[asking]

[QUOTE=ETWolverine;1923967][quote=asking;1923699]Does private health insurance cover illegals if they pay the premium?

Yes. But [illegal aliens] sure don't get it for free.

No. But as you know, single payer would be paid for with taxes, the same money you now give to a health insurer. You don't pay more, you just pay your premium to a different entity and call it "tax" instead of "premium." Illegals pay taxes, so they wouldn't be getting health care for free either IF they ended up being covered. I personally think they should not be excluded, but that's a problem that has lots of sides to it.

If they are single mothers, however, they generally get jobs and get insurance through their employers just as their husbands would.

Taking care of children is work. Husbands die or run off with secretaries or abuse their wives. A woman with one child can make enough to pay for day care. A woman with education and two children can just make it on her own. But a woman with 3-5 children and little education has no chance of ever making enough money to pay for day care AND pay for food and shelter. The least we can do is provide medical care for such a family. It shouldn't matter why the husband is out of the picture. The fact is that they often are.

Unless they are DISABLED and unable to work, they don't get Medicare. If they are earning less than 150% of the poverty line, they qualify for MediCAID which is a different program than Medicare.

I'm arguing that everyone SHOULD be eligible for Medicare, not that they already are. You shouldn't have to have a job. And frankly, being a mother in this country IS a disability! It forces you to miss work to care for sick children, forces you to work shorter hours so you can care for them regularly... and so on.

BIG PHARMACEUTICAL COMPANIES are the biggest donors of FREE MEDICINES to the people who can't afford it. Every single major pharmaceutical manufacturer in the USA has a program to help those in need get free or low-cost drugs.

Great if your doctor happens to prescribe one of these specific drugs and you can satisfy the requirements for it. But each one has different requirements and paperwork.

. But you think that Medicare is getting shafted by them because they don't give their fair share?

I think the government is allowing itself to be shafted by the pharmaceutical industry--subsidizing is a nicer word--not because Pharma doesn't ever give anything away (and take a hefty deduction for same), but because pharma benefits from the system we currently have and yet produces very few drugs that are even marginally better than what's already out there, at least not in proportion to the amount they spend on research, marketing, and executive pay. Pharma drives up the cost of health care enormously. My doctor wants me to take a $300/month NSAID when I could be taking aspirin for $3/month. When you actually look at the differences between the new drugs and the old ones, they may be only 5% more effective than an older off-patent drug, yet they cost 10 or 100 times as much.

You would also lack options, because if all there is is ONE decision maker, and if that decision maker denies your claim, there is no other option. You won't be able to change insurance providers, you won't be able to pay out of pocket. You will be STUCK.

I have insurance I can't afford and I can't switch providers. I'm already STUCK!

And insurance companies already pool risk. That's how they stay profitable and capable of paying out on claims.

This is just flat out wrong. They try hard to eliminate anyone who has ever had a major problem anyone likely to have a problem. That's how they stay profitable, by collecting premiums from the healthy and eliminating the unhealthy from membership by dropping them, reducing benefits, or raising the premiums and copays until people are bankrupt. The idea is to take only the people with lowest risk. That's not pooling risk. That's skimming the cream. And leaving the rest to the government to take care of.

Furthermore, most hospitals that are supposed to take care of the uninsured, in fact don't. They turn most of them away. There is plenty of research to support this.

Here's a little bit of detail about those "huge profits" that the insurance companies and health care providers are supposedly making.

CARPE DIEM: Profit Margin: Health Insurance Industry Ranks #86

3.6% is great for a high volume business like Aetna or Health Net! These numbers are AFTER executive pay and all sorts of other expenses. If your small business paid you 3.6% after you paid yourself $5 million a year, I bet you'd be content with it.

This shows exactly what the profitability of the various industries and their rankings.

Hospitals were 77th on the list with profitability of 3.6%.
Medical Insurance plans were 86th with profitability of 3.3%.

These companies are not making "huge profits" at all.

Yeah, they are.

That's what HUSBANDS are for.

So the price of health care is a good beating every few months from an abusive husband? Or putting up with chronic infidelity? Or getting an alcoholic out the door every morning to his job? This is an appalling argument. You really don't know anything about what it's like to be a woman in this country.

That single mother has to make a hard choice now: she can either work and obtain insurance, or she can stay home for her kids and hope that she qualifies for Medicaid.

She can't work if she can't find a job that pays A LOT more than all day child care.

But expanding Medicare isn't the answer to this problem. It only EXASERBATES the problem by driving medical costs HIGHER at a faster rate than the rest of the health care system.

No it takes the same money you'd pay in premiums to Aetna and transfers to them to a system that genuinely pools risk and has less overhead--from fewer expensive office buildings, less redundancy in middle management (think of all those different companies all doing the same thing), and FAR, FAR less CEO pay.

I said it before, and I'll say it again: if you want to make health insurance more accessible to people, make the cost of it tax-free. That automatically lowers the effective cost by 15-30%. That will make it more affordable to more people.

How does that help someone who is so poor that they pay no taxes? Last year, I paid no federal taxes, yet half my gross income went to a single health insurer. This year it will be more than half unless I drop my coverage and go without insurance.

You think my family doesn't feel that? You complain about taxes, but I bet you don't pay 50% of your income as I am. And you think the insurer has my interests at heart and that the solution is that I should not have divorced my abusive ex husband. That's what he says too. But I don't agree. No one should have to live like.

[ETWolverine]

No. But as you know, single payer would be paid for with taxes, the same money you now give to a health insurer. You don't pay more, you just pay your premium to a different entity and call it "tax" instead of "premium." Illegals pay taxes, so they wouldn't be getting health care for free either IF they ended up being covered. I personally think they should not be excluded, but that's a problem that has lots of sides to it.

So... let me get this straight. You are OK with illegal aliens getting health care that YOU pay for, even though they don't pay into the system.

And where did you get the idea that the amount that you will be paying in taxes is going to be the same as what you pay now?

It is not physically possible to pay for 46 million more people than are covered now without either limiting services or increasing the amoun that those who pay into the system will be paying. Taxes will HAVE to go up to maintain the same level of service, or services will HAVE to be limited in order to maintain the same cost.

And that doesn't even take the additional costs if government inefficiency into the equation. The CBO has estimated that the administrative costs of running government health care would be TWICE to THREE TIMES what corporations pay due to inefficiencies, waste and corruption. The Heritage Foundation estimates that it would be closer to 5 times as much. Which means that you would need to pay 2-5 times as much in taxes to the government as you are currently paying in premiums to insurance companies.

Then there's the fact that the costs of health care in Medicare are rising 35% FASTER than they are in private health systems. In order to pay for this faster increase in health care, we would have to be taxed 35% MORE than we are paying in premiums to our insurance companies.

Simply put, government health care is MORE EXPENSIVE than private insurance, and you would have to pay MORE to the government in taxes than you would be paying to a private health insurance company.

Taking care of children is work.

Agreed.

Now... explain to me why we need to change the entire health care system to fix this problem that is easily fixed through other means?

Medicaid should be covering this. So let's make sure this woman is covered under the already existing system rather than try to create a brand new system for EVERYONE just to cover her.

Lower the cost of health care for her by making insurance payments pre-tax. That creates an automatic IMMEDIATE savings on the cost of health care of 30%.

There is no need to create a brand new, HIGHER COST government system in order to help this woman.

I'm arguing that everyone SHOULD be eligible for Medicare, not that they already are.

So your solution for people who can't afford health care is to put EVERYONE on a system that is bankrupt, more expensive and less affordable. What a brilliant idea.

Great if your doctor happens to prescribe one of these specific drugs and you can satisfy the requirements for it. But each one has different requirements and paperwork.

Pretty much every drug out there is available through these patient assistance systems. And if you're not paying for it, I would think that the amount of paperwork would be the least of your complaints.

I think the government is allowing itself to be shafted by the pharmaceutical industry--subsidizing is a nicer word--not because Pharma doesn't ever give anything away (and take a hefty deduction for same), but because pharma benefits from the system we currently have and yet produces very few drugs that are even marginally better than what's already out there, at least not in proportion to the amount they spend on research, marketing, and executive pay. Pharma drives up the cost of health care enormously. My doctor wants me to take a $300/month NSAID when I could be taking aspirin for $3/month. When you actually look at the differences between the new drugs and the old ones, they may be only 5% more effective than an older off-patent drug, yet they cost 10 or 100 times as much.

Only marginally better, huh?

I guess the medicated stent that prevents you from needing a heart bypass is only a marginal improvement.

Or the chemotherapies available today are only marginally better than what was available 20 years ago, even though cancer survival rates have improved by 20-30% during that period.

Yes, it's true, some drugs are only a LITTLE BIT better than what came before it. And if the cost isn't justified, perhaps you should get the older drug. That choice is between you and your doctor. Free choice and all that.

But keep in mind that each new breakthrough builds on what happened before. And while the 2nd genereation drug might only be 5% better, the 6th generation drug might be 80% better, because it built on the prior 5 generations.

But if the government gets involved, they will only allow doctors to proscribe that first generation drug, because the 2nd generation drug is only 5% better and costs 100 times as much. Which means that no drug company will develop the 3rd -6th generations of that drug, because the government won't allow it to be prescribed. Which means we'll NEVER SEE ANY NEW DEVELOPMENTS IN THE DRUG INDUSTRY. Because it will never be cost effective to do the research and development of that drug.

So, not only does the government limit your choices (what if you want that 5% improvement in the drug), but it stifles research and development by taking away the incentive for R&D, which is PROFIT.

I have insurance I can't afford and I can't switch providers. I'm already STUCK!

Why can't you switch providers? If you already have insurance, you can't be denied another insurance due to a pre-existing condition. So the reason is most likely financial.

Tell me, would a 30% immediate decrease in your insurance cost be helpful?

This is just flat out wrong.

Not it's not. This is, in fact, how insurance companies work. They collect premiums from a bunch of people and pool them. When one of them gets sick, they use that pool to pay out for that person's needs. The rest of the people continue to pay into the system. It is very rare that EVERYONE in the system gets sick at once. That is how insurance works. It POOLS RISK and POOLS PREMIUMS. The statement was, in fact, 100% true.

They try hard to eliminate anyone who has ever had a major problem anyone likely to have a problem.

Of course they do. They try very hard to limit their costs as much as possible. That's their JOB. And yet they still cover people with major problems anyway in the vast majority of cases. And in cases where they contest the claim, generally speaking you can get the claim paid anyway, even if it takes some time to convince them.

That's how they stay profitable, by collecting premiums from the healthy and eliminating the unhealthy from membership by dropping them, reducing benefits, or raising the premiums and copays until people are bankrupt.

They do try that.

So what?

That's EXACTLY what the government is planning on doing. That's the whole point of having "efficiency counsels" and QALY calculations for services to be rendered. There is going to be a panel who's job it is to try to ELIMINATE services to people who have problems or who are getting too old from the system.

The difference is that if insurance companies do that enough times, people stop buying that insurance and instead go to a different company. In a single payer system, THERE IS NO OTHER COMPANY TO GO TO.

And again, after seeing three of my grandparents die very lingering deaths in the past 18 months, I have seen three people who had pre-existing conditions who were not denied a SINGLE TREATMENT by private insurance. Medicaid denied them certain services, but not their private insurance. The insurance companies lived up to their side of the contract in every case.

The idea is to take only the people with lowest risk. That's not pooling risk. That's skimming the cream. And leaving the rest to the government to take care of.

No... that is paying out on what they are contractually obligated to pay out on, and NOT paying out for people with whom they have no contracts. I'm good with that.

If you don't pay the insurance company, why should the insurance company pay for your services? If you don't like the contract, negotiate another one that gives better coverage, or find a company that offers a contract you do like.

Or rely on the government and pay nothing. But you get what you pay for.

Furthermore, most hospitals that are supposed to take care of the uninsured, in fact don't. They turn most of them away. There is plenty of research to support this.

I've spent quite a bit of time in ERs. I'm a former EMT, and I've been in more ERs for longer periods than just about anyone on this board. I have never ONCE seen a patient turned away from a hospital for any reason. I have, on quite a few occasions, seen patients who have walked out because they didn't like having to wait 6 hours to get their sniffles checked, even though there were trauma and cardiac cases that took precedence. I have seen patients who have been recommended to be admitted to the hospital to care for some condition or other turn down the care by signing an RMA form... or by just walking out. I have seen patients who were trying to bum narcotics off the doctors to feed their habbits turned down for their drug of choice but offered rehab instead (guess how many took up the physicians on that offer). But I have never, EVER, seen a patient in need of care turned down in any ER. And precious few who didn't really need care are turned down either. You'd be surprised at how often ERs become shelters for drunks who just need a place to shag out for the night and so they make up fake illnesses that the doctors can see through right away, but the doctors, being people who want to help, go along with the farce in order to create an excuse to keep the guy off the street for a night.

Yeah, there are cases where "patients" don't receive the care they think they ought to get. But that is usually a result of the fact that they don't really need those services, didn't feel like waiting to get service for what was not a high-priority situation, or didn't get their drug of choice from the physician. I don't consider any of those to be cases of patients being turned down for care.

3.6% is great for a high volume business like Aetna or Health Net!

You just proved to me that you have no idea what you are talking about.

3.6% profitability is MARGINAL at best. Other high volume businesses would shut down with NPMs that low. The shareholders of other businesses would be up in arms at the idea that they are only making three and a half percent, and would be demanding heads to roll.

These numbers are AFTER executive pay and all sorts of other expenses. If your small business paid you 3.6% after you paid yourself $5 million a year, I bet you'd be content with it.

Sure, if I were the sole owner and I got to take home the entire profit, yeah, I'd be OK with it.

But with MILLIONS of shareholders, a 3.6% profitability equates to hundreths of a penny per share. People don't become stock owners to earn a hundreth of a penny per share.

So the price of health care is a good beating every few months from an abusive husband? Or putting up with chronic infidelity? Or getting an alcoholic out the door every morning to his job? This is an appalling argument. You really don't know anything about what it's like to be a woman in this country.

So... for you, the opposite of single parenthood is infidelity, abuse and alchoholism. There's no such thing as traditional family values? They no longer exist? Either a woman is abused or she's a single mother? There are no other options?

And you think that I don't know what it's like to be a woman in this country? I have to say the same for you, if you can see no other options besides abuse or single motherhood.

She can't work if she can't find a job that pays A LOT more than all day child care.

True. And your point is..

I said that she is left with a hard choice. And I also said that such a choice becomes easier in traditional families where each party knows their responsibility. What part of that statement do you disagree with?

No it takes the same money you'd pay in premiums to Aetna and transfers to them to a system that genuinely pools risk and has less overhead--from fewer expensive office buildings, less redundancy in middle management (think of all those different companies all doing the same thing), and FAR, FAR less CEO pay.

I've already ansewered this point. However, I want to address the "office buildings" argument.

Do you think that government agencies work outdoors?

In fact, the government is the single largest real estate OWNER and the single largest real estate RENTER in the entire world. And when they rent, they tend to pay HIGHER THAN MARKET for their space, which is one of the two major reasons that real estate owners LOVE having the US Government as a tenant. (The other reason is the fact that the US Government guarantees their rents with the same "full faith and credit of the US government" as they do their bonds and other debt instruments.)

Building costs for the US government are HIGHER than for private corporations, not lower.

How does that help someone who is so poor that they pay no taxes? Last year, I paid no federal taxes, yet half my gross income went to a single health insurer. This year it will be more than half unless I drop my coverage and go without insurance.

You think my family doesn't feel that? You complain about taxes, but I bet you don't pay 50% of your income as I am. And you think the insurer has my interests at heart and that the solution is that I should not have divorced my abusive ex husband. That's what he says too. But I don't agree. No one should have to live like.

Actually, between income taxes, real estate taxes, and insurance, I'm paying out well over 70% of my income. Then there's tuition of roughly $19K for 2 kids. I'm separated, so I'm paying child support as well. Frankly, I'm in the hole.

You say that nobody should have to live like that. And I agree.

But better that than becoming reliant on the Federal government and having to beg crumbs from the government and giving up my free choice to do it. Because on my own my financial situation can improve. Under the government's thumb, it can't.

Government cannot create wealth for a man, but it can surely take it away from him.

Elliot