GOP Plan To Change Or Repeal Health Law Could Bring New Complications

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GOP Plan To Change Or Repeal Health Law Could Bring New Complications

Republicans, buoyed by recent polls suggesting that their party could win the House and pick up seats in the Senate in November, are vowing to repeal or make major revisions in the health overhaul law that Democrats squeezed through Congress last spring. But how difficult would it be to overturn that law?

 

http://www.kaiserhealthnews.org/Stories/2010/September/20/GOP-strategy-on-health-law.aspx

 

 


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 Easy there dude. You

 

Easy there dude. You don't really have all that much to worry about.

 

The fact is that there are always many possible laws sitting in the back rooms of every agency and department that could be involved in anything. Usually, they start life really badly thought out and only the ones that get a certain amount of polish will ever see their way to a congressional committee.

 

Seriously, that is how we got the patriot act. Hundreds of pages of new legislation were not automatically written and vetted in a day and a half. It was all out there in one form or another. After the attacks, Washington panicked and grabbed an unpolished turd of a bill that probably never would have seen the light of day otherwise.

 

So Obama care is only a combination of ideas that have been out there for many years. If there is anything to be desired about it, it is not the whole package but rather the individual parts that may need to be redone in one way or another.

 

Really, the idea of thirty million new customers would be a wet dream to end all wet dreams for any industry. If the cost to make that happen is ending some bad behavior that they knew all along was bad, well that is called the cost of doing business.

 

So what if some idiot gets elected who has repeal burned into his brain? Well, he will have to get a few things done to get anywhere. First, he has to get any bill through committee. Then he would have to get the speaker of the house to give him floor time, which BTW no speaker ever has to recognize anyone in particular. Then he would need a bunch of anti-industry republicans who think that the health insurance companies really did not want all of those new customers to take him seriously.

 

Really, if there is any action at all, it will be in playing with the details. For example, there are places in the package where one form of coverage ends but the next one does not begin until you have run into substantial out of pocket expenses.

 

At this point though, trying to take away medical coverage for substantial numbers of people would make you about as popular of a legislator as if you had publicly noted the significant constitutional issue that lies at the heart of Megan's law. Anyone who wanted to run for your seat would have an automatic platform because you were publicly the champion of civil rights for perverts.

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Rethuglicans "DON'T INVADE

Rethuglicans "DON'T INVADE MY LIFE"

Rational people, "STOP RAPING THE PUBLIC"

Rethuglicans, "HOW DARE YOU SUGGEST SPEED LIMITS, I'LL SPEED AND FUCK YOU IF YOU DON'T LIKE IT."

LET THEM EAT CAKE!

"We are a nation of Christians and Muslims, Jews and Hindus -- and nonbelievers."Obama
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Brian37 wrote:Rethuglicans

Brian37 wrote:

Rethuglicans "DON'T INVADE MY LIFE"

Rational people, "STOP RAPING THE PUBLIC"

Rethuglicans, "HOW DARE YOU SUGGEST SPEED LIMITS, I'LL SPEED AND FUCK YOU IF YOU DON'T LIKE IT."

LET THEM EAT CAKE!

Libertarian - "Traffic laws interfere with my personal liberties. It's just another way for big government to control us."

Just softer voiced Rethugs?

"I do this real moron thing, and it's called thinking. And apparently I'm not a very good American because I like to form my own opinions."
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jcgadfly wrote:Brian37

jcgadfly wrote:

Brian37 wrote:

Rethuglicans "DON'T INVADE MY LIFE"

Rational people, "STOP RAPING THE PUBLIC"

Rethuglicans, "HOW DARE YOU SUGGEST SPEED LIMITS, I'LL SPEED AND FUCK YOU IF YOU DON'T LIKE IT."

LET THEM EAT CAKE!

Libertarian - "Traffic laws interfere with my personal liberties. It's just another way for big government to control us."

Just softer voiced Rethugs?

Hey now, don't get them wrong, they'll pay for a police force as long as their homes are protected. They'll pay for a fire department as long as it protects their house. But if you don't have money, fuck you.

"We are a nation of Christians and Muslims, Jews and Hindus -- and nonbelievers."Obama
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Obama's Veto Power

They're trying to figure out how to avoid a veto now.

That's got to be a head banger.

 

 

 


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 Yeah, repeal will never

 Yeah, repeal will never happen. It is a million times easier to pass a law than it is to repeal one. But don't be so sure about the health insurance companies being eager for new customers. You only want new customers when they are profitable, if you are forced to cover preexisting conditions new customers wont be profitable. Already some insurance companies have stopped issuing new kid only policies 

http://www.disabled-world.com/news/america/healthcare/ins388745.php 

because it will not be profitable for them to cover kids when the only ones signing up are sick. When they are also forced to cover adults with preexisting conditions premiums will either become prohibitive or insurance companies will simply stop issuing new policies and make money on the business they already have. I assume the government will probably step in at that point and I predict will go for a single payer system but regardless, it is quite clear that the situation created by the current law is not sustainable and it will have to be changed drastically. The only question is will it change towards  the free market or towards single payer government ran system. I fear the latter. 

 

As for us libertarians that speed, you should thank us for donating to the police force. But I'm not aware of any movement to eliminate traffic laws. Libertarians are not anarchists. Yes rights are very important but you don't have to right to risk someone else's life without their consent and traffic laws are generally meant to keep others safe. Although in many areas the speed limit could be raised by 10-15 mph, too bad that officer never seems to agree with me.  

 

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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It's more likely that

It's more likely that concessions outside of the health care debate will resolve this.


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Beyond Saving wrote: Yeah,

Beyond Saving wrote:

 Yeah, repeal will never happen. It is a million times easier to pass a law than it is to repeal one. But don't be so sure about the health insurance companies being eager for new customers. You only want new customers when they are profitable, if you are forced to cover preexisting conditions new customers wont be profitable. Already some insurance companies have stopped issuing new kid only policies 

http://www.disabled-world.com/news/america/healthcare/ins388745.php 

because it will not be profitable for them to cover kids when the only ones signing up are sick. When they are also forced to cover adults with preexisting conditions premiums will either become prohibitive or insurance companies will simply stop issuing new policies and make money on the business they already have. I assume the government will probably step in at that point and I predict will go for a single payer system but regardless, it is quite clear that the situation created by the current law is not sustainable and it will have to be changed drastically. The only question is will it change towards  the free market or towards single payer government ran system. I fear the latter. 

 

As for us libertarians that speed, you should thank us for donating to the police force. But I'm not aware of any movement to eliminate traffic laws. Libertarians are not anarchists. Yes rights are very important but you don't have to right to risk someone else's life without their consent and traffic laws are generally meant to keep others safe. Although in many areas the speed limit could be raised by 10-15 mph, too bad that officer never seems to agree with me.  

 

Given what insurers often claim as pre-existing conditions (domestic violence, pregnancy, involved in a car accident not your fault), I fear the free market.

It's like the scam my employer is running as a "health engagement program". "Lose x% of your body fat (they're using BMI as an indicator) or we'll raise your rates."

Next year, I expect that my never having smoked won't be sufficient. I'll have to start smoking so I can enter the mandatory tobacco cessation program.

"I do this real moron thing, and it's called thinking. And apparently I'm not a very good American because I like to form my own opinions."
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 Beyond Saving wrote:  

 

Beyond Saving wrote:

 

Already some insurance companies have stopped issuing new kid only policies

 

http://www.disabled-world.com/news/america/healthcare/ins388745.php

 

because it will not be profitable for them to cover kids when the only ones signing up are sick.

 

OK, I am fairly sure that you missed a couple of points there.

 

The article starts with the fact that it is based on something Nancy Pelosi said. Of course she is entitled to have her own opinion on matters. However, her whole job is based in major part on crafting messages which are designed to manipulate people into voting for her and her friends. So right there, we are heading into potentially dangerous waters.
 

Past that, the article is a fairly standard example of how to separate what ought to be connected so that people don't realize what they are being told. The less clear the statement is, the greater the ability for people to fill in the unclear bits with their own preconceptions.

 

Let's try changing around the order of what facts are presented when and see if we don't end up with a rather different picture.

 

OK, so many moths ago, it had become clear that the insurance industry was in hot water and they had better start playing ball if they wanted to retain any ability to remain on the top of the heap. Basically, they were going to have to show some form of give back for some of what they had going on.

 

Enter the “children only” policies. These were never about insuring every child in America. These were about insuring a rather small number of children that had managed to develop preexisting conditions. The insurance companies knew from day one that this was not going to be a forever thing. It was only a stop gap that would be phased out when new programs came on line.

 

Now that the new programs are coming into existence, guess what? That's right kiddies, we are not going to issue new policies that are turds for us and that offer less protection for you than other options which you can now get into.

 

Of course, Nancy Pelosi has no interest in letting you know stuff like that. If you are not living in fear of the evil insurance companies, then you might think that some really important work had been done and you could get complacent and vote for non-democrats if they talked the right way. Noes!!!11!1, we can't have that!

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Insurance companies are evil

Insurance companies are evil enough without Pelosi's help.

I have no objection to voting for non-democrats. I just don't want another flavor of Republican lite.

The crop of libertarians I see are just that. Rand Paul comes to mind.

"I do this real moron thing, and it's called thinking. And apparently I'm not a very good American because I like to form my own opinions."
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Answers in Gene Simmons

Answers in Gene Simmons wrote:

 

Beyond Saving wrote:

 

Already some insurance companies have stopped issuing new kid only policies

 

http://www.disabled-world.com/news/america/healthcare/ins388745.php

 

because it will not be profitable for them to cover kids when the only ones signing up are sick.

 

OK, I am fairly sure that you missed a couple of points there.

 

The article starts with the fact that it is based on something Nancy Pelosi said. Of course she is entitled to have her own opinion on matters. However, her whole job is based in major part on crafting messages which are designed to manipulate people into voting for her and her friends. So right there, we are heading into potentially dangerous waters.
 

Past that, the article is a fairly standard example of how to separate what ought to be connected so that people don't realize what they are being told. The less clear the statement is, the greater the ability for people to fill in the unclear bits with their own preconceptions.

 

Let's try changing around the order of what facts are presented when and see if we don't end up with a rather different picture.

 

OK, so many moths ago, it had become clear that the insurance industry was in hot water and they had better start playing ball if they wanted to retain any ability to remain on the top of the heap. Basically, they were going to have to show some form of give back for some of what they had going on.

 

Enter the “children only” policies. These were never about insuring every child in America. These were about insuring a rather small number of children that had managed to develop preexisting conditions. The insurance companies knew from day one that this was not going to be a forever thing. It was only a stop gap that would be phased out when new programs came on line.

 

Now that the new programs are coming into existence, guess what? That's right kiddies, we are not going to issue new policies that are turds for us and that offer less protection for you than other options which you can now get into.

 

Of course, Nancy Pelosi has no interest in letting you know stuff like that. If you are not living in fear of the evil insurance companies, then you might think that some really important work had been done and you could get complacent and vote for non-democrats if they talked the right way. Noes!!!11!1, we can't have that!

Well I don't see really where we disagree. 

My main question is how can any insurance company of any type make a profit if they issue a policy to every joe with a preexisting condition? It is mathematically impossible without raising rates ridiculously high, especially when people figure out they don't need insurance until they are sitting in the emergency room. The insurance companies are simply trying to hang on and make a profit while they still can. Why should we expect most insurance companies to continue issuing policies when they can no longer turn away preexisting conditions? Are we going to pass a law requiring insurance companies to stay in business? Bama & Pelosi et al seem to think insurance companies will happily lose money to insure everyone. Well, even evil insurance company workers need to eat and pay their bills. Most Bamacare supporters I talk to simply spout vaguely about how insurance companies are evil, make too much money and screw people. No one has even attempted to explain where the money will come from. 

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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Beyond Saving wrote:Answers

Beyond Saving wrote:

Answers in Gene Simmons wrote:

 

Beyond Saving wrote:

 

Already some insurance companies have stopped issuing new kid only policies

 

http://www.disabled-world.com/news/america/healthcare/ins388745.php

 

because it will not be profitable for them to cover kids when the only ones signing up are sick.

 

OK, I am fairly sure that you missed a couple of points there.

 

The article starts with the fact that it is based on something Nancy Pelosi said. Of course she is entitled to have her own opinion on matters. However, her whole job is based in major part on crafting messages which are designed to manipulate people into voting for her and her friends. So right there, we are heading into potentially dangerous waters.
 

Past that, the article is a fairly standard example of how to separate what ought to be connected so that people don't realize what they are being told. The less clear the statement is, the greater the ability for people to fill in the unclear bits with their own preconceptions.

 

Let's try changing around the order of what facts are presented when and see if we don't end up with a rather different picture.

 

OK, so many moths ago, it had become clear that the insurance industry was in hot water and they had better start playing ball if they wanted to retain any ability to remain on the top of the heap. Basically, they were going to have to show some form of give back for some of what they had going on.

 

Enter the “children only” policies. These were never about insuring every child in America. These were about insuring a rather small number of children that had managed to develop preexisting conditions. The insurance companies knew from day one that this was not going to be a forever thing. It was only a stop gap that would be phased out when new programs came on line.

 

Now that the new programs are coming into existence, guess what? That's right kiddies, we are not going to issue new policies that are turds for us and that offer less protection for you than other options which you can now get into.

 

Of course, Nancy Pelosi has no interest in letting you know stuff like that. If you are not living in fear of the evil insurance companies, then you might think that some really important work had been done and you could get complacent and vote for non-democrats if they talked the right way. Noes!!!11!1, we can't have that!

Well I don't see really where we disagree. 

My main question is how can any insurance company of any type make a profit if they issue a policy to every joe with a preexisting condition? It is mathematically impossible without raising rates ridiculously high, especially when people figure out they don't need insurance until they are sitting in the emergency room. The insurance companies are simply trying to hang on and make a profit while they still can. Why should we expect most insurance companies to continue issuing policies when they can no longer turn away preexisting conditions? Are we going to pass a law requiring insurance companies to stay in business? Bama & Pelosi et al seem to think insurance companies will happily lose money to insure everyone. Well, even evil insurance company workers need to eat and pay their bills. Most Bamacare supporters I talk to simply spout vaguely about how insurance companies are evil, make too much money and screw people. No one has even attempted to explain where the money will come from. 

You're talking like the majority of Americans have a pre-existing condition. Not the case. They also have very capricious definitions of pre-existing conditions (as I mentioned earlier).

I don't want to be turned down for coverage because I came in with the sniffles, either.

"I do this real moron thing, and it's called thinking. And apparently I'm not a very good American because I like to form my own opinions."
— George Carlin


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Beyond Saving wrote: Yeah,

Beyond Saving wrote:

 Yeah, repeal will never happen. It is a million times easier to pass a law than it is to repeal one. But don't be so sure about the health insurance companies being eager for new customers. You only want new customers when they are profitable, if you are forced to cover preexisting conditions new customers wont be profitable. Already some insurance companies have stopped issuing new kid only policies 

http://www.disabled-world.com/news/america/healthcare/ins388745.php 

because it will not be profitable for them to cover kids when the only ones signing up are sick. When they are also forced to cover adults with preexisting conditions premiums will either become prohibitive or insurance companies will simply stop issuing new policies and make money on the business they already have. I assume the government will probably step in at that point and I predict will go for a single payer system but regardless, it is quite clear that the situation created by the current law is not sustainable and it will have to be changed drastically. The only question is will it change towards  the free market or towards single payer government ran system. I fear the latter. 

 

As for us libertarians that speed, you should thank us for donating to the police force. But I'm not aware of any movement to eliminate traffic laws. Libertarians are not anarchists. Yes rights are very important but you don't have to right to risk someone else's life without their consent and traffic laws are generally meant to keep others safe. Although in many areas the speed limit could be raised by 10-15 mph, too bad that officer never seems to agree with me.  

 

 

Tiny Town is dead. 

Shrink my wife. 

Please.

 

 

 

 


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Beyond Saving wrote:My main

Beyond Saving wrote:


My main question is how can any insurance company of any type make a profit if they issue a policy to every joe with a preexisting condition? It is mathematically impossible without raising rates ridiculously high, especially when people figure out they don't need insurance until they are sitting in the emergency room. The insurance companies are simply trying to hang on and make a profit while they still can. Why should we expect most insurance companies to continue issuing policies when they can no longer turn away preexisting conditions? Are we going to pass a law requiring insurance companies to stay in business? Bama & Pelosi et al seem to think insurance companies will happily lose money to insure everyone. Well, even evil insurance company workers need to eat and pay their bills. Most Bamacare supporters I talk to simply spout vaguely about how insurance companies are evil, make too much money and screw people. No one has even attempted to explain where the money will come from. 

 

Let's review preexisting conditions.

I have arthritis in both knees and my back.  This is a preexisting condition.  Osteoarthritis takes decades for the joint to degenerate to the point you can get medical assistance.  Prior to not being able to move, you are told to lose weight and exercise.  When you can no longer walk without pain, then your doctor starts referring you to osteopathic surgeons.

Whenever I changed jobs in the past, my doctor and I had to do the dance - again.  X-rays, specialists, different medications that I had tried before.  Again.  The arthritis never gets better, it only gets worse.  Why do all the diagnostic stuff again?  We have done it before, it hasn't got better, it is worse and getting worse.  Why again?  Because it is otherwise a preexisting condition.  The doctor has to re-diagnose it all over again to get the insurance company to cough up.  It is a colossal waste of time and money - mine, the doctors', and the insurance company's. 

So taking away the preexisting condition clause should actually save money.

And really, if people like you got insurance, it would lower everyone's costs.  Duh.  Just like good drivers lower everyone's auto insurance costs.  Duh.

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jcgadfly wrote:You're

jcgadfly wrote:

You're talking like the majority of Americans have a pre-existing condition. Not the case. They also have very capricious definitions of pre-existing conditions (as I mentioned earlier).

I don't want to be turned down for coverage because I came in with the sniffles, either.

If it was a short amnesty period where people with current preexisting conditions could get coverage it would be manageable for insurance companies. But that is not what to law does. The law requires insurance companies to cover all preexisting conditions. So why purchase health insurance before you go to the hospital? The penalty for not having insurance is only $95 or 1% of your income in 2014 and $695 or 2.5% of your income in 2016 which is likely to be substantially cheaper than buying health insurance unless you have a high income even if insurance rates don't go up and that provision is not found unconstitutional. Why pay for insurance? Just go into the high risk pool when you are actually sick and the government caps your cost at $5950. Health insurance would cost me around $200 a month right now. So my yearly insurance cost would be $2400, even with the penalty I am saving quite a bit of money each year by not buying insurance. A few years of decent health and it is a nice safety net. Since I won't be the only one thinking that way, many people will do the same thing causing premiums to be even higher encouraging even more people to just pay the penalty. Show me where my math is wrong. 

So do you really believe everyone is going to buy health insurance when it is against their financial interest? Many people who get it today would be best served by canceling their plans in 2014 unless they are already sick. 

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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cj wrote:Let's review

cj wrote:

Let's review preexisting conditions.

I have arthritis in both knees and my back.  This is a preexisting condition.  Osteoarthritis takes decades for the joint to degenerate to the point you can get medical assistance.  Prior to not being able to move, you are told to lose weight and exercise.  When you can no longer walk without pain, then your doctor starts referring you to osteopathic surgeons.

Whenever I changed jobs in the past, my doctor and I had to do the dance - again.  X-rays, specialists, different medications that I had tried before.  Again.  The arthritis never gets better, it only gets worse.  Why do all the diagnostic stuff again?  We have done it before, it hasn't got better, it is worse and getting worse.  Why again?  Because it is otherwise a preexisting condition.  The doctor has to re-diagnose it all over again to get the insurance company to cough up.  It is a colossal waste of time and money - mine, the doctors', and the insurance company's. 

Which is why I have always believed it is a bad move to get your insurance from your company. When I did have it I got a personal policy because it was A LOT cheaper and you don't lose it when you lose your job. The portability is actually one of the few good aspects of the healthcare law and one of the things the government could have done to help without spending a penny.

cj wrote:

So taking away the preexisting condition clause should actually save money.

 

A micro amount in the grand scheme of things.

cj wrote:

And really, if people like you got insurance, it would lower everyone's costs.  Duh.  Just like good drivers lower everyone's auto insurance costs.  Duh.

Yes, insurance would be cheaper if absolutely everyone purchased it. But why should I enter a transaction that is against my own personal financial interests simply because it helps those who choose to spend their money rather than invest it? I give to charity, but when I do I am really picky about who the money goes to help. I prefer to help those who really hit rough times and are really trying to better themselves rather than those who foolishly buy suburban homes and fancy cars when they have no assets to cover an emergency. So I while I would happily donate a substantial amount to say the Leukemia and Lymphoma Society but I'm not so crazy about donating money to lower the cost of other peoples insurance. Especially, since in my experience, most people spend their money foolishly.

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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Beyond Saving wrote:jcgadfly

Beyond Saving wrote:

jcgadfly wrote:

You're talking like the majority of Americans have a pre-existing condition. Not the case. They also have very capricious definitions of pre-existing conditions (as I mentioned earlier).

I don't want to be turned down for coverage because I came in with the sniffles, either.

If it was a short amnesty period where people with current preexisting conditions could get coverage it would be manageable for insurance companies. But that is not what to law does. The law requires insurance companies to cover all preexisting conditions. So why purchase health insurance before you go to the hospital? The penalty for not having insurance is only $95 or 1% of your income in 2014 and $695 or 2.5% of your income in 2016 which is likely to be substantially cheaper than buying health insurance unless you have a high income even if insurance rates don't go up and that provision is not found unconstitutional. Why pay for insurance? Just go into the high risk pool when you are actually sick and the government caps your cost at $5950. Health insurance would cost me around $200 a month right now. So my yearly insurance cost would be $2400, even with the penalty I am saving quite a bit of money each year by not buying insurance. A few years of decent health and it is a nice safety net. Since I won't be the only one thinking that way, many people will do the same thing causing premiums to be even higher encouraging even more people to just pay the penalty. Show me where my math is wrong. 

So do you really believe everyone is going to buy health insurance when it is against their financial interest? Many people who get it today would be best served by canceling their plans in 2014 unless they are already sick. 

My math sucks - it's why I'm in theatre.

Do you believe that the conditions I described earlier (domestic violence, pregnancy, etc) are valid pre-existing conditions to deny coverage?

 

"I do this real moron thing, and it's called thinking. And apparently I'm not a very good American because I like to form my own opinions."
— George Carlin


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jcgadfly wrote:My math sucks

jcgadfly wrote:

My math sucks - it's why I'm in theatre.

Do you believe that the conditions I described earlier (domestic violence, pregnancy, etc) are valid pre-existing conditions to deny coverage?

Lol, remind me never to hire you to do my taxes.

The main problem is that depending on your state, you may or may not have options. Some health insurance companies do have standards that are ridiculous, others have standards that are very fair. Those with really unfair standards tend to be in states where there are only two or three companies allowed. In states that are relatively open you might have to pay a bit more if you are unhealthy but you can get coverage. 

As for pregnancy, if you are already pregnant you shouldn't expect to get insurance that covers your pregnancy. In Ohio, you can choose whether or not your insurance covers pregnancy. In some states, like Minnesota you have to pay for pregnancy coverage even if you are male (last time I checked the odds of me getting pregnant are only slightly higher than the odds there is a god). So you ought to be able to get coverage for non-pregnancy related illness but not to cover the pregnancy itself. 

Domestic violence? You really ought to go to the cops and head to the YWCA if you are being injured enough to have a medical record substantial enough to be denied coverage.  

My solution would be to pass a law allowing companies to sell insurance across state lines regardless of what the state says. After all, one of the federal governments main constitutional duties is to ensure free commerce among the states. Again, another law that costs only the paper it is written on. That way, there would be much more competition among insurers and you would be able to find someone to cover you. Although, those who are overweight, have chronic health problems or smoke will pay more. But since two of those three are lifestyle choices I say too bad and for most chronic health problems there are charities out there. If we get rid of the idea that the government is supposed to take care of people we could encourage the growth of more charities that have led the way in finding cures and treatments for diseases.  

REALLY smart number crunchers are hired by the insurance companies to calculate the risk and probable cost of each person they insure and calculate the appropriate premium so that the insurance company can guarantee it has enough money to pay claims and also its staff. It isn't a number grabbed out of thin air. The government can't change that just by waving their pens.

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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Beyond Saving wrote:As for

Beyond Saving wrote:


As for pregnancy, if you are already pregnant you shouldn't expect to get insurance that covers your pregnancy. In Ohio, you can choose whether or not your insurance covers pregnancy. In some states, like Minnesota you have to pay for pregnancy coverage even if you are male (last time I checked the odds of me getting pregnant are only slightly higher than the odds there is a god). So you ought to be able to get coverage for non-pregnancy related illness but not to cover the pregnancy itself. 

 

You don't understand.  I am a woman, I have been pregnant in the past, I am not pregnant now, but the pregnancy is a preexisting condition.  Some women have been denied health care because they were pregnant in the past - not that they are pregnant now.

Pregnancy has the potential to give women lots of preexisting conditions - strained muscles, tendons, urinary track problems, diabetes, high blood pressure, life threatening depression, and so on. 

For your griping about paying for pregnancy - I get to pay for Viagra and erectile dysfunction.  Problems I will never have.  There are policies out there that will not pay for birth control, and/or will not pay for pregnancy of a minor child or the complications due to said pregnancy of a minor child.  And they don't cover grandchildren.  So if I had a daughter (I don't) that got pregnant my health insurance policy may not cover the costs of the pregnancy.  Costly even for a uncomplicated birth.  And my grandchild would not be covered at all.  I have heard of people who legally divorce their teenage daughters so she can get medicaid for herself and the child.  This runs up costs for you and me.

Also, you don't have to be ill to rack up mega medical bills.  You have said you travel a lot.  And if you were in a car accident?  Had to spend days in hospital and months in a rehab facility?  Do you have accident coverage?  Your auto insurance probably has some little piddly amount they will cover.  Very often only a few thousands.  Better check it out and hope you don't get rammed by a semi any time soon.

 

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..

cygo wrote:

Republicans, buoyed by recent polls suggesting that their party could win the House and pick up seats in the Senate in November, are vowing to repeal or make major revisions in the health overhaul law that Democrats squeezed through Congress last spring. But how difficult would it be to overturn that law?

Correct me if I am wrong but was not the only government benefit ever repealed the one that counted alcoholism as a medical disability qualifying for SSI? If a civil war vet resurrects from the grave I am certain he can still get his mule and 40 acres.

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Pre-existing conditions

BTW: Rule One is Life is not Fair.

The basis of insurance is statistics. The simplest example is life insurance. If you buy young and pay all your life then your premiums remain low all your life. But if you buy term insurance your rate increases every year as the odds of you dying increase every year. At some point the chances of dying are so high that the premium has to be greater than the value of the policy to make a profit.

The low, life long payments works because people start young and are thus form a group which is representative of the general population and the actuarial statistics for the general population apply to the group of policy holders.

Pre-existing condition is like allowing a 80 year old to pay the same price as a 20 year old for life insurance BUT only buy insurance after turning 80. But it is worse with a pre-existing condition. No one buys insurance at all until the cost of treatment exceeds the cost of health insurance which makes buying insurance a cost saving measure. The percentage of policy holders with pre-existing conditions becomes a greater percentage than in the general population.

The only way to make these things work is to require everyone to have insurance and to have all insurance policies to cover exactly the same things. At this point there isn't much to compete and without that not need for private insurance companies.

The Fed gov has one approach to keep it private. It matches the cost of insurance premiums the employees pay. It also allows any company to offer policies to employees. The condition is the insurer must accept everyone who accepts without conditions. Employees can use up lifetime policy limits and then change companies and start over. This works because all companies play by the same rules and deals with the same actuarial pool and thus can set their premiums to cover costs and make a profit. Everyone gets their time in the barrel with pre-existing and chronic conditions and very expensive conditions.

A bit over a year ago a proposal to make it a crime not to buy health insurance was demonstrating the evil of Obama but that was one proposal which would have created a demographic pool represented by the general population. It would have made it like the government does it for its employees.

The only issue of interest here is the nature of insurance which is the method used to set the premiums. The insured population has to represent the population as a whole. It cannot be skewed by the sick. Medicare does this. At age 65 you are in, period. It may be a more sickly demographic but it is a known demographic and not skewed by illness. Granted it costs a lot more than people pay for it but the costs are predictable. Were it affordable people could pay what it is worth because everyone is a member and everyone pays.

Note Medicare is socialized medicine as is Medicaide as in Champus (military insurance) and Fed Gov insurance (almost) and in fact about 60% of medical insurance in the US is socialized medicine under some definition of the term and most of it the simplest definition of the term.
 

Jews stole the land. The owners want it back. That is all anyone needs to know about Israel. That is all there is to know about Israel.

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Excellent point

A_Nony_Mouse wrote:

cygo wrote:

Republicans, buoyed by recent polls suggesting that their party could win the House and pick up seats in the Senate in November, are vowing to repeal or make major revisions in the health overhaul law that Democrats squeezed through Congress last spring. But how difficult would it be to overturn that law?

Correct me if I am wrong but was not the only government benefit ever repealed the one that counted alcoholism as a medical disability qualifying for SSI? If a civil war vet resurrects from the grave I am certain he can still get his mule and 40 acres.

 

Love it.

LOL

 


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cj wrote: You don't

cj wrote:
 

You don't understand.  I am a woman, I have been pregnant in the past, I am not pregnant now, but the pregnancy is a preexisting condition.  Some women have been denied health care because they were pregnant in the past - not that they are pregnant now.

Pregnancy has the potential to give women lots of preexisting conditions - strained muscles, tendons, urinary track problems, diabetes, high blood pressure, life threatening depression, and so on. 

Yes, you can have lasting health problems as a result of pregnancy. You can also have lasting health problems as a result of walking up the stairs. 

cj wrote:

For your griping about paying for pregnancy - I get to pay for Viagra and erectile dysfunction.  Problems I will never have.  There are policies out there that will not pay for birth control, and/or will not pay for pregnancy of a minor child or the complications due to said pregnancy of a minor child.  And they don't cover grandchildren.  So if I had a daughter (I don't) that got pregnant my health insurance policy may not cover the costs of the pregnancy.  Costly even for a uncomplicated birth.  And my grandchild would not be covered at all.  I have heard of people who legally divorce their teenage daughters so she can get medicaid for herself and the child.  This runs up costs for you and me.

And shouldn't you have the choice? There are thousands of different kinds of insurance policies that have different levels of coverage. If there is 0% chance of you getting pregnant, why should you have to pay for pregnancy coverage? It is a waste of money to get coverage to pay for either Viagra or birth control because they are predictable costs. When you pay with a third party, your costs will always be more expensive because they make a profit. So if the cost is predictable you are wasting money. Insurance is meant to protect you from the big costs that may or may not happen but you can't afford. And in the case of the people divorcing their daughters, they should be forced to mortgage their assets first.

cj wrote:

Also, you don't have to be ill to rack up mega medical bills.  You have said you travel a lot.  And if you were in a car accident?  Had to spend days in hospital and months in a rehab facility?  Do you have accident coverage?  Your auto insurance probably has some little piddly amount they will cover.  Very often only a few thousands.  Better check it out and hope you don't get rammed by a semi any time soon.

I am very aware of that. My auto insurance only covers liability. Just like my health, I figure I'll just pay for a new car. I drive junkers and go through one every other year or so if I have to buy one a bit earlier than planned so what. Statistically a car accident is by far the most likely way for me to die or be permanently disabled. So IF I get in that horrible accident and have 200k in bills I guess I will have to pay for it. Then in retrospect I will wish I bought insurance the month before. I know the risk I am taking and I know if I get that 200k bill I may have to sell off some investments to cover it. My retirement fund will be that much less which would suck because then I might actually have to work until I am 65. But it really isn't any worse than the cost of a new home. And yes, I also have a plan if I were to become disabled and if I become a vegetable I have a living will that says pull the damn plug. So don't panic, you won't be paying my bills. There is the off chance that I might end up losing everything I have but in that case I will just be happy to be alive because I had some seriously bad stuff happen to me. 

 

cj wrote:

 

I do have life insurance, so if my car looks like that, there will be a few very happy people. (Life insurance- making sure people show up to your funeral.)

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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A_Nony_Mouse wrote:A bit

A_Nony_Mouse wrote:

A bit over a year ago a proposal to make it a crime not to buy health insurance was demonstrating the evil of Obama but that was one proposal which would have created a demographic pool represented by the general population. It would have made it like the government does it for its employees.

Which would work from a purely economical perspective except the penalties are cheaper than the insurance and that particular provision will most likely be found unconstitutional. Generally, group policies work exactly as you described which is why you can get a group policy even with a preexisting condition. And also why they are a lot more expensive than individual policies for anyone in decent health. I never understood why most people pay for them other than sheer ignorance. I forced my boss to give me a raise in exchange for agreeing not to take medical insurance. (In many companies your boss is picking up part of the tab too, it isn't just what you see coming out of your check.)

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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 Beyond Saving wrote:Well I

 

Beyond Saving wrote:
Well I don't see really where we disagree.

 

My main question is how can any insurance company of any type make a profit if they issue a policy to every joe with a preexisting condition?

 

<snip>

 

No one has even attempted to explain where the money will come from.

 

Well, for the most part, I don't think that we do disagree apart from some details.

 

First would be on the preexisting conditions.

 

If that always and forever meant people who have a condition that costs more to treat than the amount that a company could get back in a standard premium scheme, then sure, they would be a disaster to the industry.

 

However, that is only a slice out of the pie. Prior to Obama care, the term was used by many carriers as an almost mystical term that allowed them to simply deny coverage based on whatever they felt like.

 

The news has come with many stories of people who were denied coverage for some really trivial reason. Perhaps you need to take one pill a day to keep your blood pressure down. The cost to the industry is minimal as long as you stay in your current job. However, if you more to a new company, that is grounds for you to simply be removed from any insurance at all, thus increasing the load on publicly provided health care.

 

Under Obama care, when you move jobs, your old provider still gets to drop you from their roles but a new provider will pick you up. You no longer have a huge incentive to simply remain with your current employer to prevent your provider from removing your coverage in the first place. Fewer people end up putting a gigantic strain on publicly provided health care.

 

As far as where the money comes from, this is a big one. Insurance providers do not simply run a business based on every dollar the comes in is pooled and converted to a stack of Benjamins in a vault somewhere. If that were the case, then I could see how they would need to make sure that more cash was coming in from the insured than was going out to pay their expenses. Fortunately, that is just not the case.

 

Insurance companies invest the cash. And why not? They have lots of it. They should make as much interest as they reasonably can. Perhaps a company in California may need to keep a larger percentage of the money in quickly convertible forms just in case there is an earth quake. But still, it remains a fact that even in a crappy economy, they may be getting 10% return on the gigantic pile of cash.

 

That is actually one of the reasons why it took so damned long to get even this far in the US. If we were to go the way of some countries, it would knock the whole damned economy into a tail spin.

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Beyond Saving wrote:jcgadfly

Beyond Saving wrote:

jcgadfly wrote:

My math sucks - it's why I'm in theatre.

Do you believe that the conditions I described earlier (domestic violence, pregnancy, etc) are valid pre-existing conditions to deny coverage?

Lol, remind me never to hire you to do my taxes.

The main problem is that depending on your state, you may or may not have options. Some health insurance companies do have standards that are ridiculous, others have standards that are very fair. Those with really unfair standards tend to be in states where there are only two or three companies allowed. In states that are relatively open you might have to pay a bit more if you are unhealthy but you can get coverage. 

As for pregnancy, if you are already pregnant you shouldn't expect to get insurance that covers your pregnancy. In Ohio, you can choose whether or not your insurance covers pregnancy. In some states, like Minnesota you have to pay for pregnancy coverage even if you are male (last time I checked the odds of me getting pregnant are only slightly higher than the odds there is a god). So you ought to be able to get coverage for non-pregnancy related illness but not to cover the pregnancy itself. 

Domestic violence? You really ought to go to the cops and head to the YWCA if you are being injured enough to have a medical record substantial enough to be denied coverage.  

My solution would be to pass a law allowing companies to sell insurance across state lines regardless of what the state says. After all, one of the federal governments main constitutional duties is to ensure free commerce among the states. Again, another law that costs only the paper it is written on. That way, there would be much more competition among insurers and you would be able to find someone to cover you. Although, those who are overweight, have chronic health problems or smoke will pay more. But since two of those three are lifestyle choices I say too bad and for most chronic health problems there are charities out there. If we get rid of the idea that the government is supposed to take care of people we could encourage the growth of more charities that have led the way in finding cures and treatments for diseases.  

REALLY smart number crunchers are hired by the insurance companies to calculate the risk and probable cost of each person they insure and calculate the appropriate premium so that the insurance company can guarantee it has enough money to pay claims and also its staff. It isn't a number grabbed out of thin air. The government can't change that just by waving their pens.

A pregnant woman also should not expect to be denied general health coverage because she happens to be pregnant (as in the case I described)

Many of those people do - if they can. For those who can't/won't (some of them still love their batterers) -  are you saying you want to add a housing bill to the ER bill they already can't pay?

The government can provide alternative numbers. It's called competition.

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Beyond Saving

Beyond Saving wrote:

A_Nony_Mouse wrote:

A bit over a year ago a proposal to make it a crime not to buy health insurance was demonstrating the evil of Obama but that was one proposal which would have created a demographic pool represented by the general population. It would have made it like the government does it for its employees.

Which would work from a purely economical perspective except the penalties are cheaper than the insurance and that particular provision will most likely be found unconstitutional. Generally, group policies work exactly as you described which is why you can get a group policy even with a preexisting condition. And also why they are a lot more expensive than individual policies for anyone in decent health. I never understood why most people pay for them other than sheer ignorance. I forced my boss to give me a raise in exchange for agreeing not to take medical insurance. (In many companies your boss is picking up part of the tab too, it isn't just what you see coming out of your check.)

 

That was a bold move you made with your boss -- and it benefits both of you.  

 

 


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However, that is only a slice out of the pie. Prior to Obama care, the term was used by many carriers as an almost mystical term that allowed them to simply deny coverage based on whatever they felt like.

And why shouldn't they be able to? It is their money they are risking if the person turns out to be a loss. The problem right now is you don't have a free market. Where you really have problems is states where only a couple insurance companies are allowed. If you can only legally choose between a few companies it is far more likely that all of them will turn you down. If you allow companies to sell across state lines then you will have a much easier time getting coverage. I sold health insurance for a bit (it is a real crappy job, you couldn't pay me enough to do it again) and here in Ohio we have a fairly decent selection. I knew what companies were picky and which companies were willing to take greater risks. If you have choices, some companies will be extremely strict and play it safe while others will charge higher premiums but take bigger risks.

JC is focusing on pregnancy right now. Well in Minnesota all health insurance must have pregnancy coverage period. So if you are pregnant and walk in to buy insurance you will be denied because the company knows you will be an immediate loss. In Ohio, you can still get coverage to cover any non-pregnancy related health issues but not the pregnancy itself. But, thanks to the government, a Minnesota citizen is not allowed to purchase insurance from an Ohio agent.  

 

Answers in Gene Simmons wrote:
 

Under Obama care, when you move jobs, your old provider still gets to drop you from their roles but a new provider will pick you up. You no longer have a huge incentive to simply remain with your current employer to prevent your provider from removing your coverage in the first place. Fewer people end up putting a gigantic strain on publicly provided health care.

And what incentive do you have to own insurance at all before you get sick?

 

Answers in Gene Simmons wrote:
 

As far as where the money comes from, this is a big one. Insurance providers do not simply run a business based on every dollar the comes in is pooled and converted to a stack of Benjamins in a vault somewhere. If that were the case, then I could see how they would need to make sure that more cash was coming in from the insured than was going out to pay their expenses. Fortunately, that is just not the case.

 

Insurance companies invest the cash. And why not? They have lots of it. They should make as much interest as they reasonably can. Perhaps a company in California may need to keep a larger percentage of the money in quickly convertible forms just in case there is an earth quake. But still, it remains a fact that even in a crappy economy, they may be getting 10% return on the gigantic pile of cash.

Yes, but that return is already calculated into the current premium levels. So if you require more payouts in the form of forcing coverage of preexisting conditions or forcing coverage of minors until they are 26 the premiums still need to go higher.

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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jcgadfly wrote:Many of those

jcgadfly wrote:

Many of those people do - if they can. For those who can't/won't (some of them still love their batterers) -  are you saying you want to add a housing bill to the ER bill they already can't pay?

Unfortunately you can't force people to get help. I want every person addicted to heroine to seek help getting off of it. I want everyone thinking about committing suicide to get help. I want everyone getting abused to seek help. Give them a housing bill? No. I want them to go to a battered womens shelter where they can get housing, food and protection for free while they get back on their feet. All we can do is make sure the facilities are available and if we see someone we believe is in that situation try to convince them to go. If they choose not to there isn't much you can do. How is giving them health insurance going to solve their real problem? 

 

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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Beyond Saving wrote:jcgadfly

Beyond Saving wrote:

jcgadfly wrote:

Many of those people do - if they can. For those who can't/won't (some of them still love their batterers) -  are you saying you want to add a housing bill to the ER bill they already can't pay?

Unfortunately you can't force people to get help. I want every person addicted to heroine to seek help getting off of it. I want everyone thinking about committing suicide to get help. I want everyone getting abused to seek help. Give them a housing bill? No. I want them to go to a battered womens shelter where they can get housing, food and protection for free while they get back on their feet. All we can do is make sure the facilities are available and if we see someone we believe is in that situation try to convince them to go. If they choose not to there isn't much you can do. How is giving them health insurance going to solve their real problem? 

 

Keep them alive long enough without having to spend money they don't have (which could lead to more beatings)?

You want people to get some form of help but you want the insurance companies to deny them that privilege by not paying for it? Confusing.

Note: I include all aspects of health in "health insurance".

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 Beyond Saving wrote:  

 

Beyond Saving wrote:

 

Answers in Gene Simmons wrote:
Under Obama care, when you move jobs, your old provider still gets to drop you from their roles but a new provider will pick you up. You no longer have a huge incentive to simply remain with your current employer to prevent your provider from removing your coverage in the first place. Fewer people end up putting a gigantic strain on publicly provided health care.

 

And what incentive do you have to own insurance at all before you get sick?

 

Why, under that idea, nobody would ever buy fire insurance unless their house was already on fire. And I would have no sympathy for them if it turned out that the insurance companies refused to help them out.

 

You see, that is not insurance. That is being stupid to the point of getting caught out. Then you run around crying like a two year old.

 

Beyond Saving wrote:

 

Answers in Gene Simmons wrote:
However, that is only a slice out of the pie. Prior to Obama care, the term was used by many carriers as an almost mystical term that allowed them to simply deny coverage based on whatever they felt like.

 

And why shouldn't they be able to? It is their money they are risking if the person turns out to be a loss.

 

Gee, you make it sound like they actually own the money and should be allowed to simply say give us all of your cash. If you get sick on a day when we are in a generous mood, we might actually be willing to drop a buck or two to help you out.

 

That is not insurance either. That is extortion with no real promise to meet the obligation inherent to an insurance company.

 

Insurance is when you pay a little bit from every pay check and you hope that you don't need to draw down on it. However, if you do need to do so, the fact that you have paid into the system fair and square means that the insurance company will meet their end of the contract as well. Yah, I know that is pretty basic but it is the underlying assumption for a robust system.

 

Correct me if I am wrong but when you talk about preexisting conditions, you mean like the idiot who would wait for the house fire to buy fire insurance.

 

Against that, my conception was more like someone who has done the right thing for many years only to get into a bind where changing jobs means that the new company does not have to give you the time of day while the old company gets to pocket all of the balance of your premiums. Basically, you have paid all of those premiums only to be removed from the general system. Of course because people change jobs all the time, you could think of this as if two people traded jobs, the insurance companies got to keep all the premiums and two people are left out in the rain.

 

Under a real scheme for portability, there really is no pocketing of unpaid benefits. People move jobs all the time and insurance companies know this. So insurance companies receive premiums from everyone and everyone gets coverage. Of course this only works to the extent that there are no people playing the system by not paying for stuff until they need it.

 

Perhaps, if you wait until you are 30 to start paying, then your personal premium should be that much larger because you did not pay in during your 20's. That could be an incentive right there. Your premiums are calculated at a differential based on how old you are when you enter the system.

 

That and you have to verbally state your choice every time you do certain things such as get a driver's license, vote or pay your taxes. Of course, if you have insurance, you can just pass right through the system based on that fact. Heck, getting a car registered is hard enough as it is. Can you imagine having to stand in the line for the uninsured and watching the insured people's line moving that much faster than yours?

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 Why, under that idea, nobody would ever buy fire insurance unless their house was already on fire. And I would have no sympathy for them if it turned out that the insurance companies refused to help them out.

 

You see, that is not insurance. That is being stupid to the point of getting caught out. Then you run around crying like a two year old.

Which is exactly my point about insuring people with preexisting conditions. The house on fire is a preexisting condition. We don't expect it for any other kind of insurance, why do we expect it for health insurance?

  

Answers in Gene Simmons wrote:

Gee, you make it sound like they actually own the money and should be allowed to simply say give us all of your cash. If you get sick on a day when we are in a generous mood, we might actually be willing to drop a buck or two to help you out.

 

That is not insurance either. That is extortion with no real promise to meet the obligation inherent to an insurance company.

 

Insurance is when you pay a little bit from every pay check and you hope that you don't need to draw down on it. However, if you do need to do so, the fact that you have paid into the system fair and square means that the insurance company will meet their end of the contract as well. Yah, I know that is pretty basic but it is the underlying assumption for a robust system.

I never said that. I simply said that insurance companies have the right to determine who to issue a policy to. It is a private contract. Once the contract is made the terms should be enforced. But prior to the contract being made BOTH parties should have the right to negotiate the terms and determine whether or not to enter the contract. And yes, the money at risk is their money.

 

That is what irritates me when you get people with their stories of "well I had insurance and they wouldn't pay for X, we need reform" Well if your contract says x is supposed to be covered and you paid your premium then you should be looking into a lawsuit and suing the company. I find it odd that all these people will come forward with their stories on the campaign trail but always refuse to name the company in question. If you were screwed by an insurance company wouldn't you be screaming their name from the rooftops? "Insurance company Y refused to pay for my illness X even though it was covered in the contract!" If an insurance company doesn't follow their contract they should be sued. If insurance companies are routinely getting away with not paying for legitimate claims that clearly should be covered maybe that is something we should look into. Name the companies that are rotten so people know not to buy insurance from them. Health insurance contracts are extremely detailed on what is covered and what is not. It is the consumers responsibility to read the contract and it is the insurers responsibility to fulfill its obligation.

 

Answers in Gene Simmons wrote:

Correct me if I am wrong but when you talk about preexisting conditions, you mean like the idiot who would wait for the house fire to buy fire insurance.

 

Against that, my conception was more like someone who has done the right thing for many years only to get into a bind where changing jobs means that the new company does not have to give you the time of day while the old company gets to pocket all of the balance of your premiums. Basically, you have paid all of those premiums only to be removed from the general system. Of course because people change jobs all the time, you could think of this as if two people traded jobs, the insurance companies got to keep all the premiums and two people are left out in the rain.

 

Under a real scheme for portability, there really is no pocketing of unpaid benefits. People move jobs all the time and insurance companies know this. So insurance companies receive premiums from everyone and everyone gets coverage. Of course this only works to the extent that there are no people playing the system by not paying for stuff until they need it.

Which could be done quite easily by passing a regulation that requires a group policy to branch into a personal policy after say a year of premium payments. Yet another potential fix that wouldn't cost the government a penny and have only a minor effect on the cost of premiums. Of course, if people were smart enough to buy a personal policy in the first place they wouldn't have that problem. So I don't have too much sympathy for those who rely on their jobs for health insurance. You know the terms of the contract, you know what happens if you lose your job and you know you might get sick and you still say no to the insurance salesman. But I would make a small concession in my libertarian ideals that a regulation requiring portability would make things better. It would have to allow the insurance companies to set a certain amount of time you have to be with them before it is to minimize hit & runners but would be possible and far less damaging than the trillion dollar monstrosity that passed. 

 

 

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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Beyond Saving wrote:That is

Beyond Saving wrote:

 

That is what irritates me when you get people with their stories of "well I had insurance and they wouldn't pay for X, we need reform" Well if your contract says x is supposed to be covered and you paid your premium then you should be looking into a lawsuit and suing the company. I find it odd that all these people will come forward with their stories on the campaign trail but always refuse to name the company in question. If you were screwed by an insurance company wouldn't you be screaming their name from the rooftops? "Insurance company Y refused to pay for my illness X even though it was covered in the contract!" If an insurance company doesn't follow their contract they should be sued. If insurance companies are routinely getting away with not paying for legitimate claims that clearly should be covered maybe that is something we should look into. Name the companies that are rotten so people know not to buy insurance from them. Health insurance contracts are extremely detailed on what is covered and what is not. It is the consumers responsibility to read the contract and it is the insurers responsibility to fulfill its obligation.

 

Didn't you know?  Health insurance companies are exempt from being sued for refusing to pay for care.  Thank a republican.

 

edit:  While I think the new health care law will no longer allow them to refuse to pay for care, I don't think the lawsuit exemption has been repealed.  I could be wrong.

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 Beyond Saving wrote: That

 

Beyond Saving wrote:

 

That is what irritates me when you get people with their stories of "well I had insurance and they wouldn't pay for X, we need reform" Well if your contract says x is supposed to be covered and you paid your premium then you should be looking into a lawsuit and suing the company. I find it odd that all these people will come forward with their stories on the campaign trail but always refuse to name the company in question. If you were screwed by an insurance company wouldn't you be screaming their name from the rooftops? "Insurance company Y refused to pay for my illness X even though it was covered in the contract!" If an insurance company doesn't follow their contract they should be sued. If insurance companies are routinely getting away with not paying for legitimate claims that clearly should be covered maybe that is something we should look into. Name the companies that are rotten so people know not to buy insurance from them. Health insurance contracts are extremely detailed on what is covered and what is not. It is the consumers responsibility to read the contract and it is the insurers responsibility to fulfill its obligation.

 

I don't usually comment about this because I don't know much about it but in less than five minutes I was able to find out that United Healthcare was fined in 2006 for denying 63,000 claims without having the legally required documents to make the decisions, that PacifiCare was fined in 2008 for more than 130,000 claims processing violations, and that almost every Blue Cross and Blue Shield plan in the US has settled allegations that they improperly denied, delayed or reduced payments for medically necessary covered services. And those are just some of the hundreds of thousand of know claims violations. You seem to be oblivious of any facts concerning this subject.

http://www.accessmylibrary.com/article-1G1-143135398/united-healthcare-fined-364750.html
http://www.kaiserhealthnews.org/daily-reports/2008/january/30/dr00050126.aspx?referrer=search
http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/health-insurer-settlements/blue-cross-blu...

There are twists of time and space, of vision and reality, which only a dreamer can divine
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cj wrote:Beyond Saving

cj wrote:

Beyond Saving wrote:

 

That is what irritates me when you get people with their stories of "well I had insurance and they wouldn't pay for X, we need reform" Well if your contract says x is supposed to be covered and you paid your premium then you should be looking into a lawsuit and suing the company. I find it odd that all these people will come forward with their stories on the campaign trail but always refuse to name the company in question. If you were screwed by an insurance company wouldn't you be screaming their name from the rooftops? "Insurance company Y refused to pay for my illness X even though it was covered in the contract!" If an insurance company doesn't follow their contract they should be sued. If insurance companies are routinely getting away with not paying for legitimate claims that clearly should be covered maybe that is something we should look into. Name the companies that are rotten so people know not to buy insurance from them. Health insurance contracts are extremely detailed on what is covered and what is not. It is the consumers responsibility to read the contract and it is the insurers responsibility to fulfill its obligation.

 

Didn't you know?  Health insurance companies are exempt from being sued for refusing to pay for care.  Thank a republican.

 

edit:  While I think the new health care law will no longer allow them to refuse to pay for care, I don't think the lawsuit exemption has been repealed.  I could be wrong.

What law is that? 

As far as I know you cannot sue an insurance company for damages that result from refusal to pay for care. For example, if you have a heart attack and the insurance company denies coverage for surgery because they don't think bypass surgery is necessary and then you do not get the surgery you can't sue them for millions like you could a doctor. You can get the surgery and take on the obligation and then sue them for the cost of the surgery itself. Basically, you can sue them for breach of contract but not malpractice. Now all that law is handled at the state level so exactly what you can and cannot sue for depends a lot on the state. Also, all states have an insurance board that you can file complaints to if an insurance company is doing anything dishonest and I would assume you have to go through that process before bringing a lawsuit.

I am not aware of any federal law that prevents you from suing them for breach of contract or fraud. In fact, I remember a rather large class action lawsuit against united healthcare a few years ago. But I admit, this is an area of law I am not well versed in.  

But if you are correct, then that is another example of a yet another ridiculous law probably passed because of lobbying money and ought to be repealed along with 90% of the rest of the laws and yet another example of how government creates the problem then declares more government is needed to fix it. And yet another reform that could be passed without spending a penny of taxpayer money. And yet another reason for me to stick with my "I'll pay for it myself" approach. 

 

edit: Look above at Gauche, looks like it is perfectly possible to sue your insurance company and people do and some people even get money (although the damn lawyers probably got a lot more but that is another issue).  

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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Beyond Saving wrote:cj

Beyond Saving wrote:

cj wrote:

Beyond Saving wrote:

 

That is what irritates me when you get people with their stories of "well I had insurance and they wouldn't pay for X, we need reform" Well if your contract says x is supposed to be covered and you paid your premium then you should be looking into a lawsuit and suing the company. I find it odd that all these people will come forward with their stories on the campaign trail but always refuse to name the company in question. If you were screwed by an insurance company wouldn't you be screaming their name from the rooftops? "Insurance company Y refused to pay for my illness X even though it was covered in the contract!" If an insurance company doesn't follow their contract they should be sued. If insurance companies are routinely getting away with not paying for legitimate claims that clearly should be covered maybe that is something we should look into. Name the companies that are rotten so people know not to buy insurance from them. Health insurance contracts are extremely detailed on what is covered and what is not. It is the consumers responsibility to read the contract and it is the insurers responsibility to fulfill its obligation.

 

Didn't you know?  Health insurance companies are exempt from being sued for refusing to pay for care.  Thank a republican.

 

edit:  While I think the new health care law will no longer allow them to refuse to pay for care, I don't think the lawsuit exemption has been repealed.  I could be wrong.

What law is that? 

As far as I know you cannot sue an insurance company for damages that result from refusal to pay for care. For example, if you have a heart attack and the insurance company denies coverage for surgery because they don't think bypass surgery is necessary and then you do not get the surgery you can't sue them for millions like you could a doctor. You can get the surgery and take on the obligation and then sue them for the cost of the surgery itself. Basically, you can sue them for breach of contract but not malpractice. Now all that law is handled at the state level so exactly what you can and cannot sue for depends a lot on the state. Also, all states have an insurance board that you can file complaints to if an insurance company is doing anything dishonest and I would assume you have to go through that process before bringing a lawsuit.

I am not aware of any federal law that prevents you from suing them for breach of contract or fraud. In fact, I remember a rather large class action lawsuit against united healthcare a few years ago. But I admit, this is an area of law I am not well versed in.  

But if you are correct, then that is another example of a yet another ridiculous law probably passed because of lobbying money and ought to be repealed along with 90% of the rest of the laws and yet another example of how government creates the problem then declares more government is needed to fix it. And yet another reform that could be passed without spending a penny of taxpayer money. And yet another reason for me to stick with my "I'll pay for it myself" approach. 

 

edit: Look above at Gauche, looks like it is perfectly possible to sue your insurance company and people do and some people even get money (although the damn lawyers probably got a lot more but that is another issue).  

I think she means their exemption from anti-trust laws.

From http://www.examiner.net/news/law/x1914248650/Health-insurance-companies-exempt-from-anti-trust-laws

"The two key provisions of the Health Insurance Industry Antitrust Enforcement Act will repeal the federal antitrust exemption for health insurance and medical malpractice insurance companies for flagrant antitrust violations, including price-fixing, bid rigging, and market allocations, and subject health insurers and medical malpractice insurers to the same good-competition laws that apply to virtually every other company doing business in the United States."

"I do this real moron thing, and it's called thinking. And apparently I'm not a very good American because I like to form my own opinions."
— George Carlin


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I didn't say they were sued

I didn't say they were sued by customers. I said they were fined by state regulatory bodies. In the case of Blue Cross they had to settle with physicians who submitted valid proof of claims.

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Gauche wrote:I didn't say

Gauche wrote:

I didn't say they were sued by customers. I said they were fined by state regulatory bodies. In the case of Blue Cross they had to settle with physicians who submitted valid proof of claims.

I think Beyond Saving asked. Did I reply to you by mistake?

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jcgadfly wrote:I think she

jcgadfly wrote:

I think she means their exemption from anti-trust laws.

From http://www.examiner.net/news/law/x1914248650/Health-insurance-companies-exempt-from-anti-trust-laws

"The two key provisions of the Health Insurance Industry Antitrust Enforcement Act will repeal the federal antitrust exemption for health insurance and medical malpractice insurance companies for flagrant antitrust violations, including price-fixing, bid rigging, and market allocations, and subject health insurers and medical malpractice insurers to the same good-competition laws that apply to virtually every other company doing business in the United States."

Well I know they are exempt from anti-trust laws and I made a point of that somewhere in one of these threads. I believe that is one of the main problems with the whole health insurance industry. That doesn't have any bearing on whether or not you can sue a health insurance company for denying benefits. I'll have to talk to one of my lawyer friends because as I said, I really am not familiar with that area of law.  I searched a couple websites and some of them say that you can sue your health insurance company but none that I really trust.

 

@Gauche    Does it matter who files the case? I guess technically it is the doctor that is the injured party if they perform the service and have not been reimbursed so it would be the doctor that would press the case against the insurance company. If the patient pays the doctor bill and then turns around and sues the insurance company would it make a difference legally? I suppose in most cases the doctor is willing to accept a delayed payment since they tend to be payed late anyway so I imagine in most cases the doctor would be the injured party.    

 

If, if a white man puts his arm around me voluntarily, that's brotherhood. But if you - if you hold a gun on him and make him embrace me and pretend to be friendly or brotherly toward me, then that's not brotherhood, that's hypocrisy.- Malcolm X


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Beyond Saving wrote:jcgadfly

Beyond Saving wrote:

jcgadfly wrote:

I think she means their exemption from anti-trust laws.

From http://www.examiner.net/news/law/x1914248650/Health-insurance-companies-exempt-from-anti-trust-laws

"The two key provisions of the Health Insurance Industry Antitrust Enforcement Act will repeal the federal antitrust exemption for health insurance and medical malpractice insurance companies for flagrant antitrust violations, including price-fixing, bid rigging, and market allocations, and subject health insurers and medical malpractice insurers to the same good-competition laws that apply to virtually every other company doing business in the United States."

Well I know they are exempt from anti-trust laws and I made a point of that somewhere in one of these threads. I believe that is one of the main problems with the whole health insurance industry. That doesn't have any bearing on whether or not you can sue a health insurance company for denying benefits. I'll have to talk to one of my lawyer friends because as I said, I really am not familiar with that area of law.  I searched a couple websites and some of them say that you can sue your health insurance company but none that I really trust.

 

@Gauche    Does it matter who files the case? I guess technically it is the doctor that is the injured party if they perform the service and have not been reimbursed so it would be the doctor that would press the case against the insurance company. If the patient pays the doctor bill and then turns around and sues the insurance company would it make a difference legally? I suppose in most cases the doctor is willing to accept a delayed payment since they tend to be payed late anyway so I imagine in most cases the doctor would be the injured party.    

 

If it's more than one insurer, wouldn't that fall under collusin?

"I do this real moron thing, and it's called thinking. And apparently I'm not a very good American because I like to form my own opinions."
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Beyond Saving wrote: Does it

Beyond Saving wrote:
Does it matter who files the case? I guess technically it is the doctor that is the injured party if they perform the service and have not been reimbursed so it would be the doctor that would press the case against the insurance company. If the patient pays the doctor bill and then turns around and sues the insurance company would it make a difference legally? I suppose in most cases the doctor is willing to accept a delayed payment since they tend to be payed late anyway so I imagine in most cases the doctor would be the injured party.    

 

What happened in a case where Blue Cross conspired to reject valid claims by saying that physicians filed them incorrectly I think doesn't really tell you what ones legal recourse may be in the many other situations where coverage is denied. In most cases the hospital would probably be suing the patient not the insurance provider.

There are twists of time and space, of vision and reality, which only a dreamer can divine
H.P. Lovecraft