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Originally posted by m52nickerson:
Well we shall see what the U.S. Supreme Court says.

I do not fear God, I fear the ignorance of man.

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Originally posted by AURaptor:
WASHINGTON, Aug 12 (Reuters) - President Barack Obama's signature healthcare law suffered a setback on Friday when a U.S. appeals court ruled that it was unconstitutional to require all Americans to buy insurance or face a penalty.

The U.S. Appeals Court for the 11th Circuit, based in Atlanta, ruled 2 to 1 that Congress exceeded its authority by requiring Americans to buy coverage...

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Originally posted by AURaptor:

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Originally posted by m52nickerson:
Well we shall see what the U.S. Supreme Court says.

I do not fear God, I fear the ignorance of man.

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Yep. And generally the USSC goes w/ precedent, so it's not looking too good for O-Care.

Lovin' that!


" I do not love the bright sword for its sharpness, nor the arrow for its swiftness, nor the warrior for his glory. I love only that which they defend. "

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If the mandates are the mechanism by which insurance prices would be lowered. Without them prices will continue to rise and with the the insurance companies unable to drop people costing them more money then they put in it might destroy the whole system. That would force the government to to enact universal health care.

Really all the mandates are is nothing more then a backdoor version of a single payer system.

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Originally posted by dreamtrove:

I think that was almost a perfect 180 away from my understanding of the system.

A mandate ENDS price competition, which CAUSES prices to skyrocket.

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Originally posted by SignyM:

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If the mandates are the mechanism by which insurance prices would be lowered. Without them prices will continue to rise and with the the insurance companies unable to drop people costing them more money then they put in it might destroy the whole system. That would force the government to to enact universal health care.

Really all the mandates are is nothing more then a backdoor version of a single payer system.

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Nick, you seem to be saying...

WITH the mandates- they are just a backdoor version of single-payer

WITHOUT the mandates - the "free market" system cannot sustain itself, falls apart, and we wind up with the single-payer system.

Since it seems that either way we wind up with the single-payer system, it appears that what you are saying is the the current "free market" system is unsustainable under any circumstance without a significant gift from the government.

Perhaps I misunderstand?

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Originally posted by Kwicko:
I still don't see why the government doesn't just open up its own insurance co-op. Not taxpayer-funded, but MEMBER-funded, and not for profit.

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Originally posted by m52nickerson:

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Originally posted by Kwicko:
I still don't see why the government doesn't just open up its own insurance co-op. Not taxpayer-funded, but MEMBER-funded, and not for profit.

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It makes sense, you just have to get it through congress.

I do not fear God, I fear the ignorance of man.

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Originally posted by dreamtrove:
Nick,

Thanks for the link.

That analysis seems naive to me. If you mandate, you remove negotiation, which is an invitation to pump up prices.

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Originally posted by m52nickerson:
The mandate does not directly affect what insurance companies charge. The mandates, plus the subsidies for lower incomes, mean there will be a larger pool of people that have insurance. The more people, especially healthy people, the lower the insurance companies can go with there prices while still maintaining a profit over all. That is why large companies can get lower rates for insurance because there employees are a larger group.

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Originally posted by Fremdfirma:
Invalid assumption - assumes benevolence on behalf of insurance companies, the same argument was made regarding mandated auto insurance, which is now one of the most rapacious markets on the planet, with a captive audience to boot.

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Originally posted by dreamtrove:
Frem makes me redundant here, I just wanted to add that your assumption is that insurance companies are a form of free market competition and not a headlock oligarchical cabal like OPEC.

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Not to captive as people always have the choice not to own a vehicle.

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*Impose an annual penalty of $95, or up to 1% of income, whichever is greater, on individuals who do not secure insurance; this will rise to $695, or 2.5% of income, by 2016. This is an individual limit; families have a limit of $2,085.[54][55] Exemptions to the fine in cases of financial hardship or religious beliefs are permitted.

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Originally posted by Bytemite:


Yes, just like you have the "choice" to be "poor" or the "choice" to "work a job."

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No matter how hard or easy it is it is still your choice.

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Plus what happens when someone without insurance hits someone else. It's fine if the at fault person has the money to pay, but if they don't who is going to pay for repairs or injuries?

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Everyone pays in single payer also, including that poor, unless you get rid of every type of tax or fee out there.

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Medicare keeps prices down by mandating what it will pay for services.

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Yes there is a penalty for people who could have afford insurance but chose not to get it. Just like we all pay for it when someone is not covered but used health care service and can't pay.

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I'm not saying that it is easy. No matter how hard or easy it is it is still your choice.

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Should you have to wait until someone saves the money to get your car fixed, or replaced?

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Originally posted by m52nickerson:
insurance companies denying just claims can be a problem. That problem absolutely should be addressed.

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Originally posted by BYTEMITE:
Decency leads to responsibility.

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Should you have to wait until someone saves the money to get your car fixed, or replaced?

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In that case, they'd most likely have to wait anyway. If you don't have money, then it's really hard to pay for anything, and insurance companies know when you don't have money, and are more likely to deny you if you don't have much. Quality service has a price, and they know you can't afford a lawyer to dispute them. If they can take money from you and have the option to pay out as little as possible, that's what they're gonna do.

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Originally posted by 1kiki:
I won't be able to finish the thread tonight, but I wanted to respond to this: "Without them prices will continue to rise ..." Do you really, REALLY think that prices are rising b/c costs are FORCING them up? Boy, are you naive. I don't have time to get out all the facts for you, but they are addressed here: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande]

Cost are definatly a part of it.

http://healthbeat.areavoices.com/2010/06/14/the-burden-of-unpaid-hospi
tal-bills/

http://www.usatoday.com/news/washington/2011-05-09-uninsured-unpaid-ho
spital-bills_n.htm

http://www.bizjournals.com/houston/print-edition/2011/03/11/houston-ho
spitals-unpaid-medical.html

Yes, doctors over treating patents is also part of the problem. That is of course an argument that insurance companies use to fight having to pay for tests or procedures.

I do not fear God, I fear the ignorance of man.

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Originally posted by dreamtrove:
Frem is really making me redundant.

Nick, don't play dumb, because no one wants to play that game, and if anyone thinks yiu actually are dumb, no one wants to llay that one either

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Originally posted by dreamtrove:
As flr the system, here's a better idea:

Let's just have a free market economy. You get sick, you gl to the hospital. After you're healed, they send you a bill. That bill reflects actual market costs. Those costs are available to you when you go, so you know ahead of time, and they reflect the actual cost.

Then, like everything else, you can then take out a loan if you can't cover the cost.

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Originally posted by dreamtrove:
Okay, a couple serious examples:

I went to the doctors with a bsck injury. They x-rayed my shoulder, and the doctor didn't talk to me or the PA who did talk to me. No one gets paid, because the service wasn't delivered. It's the same with anyone. The PA did her job in good faith, but she didn't see to it that the doc on duty got the informatjon she collected. She'ssupposed to meet with him, and he with her. They failed.

My mom went, breathing problems. They misdiagnosed the condition, but they used some equipment, and some hours of their time, and then they wasted three cannisters of medicine into a non-working ventilator. They then wrote her a scrip for something that half worked. It was a sucky job, but two people put two hours into it. The bill should cover their wages, and a service was done, looks like 4 woman hours work. No one should have to pay them for the wasted canisters, that's incompetence. If no one pays for incompetence, it will quickly disappear. And, a wrong diagnosis with half effective medicine should be worth a small fee. Looks like a hundred bucks or so.

My mom went again, broken collar bone, tney put it in a sling. Two people again, two hours, some medicine, tests and correct treatment. Not ideal, but functional, itshou.dbe worth more.

My sister goes for cancer treatments, the experimental drug treatment doesn't cost anything and shouldn't, but the diagnosis and brain surgery were done excellently. This was expert work, and involved a team of 6 people spending four hours, so that's worth a couple thousand by itself. The fo..ow upwork is also worth money. The week in the hospital should not have been a two thousand a night motel, however.

Also, many other doctors misdiagnosed this, and did nothing, even what they were paid to do, at a previous hospital, a doctor took an MRI, charged $1000 for it, and then never looked at it.

But the really competent hospital should be paid well.

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Originally posted by dreamtrove:
Now, who pays?

First, some credit agency or govt. Service. Next, a loan account, set up, and paid. A responsibility battle will ensue a lot of the time.

My back injury came from me tripping on a groundhog hole and whapping my fool ass. My fault.

My mom's next visit (incorrect diag: emphysema; correct diag would ahve been asthma.) fault? No ones.

My mom's shoulder, fault is the warehouse she fell lff the walkway of. They volunteered to take responsibili without any pressure from us.

My sister's cancer, TCE contamination from her workplace. It's not clear if the workplace was contaminated by the emplpyer or the gas company, as both were using TCE in the area. This one is real grey, but I would say the employer was directly responsible, and then they could then sue the gas company if they had reason (they did. There was a spill near the site aorjnd the time) which passes the buck.


Okay, so i'm just making this system up as i go along, but you see in all of these, because there is a credit account, it's auto
Aid for at the beginning, and the who and how much is worked out later.

No one has to pay for work not done. This ks how mechanics used to work. I figure medicine is more similar to an auto mechanic than anything.

Back fo the stay in the hospital:

You have roung the clock care of a nurse 24/7, so that's $480 a night, right? No, that doesn't follow, the nurse is watching 30 patients, not just you, so that's $16.

This last little logical fallacy is exploited in education as well. You sent 45 hourse kn each of four classes is 190 hours, so $3800? No, there were other students in those classes.

This is off the cuff so i'm curious if anyone sees any potential merit in some sort of system along these lines.

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Originally posted by Fremdfirma:

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Originally posted by m52nickerson:
insurance companies denying just claims can be a problem. That problem absolutely should be addressed.

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Which is where my problem with it lies - to legally mandate payin them fuckers, but do nothing about their legendary and commonplace rapacious behavior and failure to uphold their end ?
Madness.

Worse is how you wind up paying far, far more than you'll ever be covered for even IF they held up their end of the deal - I mean, if you paid the entire amount they cover AND the deductable to them over the years, you do realize every penny after that is pissed down a hole, a futile expense, right ?

-Frem

I do not serve the Blind God.

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Originally posted by BYTEMITE:
You're still missing one thing: If what we're proposing only works when people can pay, and that's a problem, then what you're proposing with insurance companies is the same problem, just transferred through a middle man.

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Originally posted by BYTEMITE:
I ask you this: how are predatory sub-prime mortgages and insurance similar? Both involve the assumption that people will not be able to pay for a service they need, and make a profit off of it.

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Originally posted by BYTEMITE:
With insurance, the whole thing hinges on some people buying more expensive packages so that there's enough money in the pool that those with cheaper packages get covered. And it seems to work, except, it relies 1) on forcing everyone to buy health insurance (not enough people buy higher end packages, because they don't NEED them, which is half of the reason for premium hikes, the other half is simple greed), and 2) even with the regulations, 20% of everything you put in does not go towards what you're paying for (if indeed you ever need to make a claim).

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Originally posted by BYTEMITE:
And that's assuming there aren't loopholes that allow them to never pay off, such as having MUCH better lawyers than you. Lawyers trump regulations every time, and the companies will have to be caught out on not making good on the 80% to actual claims. It ain't happening.

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Originally posted by BYTEMITE:
Therefore, 1) it's an unstable and impractical business model, even though on the surface all seems fine, and 2) it's a rip-off.

If the poor are being ripped off, then that's that much less money for them to live on. If someone who is poor gets into an accident or develops a serious medical problem, an insurance system might (not always) pay to save them, but afterward all their finances are completely wiped out. I consider quality of life (therefore livelyhood) to be on the same ground as health, so for me I consider this a failure, because the person is alive, but no longer has the means to thrive.

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Originally posted by BYTEMITE:
A much better alternative to insurance companies would be to make health care much more affordable. This is the point DT is getting at. You shouldn't be charged an arm and a leg to SAVE the arm and the leg. But for that, you'd have to take on both big pharm and insurance, because big pharm loves charging $1000 dollars for a pill that only took them $1 to research, develop, and produce, and the insurance industry relies on all that overcharging to justify their own existence.

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Originally posted by Fremdfirma:

Indeed, what I call bullshit-cost.

Case in point, the wheelchair I am sitting in, cost from a medical supply company runs about $795.00 USD.
Mind you, I highly doubt that's the value actually exchanged between them and an insurance company, more like a nod and a wink and an artifically inflated price to run out your coverage faster, and they'll sure as hell charge YOU that, if they can.

With deductable and all, cost to me would STILL be over three hundred bucks, cause equipment is one of the things a lot of coverage is dickheads about, especially given my prosthetics are ONLY affordable to me cause I helped with some design work for the company that makes em, and do actual function and stress testing, cause these things on paper cost about as much as a mid-grade BMW...
EACH.

Now, same wheelchair, same make and model even, via harbor freight ? $119.00 USD and I paid less than that since I got it on sale - which is still prolly more than THEY paid for it since no doubt medical supply industries buy the damn things in bulk.

So explain to me how that "coverage" does one goddamn ounce of good to me, when I had to buy my wheelchair out of pocket, had to pay for my prescriptions out of pocket, and am currently engaged in a legal battle with em over attempted retroactive coverage denial, which if not for personal favors owed, would wind up costing me as much or more than the hospitalization ?
What did I *GET* for that money - nothing, worse than nothing cause holding up the fuckin pretense allows Medicare to dodge the bullet, eliminating me from the so-called safety net.

Just cause you have been fortunate, or lucky, doesn't mean everyone is - Byte is correct in that if an insurance company thinks you haven't the will or the means to fight back, they *will* fuck you over, in fact that's HOW they make their profit, rendering the whole thing a friggin scam in the first place.

Honestly I'd rather subsidize it all through Medicare, we ALREADY pay for that, and if we cut down the amount of funding we waste on war machine welfare we could easily afford it, and step forward from a moral perspective and hold it up as a human right, rather than a pay-for-play sham.

-Frem

I do not serve the Blind God.

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That would be true until you factor in the subsities to pay for insurance

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extention of Medicare.

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No, the sub-prime mortgages where issued so that they could be bundled and sold. Mortgage companies generally don't make money when they forclose.

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Do you have a citation for that 80% claim? I found that the rate of claims being rejected is maybe around 20%.

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What your discribing is what the new reforms are ment to stop.

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You are starting off with at least one very wrong assumption. The cost of bringing a new drug to market is in the millions, if not the billions.

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If you coverage is not paying for anything why to you maintain it?

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