Insurance companies cooking up ways to standardize cancer care:

Kaara

WhiteRabbit:  That, and we rid ourselves of lobbyists and special interest groups in Washington who are paid big bucks to lobby in favor of the big corporate giants, including but not limited to insurance, tobacco, pharmaceuticals, firearms, etc.  The foxes are in the hen house!

Wabbit

I should mention that it has gotten more and more popular in my area for employers to offer a set amount of money per month to employees as a health insurance benefit.  They only have to show that they have purchased health insurance and the $$$ are included in their paychecks. 

This would blend in with the ACA very well.  Makes sense to me ... saves small employers the hassle of dealing directly with insurance for one thing. 

Mardibra

I have to add that my employer supplements my healthcare.  So, although I only pay $1,200 my employer pays some too.  

Yes, there are Massachusett state requirements for pre-existing conditions, etc. just as you mentioned.  But, my comments were related to my day to day care, my BC care, and the cost to me.  I dont believe I would get a better deal with a government plan...state or Fed.  Plus, the state and the Fed are not interested in providing me with healthcare because I already have it.  Their goal (a good one) is to provide healthcare for the currently uninsured.  A friend of mine was layed off a while ago and therefore has no health insurance but needs it because of health issues.  She had the choice of either paying the $1,000 penalty to the state for not having insurance or buying insurance from Commonwealth Care, the state, at more than $500/month.  Granted, there are different plans she could choose from with different deductibles, etc. but her situation has her paying far more than I do.  Now where is the benefit in that?  $500 a month to someone is unemployed is a lot of money.  She is using her retirement assets to pay for it and its not great coverage.  So, when people think of government healthcare they think "free".  Not so in Massachusetts.  Again, I will stick with what I have.

Wabbit

Kaara ... agreed!   Money talks ... we need to get corporate money out of our political process IMO. 

crazy4carrots

WR -- I considered that she perhaps has health insurance through her employer, but the way it was written seemed as though she secured her insurance on her own.  As part of what we call employee benefits here, the employer generally picks up the entire cost, so there is no payout unless, of course, one visits the chiropractor more times than the coverage has allowed.

Just to add a thought:  when the U.S. employer  provides health insurance benefits, the employee receives a reduction in pay equal to the cost of the benefit.  A few studies have shown that here, under universal healthcare, the extra taxes we pay are less than the reduction in salary in the U.S.

crazy4carrots

Sorry, I took much too long in posting!!

Mardibra, it seems, when discussing your friend, that you are really comparing apples to oranges.  You have coverage through your employer.  Your friend does not.

 

IMHO, it appears that the universal healthcare we enjoy is far superior to Romneycare.  But again, maybe small steps are the answer..... 

Mardibra

very true...if i lose my job i lose my health insurance.  I work for a company that employs approx 1,800 employees.  As a mid sized company they couldnt attract/retain employees without offering healthcare benefits so I dont see them suddenly deciding to eliminate healthcare benefits.  The only companies I know of that do not offer some form of healthcare are small businesses with less than, say, 10 employees.  In my line of work, there are no small businesses...only mid and large.  So for ME, I dont have that worry.  Therefore, I would like to keep the healthcare I have because I feel that is the best for ME.  Would I feel differently if my situation were different?  Maybe, I dont know.  Never been there.

Mardibra

I think the Canadian system is definitely far better than Commonwealth Care (aka Romney Care).  My point in illustrating my friends situation is to point out that Commonweal Care isnt all that great and certainly isnt cheap.

Mardibra

Regarding the US reduced pay vs. Canadians.  Very possible....

To clarify, I do have insurance through my employer.  That group plan is what offers me the better pricing.  Commonwealth Care is attempting to do the same thing by offering several pooled healthcare plans.

Wabbit

Linda ... true ... an employer considers those $$$ paid out for health insurance as part of your compensation.  I'm not surprised it would be less in a universal system ... large groups are always more economical and have more bargaining power.   

Wabbit

mardibra ... the benefit for your friend honestly is in the fact that she 'needs insurance for health issues'.  People with pre-existing conditions of any kind (which is every one of us on this board) could not buy private health insurance ... they simply would not sell it to you at any cost.  It's the difference between having something, and some choices, and being left totally without any options other than maybe selling everything you owned to pay medical bills until you had nothing left and could qualify for Medicaid.  Dismal huh.

$500 a month is not cheap.  But ... my coverage is just for me and between my contribution and the employer contribution is at least $800 per month (that was from awhile back, I'm too lazy to go check again now).  So ... it does not seem unreasonable for the private insurance market we have to work within. 

Mardibra

Whats the best answer?  Hell if I know.  

Anonymous

The original post on this thread is about insurance companies looking to control costs by developing treatment guidelines.  Another way of putting it is that they are looking for ways to ration care while making it look as though they are "helping" their clients.  Just a little slight of hand.

Debating the pros and cons of various government interventions, we seem to have lost sight of the fact that universal insurance coverage should not be the goal, universal access to quality affordable care is what we should strive for. 

If you have paid for a lousy insurance policy with a company that denies your claims, you may be worse off than someone who doesn't have insurance, but still has the money that you spent on insurance premiums to pay for at least some of those medical bills.  There are also programs that are set up to help people with no insurance, but not those with lousy insurance.

Virtually every government entitlement program currently in existence is rife with fraud and abuse. There is no reason to believe that Obamacare will be exempt from that.

Mardibra

"Virtually every government entitlement program currently in existence is rife with fraud and abuse. There is no reason to believe that Obamacare will be exempt from that."



My thoughts exactly.

crazy4carrots

Patmom - you wrote:

universal insurance coverage should not be the goal, universal access to quality affordable care is what we should strive for. 

I'm curious:  If healthcare isn't going to be paid for through those nasty insurance companies, nor via government programmes fraught with corruption, then what is the secret mechanism for ensuring universal access?  Or universal affordability? 

LtotheK

Call it a coincidence:  flew about 2 months ago, and basically had this exact conversation in the article with a health insurance exec.  The chatter is, the system cannot sustain $250,000+ treatment costs per patient.  She talked a lot about the move to preventative care to drive cost down (sheesh, they are only a decade or two behind what advocates have been saying for ages).

Yes, they already do a ton to standardize.  My fight for MRI is a classic example.  Now they are saying ultrasound/MRI should be standard of care for dense breasted women.  This is very sad in my case, as I had mammography without MRI for years that missed my tumor.  

Kaara

kayb:  Wellness care would certainly be an asset to our current health care programs, but I won't hold my breath expecting it to happen in my lifetime.  I can't even get a yearly checkup under Medicare...I have to "invent" an illness in order to go once a year and get a physical and bloodwork done...that is absolutely stupid!  They should just go ahead and approve the once a year physical and be done with it....how dumb do they think the public is.

There are all kind of things that I am doing and paying for out of my own pocket to keep my body in optimal condition to fight a recurrence of bc.  I'm saving the insurance companies thousands of dollars that they would otherwise be paying out for radiation and chemo which I want no part of. 

Anonymous

Most hospitals in this country are given tax-exempt status.  How about in exchange for those tax breaks, using a percentage of their income that is lower than, but still in the ballpark of what their tax liability would be, those hospitals provide care at low or no cost to the community they serve ?  In some communities that would mean setting up a walk in care clinic, in others it would mean running community events like health fairs, and for some, the best way to meet the need would be to significantly discount or forgive the bills of low income patients. 

There are many ways to meet the situations of various communities.  What we don't need is top down micromanaging rules and regulations from the Federal government that provides what some lobbyist from the drug or insurance industry has convinced some legislators is important rather than what a local community actually needs.

Let's get creative and lose the one size fits all attitude.  It doesn't work well in clothing, and it works even less well when applied to health care.

alexandria58

It's funny to me that so many of the people who object to "government" involvement in healthcare don't seem to have any objections to Medicare. 

The idea that local communities need different things may be true, but how much difference is there really between a cancer patient in Omaha and a cancer patient in Nebraska.  Both may need surgery and expensive drugs, with long term follow-up.    

Walk-in clinic exist for the poor exist but they do not cover the need, nor do they provide the consistent long term care that is important to.  Also discounting the bills of low income patients doesn't really account for that fact that many of the people who wind up bankrupt because of the cost of a major illness were not low income to begin with.

A system that depends on employers providing health insurance is broken to begin with.  Mardibra, you state that a midsize company that doesn't provide health insurance wouldn't attract employees.  Really?  Have you taken any notice of the economy?  Before I developed BC, I worked per diem for the state of NJ, probably the largest employer in the state, but because I was per deim, I didn't have health insurance as an option.    More and more companies are hiring "consultants" and "per diems" and in a depressed, yes, it is a depression, economy, people will take those jobs.  If they're well enough to work.  When they get sick, they lose their job - as I did.  If they're not as fortunate as I was to ahve a working spouse with insurance, they spend all their money or - unfortunately often, with people struggling to support their families - don't go in to get something checked until it is so far along that it's too late.    

crazy4carrots

PatMom -- Have you heard the term "economies of scale"?  A major reason why healthcare costs are lower in every other industrialized nation is because governments negotiate with suppliers -- pharma, high-tech equipment, lab supplies etc. -- so that they enjoy those economies of scale (e.g. lower prices).  Regardless of the fact that your suggestion means people who live in wealthy communities would get better healthcare than those poor folk who live in struggling communities would get, individual hospitals would find it incredibly difficult to keep their costs under control.  

 

There are purely economic reasons for single-payer, just as there are moral reasons.   That's why every other first-world country has far lower health costs than the U.S.

crazy4carrots

Do any of you remember Wendell Potter, the former Cigna Executive who turned whistleblower?

 

For about 20 years, Potter provided public relations for insurance giants Humana Inc. and CIGNA, where he worked his way up to head of corporate communications. He worked in high-rise corporate suites, flew on corporate jets and dutifully created corporate talking points.

His awakening occurred in 2007, when he drove to a community health fair in an Appalachian town near his hometown. His eyes opened to the spectacle of hundreds of people lined up for basic medical care in tents and barns, some lying on gurneys in the misty weather. To see so many people either too poor to afford insurance or unable to buy it at any price, he wrote in his book, "Deadly Spin," made him realize the health insurance business was "an evil system built and sustained on greed." 

Anonymous

I won't get into a deep discussion about the Obamacare.  And I haven't read every word of every post.  It's not worth my time.  It's the same ole same ol conversation.

I won't to know what you think of the Independent Payment Advisory Board (iPAD) set up for Medicare?  Who will be on that board?

Have you paid attention to the REAL cost of this law?  And, what happened to if you like your insurance you can keep it?  And, why all the waivers....even the unions who supported Obamacare?  And, what about the broken promise that we could read the bill before it was voted on?  And, what about the legislators who didn't read the bill....remember, we have to pass the bill before we know what's in it........(beyond the fog that surrounds....)..... can't remember those exact words.  And, what about doctors who are dropping out of Medicare?  Have you seen what Medicare pays?  What about companies who may drop their health insurance and pay the penalty?

With Obamacare telling companies WHAT EXACTLY they have to provide their employees IS government run health care.  Incidentally, my insurance company already provided those mandates that is required by Obamacare.

I do have one question for the Canadian ladies here.  Why did the Canadian government decide it was a must to pull Baby Joseph off the ventilator instead of doing the trach his parents wanted?  Who's decision should that be?  Was it because of the cost?  I can see no other answer. 

mardibra, good luck in defending your position.  You are outnumbered. 

alexandria58

Shirley,

    Aren't you lucky to have a job and an employer who provides health insurance?  What makes you think, though, that it's your decision to keep what you've got?  Regardless of whatever Obama and Congress passed.  Your employer can change or even drop the insurance at any time, and employers were doing it even before the ACA passed. that's one of the reasons that fewer and fewer people have health insurance.  My husband's employer changes insurance all the time - changes our deductibles - who is in and out of network, and there is nothing we can do about it.   

     Oh, and if the ACA gets tossed and your employer decides to give a $20 million dollar bonus to the CEOrather than offer health care to employees, good luck in buying insurance on the private market with a history of cancer.  

    So the ACA isn't perfect, and there are provisions I don't like, but it at least it is a step in the right direction.

    

RetiredLibby

For those retirees who are happily enjoying great benefits from their or their spouse's former employer, do the words "General Motors" ring any bells? GM retirees enjoyed great health insurance benefits until GM decided they had to discontinue them to help the company remain solvent. So *poof* no more benefits. And I know this because a high school classmate of mine retired from GM -- and developed MS. *poof* No health insurance. She is completely disabled. Her husband, a policeman, had to continue working after being struck and dragged by a suspect and spending 6 months in the hospital just to keep his insurance for his wife. Two heart attacks later, he finds he must retire or die -- and the state in which he works (which is proudly cutting benefits and pay for state employees) does not allow him to carry his health insurance into retirement. They are both under 60. They make too much in retirement income to qualify for medicaid. They are bare inches from complete bankruptcy -- and now states seem to be changing their laws to allow imprisonment for debt. Google "Lisa Lindsay" in IL for that story. It could be any one here.



And then there is Remote Area Medical - www.ramusa.org -- an organization originally established to provide medical services in Third World countries. It now spends most of its time on missions in the United States providing medical care to people who would go without -- and some would die. They provide clinics for thousands at mass venues like fairgrounds, arenas, coliseums, the Bristol Motor Speedway ... To provide medical and dental services for people who would otherwise not receive any care at all. Ever. We live in the richest country in the world and we are allowing people to receive medical treatment in horse barns at fairgrounds. Lindasa, Wendell Potter's change of heart came after he observed one of the RAM clinics in Wise County, VA.



Anyone here who relies on employer-paid insurance is one decision, one cost-cutting move away from no health insurance at all.

Kaara

The bill that passed and is better known as "Obamacare" is nothing like the original health care proposal that was systematically taken apart by congress piece by piece until there was nothing of value left.  What was left is a bill with a thousand loopholes for big insurance to continue doing what it has always done with few exceptions.  This will not benefit the masses.

If Romney is elected, I hope his first goal will be to recall that bill and do some reform efforts on our national health crisis.  It is shameful that the richest country in the world treats their people the way we do here in America. 

Mardibra

It's not realistic to think that my employer is going to drop health insurance. For them, that would be crazy. Might they increase my cost for that insurance? Sure. Will it always be competitive? Yes.



If they ever did decide to eliminate my insurance, I can buy insurance on my own BC or not. The one good thing about Mass laws...no such thing as pre-existing conditions.



ShirleyHughes - I'm way outnumbered.

rosemary-b

People retired from GM thinking their health insurance would never be taken away.  Many of them retired early and then had years of no coverage before they qualified for Medicare. Individual health insurance policies are very expensive.

alexandria58

Also, the Obama plan that Mardibra dislikes so much is modeled on the Mass law under which she has the ability to buy private health insurance despite having had breast cancer.  People in most other states, absent the ACA, are not so lucky.

RetiredLibby

Let's not forget all of those hundreds of thousands, if not millions, of workers who retired from companies that subsequently went bankrupt and liquidated their pension plans (not to mention their health insurance policies). Those people are now paid fractions of their promised (and earned) pension benefits with your tax dollars through the Pension Benefit Guaranty Corporation. Just ask any retiree United Airlines pilot. Many companies declare bankruptcy and "reorganize," shedding their pension obligations in the process and the PBGC has to step up. Nobody thought TWA, PanAm, or Eastern Airlines would go belly-up, taking pensions and health insurance with them.

Mardibra

Im not retired, im still working.  So, my insurance is in place and will likely remain in place as long as the company is in business.  

Im not understanding all the hostility.  I outlined in an earlier post why my current situation is far better and cheaper than anything I could expect on national healthcare as it is currently proposed.  Therefore, why would I want national healthcare?  Not everyone...ME.  

As someone who works in financial services, I could go on and on about GM and others.  But, im sure I will experience more hostility so why bother.  Do I think its right that folks were promised a retirement benefit and didnt get it? Hell no.  But im not attempting to chat about that point.  My current situation is fine and I would like to keep it that way.  Simple for me.