I'm speechless. I can't imagine this: British treatment of premature birth

[Haiku]

But the bill that was originally proposed would (over time) make private insurance illegal.

 

Can you link to this, please?

 

Tara

[Penelope]

I know this treatment has been used routinely in Latin American countries FOR YEARS. It is proven to work. It has been exported to other poor countries in Africa! I think they call it the kangaroo method.

 

Actually, holding newborns skin to skin rather than wrapping them in blankets immediately after birth is recommended care for all newborns in the US, not just premature. Even full term infants can drop their body temperature if they are taken away from mom and put in blankets in an incubator. Unfortunately some hospitals care more about their paperwork and procedures than about what is good for moms and babies.

[Sara R]

All I want is two things.

 

1) Anyone who wants health insurance can get it.

 

2) There is no price gouging.

 

 

I don't think those changes alone will make insurance affordable.

 

I agree that #1 is necessary. But it will make insurance more expensive for the companies to provide.

 

I think that eliminating profit isn't going to save enough money. I live in Utah and have a non-profit insurance company. It still costs too much--not as crazy high as other places, but still a huge percentage of our monthly income for a catastrophic policy.

 

Tort reform will help a bit.

 

But I think the main problem is that

 

(1) modern medical care is expensive (a lot of fancy expensive machines plus the labor of many highly trained people),

 

(2) we use it for many more things than we used to (from major important, but crazy expensive, things like long term cancer treatment or shots to prevent the progression of MS, down to relatively minor things like ADD),

 

(3) insurance coverage is presented like an all-you-can-eat buffet, encouraging as much consumption as possible, instead of true insurance (catastrophic only), where families pay their own normal medical costs, which encourages economy, and

 

(4) many people don't pay their bills, and those people are subsidized by those who do pay their bills. It's getting to the point where people who do pay their bills feel like chumps. I think this element is hugely significant. But I don't know the answer to it. I don't want people dying because of inability to pay. But I don't want the cost of caring for them to make it unaffordable for me to pay for my own insurance.

[Penelope]

Okay. Fine. Let's remove God from it (He can't be removed, but for this let's play pretend). In any medical situation, I the mother should have a right to be willing to request that a doctor go the extra mile (if the doctor isn't humane enough to do it himself) AND be willing to pay the $$ for that extra effort. If this healthcare mess goes through, unless all I'm seeing is incorrect, those rights as a mother would be taken from me because it wouldn't be worth it to them.

 

If I was dying of cancer and everyone said there was just no chance in the world I would live, I would still have a right to request treatment to do whatever it took to assist me in grabbing life if I was willing to pay that $$!! But if I'm on govt. funded healthcare, I'd be at their mercy to decide if I was even worth their $$ to save. And I'm telling you, I just don't feel that much trust in the govt. to make those decisions for me and my loved ones. <shudder>

 

 

Actually, that isn't true now in the US. Doctors are not required to provide care that they believe is futile. It is unethical to give someone a surgery or treatment just because the patient wants it. If someone is dying of cancer and there is no known treatment, a good doctor is not going to give you treatment, even if you have all the money in the world. Likewise if a doctor knows that the baby realistically cannot survive, he is not obligated to give invasive care just because someone says they will pay for it. Health professionals are not just shills working for the money.

[Melinda in VT]

Honestly, this boils down to world view. MY God can do miracles. MY God has the ability to take that 1% chance and make it a viable, worthwhile, healthy life. It really doesn't matter what statistics are because God won't be bothered with statistics. The doctors in that hospital are not God and have no right to play God. It's ridiculous & evil what was done to that baby and that mother.

 

If God had wanted to work a miracle for this baby, he could have. The doctors were letting nature (or God) take its course. They didn't cause him to be born prematurely.

[asta]

If God had wanted to work a miracle for this baby, he could have. The doctors were letting nature (or God) take its course. They didn't cause him to be born prematurely.

 

:iagree:

[tricia]

Wow, this is shocking. What kind of world do we live in?

[Ibbygirl]

I'm only moderately informed on these issues. I certainly wouldn't call myself an expert on it. I just know from listening to hundreds of conversations on these topics by lawyers and doctors (because I happen to be related to 5 lawyers and 2 doctors and have met many, many of their colleagues). Also, my mom is a registered nurse who worked in a public hospital for 12 years. She saw plenty of people who did not get decent healthcare, regardless of whether or not they had private insurance. She also saw people who had no health coverage treated very poorly. I also have good friends who worked hard all their lives. The husband worked over 20 years for the phone company and became very ill. He had heart surgery, was unable to return to work and was dropped from his insurance. Then his wife was laid off from her job of 22 years. They couldn't affored the medical bills and lost their home, their car, and all their retirement savings. Something is very, very wrong about that. I have another friend who had cervical cancer. Her husband HATES his job, but can't even consider looking for a new one, because of her "pre-existing condition", even though she's been cancer-free for 5 years. It's crazy.

 

I think this vicious cycle of rising health care costs came about when private insurance companies decided what amount of medical bills they would "allow". The doctors are forced to inflate prices, because insurance will only pay a certain percentage, and the doctors need to cover costs. I think it keeps growing and growing further out of control.

 

Except for a small portion of specialized surgeons and things, I don't think a lot of doctors are rolling in the dough. Sure, they make decent money, but most of them have HUGE student loan payments. On the other hand, from what I understand, insurance company executives ARE rolling in the dough.

 

I don't have statistics to back up any of this. It's just my opinion from hearing the news, reading the news, and the aforementioned hundreds of conversations I've endured on the topic.

 

That is so sad. :( My insurance company won't even acknowledge Autism at all even though it is the fastest growing developmental disorder. They won't cover ANYTHING that is Autism related. :( I have been on the wait list for Medwaiver for almost 6 years and I still don't know how much longer I will have to wait until I can get some help from the government for my son. They used to have a government grant called Therapy for Success. It didn't cover much, in fact I had to choose between speech therapy or occupational therapy. My son is supposed to get speech AND occupational therapy 3 times a week at least. He gets nothing other than what he gets in school because we cannot afford it. Under the Therapy for Success grant he was allowed two sessions a week of one or the other and so we chose occupational therapy since he has so many sensory issues and it effects everything in his life. We had to re-apply for the grant every month and sometimes there was a gap while we waited for them to approve it. It was a pain but at least he got something. He only got services under that grant for 8 months before they cancelled it altogether and they have never replaced it with anything else. :(

 

It just dumbfounds me. We're supposedly "the richest nation in the world" or at least that is what our leaders keep telling us and yet average ordinary citizens cannot get good medical care. I don't understand it. It's so frustrating.

 

I am trying to understand also why the medical costs keep going up higher and higher and higher all the time. I am thinking about what you said, and thank you for your reply btw, it's so good to hear from people who have knowledge about what goes on inside.

 

I'm trying to understand, so if the doctors are not rolling in dough and the insurance companies have decided how much they will pay ahead of time then why is everything still so expensive?? I mean, if I go to the doctor and they bill the insurance company $200.00 for a visit at a general checkup and my co-payment is $25.00 and the insurance company covers the rest who is making the money? I don't really know how the billing system works but wouldn't there be a paper trail and wouldn't the insurance company just pay to cover what was billed that was not paid for out of pocket by the patient?? I still don't understand how that makes two Tylenol cost $10.00 :confused::confused:

 

How are the insurance company execs getting rich? That sounds so elementary a question and I feel so stupid asking it, but the truth is I really don't know. And I don't understand how that makes everything else so expensive.

 

I'll tell you one thing that really drives me batty. I have seen so many fundraisers trying to draw attention to Autism. Run/walk for Autism, t-shirts to "raise awareness", stickers on cars with puzzles to raise awareness. Fundraisers on tv where millions of dollars are raised for Autism and yet the families who are raising the kids with Autism don't see one penny of it. They hold our kids up as examples of why we need to raise money, they cite the statistics about how prevalent it is and that this is the crisis of our generation blah blah blah, and yet they do NOTHING for the families. I agree that some money needs to go to research for a cure. I'm all for that, but for crying how much do they really need?? Why can't they set aside some of that money to actually HELP our kids NOW?? Drives me nuts.

[mommaduck]

If God had wanted to work a miracle for this baby, he could have. The doctors were letting nature (or God) take its course. They didn't cause him to be born prematurely.

Did they try to prevent him from being born prematurely?

[Lovedtodeath]

 

Did they try to prevent him from being born prematurely?

From what I understand, since I went into PTL with DS at 5 months... In the case of an incompetent cervix, once you get to this point in the pregnancy there is nothing they can do. They would have had to know about it earlier and already had preventative measures in place.

[NoPlaceLikeHome]

 

I think that eliminating profit isn't going to save enough money. I live in Utah and have a non-profit insurance company. It still costs too much--not as crazy high as other places, but still a huge percentage of our monthly income for a catastrophic policy.

 

 

 

 

I agree that non-profits do not save a lot of money since we have "non-profit" blue cross blue shield locally and if I am not mistaken they have many executives making a lot of money compared to government executives. This is why I am skeptical of non-profit co-ops for health care since there is still a great risk IMHO of exorbitant salaries. On top of that the local blue cross company is very inefficient when it comes to processing claims. They have 3 different divisions who do not talk to one another processing the same claim sometimes from what I understand:001_huh: Talk about redundancy! They also have bullet-proof glass in their lobby in a pretty safe city:001_huh:. Makes you wonder why. Perhaps it is all the unhappy customers.

Edited September 13, 2009 by priscilla
spelling

[NoPlaceLikeHome]

McCain was supposedly planning to give us $3,000 in cash for insurance. I really thought that would be great.

 

Is that per year? If it is it would only pay for 2-3 months of health insurance for our family and for some in this country it would only pay for 1 month of insurance:001_huh:. I do not see how that would help in all honesty.

[Lovedtodeath]

 

Is that per year? If it is it would only pay for 2-3 months of health insurance for our family and for some in this country it would only pay for 1 month of insurance:001_huh:. I do not see how that would help in all honesty.

Yeah, I thought of that after I posted. It would do nothing for pre-existing conditions. It would help my family quite a bit, as we only want it for catastrophic coverage and a couple of doctor's visits. It would cover most of that. We use Natural Medicine and Natural Doctors for serious or chronic illness.

[muffinmom]

Can you link to this, please?

 

Tara

 

 

I'll try to find this...it's been a while since I found that.

[mommyrooch]

I think you're terribly naive...there are many,many people working a 40 hour week that can barely make ends meet, even without all the extras you mention. One doctor visit for me costs over $400, I do not have a cell phone, my utilities are not 300, and there's no way I could have a land line for $20. You seem to be making so many assumptions based on your little slice of life, without even realizing all the different situations out there. Where's the logic in that? It seems to be for many, just the opposite of your last sentence...it's about what I have, and to hell with anyone else.

 

:iagree::iagree::iagree:

[muffinmom]

Can you link to this, please?

 

Tara

 

Just so you know, the bill does not say the words "we will make private insurance illegal." They know they couldn't get away with that. Instead, they say we can "keep" our current private plan, but they will require that private plan to (over a 5-year period) become identical to the govt. plan. If it does not comply during the 5-year deadline, you the individual (not the insurance co.) will be taxed 2.5 % of your gross income--why? to punish you for not having a plan that complies.

 

Let me give you an analogy: It's like my husband who owns a recycling collection service. Imagine that the govt. wants more people to recycle, so they decide that the way to do that is to reform the recycling collection industry, rather than encourage individuals to recycle more. So in order to have more people recycle, the govt. decides to go into the recycling collection biz, in competition with my husband to "accomplish more recycling." They also decide to create new rules and regulations that all recycling collections companies must comply with, defining HOW to collect recycling from individuals. Despite my husband's chosen business model for recycling collection that's been proven to help customers recycle more and throw away less, he is now required to collect in the way the govt. says he must, or he will be penalized. And within 5 years, he must comply completely.

 

Not only that, once the govt. starts competing with him, he will not be allowed to sign up one more customer, or change and improve his service (which a good business must do in order to compete). In effect, my husband has become shackled. And if he chooses not to recycle according to the govt.'s regulations, his CUSTOMERS will be penalized by paying an additional tax to do business with him. So the choice is to either not comply, thereby it would become illegal for my husband to do business the way he's been doing it all these years, OR comply, become identical to the govt.'s plan, which is "free". When consumers see that the plans are both identical, but the govt. one is "free," then which one are they likely to choose? The "free" one, of course, which means that eventually all will naturally enroll in the govt. plan, which is what they wanted in the first place.

 

They didn't "force" it, but, yeah, they made it impossible for the private sector to compete--same difference. So they are manipulating to get what they want. And why do they so badly want everyone on the govt. plan? Good question. If some people are happy with their private plans, why should they have to go with a public "option"?

 

This is less about healthcare than we think. They are taking a topic that matters to Americans (as it should) and manipulating them to gain more power and control.

 

 

Here is a link that discusses the HR 3200 a litte more regarding this topic.

http://www.wizbangblog.com/content/2009/07/20/barack-obama-inadvertently-tells-the-truth-about-his-health-care-plan.php

 

Here is some of my husband's documentation on this issue:

 

Obama: “If you like your health care plan, you keep your plan. I don’t want to take your plan over.”

 

My first reaction is to ask the question: Why does the President think he has the authority to “allow” me to keep the insurance plan I have? He is mistaken! In reality, since he is a servant of the American people, WE have the power to approve or reject HIS health benefits package.

 

Can you keep your health coverage if this healthcare bill passes? Yes, you can but . . .

 

(To read the bill for yourself go to: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf )

 

1. Your existing insurance plan must meet minimum coverage set by this bill. See pages 167-168, section 401, TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE or you (not the insurance provider) will be taxed on top of your plan at a 2.5% rate of your gross income and the IRS will enforce your compliance. Go to pages 26-30, SEC. 122, ESSENTIAL BENEFITS PACKAGE to learn what the minimums are and then to your insurance policy to determine whether you will pay the special tax.

 

2. Health Savings Accounts (HSAs) with high deductible insurance plans will not qualify due to the minimum standard set by the bill of a minimum 70% actuarial value of benefits (page 30, line 2). Actuarial value is a summary measure of likely payments by a plan. It measures the percentage of medical expenses paid by a health plan for a standard population, ranging from 0.00 for a plan that pays nothing to 1.00 for a plan that pays all medical expenses. To learn more about actuarial value method. Go to: http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=133789

 

3. Companies have the option to “contribute” 8% of the average wages paid by the employer in lieu of coverage (there is a sliding scale up to 8% for companies whose payroll is less than $400,000 per year). See pages149-150, SEC. 313, EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE. Businesses will either have to provide insurance to federal standards, or pay an 8% payroll tax. Business costs for health care are higher than this, especially considering administrative costs. Any competitive business that tries to stay with a private plan will face a payroll disadvantage against competitors who go with the government “option.” With employers ending plans, millions of Americans will lose their private coverage, and fewer companies will offer it. With private insurance starved, many people enrolled in the government “option” will have no place else to go.

 

4. Your “grandfathered-in” plan can remain in effect under the following conditions:

· The policy issuer does not change any of its terms or conditions, including benefits from those in effect as of the day before the first day that the bill goes into effect.

· The policy issuer does not enroll any more people in the plan once the bill goes into effect

· The policy issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate

· The policy must meet the requirements as this bill specifies for all to a qualified health by year five. In other words, your private plan will be identical to the government plan.

· See page 16; SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.

 

Hope that helps. I know it's a lot of info.

[Sputterduck]

I think you're terribly naive...there are many,many people working a 40 hour week that can barely make ends meet, even without all the extras you mention. One doctor visit for me costs over $400, I do not have a cell phone, my utilities are not 300, and there's no way I could have a land line for $20. You seem to be making so many assumptions based on your little slice of life, without even realizing all the different situations out there. Where's the logic in that? It seems to be for many, just the opposite of your last sentence...it's about what I have, and to hell with anyone else.

 

 

I think you hit the nail on the head with the part I bolded. This is how many people who have good health insurance and don't have severe health problems in their family seem to think. We have an obligation to not let people suffer and die. How are people so blind to the fact that this is what's going on right now for many people in America? I guess many people feel if it's not their family or their friends, they don't need to bother to care.

[Karen in CO]

I make wayyyy more than many people, but you know - let's put some more reality here. I pay more $1600 per month for my insurance and I still pay out of pocket over $2000 per year in copays for medication and doctors visits- I have asthma and migraines and 3 kids. Did you know the primary variable in whether or not an asthmatic dies from their asthma is whether or not they have insurance and how well it covers their medications?

 

My doctors visits are between $75 and $150 per visit. My dd hit her head on the corner of my table saw and needed surgical glue in the emergency room at a tune to at least $2000 which my insurance will cover most of. I don't have basic cable but it is $45 per month. My ultility bill is $200 in summer and $350 in winter. I had to replace my 25 year old furnace last year for $8000; my car failed its 42 point inspection on all 42 points but Ijust keep an eye on the fluids and keep refilling them; then I broke my wrist in 4 place - wanna guess how much that cost even with my very expensive insurance?

 

Blaming the unisured for their lack of insurance is AWFUL and very small. Hopefully, those that are doing that will never need to reach the maximum benefit and then find it gone, and hopefully they will never loose the job that helps to pay for it.

 

btw - my ds pays $17 per month for Japanese NATIONAL health insurance, and they have much better health outcomes than us.

[Lovedtodeath]

Hopefully, those that are doing that will never need to reach the maximum benefit and then find it gone, and hopefully they will never loose the job that helps to pay for it.

This is the first time I have heard anyone talk about maxing it out. Thank you. I was wondering why no one had mentioned it.

[Karen in CO]

This is the first time I have heard anyone talk about maxing it out. Thank you. I was wondering why no one had mentioned it.

 

I worked with a guy with leukemia - he maxed his insurance out and went bankrupt, lost his house, his wife went back to work, but her insurance wouldn't cover him. When he died, she had almost a million dollars of debt and three little kids.

 

I am huge believer in limited government, but I think that with modern medicine we have the opportunity to extend lives and quality of life, but it is not with in the reach of everyone. We need to be honest about it. It is a choice of our values and I think that is why it is such a heated debate. Yes, we believe in life, liberty and the pursuit of happiness. But do we go back to 18th century medical practices in order to obtain that? If all men are created equal, then whose responsibility is it to see that the asthmatic child gets the simple and affordable, lifesaving treatment that is out of his reach if his parents are unemployed or work for minimum wage? Do we have to pull our own teeth like people used to? Do we let people die from a simple infection instead of providing a simple antibiotic?

 

I think my views of insurance and medical care are probably skewed because I grew up with government health care - my dad is retired military, and I went the local military hospital for al my medical needs until I turned graduated from college. It wasn't perfect, but I don't know a single person that died because they couldn't get basic preventative care, or left a huge burden on their families when they became terminally ill.

 

And please don't anyone forget that the same senators and congressmen that are arguing against the government run healthcare have government run healthcare that is far better than the Tricare or Medicare that most of us would be eligible for.

[muffinmom]

I worked with a guy with leukemia - he maxed his insurance out and went bankrupt, lost his house, his wife went back to work, but her insurance wouldn't cover him. When he died, she had almost a million dollars of debt and three little kids.

 

I am huge believer in limited government, but I think that with modern medicine we have the opportunity to extend lives and quality of life, but it is not with in the reach of everyone. We need to be honest about it. It is a choice of our values and I think that is why it is such a heated debate. Yes, we believe in life, liberty and the pursuit of happiness. But do we go back to 18th century medical practices in order to obtain that? If all men are created equal, then whose responsibility is it to see that the asthmatic child gets the simple and affordable, lifesaving treatment that is out of his reach if his parents are unemployed or work for minimum wage? Do we have to pull our own teeth like people used to? Do we let people die from a simple infection instead of providing a simple antibiotic?

 

I think my views of insurance and medical care are probably skewed because I grew up with government health care - my dad is retired military, and I went the local military hospital for al my medical needs until I turned graduated from college. It wasn't perfect, but I don't know a single person that died because they couldn't get basic preventative care, or left a huge burden on their families when they became terminally ill.

 

And please don't anyone forget that the same senators and congressmen that are arguing against the government run healthcare have government run healthcare that is far better than the Tricare or Medicare that most of us would be eligible for.

 

 

What are typical max amounts? Ours is $5 million. If I get sick enough for the insurance company to pay out $5 million for my medical care, that is WAY more than I will pay in insurance premiums in my lifetime...in other words, I got a lot of something for not much. Instead of my family being strapped with the whole $5 million, the insurance took that hit. From a financial point of view, there is little to complain about in that case. (Of course this does not address the fact that this is a real family who is hurting and in need of further relief...and whom I have compassion for). It also highlights the absurdity of health care costs.

 

I also wonder, Would the govt. be willing to pay more than that for one person's medical care? I really don't know the answer to that. I have my doubts.

Edited September 13, 2009 by muffinmom

[Erica in PA]

And this NEVER happens in the US, because health insurance companies are angels anointed by god who have no concern whatsoever for the bottom line and rush to spend as much money as they can treating people, all out of the goodness of their hearts. US health insurance companies would never even CONSIDER denying care, and all those people who had to sue their HMO's to get care are just ... imaginary?

 

Oh, and this month our insurance company decided to drop my son's asthma medicine from coverage. They helpfully provided me with a lost of (less expensive) alternatives to tell my doctor to prescribe. Every single "alternative" has been tried and does not control my son's asthma.

 

Tara

 

I have never heard of anything as barbaric as this happening in the US. In my understanding, here it's more an issue of the insurance not paying for it, than the doctors refusing life-saving care. There is a big difference between going into large amounts of debt because an insurance company wouldn't pay for treatment, and being denied the treatment altogether, by health care professionals, and resigned to death. If this were happening in large numbers in the US, I do think we'd be hearing a lot more about it.

[Haiku]

From a financial point of view, there is little to complain about in that case.

 

 

And that right there is, I believe, the crux of people's differing opinions on healthcare. For some, it's all about money (I am not saying you hold this opinion).

 

The thing is, the entire point of insurance is that the healthy pay for the sick. The health insurance company will collect far more than $5 million from people who end up costing them far, far less than that. It's not about "what I pay versus what I get back." It's about resources being pooled so that individuals have access to something they couldn't afford on their own.

 

Our cap is $2 million. One of my children could easily go through that if this child were to get sick. And then what happens? If that child survives, the current insurance will no longer cover that child. And that child will not be eligible for insurance through another plan ... what company would cover someone who already maxed out their benefits with another plan? And our state does not have "insurance of last resort" for those who can't otherwise obtain care. In our state, if you are denied insurance, oh well!

 

I think people need to get over the idea that insurance is an individual thing with individual costs and returns.

 

Tara

[ma23peas]

I think you're terribly naive...there are many,many people working a 40 hour week that can barely make ends meet, even without all the extras you mention. One doctor visit for me costs over $400, I do not have a cell phone, my utilities are not 300, and there's no way I could have a land line for $20. You seem to be making so many assumptions based on your little slice of life, without even realizing all the different situations out there. Where's the logic in that? It seems to be for many, just the opposite of your last sentence...it's about what I have, and to hell with anyone else.

 

Let's get nitpicky, my husband is working 80 hours a week and we have just enough to pay our bills, nothing extra...we have had 2 house payments for 2 years...no bailout for me...just because your doctor visit costs $400 doesn't mean mine didn't cost $65...you can have Vonage/Packet 8 for $20 bucks a month, I've done it, I know. It's not my little slice of life it's the hundreds if not thousands of people I know...$300 for utilities is a number plucked to cover everything, water, utilities, garbage, electricity, etc. It's not to h*** with everyone else, it's TAKE CARE OF YOURSELF!!! Don't expect your neighbor to do it for you. Our country was designed to let charitable organizations and churches help those who can't help themselves....my parents could not afford car insurance when I was growing up (before it became a law you HAD to have it) we had an accident and had to pay a lot of money, did anyone come in and bail us out?? Life is tough, do your best, stay in school..take the good with the bad, all these examples many of you are pulling do not TOUCH the 80% of cases that are handled excellently and families that still have members due to excellent health care...my parents just had 2 surgeries this year, without them they wouldn't be here...I truly believe it would have been years before they had them in other countries b/c both were considered elective, but in BOTH cases, when they got in there the surgeon found problems in both of them that they said my parents could have died quickly had they not had it....

 

Life is tough, it's not a handout.

[Lovedtodeath]

And that right there is, I believe, the crux of people's differing opinions on healthcare. For some, it's all about money (I am not saying you hold this opinion).

 

The thing is, the entire point of insurance is that the healthy pay for the sick. The health insurance company will collect far more than $5 million from people who end up costing them far, far less than that. It's not about "what I pay versus what I get back." It's about resources being pooled so that individuals have access to something they couldn't afford on their own.

 

Our cap is $2 million. One of my children could easily go through that if this child were to get sick. And then what happens? If that child survives, the current insurance will no longer cover that child. And that child will not be eligible for insurance through another plan ... what company would cover someone who already maxed out their benefits with another plan? And our state does not have "insurance of last resort" for those who can't otherwise obtain care. In our state, if you are denied insurance, oh well!

 

I think people need to get over the idea that insurance is an individual thing with individual costs and returns.

 

Tara

My state has the insurance of last resort. I paid $1500 for it over 3 months and it covered nothing. All was considered pre-existing or not medically necessary.:glare:

[muffinmom]

And that right there is, I believe, the crux of people's differing opinions on healthcare. For some, it's all about money (I am not saying you hold this opinion).

 

The thing is, the entire point of insurance is that the healthy pay for the sick. The health insurance company will collect far more than $5 million from people who end up costing them far, far less than that. It's not about "what I pay versus what I get back." It's about resources being pooled so that individuals have access to something they couldn't afford on their own.

 

I think people need to get over the idea that insurance is an individual thing with individual costs and returns.

 

Tara

 

 

What you have described here is socialized medicine. That is not what insurance purports to be.

 

When you enter into an agreement with an insurance company, you are taking the risk to pay premiums with the promise of a payout should a catastrophe occur (you are willing to pay a smaller amount now for a bigger payout later...you are counting on avoiding catastrophe). The insurance company is taking the risk that you will stay healthy longer and that you won't be in need of their payout (hence, the unwillingness to cover certain health issues). I'm not defending insurance companies, but just trying to point out that they are what they are, and we shouldn't expect them to be something else. Could they make improvements? I feel sure they could, but this is what we're dealing with at the moment.

 

If you feel your insurance has not kept their agreement that you signed, then you can go to your state's Dept. of Insurance to file a complaint.

[Carol in Cal.]

 

 

If you feel your insurance has not kept their agreement that you signed, then you can go to your state's Dept. of Insurance to file a complaint.

 

 

This is true, but, I think it's barbaric to deny care to a sick person, and then to require them to turn to the government to get it. It delays things to the point where the simple becomes serious, and it's kicking someone when they're down, which is deplorable.

[NoPlaceLikeHome]

This is true, but, I think it's barbaric to deny care to a sick person, and then to require them to turn to the government to get it. It delays things to the point where the simple becomes serious, and it's kicking someone when they're down, which is deplorable.

 

:iagree: The lady who had her insurance cancelled due to undisclosed acne, I believe, on the Friday before her Monday morning mastectomy for cancer, had to fight for months to get her insurance back causing a delay in treatment. These sort of things can mean the difference between life and death for the person whose insurance is cancelled and more profits for the insurance company:glare:.

[angela in ohio]

There are two issues with the health care debate that get us to where we are today. One is a cause, the other is a problem we must deal with before we can solve it:

 

1.) The current crisis with health costs and insurance started primarily because of government intervention. In the early 40's, wage freezes (caps) by the government caused labor unions to look elsewhere for ways to negotiate higher compensation packages. Health insurance plans are one of the things they decided on. It is all a spiral down from there (or up, as the costs go...)

 

2.) We have come to a point where we have the ability to cure many things, but at a great cost (a true cost, too, not just an inflated cost.) We haven't had the conversation in this country about how to balance those two things. Do we continue to cure everything, no matter what the cost? Who pays for that? Medical advances keep coming, how we are going to decide when the cost is too high?

[NoPlaceLikeHome]

This is the first time I have heard anyone talk about maxing it out. Thank you. I was wondering why no one had mentioned it.

 

Yes it is true there are usually lifetime caps of 1 to 5 million for the insured person and sometimes even annual that is less than that. I know from working in ICU, that a person can use that lifetime cap very quickly and then I guess they are out of luck:001_huh:. I took care of many people who spent months in intensive care units which is very, very expensive.

[Carol in Cal.]

I have never heard of anything as barbaric as this happening in the US. In my understanding, here it's more an issue of the insurance not paying for it, than the doctors refusing life-saving care. There is a big difference between going into large amounts of debt because an insurance company wouldn't pay for treatment, and being denied the treatment altogether, by health care professionals, and resigned to death. If this were happening in large numbers in the US, I do think we'd be hearing a lot more about it.

 

There was a female doctor who was on Rachel Ray this year--OK, a DOCTOR; presumably someone who makes a fair amount of money, and who knows what's what with medicine. She was on for human interest--I guess she had promised to make a friend of hers' daughter a wedding dress, but when she got lung cancer (as a non-smoker), she couldn't do it, and some designer got wind of this and made the daughter this gorgeous dress.

 

I looked into her story a little more, and she has been having chemo for quite a while, and the insurance company won't OK the chemo combination that her doctor recommends and that she knows would be the most effective, so she had to settle for a lesser type. She cannot afford to pay for the better chemo medicine herself. She is dying.

 

This is so, so crazy.

 

Erica, if it was just a simple decision not to cover some drug, and the drug was even remotely affordable, I wouldn't feel so strongly about this, but many drugs are so crazily expensive now that a denial of drug coverage amounts to a denial of care.

 

I think it's reasonable to debate whether the health care proposals are right or not. I see some real problems with all of the plans that I have seen; particularly in the area of end of life care. But, I am, frankly, ashamed that we don't have a better system overall. I'm embarrassed that health insurance issues dominate career and entrapeanorship (sp) decisions to the extent that they do. I don't think it's right for something so fundamental and critical to be so difficult to get and keep, and so tremendously expensive and unreliable. I don't know what the answer is, though.

Edited September 13, 2009 by Carol in Cal.

[calandalsmom]

We had in our parish an 18 yo boy suffering from leukemia who had reached his lifetime max and needed a procedure. They needed cash in hand to get the procedure.

http://mauzysmusings.blogspot.com/2008/05/michael-treinen-loses-his-leukemia.html

 

The story is there.

[NoPlaceLikeHome]

There are two issues with the health care debate that get us to where we are today. One is a cause, the other is a problem we must deal with before we can solve it:

 

1.) The current crisis with health costs and insurance started primarily because of government intervention. In the early 40's, wage freezes (caps) by the government caused labor unions to look elsewhere for ways to negotiate higher compensation packages. Health insurance plans are one of the things they decided on. It is all a spiral down from there (or up, as the costs go...)

 

2.) We have come to a point where we have the ability to cure many things, but at a great cost (a true cost, too, not just an inflated cost.) We haven't had the conversation in this country about how to balance those two things. Do we continue to cure everything, no matter what the cost? Who pays for that? Medical advances keep coming, how we are going to decide when the cost is too high?

 

I am not sure if I agree since I am not sure if wage caps were ever instituted by our government:confused:

 

Second, I am not sure that we are paying true costs for many medical expenses since there is a tremendous amount of profits and huge salaries that have to be factored in from drug makers, device makers, health insurance executives, etc. Why is it our drugs are so expensive? There is valuable research going on in Canada and other places with universal healthcare. Why is it the last administration made sure that Americans could not import drugs for significantly cheaper from Canada, England, etc.? This is American and I cannot understand why we are not free to buy drugs from overseas if we want.

[Carol in Cal.]

We had in our parish an 18 yo boy suffering from leukemia who had reached his lifetime max and needed a procedure. They needed cash in hand to get the procedure.

http://mauzysmusings.blogspot.com/2008/05/michael-treinen-loses-his-leukemia.html

 

The story is there.

 

The key word is 'had'. The boy is dead now. How horrible.

[Janet in WA]

 

I have never heard of anything as barbaric as this happening in the US.

I'm not arguing with you, Erica. Your comment just prodded me to comment that late term abortions are at least as barbaric, and they happen every day in the US.

[LMA]

This thread is fascinating to me. My only 10 cents worth is based on dealing with Medicare. Having a mother whose care is decided by what Medicare will pay, I will not support a universal health care plan until Medicare is fixed up. There is so much waste and overcharging. No one cares either. I have numerous examples from her care from tests to home equipment to doctor visits. All I can say is that she is invited to stay another night in the hospital for every ER visit because Medicare will pay for it. Yes, there is a lifetime cap with Medicare and the gap insurance so having a universal plan will not guarantee that there is no lifetime cap.

 

Louise

[Karen in CO]

 

2.) We have come to a point where we have the ability to cure many things, but at a great cost (a true cost, too, not just an inflated cost.) We haven't had the conversation in this country about how to balance those two things. Do we continue to cure everything, no matter what the cost? Who pays for that? Medical advances keep coming, how we are going to decide when the cost is too high?

 

I think this is a wonderful point that has been missed in the nitpicking in this part of the thread.

Edited September 13, 2009 by Karen in CO
who knew there was a right way to spell nitpicking?

[NoPlaceLikeHome]

Let's get nitpicky, my husband is working 80 hours a week and we have just enough to pay our bills, nothing extra...we have had 2 house payments for 2 years...no bailout for me...just because your doctor visit costs $400 doesn't mean mine didn't cost $65...you can have Vonage/Packet 8 for $20 bucks a month, I've done it, I know. It's not my little slice of life it's the hundreds if not thousands of people I know...$300 for utilities is a number plucked to cover everything, water, utilities, garbage, electricity, etc. It's not to h*** with everyone else, it's TAKE CARE OF YOURSELF!!! Don't expect your neighbor to do it for you. Our country was designed to let charitable organizations and churches help those who can't help themselves....my parents could not afford car insurance when I was growing up (before it became a law you HAD to have it) we had an accident and had to pay a lot of money, did anyone come in and bail us out?? Life is tough, do your best, stay in school..take the good with the bad, all these examples many of you are pulling do not TOUCH the 80% of cases that are handled excellently and families that still have members due to excellent health care...my parents just had 2 surgeries this year, without them they wouldn't be here...I truly believe it would have been years before they had them in other countries b/c both were considered elective, but in BOTH cases, when they got in there the surgeon found problems in both of them that they said my parents could have died quickly had they not had it....

 

Life is tough, it's not a handout.

 

So it you down on your luck, it sounds like you may end up dying:001_huh:

 

We have already heard from posters in other threads who had do deal with a loved one's cancer and catastrophic bills and no charities stepped up to the plate. I read of one lady whose husband was layed off from his job the day she found out she had cancer. They were not eligible for COBRA since her husband's company was small. They tried buying health insurance on the individual market without success since they were turned down. She paid for her mastectomy with her life savings to the tune of about $20,000. She asked every charity in the book for help in paying for chemotherapy with no luck. She has gone without chemotherapy for over 5 months since she cannot get it without the money:001_huh:They have both been trying to find jobs with insurance and no luck. It does not help that they are in their 50's and age discrimination is now rampant:glare:

 

Many people do live frugal lives and work hard and still cannot make it. many cannot get jobs. Many with health insurance go bankrupt to medical expenses. Sure there are irresponsible people but I do not think this applies to everyone. Even if some are, we all make mistakes. So if something happens, do we just kick them to the curbside and let them die? That will teach them:confused:

[NoPlaceLikeHome]

I'm not arguing with you, Erica. Your comment just prodded me to comment that late term abortions are at least as barbaric, and they happen every day in the US.

 

Really I do not know if this is true since the states have laws regulating 3rd trimester abortions and from what I understand, I could be wrong, there is only one provider in the U.S. who does that now from what I read. Frankly, I also think it another topic since it is against the law for federal dollars to be used for abortions and there is no intentions of changing that as well.

 

BTW, I believe life begins at conception and the abortion should be very rare and legal.

Edited September 13, 2009 by priscilla
clarify

[lionfamily1999]

Really I do not know if this is true since the states have laws regulating 3rd trimester abortions and from what I understand, I could be wrong, there is only one provider in the U.S. who does that now from what I read. Frankly, I also think it another topic since it is against the law for federal dollars to be used for abortions and there is no intentions of changing that as well.

 

BTW, I believe life begins at conception and the abortion should be very rare and legal.

It is illegal for citizen money (tax dollars) to be spent on anything covering abortion. Of course, in the bill in DC they conveniently forgot that. They're willing to cover or help cover ins. costs for people using companies that would cover abortion. IOW, they'd pay for coverage for someone with a company that covers abortion.

 

Just so you know. :)

[Janet in WA]

Really I do not know if this is true since the states have laws regulating 3rd trimester abortions and from what I understand, I could be wrong, there is only one provider in the U.S. who does that now from what I read.

Do some research. I think you will be surprised at the actual number of late term abortions that are performed every year. I won't quote numbers here because they vary according to the sources. But every source quotes many times enough for them to occur "every day".

 

Frankly, I also think it another topic since it is against the law for federal dollars to be used for abortions and there is no intentions of changing that as well.

I'm not sure why you think this is another topic. The article linked by the OP addressed medical ethics and the law, not federal dollars. Edited September 14, 2009 by Janet in WA

[Haiku]

The insurance company is taking the risk that you will stay healthy longer and that you won't be in need of their payout

 

But if they do pay out, the money comes from the pool of everyone who pays premiums.

 

Tara

 

ETA: Sorry, I didn't mean to edit this post but I somehow made it vanish. I tried to restore it to its original.

Edited September 14, 2009 by TaraTheLiberator

[LizzyBee]

Really I do not know if this is true since the states have laws regulating 3rd trimester abortions and from what I understand, I could be wrong, there is only one provider in the U.S. who does that now from what I read. Frankly, I also think it another topic since it is against the law for federal dollars to be used for abortions and there is no intentions of changing that as well.

 

BTW, I believe life begins at conception and the abortion should be very rare and legal.

 

In many states, 3rd trimester abortions must be done in a hospital rather than a clinic, but other than that, they're unrestricted. My oldest sister was a labor/delivery/newborn nursery nurse for over 30 years in a downtown Baltimore hospital. Their policy was that they'd do abortions as long as the mother was not in active labor. Sometimes those aborted babies were born alive, but no-one was allowed to provide any care whatsoever. They could not even hold the babies while they died. It seems to me that a person would lose a piece of their soul every time they participate in or witness that.

[Cindy in the NH Woods]

what would happen in America to someone who had no insurance? we hear stories all the time of people in America that are turned away from hospital and get no treatment because they have no insurance.

 

Not trying to be snarky at all, but.....

 

When our son was in the NICU as a very premature baby, he received the exact same care (we had private health insurance) as the preemie girl baby from a single mum with no health insurance. The same nurses, the same supplies, the same neonatologists.

 

Our NICU nurses had many stories of caring for preemies born to women on crack, etc. and these babies were not denied care. I don't mean to overgeneralize, but I still believe the U.S. offers some of the best health care in the world. And for now, the US maintains the ethic of treating those with medical emergencies, unlike the recent report of a poor Zambian woman who gave birth to a breech baby on the steps of a hospital that would not admit her due to a nurses' strike. (The baby died.)

 

Just a few of my observations...

[Lovedtodeath]

I haven't had insurance for most of my married life. I just tell them to bill me and we pay a little bit at a time. They inform me of ways that I can bring the bill down if I ask them, but other than that I get the same care.

 

My mom who is on a charity program definitely does not. She has to wait years for surgeries to be scheduled. I think she'd be better off not having anything at all and telling them to bill her.

[Renee in NC]

Not trying to be snarky at all, but.....

 

When our son was in the NICU as a very premature baby, he received the exact same care (we had private health insurance) as the preemie girl baby from a single mum with no health insurance. The same nurses, the same supplies, the same neonatologists.

 

Our NICU nurses had many stories of caring for preemies born to women on crack, etc. and these babies were not denied care. I don't mean to overgeneralize, but I still believe the U.S. offers some of the best health care in the world. And for now, the US maintains the ethic of treating those with medical emergencies, unlike the recent report of a poor Zambian woman who gave birth to a breech baby on the steps of a hospital that would not admit her due to a nurses' strike. (The baby died.)

 

Just a few of my observations...

 

The other baby was most likely covered by Medicaid.

 

Another piece of info - if your bills exceed your income and you have no assets left (other than a small amount allowed), Medicaid will pay your medical bills.

 

Now, Medicaid may not cover certain procedures or protocols, but you will get at least some care.

[muffinmom]

But if they do pay out, the money comes from the pool of everyone who pays premiums.

 

Tara

 

Not exactly sure what you are trying to say here.

 

The money also comes from dividends from investments.

 

The pool is not necessarily all healthy people. The insurance company has to be able to pay out to ALL of those who become sick, not just one or two (there are govt. requirements that insurance companies must have to have a certain amount of cash on hand for such eventualities).

[Murphy101]

I haven't had insurance for most of my married life. I just tell them to bill me and we pay a little bit at a time. They inform me of ways that I can bring the bill down if I ask them, but other than that I get the same care.

 

My mom who is on a charity program definitely does not. She has to wait years for surgeries to be scheduled. I think she'd be better off not having anything at all and telling them to bill her.

 

I hate insurance be it govt or private. Whether paid via company or individual it all reeks and provides more triage care than preventive health care IME.

 

I'd be curious to know how you handle major and continual expenses?

[Haiku]

The money also comes from dividends from investments.

 

The pool is not necessarily all healthy people. The insurance company has to be able to pay out to ALL of those who become sick, not just one or two (there are govt. requirements that insurance companies must have to have a certain amount of cash on hand for such eventualities).

 

Yes, I know that. But the reason that insurance companies exist is because of the fundamental assumption that they will make more money in premium collections--->investment income than they will have to pay out. The assumption is that more people will need less care. Insurance is based on pools of clients.

 

Tara

[Lovedtodeath]

I hate insurance be it govt or private. Whether paid via company or individual it all reeks and provides more triage care than preventive health care IME.

 

I'd be curious to know how you handle major and continual expenses?

Well, we managed the 20,000 hospital bill for my pregnancy, complications, and son's birth by making small payments. We still are, obviously. My $500 and $700 a month medication we just paid for. The doctors involved all get small payments as well.

 

Now I usually use a Naturopath. The EDS will find anything and everything for a one time fee. That is much less expensive than getting a round of several expensive tests from the Medical Doctor that are inconclusive.