Health Care and the Amish

[Arrow_Raider]

I think the USA is going to collapse entirely within the next decade.

[Davadvice]

hot topic,

i have to say that our NHS is not perfect but the times it's been there for my family and friends i have to say it is a fantastic system and i would happly pay for it.

they where there during the most important day of my life. when my wee girl was born.

I did use a private insurance group for medical cover once, i needed over £1k of work done on my teeth it saved me £500.

it's not perfect but it's better than nothing at all.

[homer13j]

I think the USA is going to collapse entirely within the next decade.

People have been saying that for 233 years.

[capsulecorpjx]

I think the USA is going to collapse entirely within the next decade.

That's a bold statement.
I don't think so. America still has some of the best land and natural resources in the world, and in the end, that's what's most important.
Everything else, paper money and wealth, can be rebuilt.

[nemaroller]

Let's stay neutral on this one - too much propoganda this, propoganda that.

People want a safety net in case the sh#t hits the fan and they run into astronomical health insurance bills. Of course, that's the very reason we have private insurance. But, depending on the contract and how it operates under State law, a renewal with pre-existing conditions may cause quite the increase in premiums. If you start out without insurance and have a condition, your premiums will of course be much higher.

So the question comes down to - why should an individual be forced to share the cost of maintaining the health of another individual? Some will argue humanity, invested value (years of education and experience), but the net effect is IT IS NOT my responsibility to care for you, nor you for me.

As an example, I have an uncle who is in his 60's, and all he has done for the better part of 20 years is drink himself silly, and most recently picked up a drug habit again. All of this has taken quite the toll on his liver. Now, if I told you that YOU HAVE to take care of my uncle's medical expenses through your taxes, and because of that, some 5 year old girl who could have a life-saving operation will be denied until next budget year because there simply isn't enough pool funds available, would you think that fair? Further, who makes the decision? And how could it ever be done accurately on an individual basis x 300 million people?

Now, people will claim there are directors making X amount of money on the backs of the poor, but the reality is government will easily waste that amount x 100 simply because it has always been ineffective at efficiency. There is no incentive to improve - ever.

In my mind, the increasing costs are due to litigation insurance. I've seen states where caps were removed, and health care costs skyrocketed, but when caps were re-instituted, costs came back in line.

• Medical malpractice liability -- the "tort tax" on doctors and hospitals -- has grown much faster than overall health care inflation and costs the average American family of four more than $3,300 a year, according to a Tillinghast-Towers Perrin study in 2003.
• Defensive medicine inflates health care costs by encouraging unnecessary procedures and referrals that doctors and hospitals prescribe in order to limit their exposure to future litigation.
• Vaccines are particularly susceptible to litigation, and although Congress has shielded some existing vaccines from liability, new vaccines and other drugs vital to public health threats remain vulnerable.

This is why you always hear the US gets less health per dollar than other countries, yet unsurprisingly, there is no part of the new health care bill that deals with capping/restricting litigation issues.

But you will never hear solutions to these problems from the Democratic party, because they are bought and paid for by lawyers.

[capsulecorpjx]

Let's stay neutral on this one - too much propoganda this, propoganda that.

People want a safety net in case the sh#t hits the fan and they run into astronomical health insurance bills. Of course, that's the very reason we have private insurance. But, depending on the contract and how it operates under State law, a renewal with pre-existing conditions may cause quite the increase in premiums. If you start out without insurance and have a condition, your premiums will of course be much higher.

So the question comes down to - why should an individual be forced to share the cost of maintaining the health of another individual? Some will argue humanity, invested value (years of education and experience), but the net effect is IT IS NOT my responsibility to care for you, nor you for me.

As an example, I have an uncle who is in his 60's, and all he has done for the better part of 20 years is drink himself silly, and most recently picked up a drug habit again. All of this has taken quite the toll on his liver. Now, if I told you that YOU HAVE to take care of my uncle's medical expenses through your taxes, and because of that, some 5 year old girl who could have a life-saving operation will be denied until next budget year because there simply isn't enough pool funds available, would you think that fair? Further, who makes the decision? And how could it ever be done accurately on an individual basis x 300 million people?

Now, people will claim there are directors making X amount of money on the backs of the poor, but the reality is government will easily waste that amount x 100 simply because it has always been ineffective at efficiency. There is no incentive to improve - ever.

In my mind, the increasing costs are due to litigation insurance. I've seen states where caps were removed, and health care costs skyrocketed, but when caps were re-instituted, costs came back in line.

• Medical malpractice liability -- the "tort tax" on doctors and hospitals -- has grown much faster than overall health care inflation and costs the average American family of four more than $3,300 a year, according to a Tillinghast-Towers Perrin study in 2003.
• Defensive medicine inflates health care costs by encouraging unnecessary procedures and referrals that doctors and hospitals prescribe in order to limit their exposure to future litigation.
• Vaccines are particularly susceptible to litigation, and although Congress has shielded some existing vaccines from liability, new vaccines and other drugs vital to public health threats remain vulnerable.

This is why you always hear the US gets less health per dollar than other countries, yet unsurprisingly, there is no part of the new health care bill that deals with capping/restricting litigation issues.

But you will never hear solutions to these problems from the Democratic party, because they are bought and paid for by lawyers.

I agree, Democrats are in the pockets of lawyers. However it is a little encouraging that Obama mentioned tort reform (I think) in his speech.

But the Republicans are in the pockets of the Health Insurance Lobby, and they are spreading lies and misinformation about the Public Option to kill it.

[FunkyDexter]

Let's stay neutral on this one

Epic Fail!

IT IS NOT my responsibility to care for you, nor you for me.

It is if you believe in society.

I have an uncle who is in his 60's...

There will always be people who take advantage of and abuse any system and any system will contain inequity and unfairness. That's as true of a private system as a state one. Would it be fair if your uncle recieved immediate treatment because he's just taken thousands in bonuses from a failing organisation while the five year old girl was left to die because her father got made redundant from that organisation 6 months ago and hasn't been able to find further work? It's easy to create a horror story to support either side of the argument but it's not particularly useful.

I think you're right about litigation being a major problem in your current system and I don't see anything inherent about a state system that would change that. I think that's part of a bigger problem the US faces, though. You guys live in a litigation culture and that damages your society. It's a peculiarly American disease that I have no idea of the cause of or the cure for. I wish I did, though, because the UK seems to be contracting an incrasingly nasty dose of it.

[schoolbusdriver]

... a renewal with pre-existing conditions may cause quite the increase in premiums. If you start out without insurance and have a condition, your premiums will of course be much higher.

Not an issue with an NHS.

... some 5 year old girl who could have a life-saving operation will be denied until next budget year because there simply isn't enough pool funds available ...

Not an issue with an NHS. Is that one of the lines that the nay-sayers have been feeding you? If they say that happens in the UK, they're lying (again ). The annual budgets are estimates, not absolutes. The medical staff also have some altruism, and will work pro bono if necessary - they didn't go into the profession with the idea of screwing every penny out of the system. Nor are they clock watchers - you can't have a change of shift in the middle of major surgery that's tripled from the original 2 hour estimate (as happened with my son).

On 2nd thoughts, the US should vote against an NHS. We don't want a "brain-drain". We're happy to keep our world beating medical staff right where they are - here in the UK

[nemaroller]

These were not comparisons against the British health system, these are actualities in life. There is only so many resources available.

But since you brought it up and had to flaunt it, here's a short list of the serious problems with social healthcare, NHS-style (I mean if you catch a cold, I'm sure the NHS is great, but if you need some real honest-to-goodness medical care, egh, er... well, just don't get cancer):

http://www.telegraph.co.uk/news/ukne...in-Europe.html

http://www.telegraph.co.uk/health/he...n-the-NHS.html

http://news.bbc.co.uk/2/hi/health/7510121.stm

http://www.capmag.com/article.asp?ID=4157

[capsulecorpjx]

Bill O'Reilly supports the Public Option.

http://www.youtube.com/watch?v=MqvWJ...e=channel_page

[Davadvice]

My mother inlaw was found to have cancer last december, she was rushed in for an emegency op and almost 1 year later she has fully recovered. i'm glad we didn't have to pay for the treatment as i would not be living in the streets with my 2 kids and mother in-law.

If the same was to happen with a person of il-means in the US how would they get treatment? would they be sent home to die in agony ?

headline grabing stories (3 of them using the same source) are the usual over here. all taken with a pinch of salt.

I could google heathcare in the US but....

i know of many people who have had serious illness and came through thanks to the NHS. i would prefer it our way than turning people without the cash away to die. different morals i suspect

[FunkyDexter]

The figures for the surveys in the Telegraph and the BBC articles are all taken from the 90's or the early millenium and the government and NHS have been specifically targetting cancer since because it was recognised as a failing. I haven't seen any up to date surveys but it's generally accepted that they'll be MUCH better now. The other article in teh Telegraph is about doctors raising a concern that they think the wrong aproach is being taken in a particular area - nothing wrong with that. I didn't bother reading the article in Capitalism Magazine because, while I don't know the magazine, I don't imagine it's particularly balanced with a name like that.

You're still missing the point though. The NHS provides a safety net. It does not replace private insurance and, if you want to get alternative treatment, you still have that option. The NHS means that anyone, no matter their circumstance, can get a good quality of basic care. Notably, Most people who have the means still don't bother going provate because we're quite happy with the service the NHS provides. The one area it really does fall down is in the procurment of some drugs (particaularly cancer drugs, incidentaly) which have become too expensive to provide through the system. for those drugs you would need to go private (although the NHS does offer less expensive alternatives)

[zaza]

There are always going to be pros and cons to whatever system is set up as a public body, health-related or otherwise.
Clearly in the case of healthcare, there are going to be people who use it despite having created many of their own problems (drug abuse, alcohol abuse etc), there is going to be government red tape, and supply and demand will not be determined simply by the price any more. Also, you will find (as we do) that A&E is perpetually overrun with people who are worried rather than actually sick, and instead of going to their GP as a first point of call (perhaps because they don't like their GP, don't trust him, or he has too long waiting times), they pitch up in hospital.

The alternative is that, by allowing a price element into it, you are discouraging people from making use of healthcare because they can't afford it, either as an upfront payment or if their premiums rise. That is the essence of a price-based system! Unfortunately, people themselves are in general not sufficiently medically-educated to determine whether or not seeking healthcare in their current medical situation represents good value for money, and sometimes are not able to make that choice.
Additionally, the nature of a private medical insurance scheme is that it is out to make money (of course!), and consequently has every incentive to deny you cover if there is the chance that it will not make the money back in premiums. That will ALWAYS happen in any insurance scheme, and I personally would rather have another option.

[nemaroller]

i'm glad we didn't have to pay for the treatment

Oh, but you did, you have, and you still are!


Seriously though, you have to realize the US is 50 States, and each State has different options. Many States have public programs and most are backed with federal dollars.

Medicaid is the first stop - but you must be poor and have little-to-no assets to qualify. You may not qualify, but it IS EXPECTED that if you have the means to BUY private health insurance, you better buy it! I mean, we're all growns up here right, we don't need the government to tell us how to run our lives, do we?

Failing eligibilty for Medicaid, a family could apply for the SCHIP program in their State - which doesn't necessarily limit to assets. In some States this program only provides health insurance to children under 18. People 18 and over are expected to buy their own insurance. But in States like mine, people of all ages get covered.

If all that fails, you have to expensive care done (cancer surgeries, etc), you declare Medical Bankruptcy or you see if the providers write it off. Sure, you have that on your credit report for 7 years, but you'll still be alive and next time perhaps you learn to buy insurance against risk.

Now, I understand the flip side, which is people in their older years generally become more sick and diseased, and at some point, everyone is sick.

And that's why we have Medicare for citizens 65 and older. Some providers accept it, some don't. Like the NHS, It is a basic level of care.

[Shaggy Hiker]

As an example, I have an uncle who is in his 60's, and all he has done for the better part of 20 years is drink himself silly, and most recently picked up a drug habit again.

That statement is redundant.

Now, people will claim there are directors making X amount of money on the backs of the poor, but the reality is government will easily waste that amount x 100 simply because it has always been ineffective at efficiency. There is no incentive to improve - ever.

So much for remaining neutral. That's a conservative position, and a combination of untrue and misunderstanding. We are the cause of the inefficiency. It isn't a lack of incentive to improve, it is caused by something else...which I'll ignore, because I don't want to talk about that now.

[Shaggy Hiker]

One more thing... One of the reasons health care is so expensive in the US is we have millions of people who regularly use our emergency rooms as their personal physicians knowing perfectly well they will never have to pay for the services rendered.

Yet when those of us who do have to pay complain about this we are the ones labeled as "selfish." I find this highly insulting.

Homer started down the right track, but didn't go far enough. Now, I'm going to fix that by going on a long rambling argument. Hopefully, this will be politically neutral, which is rare for me, but my point is mathematical, and I hope somebody will come up with a mathematical rebuttal, because I hate my own argument. Unfortunately, it is lengthy.

First off, consider the insurance model: In the case of car insurance, I have been paying for decades. In that time, I have paid in enough to pay for a new car, yet I have never made a claim. This doesn't bother me, though, because the point of insurance is that it will be there if my luck turns bad. As far as the insurance company is concerned, the actuarial tables tell them the probability of paying X amount to me, which tells them how much they need to charge me to recoup their cost. Perhaps they add a percentage for profit, or perhaps they realize a profit by investing my money (they do, I just don't know if that is ALL their profit). In any case, the lucky are paying for the unlucky with the expectation that they will benefit if they switch categories.

Second, consider the statistic that for the average person, 80% of the medical expenses they have for their entire life comes in the last two years of their lives. Sure, there are exceptions, but this appears to be true, and it makes considerable sense. We eventually get some disease (or just plain general decline) that kills us, but before we go, we spend a bundle.

Third, consider that at some point in the past (I forget how far back this is, perhaps 50 years, perhaps further), people would generally live only an average of five years past retirement. Therefore, employer health care was nearly the same as health care for life, as life generally didn't extend much beyond employment.

Fourth, many of the diseases that used to kill us quickly, either kill us much more slowly, or not at all...though at a great cost. Cancer used to be an automatic, and prompt, death sentence. Now, it may still kill you, but you will live longer (at great cost), and for many types of cancer, you will persist long enough to die of some other cause. The same is true for diabetes, AIDS, MS, Parkinsons, and many other things.

Fifth, this trend of extending life through medical advances (at great cost), is going to continue and get worse.

Therefore, the insurance model completely fails for health care. In all other kinds of insurance, the lucky pay for the unlucky. In the case of health care, we are ALL unlucky...eventually. Therefore, the actuarial tables should show that if a person is to be covered by medical insurance for life, the chance of death is 100%, and the chance of major medical costs is nearly as high. So what should the monthly charge be?

As an example, consider a friend of mine. This friend makes somewhere around the median income for Americans. His wife had a terrible pregnancy, where the baby was born months early, but even that was only because the mother was in the hospital in intensive care for a month or two. A few decades back, the baby would have died, and the mother would probably have died, as well. One hundred years ago, both would have died. Now, both are alive and reasonably well. However, to put it lightly, my friend and his wife have no realistic chance of EVER paying enough into the system to cover what they have already taken out...and that expensive end of life is yet to come for both of them.

The question that I don't have an answer to is whether or not I, or a person in my financial situation (roughly US median income with benefits), will, on average, pay in more than they take out? Even if I WILL probably pay in more than I receive, as medical technology advances, there will surely come a time when the median income person does NOT.

Isn't this an impossible spiral? As our ability to extend lives through costly medical intervention increases, won't it become increasingly hard for anybody to pay for medical coverage? It may be that the lowest 30% of incomes currently has no realistic chance of paying in as much as they will receive over the course of their lives, but as technology advances, that will increase to the lowest 40%, then 50%, then 60%, etc.

We already have socialized medicine, as Homer pointed out. True capitalism would say that if you can't pay, then you get no service, and this country doesn't allow that by law. If you can't pay...well, then the rest of us do. So we shouldn't be concerned about socialized medicine, we are already there, and probably are not willing, as a society, to tell people to just go off an die because they don't have enough money. Instead, both sides are talking about ways to squeeze more care from existing dollars. The difference is how they want to go about it. The differences appear to be a matter of speed, to me. The Dems want to move faster, the Reps slower, but neither one seems to be mentioning that neither alternative will ultimately work, with one exception:

Some of the policy makers (I think Obama used the line, but he didn't originate it) have said that if we don't do something about health care, then it will eat our economy. Frankly, it appears to me that it will eat our economy even if we DO do something, the current debate is just trying to find a means to put off that date.

I see no reason to think that this trend is survivable. At some point, we will have the technology to keep people going for a considerable time, but the cost will be prohibitive.

That's my argument, poke some holes in it.

[nemaroller]

Well Shaggy, that was a very good mathematical model. I would throw in some variance though as such that many higher-income earners pay more in monthly premiums as they shoulder the cost for lower income earners in a private pool.

I know executives at my company pay far more than some one who makes $100k/year. That's just how the pool is funded, as a company wants to be able to offer the best health care package, and they need to pay for those costs some where, and let's face it, the middle and lower wage earners can't shoulder that cost.

The second variance I would throw in would be accidental / sudden death. Obviously, if a person pays insurance premiums for 30 years and then hits a tree with his car, there are no expensive surgeries for the insurance company to pay. A sudden stroke that kills does not require hospitalization or surgery, it just happens too quickly.

Now, at some point, if the insurance company sees too much money flying out of the accounts, this is what they do:

1) NEGOTIATE LOWER PAYMENTS TO PROVIDERS
2) DELAY PAYMENTS TO PROVIDERS

Of course, as you point out, none of those two options will make up for the heavy burden the baby boomer generation is going to place on the cost of premiums in the private health insurance industry.

But at the end of it all, the private US capitalist healthcare system is able to pay for more research and development toward the goal of advancing health care technology worldwide.

"In 2006, the United States accounted for three quarters of the world’s biotechnology revenues and 82% of world R&D spending in biotechnology.[4][6]. The amount of financing by private industry has increased 102% from 1994 to 2003.[20] Most medical research is privately funded. As of 2003, the NIH was responsible for 28%—about $28 billion—of the total biomedical research funding spent annually in the U.S., with most of the rest coming from industry.[21] The National Institutes of Health play a larger role in funding basic research.[citation needed]

The top five U.S. hospitals carry out more clinical trials than all the hospitals in any other country.
"
There was also a thing in there about more than half of Nobel prize winners for medicine being American doctors , but since Al Gore won a Nobel prize, I hesitate to use that as a measure of success.

[nemaroller]

Well Shaggy, that was a very good mathematical model. I would throw in some variance though as such that many higher-income earners pay more in monthly premiums as they shoulder the cost for lower income earners in a private pool.

I know executives at my company pay far more than some one who makes $100k/year. That's just how the pool is funded, as a company wants to be able to offer the best health care package, and they need to pay for those costs some where, and let's face it, the middle and lower wage earners can't shoulder that cost.

The second variance I would throw in would be accidental / sudden death. Obviously, if a person pays insurance premiums for 30 years and then hits a tree with his car, there are no expensive surgeries for the insurance company to pay. A sudden stroke that kills does not require hospitalization or surgery, it just happens too quickly.

Now, at some point, if the insurance company sees too much money flying out of the accounts, this is what they do:

1) NEGOTIATE LOWER PAYMENTS TO PROVIDERS
2) DELAY PAYMENTS TO PROVIDERS

Of course, as you point out, none of those two options will make up for the heavy burden the baby boomer generation is going to place on the cost of premiums in the private health insurance industry.

But at the end of it all, the private US capitalist healthcare system is able to pay for more research and development toward the goal of advancing health care technology worldwide.

"In 2006, the United States accounted for three quarters of the world’s biotechnology revenues and 82% of world R&D spending in biotechnology.[4][6]. The amount of financing by private industry has increased 102% from 1994 to 2003.[20] Most medical research is privately funded. As of 2003, the NIH was responsible for 28%—about $28 billion—of the total biomedical research funding spent annually in the U.S., with most of the rest coming from industry.[21] The National Institutes of Health play a larger role in funding basic research.[citation needed]

The top five U.S. hospitals carry out more clinical trials than all the hospitals in any other country.
"
There was also a thing in there about more than half of Nobel prize winners for medicine being American doctors , but since Al Gore won a Nobel prize, I hesitate to use that as a measure of success.

[nemaroller]

The math is easy (we'll assume the employee stays at the same company or moves to a different company with the same insurance company for simplicity sake):

Employee pays $100/mo.
Employer pays $800/mo.

Insurance company receives $900/mo for 12 months = $10,800 annually.

After graduating college at 21, the employee works for 44 years until retirement when government Medicare kicks in at age 65.

$10,800 x 44= $475,200

.8 x 475,200 = $380,160 to pay for medical expenses in the last two years of said insured person's life.

Which leaves $95,040 in medical payments ($2,262 / yr) in the previous 42 years to which the insurance company can pay out.

Let's say at age 31 the insured goes rock climbing and falls breaking his arm, costing him $15,000 in medical expenses. Even with that from $95,040, he'd still have to use $1900/yr in medical expenses to use up his payment in premiums.

So, if the insurance company takes only 1 to 2 percent of the insured's pool for profit, it is still a good financial model.

[KiwiDexter]

Actually you do the math. It would be cheaper if we paid all healthcare expenses for the entire country of new zeland

NZ Population: 4,327,091

Feel free to go ahead and pay NZ's medical bills

That population figure does not include sheep so ergo is completely wrong.

[Shaggy Hiker]

Feel free to go ahead and pay NZ's medical bills

That population figure does not include sheep so ergo is completely wrong.

Yeah, you really SHOULD include spousal benefits whenever discussing health care.

[Shaggy Hiker]

Well Shaggy, that was a very good mathematical model. I would throw in some variance though as such that many higher-income earners pay more in monthly premiums as they shoulder the cost for lower income earners in a private pool.

I agree. My concern is that they will eventually be paying for more than half of the rest of the country which will contribute, but not enough to cover their own care.

I know executives at my company pay far more than some one who makes $100k/year. That's just how the pool is funded, as a company wants to be able to offer the best health care package, and they need to pay for those costs some where, and let's face it, the middle and lower wage earners can't shoulder that cost.

I would say that the same is true here. Technically, it IS true, but our top people make only about 2-3x what the bottom teir of full time people make, so the difference is not as extreme as it might be in some sectors.

The second variance I would throw in would be accidental / sudden death. Obviously, if a person pays insurance premiums for 30 years and then hits a tree with his car, there are no expensive surgeries for the insurance company to pay. A sudden stroke that kills does not require hospitalization or surgery, it just happens too quickly.

Yes! However, MANY more ailments could be counted in the category of sudden death a few decades ago, and are now counted in non-fatal, or slowly fatal.

As for the rest: I see a trend developing where I am mostly posting pessimistic, depressing, rants. Perhaps I am getting old. However, I feel that the advance of medical technology will inevitably lead to a time when it will be possible to survive for a long time at a high degree of functionality, but only a handful of the very rich will be able to afford that care. Fortunately, I also believe that society as a whole will collapse for a different reason (see my earlier rant on technological interdependence a month or so back) before we reach that day.

[Shaggy Hiker]

The math is easy (we'll assume the employee stays at the same company or moves to a different company with the same insurance company for simplicity sake):

Employee pays $100/mo.
Employer pays $800/mo.

Insurance company receives $900/mo for 12 months = $10,800 annually.

After graduating college at 21, the employee works for 44 years until retirement when government Medicare kicks in at age 65.

$10,800 x 44= $475,200

.8 x 475,200 = $380,160 to pay for medical expenses in the last two years of said insured person's life.

Which leaves $95,040 in medical payments ($2,262 / yr) in the previous 42 years to which the insurance company can pay out.

Let's say at age 31 the insured goes rock climbing and falls breaking his arm, costing him $15,000 in medical expenses. Even with that from $95,040, he'd still have to use $1900/yr in medical expenses to use up his payment in premiums.

So, if the insurance company takes only 1 to 2 percent of the insured's pool for profit, it is still a good financial model.

Good math. However, I would not leave out medicare/medicaid. The principle behind those two is that they take over, on the public tab, the costs that insurance companies don't want to cover: Elder care and end of life care, to a large extent. When looking at the total health care situation, those need to be included into any solution. The insurance industry is largely working by dumping the most expensive cases (elderly) on the public, along with any other expensive cases that it can (pre-existing conditions). Therefore, they are picking the remaining flesh off of a corpse that doesn't yet acknowledge its own demise. When we talk about health care, we need to talk about the whole thing, not just the economical pool that current insurance companies are tapping for their existence.

[NeedSomeAnswers]

The main problem with the current Insurance model to me seems to be with those, who are either self employed or in low income jobs that don't earn enough for the person to contribute to a health care policy.

This means that the poor basically don't get much healthcare. Also those people who work freelance or contracting, if they or there child suddenly gets very ill and requires very expensive treatment they will not be able to afford it so you are basically putting a price on their lives.

Those either too poor or basically too unlucky well you can just die.

A National Health insurance policy should be to look after those who are too poor or too unlucky.

Everyone else can still pay privately if they wish.

Personally i believe there are some things that companies should not be able to make a profit out of and they are

Public Utilities - Gas / Electric / Water

Public Transport - Trains / Tubes / Trams

Health Care

These areas (in my opinion) should be not for profit. I don't understand how making these things run at a profit benefits the public. Some people say that Private companies run more efficiently than government run agencies, well then isn't just the Public Agency model broken ?

Why cant we have a regulated private company that is run not for profit for any of our utilities ?

Directors can still be paid the equivalent of private sector salaries the companies can still run in a similar manor to private companies but instead of having targets based on the amount of profit you make, have targets based on how well you serve your public or how much of a saving your customers are making that year !!!

Nobody has ever been able to explain to me how my Gas (for example) can cost me less when the company selling me gas now has to make a profit ??

I am all for market forces and the idea that competition will regulate the market for you in markets were people actually have a real choice to buy or not to buy

[Shaggy Hiker]

One of the really odd statistics, which I can't find a current citation for because I haven't looked, is that the socioeconomic class that you are born into has a HUGE impact on how many health problems you will have, even when factors such as access to health care, smoking, etc., are factored out. I have seen studies looking at why this is, but have not looked for a primary source demonstrating the magnitude of this effect.

The point is: If you are born poor, you will have a greater need for health care in your life, even if you become affluent by your teenage years.

[zaza]

...
Which leaves $95,040 in medical payments ($2,262 / yr) in the previous 42 years to which the insurance company can pay out.

Let's say at age 31 the insured goes rock climbing and falls breaking his arm, costing him $15,000 in medical expenses. Even with that from $95,040, he'd still have to use $1900/yr in medical expenses to use up his payment in premiums.

So, if the insurance company takes only 1 to 2 percent of the insured's pool for profit, it is still a good financial model.

Let's assume that our insured's name is visualAd. There's pretty much no chronic condition that he hasn't developed, and that includes chronic halitosis. When he is diagnosed with ulcerative colitis and the prospect of three or four sessions of major surgery and all that goes along with it, as well as the prospect that he may develop complications later in life, the insurance company has to re-assess their model.

Result: his premiums rocket.
Solution: he has to either pay through the nose, or (presumably) exempt himself from insurance on related illness. Or have no medical insurance at all.

visualAd is but a young'un, starting out in his career, and already he's facing the prospect that his insurance premiums are larger than his mortgage payments. With the right treatment, he will likely contribute 40+ years of useful work to society, during which time he may become filthy rich and easily able to afford his payments. (OK, so the "useful work" line is debatable). But right now, what are his options?

As I don't live in the US under a medical insurance system, I'd actually like to know the answer.

[wild_bill]

If he's got my health plan he'll pay his $5000 deductible, and the rest will be covered. When my group is up for renewal, an underwriter will asses the group's utilization and determine what the premiums should be. They will likely go up, but not sky rocket.

[Shaggy Hiker]

visualAd is but a young'un, starting out in his career, and already he's facing the prospect that his insurance premiums are larger than his mortgage payments.

I have health insurance through my employer. My portion is tiny, and the employers portion is hidden from view (it isn't reported as part of gross pay). However, my employer has to factor in the total cost of employing me, which includes the health care costs and a few other hidden charges. If I add my contribution to the contribution made by my employer, my insurance premiums utterly dwarf my mortgage payments already, and I live in a pretty nice house.

[visualAd]

Let's assume that our insured's name is visualAd. There's pretty much no chronic condition that he hasn't developed, and that includes chronic halitosis. When he is diagnosed with ulcerative colitis and the prospect of three or four sessions of major surgery and all that goes along with it, as well as the prospect that he may develop complications later in life, the insurance company has to re-assess their model.

Result: his premiums rocket.
Solution: he has to either pay through the nose, or (presumably) exempt himself from insurance on related illness. Or have no medical insurance at all.

visualAd is but a young'un, starting out in his career, and already he's facing the prospect that his insurance premiums are larger than his mortgage payments. With the right treatment, he will likely contribute 40+ years of useful work to society, during which time he may become filthy rich and easily able to afford his payments. (OK, so the "useful work" line is debatable). But right now, what are his options?

As I don't live in the US under a medical insurance system, I'd actually like to know the answer.

Your apparent concern surprises me; are you hoping to benefit in some way from my future wealth?

[visualAd]

I think that the value of a person in terms of the amount you earn can be rather misleading. There are hundreds of low paid jobs that are essential and without people to fill the positions, those who would have otherwise had a better job will have to fill them instead.

A sick person who is unable to work, even in a country with no state run healthcare still costs the economy money as they are unable to contribute to the GDB of the country. Most private sector companies make 5-10 times as much money out of an employee as they pay them, there might even be a trend that lower level staff make even more. The money the company makes is then subject to corporation tax and the profit contributes to the health of the economy. It is therefore in everyone's interest that as many people as possible are healthy enough to work and contribute not only to the state healthcare system but also the economy.

There are always a minority who take advantage of such systems and try and do as much as they can to avoid doing anything other than going to their local pub for a few pints, get drunk, get arrested then get sick with lung cancer and expect treatment despite having smoked like a chimney all their lives. I do believe the benefits outweigh the drawbacks.

[nemaroller]

But right now, what are his options?
As I don't live in the US under a medical insurance system, I'd actually like to know the answer.

If he has chronic life-long conditions, he would most likely apply and be accepted for Medicaid or Social Security Disability.

Medicare is for elderly people age 65 and over.
Medicaid is for people in need - with little income and little to no assets.
Additionally, depending on the actual US State visualAD works in, he would apply for the federal sChip program (which in his case would probably work out to the same cost of a private industry premium - but he wouldn't be denied coverage).

We all know the Save Ana story that was posted on VBForums a while back. If I remember, the father was an independent IT contractor. While he made just over six figures, he decided not to buy any health insurance for his family.

His wife's employer actually offered health insurance, but they chose to not pay the higher premium for family coverage and only insure the wife (family premium is usually 3x the individual rate per paycheck).

The daughter got a brain tumor and for the past 3-4 years, the family has accumulated a bunch of medical bills. Obviously, they don't have the means to pay them off, and yet it appears they have not declared bankruptcy, lost their house, or been forced to court. Why?

1) Either they applied for and now receive social security disability coverage.
2) The health organizations realized the family couldn't pay the bills and wrote them off.

I would be curious on an update on Ana, as I know quite a few people in this forum donated (myself included) to help that family along. It appears Ana is doing well now, but the bill situation has been kept understandably quiet.

[FunkyDexter]

Directors can still be paid the equivalent of private sector salaries the companies can still run in a similar manor to private companies but instead of having targets based on the amount of profit you make, have targets based on how well you serve your public or how much of a saving your customers are making that year !!!

I agree with this general principle but it's not quite that simple. As soon as you set a target you change the behaviour of an organisation, usually with unintended and unwanted circumstances. For a long time, if I wanted to see my doctor I had to phone up in the morning and book an appointment for that day - I couldn't book an appointmnet in advance. The reason for this is that the government decided they wanted to reduce waiting times so they set targets specifying how many appointments a surgery could have outstanding. Seemed like a good idea except that surgery simply stopped booking appointments in advance. Their figures looked great but it didn't mean the system was working any more efficiently. In fact it was considerably less efficient. Can we get a facepalm smiley for the forum? I feel the need to use it at times like this.

Like I say, I agree with the principle but it's hard to motivate public bodies without targets and targets can themselves be damaging. Actually I think the NHS used to work better without so many targets, mainly because the individuals they attracted tended to be, by nature, motivated anyway. The same was true of schools a decade or so ago. Unfortunately, as we've allowed the private sector into both these areas over the last decade I don't think we could now return to a relatively targetless set up. We've got the worst of both worlds.