Why don't the health providers appeal independently to the uninsured?

[Phoebe Loosinhouse]

Some people are uninsured because it makes no sense for them to pay 10K out of pocket for stupid limited policies that only cover 20K. I've read post after post after post here on these forums making that point. People are going naked because in a sense they are self-insuring.

So here is this market of 30, 40, 50 million people, not all destitute.

We have heard that American health providers PUNISH the uninsured by charging them mulitples of what an insured person pays - this drives people off to medical tourism for elective procedures, in my opinion.

Cosmetic and elective procedures are pretty much competitive, advertised, etc. as far as I can see - why not other procedures?

Why doesn't some hospital run an ad that says, Private customers pay the same as our insured rate?

Wouldn't that drive business to the hospital? Why don't clinics advertise? Why do we keep being told that the "free market" works in healthcare, which we know it doesn't, when there is no actual free market?

If the average American is supposed to consider 17 - 24% of their gross income as "acceptable" in terms of personal outlay, why don't we have some actual free market to accompany that?

[northzax]

1. you're talking about purely elective procedures

and those are, in fact, often negotiated to a lower price, if you try. as for emergency procedures, well, you're not thinking of cost while someone's cracking your chest.

as for those paltry caps on coverage, wouldn't it be great if those were made illegal? someone should pass a law or something. oh wait, they did.

[ibegurpard]

2. they did?

where?

[northzax]

4. um, kinda both the House and the Senate

prohibit lifetime caps (and being dropped as long as you pay the premium) the House bans annual caps, and the Senate allows 'reasonable' caps. you're going to have a hard time selling a 'reasonable' cap as anything less than 20 times the annual premium. so the ten thousand dollar policy would have an annual cap of about $200,000. and most plans don't even have that.

[sandnsea]

3. Wow. Straight from Freeperville

You do know that's the argument the right has been making all along, right? People aren't covered because they don't want to be.

As for equalizing costs, that's what the exchange will do. When there is a basic plan in every single state that has to offer the same coverage and has to be subsidized for families under $88,000, insurance will either get affordable or get gone.

[Cleita]

5. In this one the freepers have a point.

In a true free market, Medicare would have been made available to all who wanted to buy into it and who don't qualify for Medicaid.

[sandnsea]

6. Does Heritage have a point too?

Almost every argument against this health care bill or the tax are arguments Republicans have made in one form or other for decades. It's astonishing to watch.

http://www.heritage.org/Research/HealthCAre/bg2350.cfm

[Cleita]

7. Actually, since you ask, the Repugs have been making a really

good case against this health bill, which is amazing, because it has all the elements in it that the Republicans wanted years back. Nixon wanted a health plan like this and Arnold Schwarzenegger proposed it for California. Yet, when our DLC Democrats brought this very same Republican plan to the floor of Congress, they turned against it. You don't have to go to Heritage. Just go to the C-Span archives and listen to the debates. Those Republican Senators actually unknowingly made the case for single payer while denouncing legislation that their own think tanks invented. If it weren't so tragic, it would be hilarious.

[ibegurpard]

8. indeed

eom

[sandnsea]

9. lol. This is Howard Dean & John Kerry's bill

Because they were both smart enough to know this was the best we would get passed, as Ted Kennedy admitted when he said he wished he had passed Nixon's bill.

And these arguments are the routine argument Republicans haul out to attack every Democratic social service bill.

If you agree with them, then you need to rethink your political affiliation.

[Cleita]

10. Actually, the bill the way it's ending up is getting closer and closer

to GWB's bill, well the one he had on his website when he ran against Kerry. Of course, he never went near it again once he won.

[sandnsea]

11. What bullshit

You do remember that Dean and Kerry are the ones who proposed plans just like FEHB to put together competitive insurance packages, right? They had nothing about ending pre-existing conditions or limiting out of pocket expenses. Nothing about expanding Medicaid. Certainly didn't have the huge expanse in health care clinics. Neither one of their bills was anywhere near as good as this one. And you think this looks like Georgie's bill??? You need an optorectomy.

[Cleita]

12. Yes, but they also had plans for government run type coverage for

those who couldn't quite do FEHB. Bush's plan had the medical savings accounts, the tax credits, the mandates and no limits on premiums, deductibles, also the four tiered BS from bronze, silver, gold and platinum, or what is going on now with the Senate bill. It was of course, like this bill, written by the insurance company lobbyists. If you deny that then you are a liar. I'm sure some of our wonkier DUers were able to preserve those websites for future posterity. Dean hates this plan and you would know it if you are paying attention to his recent press statements. There is no way his plan resembled this.

[sandnsea]

14. No they didn't

Kerry certainly didn't and Dean only had some form of a Medicare expansion. Tax credits are not remotely the same thing as premium subsidies, the Bush tiered plan was for small business, the current plan discourages MSAs through taxes and caps, and there will be limits on premiums and deductibles when the HHS creates or approves the exchanges. You really need to question who is feeding you this shit and why.

And yes I know Dean "hates" this plan, just like he hated the Iraq War after he said we should give Saddam 2 months and then bomb him. He'll say whatever he needs to say to keep his following and boy he really needs it now that he has no job.

[Cleita]

16. Got news for you. The premium subsidies are by and large tax credits.

Subsidies kick in after there are no credits to give and only for a segment of the population that is underpaid to begin with. That is what is shaping up. Of course now that the final bill is being done behind closed doors, we may not even get that. Thanks for kicking Dean down with a lot of RW BS. Now we really know where you are coming from. You have been apologizing for this insurance industry give away since we even had hope for something meaningful. Now go collect your money and go away. You won.

[sandnsea]

18. Making more shit up

That is just not true, but what the hell do you care. Subsidies will be available for everyone going to the exchange because the vast majority of people earn less than $88,000 annually. I guess those are your "underpaid" folks. And even though that's not them, the true "underpaid" are the only people I really worry about anyway. The rest of YOU have insurance and health care. I'm not advocating for YOU or YOUR insurance. I'm advocating for the people who have nothing and nobody to ever give a shit about us and yes, WE are going to win something in this health care bill, finally. Despite the people who want their Medicare for over 55 and fuck everybody else, or the people who want single payer or death to OTHER people, or the ones who put union health benefits over the uninsured. Don't talk to me about "collecting money" when the people at DU who collect the most money are the ones who are constantl stirring up shit for their own ends.

And I have never had much use for Howard Dean, I've just kept my mouth shut about him after 2004. But, once again, he's proven what he is, a political opportunist who will say any damn thing to stay in the limelight.

[Cleita]

19. I have advocated for single payer universal health care for everyone or an

improved Medicare for everyone to be paid for from various taxes since Hillarycare flopped back in the first Clinton administration. Believe me, no one pays me to write about it. But you claim you want real health care access for poor people, yet you apologize for this insurance company welfare bill over and over again. Everytime something useful gets removed from the bill, you apologized for it and you still are. Then mandates and excise taxes are put in and you apologize for it. We are scraping the bottom of the barrel in this and Congress is feeding us splinters because that is what the insurance industry is giving us and yet you continue to apologize for it not to mention you keep bringing up talking points from right wing think tanks like The Heritage Foundation no less. It's not hard to put two and two together.

[sandnsea]

20. Single Payer Can't Pass - can't you comprehend that?

And just because I've known that all along doesn't mean I'm an insurance company apologist. It means I can fucking THINK, that's all. Subsidized insurance will get people to the doctor. If you really really care about people, then nothing else matters except that. If rich fucks want to keep shuffling piles of green paper between them - I Don't Care. All I want is for People To Get Health Care. I'm supporting a plan that is going to pass and going to make a difference in millions of people's lives. So who is making a difference for the poor and working people? Certainly not you - YOU who are repeating those Heritage Foundation talking points, not me, but nice try.

[Lydia Leftcoast]

13. It's because of the way insurance companies structure their rates

They pay some set percentage of "customary" costs, usually less than 50%.

In order to break even, doctors and hospitals have to figure out what they need to stay in business and then work backwards so that whatever the insurance company pays is what they need.

For example, if an insurance company pays 50% of "customary charges" and a procedure costs $2000, the provider lists it at $4000 in order to force the insurance company to pay what they need.

[subterranean]

15. Each insurance company negotiates its own rates.

Also, I read somewhere that Medicare policies are at least partly responsible for the high rates charged to uninsured individuals. Since Medicare only pays a percentage of the "regular" price for each procedure, hospitals raise their prices in order to get a higher reimbursement from Medicare. But under Medicare rules, they have to be able to prove that they actually charge those prices to someone and make a serious effort to collect them. That someone is the uninsured. It's quite the screwed-up system we have.

[Cleita]

17. Huh?

Medicare pays 80% of a pre-approved amount for procedures. Either you or a co-insurance picks up the 20%. There is no doubt Medicare needs to update their fee schedule and Congress should have been working on that instead of figuring out ways to screw the middle class with mandates. Since Medicare gets it's funding from FICA and premiums from old people, there is no way hospitals raising their prices get higher reimbursements from Medicare. Please rethink that sentence. I hope you aren't serious. Hospitals charge a higher rate to pay for the uninsured who can't pay not to cover Medicare patients. If everyone had Medicare, hospitals wouldn't need to overcharge to cover the uninsured because everyone would be covered. That talking point comes from the same place (insurance industry) that the talking point that Canadians are coming over here in busloads because they can't get health care in their own country because of the waiting lists. I also know that you can renegotiate your hospital bills if you find yourself uninsured and have to pay cash. They will lower it for you if you can convince them that it would be an extreme hardship to pay $3 for a band aid and down the line.

[sandnsea]

21. That's true for all insurance billing

If you don't expect to collect the 20% and set your rates so that you can operate on 80%, then you have to charge everyone the 100% rate and sincerely try to collect it and the 20%. It's fraud if you don't, whether it's Medicare, Medicaid, VA or insurance.

[SoCalDem]

22. Low income people can't even find an extra $20 in their budgets

"buying" insurance is not in their plan. People who are poor, have to rely on home-remedies, hope and luck...and when those do not cut it, they use the ER, and then avoid answering the phone..
Insurance companies do not even WANT "those people".