My insurance, Blue Cross, has started a new thing recently - 

Whenever you call them, before you are connected to a person you get a recording that says basically, nothing that is said in the call guarantees benefits -

AND the claim must be processed before the final decision of whether or not to pay will be made! 

So they've decided you first have to  go get the service, make a claim and only then will they tell you if it will be paid or not.  

I do not have the opportunity to vote with my feet about this outrageous policy by picking a different insurer.  It's employer provided, no alternative, no opt out.  

These companies just kept  getting bolder and  bolder with their greed and poor service, because the public had no choice. 

Thank goodness the public has had enough and is finally pressuring for change. 

07rescue wrote: ... terms are opaque and they regularly imply coverage for services and then deny it when claims are made.

Hi Pitanga,

Great point about the petition.  I will send an e-mail and mention it.  Thanks for pointing that out.

Shirley, I have already seen the Wall Street Journal piece you posted, along with a slew of other similar peices from the US radical-right media, all from the month of August.

But the Wall Street Journal is not a Brazilian publication.

I repeat, there is nothing in the BRAZILIAN press about this, and 2 billion US smackeroos would be very big news here (in Brazil, where I am posting from). The silence on the subject here suggests that the rumor of a US handout for offshore drilling is much ado about nothing. Otherwise they would be talking about it.

.

What does whether or not the Brazilian press chooses to report about loans for offshore drilling have to do with healthcare reform in the US?

It's been nearly a year since the Presidential election, when we had promises of change drilled into our heads.   The deal is that change is a double edged sword, and can make things better, or it can make things worse.  So far, in my experience, the change has been worse.

My house is worth about 10% less than it was a year ago.  Our household income has declined by about 8%.  Has anyone experienced change driven by the federal government that has made their lives better in the last year?

Congress is bent on passing healthcare reform because anything is better than the status quo.  Well no, it's not.  I'm saying that it is time to stop looking to create change for the sake of change, and start focusing on making improvements instead. 

According to this article by the Associated Press, health insurance companies aren't as profitable as some politicians have led us to believe.   http://news.yahoo.com/s/ap/20091025/ap_on_go_co/us_fact_check_health_insurance

According to this article by The Hill, some democrats are starting to look to expand Medicare to everyone, with a small difference; they would pay doctors and hospitals more to treat people under Medicare "E" than under traditional Medicare.

http://thehill.com/homenews/house/64029-medicare-for-everyone.

Does it cost more to treat people who are under age 65? 

One of the bigger inequities in the current system is that doctors and hospitals give HUGE discounts (as much as 80%) to large insurers.  Someone has to make up the difference between the actual costs of treatment and the amount paid by the insurance.  Why don't we make some regulations that hospitals and doctors can only offer discounts that reflect their actual savings in dealing with a large entity?  They could still offer a discount if their billing costs are less dealing with a large company that pays promptly, and electronically.  If there was an arrangement that specific procedures and equipment ordered by a doctor will be covered so that staff members spend less time fighting with that company, possibly allowing a smaller staff to do the same job resulting in actual savings, that could be passed along as well.  Hospitals also have times of the year when they need every bed they have, and could fill more if they were available, and other times when the census dips.  Offering discounts for scheduling elective procedures during those times of low census would make more sense than charging vastly different rates for the same care based on who is paying.

What happens today is that hospitals and doctors offer a discount to insurers to be on the preferred provider list, and then pass the costs along to their other patients.  That is just wrong. 

About  the  health insurer profit article -  the percentage of how much profit is beside the point. What does it matter if the amount is  2% or 20%  -  if  the profit is achieved  by the  denial of claims?  The conservatives were very outspoken about creating  govt. death panels and rationing.  Yet,  point out that death panels and rationing are already happening - insurers are doing these things everyday,  and the status quo is ok?

The fact that insurance companies have been rewarding employees for withholding health care has been exposed to the public, and many of us are not going to let that get brushed aside... 

Besides, those profit numbers are very respectable. Health care (a necessity)  cannot and should not be compared to frivolities like tupperware or Jack in the Box....How much profit is "enough"? Who decides? 

 About the medicare E article - PatsMom wrote: Does it cost more to treat people who are under age 65?

The article did not say this. Rather the increase is a response to the  a conservative complaint that current medicare payments are too low, so the new bill would increase the payments.   

 PatMom Wrote: It matters because if there is only a little bit of profit, there is probably much less of an opportunity to acheive savings under a government run plan without that plan denying claims as well.

I have to respectfully disagree on several levels. 

Axing 8% off the top is not insignificant, especially relative to enormous numbers.

In addition, insurance profits are not the sole source of proposed savings.  (The article you posted also points out that other health care sectors are enjoying much larger profits than the 8% average - ie drug companies -   if the government  controls those costs, as well, the tally is getting pretty huge.)

That doesn't even begin to consider the general savings from reducing admin costs, etc. 

Patmom also wrote: I questioned if it costs more to treat people under age 65 because the proposal is to set a higher scale of payments under "Medicare E" than providers would be paid under regular Medicare.

The news I'm getting says  increases are most certainly on the table: 

Health reform bill could include Medicare payment changes

 | Posted: Thursday, October 22, 2009 10:35 pm 

A two-year study aimed at changing the Medicare payment system will be added to the House's health-care reform bill, three Iowa congressmen said Thursday...

...Braley and Reps. Dave Loebsack and Leonard Boswell, also Democrats, announced the deal Thursday. It would require the Institute of Medicine to study geographic variations in rates and recommend changes.

It also would require a study aimed at providing recommendations on changing Medicare to a value-based payment system. Medicare currently operates on a fee-for-service basis.

Many of our Senators and Reps live in Maryland at least part time, why isn't that included in any of the bills in congress?  Do they think it is already everywhere?

I also wouldn't care if they gave discounts based on actual savings, but to cost shift to smaller companies and the uninsured is criminal.  

It looks like there will be a government run option in all the proposals.  The Senate proposal looks like it will make things much worse for some people.  Their proposal is to make everyone pay into the government plan (yes, federal tax money will need to be used to get the bureaucracy in place, up and running for years before the first dime of premiums is collected) but states will be allowed to opt out.  http://news.yahoo.com/s/ap/20091027/ap_on_go_co/us_health_care_overhaul  

So some people who are struggling to pay for health care now in states that opt out of the plan will have to pay more in taxes, then be forced to either sign up for a private plan that they won't be able to afford to use, or face fines, and won't even have the option of joining the government run plan they are paying for.  That's a change, does anyone think it is an improvement?

Another brilliant piece is that they are considering adding a long term care plan which would collect premiums for at least 5 years before they pay out one penny in benefits.  http://news.yahoo.com/s/ap/20091027/ap_on_go_co/us_health_care_long_term

This would make the budget look much better during the years that this fund is building up, and if it is included in the healthcare bill, it will make that look like the costs are much less than they actually are. 

The name for this is smoke and mirrors.  We need real meaningful REFORM that will help every health care consumer, and increase the number of people with affordable access to healthcare, not merely a cost shifting scheme which is what all the bills currently in congress seem to be. 

The thing is, these bills stink so much that it will be easy for the Republicans to vote against them, and difficult to get support from Democrats up for re-election in 2010 in any district that is anything but guaranteed to a Democratic Candidate.

Yes, there are savings that can be found in health care.  Lowering, or eliminating advertising budgets, and lowering bloated executive salaries are great places to start.  I haven't seen anything in any of the proposals to do those things.  Are they there and I just missed them?

Please, I do not want to offend anybody.Doesl the policy of giving every citizen universal health insurance lead to poverty or prosperity?

 The Financial Times studied all nations on the globe and nro 1 was my country, Finland, the most prosperios country in the world. The next were also small European countries: Switzerland, Sweden, Norway, Denmark .The US was 9th, good!- So taking care of citizens brings prosperity according to The Financial Times, Oct 26th, 2009. Also schooling, access to social services add to prosperity of a nation.

Google the words Financial Times Index Finland and you will able to read the article. Cut- paste did not work.

Tirlie, Finland

Tirlie, 

Thanks for the link, and congrats on your country's high ranking, especially on healthcare. 

I liked that the chart allows viewers to look not only at overall rank, but also rank by category, including health. (Finland 7 - US 27)  

The way I understand it, there aren't many details about how the opt out would work, it's still being discussed.  There are a lot of issues with it, though, including the one you are concerned about. There is also the problem of  folks in states who opt out  migrating when they need health care, putting an unfair burden on the states that do participate. 

The whole idea might be morphing a little from the "opt out" to the "trigger" plan -

meaning, they will try to implement just putting pressure on insurance companies. But if the insurers don't shape up and show improvement, that would be the trigger for a public option to kick in. 

I guess we'll just have to keep listening to talks as they evolve.... 

Anyway, the US has all that it is take to give universal health insurance for all:

-strong sense  of unity

-great, wealthy nation

-very strong sense of  " justice for all "- sure including health, schooling ( including college, university), access to social services.

Tirlie, MD, Finland