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Thread: Health Insurance

  1. #301
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    The Netherlands' healthcare system is entirely private and entirely for-profit but doesn't have this issue.

    "What the market will bear" has been largely irrelevant in the past 70 years; there has been essentially no price competition among doctors and hospitals since WW II. This is the theory behind CDHPs, that it will cause healthcare providers to be accountable to their patients on cost. I'm skeptical that it will work.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  2. #302
    Banned thelastgreatman's Avatar
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    Default Re: Health Insurance

    So collusion then?
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  3. #303
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Nationalization of the health insurance system is plausible though politically highly unlikely in my view. Nationalization of the healthcare delivery system would be about 100 times harder. You're talking about the government seizing trillions in hard assets from private organizations. I don't think that can happen without violent revolution.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  4. #304
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by thelastgreatman View Post
    So collusion then?
    Why would they need to collude when there's no price competition? They can act unilaterally and just raise prices.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  5. #305
    Coachella Junkie SoulDischarge's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by thelastgreatman View Post
    What's your theory to that last point, Tom? Why is it so much more expensive? Does the simplest answer stand to reason, that when you have an unregulated capitalist enterprise that is of the UTMOST necessity to the population, it is only natural for an industry to continue increasing their profit margins to the absolute limit of what the market will bear?

    In other words--it will never be fixed without nationalization.
    From the article he posted:

    The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.
    Quote Originally Posted by guedita View Post
    Thanks for giving us the opportunity to not give a fuck again.

  6. #306
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    That's actually the 4th major hole in our healthcare system, which I forgot to mention.

    Our current system too heavily rewards expensive tests and under-rewards (comparatively) actual treatment.

    This leads to doctors prescribing all kinds of expensive (and often unnecessary) tests, especially if they can be performed in house.

    Many doctors derive a majority of their income from expensive (and relatively easy-to-perform) testing. While some of the costs are justified due to the necessity for expensive equipment, they are still far too high.

    I am not sure how the insurance industry allowed this to happen (as they shoulder a lot of burden of these costs), but it did, and it needs to be reversed somewhat.
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  7. #307
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by thelastgreatman View Post
    What works in every other fucking country in the industrialized world won't necessarily work here: idiotic bullshit being used by assholes to control morons.
    Try full gun-control here and see what it does for the crime rate.

    Take a look at the current amount of Medicare fraud, and tell me that won't transfer (on a much larger scale) to a national health care plan.
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  8. #308
    Coachella Junkie SoulDischarge's Avatar
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    Default Re: Health Insurance

    America: where fraud from the top down is encouraged, but fraud from the most disadvantaged people is inexcusable.
    Quote Originally Posted by guedita View Post
    Thanks for giving us the opportunity to not give a fuck again.

  9. #309
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by Archie Bunker View Post
    That's actually the 4th major hole in our healthcare system, which I forgot to mention.

    Our current system too heavily rewards expensive tests and under-rewards (comparatively) actual treatment.

    This leads to doctors prescribing all kinds of expensive (and often unnecessary) tests, especially if they can be performed in house.

    Many doctors derive a majority of their income from expensive (and relatively easy-to-perform) testing. While some of the costs are justified due to the necessity for expensive equipment, they are still far too high.

    I am not sure how the insurance industry allowed this to happen (as they shoulder a lot of burden of these costs), but it did, and it needs to be reversed somewhat.
    If you read the NY Times article, it's more than just doing expensive tests.. it's the actual price tag on those test as well.

    The insurance industry allowed this to happen because for many years their customer base (large employers, for the most part) were more concerned with other things. They had to compete for employees in a tight labor market, and employees value health insurance. It is only in the Great Recession where we've had an extended period where employers have been more concerned about cost than about attracting skilled labor. No coincidence that this is when we see increased focus on cost and major health reform legislation passed.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  10. #310
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by TomAz View Post
    The Netherlands' healthcare system is entirely private and entirely for-profit but doesn't have this issue.

    "What the market will bear" has been largely irrelevant in the past 70 years; there has been essentially no price competition among doctors and hospitals since WW II. This is the theory behind CDHPs, that it will cause healthcare providers to be accountable to their patients on cost. I'm skeptical that it will work.
    Why are you so anti-CDHP?

    They definitely don't come close to fixing all of our existing problems with the system, but I feel they're very much a step in the right direction.

    One of the biggest issues (related to the convoluted billing system I discussed) is that most patients just say "Duh, okay" when doctors prescribe expensive tests and treatments. The result becomes either panic when the bill comes and out-of-pocket costs are far higher than expected (especially if insurance doesn't cover it when they thought it would), or a hefty bill to insurance companies (which multiplied by hundreds of millions of people causes increased rates).

    The CDHP model provides a lot more visibility and choice into often non-essential tests and procedures.

    I agree that it could be implemented incorrectly and therefore fail (perhaps this is your point?), but in concept I think it's great.
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  11. #311
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by SoulDischarge View Post
    America: where fraud from the top down is encouraged, but fraud from the most disadvantaged people is inexcusable.
    I'm not sure you understand.

    Health care fraud is not typically perpetrated by the disadvantaged.

    I mean, they're usually pawns in the schemes, but they are paid relatively little, and the ones greatly benefiting from it are career scammers and shady doctors.
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  12. #312
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    I am skeptical of CDHPs because no one is going to price shop when they are having a heart attack. Or when they've just been diagnosed with pancreatic cancer. Or when they just had a major automobile accident. This is where 80% of the healthcare dollars go. yes, CDHPs will influence behavior on routine, budgetable, plannable care, but I just don't think it drives enough $.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  13. #313
    Coachella Junkie SoulDischarge's Avatar
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    Default Re: Health Insurance

    America: where punishing wrongdoers is more important than protecting the innocent.
    Quote Originally Posted by guedita View Post
    Thanks for giving us the opportunity to not give a fuck again.

  14. #314
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by guedita View Post
    Sure, but the argument that the system change is all of a sudden going to cause a major influx of people willing to put in effort to commit fraud is a flawed argument. It presumes that there's a significant portion of society that is just waiting and hoping and plotting to commit fraud but it's too hard for them to do now with the current system.

    And that's stupid.
    Not stupid at all.

    Opportunity to commit this fraud will rise dramatically, and resources to investigate it (in comparison to the number of healthcare providers receiving government money) will be stretched beyond thin.

    The government likes to talk a big talk about clamping down on fraud, but in reality they are very poor at policing it. Medicare/Medicaid has proved that over the years. CNN just did an eye-opening report about rehab fraud, and the incredibly poor oversight involved.

    If you think the oversight is bad regarding Medicare dollars, it will be many times worse if the entire health care industry is paid with tax dollars.

    Lack of oversight = more people scamming that were afraid to do it before.

    Also, there's more than just fraud. There's also waste, which can be an even bigger problem. The government has been notoriously bad with waste (it's pretty much inevitable with any government body), and when you combine that with an industry where it's incredibly easy to commit waste, we will have a big problem.

    This also doesn't solve our current problem that our EXISTING healthcare system is ridiculously expensive as it is -- it just transfers the bill to the government, which in turn has to tax us at a ridiculously higher rate to pay for it. So you still pay -- just in a different way. That's not a solution. That's a shell game.
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  15. #315
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Archie, not saying i (necessarily) disagree with you re fraud, but what makes you think fraud isn't currently as big an issue for private health plans as for government programs?
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  16. #316
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by TomAz View Post
    I am skeptical of CDHPs because no one is going to price shop when they are having a heart attack. Or when they've just been diagnosed with pancreatic cancer. Or when they just had a major automobile accident. This is where 80% of the healthcare dollars go. yes, CDHPs will influence behavior on routine, budgetable, plannable care, but I just don't think it drives enough $.
    But these are all in the "catastrophic insurance" category, where the average consumer is covered.

    So yes, in these expensive situations, there won't be price shopping, but I somewhat doubt your 80% figure, and even if it's accurate, that's a completely different area in which reform is needed (high cost of care). At least the CDHPs are addressing many of the smaller/medium concerns, and even if that is only 20%, that's still tangible enough to pronounce them as progress.
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  17. #317
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    The one tangible provable thing CDHPs have done is significantly increased the use of generics.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  18. #318
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by TomAz View Post
    Archie, not saying i (necessarily) disagree with you re fraud, but what makes you think fraud isn't currently as big an issue for private health plans as for government programs?
    Because private health companies do not suffer for the same crushing bureaucracy as the government does.

    Do they have some bureaucracy? Yes.

    But I actually had a girlfriend for awhile who investigated fraud claims against her employer (a private insurance company), and they were very good at tracking down the fraud, investigating fraud reports, and quickly denying payment to the perpetrators.

    If you read the recent CNN report (google CNN report rehab fraud -- just came out a few days ago), it paints an unfortunately accurate picture of Medicaid to where they claim zero fraud tolerance but lack the desire, structure, and resources to actually fight it -- even in many super-obvious cases.

    In general, many support nationalized healthcare believing that we will get better bang for our buck when you remove for-profit insurance companies from the equation. They fail to realize that rarely does the consumer benefit when the government takes something over from private industry.
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  19. #319
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    I think you're probably right, but anecdotes are not data.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  20. #320
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by TomAz View Post
    I think you're probably right, but anecdotes are not data.
    True, but in general a private company is not going to tolerate rampant fraud when its own dollars are at stake.

    I was just giving an example of seeing someone at work in fraud-prevention and the feeling I got for the general culture at one of these companies regarding the matter.
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  21. #321
    Banned thelastgreatman's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by TomAz View Post
    Why would they need to collude when there's no price competition? They can act unilaterally and just raise prices.
    In typical free market theory though, if there weren't collusion shouldn't there be somebody trying to undercut all these fucks? I mean if the markup they're charging is so insanely above the true market value, why isn't someone out there delivering the same service at only a 250 percent markup?
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  22. #322
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    'No price competition' means lower price gives you no advantage. There is no incentive to undercut because market share is independent of price.

    Overly simplistic example that illustrates the idea: People with cancer don't want to go to Discount Cancers R Us. They want to go to MD Anderson or Mayo or Cleveland Clinic or Scripps or whatever it is in their part of the country. And since they have insurance, they don't care that it costs a lot more there; they are price indifferent. Because these organizations have such powerful market caché, they can pretty much dictate to insurance companies what they'll get paid.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  23. #323
    Banned thelastgreatman's Avatar
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    Default Re: Health Insurance

    ... Tom, I don't think that argument holds water. You're acting as if "having insurance" makes price irrelevant for the sick. People go hundreds of thousands of dollars into debt covering the amount they still owe after their insurance has had its slice.

    If your case was valid, then why would anyone ever choose HMO over PPO to save money?
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  24. #324
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Because of the lower premiums.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  25. #325
    Banned thelastgreatman's Avatar
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    Default Re: Health Insurance

    Right. So why wouldn't people choose a provider with even lower premiums?

    Sorry, but this line of logic does not hold up. The reason there's no price competition is because they've locked out competition. I don't buy for a second this bullshit about the cost of medicine somehow naturally elevating itself to this unreasonable level just because all the providers unilaterally--but SEPARATELY--decided to start charging that much.

    Price fixing.
    Quote Originally Posted by schoolofruckus View Post
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  26. #326
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by thelastgreatman View Post
    ... Tom, I don't think that argument holds water. You're acting as if "having insurance" makes price irrelevant for the sick. People go hundreds of thousands of dollars into debt covering the amount they still owe after their insurance has had its slice.

    If your case was valid, then why would anyone ever choose HMO over PPO to save money?

    That's also not how people go hundreds of K into debt from health issues.

    This typically happens because they have no insurance, or they want to get treatments at facilities that are not covered by their insurance, or they want to get procedures done that are not covered (typically fringe procedures that are not accepted by mainstream medicine).

    Health insurance no longer has any lifetime maximum, and out-of-pocket maximums are relatively low (usually $10k per year at most). So if you legitimately need $2 million worth of care for your heart condition or cancer, you won't be out all that much money if you were insured prior to the condition coming up.
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  27. #327
    Banned thelastgreatman's Avatar
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    Default Re: Health Insurance

    How about fuck all this cancer shit--I want a fucking insurance plan that will actually cover more than 50 percent of my goddamn dental. This is bullshit. I don't give a shit about people with cancer, they're a bunch of dead dicks anyway. WHAT ABOUT KEEPING THE LIVING PRETTY?
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  28. #328
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by thelastgreatman View Post
    How about fuck all this cancer shit--I want a fucking insurance plan that will actually cover more than 50 percent of my goddamn dental. This is bullshit. I don't give a shit about people with cancer, they're a bunch of dead dicks anyway. WHAT ABOUT KEEPING THE LIVING PRETTY?
    I might support socialized dental benefits for those who are already pretty and need to keep their teeth on par with the rest of their looks.

    For most of the ugly people of this forum (myself included), I can't support my tax dollars going to such waste.
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  29. #329
    Banned thelastgreatman's Avatar
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    Default Re: Health Insurance

    That is actually a good point:

    WHO CARES ABOUT UGLY PEOPLE.

    Let's divert more funds to taking care of beautiful people like myself who don't really have any problems whatsoever besides our health costs. Because at least then SOME of us are living perfect, worry-free lives of leisure and glory that the rest of you can enjoy vicariously while doing whatever the fuck it is you ugly cocksuckers do all day until you die alone.
    Quote Originally Posted by schoolofruckus View Post
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  30. #330
    zeezus amyzzz's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by TomAz View Post
    I am skeptical of CDHPs because no one is going to price shop when they are having a heart attack. Or when they've just been diagnosed with pancreatic cancer. Or when they just had a major automobile accident. This is where 80% of the healthcare dollars go. yes, CDHPs will influence behavior on routine, budgetable, plannable care, but I just don't think it drives enough $.
    A CDHP is on the new contract that my union tentatively agreed to. We vote on the contract in September.
    Quote Originally Posted by guedita View Post
    Because fucking millenials that's what

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