Pandora's box has been opened
- Did Clay really intend to goad me into a defense of INSURANCE???
Clay responds to my comments about Hillary Clinton and "Hillarycare"
I loved Hillary because of Health Care coverage. I can't get medicine or surgery I need because of the insurance I am forced to carry. The company chooses who lives or dies who lives pain free or suffers. My grandfather a WWII vet who worked hard for 40+ years has no medication coveraged. My mom and dad both have specific medications that work inspite of other meds attempted but as these arew not covered its out of pocket inspite of insurance and there premiums. Several student I teach have one medication theat works for ADD but of course since its not on the formulary they either deal with bad side effects or suffer academically. Government Health Care as an option for folks is required to truly make private companies competitive.
Quoting Jules from Pulp Fiction: "Well allow me to retort..."
I’m just going to venture a guess, but there’s probably a common thread here: you, your parents and your grandfather are currently covered under a group health insurance policy customized and, to some extent, paid for, by a governmental agency.
When an employer purchases a group health insurance program, they are allowed to customize their policy by itilizing components they feel would be most beneficial to the overall population AND would be the most affordable for the employer and the employee. Because governmental agencies are held to such tight budgets (Congress and the White House, of course, excluded), they essentially are required to purchase an insurance policy which will fit within their budget constraints (read: “cheap”).
Even “cheap” health insurance policies cost, in most cases, thousands of dollars a year for a small family. Thousands of dollars per family, multiplied by millions of families in this country…that means the Health Insurance Industry is raking in money hand over fist, right? Of course it does. They’re sitting on a significant potion of the US GDP.
Except they’re not. In 2005, the profit margin for the entire US Health Insurance Industry was a whopping 4.6%.
Did the insurance company manage to make that 4.6% profit because they cheated their insureds out of services the insured is entitled to? No. In many cases, total claims payments are pretty close to the total premium the insurance company has taken in…give or take a couple points. No insurance company in it’s right mind is going to willfully deny claims that are rightfully due in order to enhance their profit margins. Doing so can result in major legal exposure, huge fines, loss of certificates of authority and even jail time for choice insurance executives. Once one state uncovers wrongdoing, all the rest start investigating too. (This is why I wasn’t a big fan of the book or movie “The Rainmaker.” Required entirely too much suspension of disbelief)
They managed to keep that 4.6% is for a few different reasons:
1. Insurance companies are also notoriously cheap when it comes to administrative costs, meaning that they do as much as possible with as little as possible. This is why your average insurance industry worker makes a fair salary but, in many cases is doing the job of more than one person.
2. Underwriting practices are integral to the viability of an insurance company. They do their best to make sure that they’re insuring low and medium-low insurance risks only. In the case of Group Policies, there’s no way to weed out every high-risk employee, so they depend on the law of averages to ensure that the program won’t go down in flames. In the event that it does, the company reserves the right to cancel the policy. Of course, when the employer goes out to shop for a new policy, the premiums are going to be significantly higher than the previous policy.
3. Insurance companies are major investors and invests pretty much every penny they don’t have to pay out or keep in reserves. Much of their income comes from their investments. Investment capital is not only good for the insurance company, it’s good for the economy overall.
Now, I said all that to say this:
Hillary’s health care idea was to allow the government to take over the entire health insurance industry and create a 300 million person strong HMO. It goes a little something like this:
“All employers will pay for this health care coverage for their employees. Can’t afford it? Too bad.” (I kinda liken this to the “F^($ you, pay me!” monologue in GoodFellas.).
“You don’t have a job and no way to pay the premium? Don’t worry. We’ll pick up the check. There are plenty of people out there who can pay some additional taxes to cover it.
“To all of you folks who DO have jobs, well, we’ll be taxing you. Don’t worry, though. It’s a
“progressive tax” We’ll try to keep it affordable. Hey, from each according to his ability, to each according to his need, right??”
“So, after you’ve paid all your taxes, you can still afford to pay for better healthcare for yourself? Tough. Free-choice is gone. In fact, if you even TRY to pay cash for superior services, we’re going to toss you AND your Dr. in jail. We’re the US Government and we’re here to take care of all of you equally.”
“To all you health insurance companies out there,uhh…we won’t be needing you. We’ll be “contracting” with a couple HMOs. OF COURSE, they’ll be non-government entities…they’ll just be completely under our oversight. Maybe, though, we can give some of those millions of employees you’re going to have to can civil service jobs! They can do the dirty work! We’re talking about the largest expansion of Federal Government in the history of the planet so we’ll have some openings.”
“To all of you med students out there with $250K in student loans, you should be able to get a fine salaried position with some governm…uhhh.…HMO owned-and-operated hospital or association group. Now, don’t go getting these silly notions in your pretty little head about “private practice”. We’ve done away with that. We’ll try to make sure that your salary is sufficient to have your loans paid off before you’ve hit retirement age.”
“To the rest of our new HMO subscribers: WELCOME! We’re going to do everything we can to make sure that you’re getting equal healthcare, regardless of financial status. All you welfare cases…uh…make that ”economically-challenged” families, all you middle-classers and all of you horrible wealthy people can count on the same sub-par service HMOs have been providing for years. We’re looking forward to a long-term partnership with you. We know some of you are concerned about this, but Canada’s been doing this for years and look how successful they’ve been!”
“Oh, that reminds me: To all you Canadians who’ve regularly crossed the border into the US to pay cash for better health care than what your government is capable of providing, well, uh…sorry. We’re closed. Thanks for all your past business, though!”
I’m the first person who says that there needs to be some sort of health care reform but a complete federal takeover of 14% of the US economy isn’t the way to do it. Apparently, I’m not alone in this opinion because this little idea of Hillary’s cost the Democratic Party a majority status for the past 11 years (with the exception of that little Jeffords defection in 2001 to 2002).
How do you reform health care? Who knows? Maybe you look at the two most expensive aspects of being a doctor: education and lawsuits. If you pass tort reform (thereby lowering malpractice insurance premiums) and maybe try to reduce the cost of a med school education (via grants, tax incentives etc.), you stand a better chance at lowering health care expenses.
Lowering expenses is the ONLY way you can lower health care insurance costs.
But, of course, that’s just ONE opinion:
Clay responds to my comments about Hillary Clinton and "Hillarycare"
I loved Hillary because of Health Care coverage. I can't get medicine or surgery I need because of the insurance I am forced to carry. The company chooses who lives or dies who lives pain free or suffers. My grandfather a WWII vet who worked hard for 40+ years has no medication coveraged. My mom and dad both have specific medications that work inspite of other meds attempted but as these arew not covered its out of pocket inspite of insurance and there premiums. Several student I teach have one medication theat works for ADD but of course since its not on the formulary they either deal with bad side effects or suffer academically. Government Health Care as an option for folks is required to truly make private companies competitive.
Quoting Jules from Pulp Fiction: "Well allow me to retort..."
I’m just going to venture a guess, but there’s probably a common thread here: you, your parents and your grandfather are currently covered under a group health insurance policy customized and, to some extent, paid for, by a governmental agency.
When an employer purchases a group health insurance program, they are allowed to customize their policy by itilizing components they feel would be most beneficial to the overall population AND would be the most affordable for the employer and the employee. Because governmental agencies are held to such tight budgets (Congress and the White House, of course, excluded), they essentially are required to purchase an insurance policy which will fit within their budget constraints (read: “cheap”).
Even “cheap” health insurance policies cost, in most cases, thousands of dollars a year for a small family. Thousands of dollars per family, multiplied by millions of families in this country…that means the Health Insurance Industry is raking in money hand over fist, right? Of course it does. They’re sitting on a significant potion of the US GDP.
Except they’re not. In 2005, the profit margin for the entire US Health Insurance Industry was a whopping 4.6%.
Did the insurance company manage to make that 4.6% profit because they cheated their insureds out of services the insured is entitled to? No. In many cases, total claims payments are pretty close to the total premium the insurance company has taken in…give or take a couple points. No insurance company in it’s right mind is going to willfully deny claims that are rightfully due in order to enhance their profit margins. Doing so can result in major legal exposure, huge fines, loss of certificates of authority and even jail time for choice insurance executives. Once one state uncovers wrongdoing, all the rest start investigating too. (This is why I wasn’t a big fan of the book or movie “The Rainmaker.” Required entirely too much suspension of disbelief)
They managed to keep that 4.6% is for a few different reasons:
1. Insurance companies are also notoriously cheap when it comes to administrative costs, meaning that they do as much as possible with as little as possible. This is why your average insurance industry worker makes a fair salary but, in many cases is doing the job of more than one person.
2. Underwriting practices are integral to the viability of an insurance company. They do their best to make sure that they’re insuring low and medium-low insurance risks only. In the case of Group Policies, there’s no way to weed out every high-risk employee, so they depend on the law of averages to ensure that the program won’t go down in flames. In the event that it does, the company reserves the right to cancel the policy. Of course, when the employer goes out to shop for a new policy, the premiums are going to be significantly higher than the previous policy.
3. Insurance companies are major investors and invests pretty much every penny they don’t have to pay out or keep in reserves. Much of their income comes from their investments. Investment capital is not only good for the insurance company, it’s good for the economy overall.
Now, I said all that to say this:
Hillary’s health care idea was to allow the government to take over the entire health insurance industry and create a 300 million person strong HMO. It goes a little something like this:
“All employers will pay for this health care coverage for their employees. Can’t afford it? Too bad.” (I kinda liken this to the “F^($ you, pay me!” monologue in GoodFellas.).
“You don’t have a job and no way to pay the premium? Don’t worry. We’ll pick up the check. There are plenty of people out there who can pay some additional taxes to cover it.
“To all of you folks who DO have jobs, well, we’ll be taxing you. Don’t worry, though. It’s a
“progressive tax” We’ll try to keep it affordable. Hey, from each according to his ability, to each according to his need, right??”
“So, after you’ve paid all your taxes, you can still afford to pay for better healthcare for yourself? Tough. Free-choice is gone. In fact, if you even TRY to pay cash for superior services, we’re going to toss you AND your Dr. in jail. We’re the US Government and we’re here to take care of all of you equally.”
“To all you health insurance companies out there,uhh…we won’t be needing you. We’ll be “contracting” with a couple HMOs. OF COURSE, they’ll be non-government entities…they’ll just be completely under our oversight. Maybe, though, we can give some of those millions of employees you’re going to have to can civil service jobs! They can do the dirty work! We’re talking about the largest expansion of Federal Government in the history of the planet so we’ll have some openings.”
“To all of you med students out there with $250K in student loans, you should be able to get a fine salaried position with some governm…uhhh.…HMO owned-and-operated hospital or association group. Now, don’t go getting these silly notions in your pretty little head about “private practice”. We’ve done away with that. We’ll try to make sure that your salary is sufficient to have your loans paid off before you’ve hit retirement age.”
“To the rest of our new HMO subscribers: WELCOME! We’re going to do everything we can to make sure that you’re getting equal healthcare, regardless of financial status. All you welfare cases…uh…make that ”economically-challenged” families, all you middle-classers and all of you horrible wealthy people can count on the same sub-par service HMOs have been providing for years. We’re looking forward to a long-term partnership with you. We know some of you are concerned about this, but Canada’s been doing this for years and look how successful they’ve been!”
“Oh, that reminds me: To all you Canadians who’ve regularly crossed the border into the US to pay cash for better health care than what your government is capable of providing, well, uh…sorry. We’re closed. Thanks for all your past business, though!”
I’m the first person who says that there needs to be some sort of health care reform but a complete federal takeover of 14% of the US economy isn’t the way to do it. Apparently, I’m not alone in this opinion because this little idea of Hillary’s cost the Democratic Party a majority status for the past 11 years (with the exception of that little Jeffords defection in 2001 to 2002).
How do you reform health care? Who knows? Maybe you look at the two most expensive aspects of being a doctor: education and lawsuits. If you pass tort reform (thereby lowering malpractice insurance premiums) and maybe try to reduce the cost of a med school education (via grants, tax incentives etc.), you stand a better chance at lowering health care expenses.
Lowering expenses is the ONLY way you can lower health care insurance costs.
But, of course, that’s just ONE opinion:
posted by Big Bad Dad at 4:23 PM
1 Comments:
Here in lies the issue...
4.6% of 14% of the US economy is pretty good. Somewhere someone is making money or they wouldn't be doing it.
And in fact no my parents are not under a State Plan but yes it is another group plan. With all these plans ignorance abounds. We will pay quadruple for surgery after the heart attack or ruptured planters tendon but not pay 1/10th the cost for prevention.
In Nascar terms run it with out changing tires and then fix it when it hits the wall.
Additionally Health Care and its structure really should be based on Rawls Veil of Identity. Under this Veil the natural postion would be that economic inequalities are only permitted insofar as they benefit the least well off members of society.
For example, if one were to consider whether or not slavery based on race should be allowed, the original position makes it clear that it should not. No rational person, not knowing whether or not they would be the race that is in slavery or the race that is in slave mastery, would choose to allow that system. Nobody wants to risk being a slave. It would be more sensible to choose a society where equality is a guiding principle, because then whichever race one was would not matter. The power of the original position in providing a lens through which to view moral issues has convinced many that Rawls' ideas, if not his conclusions, are to be held in high esteem. (Wikipedia)
The same with taxes etc...
Pragmatic - certainly it is not always but to at least use this lense in seeking what is just for both individuals and society is required for a moral societies decision making. And yes I am calling many of our nations and its leaders actions and decisions immoral (boths dems and repubs).
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