The Real Myth of Healthcare
by Joseph C. PhillipsOne of the more pernicious myths surrounding the debate over healthcare is the oft repeated claim that conservatives do not want reform. Nonsense! What we do not want is the warm bucket of snake oil currently being sold to the American people by this administration. Conservatives have long argued for the need to reduce mandated benefits, reduce the reliance on third-party payers and get rid of public policies that hinder entrepreneurship and innovation. This is the kind of reform conservatives want – the right kind of reform.
Because the number of Americans that are actually denied medical care is zero, the administration has chosen to cite the fact that 47 million Americans lack medical insurance (another myth) as the reason for its urgency in passing a huge bill that congressmen can’t be bothered to read. Why, just yesterday the administration and its army of sales people began to talk about health insurance reform; this after years of hearing about the need to reform healthcare. Ahh! The power of focus groups. Now we need single-payer universal healthcare to bring down costs (prices) and to protect the sick from “discrimination” at the hands of evil insurance companies.
So the cause of our national distress is the private health insurance industry, which no doubt explains why A) Obama has made back room deals with the insurance and pharmaceutical industries and B) why the bill making its way through the House of Representatives devotes exactly 6 of its more than 1000 pages to insurance reform.
Conservatives of course have long pointed to the over-reliance on insurance companies and other third party payers as one of the major causes of the increase in healthcare costs. It is worth remembering that the largest insurer in the nation is the federal government through Medicare and Medicaid. And how’s that working out?
A recent study from the National Bureau of Economic Research found that about half of the increase in health expenditures nationwide since 1965 was caused by the creation of Medicare and Medicaid. Why? One reason is that under the government programs prices are not the result of contracts between providers and patients. Instead, prices are set between providers and the U.S. Government. In practice, this means the U.S. government says what’s covered and what the price is (regardless of the actual cost), and providers and patients have no choice in the matter.
Worse, since patients do not negotiate price, they don’t care what the price is and have no incentive to seek out a provider with a lower one. On the other hand, they have every incentive to take health risks they couldn’t otherwise afford and use services they might not otherwise be willing to pay for. There is a similar incentive for providers to charge for things covered by Medicare and Medicaid and do those things as rapidly as possible, whether or not that is what the art of medicine indicates would be the best treatment. So price – the most effective way to allocate scarce resources – isn’t determined by negotiation but rather by politics, (as has already been demonstrated by Obama’s back room deals) which invariably leads to shortages and rationing.
And what of the huge cost savings that Obama promises will magically appear under reform with the same perverse incentives?
According to the National Center for Policy Analysis, “Medicare’s total unfunded liability is more than five times larger than that of Social Security.” In fact, the new Medicare prescription drug benefit enacted in 2006 (Part D) has proven to be twice as much as the original congressional budget office estimates and alone adds some $17 trillion to the projected Medicare shortfall – an amount greater than all of Social Security’s unfunded obligations.” The liability for Medicaid is off the charts because unlike Medicare Medicaid has no “trust fund” but is paid for by the states with matching grants from the fed. I can’t speak for you, but I am overflowing with confidence that a government takeover of healthcare is just the ticket to solve our fiscal problems.
The reform the new left is attempting to force upon us is the wrong kind of reform. It will not bring down costs, it will not improve the overall health of Americans and it will not encourage innovation and entrepreneurship. What it will do is dramatically increase the number of Americans dependant upon government for their medical care and their livelihoods. That may be a good way to build a political base, but it ain’t reform.







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Thank you for the well researched and well thought out commentary. You are spot on target. The fact that you are African-American disputes the line that those who disagree with the current health plan proposal are "racist". We simply are citizens who can read and think and know when we are being given dross and told it is gold. .
"Because the number of Americans that are actually denied medical care is zero" That is a little misleading. Insurance companies regularly deny medical care to those it insures. It denies procedures and medications every day. If you cannot afford to pay for it out of pocket, you either do without it, hold a fund raiser or wait until you fall so ill that emergency intervention is needed. Who has not seen this?
You hit the nail on the head with the third party payers. If you do not have a direct say in what your insurance looks like, you end up getting the equivalent of Morrisons cafeteria food when you are paying the same as you would have for say… The Charthouse. Yeh, not the best, but better than Morrisons.
And Tort reform. But what is the likelyhood of those turds in DC fixing that problem? They are as likely to hurt themselves with that as they are to vote for term limits. Both necessary and over due.
I agree with your comment that just because we disagree with the Democratic Party ideas of reform we are against any reform. No reform at all is vastly superior to passage of the proposals that the administration tried to push through on a rush basis. Insurance companies can and should deny coverage for treatments or procedures that are not covered, however. Typically, a more comprehensive P.P.O. plan will do a better job than an H.M.O. ,but it is, of course, more expensive.
Great read Joseph! We had a anti-obamacare rally two weeks ago in Atlanta the organizers handed out 12,800 arm band passes. It was reported by the MSM a few hundred attended. We have the wind at our backs keep pushing people, hot dog!
Joseph, great article. See you in the gulags, I mean flu quarantine zones.
The sad irony is that 'healthcare reform' is not about healthcare. As a matter of fact, the entire dog and pony show, cap and trade, healthcare, green technologies, et al, are a clever attempt at mis-direction while the administration 'transforms' itself into it's new 'staist' self. Where is the outrage over the appointing of 'czars' to key policy-making posts or the bleating of the left "we lack bi-partisanship because the Republicans won't
cooperate" while denying then access and anything the right suggests. When these malfeasants complete the transformation they won't care about what anyone thinks, they'll have won the war while everyone is still gearing up for the battles. WTF, OVER! If you're not beating down your representative's door his e-mail box should be smoking or their aides ears ringing as much as the phone while you call them every day. This is war, folks, and we're losing sight of what really important because we've allowed them to make the rules by co-opting factions of the private sector and most of the MSM. Here's an example: MSNBC. Need I say more?
No it's not reform but it was never meant that way except as the start of the takeover of our Republic.
But otherwise an Excellent post. Obama and his cartel of commies, radicals and followers are not going to give up easy. They might just shelve the Health bill and go on to the drastic commie take over of our Educational System. Not that it is very far from that now. Or maybe they will double down on the Cap and Trade which promises to not only bankrupt America but usher in International rule under Obama's reign.
May I expound on how I think we got to this terrible moment in our young Republic?
But first, Obama does understand the incremental nature of legislation, but he also has been taught the Chicago way of doing business in politics, and he has backers and handlers that understand it even more. The dirty tricks dept not only extends to elections, false registrations and vote fraud, but to Chicago dirty tricks in not only the Senate and the House, but in the back rooms of Lobbyists, Progressive Support Groups such as Acorn but also Corporations and Unions.
OK…When Americans (or at least a majority of those that vote) finally come to the realization that our Republic (NOT designed nor meant to be a Democracy) has strayed far from the path that our Founders intended. When those Americans finally understand what our Founders feared would happen, has indeed happened slowly and steadily over the last fifty or so years, Obama, Reid, Pelosi and others like them will never be reelected. Or you would think so, wouldn't you? But let me ramble on here a minute or so, because if we go by our past record, it shows that term limits are never set by the voters, except in very extreme circumstances..
In the LAST nine or so years, it took an out of control federal government spending our money and lots of it to FINALLY get (some of us) our attention. while it (getting our attention) should have happened over these last fifty or so years, it didn't because it was a slow and steady drain of our liberty and stealthy building of government theft and accumulation of powers. There are still millions of Americans that don't know or care a twit about politics but just vote the party line or even worse…don't vote at all.
Our Founder's not only warned us against all this, but wrote rules and regulations in our Bill of Rights (and it's Preamble), our Constitution, and inscribed in other important papers meant to warn, prepare and enable us to protect the Republic for which they stood, died for and wanted for all of their future generations of Americans.
So over these years, we have allowed the slow destruction of our Founder's vision, their plan and their hopes for our Republic- by our inability to understand and stop those like Reid, Obama and their host of radical thugs posing as politicians and the incompetents posing as journalists. Or by just not paying attention and/or caring about "politics".
Now we are at the point where all of the years we neglected and forgot our responsibilities to our Republic are going to finally allow the complete destruction and END of our Republic. Maybe that is seen to be best by some like the ones in power now.
But has been seen the last month or so, Americans attention has been not only raised, but also their long held anger.
I pray in the next year or so there are many millions more Americans that will voice their opinion and vote accordingly.
Papa Ray
West Texas
The Second Amendment is a doomsday provision, one designed for those exceptionally rare circumstances where all other rights have failed – where the government refuses to stand for reelection and silences those who protest; where courts have lost the courage to oppose, or can find no one to enforce their decrees. However improbable these contingencies may seem today, facing them unprepared is a mistake a free people get to make only once.
2009 Judge Alex Kozinski
Very good article, but one correction. Americans can be denied essential health care, and are done so every day. Yes, you can go to an ER with a life-threatening condition and they have to treat you, but they don't have to provide long-term care. Additionally, someone with conditions that can be deadly but aren't "urgent" are out in the cold (such as sleep apnea, which people can die from or die because of when they nod off while driving). There is no guarantee of dental care, yet infected teeth often cause serious illness (I had a friend who's husband was in intensive care for days in a close brush with death over such an infection). I'm not sure about the current state of transplants, but in the past Hospitals refused them if the patients lacked the ability to pay…even ones necessary for saving someone's life. I also am close to someone who requires a prosthetic (in this case an eye), and can assure you that hospitals will not dole out ones to anyone who can't pay, no matter how desperately they need them.
Part of the problem with the debate is that everyone skews the facts to make their argument appear in the best light, but the only solution is to be completely honest about the good and the bad so people can make informed decisions.
What a refreshing read! Like "lisabb" I also can't help but notice this position is being taken by an African-American. Sure blows the claim out of the water that all black Americans are mind-numbed robots with the same position on issues. Also debunks the myth – which I fall into all the time! – that all Hollywood entertainers are like-minded lefties as well. Kudos, Mr. Phillips.
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I've been involved with both group & individual health insurance for over 23 years. There are very few, if any, LIGITIMATE procedures or medications that are denied. Insurance plans are "written contracts', and again with very few exceptions, they provide what their contracts call for. Yes, there are cases where someone that wants a particular procedure that is not deemed "medically neccesary" by the carrier is denied, however when that happens, documentation by the Dr. to prove medical neccesity will reverse that decision. The same holds true for medications.
You are pointing out what Arthur Laffer calls "the wedge" which is the difference in the care we receive and the care we pay for. My company health care plan which covers my family includes a whole pile of services that I don't use or wouldn't choose to pay for if I had to negotiate it myself.
Obama's plan only expands the wedge and will therefore expand the cost. We should look at ways to exactly the opposite of what Obama is proposing. But I doubt any Republicans would have the guts to propose it.
My brother in law is a doctor who supports Obama. My sister works for a pharmacy giant and she supports Obama. I wonder if each is willing to work 15% more hours for same pay.
As an advocate for my clients, I've assisted many people over my career to "overturn" the initial denial, and in almost every case, decisions were reversed, and the procedure or medication was covered. In the few (3) cases they weren't, I've gone all the way up to the dept. of insurance in my state with the particular's, and with only 1 exception, again the insurance carrier covered the client. In that ONE iinstance, in over 23 years, it turned out to be insurance fraud, and the client was given back (recinded) all premiums paid into the plan.
My client base incudes over 2,000 employees & individuals, so I truly believe that my experience's are the norm, not the exception.
I find it extremely ironic that the same politicians that complain about the crisis in the private heatlh insurance industry are covered by these same companies as part of the federal employee menu of plans. Why have they not enacted their own "government funded" group plan for themselves if they are such experts on the topic?
You mean you have worked for insurance companies or have had policies under each kind?
I cannot, obviously, recount all times coverage has been denied and by whom, but I can briefly go over what I have gone thru myself or with my family and friends.
Like my girlfriend was booted from the hospital the day after having a cesarean because the insurance did not cover it (insurer and hospital being the same). She got a bad infection and they still would not admit her. Her gyno followed her out to her car and gave her a pelvic in the back seat so she could see what was going on. She ended up coming in later int he week and got readmitted after the infection had worsened and she was very sick.
Then there was my mom who was prescribed a medication by her doctor. Her insurance company refused to pay for it. She bought it herself and she and her gen. physician and her oncologist wrote to the insurance co to dispute their refusal. They still refused so they switched her to a different medication that they considered to be less effective. She wound up having an allergic reaction to it and got admitted to the hospital to treat that. They limited her length of stay and she had to leave early, sick from that and her cancer. We just ended up getting the money together and paying for it. What do you do?
It is very very hard to fight the insurance companies. Try to do it while sick or while someone you love is ill. It is overwhelming.
Those are just two instances. I could go on all night, but who wants to hear it? It makes you angry.
— On Mon, 8/31/09, IntenseDebate Notifications <notifications@intensedebatemail.com> wrote:
Not completely true. I worked for the Daughter's of Charity – their Seton Medical Center in Austin, Texas. If the need there and the treatment, cure, proceedure was anywhere CLOSE to being neccessary and the patient couldn't afford it the Nuns would and DID pay for it. I've SEEN it all, cancer, AIDS HIV, the most horrendeous tragic sicknesses you can imagine and NO ONE, nobody was turned away. I'm proud of my years at Seton and the work we did, the good we accomplished and the charity work that was donated by the hospital by donors patrons and everyday people contributing to the cause.
Tort reform? TORT REFORM??? NOT WHILE LAWYERS run the Congress…..
Too bad we all cannot be treated at Seaton. I admire that nobody at your facility was ever denied anything. I can assure you that is not the case anywhere else under regular old insurance – non donor care. Seems even with generous donors there would be a limit, but I will take you at your word. Maybe it is time to move to Austin.
— On Mon, 8/31/09, IntenseDebate Notifications <notifications@intensedebatemail.com> wrote:
Thanks, old dog—I wish your statement would get greater play. I also hate that the line "pre-existing condition" is thrown out there like insurers are big scrooges; if that clause did not exist, even more people would opt-out of paying for insurance until they need it.
This is not a case of completely innocent people versus corrupt insurers; people game the system—-or are too lazy to look for help until they really need it. Ask any emergency room nurse.
You're correct, it is very hard to fight insurance companies. No Wanda, what makes me angry is that you never mentioned what role your insurance agent played in both cases. As an agent, I work for my clients. Doing this for many years, I've learned how to "play the game", although I don't consider it a game! There are correct ways to make appeals, and my experience has been that clients/patients don't do a very good job on their own. I can't speak to your specific cases as I don't know all the facts involved, but I can say with confidence that if I had been your agent, the outcome may have been very different.
I know agents are not thought of very highly by many people, until you find a good one that works for YOU. I've almost 100 letters from clients thanking me for resolving denied claims, fixing disputes, etc. Again this is over a 23 year career, so it's the exception, not the rule.
A big issue I have with Obamacare is; who is going to service your problems, and what incentive do they have to make sure you're satisfied with those outcomes?
"Just say no". Nancy Reagan
I just have never bought into the fact that because the Constitution speaks of "promoting the general welfare" that we then jump to the conclusion that all of our citizens necessarily receive free or equal healthcare. If this was so the government would have had to have sent roving medical folks all over the colonies and then westward when population moved in that direction. When and how did this happen? It never did. Now, 230 years later we are of a mind that everyone deserves equality. Hey, it sounds nice in Utopia but it does not exist and if you want to make it exist we will need a tripling of medical folks to handle the onslaught of sick (or lazy?) people almost immediately. We can not afford this nonsense!!!
I think an even simpler approach is to ask what can be so good about ObamaCare if Congress exempts itself from it and if I am not mistaken extends that exemption to union members. Until the Democrats can answer that question this discussion of reform is a non-starter.
Surprise, the post-racial, post-partisian President is neither, Just another Chicago hack.
Raise your hand if you are surprised.
You are the exception not the rule. You are right… in fact I would have been THRILLED to have you to deal with.
Dealing with the insurance was more upsetting to my mom that going to get her chemo or radiation. Thinking about it raises my BP. I will instead think about the wonderful doctor I had in St. Pete lo so many years ago. He was Aetna. I adored him. I adored his staff. I will never take a good, caring and inquisitive physician for granted again. And my mom's onco – made a sucko situation less painful.
If POTUS wants to reduce costs and increase competition, the first thing he should do is allow us to buy insurance across state lines. However, that doesn't consolidate his power so . . .
I love the "do it for Teddy" rallying calls. Do these people realize that if we had the Canadian system, Teddy would've been Deady a year ago?
Yeah, laziness and gamers… those are the real problems. You know who gets gamed at the ER? Medicade. They go the ER for aspirin rather than pay 5 bucks for it at Walgreens.
I hope you are not an ER nurse. Sincerely I hope that. If so, a vacation is in order at the very least.
Maybe those lazy gamers are really just self rationers who are trying to decide whether to go to the ER with chest pains – I mean it could just be gas. And there is a life time limit on insurance coverage to consider… must not be wasteful.
Great article! Another great one has been posted at this website.
http://www.associatedcontent.com/article/2106949/...
Lets start with why anyone is accepting the numbers. 47M no insurance -15M illegals(easy one) -12Mwho just didn't apply to medicaid, 6M by choice. So really we're talking about 12M or so who need help. For this we're going to destroy our medical system? I think we can come up with a better plan if we sat down and worked on it. But then again, this isn't as much about healthcare as it is an incremental socialist takeover, now is it?
Thanks so much for the link! I too am a Jew & a conservative Republican. Just added your site to my favorites, looking forward to exploring it in detail.
That will work up to a point. The reason is some states don't have as many "mandated" benefits required as others. Some states don't require coverage for Chiropractic for example. A plan that doesn't cover Chiropractors will be less expensive then one that includes it. Some people believe in Chiropractic, some think it's quackery. A good solution would be to allow the insurance carriers to come up with what I'd call a "basic plan" that would also have a whole menu of options. That way you'd pay a reasonable price for a good, basic plan, and if you're inclined to add more "bells & whistles" you could, and you'd pay more for it.
That would mean taking mandated benefits out of the hands of politicians & bureaucrats, and put the decisions as to what benefits you want and are willing to pay for.
Touche.
I have regents blue shield. We found a doctor that looked decent (I live in a small town), found out what he took and called the insurance company and applied online. Frankly I did not know you could have a health insurance person locally. I thought you were talking about the agent you talk to when you call the offices.
I cannot remember who my mom used. Now she is on medicare and has a supplemental that she applied for online. She chose it because of the meds she was taking – they covered the most. I looked up Independent Agents & Brokers of America for my area. and there are 5! Who knew? If my doctor retires or I hear there is a snappy doc not covered by Regents, I will head over to one. I saved the list on a word doc. You never know.
I am never sick so I have not tested the limits of Regents. I have a basic policy with yearly and lifetime limits. Your standard I guess. I am self insuring because I am early retired. God I hope we stay well. I better lay off the fat and liquor and get myself on the treadmill!
— On Mon, 8/31/09, IntenseDebate Notifications <notifications@intensedebatemail.com> wrote:
I know someone who had ovarian cancer and had to have surgery. The hospital had schedules of what they charge and the insurance company had schedules of what they will pay for. These schedules are controlled by medicare rates of reimbursement. The hospital required a doctor to be present at the operation to observe, the insurance company would not pay for it, etc. The doctors prepped her and performed the operation and kept her in the hospital. She recovered and the day she was let out she had to meet with the finance people at the hospital. There she learned she owed tens of thousands of dollars.
The hospital never once told here she would not receive the operation. However, before she left she had to agree to a payment plan. When I was in public practice I did the books for several doctors, their bad debt expense averaged 50%. The doctors performed many procedures knowing they either would not be paid or could not be paid. Prices were higher to cover this. They will give you the treatment but it will put you into debt. That is the problem people have but hey if your alive……..
Health care monopolies will have a quality that is pure magic. The quality of being owned by the government. This makes it all OK. {wave of the hand while using the force}.
Just look at Fannae Mae. There 2005 financial statements had an adverse opinion by the accountants. This means there were so many irregularities (a CPA code word for potential fraud) that the accountants had the opinion that one could not say what the financial position of Fannae Mae was at the time. OFHEO the government regulators brought this before congress ion 2006 after their release and Barney Frank said they were being mean.
And we know that this magic statement by Barney meant that we had no trouble whatsoever after that.
See government has magic qualities and can do things that are impossible for private business or at least the say the do. So don't worry….
I think if you contacted on of those agents, they'd be more then happy to become your "agent of record". All this takes is a letter from you to Regents, asking that they assign the agent that you. That way you'll have someone "independent" of the insurance carrier that can assist you when needed. Their incentive for the assistance will be a commission, usually about 4-5% of the premium you pay, that the agent is paid directly by the carrier. This will not cost you anything above what you're already paying. That's one of the biggest reasons that insurance companies sell policies online! They cut out the agent, but your cost is the same, and now the only people that you can call when you have a problem is the insurance company. It's hit or miss at best as to how they treat you as a customer.
Health care monopolies will have a quality that is pure magic. The quality of being owned by the government. This makes it all OK. {wave of the hand while using the force}.
Just look at Fannae Mae. There 2005 financial statements had an adverse opinion by the accountants. This means there were so many irregularities (a CPA code word for potential fraud) that the accountants had the opinion that one could not say what the financial position of Fannae Mae was at the time. OFHEO the government regulators brought this before congress in 2006 after their release and Barney Frank said they were being mean.
And we know that this magic statement by Barney meant that we had no trouble whatsoever after that.
See government has magic qualities and can do things that are impossible for private business or at least the say the do. So don't worry….
Thank you Old Dog. I will call them in the a.m.! I was talking to my husband about it. He did not know you could get a local agent either. It never occured to us – maybe b/c we always had insurance thru work.
Thank you again for giving me that info. Anything in particular I should be asking them that would separate one from six? I will be doing the calling. My husband likes to pretend he is invincible and just has health insurance to shut me up. Maybe that is why we are so clueless about agents. When I was talking to husband abt. insurance just now, he actually lied to me and told me he was doing a fantasy football draft and could not have a talk about it. MEN! sorry…
— On Mon, 8/31/09, IntenseDebate Notifications <notifications@intensedebatemail.com> wrote:
The best way to decide on an agent is to ask them for a reference or two. Some may also be able to provide you with a few letters from clients. If they are good agents, believe me, they will have references and or letters, that's something we're very proud of!
BTW, men are terrible when it comes to health insurance. I think the main reason is that most (myself included) have fears about their own health issues. Woman have a much more common sense approach to healthcare, and are more apt to understanding the importance of the "details". Feel free to contact me with any questions anytime at olddog3006@hotmail.com
First of all, with insurance company you have a legal and binding contract of what services they will pay and then one they will not. Look at you insurance policy and you will see what is paid for, if you want additional services you have to pay out of pocket, normal business. You can get any medical service you desire, however the insurance company only have to pay for is what they are legally bonded to do, and that is your contract between them and you. No one is prevent in America from getting health care, if the can not pay then the cost is transferred to those who do in the cost of there medical care.
This winning about some filing for bankruptcy because of medical bill, you need to, look at each case, what were the services provided, what insurance coverage did they have and what was the dollar limits on their policies. Sure it not fair, but is life really, you have a obligation for yourself and family to provide the health care you think is most beneficial to you and them. Since when did we become a nation of un-self reliant people, who expect other to take care of them? I for one have insurance for medical care, does it cover everything no, nor do I expect it to, if something unexpected happens, we as a family will take care of the cost and not impose on other to pay for it, that is call responsibility. Quit having your hand out for other to pick-up you slack, grow up and be responsible for your actions and needs.
Kudos for the top -notch journalism @ Big H.
Mr. Phillips, you summarized it very well with the last two lines.
Spot-on David!
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I've been in pharma and research industry for 20+ years and am familiar with most sides of thought. One troubling aspect of Obamacare that doesn't seem to be getting any discussion however is the very issue that caused much of Hillary Clinton's efforts at reform to crumble. Its the thorny issue of privacy.
I've provided more details about this issue on my blog. (http://blog.hjbnet.com/) There's not enough space here. If this is bad form, please excuse. I just needed more space to pass along some comments.
Kepe up the good, objective analysis. America's strength has always in been in the hands of those who are willing to think.
Good post… The Democrat party has long been known as “the party of unintended consequence"… Every day I discover new reasons why Obama care is inadequate, destructive, and will threaten more industries…
Two worth mentioning are:
1) How the Obama plan’s "worth of life" panels for seniors will negatively impact the cost of the Life Insurance Market…
2) Why the figures of the literally millions of foreigners, who come to US to receive the best health care in the world, are missing in debate…
Inadequate care will drastically affect hospital’s foreign bread-and-butter clients, if Democrats kill it… And yet, Democrats aren’t concerned with Foreign-paying healthcare clients; they are too busy setting an IV from taxpayers to foreign (no-paying) populations; all to create potential blocks of voters…
This market plan will destroy the market for all… Think of what the Democrats are really asking here…. They are asking a solid 84 % of healthcare subscribers, satisfied with their Drs and Health plans, to settle for inadequate medical services… And then pay more for the muddle and catastrophe it will eventually induce…
Thank you Joseph, good research, brave stance. Obama is trying to create a new dependent constituency, not reform health care.
What a great article. You're writing speaks to your intelligence and willingness to be considered a racist since you are going against the annointed one's wishes. Thank you very much for the info and keep the articles coming.
My ex-girlfriend is a single mom who's had it incredibly rough. She finally landed a good job with an insurance company (handling phone claims, which is a very rough gig). She was solidly in Obama's corner during the election (nothing I did could talk her down), but now with cap & trade (higher energy bills) and the health care bill (possibly thinning out her market), she's finally beginning to crack. She sees what it's like to make her own way and likes not having to depend on anyone. Then she sees the Democrats about to take it all away. It's sad, but the only way some people are going to wake up to what's going on.
They had some Playboy model/singer on Hannity tonight, who cheerfully said the government should pay for all healthcare (including dental), and even pay much of the world's healthcare needs. She does have a charity (so she's not a total hypocrite), but somehow thinks "the government" has all the money in the world to take care of it. Sean couldn't manage to explain to her that the government comes from people like her boss, who would be giving up his mansion and luxury toys to pay for said policies (although that still wouldn't come close to covering it). Does anyone actually think she'd give up her lifestyle and live like a lower-middle class person again to attain her goal?
Wow! What a great thread and great advice! I've been very lucky to have had awesome doctors and insurance coverage but you never know when you might need help you didn't know you could have. Thanks so much for the information you've shared here.
I copied down your email if you want to edit it out. Thank you!
Husband still on computer drafting. Unbelievable marathon! LOL
There is an editorial in the Washington Times (http://washingtontimes.com/news/2009/aug/27/healt... that has this quote from Howard Dean:
"The reason that tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on, and that is the plain and simple truth…"
So tort reform isn't there because it will make the trial lawyers mad – straight from the horse's…mouth?
There is an editorial in the Washington Times (http://washingtontimes.com/news/2009/aug/27/healt... that has this quote from Howard Dean:
"The reason that tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on, and that is the plain and simple truth…"
So tort reform isn't there because it will make the trial lawyers mad – straight from the horse's…mouth?
Excellent piece! Being a citizen in a democratic republic doesn’t mean we have the luxury of being passé about our government. It takes a well educated populace on political matters. We all do not have to scholars just well versed on the constitution and keep a wary eye on those we elect. We as Americans are finding this out the hard way as severe buyer’s remorse is setting in. A majority of American voters who are fighting through a recession, raising their kids, making other significant contributions and working harder than ever to keep their jobs are forced to read legislation they could have never imagined being pushed by politicians. The statist politicians designed Medicare, Medicaid, and Social Security all programs born of a real need but implemented to give power to government and votes for a political party. They were created outside “the reach of the invisible hand” of the free market and thus were doomed to be anchor on the American tax payer. Now the same likeminded politicians want to dig a deeper hole to cover up the failure of Medicare and Medicaid. It could be called brilliant if it wasn’t so painful.
I could not get to your link. BUT I did see the video clip of Dean admitting why it was not included. It is also because THEY are lawyers. Lawyers give them money and support them. Never dump in your own nest. Speaking of, there is a funny quote that goes something like…. politicians should be changed as often as diapers and for the same reason. LOL That isn't exact, but you get the idea.
Some on both sides of the political aisle have some good ideas. Too bad we are too divided to see that.
Let me try again:
http://washingtontimes.com/news/2009/aug/27/healt...
Based on current poll numbers, I am sure that Obama is going to add some Oxycontin to that "warm bucket of snake oil" in an attempt to make it less painful and much more pleasant. Hoping we will become addicted.
When do STOP THIS FEDERAL GOVERNMENT? WHERE IS THE LINE IN THE SAND?
"Seller, beware: Feds cracking down on secondhand sales of some products"
"If you're planning a garage sale or organizing a church bazaar, you'd best beware: You could be breaking a new federal law."
Dear Federal Government, stay the f— out my life…
The only way for the government to cut costs is to cut services. Only a lying liberal would not call that rationing. Ditto for " end of life counseling" not being called death panels. This legislation is not only bulls%&t but it is downright evil. Conservatives have laid out better ideas for reform but that does not serve the libs end game which is for TOTAL CONTROL of the American citizen. They have proven over and over that they will shamelessly cheat and lie to achieve this goal.
How many Christians have prayed and prayed about something and felt like they never got an answer from God? No doubt there have been millions. There are many reasons that people do not get answers to prayer. One of them that is not discussed much is that God expects us to obey Him and use wisdom in our daily lives. God is certainly loving, kind, and 'rich in mercy,' but on the other hand, He is not a dispenser of 'cheap grace,' always responsible to rescue us from the problems we cause for ourselves
I really don't believe that I'm the exception, although I'm sure there are plenty of agents that work only for commissions and don't understand just why those commissions are paid. I know many agents that have the same attitude as me, that realize that their clients count on them when they have a problem, not just a visit once a year at renewal time.
If your agent is not pro-active on your behalf, fire him/her, and find one that has your best interests at heart. The insurance carrier has no problem with you assigning a new agent to your account. Find one associated with Independent Agents & Brokers of America, you can be assured there's many in your area.
Man Thing. Swamp Thing is a DC character.
I am not scared to walk up to African Americans and ask them why they want Obamacare, everyone I talked to was as dumb as a rock. They think Obama would never screw them.
Marvel's sale to Disney is only pending anti-trust approval. Because forming monopolies is illegal. Technically it's Fascism. Our anti-trust laws even stopped FDR.
So . . . how about health care monopolies? I guess it's not as vital as Swamp Thing.
True story:
Shortly after we got married, my wife got pregnant. It was a stressful time, she was working while I was in school, and we lived in a university subsidized efficiency. We bought health insurance, knowing that the cost of having a baby was pretty expensive, and the plan covered childbirth. the plan also had a $3250 deductible, and at the time we weren't entirely sure what that meant, but childbirth was covered, so all systems go. We paid about $250 a month for this coverage. Three months later, she miscarried. One eight hour ER visit and a surgery later, we realized what a deductible was.
cont'd
Had we not been insured, we would have saved 750 bucks. I graduated shortly thereafter, and knew enough to get a job with health benefits. Turns out, FedEx Office has some damn fine health insurance–$10 copays for office visits, chiropractic is covered, $250 deductible. I was making 8 bucks an hour, but with what we spent on health care, I effectively made twice that.
I learned from the school of hard knocks–While at FedEx, I took classes, eventually got a better job with better insurance. You can either learn from past mistakes, or whine and moan and ask for others to fix your problems.
The same can be said for those waiting for Government aid… My uncle had hurt his knee while working and was on workers comp to fix the knee… well he just got sicker and sicker (because of the knee?) but because it was only his knee that he hurt workers comp (and he didn't have insurance) would only fix the knee. Well he got so bad that he eventually applied for Disability and SSI because he couldn't work anymore to support himself or his children or even get his health problems taken care of. Well, very unfortunately, he died Easter of 2008… and not a month later he qualified for for Disability and SSI.
Tort reform should be step one, but it won't be. I don't think it's a coincidence that politicians don't seem to see the need (or it's against their personal interests) for tort reform and the fact thata majority of politicians have a legal background. The few legislators we have who were former doctors have great insight, but they're largely ignored, unless their name is Howard Dean.
As far as providers go, a person close to me is a provider. She spends all her time essentially begging insurance companies to simply pay what they owe. Apparently, their goal is to put providers through so much red tape they'll just give up. Often she does. And no, she can't sue Blue Cross over a $200 bill.
Regardless, the goal should be to bring cost down to reduce the role of big insurance, and cut out the middle man as much as possible. Regular doctor's visits should be affordable and insurance should be for catastrophic only. Am I the only one this stuff seems obvious to?
Unfortunately the nanny state has already rendered the notion of affordable health care (like where YOU pay YOUR bills) ludicrous to the average american. I don't see how we'll ever get it straightened out.
Was that the recess rally? I attended ours. The local paper barely covered it and called us loud and boisterous. Most of the article was devoted to Organizing for America and the carpenter's union who went doorbelling during the rally. They were depicted as rational. It made me sick.
Thanks for your hard work!
It's always time to move to Austin. Great city!
Well said Joseph. Great writing.
CaliDave,
Got it!
I am glad you tried again because… ouch and hooray! I think the news folks are starting to get it. Barely.
The icing on the cake was the editorialist's use of both \”mollycoddling\” and \”scot-free\” in the same piece – and so close together. ~
It sure drives home WHO these people running the country are working for and representing. Themselves! Representative government my arse.
— On Mon, 8/31/09, IntenseDebate Notifications <notifications@intensedebatemail.com> wrote:
CaliDave,
Got it!
I am glad you tried again because… ouch and hooray! I think the news folks are starting to get it. Barely.
The icing on the cake was the editorialist's use of both \”mollycoddling\” and \”scot-free\” in the same piece – and so close together. ~
It sure drives home WHO these people running the country are working for and representing. Themselves! Representative government my arse.
— On Mon, 8/31/09, IntenseDebate Notifications <notifications@intensedebatemail.com> wrote:
From the "Mary Jo takes one for the team" thread:
Do it for Teddy!
Drown ObamaCare!
Nothing is a right when you have to force other people to pay for it.
Nathan,
I'm sorry for your loss, but , your story is an example of what happens when you buy insurance after the fact. You bought insurance to offset known future costs instead of unknown potential costs. The Insurance company then had to make your deductible high enough to offset the known future cost, but it still covered unknown excess costs. People need to be educated on how insurance works so they know enough to buy it before they need it.
The thing was, the insurance company didn't know my wife was pregnant. We'd done the EPT, but hadn't seen a doctor for specifically that reason. Once we had policy in hand, she made the pcp appt.It wasn't a high deductible because of pregnancy, it was a high deductible because of they-can-get-away-with-it.
As a physician I am especially embarrassed by Howard Dean (a non-practicing MD)
Exactly! We were given free will, the greatest of all gifts. But this comes with a price, personal responsibilty and the need to solve our own problems for ourselves.
Exactly! We were given free will, the greatest of all gifts aside from life itself. But this comes with a price, personal responsibilty and the need to solve our own problems for ourselves.
Nathan,
Yes, they could get away with it because you didn't know what you were buying. On the other hand, even though you didn't disclose your pre-existing condition, they might have assumed you had one when you didn't argue the deductible. When you try to con the system, it's hard to say "foul".
Do you take no responsibility for knowing what you paid for? You stated: " for the plan also had a $3250 deductible, and at the time we weren't entirely sure what that meant, but childbirth was covered"
I know you were excited about the pregnancy, but that's no excuse for not understanding what your plan covered, and what your maximum out of pocket would be. That is always stated up-front in a health insurance policy, it's not a "fine print" issue.
The insurance company didn't try to "get away with" a high deductible, YOU chose that deductible. If you took the time to understand what that deductible applied to, you might have chosen a much lower deductible. Of course, you'd pay a higher premium, that's the trade-off.
The only thing we were trying to do was avoid the pregnancy as a pre-existing condition caveat. We looked at lower deductibles vs higher monthly payments, but the fact is, we did not do the research and we screwed ourselves over. Had we sought an agent, it would have helped us tremendously, but we didn't even know that was an option. My intention in sharing that story wasn't to say insurance companies are evil institutions, but to get other people to go into this with both eyes open.
The fact that your post got split into two posts makes it hard to see what your intention was until you read the second half, then it's clear.
The other thing your story illustrates, is why there are and must be pre-existing condition caveats. If you could wait until you had a problem before you bought insurance, no one would buy it until then. It's not a something for nothing deal.
That's exactly right. We were caught as healthy, albeit completely unprepared 22 year olds. A little bit of education from some grown-ups would have been great, but we just didn't think about it.
The pre-existing caveat makes perfect sense from a business standpoint. There's a youtube video (http://www.youtube.com/watch?v=SPq6_7AFsp4) that explains it pretty well. The issue is talking that kind of sense into freshly graduated, healthy adults with no life experience.
I'm sorry, I didn't mean to come across as "scolding" you, however when you said that the insurance companies do it because "they can get away with it", it raised my hackles. The health insurance business is one of the most highly regulated industries in the US, mostly by the states, some by the feds, and believe me there's very little they can get away with.
Your link doesn't work. It would be nice if there was a way to educate young people on things like this. I would bet the majority of insurance holders have no idea that they could be getting the service that olddog55 is talking about. Most preconceptions of insurance companies and insurance agents are about as flattering as those associated with used car dealers or carneys.
Youtube > search for: "why we don't need socialized medicine". Should be the first one on the list, about 8:30 long.
According to Politico, it's now official: Harry Reid just said in an interview that Ted Kennedy's death "would help us out" with regard to getting the bill passed. If I were a betting man, and judging from the comments on Politico, I'd say he's going to be rueing that comment for the next 14 months.
But then the provider has to eat that $4K. That's not the insurance company bringing the cost down, that's just the insurance company sticking it to the provider.
It matters a great deal whether your health insurance is employment-based or not. If your coverage is through your employer it becomes very, very difficult to enforce. See this post at my blog:
http://problemiserisa.blogspot.com/2009/08/timoth...
and play the tape of Representative Shadegg, where he briefly discusses the problem.
Which is exactly what the Govt plan is designed to do – at even lower rates than the Insurance companies pay – so even MORE of the cost is "stuck" to the provider. That plus cutting back and rationing what Medicare & Medicaid provides, to save money there. How else do you think they are planning on "lowering" costs? Insurance companies negotiate better rates, by providing a large pool of "clients/customers" and a streamlined cost-effective billing/payment system to the providers that gives them instant cash-flow with little back-office/billing costs. My wife had major surgery 2 weeks ago and the Dr. and Hospital were paid in less than 5 days by my Insurance Co.. Dr.s taking Medicare and Medicaid wait 6 months for payment from the Govt, and have half their claims denied and having to be re-submitted multiple times on technicalities to get payment. Why do you think most Dr's won't take Medicare patients anymore? With the Govt plan, all we will end up with is Universal Medicare/Medicaid for everyone, or a two tiered system – Gov't plan, and Private Plan. Private plan people with the good Dr's and the best hospitals, and the Govt plan people with public health clinic Dr.s and the Indigent hospital. If there is a third way that keeps or expands the current system and doesn't cost money, and doesn't involve the Govt which couldn't run a lemonade stand efficiently, speak up – you'll be famous and the next Surgeon General of the United States.
David I disagree that you have a "legal and binding contract" with the insurance company if your coverage is employment-based, at least is "legal and binding" is supposed to mean "enforceable in court." See my blog:
http://problemiserisa.blogspot.com
for more, and do some further reading to confirm I'm not making it up. If your coverage is employment-based, among other things: your remedies are very very limited if you can win your case, and in order to win anything at all you have to overcome no right to jury; very limited discovery; inability to testify or to cross-examine the people who denied your claim; and a burden of proof that means if you prove the insurance company was wrong you still lose — you have to prove they were absurdly, ridiculously wrong.
Olddog, I think they are able to "get away with" quite a bit if they sell a group plan to an employer. See my blog:
http://problemiserisa.blogspot.com
and see what you think.
You should know the facts a little better. ERISA applies ONLY to "self funded" plans, and "group association" plans that are not subject to State rules. In those plans the EMPLOYER or the ASSOCIATION writes the plan documents & the rules governing those plans, not the insurance carrier that underwrites it. ERISA plans account for a very small percentage of people covered under employer group plans. In my career, I've not had one group that was subjected to ERISA, it doesn't apply to any fully insured group plans.
Usually only very large groups will "self fund" which means the EMPLOYER will usually pay the 1st $50,000 in claims and then the insurance plan pays over that amount.
Association plans were intentionally designed to circumvent state mandates, and in my opinion are more "scams" then true health insurance. That's why you'll find most of the association plans written out of Texas, as they have very weak state laws regarding health insurance and an association plan only has to abide by the rules of the state it's domiciled in.
So while I find you blog very impressive, by saying all group plans are covererd by ERISA is just plain not factual.
BTW, I don't mean to disparage Texas, I love that state, but their Dept. of Insurance is pretty weak compared to most states.
Ditto's Mack!
Olddog, I am afraid you are mistaken. ERISA applies to any employment-based coverage (unless the employer is either a church or a government entity). It certainly applies to fully insured plans –just look at some of the ERISA Supreme Court cases, such as 1987's Pilot Life Ins. Co. v. Dedeaux, or last year's MetLife v. Glenn. Or look at some of the judicial opinions quoted at my blog discussing precisely how the insurance industry "get away with" lots of stuff under ERISA:
http://problemiserisa.blogspot.com/2009/08/rising... ("Every single case brought before this Court has involved insurance companies using ERISA as a shield to prevent employees from having the legal redress and remedies they would have had under long-standing state laws existing before the adoption of ERISA.").
http://problemiserisa.blogspot.com/2009/08/rising...
("ERISA has evolved into a shield that insulates HMOs from liability for even the most egregious acts of dereliction committed against plan beneficiaries, a state of affairs that I view as directly contrary to the intent of Congress. Indeed, existing ERISA jurisprudence creates a monetary incentive for HMOs to mistreat those beneficiaries, who are often in the throes of medical crises and entirely unable to assert what meager rights they possess").
I don't think ERISA was intended to apply to insurance companies when it was enacted, but that is how it has been interpreted, and as a result insurance companies are immune from liability for any bad behavior up to and including fraud. And the insurance policy written by the insurance company is very frequently what the court uses as the "plan document," including grants of discretion that the insurer conferred upon itself. Right now I have a case pending before the Eleventh Circuit, and I can tell you that Metropolitan Life Insurance Company is certainly using ERISA in its defense for all it's worth. And they are (legally) correct in doing so.
Rich,
Went to your site, Made me sick to my stomach. Had to use my blogger acct. to post. PLEASE feel free to ignore my site.
W
— On Tue, 9/1/09, IntenseDebate Notifications <notifications@intensedebatemail.com> wrote:
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