# Health insurance



## Chef Niloc (Sep 24, 2011)

Health insurance

This came up in another thread and it got me thinking....well I guess more wondering.

First I don't want this thread to become a political discussion! Only post practical, posable, ideas that would not call for government change.

So that sad:
Health insurance has long been a problem for many restaurant workers, and from what it seems is knife makers are in the same boat. 
I have worked at small places that provided coverage. It seems a small business owner can set up a plane for his employes, only need a hand full of people from the way it looked to me ( last place had I think 7 or 8 on the plane)? 

I have also looked into more then once buying my own plane, never did because the cheapest I have ever found was between 700-1000 a month! So in my book buying a personal plane just not seem reasonable, cost are not affordable and benefits don't out way the monthly cost of those plans. 

So here is the topic of my thread:
Is there a way to set up a affordable plane? I know some unions and guilds set them up, at lest I think they do??
Could one create a online group say " united food survive forum " and then allow it's bored members to buy into a insurance plane? It would seem to me that this type of thing would be of interest/ help to many in the business and that the more people that joined up the better the rates would get?


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## Dave Martell (Sep 24, 2011)

On the surface I like this idea. I'm without and desperately need coverage for the family.


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## Eamon Burke (Sep 24, 2011)

There are groups that do that, but the costs of setting it up, upkeep, inevitable legal fees, fighting companies to get the promised benefits make it burdensome to do it cheaply.

There was an intentional Christian community in Philadelphia that had a program where everyone paid into a pool according to their ability, and withdrew from the pool for emergencies according to their needs. This, of course, is tough to run without a strong, mutually shared moral grounding and trust. But the advantage is that it meant people with little means and the good sense to stay as healthy as possible never wanted for medical care when the need arose.


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## rahimlee54 (Sep 24, 2011)

If you own your own business I'd say just get a catastrophe plan that has a high deductible and set up a Health savings account to do the rest.

There are groups that do what you mentioned but as he said it really isn't all that much cheaper in the long run.


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## TamanegiKin (Sep 24, 2011)

I'm currently seeking different health care options.
My current employer offers no insurance. My plan through a previous job was about $140 but after fifteen months it is now $391. Somewhat of a jump, one that I can't afford as a cook. Not to mention I'm due for surgery in less than a week. Health insurance for me at the moment is my biggest expense aside from rent, sucks but It's a necessity. I plan on doing my homework on independent coverage but am skeptical that I'll find anything good. If I find anything I'll be sure to post.


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## Eamon Burke (Sep 24, 2011)

rahimlee54 said:


> If you own your own business I'd say just get a catastrophe plan that has a high deductible and set up a Health savings account to do the rest.


 
Oh yeah I forgot to add that. A HSA is amazing! Triple-tax free money is hard to pass up.


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## jm2hill (Sep 24, 2011)

working in the insurance field I wish I could help you guys out. As I'm not in anyway responsible for selling plans or creating plans I can only say a few things relating to insurance.

While expensive it really is a necessity (even to us with free health care in Canada). There will be plenty of group plans out there for you to buy into (including starting your own, or one run by the company) however don't expect fee's to always be cheap and claims to always be easy, that is of course the nature of things. 

You don't also have to look only at straight health care plans (i.e monthly fee for claimable objects) there are variety of plans that imho there are better plans out there including: mutual fund plans with withdrawal benefits (very big risk due to market volatility) or variable claim plans (similar to a monthly fee plan but you can vary your coverage on a month to month basis to a certain period).

The only issue that may arrise is at times a company will reject a group plan buy because you don't fall under the definition of a group (i.e union, work force, family)
this while seems unfair adds risk to the company. There are ways around this however.

I have quite a bit of experience as I do work for a Canadian owned US company and will try answer any questions as best I can. With that said I have not priced a product in a long time and am not always up to date with product standards.


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## ajhuff (Sep 24, 2011)

Let me know when you find an answer.I have no insurance and not for lack of trying. Being diabetic I am automatically disqualified from every plan.

-AJ


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## WildBoar (Sep 24, 2011)

You might want to contact an insurance broker, as they usually have a lot of different providers and plans at their disposal.

We provide BCBS PPO coverage for our employees, and the monthly premium is about $550/ worker (which we cover). But if an employee needs to cover a spouse or family as well they need to pay that portion, which is $400-$700/ month.

Each year one of my business partners looks for ways to cut our insurance costs. So we sift through opetions of higher deductables, lower total payouts, switching to HMOs, etc. But in the end we continue to suck up the 15%+ yearly premium increases and maintain the same level of coverage.

I talked to a carpenter the other day who has a similar BCBS PPO policy (not part of a group, though), but with a much higher deductable ($2k, vs the $200 for our policy). His monthly cost is about $200 -- which is far less then we pay. So we are actually paying $4,200 more per employee each year for an $1,800 lower deductable. Boy, that math does not work well -- we would be better off going w/ a policy like his and giving our employees $1,800 raises!

The carpenter gambles that he won't need too many emergency room visits. One saw accident about 2 years ago ran $3k+, and that was only for a visit to hospital and some stitches. So his total outlay that year was $2,400 in premiums + $2,000 deductable, which was still less then we pay per employee just for the premiums.

Deciding to stick with the expensive PPO policy is currently proving to be a good thing though (sadly), as the third business partner was diagnosed with one of the worst cancers early this year and the insurance allows him to go to a premier cancer-treatment hospital and has been covering the bulk of the chemo and radiation costs.

Health insurance is not cheap, but the alternative could be a lot worse. The cancer-related bills have totalled over 10 years worth of premium costs so far, and there will be quite a bit more before all is said and done.


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## WildBoar (Sep 24, 2011)

ajhuff said:


> Let me know when you find an answer.I have no insurance and not for lack of trying. Being diabetic I am automatically disqualified from every plan.
> 
> -AJ


That is one of the toughest things right there. It's the kind of situation that often forces someone to accept employment somewhere where they really do not want to work, as it is the only way to get coverage.


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## Eamon Burke (Sep 24, 2011)

As a lifelong uninsured person, I have to say that this sounds insane. How could a person financially justify paying out 6-10k a year? Do you really rack up MORE than that at medical institutions?!

Seems to me more like a gamble that you are betting $80,000 that you will get a $100,000 injury in the next decade.

The 3 months I had insurance at a job, it was dental, and only covered a few grand a year, max and I still had to pay out a large portion. So long as anyone is making a profit selling you insurance, I can't see how it would ever be financially wise to get insurance for a person who isn't hiding knowledge of a serious problem.


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## WildBoar (Sep 24, 2011)

johndoughy said:


> As a lifelong uninsured person, I have to say that this sounds insane. How could a person financially justify paying out 6-10k a year? Do you really rack up MORE than that at medical institutions?!
> 
> Seems to me more like a gamble that you are betting $80,000 that you will get a $100,000 injury in the next decade.
> 
> The 3 months I had insurance at a job, it was dental, and only covered a few grand a year, max and I still had to pay out a large portion. So long as anyone is making a profit selling you insurance, I can't see how it would ever be financially wise to get insurance for a person who isn't hiding knowledge of a serious problem.


Well you are right, insurance is a gamble. All it takes is one ambulance ride and an overnight in the hospital to run up a bill exceeding $5k. The fact is a minority of people will run up bills exceeding what would have saved if premiums did not have to be paid. But the ones who do exceed, will likely exceed by quite a bit.

I find the insurance debate (Gov't should cover vs companies vs individuals) to be funny, as in all scenarios all working individuals pay into an insurance pool. And many of us will never accumulate doctor bills that match or exceed the amount of premiums paid in our lifetime. But an unlucky minority will, and frankly there is no way to assure you will not be one of those. My business partner does not play sports or engage in any hobbies that could result in injuries, so all he had to worry about was getting sick. I suspect at 47/ 48 years of age, he never would have anticipated getting cancer. But I'm guessing he probably thinks the insurance premiums we've been paying have been well worth it, as he and his family would be in even more of a world of hurt then they are.

Insurance companies are highly skilled at risk assessment and analysis. And while the companies are 'for profit', they do not run at huge profit magins. If they did, everyone would hold as many shares of health insurance company stock that they could lay their hands on. -- and I do not believe that is the case.

At the end of the day, it's an individual's decision to make. If you have a job where health insurance is not provided, you need to decide if you want to 'self insure' or suck it up and pay a significant portion of your salary to purchase health insurance. And there is always the option of seeking employment at a company that provides insurance. Health insurance is a worker benefit, and it obviously has a dollar value associated with it. A $40k/ year job that provides no insurance is not the equal of a $40k job that does.


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## apicius9 (Sep 24, 2011)

I have been thinking for 10 minutes now about what I can say that is not in some way political, but I can't. So, I just hope that you all find the best ways for your individual situations.

Stefan


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## SpikeC (Sep 24, 2011)

The nation's five largest for-profit insurers closed 2009 with a combined profit of $12.2 billion, according to a report by the advocacy group Health Care for American Now (HCAN).


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## Cipcich (Sep 24, 2011)

SpikeC said:


> The nation's five largest for-profit insurers closed 2009 with a combined profit of $12.2 billion, according to a report by the advocacy group Health Care for American Now (HCAN).


 
Of course it's political. There is no other way out of this dilemma. Perhaps there should be yet another thread, wherein we debate the dubious merits of a capitalist approach to health care?


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## Cipcich (Sep 24, 2011)

I'd like to share an amusing (hopefully) anecdote about an experience that colors my view of the issue.
Thirty-five years ago, I was lying on a gurney in a San Diego hospital at 3 a.m., soaked in blood, with my shin bone blown in half by a .38 hollowpoint. 
Propping my head up, I noticed a small group of doctors and nurses huddled in a corner, looking my way and whispering among themselves. Finally, they sent one of the nurses over, and after she covered me for decency (they had removed my pants), she asked if by any chance I had health insurance.
Much to their amazement, after asking for my pants back, I pulled out a high-option Blue Cross card. It was like magic. Everything changed. I was a star, not some bum bound for a quick ride to the county hospital.
The question is, what if I'd not had that little piece of plastic?


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## Eamon Burke (Sep 24, 2011)

Imagine insurance as being a casino being run by someone who doesn't make any money--every table is a pool of money being gambled fairly between players. That would make sense--not everyone is going to win, but their money is going to help someone in need. Now imagine the casino owner makes billions of dollars after covering their operational costs. That's a lot of help a lot of people aren't getting, and a lot of paying out that doesn't equate to coverage.

It's the profiteering that makes it impossible for me, expensive for most, and turns medical facilities into elitest drug factories and jobs into indentured servitude.


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## Kentucky Jeff (Sep 24, 2011)

There are a lot of problems with health care insurance in this country. Most of the problems are created by politicians who have distorted the insurance marketplace with too many rules and regulations that drive up cost and create market conditions that make it hard for small companies to innovate and compete. It should be no news to anyone that politicians make decisions based on political calculations and not based on medical or economic considerations. Which is why I don't want them MORE involved in the whole mess. I have no interest in competing with other political classes of people in this nation for my healthcare!

One of the biggest problems we have is that people cannot discern the difference between insurance coverage and simply paying for routine medical care.... 

You can still buy catestrophic (major medical) healthcare plans in most states that don't cover routine doctor visits etc. These are far less expensive than the Cadillac health care plans that cover every hang nail and stuffy nose. You have to think of health care insurance like car insurance. Most of the expensive health care plans out there now would be like auto coverage that covers things like oil changes, fuses, and visits to the car wash! If you could afford such auto coverage and price it against say a simple liability policy you'd buy the cheap liability policy every time!

But because this is health care, somehow we seem to think that some insurance company should pay for all our ongoing medical expenses. Problem is, EVERYONE who has a cadillac healthcare policy thinks this way...after all...its not money out of their pocket. 

I've had major medical coverage only for me and my family for a couple of years now and paid for simple doctor visits out of my pocket. Last year I paid out about $4k out of pocket for treatment not covered by the insurance for the three of us which was much higher than normal. I will tell you that when I walk in a Doctors office and they ask how I'm going to pay we have a discussion about the pricing and I usually negotiate a MUCH reduced price over what they would normally bill the insurance company! I had a CT scan this summer that they normally bill the insurance company $1200 for and I paid less than $500 cash for the procedure!

Part of the problem is we as healthcare consumers have little relationship to the pricing of the healthcare we receive--again--because someone else is paying for it. So who cares what it costs!?!
How can you be a responsible consumer when you have no accoutnability for the cost of what you are buying? You don't do business in any other area of your life like that...

In any case, if you need healthcare coverage for your family, look into a major medical policy. They are MUCH cheaper than the big dollar policies. Like liability coverage on a car the major medical plan covers you if you get hospitalized and need major surgery or go to the emergency room. Its pure insurance vs. the expensive cadillac plans which are really nothing more than pre-payment for routine services....


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## apicius9 (Sep 24, 2011)

Working in public health, I have learned a bit about the health care system in the US in the past few years, and it may be the biggest mess I have ever seen. Being German, where health insurance is mandatory for the vast majority and covered by the state for those who are unemployed or on wellfare, the concept of not having almost every health risk covered -including the common cold - still seems absurd to me. I always considered it a sign of a mature society that cares about the well-being of their citizens that you would get help for health issues when you need it. 

The original thought when this German system was created in the 1880s was that there needs to be solidarity among the people in one country, the rich pay more because they can and the poor as much as they can and get help when they need it. Of course, there is abuse - for the same reasons that Jeff has pointed out - and with the changes in society the system cannot be maintained as it was 30 years ago. This was also based on the idea that even the poor could make wages theyncould live on. BTW, health care costs about 15% of the income, half of that is paid by the employer, and ther is a cap of about 1000Euros total (my guess, it was below that when I left 5 years ago). 

Some of the reasons for increasing costs in Germany and Europe are similar to the US, like an increasing use of technology. But the main reason why the US has the highest cost for health care, by far, is that someone had the stupid idea that health care could be a for profit business. Now greed has taken over, everybody is taking out their share, and hardly anybody gives a damn about solidarity anymore. There are a lot of people in Germany who will never get their money's worth of services over their life time, but that is widely accepted as a principle in the society. Ver here, people would shoot themselves in the foot, just to make use of the money they paid into insurance... I also think it would get worse without regulating, but the regulations would need to be different. I am certain that some of the cuts that were done in the social and health care system in the past few years killed more Americans than all terrorist activities in the history of this country. But the ones affected often don't vote, have the wrong skin color, or speak with an accent. There you have it. I try very hard to keep my mouth shut about religion and gun control, but can't help myself when it comes to health issues - that's the area I work in, after all.

Of course, this rant doesn't help anybody one bit who does not have health coverage...


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## Eamon Burke (Sep 25, 2011)

apicius9 said:


> Of course, this rant doesn't help anybody one bit who does not have health coverage...


 
It does reassure me that there are people who see it the way I do that are inside the machine, as it were. The last thing I like to hear is that I somehow just need to get on board and accept that I have to find some a-hole to work for and grovel at his feet to keep my job, or else I'm neglecting my family. You'd be surprised how often I hear that.


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## sachem allison (Sep 25, 2011)

i had two heart attacks walked into the emergency room and was told that I needed to have triple pass right now or I wasn't going to make it out the door. I said, "doc, I have no insurance, no job ." Doc says," That's too bad, your going to die if we don't do this surgery, Too bad your not an illegal alien." I say " why is that?" Doc says, " because in The State of New York we treat them for free." 
I had the surgery because I had no choice, as they are wheeling me out of the operating room the administrator comes up to me and says" Mr Allison, you can't leave the hospital until you pay the bill!" $397,000.00. I pay them a dollar a week, what are they gonna do take the heart back. She told me that if I knew I was going to have a heart attack I shouldn't have come there since it was a for profit hospital and I didn't have insurance and that I was one of the reasons insurance rates are so high.
Now I can't get healthcare because of preexisting condition, unless I pay $1200 a month for three years continuously and nothing that has anything to do with the condition would be covered including the $1800.00 a month meds. I need a job with insurance and then the preexisting is automatically covered. I was 33 when this happened at least I made it to 37 or 38 I don't remember , had a stroke as a complication to the surgery a couple of months later, couldn't sue them as apparently I signed a waver sometime after I was sedated. SOB's


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## apicius9 (Sep 25, 2011)

sachem allison said:


> She told me that if I knew I was going to have a heart attack I shouldn't have come there since it was a for profit hospital and I didn't have insurance and that I was one of the reasons insurance rates are so high.


 
See, that's one of the things I am talking about. It would have been better you died somewhere else then burden the poor hospital administrator with more problems. I am not big on corporal punishment, but somebody like this should be slapped in the face every morning for the rest of her life... I have heard similar things from physicians who, IMHO, don't have the character to work as a health professional and should give back their license. Incidentally, my med school dean is a great example for that breed of creatures, but I am bit biased there...

Stefan


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## Chef Niloc (Sep 25, 2011)

sachem allison said:


> i had two heart attacks walked into the emergency room and was told that I needed to have triple pass right now or I wasn't going to make it out the door. I said, "doc, I have no insurance, no job ." Doc says," That's too bad, your going to die if we don't do this surgery, Too bad your not an illegal alien." I say " why is that?" Doc says, " because in The State of New York we treat them for free."
> I had the surgery because I had no choice, as they are wheeling me out of the operating room the administrator comes up to me and says" Mr Allison, you can't leave the hospital until you pay the bill!" $397,000.00. I pay them a dollar a week, what are they gonna do take the heart back. She told me that if I knew I was going to have a heart attack I shouldn't have come there since it was a for profit hospital and I didn't have insurance and that I was one of the reasons insurance rates are so high.
> Now I can't get healthcare because of preexisting condition, unless I pay $1200 a month for three years continuously and nothing that has anything to do with the condition would be covered including the $1800.00 a month meds. I need a job with insurance and then the preexisting is automatically covered. I was 33 when this happened at least I made it to 37 or 38 I don't remember , had a stroke as a complication to the surgery a couple of months later, couldn't sue them as apparently I signed a waver sometime after I was sedated. SOB's


 
It's NY you can always Sue! You just got to go out and get you one of those shyster lawyers.

Back to the topic, boy I guess I started a good one this time

When you work for even a small company you can get health coverage for a some what resoluble amount of money. So why can't a individual? The last place I worked it cost 380 a month and there were less then 12 families on this plane. The insurance companies can't by off setting costs with so few people, got to come out of a bigger pot. So why can't everyone jump into it? Sounds to me like it would be in a insurance companies best interest to sell as many policy's as they can??


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## so_sleepy (Sep 25, 2011)

Chef Niloc said:


> It's NY you can always Sue! You just got to go out and get you one of those shyster lawyers.
> 
> Back to the topic, boy I guess I started a good one this time
> 
> When you work for even a small company you can get health coverage for a some what resoluble amount of money. So why can't a individual? The last place I worked it cost 380 a month and there were less then 12 families on this plane. The insurance companies can't by off setting costs with so few people, got to come out of a bigger pot. So why can't everyone jump into it? Sounds to me like it would be in a insurance companies best interest to sell as many policy's as they can??


 
Insurance companies want to maximize profits, so it isn't the number of policies, it is the aggregate risk. A small pool is risky, one person gets a catastrophic illness and it kills the profit. Good companies pay a bigger chunk of the cost themselves, In my case, I'm told that my employer pays more than half of the actual premium. 

Reasonable cost is in the eye of the beholder. At my company, we have a wide spread of incomes, anywhere from close to minimum wage to six figures. Everyone pays the same monthly premium for healthcare. The seven figure guys pay nothing.


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## Cipcich (Sep 25, 2011)

Refraining, for the moment, from polemics, Wild Boar made a constructive suggestion; find a good insurance broker.
While I've taken care to have health insurance for the last forty years, I was unprepared for what would happen when my daughter got too old to be covered by my policy. With a pre-existing condition, it was a scuffle.
We had the (not entirely accidental) good fortune to be referred to an insurance broker with a child in the same circumstance; he was a crusader, and knew his stuff.
It is unlikely you will develop the knowledge or expertise to do (a good job of) this yourself. I can't cook, but for the last twenty years I've been an arbitration advocate for a labor union, and I'm pretty good at this kind of thing (bureaucratic crap). Nevertheless, there are times when the best play is to have someone do it for you. 
I will no doubt return to polemics before dawn, having been encouraged by the postings of Apicus, Spike, and JD.


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## Cipcich (Sep 25, 2011)

OK Niloc. You may have started this thread,but you certainly didn't start the discussion. You know you can't realistically expect people to keep their comments withing prescribed limits, especially when they're intoxicated.
I've offered the best advice I could with regard to securing coverage for yourself or your employees.; i.e., find a good insurance broker. Kind of like, "Get a good lawyer."
Now, to the point. The problem is universal. If you, or I, find a way out, that does nothing to help everyone else. Do you care? I do.
Where is it written that we have to pay some exorbitant (any) percentage of every dollar we spend on health care to capitalist parasites? Why should we? Isn't it enough that they control almost everything else; pretty soon they'll even own the Postal Service.
In some former life I played poker for a living, and it was widely accepted that you couldn't beat a game with a four percent rake. So, after a time, I owned a game, and raked the **** out of it. No one won, because all the chips eventually went down the slot. I even made my dealers kick back 25% of their tips. Someone should have shot me.
What sense is there in Bill burke having to work in some wage job so he can provide health care for his family? You can expand that to encompass all the people who have to take jobs they despise for that reason, as another poster opined.
Yes, there would be inefficiencies and graft in a government administered program, but the civil service on its worst day could not match the greed and corruption of "private enterprise". Insurance companies are a loathsome scam; they're in business to collect premiums, and do everything possible to avoid paying claims. 
Capitalism is much like a religion, demanding unthinking devotion. And all the gold winds up in Rome.


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## apicius9 (Sep 25, 2011)

Makes me wonder whatever happened to my red flags after I stowed them away 20 years ago I said my piece and don't want to rile this up any more, I just hope that all of you may find a good solution for themselves. Who knows, my contract runs out in Juli and I may be in the same situation then.

Stefan


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## sudsy9977 (Sep 25, 2011)

When i was 24 i decided i probably should finally get insurance. Convinced my boss to start a group for 3 people. Was about900 a month. Less than 6 months later a two freak things that required surgery and over 40000 in bills. I was pretty glad i was payin 900. No insurance now however. It is a sad thing indeed Way too many people not covered.


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## mhlee (Sep 25, 2011)

Chef Niloc said:


> It's NY you can always Sue! You just got to go out and get you one of those shyster lawyers.


 
The term "shyster" is regarded by some Jewish people as an anti-Semitic term.


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## Eamon Burke (Sep 25, 2011)

He meant "oyster"...the shellfish business is pretty competitive these days.




.....


The Aztecs had a practice of paying their doctors to keep them healthy, they stopped getting paid when a patient got sick. If the royal doctor lost a patient in a ruling family, they killed him too. Not saying we should kill anyone, just saying the incentives went the right direction is all.


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## mr drinky (Sep 25, 2011)

I don't even want to read the previous posts on this as I am very passionate about health insurance, and I am now married to a doctor who has her own perspective. 

I didn't have health insurance until I was 15 years old. But before that I broke my arm at 13 and my brother got pneumonia that same year. It almost bankrupted my family. 

When I broke my back right before we had insurance, I chose to not tell my mother. I got NO treatment and let my back heal incorrectly. Now I have back problems galore, but I did finally tell my mother a few years ago (20+ years later). 

It was my choice, however, not to tell my parents. At the time we were poor, both my parents worked just to get by, and they never saw me for most the week. I was able to hide from them a broken back. 

I don't find this story the American feel-good one about our fabulous health care innovation. The lack of health care brought my family to the brink of bankruptcy, meant that I got improper (or no) care, and it was frankly one of the first times I lied to my parents -- just because I knew they couldn't afford the truth.

Fu<k the health care system.

k.


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## Chef Niloc (Sep 25, 2011)

mhlee said:


> The term "shyster" is regarded by some Jewish people as an anti-Semitic term.


 
Sorry did not know that, no anti-Semitism. I always just thought it was a term for a shady lawyer, like ambulance chaser.
http://dictionary.reference.com/browse/shyster


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## Andrew H (Sep 25, 2011)

One of the main arguments of people against a universal health care system is that "Government is wasteful! The private sector will do it better." Here is a great quote from a NYT article on the subject:
The Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than *2* percent of expenditures, compared with approximately *11* percent of spending by private plans under Medicare Advantage. This is a near perfect &#8220;apples to apples&#8221; comparison of administrative costs, because the public Medicare plan and Medicare Advantage plans are operating under similar rules and treating the same population.

Article by Nobel Prize winner Paul Krugman:
http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/


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## EdipisReks (Sep 25, 2011)

johndoughy said:


> As a lifelong uninsured person, I have to say that this sounds insane. How could a person financially justify paying out 6-10k a year? Do you really rack up MORE than that at medical institutions?!


 
i slipped and fell on ice this past December. i landed in just the wrong way and broke my ankle, smashed my tibia, and cracked my fibula. the whole thing was billed at $62k (i had a long surgery and spent three days in the hospital, which accounted for a lot of it). i paid $18 out of pocket, plus about $250 in medicine and physical therapy copays. i work at a state university (and the hospital was the hospital the building i work in is attached to, which certainly was to my advantage), and have really fantastic insurance that i pay about $80 a month for (it's about $1000 in benefits monthly). even with the inevitable deals that are made in these situations (and the billed amount certainly isn't what was actually paid out), i certainly would have been happy to have paid $6-10k to avoid even half of that $62k, if i had known it was going to happen and didn't have insurance. there is a reason that accidents are called accidents. so yes, you can certainly rack up more than that at medical institutions.


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## so_sleepy (Sep 25, 2011)

EdipisReks said:


> the whole thing was billed at $62k.


 
The uninsured are the only people that pay the billed amount. It is the basis for calculating the discount for insurance providers. Each Insurer negotiates the discount for its network which is why some doctors don't accept certain insurance. It isn't unusual for Medicare to pay 10-20% for a given procedure, so you see a lot of doctors refusing to treat them. Reimbursement rates vary a lot for private insurers. I helped set up a billing system for a doctor once. It was unusual when anyone reimbursed over 50%.


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## Eamon Burke (Sep 25, 2011)

so_sleepy said:


> The uninsured are the only people that pay the billed amount. It is the basis for calculating the discount for insurance providers. Each Insurer negotiates the discount for its network which is why some doctors don't accept certain insurance. It isn't unusual for Medicare to pay 10-20% for a given procedure, so you see a lot of doctors refusing to treat them. Reimbursement rates vary a lot for private insurers. I helped set up a billing system for a doctor once. It was unusual when anyone reimbursed over 50%.


 
Word. It's the insurance that made it 62k.

BTW, $80/mo insurance sounds great to me. The downside is that it isn't costing you $80/mo...because your boss could be paying YOU what he is paying the insurance company to cover you at $80/mo. And you are losing the money that is going to the pockets of every paid employee and business owner along the line. Your money and the money you aren't getting is paying for everything from advertisements for drugs that extend eyelashes during primetime to the food cost at a cafeteria in a nearby hospital. Essentially, you are carrying the burden of an entire culture and suffering under the weight of those who would game the system for profit.

Ask anyone who practices medicine charitably overseas--although it is a severe injury, it doesn't cost $62,000 to fix three broken bones.


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## EdipisReks (Sep 25, 2011)

johndoughy said:


> Ask anyone who practices medicine charitably overseas--although it is a severe injury, it doesn't cost $62,000 to fix three broken bones.


 
no, of course it doesn't. the whole thing was unbelievably ridiculous. and it certainly doesn't cost $10k a day for me to sit in a bed and not be given enough pain medication.


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## Kentucky Jeff (Sep 26, 2011)

Andrew H said:


> One of the main arguments of people against a universal health care system is that "Government is wasteful! The private sector will do it better." Here is a great quote from a NYT article on the subject:
> The Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than *2* percent of expenditures, compared with approximately *11* percent of spending by private plans under Medicare Advantage. This is a near perfect apples to apples comparison of administrative costs, because the public Medicare plan and Medicare Advantage plans are operating under similar rules and treating the same population.
> 
> Article by Nobel Prize winner Paul Krugman:
> http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/



You forgot to add "Former ENRON economic advisor" to Krugman's tag line. He's not well regarded in most respected economic circles btw....


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## WildBoar (Sep 26, 2011)

One thing that has not really entered into discussion is the cost of liability insurance for the docs/ hospitals. Litigation and liability insurance costs really have a big impact on health care costs in the US. (yeah, this is straying more from the OP, but heck, it's been that way for the last few days)


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## mr drinky (Sep 26, 2011)

Kentucky Jeff said:


> You forgot to add "Former ENRON economic advisor" to Krugman's tag line. He's not well regarded in most respected economic circles btw....



It is true that economists generally see him now as a journalist and not so much of an economist, but when he won the John Bates Clark Medal in 1991 he was very well respected. That was 20 years ago though.

k.


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## EdipisReks (Sep 26, 2011)

Kentucky Jeff said:


> He's not well regarded in most respected economic circles btw....


 
can't say i give a toss about "respected economic circles," these days.


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## Andrew H (Sep 26, 2011)

Kentucky Jeff said:


> You forgot to add "Former ENRON economic advisor" to Krugman's tag line. He's not well regarded in most respected economic circles btw....


 
True, he was a former Enron adviser. Also true that he worked there for I think 9-10 months, and was on an advisory board that did nothing. I don't even know how you gauge respect in economic circles (is there a poll you know about that I don't?), but I do know that he writes an Op-Ed for arguably the most prestigious newspaper in the country.


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## jheis (Sep 26, 2011)

SpikeC said:


> The nation's five largest for-profit insurers closed 2009 with a combined profit of $12.2 billion, according to a report by the advocacy group Health Care for American Now (HCAN).


 
And that is after even their lowest level "executive" officers are paid well in excess of $200k/yr.


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## Cipcich (Sep 30, 2011)

Oh good. This unpleasantness is behind us. Back to collecting knives.


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## gic (Jan 30, 2014)

In California, a "company" can have as little as two employees and qualify for group rates, the trick is both people have to be drawing a salary - so a family owned business can qualify by splitting the draw among two people - i'm not sure of the rule sin other states.

That having been said the subsidies in Obamacare are quite good for moderate income people and are worth looking into...


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## scotchef38 (Jan 30, 2014)

As a non US citizen,i find your health care system incomprehensible.Some of your stories i find shocking.If i was an elected representative of the people of one of the most wealthy countries in the world and failed to at least attempt to address this issue i would expect to live my remaining days in shame.
I am also not a Doctor but my understanding is that ,prior to obtaining ones licence to practice,the individual is required to swear to uphold the Hypocratic oath.Maybe this is a myth?-the lack of empathy and compassion to those in suffering and who do not possess a fat wallet from many (but i am sure not all)medical practitioners would suggest that the moral compass needs to be redressed.Perhaps Ethics is no longer taught in medical schools?


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## mr drinky (Jan 30, 2014)

scotchef38 said:


> As a non US citizen,i find your health care system incomprehensible.Some of your stories i find shocking.If i was an elected representative of the people of one of the most wealthy countries in the world and failed to at least attempt to address this issue i would expect to live my remaining days in shame.
> I am also not a Doctor but my understanding is that ,prior to obtaining ones licence to practice,the individual is required to swear to uphold the Hypocratic oath.Maybe this is a myth?-the lack of empathy and compassion to those in suffering and who do not possess a fat wallet from many (but i am sure not all)medical practitioners would suggest that the moral compass needs to be redressed.Perhaps Ethics is no longer taught in medical schools?



I can understand how foreigners find our system incomprehensible, but it is a bit more complicated than that and you may get some harsh comments in response. Don't get me wrong, I have experienced medical care in Europe and the US, I spent a good chunk of my life uninsured, I deplore the US system, and I am married to a doctor. But the Spanish flu, the advent of BlueCross in the 1920s selling insurance to Texas teachers, the great depression, and then the wage and price controls during WWII all worked together to create the rather contorted employer-based health care we have today. Add to that LBJ's addition of medicare and we have a big pile of something -- not sure what, just something. And that something just happens to take care of some really well and others not at all. 

The only thing that will ever change it IMO is the next health catastrophe similar to the Spanish flu. Once that happens, private health insurers will go bankrupt just like the banks of the most recent 'catastrophe' and the government will have to bail them out. That event will probably change things drastically. But wt-f do I know really 

k.


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## WildBoar (Jan 30, 2014)

scotchef38 said:


> As a non US citizen,i find your health care system incomprehensible.Some of your stories i find shocking.If i was an elected representative of the people of one of the most wealthy countries in the world and failed to at least attempt to address this issue i would expect to live my remaining days in shame.
> I am also not a Doctor but my understanding is that ,prior to obtaining ones licence to practice,the individual is required to swear to uphold the Hypocratic oath.Maybe this is a myth?-the lack of empathy and compassion to those in suffering and who do not possess a fat wallet from many (but i am sure not all)medical practitioners would suggest that the moral compass needs to be redressed.Perhaps Ethics is no longer taught in medical schools?


Since you are not familiar with it, and have not used it, your comments really are just conjecture. You are attacking it based on hearing a few stories. Just as with anything else, no one publicizes when everything goes A-Okay, which is the vast majority of the time.


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## Salty dog (Jan 30, 2014)

I talked to my insurance broker the other day. My rates have been going crazy.
Long story short, I was paying $1427 per month for my ex, daughter and myself. For a crappy plan with a high deductible. 
Under Obamacare my monthly cost, for a better plan will be $213 limited providers or $306 unlimited providers. And it includes Mental health (A must have) which my other plan didn't cover. In all fairness I took a pay cut last year which helped the premium.

That's for me only. The ex will be about the same and daughter dirt cheap.


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## WildBoar (Jan 30, 2014)

We pay close to $600/ mo now per employee for single person coverage under a decent preferred provider plan that has reasonable deductibles. A family plan with the same coverage is ~$1,500/ mo (we pay 100% of the single person coverage, anyone who needs to cover spouse/ family needs to pick up the difference). Probably better coverage that most younger workers need, but we had two people with serious health conditions over the last few years (one terminal pancreatic cancer) and the coverage resulted in them paying very little out-of-pocket. And also several people with sports-related injuries from flag football/ softball/ skiing, etc.


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## Lucretia (Jan 31, 2014)

Hubby is eligible to retire in just over a year. We have pre-existing conditions, and didn't see any way for him to retire due to health insurance costs/availability. Even though he can get coverage through his employer after retirement, we were looking at over $2800/month for not-so-good health insurance--and getting insurance through someone else was next to impossible due to the pre-existing stuff. Once the exchange came out, we started shopping--a good HSA eligible policy is less than $800 for both of us, and the most expensive/cover everything policy is around $1400 for both. That's without any subsidies.

I might have to stop buying new knives, but he might be able to retire when he's eligible.


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## ecchef (Jan 31, 2014)

How about this: an acquaintance went into the hospital for major surgery; stayed 7days and received really good care. 
Cost less than $400. Yeah, I got the zeros right. 
So I have a really hard time buying that we can't do a similar thing in the US if we tried.


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## Lucretia (Jan 31, 2014)

Then there are the ones who help drive up the cost. My sister's in the health care industry and does lab support for a hospital emergency room. Every month like clockwork, there's a woman who shows up in the middle of the night with her teenaged daughter, who has bad cramps. What she needs is a beer (best medicine ever for that sort of thing.) Instead the hospital has to run all sorts of expensive tests or risk a lawsuit.


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## Mingooch (Jan 31, 2014)

Sadly I have good insurance, but my plan that covers the family costs about 26k a year.


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## ecchef (Jan 31, 2014)

Mingooch said:


> Sadly I have good insurance, but my plan that covers the family costs about 26k a year.



Does it cover the proctologist visits? Cause I'm sure you butt's gotta hurt after receiving the premium bills.


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## bahamaroot (Feb 1, 2014)

My wife works for Wellpoint which owns BCBS and Anthem. We pay 5k a year to insure the two of us and have a 3k deductible and a 6k out of pocket per year. We hit our out of pocket every year because I have epilepsy and my medications run about 15k a year. We shell out 11k a year for health care premiums and health expenses but it's cheaper than paying for just my meds. You want to talk profits and milking the public look at big pharma.


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## mr drinky (Feb 1, 2014)

Ok, I am going to say it because I have drunk just enough. Just enough, that is. Ok, maybe too much, but it is fun to rant isn't it?

The key (or one of the keys) to understanding health insurance costs is all about taxes. One of the main reasons we have high cost is because so many people are not covered by insurance. When someone walks into an emergency room without coverage, or when the family goes bankrupt due to health costs that their insurance doesn't cover, these are all costs that have to be absorbed (somewhere). Despite what many would like to believe, the government doesn't absorb these costs (unless it is directly through Medicare/Medicaid), but the private doctors, hospitals, clinics, non-profit hospitals etc -- they absorb the costs. 

In turn, they raise the costs of everything to compensate for this, just as a convenience store incorporates theft into the cost of their retail items. Every hospital bed, doctor visit, and nursing hour you receive has built into it a cost that recuperates the loss of the uninsured and the unpaid bills. It is a private tax levied by independent organizations and private corporations that you will never see. 

One can complain about taxes and health mandates, but the the reality is that every time we enter a medical institution in the USA now and in the past decades, we have been and are being taxed by a corporation. There are no voters, elected representative debates, transparency, electoral accountability, OMB audits, or anything. It is a hidden tax levied by boards of directors, financial analysts, and adjustors to recuperate losses from the uninsured and unpaid bills. This is built into every hospital visit. And even if someone tries to control it (i.e., the government), MONEY IS FUNGIBLE and costs will be shifted to other areas eventually. 

Everybody pays for the uninsured whether you know it or not. You are being taxed for it right now whether you know it or not.

Now, just to be the devil's advocate and present another situation: If you let a city government tax like a health corporation with no debate, transparency, accountability, popular voting etc and the only people they answered to were a handful of majority municipal bond holders, what do you think would happen in that city? Do you think it would magically produce the best run city in the country with the most frugal budget and lowest cost increases?? No, it wouldn't.

The American health system is exactly what we want and expect it to be. We trust private corporations with stock holder oversight to tax us more than we trust the government with elected representative oversight to tax us. That is reality. We also believe we get the best care in the world, but until you have challenged the system with a life-threatening illness, you really can't say that for sure, and unless you have received primary care outside of the USA, you don't really have a comparison. Bankruptcies to INSURED families happen all the time; millions of American with insurance go bankrupt every year.

So that is my statement. I am married to a physician and for those who want to blame doctors, we have taken a 15% pay cut since Obamacare was enacted this last year. That's our tax as reimbursements have changed. Doctors have accepted the tax, have you??

k.


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## bahamaroot (Feb 1, 2014)

I love ya Drinky but it is much more than that. When you look at the profit margins of said corporations we are being more than just taxed by them to recover losses, we are being raped. There is a lot of greed priced in there too, and they do it because they can and call it what ever they want.


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## apicius9 (Feb 1, 2014)

I don't think you can seriously talk about health insurance without going into politics, and that's not wanted here. So I will just ask one question? If you build a health care system on the values of capitalism and expect the pharma industry, the medical supply and technology industry, the insurance industry, the whole range of medical personel and staff, the pharmacists, the politicians who need to be lobbied and corrupted, and the lobbyists to profit - who the $)&& did you think would have to pay for all this? 

Stefan


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## Burl Source (Feb 1, 2014)

Mingooch said:


> Sadly I have good insurance, but my plan that covers the family costs about 26k a year.


26k is more than most people earn annually around here.

US having the best health care in the world?
My boss just recently died after half a dozen trips to 2 different hospitals.
Seems the doctors around here are unable to diagnose pneumonia. I thought even a school nurse could do that.
Sorry, but I am still upset.


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## mr drinky (Feb 1, 2014)

bahamaroot said:


> I love ya Drinky but it is much more than that. When you look at the profit margins of said corporations we are being more than just taxed by them to recover losses, we are being raped. There is a lot of greed priced in there too, and they do it because they can and call it what ever they want.



In my defense, I was completely ripped when I wrote that at 3 am.

k.


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## bahamaroot (Feb 2, 2014)

mr drinky said:


> In my defense, I was completely ripped when I wrote that at 3 am.
> 
> k.


Understand, been there done that.


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