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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Fri Apr 15, 2011 10:09 pm 
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m0002a wrote:
Insurance is not a Republican theory. Insurance companies can predict the amount they will pay in claims. They hire underwriters (who are statisticians) who calculate these things based on prior claim history. Same principle applies to causality, life, and health insurance. Sometimes they take big loses on things like hurricanes, but that is why you often see them quit insuring property in high risk areas.
The health insurance industry is a lot more complex than it appears. The underwriting is substantially different. And in fact most of the risk is underwritten not by insurance companies but by employers. The risks are much more predictable than hurricanes. For the risk to be shared, it has to be shared by entire populations with mixed demographics.

It is highly non-intuitive. It takes most people 10 to 15 years to understand how it works. When you go delving into its details, you really can't. It has more moving parts than you are seeing. That makes it sort of hard to respond to some of your more detailed assumptions on cause and effect.

Many portions of what you are saying are logical and rational... but this is an industry that doesn't on the surface operate logically or rationally as you might expect.

But we can discuss and argue public policy without getting caught up in those details.

A CEO getting a $1.5 Billion dollar bonus paid with health care dollars... that doesn't require a lot of nuance to have an informed opinion about. An insurance company that only pays out 60% of its insurance premiums - doesn't require a sophisticated analysis to determine whether that is something the government should promote or discourage.

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 3:36 am 
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ces wrote:
The health insurance industry is a lot more complex than it appears. The underwriting is substantially different. And in fact most of the risk is underwritten not by insurance companies but by employers. The risks are much more predictable than hurricanes. For the risk to be shared, it has to be shared by entire populations with mixed demographics.

1. Yes, the health care industry is complex. I never suggested it wasn't. It even "appears" to be complex, so not sure it is more complex than it appears. Maybe you mean it is more complex than it appears to left-wingers, who seem to think everything is simple and have simple solutions to fix everything (usually government control).

2. Underwriting for health care insurance is "somewhat" different than casualty insurance, but same is true for all other kinds of kinds of insurance. But underwriting of all insurance is based on statistical data of prior claims, mixed with beta (volatility of the risk), to calculate rates needed to pay off claims.

3. Risk can be shared without having to be shared by the entire population. Obviously, the more people in the pool, the lower the volatility of risk (the more predictable the claim rate will be). Same principle applies to all other kinds of insurance, none of which requires the entire population to be in the same risk pool.

4. More and more, larger companies are assuming the risk themselves, and hire insurance companies to only administer the plans, which then charge the company for actual claims (plus the admin fee). I don't know the exact percentage of companies that do this, but there still are a lot insured where the insurance company assumes the risk.

5. One of he major problems with the US health care insurance business is that it is not really just providing insurance against major unexpected events (as is the case with other kinds of insurance), but is being used as a way to provide entitlements to people (free or reduced price health care). There may be nothing wrong with such entitlements, but it is not really insurance in the traditional sense, which is why more and more health care insurance companies are moving toward just providing an administrative role, and the employers (or governments) are assuming the risks.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 3:55 am 
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ces wrote:
UnitedHealth CEO William McGuire got a 9 figure 1.6 billion dollar bonus.
See: http://money.cnn.com/magazines/fortune/ ... 0/8380799/
How many people didn't get their cancer treatments in order to pay for that?

No, he did not get a bonus. He was awarded stock options long ago when the stock price was much lower, and there was a "40-fold increase in total return over fifteen years" (direct quote from the article you linked). The $1.6 billion was as of December 2005. The article noted that stock price decreased by June 2006, so that his options were only worth about $1 billion (which was on paper, and not a realized gain yet). By 2009, United Healthcare stock decreased again to half of its 2006 value, although it has gone up in recent years to about 80% of its 2006 levels.

I am not necessarily condoning such large grants of stock options, but they are not a "bonus" paid out by the company (as you claimed), so lets be accurate about that. Many other companies have had similar stock grant option policies over the years. Stock option grants primarily affect the stockholders, and not the customers (to whom claims are paid).


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 4:22 am 
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Our healthcare system is unsustainable -- costs are going up many times faster than inflation. Fewer and fewer people have adequate insurance. A personal example: I have both health and dental insurance. I had a surgery to get rid of a cancer in my gums, which removed 3 teeth and part of the bone around the roots. That was paid for. But now, I have a big gap in my mouth where I need implants. But no "insurance" company will pay for them. I will have to pay $6-10Kout of pocket if I want to have this corrected. My appearance, speech, eating, are all affected. Oh, and I paid $500 for the "flipper" that I wear now.

Why isn't this paid for?

Other healthcare systems are working very well, and will continue to do so -- and they are paying less than half as much.

What else is there to understand?

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 5:49 am 
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NeilBlanchard wrote:
What else is there to understand?
Nothing.

Luckily in your case our current excuse for a healthcare system didn't destroy your life. For many others the damage it does to them is even worse. What would have happened if your insurance policy had fine print that denied any coverage to you? It happens to many families every year.

I can't remember the source of this information... but I remember hearing some place that a person without health insurance in the US has something like a 20 year shorter life expectancy that someone who does. I did a quick search and couldn't find that number, but I found this:

http://www.bloomberg.com/apps/news?pid= ... Y&refer=us
http://www.acponline.org/advocacy/where ... eans04.pdf
That number is averaged into larger numbers... but seems consistent with the info in these links

'Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.'

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 5:53 am 
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m0002a wrote:
No, he did not get a bonus.
That money doesn't come out of no where. It represents the securetized value of a stream of income. It is basically a derivative. It is money that comes from insurance revenues. Without the payment of the bonus, more healthcare could have been purchased. In order to generate that bonus... healthcare had to have been denied.

Why am I wasting my time?

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"Aristotle calls man the rational animal. All my life I have been seeking evidence to confirm this" Bertrand Russell
"Only two things are infinite, the universe and human stupidity, and I'm not sure about the former" Albert Einstein


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 6:23 am 
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I give up. There is too much ignorance here.

And I am not talking about differences of opinion. There is room for wide ranging differences of opinion on this subject.

Everyone gets their own opinions. They don't get their own facts.

But coupling that opinion with flawed understandings of a complex system. And posing as knowledgeable on subject matter that you don't understand.... I just can't keep up with all the flawed and inaccurate assumptions. Many of the facts people are using are sort of close to right. But there are so many zingers thrown in. This just isn't the right medium to conduct this dialog.

And it doesn't need to be that complicated. People are dieing. Lives are being destroyed and vandalized by people with incentive compensation to do that. Society has a finite amount of resources. Is the current system acceptable if you think the burden of its deficiencies is being borne by others? Is the money better spent on private jets and million dollar birthday parties?

Talking about what do to with a car and where to drive it is one thing. Claiming knowledge about the finer points of combustion engineering in its internal combustion engine... when your knowledge comes from popular car magazines is another.

I actually worked in this field for a number of years. Reading some of these flawed assumptions. Watching people reach beyond their level of knowledge to support preexisting ideology that they are unwilling to change in any event. I can't take it. It is like listening to fingers nails drawn across a chalk board.

I'm dropping out of this discussion.

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 7:34 am 
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NeilBlanchard wrote:
Our healthcare system is unsustainable -- costs are going up many times faster than inflation. Fewer and fewer people have adequate insurance. A personal example: I have both health and dental insurance. I had a surgery to get rid of a cancer in my gums, which removed 3 teeth and part of the bone around the roots. That was paid for. But now, I have a big gap in my mouth where I need implants. But no "insurance" company will pay for them. I will have to pay $6-10Kout of pocket if I want to have this corrected. My appearance, speech, eating, are all affected. Oh, and I paid $500 for the "flipper" that I wear now.

Why isn't this paid for?

Other healthcare systems are working very well, and will continue to do so -- and they are paying less than half as much.

What else is there to understand?

I sympathize with your situation. I paid over $3K for my implant/crown out of my own pocket, and I need another one (teeth that have cracked and had to be extracted).

You can get the government to pay about 35% of the cost by paying for it out of your FSA account using pre-tax dollars.

As to why it is not covered by your dental or health insurance, you will have to ask your employer, who determines the coverage for your plans. Insurance companies do not determine what is covered, they will cover anything if your employer wants that in your plan. Obviously the more things that are covered, the more the insurance premiums will be (or maybe your employer is self-insured). The point is, people are being ridiculous in blaming all of this on insurance companies. I have my own beef with them at times but they are not to blame for your implants not being covered in your policy.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 7:45 am 
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ces wrote:
m0002a wrote:
No, he did not get a bonus.
That money doesn't come out of no where. It represents the securetized value of a stream of income. It is basically a derivative. It is money that comes from insurance revenues. Without the payment of the bonus, more healthcare could have been purchased. In order to generate that bonus... healthcare had to have been denied.

Why am I wasting my time?

I don't necessarily agree that he should have been awarded all those stock options (20 years ago), but all of your statements are false except the first one.

You are correct that the money does not come out of nowhere, it comes out of the pockets of other shareholders (not the policy holders or customers as you claim). The shareholders agreed (through their representatives on the board of directors) to grant him those stock options, since if he benefited by $800 million in the last 20 years (UHC stock price has decreased since 2005) because of the stock price going up that much in the last 20 years, then the shareholders would benefit even more (collectively) by their own stock price going up.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 9:49 am 
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Ohhh one last time :)

m0002a wrote:
The shareholders agreed (through their representatives on the board of directors)
If only it worked that way. The directors are selected by management. Every attempt to reform the system has been successfully fought off by the Repubs. The current philosophy is... you don't like the company, you don't like our directors... sell the stock.

Stocks go up and down. We all get to share the going down. But when a company is undervalued by the market... only hedge funds have the option of coming in, buying off the gatekeeper CEO with a comp plan, and taking it private. The hedge funds get the house odds in this casino. When you see a hedge fund manager making a few billion a year... it is in effect being funded from your 401K fund. He is skimming your money. All he has to do is spend a few million per year 1/3 to the Democrats and 2/3 to the Repubs to keep the merry go round going round.

m0002a wrote:
There may be nothing wrong with such entitlements, but it is not really insurance in the traditional sense, which is why more and more health care insurance companies are moving toward just providing an administrative role, and the employers (or governments) are assuming the risks.
That may seem like reasonable logic. That isn't how it actually is. The insurance companies were over charging employers for pretending to bear risk. The employers kicked them out. Most employers with at least 200 to 300 employees save money by "self administering" through a TPA. As an employee it is hard to tell if your employer is self administered. That is because even when they "self administer", they aren't doing it themselves... and they are still using someone else's provider network. This is why watching this discussion is so frustrating to me.

Bottom line, in most insurance the risk is shared by the same cohort of insureds with the Insurance company bearing the ultimate risk, moderated by careful underwriting.... and most importantly a high rate of return from the investment of premiums.

Bottom line for health insurance, the risk must be shared across different age groups. The young and healthy are easily identified. You don't need much underwriting to do that. They have to pay more... as they age they get subsidized by their children. If insurance companies are permitted to cherry pick, they have to in order to retain competitiveness. If cherry picking is permitted, the old and infirm are in effect denied access to health insurance.

Repubs Stand up for their Real Consituents

Single payor is only one of many solutions.

But any workable solution requires the dismantling of the free market insurance industry as it currently stands. Our decision makers must decide what is more important, the welfare of American citizens or the welfare of CEOs who have commandeered insurance companies that were built by someone else and that are owned by someone else. That is the rub for the Repubs.

The Repubs have made their position quite clear.

Snookered Again - Modern Day Johny Rebs

And that is where I see the analogy of
(a) the Johny Rebs dieing to protect a slaveholder system that was inimical to their welfare and that of their loved ones, and
(b) modern day Johny Rebs literally dieing to protect a healthcare system also inimical to their welfare and that of their loved ones.

The only difference is that the Civil War Johny Rebs at least understood they were risking their lives. Modern day Johny Rebs won't figure it out until they get a bit older and get sucker punched by a claims adjuster (this violence is done person to person... though you will never be permitted to speak to the person who is screwing you). Some portion of the modern day Johny Rebs figure it out... but only after it is too late and they have cast too many self destructive votes. And some never make the connection between their past voting habits and what befalls them.

What Goes Around Comes Around

Though even if they didn't get it, if they would have only followed the Golden Rule, they would not have done so much harm to themselves.

One day you will get it. I sort of hope that when you do you will have a dim memory of having heard it here first.

'Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.'

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"Aristotle calls man the rational animal. All my life I have been seeking evidence to confirm this" Bertrand Russell
"Only two things are infinite, the universe and human stupidity, and I'm not sure about the former" Albert Einstein


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 9:43 pm 
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ces wrote:
Ohhh one last time :)
If only that were true! But alas, more false statements.

ces wrote:
If only it worked that way. The directors are selected by management. Every attempt to reform the system has been successfully fought off by the Repubs. The current philosophy is... you don't like the company, you don't like our directors... sell the stock.
Can you show us any evidence of a bill introduced by Democrats in Congress that would change that, and the Republicans who were the ones who killed it? Up until this past January, for the previous two years, the Democrats had a strong majority in Congress and could pass any bill they liked. So show me the evidence. Most likely such legislation is only in your dreams, and would probably be unconstitutional anyway. There are many companies who granted a much larger number of stock options than UHC.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sat Apr 16, 2011 9:56 pm 
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ces wrote:
djkest wrote:
3.14 is a good approximation, who can't remember that?
3 is a good approximation in some instances (doing approximations in your head). But I don't think we need to legislate that.

It's amazing how laissez fair and pro-states rights Republicans are when it comes to the freedom of corporations and robber barons to rape and pillage and undermining the US middle class....

but how intrusive and anti-states rights they are when it come to imposing their values, will and prejudices on others.


no, 3 is a terrible approximation.

i tend to just leave it in pi and give answers as multiples of pi. that's kind of necessary when you get to advanced math.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sun Apr 17, 2011 4:05 pm 
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m0002a wrote:
NeilBlanchard wrote:
Our healthcare system is unsustainable -- costs are going up many times faster than inflation. Fewer and fewer people have adequate insurance. A personal example: I have both health and dental insurance. I had a surgery to get rid of a cancer in my gums, which removed 3 teeth and part of the bone around the roots. That was paid for. But now, I have a big gap in my mouth where I need implants. But no "insurance" company will pay for them. I will have to pay $6-10Kout of pocket if I want to have this corrected. My appearance, speech, eating, are all affected. Oh, and I paid $500 for the "flipper" that I wear now.

Why isn't this paid for?

Other healthcare systems are working very well, and will continue to do so -- and they are paying less than half as much.

What else is there to understand?

I sympathize with your situation. I paid over $3K for my implant/crown out of my own pocket, and I need another one (teeth that have cracked and had to be extracted).

You can get the government to pay about 35% of the cost by paying for it out of your FSA account using pre-tax dollars.

As to why it is not covered by your dental or health insurance, you will have to ask your employer, who determines the coverage for your plans. Insurance companies do not determine what is covered, they will cover anything if your employer wants that in your plan. Obviously the more things that are covered, the more the insurance premiums will be (or maybe your employer is self-insured). The point is, people are being ridiculous in blaming all of this on insurance companies. I have my own beef with them at times but they are not to blame for your implants not being covered in your policy.


I had cancer. Why is there even a question of replacing my teeth? Women get cosmetic surgery fully paid for after having breast cancer. My teeth are both functional and cosmetic.

I didn't neglect my teeth, and it was not an accident.

The medical plan won't pay because it is teeth that are getting replaced. The dental plan won't pay for it because it was cancer.

Part of the problem is, there should not be separate dental "insurance". Teeth are part of your body, and therefore part of your health. Having them separated creates this "in-between" problem. We have very good insurance through my wife's employer -- a very large university. I don't know how we could have "better" coverage -- what we have is virtually as good as all but the "gold" plans.

And can you imagine what it would be like for someone with only minimal health "insurance"? My dentist was the one who spotted this, by the way.

In any other country with a single payer medical system would have paid for all of it. Our system is broken, and getting worse a time goes on.

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Sun Apr 17, 2011 6:26 pm 
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NeilBlanchard wrote:
I had cancer. Why is there even a question of replacing my teeth? Women get cosmetic surgery fully paid for after having breast cancer. My teeth are both functional and cosmetic.

I didn't neglect my teeth, and it was not an accident.

The medical plan won't pay because it is teeth that are getting replaced. The dental plan won't pay for it because it was cancer.

Part of the problem is, there should not be separate dental "insurance". Teeth are part of your body, and therefore part of your health. Having them separated creates this "in-between" problem. We have very good insurance through my wife's employer -- a very large university. I don't know how we could have "better" coverage -- what we have is virtually as good as all but the "gold" plans.

And can you imagine what it would be like for someone with only minimal health "insurance"? My dentist was the one who spotted this, by the way.

In any other country with a single payer medical system would have paid for all of it. Our system is broken, and getting worse a time goes on.

I didn't neglect my teeth. They cracked because of my fondness of pitted kalamata olives in my salad, which unfortunately I have found out the hard way are not always pitted, and I know slice everyone of them in half before hand). I don't know why you think that someone who needs medical care because of an accident is less entitled to coverage than someone who needs medical care because of an illness.

No, the problem is not that you have separate medical and dental insurance. The "problem" is that University chose not to cover dental implants when they obtained medical/dental insurance for their employees and their families. Insurance companies will cover anything you ask them to (including your beard-if you have one, I don't know if you do), but of course they have to factor all the items covered into the premiums they charge (but even most companies that are self-insured don't pay for tooth implants, so it has nothing to do with the insurance company).

A single payer plan would likewise make no difference, unless the single payer decided to have implants covered.

As to why women who get breast cancer have breast reconstruction covered as part of your plan, that was just a decision that was made. Probably because life is not fair, and also because almost everyone looses at least one tooth during their lifetime (most more than one) and at $3.5K per implant/crown the University thinks that would raise insurance premiums to an unacceptable amount.

I do agree with you that in your case it "should" be covered, but that was a decision of the University, not the insurance company. What is crazy are things like Viagra being covered under most drug plans even if not really needed (all you need is an Rx, and those are easy to come by for Viagra, etc). So the US government is paying huge amounts of money to extend the sexual lives of those on Medicare, even if there is nothing wrong "patients" other than that they are getting old.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Mon Apr 18, 2011 4:10 pm 
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Why are dental and medical coverage separated? Both are directly related to health, and both are in one body. They are part of the whole, so the payment for the care of them should not be arbitrarily separated.

For that matter, why is anything in particular excluded from medical coverage? If you get some strange and rare disease -- why does some underwriter's list "decide" whether you get care, or not? Why isn't prevention covered in all cases?

With the less expensive plans having silly-high deductibles, a person avoids regular checkups which easily are the most important thing for prevention, and when so many are barely living paycheck to paycheck, a $5,000 deductible will bankrupt them. Having so many people not adequately covered is the single most expensive thing about our medical payment system.

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Mon Apr 18, 2011 5:56 pm 
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NeilBlanchard wrote:
Why are dental and medical coverage separated? Both are directly related to health, and both are in one body. They are part of the whole, so the payment for the care of them should not be arbitrarily separated.
To some degree dental health is related to general health, but there is also a very large cosmetic component to dental coverage that can be very expensive (braces, dentures, implants, whitening, etc). There are many cosmetic medical procedures that are not covered under medical insurance.

NeilBlanchard wrote:
For that matter, why is anything in particular excluded from medical coverage? If you get some strange and rare disease -- why does some underwriter's list "decide" whether you get care, or not? Why isn't prevention covered in all cases?

With the less expensive plans having silly-high deductibles, a person avoids regular checkups which easily are the most important thing for prevention, and when so many are barely living paycheck to paycheck, a $5,000 deductible will bankrupt them. Having so many people not adequately covered is the single most expensive thing about our medical payment system.
Your employer (or your spouses employer if you are covered under that plan) determines the coverage they want to offer their employees. Insurance companies will underwrite any risk you ask them to insure, but obviously the more the risk, the greater the premiums. This holds true for "Democratic" insurance companies in addition to "Republican" insurance companies.

Many self-insured companies with high deductibles are now requiring employees (and insured family members) to get annual physicals, participate in health self-assessments, and perform other specified preventive care, or else they will be charged higher payroll deductions for healthcare benefits (employees usually pay about 20% of the actual cost of the insurance for most private companies, although many public companies offer it for free or at much lower cost). Similar payroll deduction surcharges are often charged for smokers.

Bottom line is that insurance companies do not make these decisions. The employer that pays about 80% of the cost of healthcare for their employees is the one who makes the decisions about plans, coverage, etc. In many cases (as already mentioned by others) employers are now self-insured, so the insurance companies just do the administration and play "bad-cop", when in fact it is the employer who is making all the decisions about what is covered.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Mon Apr 18, 2011 7:26 pm 
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Neil

The Repubs claim they want to avoid healthcare rationing such you are describing (and yours is only a light case of it) Alan Grayson best captured how they intend to prevent healthcare rationing and death committees> I present you the Repub Healthcare being shepparded out of the house of representatives being under the guidance of Rep. Ryan: "Don't get sick, and if you do, die quickly"

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Tue Apr 19, 2011 2:53 am 
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Of course it is the "insurance" companies who make the decision to cover or not cover something. We already have "rationed" healthcare. If you are too poor, then no healthcare. If you are not able to pay for everything yourself, then you are at the mercy of the "insurance" companies.

Why wouldn't we want to cover everybody, for half the cost we are paying now?

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Tue Apr 19, 2011 6:38 am 
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NeilBlanchard wrote:
Why wouldn't we want to cover everybody, for half the cost we are paying now?
Let them eat cake.

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Tue Apr 19, 2011 11:57 am 
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NeilBlanchard wrote:
Of course it is the "insurance" companies who make the decision to cover or not cover something. We already have "rationed" healthcare. If you are too poor, then no healthcare. If you are not able to pay for everything yourself, then you are at the mercy of the "insurance" companies.

Why wouldn't we want to cover everybody, for half the cost we are paying now?

I guess it is considered OK to bash Republicans and characterize them as idiots, as is the case of the title of this thread. But when a "person of the left" (I won't limit that to Democrats) says something of questionable intelligence, we are not allowed to respond in kind.

That being said, here goes, one more time:

The employer is presented with a wide range of healthcare plans by the insurance company, or the insurance company can develop a custom plan of whatever the employer wants to provide their employees in terms of coverage. The employer determines which plan they will pay for (or subsidize) and offer to their employees. The insurance company is the administrator of the plan (regardless of whether the employer is self-insured or insured at a fixed cost by insurance company). As administrator, it is the job of the insurance to tell members (employees, etc) what is covered or not covered under the plan chosen by the employer. Therefore, the real decision of what is covered is made by the employer when they chose which plan to offer their employees.

Countries where healthcare is provided for free to everyone at half the cost of the US expenditures, are not "covered" by an insurance plan. The government is the provider of the healthcare.

In the US, where private companies offer "insurance," they can only provide coverage where the claims are less than the premiums they charge, since they cannot print money like governments can (to run a deficit).

I have already explained to you (in previous posts) why healthcare in the US is twice the cost as in other developed countries. If you can get all those physicians to take a 50% pay cut, and put the personal injury lawyers out of business so that physicians don't pay $100K per year in malpractice insurance, and regulate the prices charged for drugs (or allow imports from Canada), then maybe we could cut the cost of medical care in half. But there are millions of upper income healthcare workers (not necessarily wealthy) and powerful people (many of them Democrats) in the healthcare business (or personal injury lawyers) who are not going to sit by while you destroy their standard of living. Keep in mind, that I personally have no problem cutting the salaries in half, because I am not in the healthcare industry.

So there probably is no real choice of "half the cost". There is only the choice of double the coverage at twice the cost (or a little less than that if we are really lucky). And unfortunately money does not grow on trees.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Tue Apr 19, 2011 2:03 pm 
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NeilBlanchard wrote:
Why wouldn't we want to cover everybody, for half the cost we are paying now?
Let them eat more cake.

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 8:05 am 
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m0002a wrote:
Countries where healthcare is provided for free to everyone at half the cost of the US expenditures, are not "covered" by an insurance plan. The government is the provider of the healthcare.


While I agree with a lot of what you are saying here, the statement above is not quite true in the sense that taxpayers pay for the health care.
In the UK the standard rate of tax is around 22% at the moment going up to 40% on income over roughly £40,000 per annum. On top of that we pay around 10% "National Insurance" which is supposedly for our pension but is just tax by another name because it gets spent now and not put away for our future pensions. I'm not sure of the precise figures for tax and cannot be bothered to look it up but I think that in the US you pay a bit less. I also think that average earnings are higher in the US and you certainly have lower prices than we do in Europe.
The healthcare in the UK is limited because of the amount of money available without taxes being raised. Choices have to be made as to who gets treatment and what treatments are available on the National Health, especially as there are ever increasing numbers of new and expensive treatments available. Someone has to decide - I would spend the money on looking after younger people with families rather than prolonging the life of old people or terminally ill cancer patients, by a few months. Cosmetic treatment would also have a lower priority and wealthy people would be welcome to continue to pay for their own private treatment.
There is just not enough money around to give everyone the best care given the population demographic we have at the moment.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 9:26 am 
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judge56988 wrote:
While I agree with a lot of what you are saying here, the statement above is not quite true in the sense that taxpayers pay for the health care.

In the UK the standard rate of tax is around 22% at the moment going up to 40% on income over roughly £40,000 per annum. On top of that we pay around 10% "National Insurance" which is supposedly for our pension but is just tax by another name because it gets spent now and not put away for our future pensions. I'm not sure of the precise figures for tax and cannot be bothered to look it up but I think that in the US you pay a bit less. I also think that average earnings are higher in the US and you certainly have lower prices than we do in Europe.
Thanks for clarifying that. In the USA we have social security retirement that is funded by a social security tax on income. However, there is not a one-for-one correlation between the taxes collected and benefits paid. The government can (and usually does) spend more money on social security benefits than they take in with taxes, which is something that a private insurance or retirement benefit company cannot do (at least not for very long). That was the point I was trying to make, not to suggest that government healthcare is "free," since we all know that taxpayers have to fund it (in terms of taxes, or with inflation is taxes don't cover expenditures).

With respect to healthcare costs in the US, it is much higher than most other places, because it is not government regulated, but at the same time many people have private insurance and there is not much (if any) comparison shopping with regard to prices.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 10:46 am 
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judge56988 wrote:
In the UK the standard rate of tax is around 22% at the moment going up to 40% on income over roughly £40,000 per annum.
Most countries spend a smaller portion of their GDP on health and generating materially superior healthcare outcomes than that of the US. I am not familiar with the UK, but I find it difficult to believe you have worse health care statistics than the US even if you spend less. That seems to be the pattern in the civilized world.

Just leave it to the Republicans. Cheap and stupid votes available almost for free.

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 10:48 am 
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NeilBlanchard wrote:
Why wouldn't we want to cover everybody, for half the cost we are paying now?
Cake, Cake..... more Cake.

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 11:02 am 
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m0002a wrote:
With respect to healthcare costs in the US, it is much higher than most other places, because it is not government regulated, but at the same time many people have private insurance and there is not much (if any) comparison shopping with regard to prices.

I'll add in my 2 cents and say that many healthcare providers in the US are run on business models, and thus their primary interest is in increasing profits/revenue (because they have to answer to shareholders) rather than necessarily providing quality/efficient/inexpensive healthcare. There is some suggestion that this is why there is less preventative medicine practiced in the US compared to other industrialized countries (because the costs for preventative medicine are harder to justify), but there is also some interest in pursuing a preventative medicine model because it can save money that might otherwise be spent on urgent/emergency care.

Finally, I'll add that the idea of tying healthcare to employment is a horrible idea, because it screws over anyone who does not have a FTE position, and prevents employees with chronic conditions from having job mobility, because their chronic conditions will suddenly become "pre-existing" if they switch.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 11:12 am 
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ces wrote:
Most countries spend a smaller portion of their GDP on health and generating materially superior healthcare outcomes than that of the US.

I am not familiar with the UK, but I find it difficult to believe you have worse health care statistics than the US even if you spend less. That seems to be the pattern in the civilized world.
That is only true in aggregate (if it is true at all) taking into account the uninsured (which includes tens of millions of illegal aliens, a problem not encountered by the UK or other EU countries to anywhere near the extent as in the USA). On an individual basis, for a person with decent insurance, the medical care and outcomes are superior in the US. Of course the cost is much higher.

ces wrote:
Just leave it to the Republicans. Cheap and stupid votes available almost for free.
So when Obama and Democrats had complete control of the Congress and the Presidency, and could pass any legislation, and then have Obama sign it into law, why didn't they fix the healthcare problems to your satisfaction? You have no answer because your tirade against Republicans is nothing more than demagoguery and trolling, as opposed to rational discussion.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 11:14 am 
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ces wrote:
Cake, Cake..... more Cake.
Trolling, Trolling..... more Trolling.


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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 3:32 pm 
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m0002a wrote:
ces wrote:
Cake, Cake..... more Cake.
Trolling, Trolling..... more Trolling.

:mrgreen:

http://www.visualeconomics.com/healthca ... 010-03-01/
I'm not sure how accurate the numbers on this site are, but I think the general idea is here : the US spends more on healthcare than any other country, but the healthcare system is not the best. And one would think the insurance companies would want to charge as much as possible without loosing customers while at the same time encouraging their customers to not get sick (ie not smoke, not be overweight, exercise...) and therefore not spending money on those customers.
It's not working for customers. Why ? I'm not sure the best interest of those insurance company customers (health) is the same best interest that drives all the other industries (food/drink, tabacco...).

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 Post subject: Re: Republican Bill to Redefine Pi - Again
PostPosted: Wed Apr 20, 2011 4:18 pm 
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frenchie wrote:
And one would think the insurance companies would want to charge as much as possible without loosing customers while at the same time encouraging their customers to not get sick (ie not smoke, not be overweight, exercise...) and therefore not spending money on those customers.
It's not working for customers. Why ? I'm not sure the best interest of those insurance company customers (health) is the same best interest that drives all the other industries (food/drink, tabacco...).
That shared interest is so if everyone (high risk and low risk) belong to the same plan... such as a single national health care plan. Once you have plan turnover, the insurer's time horizon becomes limited to the 12 month health plan life cycle.

12 months from now, someone else, quoting a little less, might have the plan. Why should they increase their costs to benefit the next insurer. Even if the employer keeps them, the members covered in the plan turn over a lot more than you would think.

In the US, each plan has fairly high levels of turnover. It varies from industry to industry. But as was explained to me by an employer side health care economist, this turnover means that US health plans are not "invested" in the "lives" of their "insureds". In most cases, some other plan will be paying future healthcare expenses. Why on earth would they spend money to reduce the costs of their competitors?

It is substantially cheaper for them to wait until something is broke and fix it... or wait until the lifetime coverage is used up... or wait and see if they will be the insurer at the time the cost is incured. (related: Pre-existing conditions inhibit a free market in labor.... if any member in your family has a serious illness, you don't dare leave your job for a better one. Why would healthcare be artificially tied to employment? WHY????.....ONLY IN AMERICA)

If you or I were to run a US insurer, and we tried to do the right thing, either the insurance company would fail out from under us (out competitors would offer lower cost insurance by cutting unseen corners), or we would get acquired by someone more ruthless and unprincipled.

Free markets work... but only where decision makers have good information. That would not come remotely close to describing the US healthcare market. Actually, there is not a market in the traditional sense. You select from the plan(s) your employer offers. Once just for the heck of it, I asked for a copy of the plan. They were dumbfounded. No one knew where it was. All they had was an inaccurate brochure. The have a special department that hauls out the 80 page plan only when you want them to pay for a major condition or procedure. Guess what, somehow the fine print never favors the insured.

You couldn't even begin to have a real market without standardized insurance policies. Otherwise you need to be an actuary to even begin to compare products.

The underpinnings of a health care system, slavishly supported and defended Republicans, punish any insurance plan that would foolishly waste money (other than token amounts) on preventing disease. They assign case managers only to control spending on larger cases.

They prohibit human decency and reward misdirection, trickery and device (so many people think they are covered by their insurance... but discover the fraud perpetrated on them only after it is too late to correct).

The Republican Healthcare plan: "Don't get sick, and if you do, die quickly" Alan Grayson

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