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Author: Subject: Health Insurance / Health Care and you?

Maximum Peach



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  posted on 3/27/2017 at 08:14 AM
I saw Kathleen Sebelius on Don Lemon I think it was the other night. And Lemon posed her a question, "some people complain that they are forced to pay for things they don't need or want in their insurance policies, as in mental health care, maternity care for a man, etc". Sebelius' response is "those people don't understand how insurance works" (kind of laughing while she is saying it).

With all due respect to Mrs Sebelius, I remember how private health insurance plans worked before ACA when premiums were lower and when many people got the appropriate coverage for their needs (without having ACA mandated provisions in the plan).

I wonder if Mrs Sebelius understands how insurance works? Because choice in what you want to pay for and what you want covered is found in all other forms of major insurance.

Take home insurance. First of all, wide ranging choice of deductibles are available, in either dollar amounts or percentage of home value (and when deductibles go up, the premium goes down - in inverse was true with ACA). Then, you can insure the home for market value or replacement cost; and within this you the homeowner can submit a professional appraisal or quote from a certified home builder to determine the replace cost coverage you want (as in you don't just have to rely upon the insurance company to tell you how much it will take to rebuild your home). You can work to set a customized value for contents, with special provisions for collectables. You can choose different coverage levels of liability coverage. You can purchase earthquake coverage, or special policies for additional high wind/hail or flood/water backup coverage. Mold remediation coverage can be increased. If you have detached building on the property, coverage levels for those buildings can be selected. So many varied choices to customized coverage to suit one's needs or wants with different price points along the way.

Let's look at auto coverage. Again, off the bat, you can choose a deducible that fulfills your objective and the premiums is priced accordingly (higher deductible = lower premium, the way insurance pricing is supposed to work). I can have comprehensive, liability only, or fire & theft only. I can determine what extent of liability coverage I want to pay for. I can select or reject under insured / uninsured motorist coverage. I can pick certain coverage for hail damage or cracked windshield replacement. I can get a premium discount for safe driving record.

There is alot of choice in home and auto policies and alot of opportunity to save in not paying for coverage that one doesn't need or want. It doesn't sound to me like Mrs Sebelius is very familiar with how other insurance works. Thankfully she wasn't in charge of changing the home or auto insurance industry.

 

Zen Peach



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  posted on 3/27/2017 at 06:14 PM
quote:
The Trump supporters weren't duped. They never cared whether he could enact his policies or not. They just admired someone who was willing to be as hostile as he was/is. They just want the hostility - nothing more, nothing less. Accomplishments? not important.


Not so, he had and has a platform of changes he wants to make, and that is why people voted for him. People want tax reform, and he is on that right now. People want the illegal immigration to be effectively dealt with, it is my understanding bids will be accepted in April for the building of the wall, and construction can begin within 6 months. Trump is a man of action, and he will try his hardest to make America great again. I will concede that the health care proposal needs more work.

 

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World Class Peach



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  posted on 3/27/2017 at 08:14 PM
quote:
I saw Kathleen Sebelius on Don Lemon I think it was the other night. And Lemon posed her a question, "some people complain that they are forced to pay for things they don't need or want in their insurance policies, as in mental health care, maternity care for a man, etc". Sebelius' response is "those people don't understand how insurance works" (kind of laughing while she is saying it).

With all due respect to Mrs Sebelius, I remember how private health insurance plans worked before ACA when premiums were lower and when many people got the appropriate coverage for their needs (without having ACA mandated provisions in the plan).

I wonder if Mrs Sebelius understands how insurance works? Because choice in what you want to pay for and what you want covered is found in all other forms of major insurance.

Take home insurance. First of all, wide ranging choice of deductibles are available, in either dollar amounts or percentage of home value (and when deductibles go up, the premium goes down - in inverse was true with ACA). Then, you can insure the home for market value or replacement cost; and within this you the homeowner can submit a professional appraisal or quote from a certified home builder to determine the replace cost coverage you want (as in you don't just have to rely upon the insurance company to tell you how much it will take to rebuild your home). You can work to set a customized value for contents, with special provisions for collectables. You can choose different coverage levels of liability coverage. You can purchase earthquake coverage, or special policies for additional high wind/hail or flood/water backup coverage. Mold remediation coverage can be increased. If you have detached building on the property, coverage levels for those buildings can be selected. So many varied choices to customized coverage to suit one's needs or wants with different price points along the way.

Let's look at auto coverage. Again, off the bat, you can choose a deducible that fulfills your objective and the premiums is priced accordingly (higher deductible = lower premium, the way insurance pricing is supposed to work). I can have comprehensive, liability only, or fire & theft only. I can determine what extent of liability coverage I want to pay for. I can select or reject under insured / uninsured motorist coverage. I can pick certain coverage for hail damage or cracked windshield replacement. I can get a premium discount for safe driving record.

There is alot of choice in home and auto policies and alot of opportunity to save in not paying for coverage that one doesn't need or want. It doesn't sound to me like Mrs Sebelius is very familiar with how other insurance works. Thankfully she wasn't in charge of changing the home or auto insurance industry.



Not to repeat myself too much (which I've been known to do) but if you elect not to insure your car for replacement value and it is totaled you are not driving away with a new one. If you underinsure your health and show up at the ER at 3:00AM you are going to be treated by the hospital and its physicians for whatever ails you. Yes; it may bankrupt you. But one can't get blood from a stone.

And down to detail. If a Jehovah's witness signs up for insurance that doesn't cover blood transfusions and/or organ transplantation and changes their mind it is malpractice to deny them the service

 

Maximum Peach



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  posted on 3/27/2017 at 09:15 PM
quote:
quote:
The Trump supporters weren't duped. They never cared whether he could enact his policies or not. They just admired someone who was willing to be as hostile as he was/is. They just want the hostility - nothing more, nothing less. Accomplishments? not important.


Not so, he had and has a platform of changes he wants to make, and that is why people voted for him. People want tax reform, and he is on that right now. People want the illegal immigration to be effectively dealt with, it is my understanding bids will be accepted in April for the building of the wall, and construction can begin within 6 months. Trump is a man of action, and he will try his hardest to make America great again. I will concede that the health care proposal needs more work.


For 8 years the Republicans made it priority #1 to repeal, and sometimes, to repeal and replace "Obamacare". And Donald Trump is the Republican President, the Republicans have a majority in the House of Representatives and have previously passed ACA repeal bills.

I'm not vested in this, but Trump and the Republicans are certainly vested in this...neck deep. 8 years, Eight Years...they told people they would do this, and they - or he - couldn't. "People" may want tax reform and "people" may want immigration reform, those issues strike much closer to my area of interest, but you just can't say 'oh well' and move on now and act like nobody else is watching or cares.

quote:
Not to repeat myself too much (which I've been known to do) but if you elect not to insure your car for replacement value and it is totaled you are not driving away with a new one. If you underinsure your health and show up at the ER at 3:00AM you are going to be treated by the hospital and its physicians for whatever ails you. Yes; it may bankrupt you. But one can't get blood from a stone.

And down to detail. If a Jehovah's witness signs up for insurance that doesn't cover blood transfusions and/or organ transplantation and changes their mind it is malpractice to deny them the service


I don't mind repetitive posts as it shows conviction and consistency and helps remind people who quickly scroll through posts of important points you want to make.

The current health insurance industry in this country is not capable of enacting the kind of changes that a person like Kathleen Sebelus wants to set forth. She says 'we' don't understand how insurance works, well if she was setting the parameters for home owners insurance 'we' would all have hurricane and earthquake coverage on our homes, regardless of location. That is the same thing as requiring me to pay for drug rehab or maternity costs - something I will never use.

People need to have skin in the game, people need to budget and save for their medical costs. Nobody should get a free ride. If you have income of 20k or 200k some portion of that should go towards medical expenses that you incur.

You know really, alot of the people complaining about ACA now are complaining because their deductibles are too high and they can't "use" the insurance, as in they are having to pay for too much.

That is a good thing, people having to be accountable for their costs up to the deductible and make decisions and form habits accordingly. Health insurance should not be an all-expenses-paid vehicle. It should cover events and circumstances that are unforseen and unexpected in our lives.

The problem that I see with the ACA is that if you are searching for an individual policy and make too much money to get a subsidy then you find premiums on $6000 deductible plans too high. I mean, why we have to subsidize up to 400% of federal poverty level points to another underlying problem, the sh:t is too damn expense in the first place. 400%. I think federal poverty level is 12,500, so if you make $50k as an individual you are still eligible for subsidy. Why? A $6000 deductible plan should have relatively low premiums, that essentially is a catastrophic plan and should be billed as such. But no, we have some people paying several hundred dollars per month for that and then still have to pay out of pocket for everything up to that point. I don't know exactly, I think I have an idea, but something after ACA made high deductible plans have the same premium as previous lower deductible plans. And as deductibles rise, premiums should decrease - the inverse was true with ACA. People paid more and got less - atleast some of them.

And then there is that. This is hardily the first time and won't be the last time, but ACA has divided us as so many other things in our history has.

Middle class people buying individual plans not eligible for subsidy assistance are seeing their premiums go up and they get pinched more, while somebody on Medicaid can just walk into the ER and get what they need and walk out with no bills.

Resentment is building from the middle down. Surely we've had resentment from the lower tier of society upwards, and to an extent alot of people resent somebody else for what they have or where they are in life.

But here the example is, work hard, save when you can for your medical expenses and then somebody else in society doesn't have to work and doesn't have to save for their expenses. Medicaid certainly has it's drawbacks, but then again, when you look at it this way it has it's benefits too. When working middle class people would rather have Medicaid then their private plans we have a problem with how this system is constructed.

 

Zen Peach



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  posted on 3/27/2017 at 11:02 PM
Why I understand what you are saying, this line from you always bothers me about republicans/conservatives...

"But here the example is, work hard, save when you can for your medical expenses and then somebody else in society doesn't have to work and doesn't have to save for their expenses."

This seems to always be code for 'lazy people' and usually minorities... I hear all the time from a few libertarians that I know that 'I worked hard for my money, why can't they'.... well, maybe they weren't a privileged white person who was able to get a good education and had a network of friends and relatives to help them get a good job.....

It's always "they" that just don't want to work .... and I don't think it's that simple.

I know that's not what you meant...... but if you listen to Paul Ryan and the other republican mouthpieces on the healthcare issue, you wonder if they know how the real world works and how most people struggle to pay just their very basic bills....

 

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Maximum Peach



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  posted on 3/28/2017 at 08:05 AM
I think that something we rarely stop to do or talk about is that there are all different types of people in any group. Not every person in whatever category is the same with the same circumstances or background or feelings.

So ofcourse, there are many people that have been less fortunate in their lives which hasn't been of their own doing. Life's circumstances, or luck as it is, has put them where they are - not that they want to be there, or stay there...it's just the facts of life. They aren't bad in any way. Just like there are many people who through no good special efforts of their own have found themselves in better circumstances, these people aren't better in any way. It is just the way life works.

What I feel related to medical expenses is that everyone needs to have an appreciation and exposure to the costs they are creating through their use of products and services in our health care system.

Even if a medicaid recipient was responsible for say 10% of their billed cost and the government would pick up some larger portion...it doesn't have to be the same % or amount that somebody more financially stable is responsible for, it just has to be some amount that makes people realize and think about their actions and the consequences of choices and different types of services they use. There should not be a total disconnect between the ones receiving the care and the ones paying for the care.

 

World Class Peach



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  posted on 3/28/2017 at 08:41 AM
Almost all Insurance companies now make the consumer responsible for an increasing amounts of their bill - for just the reason you stated. Charging Medicaid participants even $5 would make them more responsible. A few don't have even that.

I think we all agree that the system is broken; the question is how to fix it. I think the middle class felt a bit thrown under the bus with ACA when it found out it was going to pay the bill for the poor. The definition of rich is akin to the definition of promiscuity (AKA anyone who gets laid more than you do.) Everyone thinks those who make more than they do should pay.

 

Zen Peach



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  posted on 3/28/2017 at 01:42 PM
A $5 fee to someone living on $7,000 per year is not reasonable. That's what public assistance recipients in New York have who are on assistance only and covered by Medicaid receive. Medicaid is income based. There are working poor people and families, the qualifying income is not much above migrant worker incomes.

The insurance companies need to stop the greed, and their executives do not need triple digit incomes off the backs of the poor and the working class. Just like the oil executives who were getting 300-400% profits back in 2008, I don't even know what it is now, it is wrong.

Here's a novel idea, insurance and housing costs based on a person's income. So if you have almost nothing, you do not pay the same as someone else who has a lot more. Minimum wages need to be indexed to the costs of living in different parts of the country, one size does not fit all.

http://www.universallivingwage.org/

If people earned a LIVING WAGE, they could pay something towards their health care, as things are now, they cannot. Multiple problems, common sense solutions.







[Edited on 3/28/2017 by gina]

 

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Peach Extraordinaire



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  posted on 4/2/2017 at 09:55 AM
The New York Times reinforces President Trump on ObamaCare being on the brink of collapse.

Obamacare Choices Could Go From One to Zero in Some Areas

https://www.nytimes.com/2017/03/31/upshot/obamacare-choices-could-go-from-o ne-to-zero-in-some-areas.html?_r=1

The NYT agrees with President Trump.
Things are really changing.


 

Maximum Peach



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  posted on 5/4/2017 at 11:59 AM
On the verge of a vote in the House on the Republican American Health Care Act.

Wondering of the forum members who participate here...

who has insurance through their employer, who is retired on medicare or has health insurance through a pension plan, who purchases individual plans, who has coverage through ACA provisions?

And does anyone care to share their plan details or out-of-pocket payments? I've mentioned some of mine here or in other threads, but would be happy to do so again for comparison purposes with others.

 

World Class Peach



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  posted on 5/4/2017 at 03:47 PM
Have insurance through small business; pay the majority. Its a good plan; but Oxford/UHC is the last insurer in NY to offer PPO to small businesses (mostly owned and staffed by boomers so underwriting is tough)

There is a cost to insuring our populace. No one seems to mention that decisions life coverage for prior conditions etc are all a way of cost shuffling. Someone (individual; insurer; state; fed) pays for care because it is never denied in our country in an emergency

 

Ultimate Peach



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  posted on 5/4/2017 at 04:17 PM
My employer pays the entire premium for my family, as that is a concession we agreed upon many years ago instead of a raise and my pay is significantly under market. My copay are $40 for office visits, $40 for most prescriptions, and $250 for ER visits. I also have a $500 annual deductible per person for prescriptions.

My company who I've worked for for the last 25 years is on the verge of going out of business, so I am quite concerned about health coverage. I will likely start my own company, so I'll be buying coverage out of pocket. I'm very concerned about the Trump care plan that passed the house today. I'm not sure how I'll be able to afford a plan with my wife's preexisting conditions. Due to some investment property we own we thought we were pretty well set for retirement, but the thought of what I'm hearing healthcare coverage will cost for my family is pretty terrifying.

 

Peach Extraordinaire



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  posted on 5/4/2017 at 04:32 PM
as an aside, my brother went to a lunch thing with linda mcmahon yesterday here in indy. one topic was, that he brought up, is how do small businesses get this off of their books as an employee "benefit"? universal health care. he said she was taken aback by this and asked the room who else felt that way. about 50% or more raised their hands.

health care is a huge cost for small businesses and even though those costs go up, employees still also want raises every year.

we figured out last year that the ACA was a better deal for the guys than us providing it, other than the guys would want raises equal to what we took away and adjustments every year after that. just can't please everyone.

[Edited on 5/4/2017 by LeglizHemp]

 

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A Peach Supreme



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  posted on 5/4/2017 at 07:31 PM

interesting comments about the skyrocketing costs of health care under Obama and the obvious link to low and stagnant wages made by some small business owners here.

 

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Peach Extraordinaire



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  posted on 5/4/2017 at 07:50 PM
as far as skyrocketing, insurance has gone up between 4 and 20% every year for the last 30
lots of small businesses don't pay that much of employees benefits either
its all a shell game
people don't look at insurance as wages...just the way it is

 

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Are they zeros someone painted?,
It has never been explained since at first it was created

 

Ultimate Peach



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  posted on 5/4/2017 at 08:05 PM
Insurance prices were skyrocketing way before Obama took office. Seems how that is so easily forgotten. If you think prices are high now, and you have any preexisting condition, just wait and see how quickly you will appreciate what we have now. Maybe in the long run this will be a good thing if it eventually leads to single payer down the road.
 

Maximum Peach



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  posted on 5/4/2017 at 11:51 PM
quote:
i have insurance from work. i am the employer (president) of 21 people. but i gave my resignation to the stockholders (family) in january, after 30 years,so later this year i'm gonna have to get my own insurance. i'm only 55, 56 later this year. LOL on top of that i'm going to australia for 3 months so i need to be covered while i'm there. this pre-existing condition thing has me concerned as i've had a heart attack 6 yrs ago. LOL, exciting times.

we have provided insurance for over 30 yrs to employees, so i have watched how it works for a long time. my opinion is that % wise rates are not going up anymore than they ever have.

we pay 100% after 5 years and 75% have been with us over 5 yrs. up to $1800 a month, they pay any over that.

[Edited on 5/4/2017 by LeglizHemp]

[Edited on 5/4/2017 by LeglizHemp]


Heart attack 6 years ago...glad you are still with us!!!

The way it used to work in the individual market before ACA on preexisting conditions is some insurers would accept you as long as:
1) you had no gap in coverage longer than 63 days (according to a certificate of coverage I have)
2) if the condition existing 6 months prior to the application or enrollment date, benefits would be provided for the preexisting condition after a 12 month waiting period.

ACA did away with the waiting period that some plans (group and individual) used.

Insurers could also 'rate' you accordingly, since a preexisting condition puts them at greater financial risk and therefore they charge you more. Which, not trying to be a dick, but people who are at risk of costing insurers more should pay more. My wife has a preexisting condition, which I will get into in a minute. But what I mean is that I am exposed as well and I believe that "she" or "us" should be exposed to higher costs because she creates higher costs. That gets into the philosophical part of the debate I guess.

Sometimes if your preexisting condition in in the past, they may not rate you as having a preexisting condition. So if your heart attack was 6 years ago and you show no signs of another issue and are in good health, that heart attack may not count. My wife had cancer some time ago and insurance companies don't care about that, she has another issue that caused her a problem.

quote:
My employer pays the entire premium for my family, as that is a concession we agreed upon many years ago instead of a raise and my pay is significantly under market. My copay are $40 for office visits, $40 for most prescriptions, and $250 for ER visits. I also have a $500 annual deductible per person for prescriptions.

My company who I've worked for for the last 25 years is on the verge of going out of business, so I am quite concerned about health coverage. I will likely start my own company, so I'll be buying coverage out of pocket. I'm very concerned about the Trump care plan that passed the house today. I'm not sure how I'll be able to afford a plan with my wife's preexisting conditions. Due to some investment property we own we thought we were pretty well set for retirement, but the thought of what I'm hearing healthcare coverage will cost for my family is pretty terrifying.


Nice deal for you on one hand with the benefits, but sorry to hear your company may be going out of business.

If you are considering starting a business then DEFINITELY consider making your wife an employee. Group plans did not ban preexisting condition applicants before. I know because I did this, I'll touch on that in my next post. I think it is fair to say that nobody really knows what the future of health insurance will look like next year and beyond. But the way it was before is that group employer sponsored plans had to accept preexisting condition applicants, but they could rate them a higher premium - still considerably lower than what an individual plan premium would've been. Once the dust settles and you know where things stand I encourage you to talk to a insurance broker in your area and see what the options are. It may not be great, but it may not be dire either.

 

Maximum Peach



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  posted on 5/4/2017 at 11:57 PM
Throughout the years I detail below my individual health insurance plan has included: $5000 deductible, 100% co-insurance (50% non-network except ER is 100% regardless of network), office visit, ER, urgent care, impatient, outpatient, diagnostic services like x-ray and lab work, drugs all 100% after deductible, “overall annual benefit period maximum” $7.5m – no optional maternity, dental, vision or life coverages.

In September of 2016 I received a letter stating that my plan does not follow all the ACA rules and that a government set deadline of January 1, 2018 means my current plan can no longer be offered, so this would’ve been the last year for my “cheap” plan.

With that in mind, in December of 2016 I got a quote from healthcare.gov and if I were to buy an ACA compliant plan then it would’ve cost me $274 for bronze ($6750 avg deductible on various bronze plans), $329 for silver and $364 for Gold ($4700 deductible). The cheapest ACA plan for me would mean 87% increase over my current plan (plus have a higher deductible).

I do not qualify for premium “assistance” subsidy which had a $67,500 income threshold.

Thankfully I am relatively young (early 40s) and relatively healthy and have enjoyed these individual premiums:

2017 – $146.47 (now covering transgender transition surgery and treatments – I have “gender dysphoria treatment” benefits...yippee!)
2016 – $120.23
2015 – $111.68
2014 – $95.33
2013 – $78.26
2012 – $59.90
2011 – $53.32

Prior to this I had a group plan (of 2) for my business in which my wife was an employee ($5000 deductible)

2010 – $760.64 (me $211.10, wife $524.54)
2009 – $835.64 (me $199.16, wife $636.48)
2008 – $924.76 (me $253.35, wife $670.11)* after this rate hike we shopped the plans in 09 and 10 to find lower premiums*
2007 – $708.12 (me $191.85, wife $507.27)
2006 – $691.86 (me $201.78, wife $484.98)

My wife has a preexisting condition. She is a breast cancer survivor, but the insurance companies did not count the cancer as a preexisting condition because it hasn’t been present for 6 or 12 months prior to here application. She does however have an ongoing issue with rheumatoid arthritis which puts her on the preexisting condition list. When she left an employer sponsored plan, I “hired” her so she could get on a group plan (which did not discriminate against preexisting condition eligibility because she had no gap in coverage from her prior employer to me). Currently she works for a non-profit organization and is an ACA enrollee. I don’t know how many couple are like this, but much of our finances are separate and we pay a lot of our own bills. I know little about her ACA costs, but do know some pros and cons she has gotten out of it. From what I've gathered, here premiums are very cheap compared to the services she receives (pays less than benefits received). However, she has had problems getting some providers to accept the Ohio exchange Care Source provider's insurance (recently had to cancel a surgery due to that). I will look into her payments and post what I can at some point.

 

World Class Peach



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  posted on 5/5/2017 at 07:44 AM
To be repetitive (I'm good at that) say it costs 10K per year per person to cover their health care that's the cost. Who pays for it is the question. But sick old people cost money; young healthy ones generally don't. Whichever system is in place there will be winners and losers but the total cost will be the same (included in that cost are services rendered by hospitals/doctors without compensation
 

Maximum Peach



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  posted on 5/5/2017 at 09:14 AM
quote:
To be repetitive (I'm good at that) say it costs 10K per year per person to cover their health care that's the cost. Who pays for it is the question. But sick old people cost money; young healthy ones generally don't. Whichever system is in place there will be winners and losers but the total cost will be the same (included in that cost are services rendered by hospitals/doctors without compensation


That is true the cost does get spread around, but to what point should it?

I'm pretty sure you aren't suggesting that in a $10k example that an sicker older person and a younger healthy person shouldn't have the same premium, each $5000 a year ($416 a month). But in reality the trajectory that some progressives want is putting us closer to that. The sicker older person should pay more because they are using more of the benefits. While they were younger and healthier they should've enjoyed lower premiums that are more associated with being younger and healthier and less use of the system. Such as in my case with the individual premiums I've been paying up to this point.

If I was in ACA I today would be looking at nearly $300 a month, which that might be a bargain still compared to some people and some cases. But in my case, it's not a bargain because I know what private insurance that I've had for several years cost before. I'm not getting anything better (actually worse in terms of out-of-pocket deductible). I didn't cross a milestone age or have a condition that dictated an increase of nearly double. No, it's arbitrary just because the Government says so, they want me to bear more of a burden than I have to pay for somebody else...when in reality since I use very little benefit of the system, I've already been paying for somebody else. Now they say it's not enough, pay more.

We know what insurance is and what it exists for. I hear so often that "republicans don't know how insurance works", but really I think that Democrats are trying to get insurance to be something and do something it is not intended to do.

Look at all other forms of insurance, life insurance, home insurance, auto insurance....if you apply for life insurance you are going to be subjected to underwriting and the results of your physical, urine sample, blood work, family history, alcohol consumption, tobacco or drug use, even some recreational activities - all of those things get taken into consideration for the insurance company to determine the risk of insuring you and they come back with a benefit / premium figure.

Same with home insurance. Two homes next to eachother on the same street may or may not have the same premium from the same insurer. Often an insurance agent comes out to the home to inspect the construction, the condition, any liability issues and one home may be deemed a higher risk to insure than another and therefore have a higher premium.

Auto coverage...if you have some accidents or tickets in your past you can pay more. The type of car you are insuring plays a role. Two people may pay different rates based on their history and vehicles covered.

When we pay insurance premiums the truth is that most of us will not need to rely upon our policies being acted upon (or in life insurance it is a length of time/maturity situation) and that the money goes to pay for somebody else's claim. And that has always happened in health insurance too. But in health insurance, insurers have and rightfully should look at who they are insuring and what risks are associated with that person, just as all the other insurance products do and come up with an appropriate premium based on risk of insured. But here we meet resistance and we are told that is unjust and that is not how insurance is supposed to work.

It pains me to defend insurance companies, I'm not a fan of their practices overall. But insurance is what it is and I accept it for what it is.

It would be much more honest for progressives to put all their time and effort to pursuing the single payer option instead of trying to transform insurance industry into something it is not.

I want things to work as they should and I think that private health insurance is being asked to do something it was not designed for. We have this hodgepodge of a system and it's seems like it is all cobbled together and nobody can agree on what it should or shouldn't be doing. Just throw the whole thing away and start over is what really needs done.

 

Peach Extraordinaire



Karma:
Posts: 4848
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Registered: 9/9/2011
Status: Offline

  posted on 5/5/2017 at 09:27 AM
From Senator Sherrod Brown (Ohio), a list of pre-existing conditions with coverage lost under #Trumpcare:

AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer's/dementia, anemia, aneurysm, angioplasty, anorexia, anxiety, arrhythmia, arthritis, asthma, atrial fibrillation, autism, bariatric surgery, basal cell carcinoma, bipolar disorder, blood clot, breast cancer, bulimia, bypass surgery, celiac disease, cerebral aneurysm, cerebral embolism, cerebral palsy, cerebral thrombosis, cervical cancer, colon cancer, colon polyps, congestive heart failure, COPD, Crohn's disease, cystic fibrosis, DMD, depression, diabetes, disabilities, Down syndrome, eating disorder, enlarged prostate, epilepsy, glaucoma, gout, heart disease, heart murmur, heartburn, hemophilia, hepatitis C, herpes, high cholesterol, hypertension, hysterectomy, kidney disease, kidney stones, kidney transplant, leukemia, lung cancer, lupus, lymphoma, mental health issues, migraines, MS, muscular dystrophy, narcolepsy, nasal polyps, obesity, OCD, organ transplant, osteoporosis, pacemaker, panic disorder, paralysis, paraplegia, Parkinson's disease, pregnancy, restless leg syndrome, schizophrenia, seasonal affective disorder, seizures, sickle cell disease, skin cancer, sleep apnea, sleep disorders, stent, stroke, thyroid issues, tooth disease, tuberculosis, ulcers.

 

____________________
Flies all green 'n buzzin' in his dungeon of despair
Who are all those people that he's locked away up there
Are they crazy?,
Are they sainted?
Are they zeros someone painted?,
It has never been explained since at first it was created

 

Maximum Peach



Karma:
Posts: 8359
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Registered: 4/27/2003
Status: Offline

  posted on 5/5/2017 at 09:45 AM
quote:
From Senator Sherrod Brown (Ohio), a list of pre-existing conditions with coverage lost under #Trumpcare:

AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer's/dementia, anemia, aneurysm, angioplasty, anorexia, anxiety, arrhythmia, arthritis, asthma, atrial fibrillation, autism, bariatric surgery, basal cell carcinoma, bipolar disorder, blood clot, breast cancer, bulimia, bypass surgery, celiac disease, cerebral aneurysm, cerebral embolism, cerebral palsy, cerebral thrombosis, cervical cancer, colon cancer, colon polyps, congestive heart failure, COPD, Crohn's disease, cystic fibrosis, DMD, depression, diabetes, disabilities, Down syndrome, eating disorder, enlarged prostate, epilepsy, glaucoma, gout, heart disease, heart murmur, heartburn, hemophilia, hepatitis C, herpes, high cholesterol, hypertension, hysterectomy, kidney disease, kidney stones, kidney transplant, leukemia, lung cancer, lupus, lymphoma, mental health issues, migraines, MS, muscular dystrophy, narcolepsy, nasal polyps, obesity, OCD, organ transplant, osteoporosis, pacemaker, panic disorder, paralysis, paraplegia, Parkinson's disease, pregnancy, restless leg syndrome, schizophrenia, seasonal affective disorder, seizures, sickle cell disease, skin cancer, sleep apnea, sleep disorders, stent, stroke, thyroid issues, tooth disease, tuberculosis, ulcers.


That can't be said with any certainty. Insurers are still required to cover preexisting conditions, but the multiple at which an insurer rates a preexisting applicant vs a non preexisting applicant changes. And then if a state opts out you have to see what the high risk pool looks like.

To come out definitively and say that people with those conditions will not be able to have insurance isn't accurate.

I don't want to carry the water on this, the AHCA is probably going to be a mess like the ACA is. I do want to try and voice some other side of the arguement.

Remember, ACA wasn't all roses. I mentioned my wife being on ACA. So she has Care Source the Ohio state exchange. She needed foot surgery. Her foot doctor schedules her his typical place for surgery (a privately owned surgery center) and they do not take Care Source. Ok, the doctor says well I also perform surgeries at this nice new local hospital (a Mercy Health Partners hospital), nope they don't take Care Source either. So she finds out that another hospital does take Care Source (a Steward Health Care facility), nope...foot doctor doesn't work there. So no surgery.

If you paint one side of the picture as being bad, atleast acknowledge there was some bad on the other side as well, because there is alot of **** to spread around here.

 
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