Submitted by rlp on Mon, 05/12/2008 - 10:02.
Yeah yeah, I know, I'm talking about insurance again. But I got a couple of emails that interested me, and I wanted to respond to them. One of them was pretty funny, I thought. Well, mean and funny.
Oh, I tried to keep this to my traditional 6 minutes. I went over a bit. Not that much.
rlp
Oh yeah, I didn't write about this, but Humana messed up AGAIN. This time canceling only Shelby's insurance. Another "show up at the pharmacy and be embarrassed when they announce that your insurance has been cancelled" episode followed by angry phone calls, etc. We pay one premium as a family, so you'd think it would be all or nothing. No, just Shelby was cancelled. Another round of phone calls got her reinstated.
Do you think they just hope to wear people down?
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National Health Insurance
As someone who tries to follow the teachings of Jesus and who observes that supporters of national health insurance are largely called secularists by segments of our society, I find the concept of anyone in this country without health insurance to be outrageous and unsupportable.
David Spitko
Do you think they just hope to wear people down?
...in a word, yes. The first answer is always "no", and some fraction of their subscribers will be too sick, too tired, too overwhelmed, too busy to do what it takes to turn the "no" into the "yes" they were supposed to have gotten. This improves the bottom line, and with a for-profit insurance company, the bottom line is a higher priority than the health of the subscribers.
It may take three or four tries - but keep at it.
Uninsurable?
Uninsurable is the part that really bugs me about all this. Perhaps I'm a bit naive, or New York is very different... there are 3 separate Chambers of Commerce I can join locally, and get group health insurance from. Admittedly, it still comes to about 1k a month for a family... but it's group health insurance, and thus because of HIPPA, the worst case is that pre-existing conditions won't be covered for up to 18 months if I had a lapse in my coverage.
Am I being misled by the people at these groups, or is it just that there is no group which RPL is able to join?
Some clarifications are in
Some clarifications are in order:
1. Group insurance. It's good if you can get it. Check again, but your local chamber probably doesn't offer it. They have someone they refer you to who can help you set up a small group policy. That's what our chamber does. "Oh, we know someone who can setup a group policy for your work."
So it's really not Chamber insurance.
We looked into this. We have two employees at our church. Both of us part time. We could get a group policy at about $1300 a month. The problem: We don't really know the future. If Tim leaves, for example, our group policy is over since that leaves only one.
These group policies are only good if you have a group. That's a minimum of two employees. But remember, if you are the minimum, the rates are outrageous AND, your insurance goes away if one employee leaves. It's not very secure insurance.
2. Uninsurable. It's not our entire family that is uninsurable. Only my daughter. I was turned down a couple of times, but we found a place that will take me.
My middle daughter had to spend some time in a psych unit and was put on a medication. That experience and that medication means that everyone turns her down. Yes, if I got a job with insurance, she would be covered. But I don't have that job. That would mean leaving my church. I suppose I could do that if worse came to worse.
3. Thinking long term. As a further complicating factor, you have to consider what will happen if you lose your insurance. Say we formed a small group at our church with two employees. Let's say it lasted two years. Then Tim got cancer and have to leave his job. Now our group policy is done because we don't have a group of 2 employees. And let's say that during that two years, Jeanene had a benign tumor removed from a breast. Now that we are on our own, she will get turned down because she had this problem.
You have to find a policy, somewhere, and get on it. You can't get sick if you are between companies. If you are just searching for individual coverage, the insurance can turn you down for any reason.
Conclusion: Yeah, we could do the group thing but it's $300 a month more expensive and we're already at $1000 a month. And it is not secure, meaning it could go away if there is a change in employment.
Remember: We are currently covered by COBRA for another year. A lot of what we've been working on is what we will do at the end of that year. As it turns out, four of us will get private insurance, leaving Shelby out. There is a State pool for the uninsured. Each state must have one. Some are better than others. Ours is VERY expensive, but at least she'll have insurance. $300 a month for one child.
By the time you put it all together, our family will always be paying about $1000 a month for insurance. My point is that while we've figured out how to do this (live simply, don't spend on frills) there are millions who could never afford $1000 a month.
Interesting
To 1. When I talked to the lady, she said that joining the chamber*, was joining the group, and for a sole proprietorship or small LLC or whatnot, and I would actually be getting group insurance. I will have to re-verify though, before I make any big career leap. ;)
Actually, looking back, this was the "Buffalo-Niagara Partnership," but my dad is a member of the local chamber of commerce and has rates for their group plan.
I do wonder how much of this is state-based, I believe that I've read that NYS laws provide additional rules above and beyond HIPPA, which makes things more expensive but also forces companies to insure more people.
I guess the "uninsurable" part just bugged me, because my family of four has had enough medical issues, that I'm deadly afraid of having anyone uncovered. I know that if I ever leave group care, nearly all of us will have pre-exisitng conditions that won't be covered for some time. The HIPPA protection of group-coverage just seems incredibly important to me.
(Even though they can get medical care, lack of preventative care, and the number of people I know who have gone bankrupt paying for care, scares me). It's the primary issue I've been researching as I've debated starting my own consulting business.
The lone, wild bird
You are a really good person, and I see the Spirit at work in you - not the 'dove' image of Spirit that coos and looks pretty; however, the 'wild goose' image of Spirit that honks, and flaps its wings vigorously.
Keep honking.
Insurance
It often comes down to this.
As long as the people of God think and act in terms of what is best for themselves or their own family (or community) for the short term, they will never see that God intends for all of us to share our gifts so all of us can thrive.
This view of caring for the whole people of God (the saved and the yet-to-realize God has already saved them) is often put down as some sort of socialism/commie/pinko threat to those who have.
But the bottom line, is that we ARE all in this together. So for today, I offer my prayers and blessings. And I urge you to continue to chew on the topic and share your concerns. And for tomorrow, I will continue to vote for local and national leaders to support and are willing to take the hard knocks for supporting universal health insurance.
It's All Good Today!
universal healthcare:
I'm also waiting for the day when we realize, as a nation comprised of individuals and small groups, that the private sector is using pharmaceuticals and the insurance companies as a commodity to be sold and made money on rather than a service that needs to be rendered. And I also agree with Aaron, keep honking.
j
Most Beautiful Problem
Nationalized healthcare
Nationalized healthcare would be unwieldy. Of course privatized healthcare may be too.
The problem isn't the fact that you can't afford insurance, or that insurers can't afford to insure you. The problem is the cost of health care. It is artificially high, because we have a system that relies on insurers. Cut out the insurers, and the cost of health care will adjust itself to match what individuals can actually afford.
The downside to this is that pharmaceutical companies won't have the unrealistically huge profits to invest in research. The problem with nationalized healthcare is that we'll essentially be handing over those inflated costs to the pharma companies at the tax payers expense.
Nationalized health care, and other services probably have a place in the economy, but it is not the job of our political leadership to create or maintain those institutions. Their job is simply to define the law and national policy.
Gordon:Am addressing this
Gordon:
Am addressing this to you, though in reply to the preceeding post, because it echoes several of my thoughts.
Our family has been acutely aware of healthcare issues for quite a while and have also run down most all of the paths you describe at one time or another. Though also in relative well health, we have dealt with various and ongoing issues for some 30+ years now, including loss of insurability.
Is the system broke? Absolutely. But what is the repair? Not so sure. We have had benefit of outstanding Doctors while at other times we have received substandard or worse M.D's and hospital care. I personally want to be able to pick and choose who I or a family member sees as well as when or how long it takes to get in. Don't see that happening under a govt. operated system.
I firmly believe that pharmacutical cos. need profits to fund their R & D. In awarding grants, too often someone in power determines what is to be researched and how that research is to take place without even adequate knowledge of the subject to be addressed. Guess I'm enough of a Libertarian I don't want someone else making decisions for me.
A personal opinion is that everything the govt. gets involved in turns to crap. Ergo, I don't see that as an answer. In our town we are lucky in that we have an outstanding Family Practice system (preventative care and health issues treatable within a Dr's. office and for all, but particularly lower income folks, though it has it's own limitations). They're great for immediate short term or even non critical long term care; however, all they can do is refer when serious treatment or examination procedures are required and then one is back at the mercy of the hospital or clinic with the necessary testing equipment and cost again becomes a factor. A program like this might be a starting point for reform. Possibly going back to lower cost general and preventative care coupled with some type mandated "overarching" insurance for major medical issues.
When will real reform be addressed? When we as a Nation are willing to swallow one of many "bitter pills" that the future generations will have to deal with. Government seems to be too interested in maintaining its power over its citizens to effect real reform because when that happens someone (or lots of someones) will be out of both work and power and that's not very attractive to them. And as long as we're willing to put up with what they give us, real change will NOT occur.
The problem with the profits
The problem with the profits pharma companies make, is that they don't really put it to good use anyway. They do R&D to create designer medications for unimportant ailments, that no one considered an ailment a couple decades ago. See they are concerned with making more profits, rather than putting the profits they make to good use. This is a problem throughout the market right now (and within capitalism in general).
Also, I've always felt that the conservative fear, hate, and distrust of government was bull-malarkey. The government is us. There is no reason that what it does "goes to crap" besides our electing unfit leadership. Perhaps when we get past all this republicans versus democrats (vice verse) bull crap we can finally get something done.
The government USED TO BE us
I am glad to see that this generating some real discussion instead of the vitriol that has shown up here lately.
When I say the government USED TO BE us, all you have to do is look at the bi-annual elections in House of Representatives. In theory, all 435 members of the house could be dumped out in a fruit basket turnover, but that will never come close to happening. How many House races are considered competitive each election cycle? 30? 40? 50, if we're lucky? This is because the districts are so gerrymandered these days that a congressman could have a permamnent post if he/she wanted it. The main job that politicians have in Washington is get re-elected, not to serve the people. And I would also argue that the kind of people we would want to have in office wouldn't want to put themselves or their families through an election.
As far as a government health insurance system, we have a microcosm here in the United States to look at - in Massachusetts. Here is a link to an article in the New York Times (http://www.nytimes.com/2008/04/05/us/05doctors.html?_r=1&scp=8&sq=massac...). People were excited about the coverage, but primary care doctors are so overwhelmed that the wait time for a simple physical could be up to a year. And, of course, it is costing the government more than anticipated. (http://www.nytimes.com/2008/04/17/us/17brfs-UNIVERSALHEA_BRF.html?ref=us)
As far as the performance of the Fed. Gov't. goes, let's take a look at how well they have handled the USA's finances. The published national debt number out there is $9 trillion. Yes, that is $9,000,000,000,000. However, if the government were to keep it's books like it requires all corporations to do, that number would be $50.5 trillion. Yes that is $50,500,000,000,000. (http://www.gao.gov/cghome/d08353cg.pdf - see page 6). This number represents future payments for Medicare, Social Security, government pensions, and other "promises to pay" the U.S. government has made. From this GAO report, every man, woman, and child in the U.S. would have to fork over $170,000 to cover these obligations, assuming a balanced budget going forward.
Social Security is a wreck. Medicare is going bankrupt. And, just to drive home a more concrete point - look at the government's response to Katrina. Do you really want this bureaucracy in charge of all health care?
FWIW - Gordon, you did hit the nail on the head in one respect. McCain's proposal is a start. The uninsurable (either through health or cost) remains the real issue. But maybe, just maybe, if the artificially high cost of health care (and other systemic issues) can be adressed, other issues may start to resolve themselves).
Our system has real problems
Our system has real problems but letting the government run it scares me to death.
Government in Healthcare
Well that's all sounds really good, but there are several problems with this line of thought. In no particular order:
1: The "Government" already IS involved in your healthcare, and has been since 1965 when Medicare was founded. That's 43 years of DIRECT government regulation of healthcare, and healthcare costs. Yes, I said REGULATION. The Government regulates the price of healthcare through DIRECT PRICE SETTING for Medicare services. So the idea that government shouldn't be in the healthcare business is a wasted thought. That ship has sailed. Medicare expenditures for 2006 was just over 3.2% of the entire GDP. Think about that. What's the largest insurance company in the world? Medicare, of course.
2: When you combine Medicare (roughly 55% of ALL healthcare reimbursement, and Medicaid (another 12%), then Champus/Champva (approx. 3%) then the US Government directly controls 70%, conservatively, of all healthcare expenditures in the US annually. Take an average of 10% for all those pesky "self pay" patients out of the mix, and we learn that only 20% of healthcare is paid for by "private" agencies. Folks, if you think that 20% is driving the reimbursement train, you better think again. Medicare is the big dog. Don't believe it? Pick up the phone. Call your LOCAL hospital. Make an appointment with the Director of Patient Financial Services. Tell them you just want to learn more about the system. Ask him/her for an annual report for their hospital, and ask them to explain the following terms: contractual adjustments, DRG, APCs, and "the cost shift." Thine eyes will be opened, and quickly.
3: The idea that we cannot have a workable nationalized healthcare plan in ludicrous. Of course we can. It's a question of priority. We've spent 538 Billion dollars on th Iraq debacle already. And that amount will be a true drop in the bucket in another 15 years when the rush of baby boomers really strike. Nationalized healthcare (most likely via capitation) will absolutely happen. Like Gordon says, "wait and see". And when that occurs, the only profitable hospitals will be those that are...wait for it...empty. Yep, empty. This means that our healthcare will move away from reactionary medicine to proactive medicine. And drug companies will move away from highly profitable acute systemic drugs, to those that are stabilizing in nature (vaccines, for example). And healthcare will begin being delivered by parish nurses, home health agencies, school nurses, physician extenders, etc. And physicians will be paid not on the volume of patients they see (which reward defensive medicine), but on the actual outcomes of their services (ie: "the overall Type II diabetic instability rates for ABC Medical Practice fell by 2.2% last year"). It's already beginning to happen, and it's called "numerical credentialing".
4. Rant over.
Thank you. I spent some time
Thank you. I spent some time collecting from insurance companies and government agencies for a major non-profit hospital. I can tell you for a fact that the government agencies made me jump through some hoops, but they paid consistently, while the insurance companies denied every claim and made me fight for every penny (don't even get me started). The healthcare system in the US is a disgrace.
I could go on and on (take it from people who have had to listen to me). Suffice it to say that I think things will be changing in a big way, because I just don't see how they can continue as they are.
I am a fan of Concierge
I am a fan of Concierge Medical Services. I was found to be "un-insurable" because of "pre-existing conditions" by all of the health insurance companies I applied to.
I finally realized that even if I could get accepted, the $1000 or more a month was crippling. I joined a Concierge Medical Service and for $5000 a year, I get everything that my entire family of 5 needs -- plus unlimited office visits, free physicals, 24/7 access to my MD, his cell phone number that I can call anytime day or night -- AND he does house calls. He has X-Ray machines and a blood lab in house and it's covered. For the things that he cannot do, he gets us the "at cost" price at the hospital -- the cash price which is anywhere to one tenth to half what the hospital charges the insurance companies. I have not had to do that yet. And there are other medical professionals that he has an agreement with who will take up on consults.
I continue to pay for hospitalization and other specialists (and it has a huge deductible, too) -- but it's a manageable $70 a month. Then we place the money we WOULD have paid to an insurance company into a savings account for WHEN (not if) someone ends up in the hospital.
Insurance
Glad to see/hear the comments.
I don't have a final answer, but am pleased that others are willing to share and struggle with the issue.
It is still a major justice issue, that will not go away.
Let's pray for the day that justice and compassion rule, rather then profit and exclusion.
insurance
yes, rlp, they do want to wear you down.
Video question
How do you post your videos? Do you use software to compress them first. Video files are usually large.
Thanks.
I use either my digital
I use either my digital camera or my Macintosh. this recent one was simply done with imovie on the mac. The files usually end up being very large. like 200 meg.
when you setup an account with Google or YouTube, you upload that large file. It does take awhile to upload. Do it at night if you want and it will be there in the morning. Google and YouTube create flash movies out of these video files. The quality drops, but they stream nicely. Then I simply paste the code from the Google (YouTube same way) video site into my post.
Done both
Well I couldn't quite read many of the comments and have watched this video without throwing in my own two cents. I was born in, and grew up in Canada but am now living and working in the U.S. I just arrived not long ago so naturally health care is a significant issue of mine for my family of four (wife and two kids 2 and under). I have, thus, lived in both conditions and through experience in health care in Canada (where I have recieved care for 5 years now for a "degenerative condition) and educating myself about the system stateside I have come to an easy and overwhelming conclusion that the nationalized health care of Canada is vastly superior to the privatized system I have become a part of here.
I am one of those "unisurable's" and it is not even that that is the entirety of the issue. I am fortunate enough to have an employer who will pay for the insurance for all of my family but where I came from they did not have to. Those who have real health issues and those that don't have the same access to the same doctors. There is no tiered doctor system. That is called discrimination and for better or worse Canadians would rather die than be thought of as discriminatory.
I am not sure what system some of the people who have commented here have looked at when being "afaid" of a public system but I guarantee it wasn't the Canadian one. I don't miss the weather, politics or even really the culture of my home country...but I do miss the healthcare.
Trevor in Oregon
P.S. drugs are cheaper there too.
It's so amazing to me that
It's so amazing to me that people keep saying Government run health care is going to fail and be horribly managed and people will be miserable and you'll wait 6 months for an operation. I never hear Canadians or people from England or France say this. I'd like to have no one else tell me what a disaster Canadian health care is unless they are from Canada.
I'm serious now Canadians. If you've had a bad experience or one that compares to our stories, please tell us. So far no one speaks up except those who were very happy with the Canadian health care system.
(from england) it seems to
(from england)
it seems to me that the problems found in the NHS (national health service) are usually do to with governmental screw ups. there's a huge shortage of nurses and doctors because the majority of them are woefully underpaid. there's a ready supply of european migrants coming in to fill up this deficit but hundreds of them are getting sent back due to our sick, reactionary 'immigrant infestation' culture.
so yeah, i can understand that the thought of handing over medical care to the government may be scary. especially (and i mean this with respect to america's citizens) if your current administration is flushing hundreds of billions of dollars into endless wars. it doesn't inspire confidence.
but, hey - when i get sick i can call up my GP in my local surgery and go in. at most, i'll have to wait a couple of days for an appointment but once i'm there, whatever treatment i need will be prescribed to me - prescriptions cost about £7 a pop, but there are discounts available for repeat prescriptions - and the appointment is covered by the NHS.
everybody who works pays national insurance and if you don't work, NI is deducted from whatever benefits you may receive. everybody pays, but everybody with an NI number is eligible. it doesn't matter how sick you are or how much you earn because the taxes you pay are adjusted to your wage bracket.
it's not perfect, at all. there are certain drugs not covered by the NHS because pharmaceutical companies don't give discounts for nationalised health services. our hospitals are overcrowded, understaffed - if you've ever heard of MRSA you'll know how dangerous they sometimes can be.
but healthcare should never be a business. you should never, EVER be too sick or too poor to receive adequate care and it's disgusting that this is still the case. i know that that vast majority of people in my country use the NHS and as such, the government is accountable to us when things go wrong. and i know that if i find a lump on my breast tomorrow, my NI contribution will be the same as it always has been - sound fair?
* just to add, i'm from
* just to add, i'm from england but the NHS covers scotland and wales and i think(?) northen ireland as well (although there are slight variations, such as scots don't pay for prescriptions), so there's a couple more countries for the list.
How about the guy that came up with idea (quoted in a paper)
http://www.ibdeditorials.com/IBDArticles.aspx?id=299282509335931
A positive experience of govt. healthcare
My father is a Viet Nam vet and a insulin dependent diabetic. They have medical studies showing links between Agent Orange exposure and diabetes. So he was fortunately eligible to receive VA medical care. He's still working in the work force full-time but couldn't be insured due to this severe and chronic condition. His insulin and all the supplies and supporting medicines that went with it costs hundreds of dollars a month.
Now that he's in the VA system he sees a doctor regularly, has all the medical supplies he needs to better care for his diabetes. He likes his doctors who he claims seem more willing to work with him than his previous "preferred provider". They are also treating not just the diabetes, but diabetes related issues like loss of eye-sight, circulation issues etc. He's the healthiest I've seen him in years.
My mother on the other hand is 10 years post breast cancer and is covered under her work's private insurance. However, she is no longer eligible for "cancer insurance" and because they now deem her "high risk" she has a $10,000 annual deductible and she has had to change her doctor 5 times in 2 years as the insurance company changes their "preferred provider" list. In fact her physician who accepted all insurances was being sued for violating a non-compete clause she never signed.
That's insanity and it's criminal. I agree with Rev Bill. This is a social justice issue. There are small co-operative communities who have created their own health insurance system. I have friends living in an intentional community and they participate. It's affordable and flexible and includes alternative healthcare. Why couldn't a group of like minded folks do the same?
It's a thought...
Glad to see the conversation happening.
Insurance
I was one of those "I'm insured so screw you..." types UNTIL my wife (then my fiance) was without insurance for a while. The cost and hoops you have to go through is just so bad it's comical. I'm all for a national health care system.
It's amazing how so many conservatives rail against it while almost every other country in the civilized world (Canada, England, Ireland, France just to name a few...) manage to have a pretty good system in place.
I think the US is the most bass akwards nation in the civilized world...
This insurance post brought
This insurance post brought back something I'd been thinking earlier and hadn't posted. Most of my family is on mission-critical mental health medicines of some sort, and my mom would always have an extra month's supply stashed away with our emergency supplies. I wonder if it would be worthwhile to use Canadian pharmacies to create an insurance emergency supply. You'd only need to buy one month's worth online, and then you'd be set for your extra month supply. Just make sure to use whatever was in the emergency supplies first and put the fresh prescription from the pharmacy in the emergency supplies.
I mean, Humana is still sucking but this may help your situation outside of fixing the root cause. Sadly, that probably won't happen in the very immediate future.
Wearing people down?
Absolutely, they hope to wear people down. What's worse, there is some actuary sitting there putting this in his calculations.
I'm Canadian
I've been to the hospital 6 times here in Canada. Waited about an hour or two each time, was treated and sent home.
I have a relative in America (Washington DC) that I visit from time to time. When I was there, I broke my ulna (Bone in your forearm). I waited for 30 minutes at the hospital, was looked at, and then waited for 4 hours while they verified that I could pay to have it set and casted. I received treatment and had to pay $75,000(US).
Right. If I ever meet a Canadian who prefers the American health care system, I will be shocked.
Medical Advances? America has had the most in the past decade. Mind you, they've all been pills that do the same job other pills already do (Only, perhaps, they do it slightly better or slightly faster).
Significant Medical Advances? Not one is from America. They're all from France, England, (Not so much Canada), and even China, Japan, & Russia. Why is America one of the few economically large countries that has contributed so little to breakthrough health care? Because a company doesn't care about people, it cares about $$. Frankly, there is more to be made by treating cancer patients for years on end then there is from curing cancer.
Its intense when you discover the number of times an amazing idea is born in America and then is denied funding the moment the idea is coming to fruition. The number of scientists who look toward other countries for funding that American companies never seem to give is astounding.
Interestingly enough. America easily seems to have the most potential (Money, Brilliant Minds, ect.) and yet they're doing comparatively little.
Also... $75,000 to set and cast a broken bone? Seriously?
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