Health Care Info from CBS News

[nerdgirl 0]

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Here’s my gripe for the day about current health care system: I’ve got health insurance through my employer (HMO, with co-pay & monthly contribution – fair & fine, imo). I’m going to Cambodia and will be in areas where malaria is endemic.

In the interest of preventative health/medicine/being responsible/not-being-stupid, I made an appointment to get immunization updates and anti-malaria pills. Got the tetanus booster through my primary care physician, but I have to go to a “travel clinic” for anti-malaria pills. My insurance doesn’t cover me getting the malaria prevention pills (which requires another doctor’s consultation). But if I come down with malaria, my insurance will cover treatment (more expensive).

I’m still going to go get the pills even tho’ the system is counter-incentive in multiple ways, i.e., to do the “right thing” costs me more in terms of my time and money: $75-200 consultation + malaria pills [Malarone] aren’t cheap: $5 - $8.50 per pill, generally take 2 days before leaving, while in endemic area, & 7 days afterward. Nonetheless staying healthy is much cheaper than getting sick. And btw: Atovaquone/Proguanil HCl (Malarone) is covered under the US, Canadian, and UK formularies.

In speaking with a representative of my health insurance provider, which is widely perceived as being very good to excellent, he never would explain(or possibly couldn't, either he doesn't know or is not permitted) the rationale for that decision.

/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

[kallend 1,635]

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And...maybe not.

You are comparing what IS with what may be.

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How's that 8% unemployment going, again?

Fact is, the economy died under Bush's watch, and bringing the dead back to life is always challenging.

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The only sure way to survive a canopy collision is not to have one.

[futuredivot 0]

The preventative part of the plan is discouraging you from going where you might get sick. If you choose to ignore that plan-pays your dollar and takes your chances. If work requires you go, work foots the bill. That's how it goes when I have to travel abroad. If your employer won't cover that expense, negotiate a better deal with your next employer. I'm not going to Cambodia, I don't want to buy your meds either through an increase in my current insurance rates or in future taxes. Personal accountability. A great concept when applied.

You are only as strong as the prey you devour

[rushmc 18]

A reasonable question.

Again, in part, IMO it has to do with the madated regulations a given state has. The link attached has some info from The Heritage Org.

There are some tables showing, by state, the mandated coverage. Now, this in and of itself does not anwer your concern but, I think the amount of current state regulation precludes insurers (either by regulation or, individuale insurers cost consideration) from covering preventative type treatments.

Your kind of info linked Marg

Marc

http://www.heritage.org/research/healthcare/cda06-04.cfm

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[nerdgirl 0]

Thanks for the link!. I'll check it out.

/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

[kallend 1,635]

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Thanks for the link!. I'll check it out.

/Marg

If you can find any regulation that precludes insurers from covering preventive medicine as he suggests, I'd be interested to know about it.

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The only sure way to survive a canopy collision is not to have one.

[rushmc 18]

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Thanks for the link!. I'll check it out.

/Marg

If you can find any regulation that precludes insurers from covering preventive medicine as he suggests, I'd be interested to know about it.

I doubt you will find (nor did I imply you will find) regulation that specifically precludes preventative coverage.

I was only saying that as a cost control measure it costs money and (for the most part not this example specifically) studies have conclusivly proven that preventative health does not cost less in the long run, so it is not included.

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[GeorgiaDon 340]

Thanks for the link Marc, it was an interesting read.

There is no doubt that regulatory mandates increase the cost (premiums) of insurance, and the article does show that. What I wonder about is if mandates increase the value to the customer (benefits recieved/premium cost) more than they increase the cost. If an insurer only covers you when you are healthy, and they can kick you off the plan if you get seriously sick, premiums can be low because they get to keep the premiums they collect when you are healthy and hardly pay out anything. Sure the premiums are low, but the coverage is worthless. Similarly if the plan covers lots of flashy but useless things like homeopathy and colonotherapy and toad licking or whatever, but buried deep in the 500 page book of "explainations" that you only get to see after you have purchased the plan is a notice that mental health benefits are not covered, the plan may not be as much of a bargain as it looks at first. Unfortunately many insurance companies engaged in such practices, which is what led to the mandates in the first place.

I'm not saying that all insurers would behave in such a manner if they were unregulated, but it used to be common practice. Even today you have to be an exceptionally savy consumer who has a good grasp of medical risk, which involves the probablility of incurring a disease factored by the cost of treatment, in order to effectively compare plans and shop wisely. I'm just saying there is more to value, which is protection from catastrophic expenses in the event of a serious injury/disease, than just low premiums. The paper you linked discussed only cost (premiums), it said nothing about value.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[kallend 1,635]

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Thanks for the link Marc, it was an interesting read.

There is no doubt that regulatory mandates increase the cost (premiums) of insurance, and the article does show that. What I wonder about is if mandates increase the value to the customer (benefits recieved/premium cost) more than they increase the cost. If an insurer only covers you when you are healthy, and they can kick you off the plan if you get seriously sick, premiums can be low because they get to keep the premiums they collect when you are healthy and hardly pay out anything. Sure the premiums are low, but the coverage is worthless. Similarly if the plan covers lots of flashy but useless things like homeopathy and colonotherapy and toad licking or whatever, but buried deep in the 500 page book of "explainations" that you only get to see after you have purchased the plan is a notice that mental health benefits are not covered, the plan may not be as much of a bargain as it looks at first. Unfortunately many insurance companies engaged in such practices, which is what led to the mandates in the first place.

I'm not saying that all insurers would behave in such a manner if they were unregulated, but it used to be common practice. Even today you have to be an exceptionally savy consumer who has a good grasp of medical risk, which involves the probablility of incurring a disease factored by the cost of treatment, in order to effectively compare plans and shop wisely. I'm just saying there is more to value, which is protection from catastrophic expenses in the event of a serious injury/disease, than just low premiums. The paper you linked discussed only cost (premiums), it said nothing about value.

Don

Somehow this comes to mind.

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The only sure way to survive a canopy collision is not to have one.

[dsandreas 0]

I am hungry tonight. I would like a nice steak but I can not get my employer, nor my various insurance companies, nor my local Publix nor my local restaurant to pay for it. Food is certainly a more basic need than health care...without food I need no health care. Yet it appears I will have to cover it myself. What kind of country is this?

Now, in order to have my job I need a car to get to work....

[rushmc 18]

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Thanks for the link Marc, it was an interesting read.

There is no doubt that regulatory mandates increase the cost (premiums) of insurance, and the article does show that. What I wonder about is if mandates increase the value to the customer (benefits recieved/premium cost) more than they increase the cost. If an insurer only covers you when you are healthy, and they can kick you off the plan if you get seriously sick, premiums can be low because they get to keep the premiums they collect when you are healthy and hardly pay out anything. Sure the premiums are low, but the coverage is worthless. Similarly if the plan covers lots of flashy but useless things like homeopathy and colonotherapy and toad licking or whatever, but buried deep in the 500 page book of "explainations" that you only get to see after you have purchased the plan is a notice that mental health benefits are not covered, the plan may not be as much of a bargain as it looks at first. Unfortunately many insurance companies engaged in such practices, which is what led to the mandates in the first place. Please show me where you got this

I'm not saying that all insurers would behave in such a manner if they were unregulated, but it used to be common practice. Even today you have to be an exceptionally savy consumer who has a good grasp of medical risk, which involves the probablility of incurring a disease factored by the cost of treatment, in order to effectively compare plans and shop wisely. I'm just saying there is more to value, which is protection from catastrophic expenses in the event of a serious injury/disease, than just low premiums. The paper you linked discussed only cost (premiums), it said nothing about value.

Don

Nice reply with good questions. One has to wonder however what might happen should these companies be allowed to create packages, and compete across state lines? Today, for most states, your headquarters must be in the state you offer insurance.(I wonder who lobbied for that???)

If allowed to fight for consumers across state lines, those with good customer service and fair priced policies would survive. I still see a level of regulation or oversite to keep the big from killing compititon.

Marc

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[rushmc 18]

Monty Python and kallend. A match made by God!

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[dsandreas 0]

Kallend is wrong again....IRS to be the enforcer for Obamacare.

IRS The New Health Care Enforcer

CLOSE [X] People often joke that government-run health care will have the efficiency of the motor vehicle department, and the compassion of the Internal Revenue Service. This joke will become reality if present Democratic health restructuring proposals are enacted.

Under both the House and Senate Health, Education, Labor and Pensions (HELP) Committee bills released to the public, the Internal Revenue Ser More..vice will play a key role in monitoring and enforcing health care mandates against individual taxpayers. Yet the introduction of the IRS into the health care system has received scant attention.

The Senate bill imposes a new requirement that all persons who provide health care coverage to others must file a return with the IRS listing the names, addresses, social security numbers, and the coverage period for each person, and "such other information as the Secretary [of Health and Human Services] may prescribe." (Section 161(b) starting at page 107). The bill does not limit what information the Secretary may request, so it is conceivable and likely that information as to the nature of the coverage, the family members included, and other details will be reported to the IRS.

The House bill contains similar provisions in section 401(b) (at pp. 175-176). The following information must be reported by the person providing health coverage:

(A) the name, address, and TIN of the primary insured and the name of each other individual obtaining coverage under the policy, (B) the period for which each such individual was provided with the coverage referred to in subsection (a), and (C) such other information as the Secretary may require.

This information is to be provided to the IRS for good reason. The House bill provides for a tax on people who do not have acceptable coverage at "any time" during the tax year. House bill section 401 provides for a new section 59B (at pp. 167-168) of the Internal Revenue Code:

(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—
(1) the taxpayer’s modified adjusted gross income for the taxable year, over
(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.

The Senate version is similar, although the tax is called a "shared responsibility payment" not a tax. Section 161 (at pp. 103-104) words new section 59B of the IRC to require lack of coverage for a month (subject to certain exemptions) before the tax kicks in, and does not specify a specific percentage, but instead, directs that annually

the Secretary shall seek to establish the minimum practicable amount that can accomplish the goal of enhancing participation in qualifying coverage (as so defined).

The reporting requirements can only be understood in this tax context. In order to know which taxpayers to tax, the IRS needs to know which taxpayers do not have coverage received from someone else (normally, an employer).

These reporting provisions would allow the IRS to cross-check income tax returns and health coverage filings, and withhold tax refunds or utilize other collection methods for persons who do not have coverage unless they can prove they have acceptable coverage from some other source. This is similar to the cross-checking the IRS does on income reported separately by the person making the payment and the taxpayer receiving the payment. But for the first time the IRS is not checking for income to tax, but for lack of health coverage.

These provisions should have people interested in privacy greatly concerned. While income information already is reported to the IRS, the IRS traditionally has not received personal health care information about individuals.

The IRS involved in health care monitoring and enforcement. Somehow, I doubt that most supporters of Democratic health care restructuring concepts will like this detail. But it's in there.

SOURCE: http://legalinsurrection.blogspot.com/2009/08/irs-new-health-care-enforcer.html Less..

[kallend 1,635]

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Kallend is wrong again....IRS to be the enforcer for Obamacare.

Please provide a link to any post in which I wrote anything about IRS and healthcare.

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The only sure way to survive a canopy collision is not to have one.

[kallend 1,635]

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Kallend is wrong again....IRS to be the enforcer for Obamacare.

Please provide a link to any post in which I wrote anything about IRS and healthcare.

BUMP

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The only sure way to survive a canopy collision is not to have one.

[mnealtx 0]

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Kallend is wrong again....IRS to be the enforcer for Obamacare.

Please provide a link to any post in which I wrote anything about IRS and healthcare.

BUMP

You've been doing it the whole thread - the OP was the Obamacare program having access to tax records and using them to get info on who could pay.

Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

[kallend 1,635]

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Kallend is wrong again....IRS to be the enforcer for Obamacare.

Please provide a link to any post in which I wrote anything about IRS and healthcare.

BUMP

You've been doing it the whole thread - the OP was the Obamacare program having access to tax records and using them to get info on who could pay.

So you can't find such a post either.

Not that the right wing rant he posted is relevant anyway.

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The only sure way to survive a canopy collision is not to have one.

[georgerussia 0]

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You've been doing it the whole thread - the OP was the Obamacare program having access to tax records and using them to get info on who could pay.

Nope - to find who qualifies for governmental aid.
And - surprise - this is not different from any other governmental aid program.

* Don't pray for me if you wanna help - just send me a check. *

[kbordson 8]

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You've been doing it the whole thread - the OP was the Obamacare program having access to tax records and using them to get info on who could pay.

Nope - to find who qualifies for governmental aid.
And - surprise - this is not different from any other governmental aid program.

Actually, according to the bill (and yes, last night I did print it and read through bits of it)

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Tax #1: Individuals Without Acceptable Health Care Coverage

Under the House health care bill, all Americans would be required to get health insurance. For people that are currently uninsured, that would mean getting insurance with the help of new government-provided affordability credits, if eligible, buying it without government assistance, or paying a new tax.

Read the provision taxing individuals without insurance in the official bill text >>

Here’s the specifics on how this would work. First off, for people who don’t get insurance through their job and aren’t eligible for Medicare or Medicaid, the government would subsidize, on a sliding scale, the cost of buying insurance. The subsidies will be most generous for people with annual incomes around the new cut-off for Medicaid – $14,400 – and will be entirely phased out for people making $43,320 or more.

People who don’t get insurance will be charged a tax based on the lesser amount of (a) the national average cost of a basic healthcare plan, or (b) two percent of their adjusted gross income. If a person is uninsured for only part of the year, the tax penalty will be based on a ratio of the above rate proportional to the number of months they were uninsured. The only way out of the individual requirement to buy health insurance would be with a religious exemption. The bill uses language based on an existing “religious conscience” exemption to laws relating to Social Security and Medicare. The language was originally designed to apply to older Amish and Mennonite groups, and it’s unclear whether other groups, like Christian Scientists, will be eligible for the exemption.

source

This isn't to see who "qualifies." It's to calculate your new tax if you chose not to get insurance on their own.

[georgerussia 0]

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Tax #1: Individuals Without Acceptable Health Care Coverage
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This isn't to see who "qualifies." It's to calculate your new tax if you chose not to get insurance on their own.

This one is more like a fine - to punish those who claim that they cannot afford health insurance, yet they somehow make enough money to own a rig and skydive. After seeing quite a few examples right here, now I fully support this part of the bill.

* Don't pray for me if you wanna help - just send me a check. *

[kbordson 8]

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Tax #1: Individuals Without Acceptable Health Care Coverage
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This isn't to see who "qualifies." It's to calculate your new tax if you chose not to get insurance on their own.

This one is more like a fine - to punish those who claim that they cannot afford health insurance, yet they somehow make enough money to own a rig and skydive. After seeing quite a few examples right here, now I fully support this part of the bill.

But is kinda supports mnealtx statements - allows access to income/tax records to calculate that "fine" or "tax" or whatever term is to be used.

You will not have the FREEDOM to be without.

Why do some actually make the CHOICE to be without. Because they might want the doctor to actually be working FOR them and not for the Government. I have some friends that are actually do feel that way. They don't want insurance nor would they want the government plan.

But with this bill - they will be "fined" on that choice.

Should someone be given the choice to be without insurance? Depends on if they would be able to pay their bills independently if they were to need care.

And note... there are also exemptions in the bill for "religious" beliefs (amish, maybe scientologist?) Is that a violation of church and state? Everyone NEEDS insurance... well... except this religious group. They don't need to pay.

[georgerussia 0]

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But is kinda supports mnealtx statements - allows access to income/tax records to calculate that "fine" or "tax" or whatever term is to be used.

I understood his statement as the government will use those records to decide between those who could pay themselves, and those who need government support. A tax for those who can pay but chooses not to (it's actually a fine, not tax) is something else. But maybe he meant that, in this case I apologize for misunderstanding.

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You will not have the FREEDOM to be without.

And now I think it would be better for us as a society. I read your argument about car liability insurance with great pleasure (well, I always like your posts, but this one was special). There you said that it would be nice if all the people were responsible, and the insurance was not mandatory. Unfortunately the problem is that a lot of people are not responsible, and once it goes to the point when others have to pay for their irresponsibility, the law is in place which restricts freedom for all of us.

Right now basically there are four choices:

1. A person could prove they cannot afford health insurance, and get it from some government program. This is paid by taxpayers.

2. A person could buy insurance themselves. They are on their own.

3. A person is so rich that they do not need insurance at all, they could pay cash for their treatment (and I do not mean something stupid like "$20 a month"). I do not know if it ever exists, but even so this is a tiny group.

4. A person could claim they cannot afford insurance. Depending on details, it might mean they are really unable to afford it. It might also mean they just want to spend money on something else, like skydiving, a new rig or a cell phone. If something happens, vast majority of them goes to ER, and does not pay anything for treatment. Since someone still has to pay for their treatment, it is covered by taxpayers. Therefore, this whole group is in fact the same as the group #1, which is on government assistance - even those at least some people in this group can afford it.

So the goal of this "Individuals Without Acceptable Health Care Coverage" section is to get rid of group #4. Those who do not have healthcare because they cannot afford it, will join #1 and will get it from the government. Those who do not have healthcare because they decided to spend on different things, will be forced to either pay for it, or pay a fine (a "tax"). Since the fine is larger than the cost of a healthcare plan, it makes no sense and nobody will use it. This will mean some people would have to jump less, or give up cable and cell phone to get health insurance - and I consider it a good thing.

An unfortunate consequence would be also getting rid of group #2, but to far smaller effect, as someone who has enough cash reserves to cover 100k surgery should not have a problem getting a cheap $150/mo plan.

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Why do some actually make the CHOICE to be without. Because they might want the doctor to actually be working FOR them and not for the Government. I have some friends that are actually do feel that way. They don't want insurance nor would they want the government plan.

So what's going to happen when they are found unconscious in their car in parking lot, got MRI and there is a tumor in their brain? This actually happened with my friend who was young and never been in hospital before. Could they afford it? If yes, they belong to #2. If this is the case, I agree that for those people it gonna get worse. For them I'd create kind of a bond - like how you can post a bond in DMV instead of buying car liability insurance. Since healthcare bills might be much larger, a 100K bond seems to be appropriate. This, however, makes little sense - even 3% return on 100K bond would be $250/month, enough for some average individual insurance.

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Should someone be given the choice to be without insurance? Depends on if they would be able to pay their bills independently if they were to need care.

Completely agree. And maybe I just was unlucky, but so far everyone I've seen who did not have insurance was also unable to pay their bills in a reasonable way (I think you'd agree that offering
$20 a month till the end of my life" is not reasonable).

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And note... there are also exemptions in the bill for "religious" beliefs (amish, maybe scientologist?) Is that a violation of church and state?

You're talking about exceptions from "Individuals Without Acceptable Health Care Coverage", right? My impression was that this was put there to bring some Republican votes with understanding that it will likely to be stuck down by courts. This is so obviously unconstitutional (to me) that I don't see any other reason to have it there.

* Don't pray for me if you wanna help - just send me a check. *

[kallend 1,635]

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You will not have the FREEDOM to be without.

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You don't have the FREEDOM not to pay income tax either.

This is just another right wing scare tactic brought to you by a bunch of proven liars.

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The only sure way to survive a canopy collision is not to have one.

[mnealtx 0]

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You don't have the FREEDOM not to pay income tax either.

Unless you're an Obama cabinet pick, that is.

Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

[kbordson 8]

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You will not have the FREEDOM to be without.

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You don't have the FREEDOM not to pay income tax either.

This is just another right wing scare tactic brought to you by a bunch of proven liars.

I posted a direct link to HR 3200, specifically to that point. Read the Bill.