"Sicko" is a revelation.

I'm not sure if I believe that. I think it might be true to a degree but I doubt that my coworker's cancer will not affect my premiums. Likewise, I doubt that his premiums will reflect the true cost of his treatment. And in any case I doubt that the insurance company will not still turn quite a profit from all of us in the office, even taking into account the cost of his cancer.

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Believe it or not as you choose. I can assure you that the insurance premium paid by the employer is indeed adjusted continuously, based on the actual claims submitted by employees. Annually we review the growth in our costs and, if necessary, contain their growth by either limiting coverage; setting higher deductables; or raising the portion of the premium deducted from employee paychecks.

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georgeob1 wrote:

Good question. In addition, why didn't he also acknowledge that the behavior of insurance companies serving the health care systems in Germany, the Netherlands and other countries also very likely involve some of the same lapses, abuses, and missteps as were reported in the article about American insurers?

You refer to what for example?

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Walter Hinteler wrote:

georgeob1 wrote:
Good question. In addition, why didn't he also acknowledge that the behavior of insurance companies serving the health care systems in Germany, the Netherlands and other countries also very likely involve some of the same lapses, abuses, and missteps as were reported in the article about American insurers?

You refer to what for example?

Nothing in particular. I just find it impossible to believe that other systems function with perfection. There are lapses and unintended side effects everywhere.

Do you claim that Germany is the sole exception?

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georgeob1 wrote:

Walter Hinteler wrote:
georgeob1 wrote:
Good question. In addition, why didn't he also acknowledge that the behavior of insurance companies serving the health care systems in Germany, the Netherlands and other countries also very likely involve some of the same lapses, abuses, and missteps as were reported in the article about American insurers?

You refer to what for example?

Nothing in particular. I just find it impossible to believe that other systems function with perfection. There are lapses and unintended side effects everywhere.

Do you claim that Germany is the sole exception?

I would rather have problems with the system doled out equally to everyone, rather then focusing them on those without money.

Cycloptichorn

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georgeob1 wrote:

Nothing in particular. I just find it impossible to believe that other systems function with perfection. There are lapses and unintended side effects everywhere.

Do you claim that Germany is the sole exception?

You said that those systems in the Netherland, Germany and others are very likely involved in some of the same lapses, abuses, and missteps as documented in the film.

And I was wondering since within all the public criticism and that by the media for our system this hadn't come up between 1883 and today.

I'm not saying that the German system is the sole exemtion. But I'm saying that our system isn't similar to yours at all.

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Well, let's be specific. Do you suggest that the behavior of insurance companies with respect to costs and profits is significantly different in Germany, compared to what occurs here? That was my point.

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You mean that of our compulsary funds or the private insurances?

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Certainly private insurance. "Compulsory Funds" may have government regulation and/or subsidy. They operate by a different dynamic.

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georgeob1 wrote:

What this means for an individual is that, absent legislation to limit it, insurance premiums will accurately reflect the actual costs of the applicant.

No, not totally correct.

What this means is that insurance premiums will reflect the costs the applicant would generate, should the inidividual become sick, and this is , in general a function of age.

For instance, breast cancer would be more likely to occur in a 62 yr old woman than a 22 yr old woman.

A 64 yr old man is more likely to have prostate problems than is a 22 yr old young man.

Insurance premiums are determined, in part, by the probablity of an event ( illness ) happening as a function of age.

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georgeob1 wrote:

Well, let's be specific. Do you suggest that the behavior of insurance companies with respect to costs and profits is significantly different in Germany, compared to what occurs here? That was my point.

I think so. Sure, insurance companies want to make a profit. But this is a system where you have insurance companies that offer statutory health insurance and insurance companies that offer private insurance. If you want to pay into private insurance, you have to either make a certain amount of money as an employee, or run a business. In terms of profits, private insurance companies therefore have the luxury to cater to a more affluent demographic in the first place.

It's a bit like your local Porsche dealer won't haggle with you about five or ten dollars, because people who can't afford to buy a Porsche don't feel a life-threatening need to get one nevertheless...

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With medicare in the US today, most enrollees have a medigap policy, carried by a private health insurance company, in addition to the medicare policy.

All medicare participants have Plan A, some will elect to also have medicare Plan B and still others will carry the medigap insurance. Total cost/month at present is about $200/month.

( Should have added some will also have Plan D for drugs. )

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Miller wrote:

With medicare in the US today, most enrollees have a medigap policy, carried by a private health insurance company, in addition to the medicare policy.

All medicare participants have Plan A, some will elect to also have medicare Plan B and still others will carry the medigap insurance. Total cost/month at present is about $200/month.

( Should have added some will also have Plan D for drugs. )

Well, but that only covers people who are age 65 and over, right?

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old europe wrote:

Miller wrote:
With medicare in the US today, most enrollees have a medigap policy, carried by a private health insurance company, in addition to the medicare policy.

All medicare participants have Plan A, some will elect to also have medicare Plan B and still others will carry the medigap insurance. Total cost/month at present is about $200/month.

( Should have added some will also have Plan D for drugs. )

Well, but that only covers people who are age 65 and over, right?

It covers, those individuals who've paid for 10 years into Social Security. Once these individuals reach 65, they can receive medicare benefits. SS benefits can be received, starting at age 62 years.

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Miller wrote:

It covers, those individuals who've paid for 10 years into Social Security. Once these individuals reach 65, they can receive medicare benefits. SS benefits can be received, starting at age 62 years.

And do you think this is a good thing, or are you opposed to the Medicare programme?

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old europe wrote:

Miller wrote:
It covers, those individuals who've paid for 10 years into Social Security. Once these individuals reach 65, they can receive medicare benefits. SS benefits can be received, starting at age 62 years.

And do you think this is a good thing, or are you opposed to the Medicare programme?

There are pros and cons to the system. A pro is of course, participants in the plan are covered by a health plan, at a time in life, when medical problems will begin to appear and at a time when they most likely are not fully employed.

Some of the cons:

It's not cheap, I don't think $200/month is cheap for the average person on a fixed income during retirement.

There are restrictions on procedures, medications, sites for treatment and of course, the constant supervision by the Federal Government.

Example of problem: An 80 year old man had chest pain, thought he was having a heart attack , called an ambulance and was taken to the hospital. ER docs found the man didn't have a heart attack ,but further examination demonstarted he had a tumor on his heart, that was causing his pain.

He submitted his bill for the ambulance and it was denied. Medicare does not cover ambulance service to the ER for
evaluation of a heart tumor. Ambulance or even helicopter service to a hospital can be very expensive, as you are probably aware.

However, the most serious problem, that's developing as we speak, is that many doctors are now refusing to take medicaid and medicare patients into their practice. This problem will explode in the near future as our "baby boomers' leave the job market and enter into retirement.

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I see. That rises new questions. One would be: do you think it is justified that a programme like Medicare can actually deny to foot the bill for ambulance service (no matter what triggered the call for an ambulance)?
And, second, do you think it is justified that doctors can refuse to take patients on those programmes into their practice?

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old europe wrote:

I see. That rises new questions. One would be: do you think it is justified that a programme like Medicare can actually deny to foot the bill for ambulance service (no matter what triggered the call for an ambulance)?
And, second, do you think it is justified that doctors can refuse to take patients on those programmes into their practice?

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I don't see how an 80 yr old man, nonmedically trained would be able to determine if he's having a heart attack. He made the right decision to take the ambulance to the hospital, because at the time, he thought he could be dying.

Legally, medicare sets the policies and I'm sure, if one took the time to work their way through the hundreds of pages of Medicare
regulations, you'd find that the medicare decision to refuse payment was legally justified. It's the law, right or wrong.
From an ethical perspective, I'd say it was wrong, but then no one asked me...

Can doctors refuse to treat medicare and medicaid patients?
If these patients are refused strictly because of this reason, as the law now stands, MDs in private practice can refuse to take these individuals on as patients.

Some physicians have now openly stated that they will not take as patients those on medicare, medicaid or even on a private insurance plan such as BC/BS. These MDs want cash- paying individuals in their practice. It wouldn't surprise me to find out that some of these very doctors will refuse personal checks, and credit cards and that they deal strictly in cash.

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Cash ! Could that be a tax evasion scheme ?

I do believe the payment system we have is unnaturally skewed by combined actions of government and insurers to hold down costs and the counter actions of doctors, laboratories and hospitals. My experience is that the typicaL hospital or doctor charges are grossly inflated but that insurers generally cap their payments at about two-thirds of the amount billed, making payment conditional on the provider's acceptance of the amount as total payment. Where I live Blue Cross payments have (so far) met with no detectable (by me) resistence from providers, while Medicare limits are very often far below market rates and are not accepted by about 20% of providers. Is that the typical situation?

I interpret all this as a partial result of our hermaphrodite system - one that appears to combine many of the worst aspects of free market and government-run systems. Still I am skeptical of increased government management of the system as a "remedy".

I suppose the reluctance of Americans to accept the regimentation associated with government management of aspects of their personal lives is a bit baffling to others. However I believe it is an enduring fact of life here - even despite the growing demand for public medical services.

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by about 20% of providers. Is that the typical situation?

Quote:

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Medicare and medicaid patients are being turned away by an increasing number of MDs.

Blue Cross/Blue Shield is widely accepted and is also a provider of the medigap medicare plan.

The lowest fees are paid by medicaid, while the medicare payments are about 75% of that paid by private insurance ( as far as I can tell).
Quote:

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"Sicko" is a revelation.

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