(Political) To the Left wing of the Democratic party

[lynchjm24]

Ah, you didn't get the whole chart. My wife's cousin's country is on the chart and according to this data the GP in Portugal would make $1,000 a month less then a postman in the US.

[DaddyTorgo]

Originally Posted by SteveBollea

I included a link and everything just in case the board made the chart look like crap. But, just for instance, France. Yes, they only make $55,000 a year approximately. But, they don't have crushing student debt, their malpractice insurance fees are much less than here in the US for obvious reasons, and the French government pays 2/3 of physician's social security tax (a tax that's typically 40% of income.)

if the govt is paying 2/3 of their 40% tax then you could just bump their income up by that amount to "net" the whole thing out...

[lynchjm24]

Originally Posted by SteveBollea

I included a link and everything just in case the board made the chart look like crap. But, just for instance, France. Yes, they only make $55,000 a year approximately. But, they don't have crushing student debt, their malpractice insurance fees are much less than here in the US for obvious reasons, and the French government pays 2/3 of physician's social security tax (a tax that's typically 40% of income.)

So all you need to do is find a generation of doctors who are willing to make $55,000 a year. Let me know where the money is coming from to allow a government takeover of our medical schools.

This isn't France. Or Portugal. Or Germany. The people here don't behave in that fashion.

Has anyone ever taken the bridge from Detroit to Windsor, Ontario? They are a few miles away. In Detroit you are lucky to not get stabbed to death or have your car pawned while you are driving it. In Windsor people walk their dogs at midnight and leave their doors unlocked.

You can't write legislation that doesn't take into account the way that Americans behave.

[lynchjm24]

Originally Posted by DaddyTorgo

if the govt is paying 2/3 of their 40% tax then you could just bump their income up by that amount to "net" the whole thing out...

And that gets them to about 1/3rd of what my 32 year old wife makes working in P&C insurance.

[lynchjm24]

Originally Posted by SteveBollea

Actually, I'm pretty sure a lot of people would take a deal that guaranteed them no student loan debt, the government picking up 2/3 of their taxes, and malpractice insurance costs much lower than in the current system.

I'd prefer the government running the medical schools compared to the AMA running them as it currently does.

But yes, a city with massive structural unemployment and massive poverty is the same exact thing as a medium-size city with none of those problems. Come on now.

Finally, I guess I just have more faith in the American people than you do. After all, if you told somebody in Alabama in 1955 that blacks would have equal rights within 20 years, he's laugh at you. The arc of the universe is long, but it bends toward justice.

Some might take that deal. They aren't going to take that deal if it comes with a $55k salary. At least not anywhere near where people actually live in this country. There wouldn't be a doctor in New York or California.

I don't know anything about the quality of medical schools, but I know that a government take over would be expensive. You might be right they would be better, but since it can't and won't happen it isn't worth worrying about.

You have faith in the American people? Do you have any idea how much money the government loses a year in Medicare and Medicaid fraud? Google "Medicare Fraud" and enjoy the ride.

[RainMaker]

Originally Posted by lynchjm24

Some might take that deal. They aren't going to take that deal if it comes with a $55k salary. At least not anywhere near where people actually live in this country. There wouldn't be a doctor in New York or California.

I don't know anything about the quality of medical schools, but I know that a government take over would be expensive. You might be right they would be better, but since it can't and won't happen it isn't worth worrying about.

You have faith in the American people? Do you have any idea how much money the government loses a year in Medicare and Medicaid fraud? Google "Medicare Fraud" and enjoy the ride.

And there is also massive insurance fraud taking place. Perhaps not as blatant, but many doctors will over-treat when it benefits them financially. Such as the statistic that shows a doctor is 4 times more likely to request an MRI when they own the machine.

Fraudulent billing is not Medicare specific, it's an issue we have with doctors. Insurance companies pass that on to consumers just as the government passes it on to taxpayers. The solution would appear better enforcement and tougher punishments for doctors who commit fraud.

[Surtt]

Originally Posted by DaddyTorgo

some of the limitations of this new legislation as far as ways insurance companies could still game the system?

As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not "unreasonable." The bill does not define what level of limits would be allowable, delegating that task to administration officials.

Who is to say what is reasonable?

The Patient Protection and Affordable Care Act will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact.

Fraud or intentional misrepresentation are the two most common excuses give now to drop polices.

The devil is in the details.
They will still be able to limit coverage and drop sick (expensive) people.
There is enough loop holes already slipped in that they don't need to game the system

[flere-imsaho]

Originally Posted by lynchjm24

It's not anecdotal evidence. It's actuarial science.. you know the type of work that would be done to figure out what healthcare costs will be.

I'm well aware of that, and I would caution you against using a condescending tone when what you write gives the impression that your grasp of certain subjects is tenuous at best.

For instance: actuarial science. You seem convinced that if use of the system was free, people would abuse the system, and abuse it to the point (or enough people would abuse it to the point) that it would bankrupt the system.

However, there exist within the system people who are already able to abuse it. For instance the number of people, like myself, who can handle paying their deductible and out-of-pocket, and then get fully free care for the rest of the year.

What does your data, data from actuarial science, data I assume you have access to since you work in the industry and impress that upon us at every step, say about the levels of abuse perpetrated by the numbers of people able to abuse the system in this manner? Does it suggest that, if such a group was expanded sufficiently in number, that it might bankrupt a private insurance company, Medicare or a Universal Health Care system?

I doubt it does, and to prove it I'll point to every other UHC system in the world which doesn't suffer from this kind of rampant abuse you seem to think comes part and parcel with a UHC system. But I'll await your evidence to the contrary.

Of course, at this point you'll tell me that Americans are different, and we'll abuse the system (again, which could be shown by current data for smaller groups, of Americans), but unless you are basing this on actual studies with actual data, you are doing nothing more than speculating.

And that, my friend, is using anecdotal evidence to suggest the presence of conclusive data.

Maybe everyone won't abuse the system, but if you don't think that people know how to utilize their health insurance to best serve them then you need to start over. It's not even worth debating, it's reality.

Originally Posted by lynchjm24

Sure if you want to qualify your statement with "everyone" it's not true. For someone as bright as you are, you are pretty out of touch with how people behave.

You are conflating the ways in which specific people behave with the ways in which groups of people behave.

Until you can provide an example of a % of waste generated in a representative system due to abuse of that system by people "gaming" it, and extrapolate that up to the amount of waste expected in a UHC system (which, of course, ignores all the common-sense safeguards that would be in effect), then you are doing nothing more than speculating, and speculating from a clearly subjective position (i.e. you think Americans are, in general, lazy and not inclined to look after themselves).

I am speculating too, but at least I'm honest about it.

[Galaxy]

Originally Posted by SteveBollea

I'd prefer the government running the medical schools compared to the AMA running them as it currently does.

The AMA runs the medical schools?

[Galaxy]

Interesting article:

Terms of Service

[flere-imsaho]

Originally Posted by lynchjm24

No, it means I've spent a week with them in WESTERN Europe and the standard of living pales in comparison to the people that live in my upper middle class neighborhood in eastern Connecticut. He's a brain surgeon, my neighbors are firemen and work on IT help desks.

I ask again:

Originally Posted by flere-imsaho

How do you define "4 levels"? Is he unhappy? Why doesn't he quit practicing or move to the States?

I'm sorry, but doesn't it strike you as a little suspect to claim to be able to make clear judgments on the differences in standards of living between two countries, two cultures, based on one week spent visiting another country?

After all, does the concept of, say Cost of Living mean nothing to you? The concept of non-salary benefits (such as, say, Universal Health Care) outweighing pure salary?

Originally Posted by lynchjm24

Ah, you didn't get the whole chart. My wife's cousin's country is on the chart and according to this data the GP in Portugal would make $1,000 a month less then a postman in the US.

Apparently not.

[lynchjm24]

Originally Posted by RainMaker

And there is also massive insurance fraud taking place. Perhaps not as blatant, but many doctors will over-treat when it benefits them financially. Such as the statistic that shows a doctor is 4 times more likely to request an MRI when they own the machine.

Fraudulent billing is not Medicare specific, it's an issue we have with doctors. Insurance companies pass that on to consumers just as the government passes it on to taxpayers. The solution would appear better enforcement and tougher punishments for doctors who commit fraud.

Of course it's not Medicare specific. Medicare is just covered more closely by the media and therefore is easy to see quickly how bad it is.

[lynchjm24]

Originally Posted by flere-imsaho

What does your data, data from actuarial science, data I assume you have access to since you work in the industry and impress that upon us at every step, say about the levels of abuse perpetrated by the numbers of people able to abuse the system in this manner? Does it suggest that, if such a group was expanded sufficiently in number, that it might bankrupt a private insurance company, Medicare or a Universal Health Care system?

I doubt it does, and to prove it I'll point to every other UHC system in the world which doesn't suffer from this kind of rampant abuse you seem to think comes part and parcel with a UHC system. But I'll await your evidence to the contrary.

Of course, at this point you'll tell me that Americans are different, and we'll abuse the system (again, which could be shown by current data for smaller groups, of Americans), but unless you are basing this on actual studies with actual data, you are doing nothing more than speculating.

And that, my friend, is using anecdotal evidence to suggest the presence of conclusive data.

Here is a something that a lot of people don't seem to grasp: Outside of the individual market, INSURANCE COMPANIES DON'T CARE WHAT YOUR CLAIMS ARE.

Where did I say anyone was going to bankrupt anyone with extra utilization.
You can't bankrupt insurance companies with some extra utilization because the services still have to be 'medically necessary' and the costs are either directly paid by the plan sponsor in real time or the rates are adjusted in the next policy period. The excess utilization contributes to the fact that medical costs go up 4x faster then overall inflation.

Sure it's technically anecdotal evidence to you, to me it's like knowing the sun is going to rise in the morning. I could certainly dig up actuarial charts that show you that deductibles curb health care spend by more then the dollar value of the deductible because they change the behavior of the member but what's the point, you are just going to tell me I didn't share the data that was used to develop the charts.

You want a single payer system and don't aren't concerned with any of the downstream issues one causes. My reasons for not wanting UHC is much stronger as a taxpayer and a father then as someone who works in the health insurance industry. I could find jobs in other industries tomorrow if I decided to.

You trust the government to do a better job, other posters have faith in the American people... I respect your opinions but have no idea how you could have arrived at them.

[lynchjm24]

Originally Posted by flere-imsaho

I ask again:



I'm sorry, but doesn't it strike you as a little suspect to claim to be able to make clear judgments on the differences in standards of living between two countries, two cultures, based on one week spent visiting another country?

After all, does the concept of, say Cost of Living mean nothing to you? The concept of non-salary benefits (such as, say, Universal Health Care) outweighing pure salary?



Apparently not.

Apparently not what?

Yes, it's an opinion that my standard of living is higher then theirs. I'm sorry I didn't hire a team of economists to travel with me to provide a study. A week? How long do you need to spend at Gillette Stadium to realize the Patriots are better then your high school football team?

I guess everything that everyone has ever experienced is suspect, because they are but one person and that isn't a sufficient sample size.

You win. Tax and spend. If the economy is so bad that there is no one to tax then just borrow it from China. By the time the Chinese figure out it's junk debt then we'll be dead and it will be someone else's problem.

[lynchjm24]

Originally Posted by flere-imsaho

Until you can provide an example of a % of waste generated in a representative system due to abuse of that system by people "gaming" it, and extrapolate that up to the amount of waste expected in a UHC system (which, of course, ignores all the common-sense safeguards that would be in effect), then you are doing nothing more than speculating, and speculating from a clearly subjective position (i.e. you think Americans are, in general, lazy and not inclined to look after themselves).

I am speculating too, but at least I'm honest about it.

What exactly is a 'common-sense' safeguard?

Are you really going to argue inane things like Americans aren't less healthy then citizens of other nations?

If this site isn't legitimate there are dozens of legitimate studies that show the same exact thing:

Obesity statistics - countries compared - NationMaster

Can you answer one question while you build the case for your Utopian UHC? If I'm supposed to contribute to the greater good by paying a huge percentage of my income in federal taxes, why is there no responsibility for those who I subsidize to minimize how much I have to subsidize them?

[flere-imsaho]

Originally Posted by lynchjm24

I could certainly dig up actuarial charts that show you that deductibles curb health care spend by more then the dollar value of the deductible because they change the behavior of the member

It's interesting that you cite this as (I assume) as positive. What of the person who forgoes a type of test due to a deductible and as a result does not catch the development of a terminal condition?

Look, I respect some of the basic logic that underlies your worldview on this subject, I just happen to think the conclusions you've arrived at concerning the efficacy of existing UHC systems, or the likely results of its implementation in the U.S., are due more in part to subjective reasoning than you'd like to (or can) admit.

[flere-imsaho]

Originally Posted by lynchjm24

Apparently not what?

Yes, it's an opinion that my standard of living is higher then theirs. I'm sorry I didn't hire a team of economists to travel with me to provide a study. A week? How long do you need to spend at Gillette Stadium to realize the Patriots are better then your high school football team?

Oh please, don't be childish.

First of all, you still haven't answered as to whether or not your wife's cousin is unhappy? Why doesn't he quit medicine if he's so poorly remunerated? How, put simply, does he manage to live?

Secondly, are you completely unaware of the cost of living differences that might make up an apparent discrepancy in raw salary? Did he have student loans? How much, in comparison, is his malpractice insurance? How much does his house cost or does he pay in rent? Does he pay to send his children to school? Does he pay for health care?

I'm sorry, but it sounds like you stayed with someone for a week, found that his house wasn't as big as yours, nor his car as nice, and decided that his life sucks, especially considering he's a doctor. Given that he lives in a country that likely has significant differences from yours, that's a hell of a conclusion to make. Can you not see this?

[lynchjm24]

Originally Posted by flere-imsaho

It's interesting that you cite this as (I assume) as positive. What of the person who forgoes a type of test due to a deductible and as a result does not catch the development of a terminal condition?

Look, I respect some of the basic logic that underlies your worldview on this subject, I just happen to think the conclusions you've arrived at concerning the efficacy of existing UHC systems, or the likely results of its implementation in the U.S., are due more in part to subjective reasoning than you'd like to (or can) admit.

Find an insurance company that doesn't support the concept that preventative care shouldn't be covered with no cost sharing for the member and we can talk about that.

Thanks for the final condescending paragraph though, it makes it more enjoyable when these ridiculous bills die slow deaths.

[DaddyTorgo]

Originally Posted by lynchjm24

Thanks for the final condescending paragraph though, it makes it more enjoyable when these ridiculous bills die slow deaths.

[lynchjm24]

Originally Posted by flere-imsaho

Oh please, don't be childish.

First of all, you still haven't answered as to whether or not your wife's cousin is unhappy? Why doesn't he quit medicine if he's so poorly remunerated? How, put simply, does he manage to live?

Secondly, are you completely unaware of the cost of living differences that might make up an apparent discrepancy in raw salary? Did he have student loans? How much, in comparison, is his malpractice insurance? How much does his house cost or does he pay in rent? Does he pay to send his children to school? Does he pay for health care?

I'm sorry, but it sounds like you stayed with someone for a week, found that his house wasn't as big as yours, nor his car as nice, and decided that his life sucks, especially considering he's a doctor. Given that he lives in a country that likely has significant differences from yours, that's a hell of a conclusion to make. Can you not see this?

I didn't see anywhere where someone asked me if he's happy. I don't speak the same language that he does, so I can't ask him. He's probably happy, I didn't say he lived in desolation. The point you can't seem to grasp is that the culture is different and many Europeans are comfortable with what we would call socialism.

Saying someone's standard of living isn't as high as someone else's doesn't mean their life sucks. There are people who live within walking distance of me who could say their standard of living is higher then mine - I don't think that means I dumpster dive for meals.

You can continue to attribute things to me that I in no way shape or form said or inferred if you like. It's pretty silly though.

[flere-imsaho]

Originally Posted by lynchjm24

What exactly is a 'common-sense' safeguard?

I'm talking about your claim that people will find ways to "make the most" of their "free" health care, presumably by doing things like getting name-brand drugs over generics, getting lots of useless tests, only seeing a doctor for emergent care, nor preventative care, etc....

There are ways to minimize abuse, and you will find them already employed by insurance companies, Medicare, and the health systems of other countries. To somehow suggest that UHC will bring about some sort of free-for-all is disingenuous.

Are you really going to argue inane things like Americans aren't less healthy then citizens of other nations?

Where did I say that? Quote me, instead of making my argument for me and then attacking it on grounds where you feel comfortable.

Certainly the poor health habits of Americans in general represent a challenge to UHC, but also to any health care system.

You seem incensed by the notion that you would help to subsidize a system where people who are fat and lazy receive coverage, yet in fact if you have private health insurance you already do this, since plenty of people also on your plan are fat and lazy.

So would you prefer to exclude the fat and lazy and live with the collateral damage that is people who, with no other sins, die from a lack of coverage (say clean-living people who develop expensive diseases and didn't have adequate coverage)? It seems that way. That's simply your worldview.

Mine's 180. I'll live with covering the fat and lazy to make sure people don't die of treatable conditions, and I'll pay more to ensure that happens. And I'll do this because I've lived in a country where I've seen it work, not out of some random altruistic notion.

[Galaxy]

Originally Posted by SteveBollea

The AMA acts as a cartel that limits the number of spots in medical schools and stops them from expanding.

The Medical Cartel: Why are MD Salaries So High?

So the article says that:

You had a 21% increase in the number of applicants with a 9% increase in the number of accepted applicants. That doesn't really say much. This is med school, not the the local community college that accepts everyone. The article needs to explain the quality of applicants.

$200,000 is the average salary. I don't really see how that as a lot when you consider you won't be hitting that mark until your mid-30's. Throw in the higher taxes, debt, cost-of-living in a lot of metro areas in the country, that isn't much,

German Brain Drain: Sick of Bad Pay, Doctors Flee Germany - SPIEGEL ONLINE - News - International

Interesting article:
U.S. health care costs for the aged are sky high

[lynchjm24]

Originally Posted by flere-imsaho

Mine's 180. I'll live with covering the fat and lazy to make sure people don't die of treatable conditions, and I'll pay more to ensure that happens. And I'll do this because I've lived in a country where I've seen it work, not out of some random altruistic notion.

I didn't say don't cover the fat and lazy. I asked if I'm financially responsible for them and the greater good, what responsibility do they have? Please explain to me how it can possibly work if only one side is responsible?

[lynchjm24]

and speculating from a clearly subjective position (i.e. you think Americans are, in general, lazy and not inclined to look after themselves).

Here is where you told me that thinking Americans are lazy and not inclined to look after themselves is subjective. The obesity numbers seem to say that it isn't subjective.

[flere-imsaho]

Originally Posted by lynchjm24

Find an insurance company that doesn't support the concept that preventative care shouldn't be covered with no cost sharing for the member and we can talk about that.

My insurance company (BCBSIL) requires that I pay a deductible for things like MRIs and CAT Scans. If, for some reason, I don't have the money for that deductible, and have to forego that test, I could die from an undiagnosed terminal, yet treatable, condition.

And I'm a best-case scenario, because a) my deductibles are pretty low and b) I enjoy a good salary.

Thanks for the final condescending paragraph though, it makes it more enjoyable when these ridiculous bills die slow deaths.

Suggesting that your conclusions may not be completely objective is condescending? No wonder you take umbrage at other people's comments in these threads so much.

Look, I'm sure we all appreciate the benefit of your insurance-company-working, Hartford-Connecticut-living, visited-Europe-once-for-one-week expansive worldview, so please don't let my deliberately obfuscatory sentences stop you from continuing to enlighten us in our deliberations.

That was condescending.

[lynchjm24]

Originally Posted by flere-imsaho

My insurance company (BCBSIL) requires that I pay a deductible for things like MRIs and CAT Scans. If, for some reason, I don't have the money for that deductible, and have to forego that test, I could die from an undiagnosed terminal, yet treatable, condition.

And I'm a best-case scenario, because a) my deductibles are pretty low and b) I enjoy a good salary.



Suggesting that your conclusions may not be completely objective is condescending? No wonder you take umbrage at other people's comments in these threads so much.

Look, I'm sure we all appreciate the benefit of your insurance-company-working, Hartford-Connecticut-living, visited-Europe-once-for-one-week expansive worldview, so please don't let my deliberately obfuscatory sentences stop you from continuing to enlighten us in our deliberations.

That was condescending.

Unless you have an individual policy, it's your employer who requires you to pay the deductible, not the insurer. Sure, something that basic is lost on you, but it doesn't stop you from pontificating for days about it.

What deliberations are you engaging in? You have one note: UHC is Utopia. You seem to think that Socialism leads to a higher quality of life. Seems silly to have left that behind to be stuck here with barbarians like me who don't know what obfuscatory means and believe in things like personal responsibility.

It's all condescending. That's the attitude all the single payer countries have towards America, I wouldn't expect you to be any different.

[flere-imsaho]

Originally Posted by lynchjm24

Unless you have an individual policy, it's your employer who requires you to pay the deductible, not the insurer. Sure, something that basic is lost on you, but it doesn't stop you from pontificating for days about it.

If I can't pay the deductible, it doesn't really matter who's requiring that I pay the deductible, does it? The result is still the same: I'm not going to get the diagnostic test.

Unless you're somehow suggesting the insurance company is going to ride in on a white horse and pay it for me.

What deliberations are you engaging in? You have one note: UHC is Utopia. You seem to think that Socialism leads to a higher quality of life. Seems silly to have left that behind to be stuck here with barbarians like me who don't know what obfuscatory means and believe in things like personal responsibility.

But the amusement I get from arguing with people who conflate self-interest with personal responsibility more than makes up for it.

[DaddyTorgo]

i think you two need to cool down...zoinks

[flere-imsaho]

Originally Posted by lynchjm24

You have one note: UHC is Utopia. You seem to think that Socialism leads to a higher quality of life.

It's all condescending. That's the attitude all the single payer countries have towards America, I wouldn't expect you to be any different.

I see we're done with rational discourse now.

[lynchjm24]

Originally Posted by flere-imsaho

If I can't pay the deductible, it doesn't really matter who's requiring that I pay the deductible, does it? The result is still the same: I'm not going to get the diagnostic test.

But the amusement I get from arguing with people who conflate self-interest with personal responsibility more than makes up for it.

It doesn't if you need the test. It does if you are debating how to design a country's health care policy.

Yes, none of my opinions on personal responsibility can be taken seriously because I work in the health insurance industry. Only those of us that lived in Socialist Utopias can have a valid opinion on how the country should move forward.

[flere-imsaho]

Originally Posted by DaddyTorgo

i think you two need to cool down...zoinks

Well, I don't feel particularly heated, but I'll agree that at this point my back-and-forth with lynchjm24 isn't adding anything to the thread, so I'll stop. Suffice it to say I don't think we're operating from anywhere close to the same frame of reference, so it's pretty pointless to continue, and I only did so because I couldn't resist getting a rise out of him.

Which, honestly, is not a great thing to do, so I apologize.

[lynchjm24]

Originally Posted by flere-imsaho

Well, I don't feel particularly heated, but I'll agree that at this point my back-and-forth with lynchjm24 isn't adding anything to the thread, so I'll stop. Suffice it to say I don't think we're operating from anywhere close to the same frame of reference, so it's pretty pointless to continue, and I only did so because I couldn't resist getting a rise out of him.

Which, honestly, is not a great thing to do, so I apologize.

Eh. I'm fine. I'm glad I made you break out your whole vocabulary.

I will say this: You seem to think that my opinion isn't valid because of what I do for a living. By that logic, an opinion held by a deployed military officer on the surge in Afghanistan would be invalid because they can't get past 'self-interest'.

[DaddyTorgo]

i mean i don't care...keep going after each other, it's just clear that you're 180 degrees apart and you're talking AT each other. it's kinda amusing though, i'll agree

[Kodos]

We need to get our resident cable company worker to debate the satellite fans now.

[flere-imsaho]

Originally Posted by lynchjm24

You seem to think that my opinion isn't valid because of what I do for a living.

If that's the impression that I gave, then I apologize, because that is absolutely not what I think. I believe I've been pretty consistent over the years in asserting that almost everyone's opinion is valid, even those of people with whom I'm pretty much diametrically opposed (Dutch and JonInMiddleGA, to pick two examples).

Of course, valid doesn't necessarily mean objectively correct. Opinions are valid, in my opinion (lol), in a person's own context. A person's individual beliefs, experiences, bias, worldview, etc... shape this context and their opinions (in general, though there are exceptions) tend to be valid in this context. So they're absolutely valid. Or, put another way, they're subjectively correct. But they're (generally) not objectively correct.

Or, put more simply:

Opinions: subjectively correct
Facts: objectively correct

So my opinion, which is obviously different from yours, is also valid. In my particular worldview, it is subjectively correct. But I'm not going to claim that it's objectively correct. I'm not going to claim that an implementation of single-payer or UHC is going to solve everything, but I do believe it's better than the alternatives. Can I prove it beyond a shadow of a doubt? No. Can I prove it to a level sufficient to convince others? Generally not.


Having said all that, I think the issue I've had with you is not that your opinions are clearly based on your experience in the industry and your access to data which is relevant to the discussion, but that you claim objectivity based on this narrow foundation while rejecting out of hand other data and information that is clearly relevant to the discussion.


In short, my issue is not that you work in the industry, but that you seem to think (and if I have this wrong, I apologize) that because you work in the industry your opinion is more valid than others.

Anyway, I'll stop now before I create an even bigger wall of text.

[RainMaker]

Originally Posted by lynchjm24

Unless you have an individual policy, it's your employer who requires you to pay the deductible, not the insurer. Sure, something that basic is lost on you, but it doesn't stop you from pontificating for days about it.

The problem for me isn't deductible, it's insurance companies making medical decisions. I don't mind paying my share on an MRI, but I do mind when an insurance company says I don't need it when my doctor says I do.

I speak from personal experience on this. My Mom suffers terribly from psoriatic arthritis. She sees arguably the best doctor in the world on this issue (he literally is considered the foremost expert on the topic). He prescribed her a drug which the insurance company refused to cover because they didn't feel it was necessary.

That's my issue with insurance companies. I don't know how that can be fixed without abuse, but I think it's something that needs to be addressed.

[DaddyTorgo]

Originally Posted by RainMaker

The problem for me isn't deductible, it's insurance companies making medical decisions. I don't mind paying my share on an MRI, but I do mind when an insurance company says I don't need it when my doctor says I do.

I speak from personal experience on this. My Mom suffers terribly from psoriatic arthritis. She sees arguably the best doctor in the world on this issue (he literally is considered the foremost expert on the topic). He prescribed her a drug which the insurance company refused to cover because they didn't feel it was necessary.

That's my issue with insurance companies. I don't know how that can be fixed without abuse, but I think it's something that needs to be addressed.

are you serious? that's fucking ridiculous!!!


and then the only way you have a chance of getting that covered is devoting like 15-20 hours of time to being on the phone with the insurance company badgering them.

and then everybody that might possibly want that drug has to do the same thing.

it's a fucking joke.

[RainMaker]

Originally Posted by DaddyTorgo

are you serious? that's fucking ridiculous!!!


and then the only way you have a chance of getting that covered is devoting like 15-20 hours of time to being on the phone with the insurance company badgering them.

and then everybody that might possibly want that drug has to do the same thing.

it's a fucking joke.

It wasn't even some fancy new test drug. It was Humira, a medicine you have probably seen ads for hundreds of times on TV. It's used to treat rheumatoid arthritis but also psoriatic arthritis since they are so similar. She has it real bad so the doctor wanted to use double the dose which they wouldn't approve (they did approve a single dose which didn't work well).

Took months of appeals to finally get them to pay for it. Paid out of pocket (like $1500/month) for 3 months. Never got reimbursed for that. The only reason I think the appeal went through is that her doctor was real helpful throughout and eventually made enough of a stink that they overturned it. And for the record, the double dose worked really well and she still takes it to this day.

[DaddyTorgo]

Originally Posted by RainMaker

It wasn't even some fancy new test drug. It was Humira, a medicine you have probably seen ads for hundreds of times on TV. It's used to treat rheumatoid arthritis but also psoriatic arthritis since they are so similar. She has it real bad so the doctor wanted to use double the dose which they wouldn't approve (they did approve a single dose which didn't work well).

Took months of appeals to finally get them to pay for it. Paid out of pocket (like $1500/month) for 3 months. Never got reimbursed for that. The only reason I think the appeal went through is that her doctor was real helpful throughout and eventually made enough of a stink that they overturned it. And for the record, the double dose worked really well and she still takes it to this day.

3 months? Imagine if that was a chronic condition. Imagine if it was life-threatening, or life-shortening rather than "just" painful.

That's fucking criminal.

[Passacaglia]

Originally Posted by lynchjm24

And that gets them to about 1/3rd of what my 32 year old wife makes working in P&C insurance.

So you work in health insurance, and your wife works in P&C insurance? Wow, you're me.

[RainMaker]

Originally Posted by DaddyTorgo

3 months? Imagine if that was a chronic condition. Imagine if it was life-threatening, or life-shortening rather than "just" painful.

That's fucking criminal.

It is a chronic condition. Once the joint goes, it's gone for good. We did pay for it so she had the second dose, but I'm sure there are people who can't afford that. If she couldn't, she could have and most likely would have had permanent damage to the tissue and joints.

It is what you get in a private system though. Their best financial interest is for you not to get the best treatment in a lot of cases.

[DaddyTorgo]

Originally Posted by RainMaker

It is a chronic condition. Once the joint goes, it's gone for good. We did pay for it so she had the second dose, but I'm sure there are people who can't afford that. If she couldn't, she could have and most likely would have had permanent damage to the tissue and joints.

It is what you get in a private system though. Their best financial interest is for you not to get the best treatment in a lot of cases.

exactly. which is fucking ridiculous.

[DaddyTorgo]

Originally Posted by Passacaglia

So you work in health insurance, and your wife works in P&C insurance? Wow, you're me.

[SportsDino]

I don't have any faith in a private system being functional in the long term in the United States... I used to try and fathom how it could be made to work, but it is fundamentally broken and causing a health care cost death spiral.

Realize that costs do not have to climb out of control. At any point we can just say: "you know, lets just provide X healthcare as effectively as possible" where X is a standard that might not please the idiotic expectations everyone seems to have... but is easily reached and can be optimized for.

Maybe it means all health care outside of the 'happy box' requires private insurance at high rates that you are expected to pay for yourself. I would honestly prefer that to a system that routinely denies treatment for bullshit reasons. I often believe that the penny pinching in the industry has gotten out of hand, and the overhead costs of it are feeding into the whole self-destructive loop.

The insurance industry itself made its own bed... they fought tooth and nail to skip out of helping customers if they could find the slightest excuse (and often times even if it required breaking law, contracts, or common sense to do so and was later overturned in court....). That is why they will get so little sympathy when the crisis really hits a breaking point (say this unemployment doesn't change right quick... destroying the whole environment the companies were built in).

Sadly, just like the banks they will continue with the 'screw everyone' approach until it goes critical, and then of course the government will bail them out and we'll end up with a 'single predominate payer' instead of just a single payer. Subsidized government dollars keeping the industry afloat while the insurance companies themselves still gouge us with shoddy treatment, shady fees, and skyrocketing costs.

As for doctors, like any industry butchering their workforce left and right the last few years... I'm sure we'll survive supply and demand kicking in. Shortages are more to do with our artificial anti-capitalistic behavior than anything else anyway (surprising how often the industries preach capitalism in general, but in specifics are always looking for gamed policies that create individual protections and uncapitalistic decision making...).

[Raiders Army]

Originally Posted by lynchjm24

Isn't that financial? Many employers are giving people money for taking part in wellness programs in the hope that this drives down their long term costs. The programs cost money though so it's mostly large employers.

I don't know many people in the insurance industry who wouldn't support preventative care being provided at no copay and no costs to members. The problem becomes that in the short term this drives costs UP and many employers aren't in a position to increase their costs in the short term especially since many industries experience enough turnover that it's a wasted investment.

Wellness programs make a lot of sense...it's too bad that turnover reduces the value. Thanks for the reply!

[lynchjm24]

Originally Posted by Passacaglia

So you work in health insurance, and your wife works in P&C insurance? Wow, you're me.

Nah.. I dislike the Big Ten. I can't wait to go to Ann Arbor in September and bury Michigan .