him change because the Fed is independent of the President and Congress. Note that we had a long period of growth and stability when Greenspan ran the Fed. But people grow old and must retire/leave.

Does anyone have more to say about health care insurance and health care providers? Is anyone participating in this discussion receiving civil service retirement benefits and can discuss Federal health care insurance programs?

Canadian healthcare myths exploded...now here's a fascinating article...Part 1...everyone should read this
Mythbusting Canadian Health Care -- Part I

I am waiting for comments on the health care issue now that the president has made a plea to Congress.
Seems it will be mandatory insurance as the very first comment/question on this page suggested.
I am wondering why the insurance industry isn't considered competitive with some many different firms? If they are in collusion there are laws against that.
I cannot imagine the govt providing health insurance at a cost lower than the market. Perhaps initially it might but with all those govt employees getting pay raises, etc., it would seem very doubtful So what is this whole exercise about????

I think they will use that one southern state, I believe it may be Alabama, where just one company holds something like 95% of the health insurance business, as the prime example of why other options are a necessity. Is there something wrong with that state's laws? Probably...

I know that people who are self-employed, over 50, but not eligible for MediCare yet, who have pre-existing conditions have problems with health insurance, here in Michigan, and I assume that may be similar elsewhere.

Changes to the system need to be made for the above group, at least. In addition, I think that health insurance needs to be available on a national basis, not state by state. For instance, I heard that the same coverage in New York state is double the cost of that in Pennsylvania.

One of the really scary things is that the proposed health insurance coverage is not supposed to begin to take effect for at least 4 years, and the true costs of the changes won't kick in until later than that.

I learned a bit about health insurance when I was last laid off, and chose to hang up my spurs and take the opportunity to retire early.

Oh yes, I was able to continue on my employer's health insurance plan, thanks to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) — for 18 months, at my own expense, paying both the portion paid by employees and any portion paid by the employer, plus a 2% administrative charge. Not a cheap proposition, especially since I was just laid off, with only a small period of salary continuation. This included a very rigorous payment schedule as well, and doncha know, if you miss just one payment, even by just a day, your COBRA coverage is gone, with no reinstatement options!

At the end of the 18 months of COBRA coverage, I had to have a certificate of coverage (demonstrating continuous unbroken coverage) in order to obtain a private health care policy without a "previously existing medical conditions" exclusion, as a "bridge" (until attaining Medicare eligibility).

Since I had already had a heart attack on the company's insurance, and back troubles from a long ago pair of ruptured lumbar disks, among other previous medical conditions, falling into a "previously existing medical conditions" exclusion was clearly not a viable option!

From that experience I can at least appreciate that part of Obama's plan that prevents the private insurance companies from denying coverage for any "previously existing medical conditions"!

Currently healthcare insurance premiums differ in the states because of different costs of providing the care.
A doctor's fees (office fees) must be high enough to pay for all the support staff in that office. All of them including custodial. The more staff to provide the various tests add up fast. On top of that the doctor needs compensation to keep him/her interested in continuing to give care.
The report from DC today on prevention care showed no improvement in health of consumers with more prevention care. For someone who has practiced prevention care (as a user) I found that a bit depressing. What I learned over the years about keeping fit added up to zip? Hard to believe.

Tom's comment, "What I learned over the years about keeping fit added up to zip?" apparently applies to many people. However, I and some of my close friends have kept physically fit since we were in our 30's and now at age 70+ we are still physically fit; we take no meds, our EKG, BP, glucose, and cholesterol are normal. We see a doctor once a year or less often.

Several other things that I think continue to help us to stay physically fit are; we retired as soon as possible before age 65, we don't exercise excessively, we never did smoke nor abuse alcohol and still don't, we eat nutritious, well-balanced meals at least three times a day. We pay very little attention to the radical right-wing and left-wing talk-show hosts and politicians, and we attend church regularly.

One more thing several of us did to stay healthy; we ended bad marriages and/or personal relationships when we became aware of their adverse effect on our health. Many years ago my doctor warned me that "bad marriages are killers".

Matt you sound a little selfish you ended your marriage because it was better for your health. Than you were not serious when you got married.Remember "FOR BETTER OR FOR WORSE"??We have had ups and downs to but still married after 53 years, health is great.

Zube, you make a good point but the selfishness was my ex-wife's affliction, not mine. I see no reason for any broken marriage to be made to last "for better or worse" when both husband and wife, and children-if there are any, are suffering more than is healthy and sensible. Ideally, couples should learn if they would be unequally yoked before they marry. Absent such a learning period, I believe there is a great risk for a broken marriage.

i would rather see a totally government run healthcare program that provides healthcare for all AMERICANS ... and to be blunt, that doesn't include ILLEGALs.

Make healthcare a RIGHT.

Just think how this would free up businesses and would also allow a lot of people to start up a small business without going broke trying to provide insurance or healthcare benefits.

Socialism ? there are plenty of examples of that right now. The main things should be a no brainier, such as a good education for all...all the way through college, and the ability to live in health. I would apply criteria however ...assistance in weight loss and healthy living. Performance criteria to have a free education.

I'm glad to see comments go back to the subject of health care insurance. Relative to Tom's Sept. 10 comments, several doctors whom I know (including my own) give discounts to patients who pay for their services before they leave the doctors' offices. I think this makes a lot of sense. Perhaps this is a practice not generally made public?

Dave
In the process of socialized health care the population would face very high taxes that would depress consumer spending.
today, lack of health care does not stop people from starting small businesses. People are always starting new businesses----trouble is, many of the ideas for a business aren't very good and thus they fail.
Putting insurance companies out of business would create more unemployment----what do we do with those people? And all the agents who sell policies?
Interfering in the market place by govt does not solve problems, but, rather creates new ones.

David Soumis:
"… a healthcare program … that doesn't include ILLEGALs."

There really does seem to be a fairly solid consensus on excluding coverage for "illegals", and I generally tend to agree.

Just remember, however, that absent medical insurance coverage for the "illegals", they will simply continue to obtain their medical care the way they do today:

They will continue fill the hospitals' Emergency departments with their everyday, unremarkable sniffles, hangnails, etc. knowing well that the hospitals are obliged to treat them, as the Federal Emergency Medical Treatment and Active Labor Act (EMTALA, also known as the Patient Anti-Dumping Law) requires hospitals and ambulance services to provide care to anyone needing treatment regardless of citizenship, legal status or ability to pay, with no reimbursement provisions. (Not to mention their populating the emergency departments with such relatively trivial issues could potentially delay care for, say, my last month's imminent cardiac arrest!)

Of course there's no free lunch, as such use of our the most costly medical care facilities for such relatively trivial, non-emergency care simply leads to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.

Ergo, since we all wind up paying for the "illegals'" medical care anyway, it might actually be more economical to include them in the program, so in an overwhelming majority of instances the program would be paying for the cost of their primary care, not "Emergency" care.

Now how's that for an uncomfortable, if pragmatic, outlook?


(During my recent hospital adventure, I shared a semi-private room with a 27-year old "illegal" immigrant who was in for dialysis, after which he was headed back to Mexico. Who do ya 'spose paid for that?)

I can't agree with FRNash. If those people in the ER are really illegal aliens then all the hospital has to do is turn them in to the police. then ship them home.

What's to agree with, Tom?

I was just stating facts, as relates to the Federal Emergency Medical Treatment and Active Labor Act, which requires the hospital to provide care regardless of citizenship, legal status or ability to pay.

Maybe you're suggesting that the law be changed to require the hospital to withhold any medical care until the citizenship or legal status has been determined?

Now that'll look good, the first time someone dies in the ER waiting room while their status is being determined! Especially if it is later determined that they were indeed "legal"!

In recent months I have been pondering a system of local health insurance districts, perhaps by townships or counties, whereby residents could pay health insurance premiums to a centrally located office, perhaps a township or county office, maybe with their property taxes. Voters would approve or disapprove establishing the district, insurance companies would bid on providing coverage for a designated period and price which would be approved of and contracted by township or county administration. Does this sound feasible?

Not suggesting that the medical services be halted but to do just as your example stated. After services ship them home. We do that but is it enforced across the board? No.
Just read an editorial by the president of a medical group here in GB. The govt requires certain medical services be done by hospitals and clinics. But those hospitals and clinics are not allowed to share test results. The outcome is that there are duplication of MRI equipment,etc., at hospitals and clinics in an area instead of sharing of test results. Seems kind dumb------but as the writer said it is an unintended consequence.
This is an example of govt trying to improve a situation but making it worse in another area.
The cheapest out of this delimma is just drop the whole issue. Let people make their own decisions about whether to buy cigarettes and beer, etc. or buy medical insurance.
A study was done on preventive care and if it improved lives------the outcome was no.
I think it is in the JEMA-----a medical journal.

Tom, I think they get around the sharing thing with MRI scans, by giving the patient their own copy of the MRI films, here in mid-Michigan. And, we can get digital copies of CT films and X-rays, on CD's to take to other doctors. So, the patient has access to the data, to carry to other doctors.

Matt Karhu (Matt_k):
"… local health insurance districts, perhaps by townships or counties …"

The problem I see with such a plan is a collection of separate relatively small "pools" of participants.

Unless I'm out of touch, as I understand it, one of the fundamental concepts of insurance is to spread the (financial) risk over as large a "pool" of participants as possible.

If one member of a relatively small "pool" of participants needs some very expensive life saving medical intervention, then the proportional cost to each member of the "pool" will be much greater than if the same financial impact were spread over a larger "pool".

Also, smaller "pools" of participants would be expected to experience greater variation in total expenses (i.e. risk), some quite small, and some devastatingly large. The larger the "pool", the more uniform the risk. Plain ol' statistics.

Of course the extension of this concept quickly leads to the conclusion that the smallest possible financial impact (i.e. insurance premium) would be experienced by members of the largest possible "pool".

What is the largest possible "pool" of participants? … Everyone!

Back to the original question in this thread: Everyone in the pool (the same pool)?

Now does that argue in favor of a "single payer" plan, composed of all possible participants?

NO!

FRNash makes a good point about having a larger pool of participants in a health insurance plan over which to spread the cost of premiums. Since premiums are mainly based on a historical experience of claims and payments and predictable conditions, it occurred to me that a pool of healthy people who have lower than normal claims should not have to pay as much for their health insurance as those who have a larger number of claims. This could be similar to automobile insurance. For example, I am insured as a "preferred risk" by my automobile insurance provider mainly because of many years of no accidents, no traffic tickets, no claims, and I live in a good neighborhood and have an 800+ credit rating. The premiums I pay are normally about 20% cheaper than premiums paid by people in the average risk category.

Do you suppose a health insurance district of mostly healthy people would attract more healthy people to seek such insurance by moving into such a district? Could this become a social problem of some kind?

I'm glad to see that this particular discussion has avoided the subject of socialized medicine. Another thought...health insurance or medical insurance, which term is a better fit?

Yes,good idea Matt. And no I see no problem. I am not as healthy as some.I do need to go once a month to my Dr.'s lab nurse so she can pick my finger, place blood drop on strip into a little device that reads my PT / INR. It has been right on the money for afew months,so he will let me go for 6 months soon.I too,like you Matt am the same with auto insurance ect.But just because you smoke or drink some should not make you more at risk,as if you cross a busy street 6 times a day.

David brings up a point that is important when a person applies for life, health and automobile insurance. Among other categories of information, insurance underwriters and inspectors report information about an applicant's drinking (alcoholic beverage consumption) and smoking habits (that they learn from various sources) to help insurance companies establish a grade of risk. Smoking and drinking habits are significant with respect to life and health insurance; drinking habits are significant with respect to automobile insurance. (Source: Life and Health Underwriting Handbook.)

It occurs to me that most people likely are unaware of these reports and what are the sources for the "usable information" in the reports. Prudent insurance agents who know the grade of risk of an applicant is unfavorable will not ordinarily reveal that information, or they will be reluctant to write a policy for the applicant.