3 Lowlights of Health-Care Reform

With health-care reform barreling forward into the law books, many Americans (including yours truly) who wanted to ignore this very important but oh-so-convoluted piece of legislation now have no choice but to take notice.

There actually is a lot to like about the bill. There are certainly feel-good elements, like extending coverage to lower-income Americans and prohibiting excluding participants based on pre-existing conditions. And as a buyer of individual coverage, I do like the idea of a national insurance exchange (even if it doesn't come online for a while).

But it ain't perfect. Earlier in the week, my fellow Fool Brian Orelli urged investors to look for investment opportunities rather than moan about the bill. That's probably smart advice, but I'm going to complain anyway.

Here are three areas where I think this hefty and historic bill falls short:

1. Bye-bye to medical underwriting
Whether we're talking about Allstate writing auto insurance or UnitedHealth (NYSE: UNH  ) pricing health-care policies, the basic process is the same. Insurers gather pertinent information on the party to be insured, and, based on actuarial number-crunching, determine the premiums they're going to charge for the policy.

Thanks to the new health bill, insurers are now hamstrung as far as what information they can use to set premiums. Specifically, they're limited to whether the plan covers an individual or family, what state rating area the insured is in, age, and tobacco use. And for the last two, insurers are limited in terms of how much they can increase premiums -- for tobacco, for example, they can't exceed a ratio of 1.5 to 1.

Medical underwriting -- that is, underwriting based on medical history and other important health facts -- will be a thing of the past.

Why does this matter? It matters because it makes everyone look very similar in the eyes of insurers. It means that two people who are similar in the categories listed above will end up paying similar premiums -- even if one person has been very reckless with their health in other ways. Without the use of medical underwriting, the reckless person will pay less than they should for insurance, while the not-so-reckless person will pay more. Nice use of incentives.

While creating stronger incentives for people to keep themselves healthy could hurt companies like Coca-Cola (NYSE: KO  ) , McDonald's (NYSE: MCD  ) , and Diageo -- all of their products aren't exactly good for your health -- it's exactly the kind of thing we need to be doing if we want to actually bring down medical costs (more on that below).

2. Thou shalt buy health insurance
Maybe it's because I haven't seen the director's cut of The Ten Commandments, but I don't remember buying health insurance being on one of those tablets. Regardless, if you're a U.S. citizen, you'll soon be required to purchase health insurance and prove it at tax time. If you don't, you'll be hit with a nice thanks-for-not-playing penalty of $750 for not having coverage for the entire year. (That level is reached beginning in 2016, after a two-year phase in.)

Particularly after the new legislation's reforms kick in (which for the most part is 2014), it may be a pretty good deal for most Americans to buy health insurance. However, someone who is fit as a fiddle and rarely ends up at the doctor may still be better off paying out of pocket. But for their good health, they'll now have to cough up $750 to Uncle Sam.

To me, this seems like a government tip 'o the hat to the health-care industry. Requiring individuals to have insurance is a big benefit to health insurers like WellPoint (NYSE: WLP  ) and Aetna (NYSE: AET  ) , not to mention drugmakers like GlaxoSmithKline (NYSE: GSK  ) and Merck (NYSE: MRK  ) .

3. Cost containment called and it wonders why it's not in the bill
Back in 2008, PricewaterhouseCoopers' Health Research Institute put out a report titled "The Price of Excess: Identifying waste in health care spending." The report started by highlighting the high level of health care spending in the U.S., the low comparative results, and the poor perception of the U.S. system.

The report suggested that up to an amazing $1.2 trillion per year, or more than 50% of all health-care spending, could be attributed to wasteful spending. It then broke down that wasteful spending into three areas: behavioral (individual behaviors such as obesity and non-adherence to drug regimens), operational (inefficient administrative and other processing costs), and clinical (practitioner issues, largely the practice of defensive medicine).

While the bill takes half-hearted stabs at a few of these areas, cost containment is clearly an afterthought rather than the thrust. And in the end, that may be the biggest disappointment of all when it comes to this supposedly huge step forward in health-care legislation.

Personally, I do like the idea that more Americans will now be insured (and that actually can help lower costs), but in the coming years, one of the country's biggest challenges will be the unbridled growth of our health-care spending -- particularly if outcomes continue to trail the rest of the world.

That's just my opinion. What do you think? Scroll down to the comments section and share your thoughts on the reform.

If only there were a Warren Buffett of health care. ... Oh well, at least we have his great investing insights.

Coca-Cola, UnitedHealth Group, and WellPoint are Motley Fool Inside Value recommendations. UnitedHealth Group is a Stock Advisor pick. Diageo and Coca-Cola are Income Investor picks. The Fool owns shares of GlaxoSmithKline and UnitedHealth. Try any of our Foolish newsletters today, free for 30 days.

Fool contributor Matt Koppenheffer owns shares of Coca-Cola and McDonald's, but does not own shares of any of the other companies mentioned. You can check out what Matt is keeping an eye on by visiting his Motley Fool CAPS portfolio, or you can follow Matt on Twitter @KoppTheFool or on his RSS feed. The Fool's disclosure policy assures you no Wookiees were harmed in the making of this article.


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Comments from our Foolish Readers

Help us keep this a respectfully Foolish area! This is a place for our readers to discuss, debate, and learn more about the Foolish investing topic you read about above. Help us keep it clean and safe. If you believe a comment is abusive or otherwise violates our Fool's Rules, please report it via the Report this Comment Report this Comment icon found on every comment.

  • Report this Comment On March 24, 2010, at 2:20 PM, bob9738 wrote:

    does that mean that it is time to dump UNH?

  • Report this Comment On March 24, 2010, at 2:24 PM, TMFKopp wrote:

    @bob9738

    Good question. Actually, pretty much everything I've read suggests that on balance the reform bill will be a net positive to insurers.

    Margins will get crunched to some extent and they will face an additional annual industry fee, but they will raise premiums to cover some of that and the massive expansion in coverage will more than make up for the rest.

    It appears to me that some of the biggest losers in the bill are younger, healthier people who spend very little on healthcare.

    Matt

  • Report this Comment On March 24, 2010, at 3:26 PM, abepaul wrote:

    All good points, Matt.

    I am an actuary who returned to Canada after retirement and a divorce, because of the prohibitive cost of Health care. But once I turned 65, I had an option.

    I believe that universal health care is a good idea, but this is not it! What will happen now, without risk assessment, is that healthy people will support the sick people. A little like paying $20,000 for a car, but some will get a beat-up jalopy, others a new BMW! Fairness or equity has been ignored!

    At least under universal health care, you KNOW what the risks are, because everyone is covered!

  • Report this Comment On March 24, 2010, at 4:03 PM, badnicolez wrote:

    I am beginning to think that the entire point of this bill is to transfer wealth, whether from "rich" to "poor" or from "young" to "old." But the real question is "why?"

  • Report this Comment On March 24, 2010, at 4:33 PM, coolapeksha wrote:

    I could not agree with you more. I think the biggest problem is going to be uncontrolled health care costs. Health care reform enacted in Massachusetts was very similar to this one and the state defiict doubled in the first two years of uts incepetion. Please keep in mind that Massachusetts is a relatively wealthy state. Overall for the entire nation expense would be a lot more.

    Also, having threadbare insurance is no better than not having insurance because if your deductibles are veru high it will be very costly to use this insurance.

  • Report this Comment On March 24, 2010, at 4:42 PM, Melaschasm wrote:

    I foresee a great new Iphone app in the near future. It will come with a hand biometric reader and automatically purchase health insurance whenever your biometric readings indicate that something really bad happened.

    This way 3/4 of the people can just pay the $750 fine and then buy the insurance when they need it.

  • Report this Comment On March 24, 2010, at 4:53 PM, voelkels wrote:

    If the U.S. government wanted to reform health care, they should have started with the VA system and Medicare/Medicare, IMHO . Telling an insurance company that they have to insure a person with a pre-existing condition is like telling an insurance company that they have to sell you fire insurance when your home is on fire.

    ;-(

    C.J.V. – doubt I’ll see many companies selling health insurance in 15 or 12 years, me

  • Report this Comment On March 24, 2010, at 5:05 PM, TMFKopp wrote:

    @abepaul

    Thanks for the comment, I'm always interested to hear from people with an inside view.

    "I believe that universal health care is a good idea, but this is not it! What will happen now, without risk assessment, is that healthy people will support the sick people. A little like paying $20,000 for a car, but some will get a beat-up jalopy, others a new BMW! Fairness or equity has been ignored!"

    I guess one of the ways I've always looked at it is that in the U.S. we seem to believe that education is important enough that everyone should have tax-funded access to it. Should life-saving healthcare be different? Of course that's subject to debate depending on which side of the fence you sit.

    But you're exactly right, this is neither a perfectly private system (which would make consumers of healthcare more sensitive to the costs) nor is it a universal system. It's some zombie system in between that's going to be like a quasi-tax-funded system. That is, some people's healthcare is actually going to be funded through taxes (Medicare/Medicaid), while other people's healthcare will be funding or funded by a disjointed "private" system where healthy people pay for sick people through undifferentiated premiums.

    The more unnecessary layers you add to any system, the more inefficient it gets. I don't care what your politics are, I think most people have to recognize that a fully private or a fully public system would be better than this mish-mosh that we have now.

    Matt

  • Report this Comment On March 24, 2010, at 5:33 PM, davbeirney wrote:

    This is def the worst idea in the history of our nation. First, we dont have money to pay for it. Obama is not helping the common citizen. He wants to raise taxes and institute fees all over the place. This health reform creates more bureaus which means more overpaid government employees and pensions we cannot support. He is taking money from the rich and giving it to the poor. All these companies like CAT and MCD say this reform will cost them a fortune. Whats to stop them from firing workers to offset the costs. Unemployment will likely rise, and in 10 years 80% of the money our government takes in will go to interest payments on debt. Im not against people having health care but this is not the right plan. You can not work at all in this country and have the government hand you all the money you need. What happened to fiscal responsibility?

    Not only that but its not going to be fun being a college student considering that we now have to get a federal loan. Obama is going to charge me more than 6% compared to private companies who will charge me around 4% for a loan. All in the name for funding his agenda. He is a community organizer, who has no right to run one of the most powerful countries in the world.

    "It is better that we are all poor instead of some being rich and some poor." Thank you liberals and progressives.

  • Report this Comment On March 24, 2010, at 5:43 PM, lmax wrote:

    Some comments from someone who works in health policy:

    1. Insured patients have always paid more than their inidivudal share of health care costs based on actuarial analysis, whatever the state of our health, because hospitals add on the costs of caring for the uninsured in the most expensive setting. Insuring everyone will bring down the costs significantly, and not just health care costs.

    2. The fed stimulus bill has dumped hundreds of millions on Health Information Technology, and going forward, we will have a new world of Electronic Health Records, Health Information Exchange, and the results of Comparative Effectiveness research....all of these initiatives will reduce the costs of medicine.

    3. Do you resent the fact that you must have auto insurance, and that the price of it varies by geographic area based on the rate of accidents and their costs in that area?

    4. What every country needs is not Health Insurance, as if you might not need it like paying for fire insurance on your home, but Health Coverage, because everyone should be using health care -- especially preventive health care -- every year. We need a system of everyone paying, some needing more and some needing less each year, in order for this to work.

  • Report this Comment On March 24, 2010, at 5:56 PM, BruceStr wrote:

    The CBO reported that the health care reform act will cost $940 billion, AND reduce the deficit by $130 billion over 10 years. How do you reconcile those two conclusions? Over $1 trillion in new taxes (wealth transfers). Bad idea.

  • Report this Comment On March 24, 2010, at 5:56 PM, ScubaStClaire wrote:

    For $2.05 a day you can avoid the opportunity to have catastrophic coverage. Hopefully you will never get cancer, suffer an accident at home, have a heart attack or need a transplant.

    The $750 “tax” is way insufficient to make many young healthy individuals buy insurance. Health insurers will have to build policies designed to attract healthy individuals (i.e. or unattractive to unhealthy individuals). For example – a policy that has a low MD office copay for the first two visits per year but higher copay for additional visits. An individual who goes the doctor every month won’t buy that policy, but a 25 year healthy male who hasn’t seen a doctor in 5 years will – especially if the policy is less than $750 per year. Government regulation will likely stop the most egregious benefit strategies, but health care insurance is complicated and there are lot’s of ways to tweak the policy coverage design to attract certain ‘buyers’.

    Insurers already in the Medicare business know how to play this game because the rules for selling Medicare Part-D drug coverage don’t allow premium differences for age or preexisting conditions. Consequently they have developed new techniques for designing policies to attract the members based on other factors.

  • Report this Comment On March 24, 2010, at 5:57 PM, Shark52 wrote:

    abepaul, you wrote:

    I believe that universal health care is a good idea, but this is not it! What will happen now, without risk assessment, is that healthy people will support the sick people.

    Please explain to a slow person like me, where the risk assessment is universal health care? If everyone is covered and, assuming for the sake of discussion, that everyone can obtain the service he/she wants, is the risk assessment simply an educated guess of what the cost is going to be divided by the tax rate required to raise that amount of money? Where is the brake on spending - certainly not from the individual.

  • Report this Comment On March 24, 2010, at 5:59 PM, somodog wrote:

    This massive and complex piece of legislation is clearly not perfect (not sure we have much legislation that is) but I believe on balance contains more good than bad. I think few would argue that getting started down this path was necessary. I think we need to continue to push those that represent us to fine tune this legislation in the years ahead to incorporate more incentives for healthy living and for making smart, cost effective decisions about how we use our healthcare benefits. In the mean time, I invite all interested in lowering healthcare costs to start now by making better choices for yourself and your family (if you have one). I know I can do better and I'm guessing some of you can too!

  • Report this Comment On March 24, 2010, at 6:00 PM, kemlab101 wrote:

    Sorry Davbeirney, you've been listening to too many talking points. I only have time to correct your last statement, but hopefully others will correct the rest. You can still get a private loan. But you will not be able to get a federal loan from a private bank. You and me have been paying the banks an obscene amount of money for being rotten middle-men. This will save the govt. approx. 85 billion dollars over the next 10 years.

  • Report this Comment On March 24, 2010, at 6:07 PM, foolhardy7 wrote:

    Matt,

    Thank you for thoughtful comments (hard to come by among the over-charged, emotional diatribes that have dominated most of the news on this issue). I share your view of what's to like, and your frustrations with the result, but offer a couple more thoughts.

    First, regarding underwriting, you are correct, it is severely reduced. But when you think about it, that's the point of making health care more universal. It was the underwriting process that made the higher cost, higher risk patients uninsurable. And as Jesse Jackson often said in the past (and by the way, I am not a fan of much of what he says, but I think he's correct here), "We're a better country than that."

    The truth is, everyone who is "fit as a fiddle," to quote one of the comments, would like to pay less. But then when they find out they have a rare form of cancer, or they have a child with a congenital defect, or they have a bad traffic accident with some drunk with a 10,000/20,000 policy, and have to deal with disability the rest of their lives, then that is when we, as a society (especially one that professes often to be compassionate, Christian, etc.), should be there as the backstop to help. So that's it. We have to get over the fact that mixed in with those who have severe problems through no fault of their own, are those who choose to smoke, or choose to over-eat, or whatever. The fact that people are stupid enough to climb mountains when snowstorms are coming does not stop us from spending thousands of dollars looking for them. Ditto with those stupid enough to sail their small boats into the ocean waters without proper equipment. We spend tens of thousands of dollars looking to save them. In the end, it's worth it. It's part of the cost of a civilized society, and it is so we can deal with the people who otherwise would literally be lying at the doors of the hospitals, unable to get in.

    Now, as for cost control, again you are correct. But I don't blame those who just passed the bill for that. Remember that it began with plans for a government option (with the negotiating power that would bring), and other ideas (like extending Medicare/Medicaid benefits, with the high percentage of dollars passed through to actual care that would bring) were also tried. We have a dysfunctional political system right now, and there was no chance that programs that would cut into the business side would be passed. True "statesmen" (including women) on both sides of the aisle lament the current state of affairs, where complex issues must be decided based on sound bites that play well on the news. Similarly, efforts at pharmaceutical cost control (such as government bargaining) were swept away under charges of socialism and worse, and that's too bad (unless you have a child who wants to be a doctor or a nurse, then it's great!). But the framework is there for us to take care of our sick. And having passed into the AARP category myself, I can assure you, we all will be there at some point. Hopefully, once the politicians all get over playing to their respective ideologues, they will be able to get together and address the cost issues next.

    Oh, and about the constitutionality issue. Be glad if you are in a state who does not have one of the attorneys general spending your state tax money on a hopeless effort. Notwithstanding how the critics like to phrase it, "No law has ever said you have to buy a car," etc., the fact is that this is set up as incentives and penalties, just like a tax, and the power to tax is solid. You are required to have something in place that will support the structure set up by the government so that the costs will be shared. If you don't have it (and no one will force you to have it), you will pay a penalty -- a tax -- for not having it. If you fall into other categories, you get a benefit, just like people get tax credits. No one forces you to buy stock, but if you do, your capital gains are taxed at a lower rate than income. Polluting companies can reduce their environmental penalties (a penalty for making us sick) by buying more expensive air and water cleaning equipment. And the list goes on. The suits are just grandstanding.

    But if you have someone in your family interested in the medical field, I hear there are going to be a lot of opportunities in the future!

  • Report this Comment On March 24, 2010, at 6:20 PM, FinnMcCoolIRA wrote:

    The need to amend the process of health insurance was self evident.

    However, this entire health insurance fiasco is being forced on Americans and DOES NOT even address the underlying causes of increased costs for MEDICAL CARE!

    The entire "debate" was NEVER about medical costs or insurance costs. It was always about the redistribution of wealth and whether a left wing progressive government could garner the power and control associated with handling the purse strings on literally TRILLIONS of taxpayer dollars.

    The country is in dire straits and it's getting worse.

  • Report this Comment On March 24, 2010, at 6:22 PM, Dforberger wrote:

    Insurance is a way to sharing and reduce risk; risk of your house burning down due to a fire, of being in a car accident .. etc. Higher risk participants pay higher premiums, this reduce risk.

    The Health Care Bill covers everyone for everything, this increases risk because there is no incentive to maintain a healthy life style. I listened to a well know anchor person on CNBC business channel, "my LIPITOR allows me to keep my McDonald's bacon burger as a friend". This person is off loading his increased risk (cost) to all of the other persons in the Health Care pool. Many people will maintain their unhealthy lifestyle because they off load their cost risk to others. Health Care Cost will Never come down. Another Social Security in the making.

    Congress has been stealing the undistributed SS premiums since 1966. It will not take 44 years for Health Care to go bust because there are no undisturbed premiums

  • Report this Comment On March 24, 2010, at 6:30 PM, dancinglight wrote:

    It is immoral for the government to run any business be it automobile, housing or health care service. So far they have essentially nationalized large swaths of the economy and the institutions are no better, in fact are worse. Sorry, but this bill undermines your individual rights and that is anti-American. Price fixing doesn't work. The doctors, hospitals, and other service providers are victims of theft. Their time has been usurped by Federal "lawmakers" who completely disregard their victim's rights.

    I have nothing but disgust for such a socialist system. Only a real free market-not the current statist system-would provide cheaper health care for all, be conducive to innovation, and let the service industry in health make a profit.

    Individual mandates are offensive and worthy of something out of Soviet Russia. How dare the Federal government try such a stunt? It points to the fact they have disrupted the market and must resort to force to make it work. That alone tells me the system will perform poorly, there will be a stagnation in care, and an even more bloated bureaucracy. After all, the bill calls for 100 or more new government panels and committees to be paid for by you and me.

    I for one will work to oust my rep who voted for this monstrosity. This bill must be repealed or we will find ourselves joining the pathetic ranks of the socialist nations of the world.

  • Report this Comment On March 24, 2010, at 6:34 PM, pacella wrote:

    Insurance is insurance It all works the same way. The smart (or lucky) people pay for the rest. If some idiot in California wants to build on the side of a mountain,or a guy on Cape Cod wants to build on a storm ravaged coast, we all pay when these jerks rebuild every few years. Health insurance is no different.

  • Report this Comment On March 24, 2010, at 7:15 PM, atxlonghorn wrote:

    I for one am glad that the health care (insurance) bill was passed. I am one of the people who have taken care of my body but through no fault of my own came down with cancer. I am now un-insurable except from an employer with a no pre-existing conditions clause. I must keep a job with health insurance to survive.

    I can hardly wait for this bill to go into effect because as it stands today if the cancer returns and I have to quit working I am toast. Huge medical bills and no insurance. It would bankrupt my family.

    As a friend of mine said he has long term care insurance. A loaded 45.

    I have lost all respect for the republican party. The fear mongering, disgusting behavior and complete lack of any effort to come to a consensus is repulsive. Congress is there to solve problems not fight like the Hatfields and McCoys and get NOTHING DONE. The republicans sold out all the people of the US to the banks by repealing Glass Steagall. Started 2 wars, created huge unfunded liabilities and nearly caused a 2nd great depression.

    Boy what a set of accomplishments. Then they have the gall to throw stones while others are working to fix the mess they made.

  • Report this Comment On March 24, 2010, at 7:30 PM, TMFKopp wrote:

    @pacella

    "Insurance is insurance It all works the same way. The smart (or lucky) people pay for the rest. If some idiot in California wants to build on the side of a mountain,or a guy on Cape Cod wants to build on a storm ravaged coast, we all pay when these jerks rebuild every few years. Health insurance is no different."

    Well, yes, it is. P&C insurers can charge the guy building on the side of a mountain more for insurance than the family building in a safe, quiet neighborhood in suburban CA. And after the mountain house needs to be rebuilt for the first time, they can charge him even more going forward.

    With the elimination of medical underwriting, the health insurance industry doesn't have the "luxury" of basing premiums on many life choices and medical history.

    But as many other commenters have alluded to, this seems to be a step towards a more universal coverage where we all pay in and everyone gets covered. My answer to that is: YES! Exactly. That's exactly what it is. However, by framing it as some weird public/private hybrid it's far more inefficient than having a fully public system. (this is basically what I said above, but it saves you the trouble of having to scroll back up...)

    But even if we all agree that it's best to have some sort of universal coverage is a good idea (and agreement on that is far off), we still need to provide carrots and sticks somehow so that a) healthcare consumers aren't blindly consuming more healthcare than they actually need and b) individuals aren't living recklessly and driving up the overall cost for everyone else.

    Matt

  • Report this Comment On March 24, 2010, at 8:06 PM, BruinAlum77 wrote:

    While I agree with the idea that people who have unhealthy lifestyles should not push those hidden costs on taxpayers on the whole, most of your article doesn't jive with basic economic and political theory.

    First, I don't think you can analyze medical insurance underwriting in comparison to auto insurance. While it's true that everyone in California is required to have auto insurance, people have choices. They can buy the cheapest possible coverage and hope that nothing happens to their car. But even if the car is totalled, that person can either buy another cheap car, take public transportation, or bum rides off their friends and family until they can afford another car.

    You can't say the same thing about health insurance. Trreatments and surgeries can cost hundreds of thousands of dollars - well beyond the means of most people. And there is no alternative for health care - unless you count a strong belief in the after life as being an alternative.

    The bottom line is health care has never been and will never be an example of a perfect free market. Without affordable substitutes and easy access to the industry for new suppliers, you will always have a captive group of buyers at the mercy of a small group of suppliers.

    The greatest fallacy of the new legislation is thinking that health insurance companies will reduce rates because there are more people being insured. They are in business to make the greatest profit possible, so any reduction in costs will not translate into lower premiums, unless there is strict government regulation over what they can charge.

    Finally, your comment about health insurance not being part of the Ten Commandments is the basis of the great debate (and in some cases, intimidating and threatening behavior by the right wing nut jobs) over the nature of health care: is it a right or a privilege?

    If you read the part in the Declaration of Independence about "life, liberty and the pursuit of happiness," is it possible to pursue happiness when one is sick or dying?

    As a country, we have decided that protecting the "commons" is one of the underlying principles which defines government action, because this allows each citizen to pursue happiness. Originally the commons was defined as simply protecting our borders, but now it is universally recognized that the commons includes police and fire departments, public education, interstate highways, airports, dams, bridges, and protecting the public from toxic foods and chemicals, dangerous products and environmental pollution.

    We have evloved past the point where it is acceptable to own someone or throw them in prison because they owe you money. Shouldn't we also recognize that it is not acceptable for people to die because they can't afford health care, or, worse, their health insurance policy won't pay for life saving treatment?

    For all the scare tactics about "death panels," the sad truth is that they already exist. They go by the names of Wellpoint, United Health, Blue Shield and other for-profit health insurance companies

  • Report this Comment On March 24, 2010, at 8:24 PM, Gorm wrote:

    Insurance is all about spreading risk and paying premiums based on loss experience.

    Health care is fundamental. I find it inexcusable that of the 32M newly covered 50% are destined for Medicaid. Where are they now?

    Who is paying now?

    Charging them 1% is hardly a premium for such a life essential need. Bottom line, I don't want to pay for them, too!!

  • Report this Comment On March 24, 2010, at 8:44 PM, TMFKopp wrote:

    @BruinAlum77

    Not sure that what you've said is that far from what I wrote. However, I will note:

    "First, I don't think you can analyze medical insurance underwriting in comparison to auto insurance. While it's true that everyone in California is required to have auto insurance, people have choices."

    First, there's a distinction between insurance underwriting in the healthcare market and medical underwriting. The latter specifically refers to underwriting based on health-related factors. There will still be actuaries in the health insurance business after this legislation, they'll just be very limited in what variables they can use.

    Further, the two really are comparable. If you're a reckless driver with a terrible driving record, you will have to pay more for auto insurance -- or, as you note, choose not to drive. If you make poor health choices, you should have to pay more for health insurance. Axe medical underwriting and the latter doesn't happen.

    Granted, not every poor health outcome is a result of poor choices -- in fact, a great many aren't. However, if we're going to discuss reducing healthcare spending and making the system more efficient (and we NEED to be discussing that), we need to identify and weed out wasteful spending.

    You say:

    "And there is no alternative for health care"

    Well, yes, when something does go wrong. But there is choice in certain factors that lead to bad medical outcomes and we need individuals to either cut out those practices or face some sort of penalty.

    And as long as I'm up on a soapbox already... Solely to play devil's advocate:

    "If you read the part in the Declaration of Independence about "life, liberty and the pursuit of happiness," is it possible to pursue happiness when one is sick or dying?"

    The counterargument to that is that what the founders were referring to was removing external / government roadblocks to a given individual pursuing happiness. And, in fact, when you tax some people to provide healthcare for others... well, many would argue that the former group is having their right to pursue happiness interfered with.

    Of course, as far as happiness goes, I think there are a great many people that have pursued happiness while they were sick. At the same time, I'd also argue (for the group that's being taxed) that you don't need a great deal of money to pursue happiness (and that's been proven time and time again in academic studies).

    But now I'm veering waaaaaay off topic.

    Matt

  • Report this Comment On March 24, 2010, at 8:53 PM, Rustyismydog wrote:

    The only place I see this bill changing the practice of "medical underwriting" is in the 10% of Americans who are currently uninsured. The other 90% of Americans virtually all get their insurance through their employers, as part of a group. There is no medical underwriting involved when they join their company group.

    The new bill forces everybody to get insured so that this new group that is being created from the uninsured will be somewhat balanced and can be priced on a reasonable basis...just like all the thousands of other groups that already exist. It is not necessary to know the health of each individual participant to effectively price the group premiums. The insurance provider really only needs to know that membership in that group is completely independent of each participant's health. Forcing everybody to join protects against the new group being all sick people. As time goes by, the actual experience of a group provides inputs to allow sensible future premium pricing--also the way it works with employer groups.

    I think there are a number of weaknesses in this bill, but putting an end to medical underwriting is certainly not one of them.

  • Report this Comment On March 24, 2010, at 8:56 PM, rtsnow wrote:

    "If you read the part in the Declaration of Independence about "life, liberty and the pursuit of happiness," is it possible to pursue happiness when one is sick or dying?"

    The Declaration and Constitution guarantee a citizen of the US the right to life -- that is, that another can not legally take your life away unless you are trying to take away their life (self-defense). It does NOT obligate another person to provide or preserve your life; whether or not you are sick or dying. Though helping another who is ill may be a moral and desirable act, it is left to conscience rather than obligatory law. Death is inevitable and disease or injury is avoidable to only a limited extent. While I'm empathetic toward one who has cancer or anoher malady it is nonetheless NOT my responsibility to fund that persons healthcare. If health expenses necessitate moving from a house to a trailer park and living on small means that is the lot of the one who is ill. It is not my responsibility to pay their costs unless I do it voluntarily. Protecting the "commons" is simply a Marxist concept that was tried and failed. The Marxist idea: "too each according to their need from each according to their ability" is counter to the premise of our founding documents. If one prefers socialism as a step toward communism one need only move north to Canada or across the pond to mother Britain or other socialist countries. This health bill greatly erodes individual freedoms and responsiblity and needs repeal before the rest of our economy and freedom follows suit.

  • Report this Comment On March 24, 2010, at 9:02 PM, TheKoz72 wrote:

    If the mandatory insurance and penalties are "deemed" legal by the courts, I predict that insurance premiums will go up sufficiently, because of the elimination of underwriting principles, to cause many people to go with the penalties rather than the insurance. Small business will also go with the fine/fees for not providing insurance.

    I am not sure if the final disruption of the system will rationalize the creation of the "single payer system" but it certainly may.

    I suspect the AMA supported the legislation because they had an agreement that the medicare cuts would be canceled. If that is true then our leaders lied when they said that the legislation would reduce the deficit, because the CBO numbers should have included the effect of eliminating the cuts in Medicare payments. Integrity demands that those who voted for the legislation make sure that the cuts in Medicare payments really happen.

    The other surprise is going to be the massive cost to the states for the growth in Medicare/Medicaid or Medical. And, the resulting cuts to schools, law enforcement, fire protection and so on that the added state medical costs will cause.

    I think it would have been more honest to just expand medicare to cover the uninsured and raise taxes to meet the costs. That would have taken more character that exists in the hallowed halls of Congress.

  • Report this Comment On March 24, 2010, at 9:05 PM, JohnG25 wrote:

    How is John Galt?

  • Report this Comment On March 24, 2010, at 9:06 PM, JohnG25 wrote:

    Who is John Galt?

  • Report this Comment On March 24, 2010, at 9:10 PM, nemaline wrote:

    dancinglight, I think you are right on. Furthermore, making healthcare a "right" essentially enslaves the providers. Where will all of these unincentivized providers come from? Watch for an outflux of physicians from the profession when this takes effect. And an influx of foreign medical grads. And a decrease in medical education enrollees with decrease in the quality of the professional. The best and brightest will migrate to where they can be incentivized.

    This article speaks of poor outcomes of our health care system: "particularly if outcomes continue to trail the rest of the world." What planet is this author on? Why do the greatest innovations in health care come from this nation? Why do so many innovative clinical trials center in this country? Why do so many wealthy from other nations continue to come to our tertiary centers for their health care? This presumption simply is not true!

    Finally, why does anyone in their right mind, with the history that exists for Medicare, Medicaid, USPS, the VA system, Welfare, etc., think that the US govt. can do a better job in a nationalized, price controlling system than any free market system? Give me one example that works better than a private alternative!

  • Report this Comment On March 24, 2010, at 9:14 PM, nemaline wrote:

    It certainly isn't Barack Obama, Harry Reid, or Nancy Pelosi!!

  • Report this Comment On March 24, 2010, at 10:01 PM, teejk wrote:

    where is tort-reform (that thing that supposedly drives the cost of "defensive care") in this plan? Flash back to Obama's nation-wide speech last fall and you'll note that Pelosi et al suddenly got VERY quiet and motionless when that topic came up...I could give them the benefit of the doubt and conclude that they were taking a break from all the jumping up and down with everything he said prior to that point and perhaps were getting ready to jump up and down for everything that was to come (which they did).

  • Report this Comment On March 24, 2010, at 10:25 PM, ericandmisti wrote:

    I agree with nemalite that the US medical system is superior to others. We have a nation that eats fast food and sits in front of the TV and want to compare the health results to places where life if much different. As far as the quality of medicines and operations that are available the US is way ahead.

    I have a huge problem with the government getting involved in healthcare because I think the end result will be a government run system with higher costs, less innovation and less availability. This ultimately has to be paid for by someone and the government can only keep printing trillions in new debt every year for so long. The government has already shown its inability to efficiently or effectively run anything. Anyone who thinks government involvement will make healthcare more efficient and less expensive has no common sense.

    I saw an interview with Jack Welch where they were talking about the healthcare bill. His comment on the costs (my paraphrase) was only an idiot would believe this bill will reduce the government's deficit. The expense cannot be accurately projected, but it will certainly cost trillions. I think he is exactly right.

    There are changes that could have been made to improve the system, but that isn't what was done. While I understand the plight of someone who has a serious health problem and have no problem with helping those in need, it would be much more effective to have a targeted program for that group than to implement a new massive government entitlement. I think it is a huge intrusion on personal rights to mandate that a healthy person must spend a significant percentage of their income on health insurance even if they don't want it.

    Eric

  • Report this Comment On March 24, 2010, at 11:07 PM, robertf36009 wrote:

    The first year fines are imposed the penalty is $95. Think about that just $95 pays your premium for the entire year and you can not be refused for preexisting conditions, meaning any reason what so ever. Why even pay that until you are actually sick? The penalty goes up for the next two years but by the third year when the penalty is a whopping $750 there will be no health insurers left. Once they are gone having been bankrupt by government mandate you will have only a public option and no recourse under penalty of law. PHARMA will suffer as well as they will see the prices they are allowed to charge reduced over time. Which means that R&D dollars will be diverted to the bottom line. I think you know where this goes. We have seen this play in other venues and know how it ends.If you thought health care was expensive this improvement will cost you your liberty and your money. Do you think it's worth it?

  • Report this Comment On March 24, 2010, at 11:33 PM, TMFKopp wrote:

    @nemaline

    "This article speaks of poor outcomes of our health care system: "particularly if outcomes continue to trail the rest of the world." What planet is this author on? Why do the greatest innovations in health care come from this nation? Why do so many innovative clinical trials center in this country? Why do so many wealthy from other nations continue to come to our tertiary centers for their health care?"

    What good is any of that when the U.S. trails many other major developed countries in areas like life expectancy and infant mortality?

    Matt

  • Report this Comment On March 24, 2010, at 11:39 PM, eldetorre wrote:

    I agree somewhat with many of the criticisms but a couple of points:

    The criticism is made that healthy people will be subsidizing unhealthy people. Well that is true. But no one is healthy forever. And the healthier you are the longer you'll live. The longer you'll live the more likely you will run into health problems. It's all a wash in the end. People who truly abuse their bodies will die sooner even with miracles of modern medicine. They'll just cost more in the short run.

    I blame much of the shortcomings on republicans. Instead of grandstanding and insisting upon starting from scratch they should have come to the table with productive alternatives.

  • Report this Comment On March 24, 2010, at 11:44 PM, robertf36009 wrote:

    Under this law the fine for the first year is $95. Think about that $95 covers your health care for the year and you can not be denied coverage for any preexisting condition, meaning for any reason what soever. Why buy insurance at all until you are injured or sick? After all you can't be turned down. The penalty goes up for the next two years reaching the whopping $750 the third year. Of course by then all of the insurers will have gone bankrupt and you will have no recourse but a public option which means no choice or competition. PHARMA will suffer as well as the amount they are allowed to charge for their products is regulated. They will defer R&D funds to their bottom line or their stock will suffer. I think we all know where that road goes. We have seen this play in other venues and we know how it ends. You may have thought health care was expensive before this law was passed but now it will cost you your money and your liberty. Do you think it's worth it?

  • Report this Comment On March 25, 2010, at 1:15 AM, RCranstonIII wrote:

    Very good comments on health and taking care of yourself, etc. Good stuff, as well as important to this country if we all get to pay the bill. We have a ways to go to tip a few off the scale in this country and all be better for it or we will now all get to pay...more...nifty.

    As long as insurance companies continue to be for profit and working to be as profitable as they can for the share holders as possible, healthcare may be in dire straights and this legislation is not necessarily pouring gas on that fire, but it smells like it.

    The providers of healthcare tools, Rx, general day to day products that a hospital requires as well as High Tech Machines that we all appreciate when we are in need of critical care continue to charge hospitals what could be construed as premium prices. The hospitals all want/need these tools...they pay to have them to be the hospital of choice and provide excellent care, makes sense. These costs will continue to rise or be passed on until the profits of all involved parties are addressed. No one wants to take a loss, be controled as to profits, etc. This in turn creates the cycle we call increased costs passed on to the insurance companies who charge the rates for taking the risk to pay for all this care and then take their cut.

    The cost of insurance has always been increased or needs to be off-set by the cost of the medicare/medicaid patient where the government pays/reimburses only a % of actual costs and this % is clearly not 100%. This government share has been shrinking in comparison to actual costs for years or at least in contrast to the whole inflation or cost trend picture. Just another pass through to the increased cost the insurance companys get to charge their commercial clients.

    Why is it that more and more Doctors no longer wish to take on "new/more" Medicare clients?

    I am not saying that hospitals are not effecient...some are better than others or are getting there or have been actively getting there for some time. Vendors/products, the price of keeping good staff, Rx's, etc. are NOT going down. Control a bit of what goes in...you control what comes out.

    Check the profits...check where are the $'s going and you have a good part of the solution.

    If Health Care (trend) has gone up 6-11% over the past 10 years, per year...depends on the study/year...10 years ago to have Rx be 10-12% of Medical/Rx cost was an average % of this total...now seeing this number in the 20% to sometimes as much as 30% or so or more of the same equasion is nuts...check the $'s folks.

    NO body wants to fight the beast and take a more reasonable piece or portion of the pie we call healthcare. Take take take...soon we will all pay...this reform has done zip to address that. Bust out your wallet.

  • Report this Comment On March 25, 2010, at 1:33 AM, RCranstonIII wrote:

    I beleive that the comment on outcomes is in part the relationship to the price that is paid for care in the United States and avereage life expectancy. We pay the most as a nation and don't necessarily live a longer life than that of a number of other countries that pay half what we currenty pay for care.

    Like putting a new $5,000 paint job on a 300,000 mile nissan it's still gona quit on ya here pretty quick.

  • Report this Comment On March 25, 2010, at 1:48 AM, RevenueVenue wrote:

    I think everyone could benefit from reading foolhardy7's post a little ways up. (March 24, 2010, at 6:07 PM)

    Bravo foolhardy7...bravo.

    People don't want to spend money that they didn't know they were all ready spending to cover the uninsured in the form of higher medical costs. People didn't want a Government option that would spark fair competition amongst insurance providers so we got reduced underwriting and an insurance mandate. People are so quick to forget...or maybe they didn't know to begin with.

  • Report this Comment On March 25, 2010, at 4:23 AM, PoundMutt wrote:

    What is the profit margin of Health Insurers? I saw somewhere that it is 4%!!! Can anyone confirm?

    I also saw somewhere that drug companies spend more on advertising than on R&D!!! Anyone confirm?

    You bet premiums will go up! My Blue Cross/Blue Shield of Michigan Advantage Plan premium was $62 per month in 2009 and went up to $172 per month for 2010!!!??? AND benefits are a little less. AND Obama Care was just an EVIL THREAT when they decided to shaft me!

    How much you want to bet against a 2-3 times OR MORE increase in premiums between now and 2014???

  • Report this Comment On March 25, 2010, at 5:55 AM, oldblueHSA wrote:

    Healthcare - My Personal Story that America

    Works & Already Has a Public Option!

    Upon expecting our first child in 1988 and no health insurance coverage from

    my employer so my wife and I negotiated with a

    hospital and our birth doctor for a total cost

    of $2,000 which included all prenatal care and

    hospital. We paid our prenatal bills as they

    came and paid the final hospital all by

    ourselves directly.

    Upon expecting our second child 6 years later my same

    employer did offer limited health coverage with

    no birth coverage so my wife again called around

    to our area hospitals to see what the cost would

    be. Each hospital was extremely surprised

    someone was asking for a price ahead of time so

    they each had to check and get back to us. We

    used the same birth doctor. We even kept the

    Total cost of our second child under $2,000 this

    time. Again, we paid our prenatal bills as they

    came and paid the final hospital all by

    ourselves directly.

    In 1995, my same employer shopped to get a

    better full health insurance plan called because

    he was afraid I would leave as I had become a

    valuable employee in his High Tech startup

    company which began in 1984 and I had began

    there in 1985. When the Health plan we were

    looking at (Aultcare) representative learned of

    my story of how I negotiated for the births of

    my first two children, she asked if she could

    bring her boss out to meet me the next day which

    she did. They just could not believe I did this

    by myself which I told them it is sad that I was

    the exception and not the rule and that is the

    problem why health care costs were rising for so

    many. This Health Insurance policy was AultCare

    being provided by one of our local hospitals

    which was Aultman in Canton, OH. I mention this

    because of the fact this insurance provider’s

    representative and then her boss were both so

    surprised by my actions to negotiate for care

    and services I wanted.

    This full coverage policy then became so

    expensive (over $5000 per year) that in 1999 I

    found that the Medical Savings Account (MSA)

    program was being offered. This founded idea by

    our government was way to wean our way off the

    current mind set that a third party (insurance

    or government) was paying the bills so who cares

    what the bill costs. So I went to my employer

    and we I started a MSA insurance plan with a

    catastrophic health insurance policy ($4000

    deductible). The money we saved from not paying

    for the $5,000 so called full coverage policy

    (it was a 80/20 plan with no eye or dental) I

    put into my interest bearing MSA and within two

    years had enough to cover the $4000 high

    deductible. I could right checks directly from

    my MSA to cover any health expense and it was MY

    money even if I left my job which I did in 2001

    and began my OWN company. Also, I even used my credit card many times for reward dollars to pay

    negotiated health bills and then have MSA

    account reimburse me. Keep in mind, the high

    deductible policy still uses its negotiating

    power to lower submitted bills also even the

    ones I then would need to pay under the

    deductible.

    I now make enough interest in my MSA (now HSA)

    to cover our yearly health expenses.

    You can not remove the consumer and self

    responsibility and expect to lower cost and

    improve service and care! That is how this

    great country works for those who choose to

    exercise our great freedoms and apply the

    fundamentals in which this country was founded.

    Even though I been strongly compelled to write

    this, I reluctantly tell my story because I fear

    someone in the current government mindset will

    do something to my current freedom of what I

    have done which in and of itself is a sad day in

    this country which tells us why power should be

    left to the individual as our founders intended.

    Please consider the repercussions of government

    dictated costs controls and fining companies and

    individuals. Ask the following questions as you

    look at health care (noting my wife is now a PTA

    in Healthcare at a nursing home):

    1. Why would anyone want to get into health care

    now with the threat of costs controls and

    controls on how they can provide services?

    2. Why would any health company want to fund

    anyone’s education now not knowing what the

    return may be in the future?

    3. What kind of mood will be created in the

    country when people will wonder if they are

    paying for someone who is not responsible for

    making sensible personal decisions about their

    personal health? (remember the backlash of

    people upset they are bailing out other people

    who made irresponsible decisions about homes

    they could not afford)

    4. Regarding comparing National Health Care to

    Auto Insurance everyone has to have now, with

    Auto Insurance you will be penalized for bad

    behavior with higher premiums or being dropped.

    Where are the consequences for bad health and

    living choices (ever watch people MTV stunts of

    people jumping cars or other video shows (Worlds

    Dumbest Videos) people doing crazy off road

    stunts on dirt bikes, etc.) if they know they

    will get cared for at no expense to them?

    I heard President Obama’s recent weekly radio

    address about how his plan could help create

    jobs by allowing individuals to leave a company

    and start their own without worrying about

    insurance. With all due respect, I have shown

    that is already available as shown above. Also,

    how does destroying the health care industry

    (which has the top 4 most in demand job

    positions per the Canton Respository) help

    create jobs? Either you believe in the people

    and a free market or you do not.

    If someone was going to dictate what an industry

    is going to charge (price controls), why would

    anyone want to go into that industry which would

    in short dictate their success or what they can

    expect from trying to create new inventions and

    ideas. My wife and I both have seen medical

    jobs drying up ever since this has been

    discussed and heard from people no longer going

    into the field. How is that going to help bring

    down prices using market conditions and how is

    that going to bring more service to health care

    customers (us!)?

    Also, given demands on employers to pay more by

    dictating what we must pay into your system or to

    give employees, why would I want to hire nayone

    right now?

    Bottom line, no personal responsibility and

    freedom (or privacy).

    We need to educate young people to self insure by keeping their own money in a health savings account NOT send it to the government.

    From here in Minerva, Oh, I hope there are

    people out there that still understand what

    makes this country great.

  • Report this Comment On March 25, 2010, at 8:50 AM, Poly1 wrote:

    Fools!

    Your loosing your freedoms, what congress did was illegal. Wake up.

  • Report this Comment On March 25, 2010, at 9:28 AM, MileHighPlus wrote:

    Just a few facts:

    More risk = higher premiums,

    There is no "reform" in this package. As everything else coming out of our government, it addresses symptoms and not root cause. Addressin symptoms and not root cause will ALWAYS cost more money and not solve the problem.

    They say insurance companies are evil, so let's make everyone buy their product??? What is the motivation here.

    They made a deal so that I will have to pay more in taxes than my union member neighbor with the same health plan. How can anyone look at me with a straight face and say that is "fair".

    4 programs: 1. Social Security 2. Post Office 3. Medicare 4. An already overbudet Cencus. How can governement involvment in such a large part of the economy be good? Fix the first 4 things and then come talk to me about taking on more.

    Light travels a little over 5.8T miles in one year. The proposed budget is $3.8T and most likely to increase. We are spending money at near the speed of light. That's really really really fast!

  • Report this Comment On March 25, 2010, at 10:04 AM, 4mythreegirls wrote:

    Thank you .. OldblueHSA speaking some sense.... we all have choices or nation was built on choices!

    I find myself in doctors office's often as that is the nature of my job. I see patients in Pulmonary offices on oxygen smoking cigarettes outside. I see severly obese patients eating a big mac in a cardiologists office. I see physicians prescribing unecessary tests because they practice defensive medicine. I see physicians over prescribing medicines because they are forced to use formulary medicines that they know will not be as effective. This results in using more medication to treat diseases. In addition, often times these patients stop using the medicine after a few days/weeks (which insurance paid for) only to have the patient return to the office (another office visit and $$$) and prescribing of another medicine that the physician knows will not be as effective - only to repeat the process again. Now you have two or more medicines that were paid for by patient and insurer that is going to waste and 2 or more office visits that were not necessary before the physician can treat the way he/she intended in the first place. Because physicians are told and mandated how to treat patients they spend less and less time with each patient resulting in poor treatment and unecessary expenses.

    You want to save money on healthcare?

    1) people have to be accountable and take responsibility.

    2) take away tort reform so physicians won't practice defensive medicine.

    3) allow physicians to practice medine the way they learned in medical school and through experience.

    4) send back the illegals, we cannot afford ourselves right now - we surely can't afford anyone who doesn't contribute.

  • Report this Comment On March 25, 2010, at 10:45 AM, mountain8 wrote:

    $750 penalty? Actually that's a fine as you are receiving nothing in return, and it's not a tax as it won't be paid by everyone. It's a fine. Which makes not having insurance a crime. Which makes all people without insurance change from being poor or unfortunate into a criminal. Next step, is it a misdemeaner or a felony. And how long the prison sentence?

    Vote no to incumbants.

  • Report this Comment On March 25, 2010, at 11:06 AM, jakemaxmat wrote:

    if insurance companies can"t rate to the risk of the pool rates will never be sufficient to cover the cost of claims. So these high risk pools will be set up to provide coverage with rates that are either properly calculated or by some imaginary government subsidy.

    If the pool isn't rated to the risk it ,the pool,will be in a classic struggle to pay for itself. If premium doesn

    t cover costs the pool is polluted.If the Government doesn't allow health insurers to rate properly several publically traded companies will find profit being destroyed and Wall Street screaming. Lets see how disgruntled share holders can affect the situation.

    The requirement to take all those without regard to prex conditions is a very difficult rating situation.The penalty is npt enough to cause healthy folks to buy.

    Average cost of health today for a family of 4 in Ohio is over $6000 per yr. Which you pay ?

  • Report this Comment On March 25, 2010, at 11:17 AM, donaldo15 wrote:

    I think you said it best when you said the bill has "feel good" measures. Remove the word health care from the debate and replace it with "food". Liberals could argue that millions of children dont have enough food to eat in the richest nation on earth. Food should be a basic right and profiting from something as necessary as food is downright evil. Replace health care with "shelter". Replace health care with "college education". Replace health care with "water" with "transportation". The list and arguments could go on and on and unfortunately I think they will with this administration.

    The question is at what cost to the basic fabric of our country. Work hard and get ahead appears to be a thing of the past. This is truly the start of class warfare from a President who prmoised to unite. How sad.

  • Report this Comment On March 25, 2010, at 11:33 AM, MORK000 wrote:

    This whole healthcare is a smoke-screen for the American citizens. All senators & representatives of our America are in some illegal way helping the big conpanies. Therefore taking us citizens of America for a ride. To produce more money of ours for themselves?

  • Report this Comment On March 25, 2010, at 3:20 PM, allied35 wrote:

    "I have nothing but disgust for such a socialist system. Only a real free market-not the current statist system-would provide cheaper health care for all, be conducive to innovation, and let the service industry in health make a profit."

    Only a free-market system would provide cheaper health care for all????

    How come European countries, with their govt funded socialist systems provide better care at half the price then?

    And don't tell me US health care is the best because if it was, your life expectancy would be higher than Europe when it actually it is lower and you infant mortality rate would be lower when in fact it is about twice as high.

  • Report this Comment On March 25, 2010, at 3:30 PM, Bamafan68 wrote:

    Imax, here is a repost of a thread I started on one of the premium boards about electronic health records. Personally, I think EHRs are not going to give us any significant cost savings.

    "As a physician who has undergone the conversion to an electronic medical record (EMR), I have very mixed feelings about projections for EMRs. Obviously, the Federal mandate to go electronic is going to be a big boost for those companies that provide such technology. The question I have is "does an EMR actually help?" Thus far, my answer would have to be "No". Here's why:

    Whether the makers of the services want us to believe it or not, EMRs are on the whole slower than paper charting. When I am charting on paper, I don't have to wait for computer lag time while the program is trying to call up previous notes or labs that I need to review while the patient is present. I also don't have to flip back and forth between several template tabs (abdominal pain, dysfunctional uterine bleeding, contraceptive management, etc.) when I am dealing with a patient who has more than one issue going on during her visit. It would be nice if patients limited their problems to just one problem a visit, but that's not how the real world works. Every time I click on a new template, I have to wait for the computer to catch up plus it's not as easy to concisely express my thought process. I could go "template free" and just type my charting in the free text areas, but the systems don't recognize diagnoses and treatment plans in the free text areas, so then when I am trying to bill and code I have to spend additional time searching electronically for the proper diagnoses and level of service.

    The argument for EMRs has been that they will lead to greater efficiencies in patient care, preventing duplication of services. Unfortunately, unless my EMR connects well with the referring physicians' EMRs, I can't readily access what testing has previously been performed on a patient. As a result, I still have to have my staff call the referring physicians' offices to obtain records.

    Maybe the EMR conversion will help large group practices cut down on medical records staffing needs. It may also lead to greater efficiencies for multispecialty groups since all the records will be consolidated. But for the average physician practicing in a single specialty practice of 1-7 MDs, I have been underwhelmed with EMR capabilities."

  • Report this Comment On March 25, 2010, at 6:41 PM, whyincreasetaxes wrote:

    It's never good when we let the lawyers make decisions about health care, mostly because they really are clueless about how the delivery of health care happens. Do you really want them inserting more of their inept ideas into the relationship you have with your doctor? It's especially bad when you let naive, bleeding heart liberal lawyers pass laws about health care when they have the key to your wallet and they don't understand economics (in the middle of the worst recession in decades) or human nature.

    Just like all the naiveocrat entitlement programs of the past, this new law is going to get abused and will soon look like all its obese, bulging at the seams predecessors. It will, no doubt, result in even more reliance on the government by certain portions of the population who will undoubtedly continue to vote for the party that they know will continue to support them with other people's money.

    Unfortunately, anyone who dares to have the audacity to be so greedy and disgusting as to make over $250K is going to have to pay for it. Personally, I'm cutting back my work schedule until people who who respect the American way of life are back in power. I already work Jan to May for the government. How dare that lawyer in the White House tell me I need to pay more in order to pay my "fair share" or in order to be "neighborly." We really need to take back this country from the socialists and get America back on track.

    Healthcare needs an overhaul and there are certainly people that need help getting health care. However, letting the party that perpetuates waste and government dependence run the show was not the way to fix the problem. Unfortunately, there were enough morons in Nov of '08 in America who thought that because the Iraq war wasn't going well it was time to put the big government politicians in power. Hopefully, America will have learned its lesson by the next election, before there are so many on the government sugar teat that they have to vote for the socialist-democratic party in order to maintain their lifestyle.

  • Report this Comment On March 25, 2010, at 8:14 PM, htbihtbi23 wrote:

    On perhaps the only positive note of this post,it's refreshing to read people discuss a highly emotional issue with respect and civility.I believe it's the 1st time I've witnessed it in 1 year.

    That noted, I'm fatigued and frustrated by hearing recycled argument's and words (Socialism)ad nauseum.

    Of all groups discussing this issue, I felt certain that this Community would be poignantly aware of both the positive AND negative facts about our " Representative Democracy" and it's "Capitalism."

    The words enclosed in quotes are what this Country has always been slowly working to make a reality from the document that's the Law of our Country-The Constitution.

    Yet I never hear the citizen's blame the members of both parties of our Government for their decades of premeditated and illegal, to treasonous wholesale corruption of the Constitution.

    Even the the most ill informed Citizen's whether labeled with an R,D, or I. affiliation all-with the exception of 17% in the most recent polling- AGREE THEY SHARE A DISTRUST OF THE ENTIRE LEGISLATIVE BODY.

    It's common knowledge that the apathetic public has long been well aware -even if the don't know the name- that we are not living in a Representative Democracy and Capitalism under a model of Capitalism.

    We live in an OLIGARCHY.(With elements of Socialism.Soc. Sec,Medicare,etc.) We do not elect public servant's who represent "We the people."

    Everyone knows they represent the interests of the Corporation's possessing the largest amount of money to elect them into office, bribe them when elected and often provide them with lucrative jobs as Lobbyists.

    A citizen/criminal who breaks the law as a member of the Mafia is said be a member of Organized Crime.

    Our Senator's and Congressman are at the most fundamental, systemic level members of Organized Crime.

    Someone posted about symptoms of a problem.

    Well, if we don't honestly and accurately diagnose and the fundamental people causing terminal societal cancer and the citizen's do not collectively ACT to surgically remove the tumors...they will spread and the Country will die.

    This is a Historical fact that can be confirmed by the demise of every single one of the most powerful empires of it's day.

    The Roman,s Greeks ,etc, Ad. Inf.

    No, I have no clue how to solve the problem. I'm not that smart. But identifying it's truth is self-evident to the majority of us.

    Any ideas what we need to to to solve the problem?

    I know they have no incentive to solve it.

    Their incentive motivating their policy decision's are personal issues....Re-election.

  • Report this Comment On March 25, 2010, at 8:44 PM, htbihtbi23 wrote:

    That must be a Congressional rebuttal. Or perhaps it's George Bush advising us once gain the solution is simple-SHOP TILL YOU DROP!

  • Report this Comment On March 25, 2010, at 9:44 PM, dlomax77 wrote:

    Health insurance companies are like bizarro Enron. They can hide assets better than anyone. If you believe their profit margins are in the 4-8% range, you should see a psychiatrist.

  • Report this Comment On March 26, 2010, at 2:34 AM, burrowsx wrote:

    At the moment, it pays for health insurance underwriters to find ways to disqualify 46 million people. The new bill makes it more expensive to disqualify, and more profitable just to deliver the service clients pay for.

  • Report this Comment On March 26, 2010, at 3:25 AM, PoundMutt wrote:

    Which entity denies twice as many claims as the second place health insurance co.? MEDICARE!!!???

    How much of the entire health care spending pie is Health Insurance? 7 (SEVEN) %

    Currently 85% of residents of the US have health insurance. According to one member of the House of Representatives I saw on Cable news, the other 15% are second class citizens because they have no health insurance. Obamacare will ensure that 100% of the population will have access to SECOND RATE health care!!! Actually slightly less than 100% because the Senate and House leadership and their staffs are EXEMPT from the new MIRACLE plan. The president is also exempt but I heard that Obama will voluntarily join the rest of us!!!??? But, will BO give up the White House Physician?

  • Report this Comment On March 26, 2010, at 12:44 PM, rgibbs100 wrote:

    I am in total agreement that we should not be required to buy health insurance. However, if insurance companies are forced to take people with pre-existing conditions, who in their right mind will buy insurance before they need it? We need to get health insurance away from being employer based. We need a system where each individual is responsible for their own costs. If a person wants free doctor visits or a $5 copay then they could pay for that service. There needs to be some financial pain involved with going to the doctor and some incentive to go over every bill to make sure they are correct.

    My last point is we will never be able to afford to pull out all of the stops and use every procedure know to man in an effort to make every US citizen live forever.

  • Report this Comment On March 26, 2010, at 1:13 PM, Robin1938 wrote:

    Years ago, when I was responsible for a "safety net" hospital, there was a legisative proposal to require helmets for riders of motorcycles. How to balance my belief in individual freedom (I rode a motorcyce at the time) with my concern about the many head injuries that appeared in the emergency room with catastrophic financial impacts on the hospital? The only answer was to let people "opt out" of the law if they agreed not to seek treatment if they had an accident. But that, of course was impossible. As long as "we the people" have to care for individuals with serioous illness, "we the people" should insist that they have insurance coverage. The discusion should be about the level of required coverage and the greater use of HSA's to cover "routine" care to further encourage individual responsibility - but with assistance to those who aren't in a position to set up and fund their HSA's.

    There is a lot right in the bill but always room for civil debate on ways to improve it.

  • Report this Comment On March 26, 2010, at 2:10 PM, pickinrick wrote:

    atxlonghorn, you said

    "I have lost all respect for the republican party. The fear mongering, disgusting behavior and complete lack of any effort to come to a consensus is repulsive. "

    If the GOP is to blame for lack of effort to come to consensus, then please explain to me why 32 House Dems and 3 Senate Dems voted with the GOP?

    Furthermore, I'm insulted by those who suggest that opposition to this bill is evidence of a lack of compassion. What about compassion for our children who will inherit an incredible tax burden, along with a government with ever increasing regulatory powers, and the implications that has for their health and liberty?

    That the Administration proposes to add thousands of IRS agents to ensure sufficient revenue for this measure suggests its inherent inefficiency, and worse, the economically-crippling tax burden coming for the American people.

    WHAT IS THE REAL SOLUTION?

    Has anyone out there asked their doctor what the breakdown of his/her costs are? My doctor tells me that, by far, his largest costs are malpractice insurance first, and then the administrative costs of managing customer payments through 3rd-party payers/negotiators. In fact, he says these costs have grown so dramatically over the past 10 years that, despite a growing patient caseload, his profits have been flat! Not a great incentive for our best and brightest young people to go through all the years of schooling and discipline required to become an M.D.!

    Regarding my doctor's two highest cost elements, the first was completely unaddressed in this bill (tort reform). As for the second, who really believes that adding layers of government bureaucracy will actually lower my doctor's administrative costs? Seriously, do you have to be a mathmetician or economist to figure this one out?

    Considering the physician's cost of managing 3rd-party payments, I can't help thinking that this reform went in entirely the wrong direction. I suspect we were long ago sold a bill of goods on the whole notion of health insurance as the method of managing routine health care costs.

    Doesn't "insurance" make more sense as a resource that covers you in a catastrophic situation, not a routine situation? Ever notice providers (especially chiropractors) that offer a discounted "cash price" (unfortunately, this cash price is still inflated by the cost of malpractice insurance, which goes back to the unaddressed tort reform issue). The implication being that, if we cut insurance (or any other 3rd party, such at the government) out of the equation, except for catastrophic situations or the truly indigent, we could see a significant lowering of health care costs.

    Following from that, if everyone was paying a reasonable cash price, might this incentivise us to make more responsible use of the system?

    Let's also consider the supply side of the solution. I understand that the supply of potential new doctors entering our medical schools is not keeping pace with the growth in demand. How about we put some tax dollars toward medical schools? Increase the supply and competition, and allow the law of supply-and-demand to do its natural work.

    Does socialized medicine really work? I noticed one or two posts from individuals, saying that moving to Canada has improved their access to health care. I can't figure this one out, becuase I've worked with Canadian ex-pats who have told me that health care this side of the border is more accessible and higher quality. Maybe it depends on your specific situation. That is, if you are higher-risk, you can benefit from the forced sharing of risk in a socialized system.

  • Report this Comment On March 26, 2010, at 4:08 PM, tomjenk wrote:

    I've been reading and investing like a Fool for 15 years, and my wife and I became self-made millionaires by doing so. We didn't get lucky, we just worked hard, saved a ton, invested for growth, and utilized tax-deferred accounts to the max. We took the same long-term approach to our health by exercising 5 days a week, eating healthy, not overindulging in alcohol or "bad" foods, and maintaining a healthy weight. However, even by doing everything right, our wealth has been decimated by an unexpected health condition I came down with 5 years ago. After losing my job I couldn't get any type of insurance coverage, and treatments have been amazingly expensive. Furthermore, each member of my family is rejected when they apply for coverage. It's a mistake to build financial plans on the hope that you won't get sick because you're currently young and healthy. It can happen to you, and if it does it can gobble up your portfolio real fast. Living without health insurance exposes years of hard work to chance; it's like taking your portfolio to the casino.

  • Report this Comment On March 26, 2010, at 4:38 PM, tomjenk wrote:

    I've been reading TMF and investing like a Fool for 15 years, and my wife and I became self-made millionaires by doing so. We didn't get lucky, we just worked hard, saved a ton, invested for growth, and utilized tax-deferred accounts to the max. We took the same long-term approach to our health by exercising 5 days a week, eating healthy, not overindulging in alcohol or "bad" foods, and maintaining a healthy weight.

    However, even by doing everything right, our wealth has been decimated by an unexpected health condition I came down with 5 years ago. After losing my job I couldn't get any type of insurance coverage, and treatments have been amazingly expensive. Furthermore, each member of my family is rejected when they apply for coverage. It's a mistake to build financial plans on the hope that you won't get sick because you're currently young and healthy. It can happen to you, and if it does it can gobble up your portfolio real fast. Living without health insurance exposes years of hard work to chance; it's like taking your portfolio to the casino. And it didn't just impact me, it impacted my wife, children, and employees (we had to let 2 go due to my reduced involvement in the business). I think it's a crude generalization to think that the health reform bill is just another transfer of wealth from rich to poor (the extension of coverage is a transfer of wealth). The new insurance regulations simply make insurance what it was always supposed to be - pooling risk to spread costs. These regulations might save your portfolio, home, kid's college savings, etc.

  • Report this Comment On March 26, 2010, at 5:16 PM, RetiredSurgeon wrote:

    After reading the above comments, I have reinforced my belief that the average reader of the Motley Fool is basically a misinfomed narrow-minded right-wing selfish and short-sighted individual who woul'nt know if someone was actually trying to help them if he or she tapped them on the shoulder. God forbid that it might cost a little more in the short run to help yourself or your fellow man. Coming from a retired Surgeon, you all should be ashamedof yourselves. Praise Presdent Obama et al for having the intestinal fortitude to fight for what is right. Next time you people get sick or older you will understand!!!

  • Report this Comment On March 26, 2010, at 6:14 PM, wolfman225 wrote:

    I have an idea of what I think a good (not ideal) health insurance reform package would look like. Lemme know what you Fools think (please, be kind):

    Firstly, the cost issue. For tort reform: payment should be made to victims in 2 levels. The primary being compensatory, the impact of the injury on his/her quality of life and ability to earn a living in their occupation over a lifetime (in the event they are totally disabled), the second is punitive and should be limited to no more than triple the compensatory damages. For example: your lifetime compensation for loss of wages/quality of life is $500K + $1.5M in punitive awards. No more awarding $10-30M to someone who "got cancer" after smoking for 30+ years and was somehow too stupid to read the warning lable!

    Secondly, insurance costs. Get rid of ALL State and Federally mandated coverages! Mandated insurance should only cover catastrofic care. HSA's should be set up to allow for people to fund their own preventive care and to pay for additional coverages (if desired) with pre-tax money, similar to an IRA. The money in these HSA's should be limited to health expenses until age 72, at which time they become a 2nd source of retirement income, thus rewarding people for making healthy life choices and being frugal with their health care dollars. A major part of the high cost of health care/insurance is the various mandates. For example: insurance companies in California are REQUIRED to cover the costs of "Gender Re-assignment" surgery! Give me a break. NO elective procedures should be a part of government-mandated coverage. If it's not medically necessary, but you want it anyway, you pay for a special policy, or pay out of pocket. There's no reason for a woman to have to contribute (through group rates) for ED drugs for middle-aged men who want to pretend they're still 21. By the same token, men should not have to subsidize breast implants, botox, lipo, fertility treatments, et al. for women who are losing (or never had) their teenage looks.

    An additional side effect of eliminating mandated insurance coverage for preventive and elective care/proceedures is that it would re-introduce the relationship between the provider and end user. This would also serve to help keep costs under control as the ones providing the care would have to keep their costs more or less in line with the patients' ability to pay. Giving people back an immediate relationship between their usage and their costs will provide an incentive to keep medical visits to a necessary minimum, as opposed to running to the doctor with every sniffle because it's somehow "free".

    So that's my idea. It's far from complete ( didn't have time or inclination to try to write 2,000+ pages), but I think it's a solid start. Provide government subisidized (if necessary) policies for major medical ONLY, combined with common sense tort reform and HSA's that also serve as auxiliary retirement accounts.

    P.S. If people want to purchase plans that do cover preventative care and electives such as cosmetic surgery, Viagra, fertility treatments, etc., they should be allowed to purchase them via a menu of "a la carte" options provided by private insurance companies competing across state lines for their business.

  • Report this Comment On March 26, 2010, at 6:25 PM, GeodesicGnome wrote:

    The whole point of insurance is the pooling of resources to spread risk. The assigning of insurance cost based on risk factors ultimately devolves back into everyone being responsible for their own losses (i.e., no one has insurance). Health insurance is all about the healthy paying for the sick. That's a GOOD thing. Pray that you are one of the healthy because it's much better to PAY for the sick than to BE sick.

    People without insurance don't shoulder all of their own risk. The rest of us pay in higher costs, like the cost for hospital care increased to cover uncompensated care for the uninsured that have come in through the emergency room. This is true whether people are uninsured because they have been priced out of the market (because of risk differentials), have been refused insurance (pre-existing conditions) or simply suffer from the invulnerability delusion so common in the young. Requiring people who opt out of insurance to pay for the burden they place on the rest of us is a good thing, too.

    The complaint about cost containment is a bit questionable. The current bill has been evaluated by the CBO as reducing the deficit by containing costs. It could have done much better in this regard, but the ones complaining about the costs now are the same one's who prevented inclusion of the most effective cost containing measures. Single payer (Medicare for all) is the cheapest. Next is the public option. Neither was acceptable to conservatives because they increased government involvement. So we have a bill that leaves for-profit insurance companies in charge but regulates them more. So in addition to spreading the cost of medical care for the sick, we also pay for returns for investors, executive bonuses and marketing. But at least this bill limits all this (plus the inevitable administrative costs) to no more than 15% instead of the 20-30% we have been seeing. This bill is definitely a compromise, which is what you would expect, right?

    As someone interested in investing, I'm all for investor returns, just not in our health insurance system. I recommend T.R. Reid's The Healing of America to everyone interested in this topic. You might find it interesting how all the other democracies have been able to accomplish what we are still struggling with. And most of them did it through private insurance, not the "socialism" we've been hearing bandied about so much recently.

    I have been disappointed in how much of the past year's disagreements have been based on slogans rather than information. Few of the opinions I've heard have been based on any research about health systems work in other countries: their advantages and problems. Everyone seems to assume all countries are like England's NHS.

  • Report this Comment On March 26, 2010, at 8:00 PM, Chromantix wrote:

    I love how the morally righteous talk down to hard-working Americans who disagree with this health care "reform". They tell us how shameful we are for objecting when the government picks our pockets...

    I understand why they are happy: they got the government to accomplish what they lack the guts to do in person.

  • Report this Comment On March 26, 2010, at 8:03 PM, tomjenk wrote:

    Dear RetiredSurgeon,

    I happen to be an independent who fully expected Obama to raise my taxes to provide universal health care, and I proudly voted for Obama. However, during his campaign Obama paraded Warren Buffett and Paul Volcker, among others, to lure fiscally concerned voters in the middle, like me. The message was that he would be a better steward of taxpayer money by blunting special interests, reducing earmarks, and making sure reasonable cost-saving measures were established. The deficits that exploded under Bush would be reduced. It was a well-executed bait-and-switch.

    Although I am still glad that the health care bill passed, I feel nervous about the program's ultimate cost. Given that the plan front-loads revenues and back-loads expenses, "borrows" from Medicare and Social Security, and includes a take-over of the student loan business just to make the CBO estimate work, I feel like this was another bait-and-switch, if not a play from Lehman Brothers' book.

    The concerns about health care's ultimate cost are legitimate, not narrow-minded or selfish. Bill Gross of Pimco estimates the health bill will add $562 billion to the deficit over 10 years, as opposed to the $138 reduction projected by CBO. It may seem a pittance compared to the total present value of our future programs, $46 Trillion, but we need to get serious about paying our bills sometime.

    It seems reasonable to get serious when bond investors start losing interest in extending us credit. Not only are China and Bill Gross steering money away from US Treasuries, this week Berkshire Hathaway, Johnson & Johnson, Proctor & Gamble and other corporations paid lower yields than the United States for their debt!

    I haven't heard a balanced discussion about how much debt we can finance without seriously slowing GDP growth or losing our default currency status, but it would be foolish to wait and find out.

    After all, if we genuinely want government to pay for health care, shouldn't we also want the program to be financially sustainable so it can last?

  • Report this Comment On March 26, 2010, at 8:09 PM, jonesericr wrote:

    Well on point number 2 I would have to say that no matter how healthy you are getting hit by baseball, a car while cycling, your daughters action figure can land you in the hospital. Through no fault of your own you will need medical care and should have some way to make sure you don't cause anyone else to pay for it.

    I think we can go round and round the healthcare issue with different scenarios but when has there ever been a bill passed by our government that was loved by everyone?

    ej

  • Report this Comment On March 26, 2010, at 9:54 PM, tgauchat wrote:

    Single payer NOW!

  • Report this Comment On March 27, 2010, at 10:05 AM, williware wrote:

    Who really thinks the government can do the same thing for less. Look at Fannie Mae, Freddie Mac and their role in the mortgage mess. We seem to manage diversifying risk with life insurance. Rates are lower than ever regardless of age. Seems to me we could have products in medical coverage that work the same way. Risks are projected over the long term and premiums are set for a 30 or 40 year term. Having big government be our nanny will just make it worse. A one time transition of existing high risk, elderly, middle aged and self insured to policies of this type would certaiinly make it cheaper for all. I wouldn't mind being mandated to buy a policy if I had a choice of a long term product.

  • Report this Comment On March 27, 2010, at 6:12 PM, stockjock11 wrote:

    @tgauchat,

    Do you know what a single payer system is? It is a step towards socialism! This bill isn't about reform, it's about control and power!

  • Report this Comment On March 28, 2010, at 10:32 AM, Nu2this1 wrote:

    Dear Fool team,

    About the health care reform bill is not perfect. Democracy is messy. However, speaking as a patient with a chronic disease that is very expensive to treat, I have to mention our perspective, as well. An estimated 1.5 million people in the USA have multiple sclerosis. It isn't the result of unhealthy living. Doctors don't know what causes it or how to stop it; it can be slowed down by some recently developed and very expensive drugs. Not all of us can afford those drugs, and so some companies will give those patients free drugs for a while. As I mentioned, these drugs just slow it down. Eventually, all of us can expect to wind up disabled in any way that destruction of the central nervous system will determine; losing our ability to walk, read, eat, etc. So, each of us has a "preexitisting condition" that is prohibitively expensive for the health insurance companies. How can such an illness be factored into the actuarial tables? It is unpredictable and so we never know when we will need health care of some kind from hospitalization to just another walking aid or a new drug. This is just one of many illnesses that can happen to someone - like cancer. So, do we do without health insurance and die faster than we would have to anyway? Not all chronic diseases are self-induced. What is your suggestion relevant to such people as we who have MS?

    Joan Hanley-Hyde, Ph.D.

  • Report this Comment On March 30, 2010, at 2:50 PM, golfer1john wrote:

    $750 if I don't buy insurance, and what? $8,000 if I do buy it? If I'm young and healthy, and I figure I'm not going to need insurance, I think I'll pay the $750. Then if I do get really sick, I'll get care anyway just like I would have before this bill. Even if I'm healthy and rich and self-insured, I'm looking at a risk of maybe $100,000 if I got an expensive illness under the old system, and $100,750 under the new one. My incentives have changed how? I think the assumption that a $750 tax is going to cause people to spend thousands for insurance that they otherwise would not have bought is a disastrous miscalculation. The financials of this plan only work if all those healthy people start paying premiums, and they are not going to do it.

    The previously uninsurable, however, will flock to the system in droves. So, if you're an insurer, and unprofitable potential customers with pre-existing conditions are beating down your door trying to buy coverage, and your prices are fixed by the government, what do you do? Insurers have proven themselves masters of red tape in handling claims, all they need to do is apply those skills to their sales departments, and it will take months of hassles to buy a policy, as it takes months to get a claim paid today. It's like two hunters running away from a bear: you can't outrun the bear, but you run anyway because all you have to do is outrun your buddy. The slowest insurance companies will make the most profits, because these unwanted customers will eventually give up and go to another company.

    Is this a great country, or what?

  • Report this Comment On March 30, 2010, at 3:09 PM, golfer1john wrote:

    Joan, I am sorry for your condition, and I wish you well. I hope you can get what you need under this new bill.

    The answer, though, is that if you want insurance to pay for your treatment, you have to buy the insurance before you get sick. You can't buy life insurance for someone who is already dead, and you can't buy car insurance after your car is wrecked. Insurance pays for things that might or might not happen, not for things that have already happened.

    This is not to say that insurance reform is not needed. The bill does a good thing in prohibiting insurers from dropping people who get sick. Premiums should be designed to cover these cases, they are not unexpected losses to the insurance companies.

    People born with expensive diseases should be covered under their parents' policies, and should be able to continue their own insurance when they become adults (some people don't achieve that by age 26, but I will count them as adults anyway), not denied because of their condition. The parents' policies should be priced to include these cases.

    People who opt not to buy insurance ought to face the consequences of their actions. There is government-provided insurance for the poor, so there is nobody who can claim that they can't afford insurance. Under this bill you get subsidies even if you make $88,000 a year! It wasn't long ago that they said $90,000 a year made you "rich" and you deserved a tax increase. Certainly anybody with a cell phone or cable TV who says he can't afford insurance is at best making bad choices, and needs to live with the choices he makes.

  • Report this Comment On March 31, 2010, at 11:18 AM, miteycasey wrote:

    3. Do you resent the fact that you must have auto insurance, and that the price of it varies by geographic area based on the rate of accidents and their costs in that area?

    The difference is auto insurance protects the people you are injuring, not yourself(liability).

    Health insurance is for you only, which you have control over. You can elect to stay healthy and not smoke, etc.

  • Report this Comment On March 31, 2010, at 1:29 PM, bmarti19 wrote:

    Obviously, this is a subject that in near and dear to most Americans. Unfortunately, I'm seeing this whole year as an orchestrated plan to take over healthcare by our left leaning government. How do insurance companies fail? One sure way is to not assess the risk through actuarial science of their policy holders and charge an appropriate premium for the policy they have to provide. The insurance companies will have to charge more to survive. Once that happens, Congress will complain and more regulation will fall on the industry and then the public option will be born, and killing the private insurance company.

    Another point to be considered with the free citizen in mind. If the government can force you to buy health insurance, who's to say that they will stop there? Suppose the costs in healthcare are traced to people not being proactive and going to the doctor for regular checkups? Will the government force yearly checkups in the name of cutting healthcare costs? Am I over reacting? Who would have ever thought the government would create the massive programs that this administration has?

    One last point to consider. I don't think students will quit becoming doctors because of this legislation, but I do believe that there will be more private clinics that are 'cash only' clinics. Why go through the inevitable hassle of getting payment from insurers who will have no incentive to pay on time? The people with cash and are willing to pay for service will get taken care of. The rest will simply have to wait.

  • Report this Comment On March 31, 2010, at 2:45 PM, donaldo15 wrote:

    Dear Tomjenk.

    Even though you bought the Obama hype and voted for him, very well stated.

  • Report this Comment On March 31, 2010, at 3:10 PM, fadler1 wrote:

    Simplify it. Lets for one minute leave the "what we should do for society" and go to "what we can do". The Baby Boomers PAID for the WWII generation. Not a criticism, just a fact. They took out much more than they put in. We are now between a rock and hard place and politicians are waiting for the "good fairy" to save them and blaming anyone they can for their problems. We just don't have enough money to pay for the Baby Boomers per capita as we paid for the last generation. Boomers did not have enough kids to do it and health care is expensive. 80%+ of all of the cost is with the doctors and hospitals but don't demonize them either. If you chopped out 50% of the drug cost, you would first eliminate all new drug development and really only save 5-6% of total health care cost. If you eliminated the insurance companies you would cut out maybe 4% (look at Forbes, insurance companies are in the lowest quartile of U.S. company profits). Diagnostics, my business, is about 8%. So, go after helping the two biggeys reduce cost, doctors and hospitals. Medicine is complex and not perfect. So eliminate the idea that "no cost is too great, no procedure is too much, no mistakes allowed". That is not the case in any other part of your life. No law suits unless the lawyer and person sueing is at risk of paying for the frivelous. No set ups for juries in states that feel the suit deserves money because maybe someday I will win the lottery too. Eliminate the frivelous costs in the two largest contributors to cost and maybe, just maybe there will be enough money. Eliminate advertising of drugs so people accept generics. Eliminate self referral wasting money and time of expensive specialists.

    THINK COST, not government plans unless you like Amtrak, the post office and the IRS.

  • Report this Comment On March 31, 2010, at 3:34 PM, TMFKopp wrote:

    @GeodesicGnome

    "The whole point of insurance is the pooling of resources to spread risk."

    The point is to spread risk among insured that have roughly equal probability of experiencing an adverse event.

    If you're insuring drivers, you can pool together a whole bunch of good drivers, of around the same age, with clean driving histories, all of whom live in the same geographic area. You assume that there is roughly equal probability that any one of them will get in an accident. You charge them similar premiums and you pool the collective risk that a couple/few of them will eventually get into an accident.

    Now what happens if you throw in a 21-year-old male that has two speeding tickets, an accident, and a DUI on his record? Now you've throw in someone that has a much higher probability of being in an accident. Should they really pay the same premium as everyone else?

    Yes, you do pool risk, but you do so while adjusting for the varying probabilities that insureds bring to the table. That's the whole point of actuarial science.

    "The complaint about cost containment is a bit questionable. The current bill has been evaluated by the CBO as reducing the deficit by containing costs."

    Have you read the reports from the CBO? More than half of the cost offsets are through new taxes and fees. And though it's notable that some Medicare payment rates were cut, it's important to point out that much of that savings will be eaten up by the adjustments to payment rates for physician services, a separate bill (H.R. 3961) which has a $210 billion price tag not account for in the healthcare reform bill.

    @Nu2this1

    I should probably just reiterate that I am very much in favor of reforming the healthcare system. There are many uncontrollable factors when it comes to an individual's health and many treatments for many conditions are simply out of reach financially for the vast majority of normal citizens. As I noted above, I think that a single-payer system would be much more efficient than this public/private hybrid -- not that that addresses the issue at hand.

    You note that 1.5 million Americans have MS. That's roughly 0.5% of the population. Roughly 33% of the nation is obese. For individuals, there are controllable factors and there are uncontrollable factors. I think it's laudable for the country to help those that were born with conditions that simply could not be prevented. But if we don’t take measures to address the very real, very costly factors that are preventable, then the system as a whole will be unsustainable and that will be bad for everyone over the long term.

    Matt

  • Report this Comment On March 31, 2010, at 4:30 PM, fadler1 wrote:

    Back to money and not enough. IF the average family of 4 consumes $14K a year in healthcare, does the average family of 4 pay in $14K a year? They need to stop playing word games and "hate" games setting one group off against an entity or industry. If someone goes to Starbucks every day and gets a Grande, shouldn't they be expected to spend the same amount of their own money on their blood pressure meds? "No I paid all my life"........no you paid for those using that did not pay in as much as they use. Wake up. Politicians are not going to fix it. We have too many older people who consume the lion's share of healthcare rolling up on Medicare. The numbers don't add up. We need to cut cost of delivery. We need to cut cost of defensive medicine. We need to ration what we have (Oh my god, I said the taboo but really there is not other option............you can't keep burning up the resources and not consider the supply..........not terribly different than any other commodity). Sure I WISH everybody and especially my family and friends got everything but also wish I was born rich, blond, and blue eyed. WAKE UP AMERICA. The reality is the reality.

  • Report this Comment On March 31, 2010, at 5:49 PM, SkinnyWallet wrote:

    I welcome the opportunity to read the comments on a story like this in a site like MF. I appreciate the educated discourse that helps enlighten me on these issues and improves my ability to think critically about them.

    That being said, it is really disappointing to me that so many feel the need to express irrational fear and anger as a way of trying to change people's minds.

    If your best argument against this law is that it will lead us down an immoral, irresponsible, unholy path to our own socialist destruction...well, then you don't really have any arguments against it, you're just looking for something to rant at and someone to cheerlead for you. People on both sides of the bill are doing way too much of it, and frankly, its a little embarrassing.

    This site is full of intelligent people. Don't make yourself look dumb by using unsubstantiated talking points and showing complete disregard for the facts.

    Thanks for reading.

  • Report this Comment On March 31, 2010, at 9:49 PM, busterbuddy wrote:

    Heathcare Bill is not just something people are moaning about. Never in the history of man has a government totally ignored the will of the people.

    People all over the country are mad as heck about it and that is an understatement. The issue is what will be the outlet.

    Anyone that looks for investment opportunities should short the market.

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