@ag7433: "...it makes me angry give these people another excuse to be a slacker. I am from Detroit, and I know they are plentiful."

I was under the impression Detroit, and Michigan in general, has quite high levels of unemployment at the moment? Maybe a lot of the people you are calling 'slackers' are just finding it difficult to get a decent job?

@Jamie - Then blaim the employee's employer. They are the ones chose to pay the claims themselves and negotiated the bonus in the contract. If they were concerned about their employees, they would make the contracts strictly be fee related, without bonuses for cost savings. That is the employer's fault, not the healthcare industry's.

@Hib. Yes, that is one of the biggest flaws with insurance as it resides now. If you don't have employer sponsored (or you own/run a small business and can't afford to sponsor) insurance, then the individual plans that are out there rape you coming and going. I worked for almost two years witout any coverage because the company was only 12 people and couldn't afford to sponsor insurance, and all the insurance comanies either denied me outright or wanted over $900 a month and a $1000 per year deductible along with large (usual 80/20 split) copays because I was over 40 and a diabetic with hypertension and a thyroid condition. Those that would accept me said my conditions were preexisting so I had to go a full year before anything related to them woul dbe covered. When I went searching for and found this position, one of the requirements was excellent health benefits. I accepted a $10K per year paycut, but have benefits without preexisting condition limitations and more in my pocket because I don't have any deductibel and my copays are fixed at $25 per office or urgent care and $100 for emergency room (waived if admitted).

More and more SMBs are getting together via their local BBB or Chamber of Commerce and grouping their plans so their employees can get sponsored coverage without putting them out of business. Have your employer look into the local Chamber of Commerce...

Why are so many so passionately against reform? I've seen nothing here that'd make me thing people were about to put on their shoes and go to a "town hall" to put on a demonstration

* make me think

Insurance (which started with shipping long before health insurance was invented) was never meant to pay your bills. It was to protect you against catastrophe. Think of it this way. Lets suppose there are 10 people with cars. They do research and find out that last year. 4 of them had accidents of $10K a piece, 5 had no accidents, one had an accident of $50K, which was devastating to the family.

So they decide to spread the risk against a catastrophic loss, because they all felt how horrible it would be to be the $50K guy. So they each pay $10K into a pool. They have the exact same accident scenarios. The guy with the bad accident is very relieved.

The 4 with $10K in damage broke even. But 5 people grumble that they wasted $10K. They still had to pay their premiums every month.

That's the idea behind insurance. Even in that simple scenario above, 50% of the people feel like they got screwed. (Now, imagine one that got into an accident in Mexico, which is specifically NOT covered. He feels doubly screwed. Or the one who let his underage son take his car. Again, specifcally NOT covered. C'mon, cut me a break, I paid $10K for this crappy policy!)

Now, health care is a different animal, its hard to look at it like a property/casualty company. The same rules apply, however. Whether the government wants to decide that is NOT the way to make their citizens healthy, that's another question altogether. But insurance has always been about pooling risk against catastrophic loss, not paying your bills.

@DingleberryJones

"Wendell Potter is the health insurance industry’s worst nightmare. He’s a whistle-blower. Potter, the former chief spokesperson for insurance giant CIGNA, recently testified before Congress, “I saw how they confuse their customers and dump the sick—all so they can satisfy their Wall Street investors.”

"In 2007, CIGNA denied a California teenager, Nataline Sarkisyan, coverage for a liver transplant. Her family went to the media. The California Nurses Association joined in. Under mounting pressure, CIGNA finally granted coverage for the procedure. But it was too late. Two hours later, Nataline died."

http://www.guardian.co.uk/world/2009/jul/26/us-healthcare-obama-barack-change
http://www.truthdig.com/report/item/20090714_health-insurance_whistle_blower_knows_where_the_bodies_are_buried/
http://www.google.com/search?q=health+insurance+whistleblower


And uh, there is an about.com page about how to deal with insurance company denials from 2004!

"1. Don’t assume that the first “no” you receive is final.
About 10 percent of all insurance claims are unjustly denied but less than 1 percent of people making insurance claims even question their insurer when their claim is denied. The majority of policyholders who do contest their cases either win their cases or improve their settlements."

http://thyroid.about.com/cs/newsresearch/a/insurancepay.htm

Yes, and they can be covered under unemployment, which they verify they had a job and was terminated. Before the 15% unemployment in Michigan, the problem prevailed. Medical coverage is a valid reason for people to work and contribute to the State. Take that away, and we're supporting a class of slackers. Next they will legalize pot and create a nation of zombies, which I will be paying for from birth to death.

@kestasjk, I would protest if I were living in a more populated region. I think many don't voice this on the sight because it's not worth putting oneself "out there" just to be dumped on be Europeans and US Democrats.

@AG - The solution is to become a slacker zombie pothead...

I prefer not to "get by".

@ag7433: Who are these "slackers"? Are you actually saying that state welfare benefits in Michigan are so generous you can make a decent living by claiming them? Having spent four months struggling to live on unemployment benefit here in the UK, which is generally taken to be more generous than in the US, I find this unlikely.

To me, it sounds like you're really saying: "Poor people are lazy, and I don't care if they get ill and die, as long as my tax bill stays as low as possible."

Hibiskiss great comment

@kestasjk, the people protesting aren't fighting against Health Care, it's just a reason to be angry. They're fighting because a Republican isn't in office. Every time a Democrat takes the office of President a loud angry minority makes the rest of us Conservatives look bad by acting like fools thinking it's the end of the world.

This same shit happened to Bill Clinton, who amusingly was pretty conservative, in the 90s.

Hibiskiss,
Regarding the California teen, her claim was denied because it was considered experimental, which is specifically excluded in almost every insurance policy. The operation was considered 'based on the information available, that the treatment would be unproven and ineffective and therefore experimental and not covered by the employer's benefit plan,"



And the first 'no' thing is the same in ANY business. If your waitress says no, you ask for the manager. So why do you hold that up as a red flag in the insurance business but not other lines of business to show how evil they are?

Claims are unjustly denied on occasion. I'll agree with that. Was there a systematic effort to unjustly deny them? Was there a thought 'If I deny this claim, my company will make more money (even though I will not).'?

@DBJ: Your car insurance example leaves out the profit margins, copays, deductibles, etc. that really make people feel screwed. Take your same 10 people in the same plan. Health insurance looks more like this:
The guy who has a $50k accident calls the insurance company and finds out that they will only cover head-on accidents, or accidents with Fords. Since this accident was a Chevy hitting the side of his car, they say that he has to pay the first $5k, and then they'll cover 80% of the rest. So he's still paying about $13k out of pocket - in addition to the $10k he fronted for the policy. So the $23k total is definitely less than the $50k he could have possibly been faced with, but still high enough to make him question why he bought into the policy.
The $10k accident folks get a little luckier - let's say their accidents were all covered under the plan. They take off a $1k deductible from each and the company covers the rest. These people have now paid $11k total - even though they only had $10k of car damage.
And as you said, the people without accidents are feeling screwed to start with.

If insurance were really just a collective protection against extreme costs, it wouldn't be quite as bad. The large profit margins in it are what skew the outcomes and make people unhappy.

@Jamiet, the "slackers" are the people who work a job for a few months, quit or put themselves in a position to get fired. Or the people who 'come up' with a fake disability claim. I'm very jaded about this because I have a very large extended family and 30% of them are like this and looking for hand outs. It's not the "poor people" it's lazy people (that I know to be lazy and grew up with), that is typical of the problem.

One person is homeless and goes hosiptal to hospital faking sickness to get meds/drugs.

Another said his father verbally abused him and he can't take stress of work, and is collecting his handout.

Another is 30 and hasn't worked a completely year in his life.

Another is knocked up a few times and collecting money.

Another is very old, didn't work basically his entire life, and has nothing to show for his life, and is mooching from family and the government.

What ever happened to personal responsibility? Why should I be responsible and GRIND if the other guy isn't? It's somehow easier for me to keep a job?

"So why do you hold that up as a red flag in the insurance business but not other lines of business to show how evil they are?"

Because the nation's health is a far more important social issue than whether you get good service at McDonalds.

Hmmm and from Wikipedia 'CIGNA notes that it had no financial stake in the decision to authorize the transplant because it merely administers the insurance plan of the parent's employer and would not bear the cost of any operation.'

So if it was unjustly denied, why?

Also, McDonalds usually says yes the first time.

@ag7433: You obviously have a very lazy family, however I'm going to respond to a couple of your examples:

"One person is homeless and goes hosiptal to hospital faking sickness to get meds/drugs"

I don't quite understand this one. You say he is faking sickness. So presumably he is not sick and therefore doesn't need any medicine. So why is he trying to obtain medicine he doesn't require?

"Another is knocked up a few times and collecting money."

Raising several children IS a full-time job. We should have more respect for stay-at-home mothers, and not call them "slackers" for not working. Bringing up children is very important.

@DBJ: Look at what that quote is actually saying. "We don't have a financial stake here because all we do is run the insurance plan, which says we shouldn't cover it. That means we won't pay the cost. Therefore, since our expected cost is $0, we can be said to have no stake in it." Yet that type of refusal, to cover an expensive, critical surgery goes against the principles that you said insurance is founded on - to pool risk to help people cover catastrophic costs like this one.

@DbJ
Even if the "No" thing is the same in similar businesses, the customer reserves the right to hate the company and never go there again. You don't have that sort of option with health where if you can't get in, you put your life at risk.

Even then some businesses are very helpful straight off. Electronics stores, at least in my own experience, are staffed by very helpful and pro-active people.

CIGNA was acting as a TPBA, then. They may happen to be an insurance company, but in this case, they weren't THE insurance company. The employer was. One thing every TPBA has in their clause is the right for an employer to tell them to pay it anyways and that it won't count against their average or cost savings numbers towards their bonus. GE did it all the time with UMR. In fact, the rule of thumb was to not bother issuing the denial and, instead, take it to GE HR for approval before cutting the check.

The fact that the heads of 3 major insurance companies went before Congress and would not rule out recission except in cases of intentional fraud makes me want a Public Option. The very idea of recission except in extreme cases of intentional fraud makes me pretty upset with the entire idea of insurance. "We will collect your premiums without checking on your application, but the minute you make a big claim we will try to find anything in your application to drop you."

@Dingle

It is a red flag because if a waitress says no, who gives a shit. If an insurance company says no you need to choose between eating dinner that week and paying rent or going to the doctor for something serious.

Another difference is with Health Insurance it is a real pain in the ass to speak with the manager and they're not going to stroll over to the table. It takes a lot of time to go through the process while the debt is hanging over you and ruining your credit.

It's not so much that there is an effort to unjustly deny, it's that everything has to fit into perfect circumstances to qualify for coverage. I'm completely uninsured right now because of my current small business employment situation but if I was insured I'd be equally at risk!

I worked for the government (School District Network Support Admin) at my last job and had what I thought was excellent coverage until I fell into one of those loopholes!

I was a passenger in a car that got nailed from the side and was knocked unconscious, they took me to the hospital and had a pretty severe concussion but otherwise got really lucky. Well when I was released the doctor said that if I start vomiting I need to come back to the hospital.

Well later that night I started vomiting like crazy and after about 20 minutes I drove to the hospital.

Later I got the $11,000 bill for who the fuck knows what cost them $11,000 and the insurance company refused to cover it because it was elective or some shit, whatever they call it. I was fine enough to drive to the hospital in the middle of the night so I was fine enough to wait until the next day. It didn't matter that the doctor ordered me to come back.

It took me almost two years of fighting that bullshit and I still had to pay it all. Why? I was retarded enough to make payments on it so it wouldn't hurt my credit. Since I made a payment it was "proof" that they shouldn't cover me.

I learned a lesson with that.

I am a Canadian and here the healthcare is a public setup. There are no private doctors in Canada. (however there has been discussion of this recently)
There huge benefits in this:
1. Emergency rooms are for emergencies, you don't get billed for it. This includes walk-in clinics. Walk in clinics are for when you think you may have broken a bone or whatever and just want to see a doctor about it.
2. Provincial healthcare pays for everything deemed 'necessary' this covers stitches to glasses to braces. This also pays for many vaccinations, ie tetanus, polio, measles, mumps, rubella hep.b. However, it does not pay for all vaccinations. (the flu shot is not covered), or cosmetic surgery, but that's fine by me.
3. Prescription medicine is also paid for. A friend of mine had a kidney transplant and all of his medicine was paid for; and he had more medicine to take than I had ever seen one person carry before.
But it also has a couple of disadvantages:
1. Wait times. A typical emergency room wait time can be many hours. When I cracked my skull open I believe I had a 6-8 hour wait time sitting at the hospital. However, when I did receive care it was good.
Surgery wait times can be around 6 months to a year, which isn't bad if its a benign tumor but can be rather problematic when it something rather painful, like a broken hip. Since there are no private practices in Canada, you can't pay to get the job done sooner either.
2. Medical job market. Canada trains many doctors, however the pay in Canada for doctors is much lower than the pay in the united states since it is privatized. As such, the hospitals in Canada are all understaffed.
3. Taxes. Since its a public system the taxes here pay for it. Taxes in Canada are much higher than in the states.

My personal opinion is that the health care here is great. I am able to see the optometrist and the dentist yearly / bi-yearly without having it cost me anything. More importantly, when I go skiing I don't have to worry about any kind of insurance company in the case where I break my legs.

"Why are so many so passionately against reform? I've seen nothing here that'd make me thing people were about to put on their shoes and go to a "town hall" to put on a demonstration"

more and more (since 1994 IMO) there are people in america who believe that one party or the other is absolutely evil and dangerous and cant possibly do anything good because they are so inheriently evil. these radicalized sides are passionate about their beliefs and selectively choose what information sources to listen to so they are only constantly renforcing what they want to believe.
there are powers that are working to agitate and manipulate these people into what you see on television (including some of the television stations themselves)
the result is America becomes fixated on the people shouting at each other who are already absolutely unmoveably convinced in their own correctness, because its entertaining and gets ratings. meanwhile the people who actively want to have a debate and be productive cant be heard above the shouting

I have actually waited in the emergency room for many hours multiple times in the last year here in the United States. It seems to depend on the hospital. My friend broke his hand, needed stitches and was falling down...5 hour wait. I couldn't stand up, felt like I had appendicitis...4 hour wait. Strangely, neither hospital looked particularly busy.

Medical costs are actually a major factor leading to bankruptcies in the US. A lot of them had coverage when it started as well. If you do get dropped by an insurance company for some reason, or have a major claim denied, it can be a lot of money to pay off the costs. Most people don't have $20,000 sitting around to use for it.

* I would like to point out that I don't think Canadian healthcare covers braces unless it is deemed to be past cosmetic.