Health “insurance” is not health “care”
Orrin Hatch may not be loving the Democrats’ health care reform plans. Of course, for a moment there, I thought he might be, since he referred to it as being “out of this world.”
Sen. Orrin Hatch (R-Utah), who has a long history of teaming up with Democrats on healthcare legislation, says Democratic healthcare reform plans now under consideration are “out of this world.”
Hatch also told The Hill in a Friday interview he would be “shocked” if Sens. Chuck Grassley (R-Iowa) and Mike Enzi (R-Wyo.) sign onto a healthcare deal with Democrats given the current trajectory of the legislation.
Don’t ask me why, but this has gotten me to thinking about an important distinction which I suspect many of my more left leaning colleagues have overlooked in this entire debate. And that is the not so subtle, but very important distinction between health insurance and health care.
For those not familiar with the industry, insurance is, at the heart of things, little more than an organized crap shoot engaged in by large, well capitalized companies. Each insurance policy is essentially a wager placed between the insurance company and the policy holder. A homeowner’s insurance company will sell policies to a vast number of owners, betting that most of the homes will not burn down, flood or be hit by a meteor. As long as the amount of money paid out to people who do suffer these calamities works out to be less than the total premium payments made by policy holders, the company turns a profit and stays in business.
The same applies to automobile, life and… yes… health insurance policies. When you take out a health insurance policy, the company is essentially betting that you’re going to remain relatively healthy so they won’t have to lay out a lot of money, while you are hedging your bets in case you do run into a catastrophic health situation.
Many of the complaints being raised against the evil insurance companies have to do with pre-existing condition clauses. But let’s think about that for a moment. Getting denied coverage in such a tragic turn of events is certainly awful, and nobody wants it to happen. But if you find out that you have bone cancer, and then go to an insurance company looking for a policy, you are essentially telling them that you just found out you’re going to soon be incurring hundreds of thousands (if not millions) of dollars in medical bills, and you would now like to start paying $125 per month and have them pay them all for you. That’s not really a very good “bet” for the company to make, is it?
The point of this admittedly cold-hearted sounding tale is that the wish list of many public option and/or government run health care reform advocates is not a request for “better” or “more fair” health insurance. What they are asking for is to have somebody else pay for their health care if they become seriously ill, regardless of who is paying for all of the expensive technology involved.
If that’s what you want, and you feel that it’s the government’s responsibility to pay for your health care as part of your basic “rights” as a citizen, then fine. Just say so. And then tell us who is going to pay for it, because as the technology continues to advance, such care becomes exponentially more and more expensive. Can the government pay for all of that for everyone? Or just some of us? If some, then who? And where will that money come from?
The bottom line here is that you should really stop trying to call it health “insurance” if this is really what you mean. It’s not insurance if the government is telling the insurance companies who they have to cover, how they structure their policies and what they can charge, regardless of what the actuarial tables say. If you do that, the “bets” are off and it’s become a social program to pay for everyone’s health needs. The same applies if the government effectively puts the entire industry out of business and takes over the whole process. Again… if that’s what you’re really looking for, then fine. But at least be honest enough to admit it. You’re not looking for reform in health insurance. You’re looking for the government to pay everyone’s medical bills. And that won’t be free, so you’re going to have to tell us how it gets paid for.
25 Responses to “Health “insurance” is not health “care””
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Jazz, part of the problem is the insurance companies go out of their way to claim, pre-existing condition, or other tactics, to delay/avoid paying. There are cases where your example fits, someone runs around without insurance until they find out they are sick, but I'll be willing to bet they are a minority of cases.
When my brother got kidney cancer a few years ago he had been on the insurance plan for years, but they tried to claim it was pre-existing condition because he had a kidney infection & stone 10 years before when he was in the Navy.
That's not even going into the spinning the life insurance company tried when my brother died. They had a clause that side-effects (even death) from experimental drugs invalided the insurance. They tried to claim one of the cancer procedures were experimental so they didn't have to pay.
Health care is what you need.
Insurance is what you pay for .
Coverage is what you get denied.
“You’re not looking for reform in health insurance. You’re looking for the government to pay everyone’s medical bills. And that won’t be free, so you’re going to have to tell us how it gets paid for.”
*****
Oh, OK.
You have every person pay in $10-$20 a month into a health-tax pool [consider it their "premium"]. Then you have a $5 copay with each visit and prescription. Even panhandlers bring in about $10 a day. Those totally incapable of raising even $10 per month can be funded through mercy charities and whatnot. Strict screening would apply for them.
Then you take the statistics on those substances legally for sale that cause the most illness, disease, organ failure and death and tax them hugely. That would include stuff like products high in sugars, saturated fats, nicotine, alcohol and such. The big killers. Add those taxes to the pool. In addition, employ a team of auditors who scour over actual procedural costs and limit them accordingly to stem scamming the system by health professionals. Yet make their work worthwhile in an honest way, set the levels high but nowhere near as high as they are sometimes billed today. Enact strict penalties for anyone caught cheating the system. Suspension of licensing and even revokation if enough offenses are commited.
Pretty much what should be going on today but isn't.
And just another reminder. If the health indu$try sees the public option as unworkable, then they should just sit back and watch the experiement fail, laugh and say “I told you so”. But they're not willing to do that. Why is that? lol….
Jazz, thanks for making me no longer the only one (other than those acknowledging the facts, such as C. Stanley, previously) who has noted aloud that what is the subject of everyone that is being wrongly called “insurance” (something catastrophic or disastrous that normally doesn't happen, and what we wish to avoid by pooling our money to reduce the consequences, at least, if not also the risks) is in fact health care, i.e., comprehensive health care.
A corollary to this, related specifically to the comprehensivity (_comprehensive_ and ideally _complete_ health care, not “insurance” [sic]) is the past political history of this comprehensivity and the hypocrisy of the still-deranged proponents of the Democratic health care initiative: For years, liberal politicians have insisted in states where they have power on enacting laws and regulations that compel (force) insurers to offer generous, broad-in-scope, “Cadillac” or “gold-plated” health care that offers all kinds of benefits (not limited to preventive care, a favored subject of hype by these politicians and by activists), which forces the cost of insurance to be much higher than true insurance (catastrophic, hospitalization-only, for example) would cost. The hypocrisy currently in effect is that while proponents of comprehensive (and notably of preventive) care tout the many rational and other benefits, and state that health care is not sought anywhere nearly enough by the target audience of these people, at the same time they wish to tax those health care plans that are “too generous” and that lead to “too much” “overuse” of health care services.
The faithful proponents of efforts like “Obamacare” don't have the intellectual capacity or developmental level to grasp, much less appreciate or concede, such facts, but the rest of us know better. (It's only an additional defect with the Dems' effort and with their faithful supporters that other fundamental defects of the effort such as the failure to pay for it, and lying about how it will be “paid for,” are also openly evident.)
“Then you take the statistics on those substances legally for sale that cause the most illness, disease, organ failure and death and tax them hugely.”
To recover actual costs arising from their use is one thing, but in reality liberal politicians, pushed by childish, ignorant, and often dishonest activists, will insist on much higher taxes than are ever merited.
That's in addition to dishonestly referring to health care provision as “insurance” [sic] and appealing to the exploitable by charging them “premiums” [sic] that are only a fraction of the total costs that are incurred.
You know, like the current defect in Medicare, whose “premiums” remain only about 25 per cent of costs, the rest coming out of general revenues.
(The “magic solution” to this by liberals will be to insist on all funding being “mandatory” out of general revenue. They really will believe that this “solves” the problem immediately and forever! Oh, and that it appeals to the kind of people who want something “magically” for “free” is no doubt in large part why it is part of the Conyers “Medicare for All” legislation. The revenues “should” be raised through progressive income and wealth taxation, as well as taxes on things like stock and bond transactions, predictably.)
[coup de grace to an already-devastated corpse]
And speaking of comprehensive health care, government health care as the ideal, and liberal hypocrisy:
Why is the term “Medigap” so familiar to everybody?
As has been pointed out in other articles, insurance is a misnomer when talking about a national health care system. Not that we want to get caught up in semantics too much, but in reality what needs to happen goes far beyond just reforming insurance industry standards. I have insurance on my car but it doesn't cover general maintenance and regular wear and tear, same with my home insurance. It is only really designed to pay off due to catastrophic events. If indeed we have adapted that “insurance” mindset to fit our use of and attitudes about health, then we are programming people to wait until “catastrophic” needs arise in their personal health needs, instead of focusing on “maintenance” and preventative care.
It won't be free but other countries have demonstrated that it can work without bankrupting the coffers or sliding the population into communism.
Jazz,
You bring up a good point. Us liberal folk are trying to move the country away from the traditional “insurance” model, because that model doesn't work for millions of Americans. Insurance companies already practically refuse to cover the elderly, and thanks to advances in predictive medical science, the rest of our policies are at risk.
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“If indeed we have adapted that 'insurance' mindset to fit our use of and attitudes about health, then we are programming people to wait until 'catastrophic' needs arise in their personal health needs, instead of focusing on 'maintenance' and preventative care.”
No, we are not. We are simply being honest, for a change, about what a “safety net” is; as for the problem of neglect (deferring maintenance), that is an individual decision, which, incidentally, far from everyone is hopelessly unable to think about and act on without parental direction from government.
I'm not a fan of ObamaCare by any means, but I would like to point out one problem: Peter Singer notwithstanding, we as a country are generally unwilling to let cancer patients die in the streets.
So do you know what happens when health insurance providers deny coverage to cancer patients (or worse, cancel coverage for long-time customers to avoid footing the bill)? To get helth care, the patient has to quit his or her job and stop contributing to the economy to be broke enough to qualify for Medicaid.
It doesn't seem to me that forcing people to go on Medicaid is an improvement to balancing those costs out across an entire system of patients. That's traditionally what insurance is about. And yes, insurers generally use actuarial tables to assess individualized costs — but even then, there are laws about things they can't do.
For example, even if an insurance company decides that black people are a greater life insurance risk than white people, it's against the law for them to jack up rates for any black person who wants life insurance just because they're black. Now maybe you think that ought to be perfectly acceptable. For that matter, maybe you think it's perfectly acceptable to discriminate against women in the workplace on the grounds that there's a higher actuarial risk that they will quit later to have babies. But most Americans think that there are limits to what companies ought to be able to do with actuarial tables, hence the laws we have in place. If pre-existing conditions become another area of regulation, it will simply fall into this tradition.
The real economic problems with health care, boil down to a few simple problems without simple answers: (1) Reimbursement for medical providers based on price per line item performed leads to overtreatment, with unnecessary tests, procedures, etc. (2) Giving people access to health care without attaching a proportionate cost per treatment to the patient (whether through a great medical plan or socialized medicine) leads to overuse of services by patients. (3) Not giving people access to affordable, timely health care is expensive (in emergency care costs, etc.), but those costs are externalities that do not fall proportionately on the stakeholders. (4) Few people can stomach letting people die for the sake of saving money, but the costs of end-of-life care are enormous and growing. (5) The risk of malpractice suits leads to overtreatment for CYA purposes.
The current proposal addresses at best two of these, but completely fails to incentivize providers to offer only treatments that are really necessary (the most important issue of all), and also fails to tackle end-of-life care or tort reform. Until health care providers themselves have reasons to look for ways to save money while retaining quality of care, no health care reform will ever be successful.
“Insurance companies already practically refuse to cover the elderly, and thanks to advances in predictive medical science, the rest of our policies are at risk.”
Actually, that has long been known and anticipated as the end of insurance and the beginning of truly-population-wide support for and insistence on government health care; it simply hasn't arrived yet and won't for years to come, longer than the most interested people have always believed.
DLS,
It's already happening, and that's why you're seeing this push for health care reform. Public opinion polls going back at least a few years have shown strong support (majorities in a lot of cases) for a public health care system of some sort.
“To get health care, the patient has to quit his or her job and stop contributing to the economy to be broke enough to qualify for Medicaid.”
1. Many of us have insurance (pre-paid health care) that is not group insurance provided by employers.
2. You will notice that _nobody_ is denying there is frequent misconduct by the insurance companies.
3. What you are describing is related to a subset of health care that has been neglected for some time by the Dems in their push to have Washington take over more health care elsewhere, to supply other, new, groups of beneficaries instead: long-term care. Long-term care (actually, late-life and end-of-life care) of the elderly is a long-neglected problem (complete with the “Medicaid trap,” which Washington has acted on to increase, not reduce, with its “[private] asset recovery” effort recently), but which will grow in time as our population ages — and which provides us with a warning now of the future insofar as cost growth and need to control it inevitably becomes a worse problem, means-testing and “asset recovery” for all kinds of government health care in addition to rationing on the basic of “futility” as well as “appropriateness” and mere political preferences (rehab for many vs. liver transplants for few, etc.).
“It's already happening, and that's why you're seeing this push for health care reform.”
That's not the only reason why we're seeing the push now, particularly this very-defective effort by the Dems ironically at a time of economic slump and “need” to stimulate the economy (which implies the avoidance of anything new that is especially costly, new entitlements as well as new and more taxes).
The desire for reform isn't going to go away if the Dems rightly grow up and slow down this and next year.
DLS,
Meanwhile millions remain without insurance, and those with insurance are financially ruined anyways. The status quo is unacceptable, economic downturn or not.
Maybe we could take a year off from blowing up sh*t in the Middle East and pay for health care for the next 10 years?
I would love to hear from one Conservative who has been canceled by their Insurance company just when they are diagnosed with Cancer. Or how about a Blue Dog who has had to file for bankruptcy due to medical bills left them by their Insurance company. What, no takers?
Could this be because the fat and happy (and disease free) are content to talk about the subtleties of Health Insurance vs Health Care because they have no experience with personal health vs corporate greed? Health Insurance is an economic issue. Health care is a life and death issue.
Actuary tables have meaning only to those who have been lucky enough to stay healthy or are still young. They see insurance as an expense that can be minimized by living correctly. I suspect your politics will change in direct relation to your health. Conservatives have shown they are proud of their lack of empathy; there will be hell to pay for your lack of comprehension.
@@I would love to hear from one Conservative who has been canceled by their Insurance company just when they are diagnosed with Cancer.@@
Let's make it easier for you to advance your illogical assertion—-let's hear from any liberal who paid their premiums are were “cancelled”……for any reason.
And if you're making your punt off of Rambie's story, have him upload a copy of the insurance policy wording that had a pre-existing conditions exclusion that lasted for 10 years……….I'd love to have a copy of an insurance policy that was illegal but was approved by the state insurance department as approved for sale in that state.
Pre-paid health care may be a pretty good idea, but it has its incentivization problems as well. If you prepay a fixed amount of money to rerecive a variable amount of care, then you have an incentive to overutilize health care, while your provider has an incentive to underprovide — for example, with longer waiting periods and reduced investments in up to date equipment. Actually, unless I'm missing something, the incentives are the same as in socialized medicine.
Of course, in a socialized system, you can't switch to a different system of care, while with prepaid you can. But if you don't get lousy treatment from your system of care until you already have a serious condition, competitors are likely to turn you down, which is perfectly understandable, as you point out.
Still, I can't really argue with the claim that prepaid health care might be a step forward in many cases.
“It won't be free but other countries have demonstrated that it can work without bankrupting the coffers or sliding the population into communism.”
Not to mention that when you compare the amount of taxes that they pay to support such a system to the amount of money the average U.S. citizen pays for insurance, we pay substantially MORE for LESS. I have no idea why people harp on higher taxes to pay for a service that would actually lower the amount of money they'd pay out of pocket in the end. Sure it would lower my taxes to not have the government supply me with police protection, but it'd be a heck of a lot more expensive for me to have to hire my own personal bodyguards. Still, I'm not barred from hiring bodyguards in addition to accepting police protection (or refusing it) should I wish to do so.
As per the “maintenance and preventative care” issue… It's a heck of a lot cheaper to pay for regular oil changes than to replace an engine. Same goes with human maintenance.
It's safe to argue that no country has found a perfect solution to health care. However, with so many other countries offering some form of socialized health care and with those countries showing lower expenses and better quality of care for those under it, I'd say that we can at the very least copy and paste to find a BETTER (not perfect) way to do things in the U.S.
There's no need to reinvent the wheel, folks, and when the other cart moves faster, it's hard to argue that it won't at the very least improve the ease of moving your own. It may not go as fast as you want it, but it's going faster than you are by just dragging a cart with no wheels at all.
You’re not looking for reform in health insurance. You’re looking for the government to pay everyone’s medical bills. And that won’t be free, so you’re going to have to tell us how it gets paid for.
It comes out of your paycheck in the form of taxes. Just like your insurance policy premium — which is higher this year than it was last year and will be even higher next year than it is this year because of millions of uninsured and underinsured Americans who get their preventive medical care in hospital emergency rooms — comes out of your checking account. Or your savings account.
It's just a question of whether you prefer to have the money taken out at the front end or prefer to take it out yourself at the back end.
I'm not sure why Kathy's point is hard to understand.
Maybe that emphasis will help?
“Meanwhile millions remain without insurance, and those with insurance are financially ruined anyways. The status quo is unacceptable, economic downturn or not.”
Obviously, that does not imply we should rush childishly and stupidly to compound the situation and introduce the substantial risk of making it worse rather than better.
Being a Utah health insurance underwriter for http://www.BenefitsManager.net and http://www.DentalInsuranceUtah.net I have the opportunity to consult within many state insurance committee meetings. Some interesting changes took place in Utah with the passage of House Bill 188 that other states should pay attention to and perhaps the federal legislation. The bill created a state insurance pool requiring private health insurance carriers to come together and underwrite risk. Through governmental guidelines (which I have traditionally opposed in the past) they created a arena of underwriting rules that essentially guarantees the participating insurance carriers a ?no loss? or ?no gain? over each other. What this essentially means is that they pool the underwriting medical risk and spread it evenly among each carrier. All the sudden, we see guaranteed issued policies. We see rates drop by as much as 13% In Utah, our average monthly family rate is $867 for a $500 deductible plan. Some of the family rates within the ?Utah Insurance Exchange Portal? are approaching $700.00 now. To see more of HB 188 and see how Utah wrangled change without increasing taxes or rationing go to: http://www.prweb.com/releases/utah_health_insur…
The private insurance sector can be corralled into cooperation where they can meet their goals. You have to understand that health insurance carriers are only looking for a 4-5% administration fee. That is it and they are more efficient as compared to a governmental portal that will cost more money. Take a look at Utah folks!