Yes, but how do you REALLY feel about it?... ;) Jeff
----- Original Message ----- From: "Bagotronix Tech Support" <[EMAIL PROTECTED]> To: "Open Topic Forum" <[EMAIL PROTECTED]> Sent: Monday, August 09, 2004 7:35 PM Subject: Re: [OT] [PEDA] Medical insurance > Abdul: > > > Actually, that's not exactly the reason. The reason is that the insurance > > companies negotiate lower prices from the hospitals. (The Capitol Hill > > problems are real, but not the cause of this particular price difference.) > > Why should insurance companies be able to get lower rates through > negotiation? IMO, the flaw in the current thinking about medical care, > insurance, and drugs is that the consumption of these things is negotiable. > It isn't. For example, if your TV stops working, you go shopping for a new > one. If you don't like the price of plasma TV's, you can wait for a sale, > decide to buy a cheaper CRT set, or just stop watching TV altogether. You > can't do this with medical problems; going without treatment is not on the > negotiating table. At least, it isn't for someone like me who wants to > continue living. Likewise, trying a cheaper treatment or operation isn't > always an option, either. In my case, the only treatment for kidney cancer > was to cut the malignant thing out and throw it away. Fortunately, the > other kidney functions well and is not cancerous (FYI, kidney cancer is > fairly common, but it is very rare for both kidneys to be cancerous). > > Anyways, back to the issue of medical costs. The law of supply and demand > doesn't really apply in the usual way. To recap the law of supply and > demand: 1) The supplier is willing to sell more units at marginally higher > prices, 2) the buyer is willing to buy more units at marginally lower > prices, therefore 3) there is an ideal point where the selling and buying > prices meet which will result in optimized unit volume sales and maximized > profit for the seller. This is Economics 101. The problem with all the > talking heads' theories about the way to manage health care is that they all > seem to think that the law of supply and demand applies to everything. As I > stated before, it doesn't apply in the usual way to medical care. You will > consume as much medical care as you need, at any price (up to your maximum > ability to pay), or you will die. What kind of choice is that? > > As to negotiating rates, here is why it's a fallacy: the number of any given > procedures or treatments is going to be fairly constant in a given time > period. After all, there is a given number of people in a fiscal year who > are going to need a nephrectomy (that's medical lingo for the surgical > removal of a kidney). So, if the numbers of different types of operations > in a fiscal year can be predicted fairly accurately, based on past years' > data, the total costs of performing these operations can be predicted also. > So, just take that, tack on a modest profit if it's a for-profit hospital > (2-7% maybe), and charge the result for it. No negotiations would be > necessary or possible. And EVERYONE pays that amount - no sweetheart deals > for insurance companies. Because if the insurance companies get sweetheart > deals and get to pay BELOW the actual cost, then those who are not > represented by lobbyists have to make up the difference by paying ABOVE > actual cost. I, for one, don't like the idea of being forced into > indirectly giving my hard-earned money to some huge insurance company who > has no financial obligation to me, and will just take that money and buy > lobbyists to lobby further against my interests. Hey, that sounds like > what's going on right now! > > > > > (And my apologies to the out-of-US readers of this list; this problem is > > peculiarly American, I think.) > > > > Yes, Canadians only need to read this to know how lucky they are. I told my > story to one of my Canadian customers. He says he has lively discussions > with some of his friends who advocate privatization of the Canadian system. > When he tells them my story, they shut up pretty quickly. Americans - we > put a man on the moon and land probes on Mars, but still don't offer health > care to all our citizens. > > > Now, you don't have to buy insurance to get the lower prices. First of > all, > > you can often negotiate after-the-fact for a lower amount, but I won't go > > into details on that -- suffice it to say that a hospital may prefer to > > accept a fraction of the original charge rather than going through a > > complicated and failure-prone collection process. I.e., if they don't > > accept the settlement, they might get little or nothing. > > The hospital can also RUIN your credit rating if you don't pay or don't pay > in full. I like having a good credit rating. Non-payment is not an option, > because I did sign an agreement stating that I would pay. I wasn't educated > at Enron U. - it's a matter of personal integrity with me that I honor such > agreements. I did manage to be somewhat savvy about what I agreed to. I > made them strike out clauses where leins could be put on my estate in the > event of my death. And also made them not require another person to > financially guarantee payment in the event I couldn't or wouldn't pay. So > basically, they only got paid if I survived the surgery and they did a good > job (I wouldn't have felt obligated to pay if malpractice occurred)! That's > the way it should be. > > > Hospital bills also *commonly* contain overcharges of various kinds. > > Yet another symptom of morally bankrupt medical economics. > > > Then, if one of us gets seriously ill, we'd switch immediately to an HMO. > > No delay. Expensive, yes, but better than paying high medical bills. > > CAUTION: Are you sure you can do this? Even though Massachussettes may not > have an eligibility waiting period, you still may not be able to get a > preexisting condition covered. Make sure you know EXACTLY how that law > works. In Florida, the eligibility period is 12 months. > > > In another state, one could buy catastrophic care insurance and set up a > > tax-deductible Medical Savings Account. We can't do that in Massachusetts > > because it turns out that the insurance which would qualify for the tax > > deduction at the federal level will not meet Mass. law for insurance. > I.e., > > it can't be sold here.... that's also insane.... > > How about when you travel? How does it work then? You will be outside of > your "plan area", right? You said it yourself - it's insane! Why the hell > does this corporatized, institutionalized, self-propagating insanity > continue to exist and escalate? It certainly doesn't serve the public > interest. > > > sold by the National Association of the Self-Employed. Note that these > > associations are closely related to the insurance companies, they are a > bit > > of a scam, but they also do sell real insurance (and provide certain other > > services). Apparently, the Alliance is settling a class-action lawsuit > > that, among other things, established clearly that, no, you don't have to > > pay Association dues in order to get the insurance. (We weren't told > that....) > > Wow, that sounds like a company that I would really want to trust with my > life...NOT! > > > The insurance, as I mentioned, is $10,000 deductible, and it does have a > > 20% copay after $10,000, and it does have a fairly low benefit limit (I > > forget how much, but it might be $100,000), but this would mean that a > > large hospital bill of, say, $50,000 -- after rebilling, Mr. Bagget's bill > > would have been quite a bit less than that -- would have cost us $18,000. > > Not a pleasant experience, to be sure, but the kind of money that can be > > borrowed if necessary. Since we are saving $12,000 per year on insurance, > > we would be, really, only out $6,000 more than we'd have been by buying > > that generous insurance. And I've never had *any* hospital bills for > > myself. Of course, I'm getting older.... > > Well, I never had any hospital bills either, until my kidney cancer. There > was no reason to expect it, because I don't engage in any of the known risk > factors (smoking, drug use, working in toxic environments, etc.). > > I did manage to get the hospital, urologists, imaging, and anesthetists to > put me on monthly payment plans. I did get a discount from the anesthetists > for early payment, and it was a whopper discount: 40%. They must not get > paid in full very often, so they automatically take less if they get it NOW. > I paid off the urologists and imaging according to schedule, and paid the > hosptal ($19K) according to schedule for about a year, and then paid the > remainder in a lump sum just to get that last monkey off my back and get a > tax deduction for last year. I'm not rich, but I am fortunate that I could > afford to do that. You may ask "Ivan, if you could afford pay off your > medical bills early, what the hell are you bitching about?" > I can't help but feel sorry for the people who can't afford medical care. I > myself was worried for a while that I might not be able to afford it, and my > potential for affording it is much better than most people in the U.S. How > much more they will have to worry! Something must change; the current > system is broken. I heard on the news last week that medical insurance > rates went up 28% last year. And the total number of uninsured Americans > rose to 49 million (from 45 million a year earlier, I think). I don't know > the current Census figures, so I just going to assume a U.S. population of > 300 million. A reduction of insured from 256 to 251 million is about a 2% > drop. A 2% drop in insured population for a 28% increase in insurance > rates. I bet these supply and demand curves are non-linear. My prediction: > if this trend continues, in a few years these curves will cross. Once the > insured population drops at a percentage rate faster than the increase in > insurance premiums, the medical profession will go into tailspin, going down > in flames. Now, didn't I say earlier that medical care doesn't follow the > law of supply and demand in the usual way? By that, I meant it doesn't > follow the "textbook" examples, which are reasonably linear supply and > demand curves. With medical, we have a demand curve that stays fairly flat > even as the price curve trends up exponentially. But at some point it > becomes impossible to scrape together any more money to pay, and the demand > curve abruptly turns down. This happens rather quickly. Insurance > companies respond to their shrinking customer base by raising rates on the > remainder. Which causes even more people to drop their insurance, which > causes another rate increase...and so on. We know this as an unstable > feedback loop. I think this is what is going to happen in the medical > industry. > > > In California, we had Kaiser insurance, which was *very* affordable, and > > the service was good. Kaiser used to be in Massachusetts, but the heavy > > regulation, it seems, forced them out. So I don't feel terribly guilty > > about working the system! I'd vote in a flash for a single-payer > system..... > > If by single-payer, you mean like what Canada has, I'm with you on that. > The problem is, *we* don't get to vote on it. Our elected Congress members > do. And they don't see the urgency of it, because they get their health > care from the U.S. government. A better deal than you and I can get > privately. And *we* cannot sue our HMO's if they deny us necessary > treatment. And *we* aren't rich enough to afford more lobbyists than the > HMOs. Yes, it's not enough to have a lobby, you must have the biggest, most > well funded lobby. After all, if you are lobbying Congress in opposition to > some other lobby, unless you have more resources than your opposition does, > you've wasted your money, because the opposing lobby will win. > > My advice to anyone who has a choice of hospitals: choose a non-profit > hospital if you can, and if it is known to be good. In Tallahassee, we have > 2 hospitals, one for-profit (Tallahassee Community Hosptial, a.k.a. TCH) and > one non-profit (Tallahassee Memorial Regional Medical Center, a.k.a. TMH). > TMH is generally regarded as having better overall care than TCH. I have > lived here over 20 years, and have observed more complaints in the news and > from others about TCH. Well, how about that? I thought capitalism was > always supposed to do things better! I was well cared for at TMH. I think > in most cases, a non-profit hospital receives funds from state and/or > federal government, and charitible donations. As a consequence, they are > required to provide health care to anyone regardless of ability to pay. Of > course, they can make it difficult on you and not be to eager to treat you > if you don't have any money! For-profit hospitals don't have to treat you > at all. If you stagger into the emergency room of a for-profit hospital, > all they have to do is stabilize you, then they can ship you off to a > non-profit. Of course, you may suffer more injury during the wait, but hey, > they gotta make a profit... > > Best regards, > Ivan Baggett > Bagotronix Inc. > website: www.bagotronix.com > > > > Actually, that's not exactly the reason. The reason is that the insurance > > companies negotiate lower prices from the hospitals. (The Capitol Hill > > problems are real, but not the cause of this particular price difference.) > > > > (And my apologies to the out-of-US readers of this list; this problem is > > peculiarly American, I think.) > > > > Now, you don't have to buy insurance to get the lower prices. First of > all, > > you can often negotiate after-the-fact for a lower amount, but I won't go > > into details on that -- suffice it to say that a hospital may prefer to > > accept a fraction of the original charge rather than going through a > > complicated and failure-prone collection process. I.e., if they don't > > accept the settlement, they might get little or nothing. > > > > Hospital bills also *commonly* contain overcharges of various kinds. > > > > But, more to the point, *before you get sick (and sometimes after)* you > can > > make the system work for you. Exactly how depends on the state in which > you > > live. > > > > When our insurance, for myself, my wife, and child, all healthy, went up > to > > $1300 per month -- we live in Massachusetts -- I did the research, and > > found several things. > > > > First, under Massachusetts law, if you have *any* qualified insurance, you > > can switch to any other insurance program, and not have to go through any > > eligibility waiting program. So we got the very minimum insurance we could > > find, $10,000 deductible, catastrophic care insurance. I thought, when we > > > got this, that we'd not see a penny from this company unless one of us > were > > hospitalized for something serious, but, hey, the insurance was only a > > little more than $300 per month. That's a savings of $12,000 per year, > > which would certainly be enough to cover routine bills! > > > > Then, if one of us gets seriously ill, we'd switch immediately to an HMO. > > No delay. Expensive, yes, but better than paying high medical bills. > > > > (It turns out that they *do* pay some bills that are legally required to > be > > paid by insurance in the State of Massachusetts; they just paid for > routine > > immunizations for our daughter, for example.) > > > > The minimal insurance uses PHCS for processing claims. PHCS is a company > > that serves large self-insurers (i.e., Private Health Care Systems); they > > have negotiated rates, and most every physician in our area accepts it. > > There is a modest discount, typically, on physician visits; but if it is a > > visit to a specialist, the discount can be hefty. > > > > Now, you can join the PHCS network for quite a bit less, though Care > > Entree, http://www.careentree.com/ > > -- for our family it would run about $70 per month for the "Total Care" > > program. We'd have no insurance at all; that is, we'd be totally > > responsible for the rebilled services. But we'd be paying just what the > > insurance companies pay... And that program includes a card that looks > like > > an insurance card, and -- we tested it -- it is accepted by providers as > > one. That part of the program includes a Medical Savings account with a > > minimum contribution, and medical bills are paid out of that account > unless > > the account is not sufficient. > > > > But by paying for minimal insurance, we can take advantage of Mass. law > and > > switch, if necessary, to a more generous insurance plan. Yes, it is > insane. > > But we'd be crazy not to take advantage of it. We can't afford the > alternative! > > > > In another state, one could buy catastrophic care insurance and set up a > > tax-deductible Medical Savings Account. We can't do that in Massachusetts > > because it turns out that the insurance which would qualify for the tax > > deduction at the federal level will not meet Mass. law for insurance. > I.e., > > it can't be sold here.... that's also insane.... > > > > Our insurance was sold through the Alliance for Affordable Services, it's > > from Midwest National Life Insurance, and, yes, I checked, they are > > licensed to sell insurance in Massachusetts.... which means that the > > insurance keeps us qualified to switch at any time. Similar insurance is > > sold by the National Association of the Self-Employed. Note that these > > associations are closely related to the insurance companies, they are a > bit > > of a scam, but they also do sell real insurance (and provide certain other > > services). Apparently, the Alliance is settling a class-action lawsuit > > that, among other things, established clearly that, no, you don't have to > > pay Association dues in order to get the insurance. (We weren't told > that....) > > > > The insurance, as I mentioned, is $10,000 deductible, and it does have a > > 20% copay after $10,000, and it does have a fairly low benefit limit (I > > forget how much, but it might be $100,000), but this would mean that a > > large hospital bill of, say, $50,000 -- after rebilling, Mr. Bagget's bill > > would have been quite a bit less than that -- would have cost us $18,000. > > Not a pleasant experience, to be sure, but the kind of money that can be > > borrowed if necessary. Since we are saving $12,000 per year on insurance, > > we would be, really, only out $6,000 more than we'd have been by buying > > that generous insurance. And I've never had *any* hospital bills for > > myself. Of course, I'm getting older.... > > > > In California, we had Kaiser insurance, which was *very* affordable, and > > the service was good. Kaiser used to be in Massachusetts, but the heavy > > regulation, it seems, forced them out. So I don't feel terribly guilty > > about working the system! I'd vote in a flash for a single-payer > system..... > > > > > * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * To post a message: mailto:[EMAIL PROTECTED] * * To leave this list visit: * http://www.techservinc.com/protelusers/leave.html * * Contact the list manager: * mailto:[EMAIL PROTECTED] * * Forum Guidelines Rules: * http://www.techservinc.com/protelusers/forumrules.html * * Browse or Search previous postings: * http://www.mail-archive.com/[EMAIL PROTECTED] * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
