Why Healthcare can not be covered by Insurance

[mandyky]

When one buys car or homeowners insurance, one is buying risk management whether it be liability, replaceability or loan requirements. Not everyone will have a car accident or a house fire.
But everyone from birth to death needs healthcare, and those healthcare decisions needs to be made by patients and doctors, not HMOs and beaurocrats trying to make a profit.

[FlaGranny]

1. I hope you mean that

insurance companies should not be reponsible for health care. Your title reads like no one should have insurance, but I think you mean that health care should be a public service and not a profit-making venture, yes? I agree completely with that.

[mandyky]

7. Yes,

I am for healthcare coverage, just not as an insurance type plan.

[Doctor Panacea]

2. Agreed!

You are right, Mandy.

The insurance model is not appropriate for health care. Another method for coverage, to include everyone, must be established. I am currently working on an article dealing with that very issue.

As a physician, I am very familiar with this problem. We have got to have coverage for everybody. We have about 42 million uninsured people, but the problem is even more far-reaching than that.

[loftycity]

9. The 43 million without -is a low count

I believe the 43 million without healthcare is an awfully low count.
Isn't that number from 1999?
I would say the number people without healthcare has doubled in the last 3 years.
In my circle of friends.. half have lost health coverage this year.
And they have had coverage all of their lives. Most are in their late 30's early 40's.

[Warpy]

11. Healthcare will belong in the marketplace

...as soon as illness becomes a consumer decision. Think about that. Right now we have a system which apportions care in such a way that the rich can choose to need heart-lung transplants, while the poor need to content themselves with the common cold. Real life doesn't work this way, and it's about time we all realized that.

[Cleita]

12. We need to pass laws that

force the for profits to maintain the same standards and administrative costs that Medicare does. The insurance companies will be forced to withdraw and open the field up for single payer universal care administered by the federal government.

[loftycity]

16. This is what I think--just a thought

I think the Health Insurance Companies know their end is coming.
They are going to bilk the government and us for all they can get.
Then throw their arms up...when they can't make a profit.
Then hand off the entire mess back to the government and let us have the bottomed out industry to try and unravel and put back together.
Of course...the money will be gone...and CEO's will be laughing all the way to their off shore bank accounts.

[Cleita]

3. Very true.

Insurance by it's very nature covers the unexpected the disaster. You buy fire insurance because you could have a fire, but most likely you won't. The insurance company is counting on that too. That's how they make money, so most likely they won't insure you if you have a fire trap or are in a fire prone area without charging you a lot for it.

On the other hand health is a necessity. By it's nature it shouldn't be administered for profit anymore than old age pensions should be, another necessity.

[SoCalDem]

4. It can only "work" if everyone is in the same "pool"

young & healthy as well as the elderly and ill..

For years and years we paid our premiums, and yet rarely went to the dr.. our premiums paid back then were "available" so that people who were sick THEN could get their claims paid..

That's how insurance is supposed to work. Lots of well people paying, but not using...their premiums are used to pay for those who ARE usiing the plan..

But, the insurance company cannot use that same money to pay 35Million bucks to their CEO and start buying reals estate and paying dividends to millions of "stockholders"..

That money can only be used ONCE..and it should be for healthcare

[DinahMoeHum]

5. The Washington Monthly said similar things 3 years ago. . .

Link:
http://www.washingtonmonthly.com/features/2001/0105.glasser.html

(snip)
All those original pronouncements of the managed-care industry in the late 1980s and early 1990s guaranteeing high-quality health care at low and affordable prices have been abandoned as...companies scramble to stay afloat as costs escalate and stock prices slip to new lows. This year (2001), Aetna Health Care, in a letter to stockholders, stated that it planned over the next four quarters to drop 2.5 million members, raise premiums, and cut back on full-time staff. Not a very encouraging business plan, especially for a company insuring more than 19 million people.
(snip)
Years ago, a few people warned that this market-driven experiment was bound to fail. The essence of sustainable insurance, whatever the product, is the size and diversity of the risk pool. The Royal Charter establishing Lloyd¹s of London, the world¹s first insurance company, made the point of their enterprise quite clear: ³So that the many can protect the few.² The idea hasn¹t changed in over 300 years. A sustainable insurance plan demands a large risk pool so that it can offer low rates and cover future claims. Managed-care companies handled the problems of risk by ignoring the elderly, the poor, the indigent and the needy, but it was hardly a strategy for long-term fiscal health.
(snip)

:hurts:

[muriel_volestrangler]

6. although I don't think insurance is efficient for health

I disagree that healthcare is not another version of risk management. Many people go many years without needing any care (with the possible exception of regular dental checkups) and then need very expensive treatment - needing far more money than they have available then. That is exactly the situation that insurance can be useful for.

However, I agree that the HMOs and insurance firms form an extra layer trying to make a profit. But you do have to recognise that the alternative is a government bureaucracy that will try to do its own rationing of healthcare too. The advantage of government healthcare is that voters, rather than corporations, determine the overall amount of money spent - and the government is more able to fight the pharmaceutical companies over their profits.

[Cleita]

10. That's been proved to be untrue.

Government health programs, even in the USA, have proved efficient and universal in giving health care to those the insurance companies won't cover. The problem is to get enough funding to them to operate.

Also, Medicare uses 2% to 3% of their dollars for administrative costs. A conservative study of insurance and HMOs gives the adminstrative costs at between 23% and 25%. Other studies put the costs even higher.

Considering that the health care industry doesn't even cover the sickest of the population, this is not very efficient.

[muriel_volestrangler]

13. I agree with you

I said that insurance wasn't efficient (it's an extra layer of people making a profit), but that healthcare is an area where you are using risk management.

What I was pointing out about government health programs is that you are bound, like HMOs, to get rationing of care - taxpayers aren't going to pay for unlimited treatment of everybody, in practice.

[Cleita]

14. I don't see this as a problem.

People will get the health care they need and the people who need it will get it. Before HMOs came along and rationed care, many doctors abused the health care system by performing unnecessary surgeries and other procedures to make money from the people who had coverage. Many women got unnecessary hysterectomies, while the children of poor people went without health care.

Look at the Canadian system. No one is rationed anymore than we are in this country and yet everyone is covered.

[blondeatlast]

8. Well said. Have you read "Health Care Meltdown?"

Ronald LeBow; it's an excellent book on the problem.

[TreasonousBastard]

15. Agreed, mostly.

The concepts of insurance are pretty ancient, and actually stated about 5,000 years ago with Phoenician traders. Probably even earlier than that. So, nothing much is really new.

Mutual pools were the first "insurance" and still exist. Everybody throws money into the pot, and whoever has the loss takes it out. Then more money goes in. Somewhere along the line, largely becasue the members didn't have enough money of their own to capitalize the pool, capital stock companies arose and filled the gaps. Lloyd's groups are exchanges and a sort of bastardizing of the two ideas.

The stock companies claimed an advantage in having enough money to pay the claims, but that often didn't happen. They merely had a little more money than the mutual pools. Nowadays, there is little difference between the two as far as solvency goes.

Stock companies have higher marketing costs and duplication of effort. Insurance policies are often commodities, and there's a lot of effort and expense going into selling "me too" products.

So, with healthcare we're left with pretty much what homeowners and every one else has-- a series of personal responsibilities, and a series of insurable risks. The homeowner agrees to replace a leaky roof at his own expense, and the insurance company agrees to pay for it if it burns or is blown off.

The parallel with health care would be minor afflictions and regular checkups that one could say are one's own responsibility, just like fixing the roof. Subsidize these, but keep them separate from the actual insurable risks.

The insurable risks would be major problems such as cancer. If you get really, really sick, the "insurance" would kick in.

But, rwo things happen to screw this up.

The first problem is the increasing ability of medicine to diagnose and treat hitherto unknown or untreatable medical conditions. This is not inflation, but progress. Vast amounts of money are spent on treatments that we didn't have in the past, and we would just die or suffer. This will undoubtedly continue, and medical costs will skyrocket just from new technologies. There are few economies of scale there.

The other problem is the aging population. People who didn't die from infections and heart diease like they used to are getting older and getting vastly more ailments that are incredibly expensive to diagnose and treat. This will get worse, too.

Ther are no easy answers, but, yes, eliminating a lot of the overhead of stock insurance companies is probably a good idea. The only people who really count in insurance companies are the claims adjusters.

[Cleita]

17. Well, if you want to go back to ancient times,

healing was done by doctor priests in the temples. It was available to everyone. The temples collected offerings from kings as well as beggars to intercede with the gods so they didn't charge fees. The Romans had an impressive infrastructure of hospitals run again through the temples, for everyone, and funded by the emperor and other offerings from rich Romans for the intercession of the gods.

The Romans, as fascist as they were politically, recognized the benefits of a healthy population. For this reason the baths were for everyone to keep away plague and the populace could get medical help regardless of whether they were slave, plebe or patrician. The emperors also distributed bread to the populace so they wouldn't go hungry. Starvation and plague would lead to riots and mob rule and this wasn't healthy for the emperor.

We don't seem to be as civilized as them. Maybe we need some mob rule to straighten out our leadership.

[onecitizen]

18. There's a show on TV today called.........

"Damaged Care". It stars Laura Dern and is about a Doctor who takes a job in an HMO run hospital and how horrible it was. Good show. On Showtime at 5PM today.

[diamond14]

19. my AETNA health insurance jumped 13% this month, with huge

increased for deductables, like emergency care deductable from $100 dollars to $500 dollars....which is a 400% increase to seek emergency care...

I was paying $312.58 per month, in December 2003

Now, in January 2004, I must pay $355.78 for this month...

that is for a single person, it is more for a family....

for a total of 13% increase, which is actually much more than that because of the increased deductables....

this company requires so much paperwork, and throws so many adminstrative burdens on me to seek medical care...that is is a truly insane pile of paperwork...they send me a sheet stating that every single claim made is NOT covered, even though I maintain a rigorous schedule of obtaining referrals and maintaining copies of all documents....each and every simple little claim made by my primary care physician is objected to...each and every referral to a specialist is objected to by AETNA mostly by claiming that I had NO referral, when I actually did have a referral, they cannot ever find referral even with documented evidence, faxed to them at least five time, continuous phone calls and more...

just as an example, in September 2003, I had an eye infection...went to my primary care physician who charged me $50 to say that I had an eye infection and write a referral to an eye doctor...AETNA was billed by the eye doctor and sent the referral ...claimed they couldn't find the referral, I faxed it to them, and called them several times, my eye doctor's billing company called them and faxed the referral several times...this little visit has now resulted in PILES of paperwork....each time you call/fax/etc., AETNA will write another letter objecting, and so far, has issued 4 different 'tiny' checks as I work my way through their complex complaint system, but still not paid the whole bill.....


IMO, these people who prey on the sick, take advantage of them, and make a PROFIT off the sick...need to be totally removed from the medical system...that alone would save tons of money, time, effort...

[loftycity]

20. Been through it

It's horrible.
Just a bunch of creeps out to bilk you out of every dime.
and the wording of 'every claim not covered' United Health Care same story. United actually announces that when you call them.
And we are paying them a fortuune...

[Cleita]

21. Me, too and they raised me again.

I can't get any health care anyway because I can't meet the deductible and the tests I need aren't covered by them anyway. Also, since I need the tests to renew a prescription that is way too expensive, it doesn't matter anyway. I'm just doing without and hope for the best.

I'm seriously considering dropping them, but then it's only a year until I qualify for Medicare, if Bush hasn't given it away to Blue Cross and Aetna by then.

[loftycity]

22. Know it

They turned me down...get this.
I had 2 ear infections in 2 years??
Sad but, true...
It will turn out it has too.

[Cleita]

23. That's terrible and it shouldn't happen

to anyone who has paid their premiums and then had to use the insurance. I really hate this whole business.

[iverglas]

24. exactly what I was saying in another thread on the subject

If your house burns down and you don't have fire insurance, you live in your car.

If your car gets stolen and you don't have car-theft insurance, you live on the street.

But you still live.

If you are ill or injured and don't have health insurance to cover the care that would save your life, you may die.

It isn't so much that everyone will need health care, it's that sometimes when you do, you just don't have the option of going without, without dying. Or without having an illness or disability that will not improve without care, and would improve with care.

You always have the possibility of buying another house or another car, even without insurance; there are other ways of replacing the loss. If health (let alone life) is what is lost, there may be no other way of restoring it -- health care insurance simply is not "optional" in that sense, the way fire and theft insurance are.

Health care insurance doesn't replace something that has been lost but can be replaced, or foregone, the way fire and theft insurance do. It doesn't insure against a loss, it insures against a need, a need that can't be met any other way than through health care.

That need is not a remote, one-time possibility the way fire and theft are; it's a virtual certainty, and it's on-going. Insurance for health care is like insurance for groceries, in that sense. Why buy the insurance, when you can just buy the groceries??

So in that sense, yes, it would perhaps make sense not to insure routine and minor health care, and to insure only catastrophic illness and accident and the like. But even those are things that it is very reasonable to expect will happen to almost everyone at some point. And even "routine" health care can be very expensive, and impact much more severely on the low-income.

So why not just pay for it on the same basis as we pay for a lot of other things that some people need and use more than others, when those things are regarded as "public goods"? Isn't that what the tax system is for -- to spread the costs around and relieve the burden on individuals who cannot pay the share represented by their use of the services?

We share the costs of schools, roads, libraries, parks, on an ability-to-pay basis through taxes: why not health care? Individuals' health is obviously as important to a society as individuals' education, individuals' ability to get from point A to point B, individuals' ability to obtain books to read, individuals' ability to enjoy nature. At least one would think it might be obvious.

.

[Flightful]

25. Correct, to a point

Expecting healthcare "insurance" to cover all routine procedures is like expecting auto insurance to cover an oil change. Premiums for high-deductible "hit by bus" policies are not that expensive.