I was wondering when she...

[Finglefinn]

Well, I just had the meeting I called a few days early and I found out that we are self insured and Great West is just the administrator.

Oh fuck I'm pissed:

1. The people above me in Executive Administration who make the decisions on this stuff have no idea what's really going on besides the bottom line.
2. Of course, they don't pay a penny for premiums. It's part of their compensation.
3. Their out-of-pocket costs are minimal compared to their salaries, i.e. their salaries are high enough that costs similar to mine would not concern them.


As a result of this, I'm going before the executive management team in a couple weeks to vent. Our HR manager and our payroll/benefits adminstrator both were very sympathetic to my concerns.

[Finglefinn]

Oh yeah, I also found out the details of the premiums I pay. My employer pays 90% of the premiums for me and 25% of dependents, which for me is my wife and son. That is obviously why my premiums are so high.

I also audited my out-of-pocket costs and the premiums I have paid so far this year and I have paid $1100 more than the insurance has paid. As you can see, I'm really pissed.

[Ddrak]

Just to toss in a flip-side:

The problem with health insurance is health costs are usually minimal until something serious happens. Then the costs skyrocket. It only really takes someone getting an illness that requires long term treatment or multiple surgeries to really balance out the whole thing. In essence you have a dozen or so people (making these numbers up) paying for that guy that just found out he had cancer and needs a full course of chemotherapy. Just saying why counting your costs for a year and comparing it to your payments probably isn't good enough to get properly pissed at. You should really look at trying to get some sort of breakdown of costs on the self-funded pool to get an idea of how/if you're being ripped off. Remember - it could be worse, you could have my insurance!

Completely going off on a tangent, someone said to me that if you find out you have cancer of some sort then you should just sign up for every credit card that gets offered to you and draw them to the limits. The cancer treatment is going to bankrupt you so why not make the most of what's going to happen anyway?

Dd

[Finglefinn]

Since we're self-insured, I have lots to be pissed about. My employer should not be making money off the employees. It is one thing to fund part of your employee's premiums, but it is another to make money on the unused premiums, essentially funding the premiums for employees who do not pay their premiums. The way I see it, of our 140 FTE, the 6 that do not pay premiums are being funded by the other 134. Any excess goes to the profit of the company. Sure the company pays a large premium annually for major medical, which I found out covers the majority of births, hospitalizations, emergencies and surgeries. The employee paid premiums go to this major medical plan and the rest to the plan administrator. At year end, any excess gets returned to the company. There is no way in hell that my company is losing money on this. If they lost money, I guarantee you they'd elect not to be self-insured and go with a regional group plan like Blue Cross or something, that is made up of 100+ companies in the Northwest. I was part of that kind of insurance group at my last job. It wasn't nearly as expensive as my current insurance and the coverage was better.

[Partha]

What, you mean you don't like paying your employers to keep you insured? Why, you dirty fucking hippie ingrate. After all, without that profit they make off of you, they'll be likely to ship your job off to India or Pakistan or Louisiana where workers KNOW double shifts with no breaks are 'just part of the job'. Why do you hate America?

[Finglefinn]

Funny, Partha.

[Arathena]

I just went through our benefit enrollment. I will be paying $903, pre-tax, (So, realistically, like 650$ in my bracket) per year for a PPO, with most routine doctors office / simple prescriptions 100% - $20 / $15 copay, 90/10 on everything else, plus dental and vision. The company is picking up a years salary in life insurance and Long Term Disability, 100%. I estimate that the company must be footing about 85% of the bill on the other insurances.

Fingle, Dd, you guys didn't even get a reach-around.

[Finglefinn]

They had no common courtesy with me. I bet they can suck a golf ball through a garden hose though. Maybe even shove a lump of coal up their ass and in an hour have a diamond.

[Partha]

For discussion's sake with Ddrak and others with brains. (That lets Embar and Kulaf out)

http://www.dailykos.com/story/2007/10/11/831/96156

Here's the basic problem. The Frosts aren't rich and they have children. That means medical expenses are their biggest problem. Under the Malkin theory, either poor people shouldn't have children because insurance is too expensive, or the poor should go into debt to pay for insurance which under the new bankruptcy laws is tantamount to indentured servitude.

Anyway -- now that I've weighed in on the Frost debate, I want to bring back the central arguments I have always made (and will continue to make) about single-payer health care.

While I will almost always advocate for a market based economic approach to allocating resources, health care is not an area where the profit motive should dominate decision making. Simply put, the end product is a patient's health. Private health insurance has a conflict of interest between the insurance company and the insured which will be resolved in favor of the insurance company a majority of the time.

Let me paint a hypothetical picture to illustrate this point. Insured makes a claim with the insurance company, which is a publicly traded company. Because the insurance company is publicly traded they must turn a profit and increase their profits to maintain their share price. In order to make a profit they have every incentive to either

1. Deny the insured's claim, or
2. Delay payment to increase the possibility the insured will drop his claim

There are numerous stories about an insured making a routine claim only to be inundated with paperwork, or being told the policy doesn't cover that procedure, or being told the insurance company has to look into the claim to see if the insurance company can make a payment. In any of these situations the central idea of insurance -- to provide some safety for the insured at a specific cost -- is compromised.

In addition, insurance companies will seek to minimize the amount of money they would have to pay to the insured. Again, remember the product here is the patient's health. Supposed the insured has a disease where the cure is expensive but a cheaper alternative exists. However, the cheaper alternative would moderately or seriously compromise the insured's quality of life. Because the insurance company is profit-driven, it will probably opt for the cheaper treatment that compromises the insured's quality of life.

[Ddrak]

By "single-payer health care" are they talking about a single commercial insurance provider that the end user is compelled to use? If so, then the argument is the same against any artificial monopoly - without the balance of the consumer simply taking their business elsewhere then the entire market theory collapses in favor of the corporation which can pretty much do whatever it wants without fear of consumer reprisal. In my mind, those markets are perfect candidates for socialization because you then introduce (theoretically) the market force of choice of government into the running of the monopoly, or you have to artificially introduce competition by splitting the company.

If they aren't talking about a single commercial insurance provider then they've simply ignored the fact that consumers can switch providers to someone that does give them service even if they have to pay a little more for it. In that case, it's no different in dynamics to auto or home insurance - the company is driven to minimize payouts while keeping their customers happy enough not to go elsewhere.

Dd

[Partha]

It's roughly analagous to the UK/Canada health systems. The government becomes the insurance provider - which makes sense if your desired outcome is healthy people instead of higher profits.

[Ddrak]

It's roughly analagous to the UK/Canada health systems. The government becomes the insurance provider - which makes sense if your desired outcome is healthy people instead of higher profits.

The problem I have with UK/Canada is if I have the cash to pay for my own treatment, why shouldn't I just be able to fork over cash for a doctor and have them run around to do my bidding? I'm a big fan of having a base level of socialized health care because I think it's overall good for a society but I'm not a fan of forcing people into that system if they have the means to go with a private insurer to give themselves better or at least more comfortable treatment.

I think there has to be some sort of happy compromise between the US and Canadian systems.

Dd

[Partha]

Don't disagree with you on that one, Dd, but I don't see the end of private practice coming. A US version will undoubtedly look more like an Australian one than a UK one, and there should be that choice for those willing to afford it. What bugs me are the folks who claim 'socialized medicine' doesn't work and is too expensive when every other major industrialized nation offers better care for all of it's citizens for a lower per-capita cost than the US. In other words, the data do not support the conclusions.

[Trollbait]

What is puzzling to me about the Democrats and the whole health care thing is this......

Democrats claim our government has been unable to care for the needs of 25 million Iraqis and has badly bungled the war in Iraq.

This is the government who made a complete mess of hurricane relief for Katrina victims.

This is the same government they assure us will be able to take care of the needs of nearly 300 million Americans with regards to health care?

I know what they will say. They will say "Oh, but if a democrat is in the White House.."

Well history tells us that the bureaucrats are all the same no matter who is in charge.

[Arathena]

I believe that it is possible to create a useful, socialized medicine system in America, along the lines of the Australian system. I also believe that for this to happen, the entire current leadership of both the Democratic and Republican parties must be excluded from the process, as must any and all lobbyists. In turn, the American public will need to be convinced that there are times when they are going to have to accept 'adequate' care instead of newer, 'superior' methods. I don't think any of these conditions can be met.

[Embar Angylwrath]

Don't disagree with you on that one, Dd, but I don't see the end of private practice coming. A US version will undoubtedly look more like an Australian one than a UK one, and there should be that choice for those willing to afford it. What bugs me are the folks who claim 'socialized medicine' doesn't work and is too expensive when every other major industrialized nation offers better care for all of it's citizens for a lower per-capita cost than the US. In other words, the data do not support the conclusions.

That statement is out of context. There are the financial considerations as well. As in... what is the tax rate in those countries, and what dollar amount per capita (adjusted to US dollars) is spent on socialized medicine. Then take that amount of money, multiply it by every person here in the US, and tell me what the increases in tax revenue would be needed.

I'm not arguing that our health care system is in need of overhaul, but falling back to a socialized medicine system, which has its own set of issues, isn't the solution.

[Klast Brell]

Socialized medicine has had a couple centuries of trial run in our armed forces. Did it work there, or should we abandon that to the free market?

[Partha]

Don't disagree with you on that one, Dd, but I don't see the end of private practice coming. A US version will undoubtedly look more like an Australian one than a UK one, and there should be that choice for those willing to afford it. What bugs me are the folks who claim 'socialized medicine' doesn't work and is too expensive when every other major industrialized nation offers better care for all of it's citizens for a lower per-capita cost than the US. In other words, the data do not support the conclusions.

That statement is out of context. There are the financial considerations as well. As in... what is the tax rate in those countries, and what dollar amount per capita (adjusted to US dollars) is spent on socialized medicine. Then take that amount of money, multiply it by every person here in the US, and tell me what the increases in tax revenue would be needed.

I'm not arguing that our health care system is in need of overhaul, but falling back to a socialized medicine system, which has its own set of issues, isn't the solution.

In actuality, we spend MORE money per capita in our system. A heck of a lot more. See the attached images in the diary. If you do the quick math from the three charts in the link, you'll see that the US spends about $2,700 per capita in public monies. (~6k from the third graph times .45, from the first graph) Australia spends a little less than $2k, and Canada just a skosh more than that. You're ALREADY paying more than they are, and getting a worse outcome while spending more out of pocket. Unless you're IN the field of insurance/health care, it's pretty hard to justify that outcome.

Jecks -

Fundamental basis for governing. Conservatives in this country are in thrall to Reaganism.

"The nine most terrifying words in the English language are: 'I'm from the government and I'm here to help.'"

You claim government can't work, and when put into power, you go about proving it. Unfortunately for that philosophy, the example of the rest of the world shows that government CAN deliver decent health care for it's citizens. The only question is why Americans don't deserve a system at least as good as Australia or Canada that doesn't involve you looking like Gollum. After all, it would make businesses much more competitive globally, give poor workers a base level of security healthwise that is less expensive than emergency room visits (which, by the by, you pay for anyways), and permits more capital to enter the system in purchases and investments.

[Embar Angylwrath]

Socialized medicine has had a couple centuries of trial run in our armed forces. Did it work there, or should we abandon that to the free market?

Because clearly the military is a system based on free-market economics.

Moron.

[Partha]

So socialism is a good thing if it involves the military?