This sounds to me like an argument against leaving the health (through payment for their care) of the members of our society, the health of which directly correlates to the health and hence productivity of those self-same members, in the hands of a profit-driven enterprise.
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Well if you think about it everything that exists and happens is the result of a pre-existing condition. Which means everyone is in the same pool anyway. Crisis averted!
Also:
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There is something missing here. Profit.
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To the patients, yeah. To the owners? Not a benefit if it costs more than $0.10 a patient.
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Precisely why health care insurance shouldn’t be a business making profits. It should be society pooling resources to protect each other from risk. I.e., government-run single payer, as is done in most modern, up-to-date, less greedy, and more sane western countries.
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Don’t forget, he’s got the federal health plan, where there are no existing condition rules. Comprehensive, affordable – you know like everyone should have.
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The imaginary exam that costs $100 would presumably include the profit for the facility. When we say something costs $100 we aren’t talking about the wholesale cost of goods and services but rather the amount charged for them.
Costs are generally reduced when you aren’t busy treating secondary hospital acquired infection and paying lawyers fees for all of those negligence and malpractice claims brought against your facility.
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We don’t cotton to that kind of long-term thinking in these here parts. 
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I agree. When companies don’t uphold their end of the bargain, that’s a problem, and those companies should be held accountable. As far as I know most health insurance companies are responsible and if you become ill or suffer a catastrophic injury your expenses will be paid. There are of course fringe cases where this doesn’t happen but those can be dealt with in the legal system for breach of contract.
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I have lots of respect for the office. That’s why I pee on the man in it.
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Ugh, that is my life.
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So Joe entered into a bet with his insurance company and they give him an incentive to stay healthy by subsidizing his routine physicals. If Joe wanted a policy that didn’t provide these incentives should he still be forced to buy one?
Meanwhile John doesn’t have a policy, so he’s making the bet that he can stay healthy on his own. He chooses to get a physical and pay $200 for the doctor’s services and hopes that will be his only health care costs for the year. Should we instead force John to get health insurance?
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Four words: annual and lifetime caps. And if the BCRA/AHCA passes Congress, those things are coming back with a vengeance. Insurers don’t like paying for expensive things, like chemotherapy.
Sure, except that contract generally also allowed insurance companies to refuse to cover anything if they discover that you have a pre-existing condition, which could be anything from cancer to undiagnosed diabetes to depression to acne. It was insurance companies’ get-out-of-obligations-free card, and the ACA is what took that away. You have to be willfully ignorant to not be aware of the utterly disastrous shitshow that was trying to get insurance companies to cover things pre-ACA. Health care (well, health insurance) reform didn’t spring up out of nowhere to subjugate well-behaved corporate citizens just looking out for their fellow citizens. The ACA was created to hold those companies accountable because they weren’t doing their job.
In the American health care system, YES. Because if he loses that $200 bet and gets hit by a drunk driver (something that no about of “staying healthy” personal responsibility could possibly prevent), someone is going to be on the hook for the astronomical cost of airlifting him to the hospital and stitching his spine back together, and I can absolutely guarantee you that John is not going to be up to that task - especially now that he’s paralyzed from the waist down. So, if John can’t pay, guess who does? Everyone else. We are already subsidizing the treatment of uninsured patients through guaranteed treatment in ERs. It’s just that this is the most expensive and inefficient possible way of taking care of people.
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I’m not likely to bill my car insurance for an oil change because I know that my contract doesn’t cover it. A better analogy might be replacing my brakes. If StateFarm decides to offer a policy that includes certain preventive maintenance items because it is proven that replacing my brakes reduces the chance of an accident then that’s great. But should the government force them to? I get a discount on my insurance because I have OnStar, I like that StateFarm does that, but should the government force Geico to provide the same benefit to everyone?
Juries make these kinds of decisions in wrongful death suits all of the time. I’m sure with some data analysis we can figure it out. Life insurance companies also make a bet based on your history, too.
Yes, I agree.
I agree that insurers shouldn’t be responsible for managing the costs of health care, but that is what we let them do. Perhaps the answer isn’t to change how insurance works but instead change how we charge for health care.
I’m in full agreement with you, actually. This is why I originally said that health insurance and health care are two different things. I’m fine with some regulation but the requirements placed on insurance companies through the AHA were an overstep (in my opinion). The government should be doing more to focus on reducing the costs of health care for everyone, not the costs of health insurance.
[quote=“Chuck_Steel, post:54, topic:104164, full:true”]Meanwhile John doesn’t have a policy, so he’s making the bet that he can stay healthy on his own. He chooses to get a physical and pay $200 for the doctor’s services and hopes that will be his only health care costs for the year. Should we instead force John to get health insurance?
[/quote]
It depends.
If John loses the bet, do we deny him care and let him die?
What if it’s not John’s fault, what if Jane harms him? Do we still let John die? Do we go after Jane’s insurance? What Jane was making the same bet as John and doesn’t have any insurance either?
After all, that’s the bet. If we’re going to backstop the bet and not really allow Joe to lose it, then, yes we should force him to have insurance.
This is much like car insurance. You’re required to have liability insurance to cover harm you do to someone else with your car, but you’re not required to have insurance to cover fixing your own car. You can bet that you’ll be able to cover your own costs and only require insurance to protect others that you could harm so you’re not forcing them to bet you don’t harm them by mistake. As a society, we don’t backstop you here. If you car is totaled, to bad, the car dies and we don’t save or replace it.
If we’re not going to make that same decision for your health, the rules shouldn’t be the same.
I don’t think we should just let you die. This mean forcing you to have insurance. And, not just any insurance, but insurance that actually works when you need it.
That’s the entire argument right there. Every time someone says you shouldn’t be forced to have insurance, ask them why we force the ER to give you any care at all? No insurance, no care, end of story. Once you’re broke, destitute and have nothing left, we kick you to the corner and let you die. That’s the argument for not requiring insurance. Otherwise, you’re asking for 2 incompatible positions.
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Here’s how it really works (and I’ve had this happen):
Your premium is $465 a month. You get a foot injury and it becomes infected and you have to go to a podiatrist. The bill is $263. Your deductible is $1500. You pay every penny of the bill out of pocket - the insurance company won’t pay one stinking penny until you have fulfilled the deductible.
You have to go back to the doctor for the same thing every month. Finally, after 6 months, you fill the deductible. So the next time you get that $263 bill, in month 7, you still pay the $465 premium but at the doctor’s office you pay only a $20 copay. The doctor’s office bills the insurance company for the rest ($243).
For the next 4 months, the insurance company keeps bouncing the bill back to the doctor’s office, saying there’s something wrong. They say the ICD codes on the records are wrong. They say the paperwork is too difficult to read. They argue that the procedure you’ve been paying for is the wrong thing (some high school dropout who can barely read looks at the company policy paper which says what they’ll pay for, and he writes a note, which means that some semiliterate clerk is telling your doctor that a bean counter who’s never had one minute of medical training has ruled that the medical procedure the doctor performed on you is wrong).
After all this squirreling around, the insurance company tells your doctor’s office that they will pay $38 on that bill - not one penny more. They and your doctor’s business manager argue for another 2 months, but the insurance company flat refuses to budge and the only way the doctor could get any more would be to sue the insurance company. That means the doctor has a bill for his services that still has $205 on it. So, 6 months after that last medical procedure that you thought your insurance was going to take care of, your doctor’s office sends you a bill for $205.
It took you 6 months to fill the deductible. During that time, each month you paid $465 for health insurance, and $263 for that month’s medical procedure. That’s $728 each month. That’s a total of $4,368 you have to spend before your insurance will pay one penny of your medical costs.
6 months later, you have still been paying $465 each month. And now, you have to pay another $205 on that unfilled bill because your insurance company needs to put their money into the CEO’s golden parachute plan instead of providing the help they told you they would provide in return for your premium.
13 months of insurance premiums = $6,045. 6 visits to the doctor at $263 each before you filled the deductible = $1,578. One copay = $20 copay. Amount the insurance refuses to pay and the doctor bills you = $205. At the end of all this, you have spent $7,848. Your insurance company has paid exactly $38 toward the cost of your treatment. This is perfectly legal under current laws.
Your payments to the insurance company = $6,045. Their payments on your medical bills = $38. Their “overhead” - the cost of paying low-wage clerks for the few minutes it takes to route the paperwork for that $38 = (wild guess, I admit) $248. Their total costs = $286. Their total profit = $5,659, or 2,114 percent.
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This would indeed be awful, but I didn’t see anything in the source article supporting the claim that a GSW would be counted as a pre-existing condition. To be fair, I didn’t watch the clip, because I generally only consume news via text, so maybe something was said in the video.
There is so much that is so very wrong about this administration and this congress (and the AHA) that we should definitely shine a light on such things, but I think we should be careful to confirm that we’re talking about, you know, actual things.
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I’m not arguing about the pre-existing conditions provisions, and that is the least likely thing to get removed. For things like annual and lifetime caps it is much more complicated and I certainly sympathize with parents of chronically ill children and victims of serious crimes/accidents. Please don’t misunderstand me on that point.
And you’re right, when John gets hit by a drunk driver (or Jane shoots him or whatever) we are paying for it. We’re already paying for it through our taxes so why all of the sudden did we decide that a for profit company should pay for it instead. As fas as I can tell, all that change did was raise the costs of John’s and our healthcare for all of the reasons that others are posting here (how much insurance pays providers, how providers compensate, etc.). If someone is chronically ill and needs lifetime care I don’t think that we should require a company to provide that care at a loss, because in the end they won’t tolerate the loss and will find some other way to get out of paying or just pass the fees along to someone else. That’s kind of my whole point. People are getting upset about the reduction in regulation on the health insurance companies when instead we should be focusing on the costs of health care and why it is so expensive.
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No doubt that happens with many plans. You have a couple of issues at once in your scenario. First, the delaying of payment to your provider happens because doctors aren’t trained in business and have little idea how to run a practice. At a hospital, your claims will be handled much more efficiently. Professional coders will create the claim using the correct codes and a professional claims handler will get the claim paid in under 45 days or the insurer will suffer penalties which vary by state.
Another issue at play in that scenario is a low cost insurance plan with a high deductible. A more expensive plan would have a much lower deductible and may have none at all so that’s really a matter of which bet you place at the window when you buy your insurance. This is why the individual mandate bothered so many people. They feel they would have come out better if they paid cash. But that’s not my point.
You are correct to point out the inequities of medical coverage. What I was attempting to illustrate is the general way insurance is handled at a hospital and not to discount the idea that stories such as yours happen every day in this country. I was responding to Joe who claimed that health insurance networks lower the overall cost of healthcare with an example of how they in fact increase the amount charged the consumer in order to recoup the cost of care under a provider/insurer contract. This is why my first post is about doing away with insurance in healthcare entirely and moving to a single payer system like they do in more modern countries like Botswana, Thailand, and Serbia.
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