Health Insurance…
Posted on Jun 23, 2009 - 10:12pm by Marshall J. Gruskin in Trucking
Let me state something very important right from the outset of this post. I don’t care what the Republicans or Democrats have to say about this issue. I’m an iconoclast. If you don’t know what that means look it up. If anything, I also consider myself a sort of conservative libertarian. But it makes no darn difference what I am. My view of health insurance is very much egocentric. I’m sorry that 45 million people don’t have health insurance. And it’s too bad that – according to *AARP: “Americans spend more on health care every year than we do educating our children, building roads, even feeding ourselves – an estimated $2.6 trillion in 2009, or around $8300 per person.” But, my overwhelming concern quite honestly is me, my wife and son. I want to live a long and healthy life, and hopefully I can get superior medical care until the day I pass on.
Now as a OTR trucker I have health insurance through my company. We share the cost which is high. My wife is a teacher and her employer pays for some of her medical coverage. My son, 21, soon to a member of the US Army, does not have health insurance. My wife and I, should our employers decide it is too costly or go out of business, are always at risk of losing our coverage. In the past, when I’ve been out of work, I was lucky to remain healthy and did not require medical services. Did you hear what I just said? I was lucky. If I became ill for whatever reason, I would not have the financial resources to obtain medical care. The COBRA plan – when you lose your job – and it’s cost of $650 per month (2004 dollars) to continue similar health coverage I had when I was employed, was impossible for me to afford.
The AP – Associated Press – reports that President Obama’s top legislative priority is to provide coverage to all uninsured Americans and cut costs. He wants to sign a bill in October. The President, today, responded sternly to the health insurance industry, which had sent him a warning. The industry’s two largest trade groups said his proposed government insurance plan would have unfair advantages and would likely dismantle the employer-supplied coverage that millions of Americans have relied on for a half-century. The President disagreed, sharply. "The public plan, I think, is an important tool to discipline insurance companies," he said. "Too often, insurance companies have been spending more time thinking about how to take premiums and then avoid providing people coverage than they have been thinking about ‘How can we make sure that insurance is there, health care is there, when families need it?’"
I’m not going to debate the President’s objectives. I just paid $80 for a ten minute DOT physical at a doctors walk-in clinic to remain employed as a truck driver for another arduous year. Health insurance does not cover it. There many other things it does not cover that my wife and I might need down the road. When we both retire – and I don’t ever see that happening right now – I don’t know if Medicare/Medicaid will be solvent. I can’t rely on my son to take of us. So I have absolutely no future guarantee of care. That worries me greatly. And I don’t know what the answers are. I see a lot of good folks who worked hard all their lives who are much worse off than my wife and I. And that bothers me. No, it scares me. And its time to do something, I just don’t know what.
Photo credit: directory…rect.info/Health_BodyHospitals_Health_Centres, http://www.dallasnews.com/sharedcontent/dws/img/06-07/0621uninsured1.jpg
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General public ignorance of the subject is what the politicians, providers, and health insurance companies have learned to thrive one. Don’t get me wrong, ignorance on the subject of health insurance is nothing to be ashamed of and I’m not name calling. The laws, policies, and treatment descriptions are designed to keep you in the dark and the poor house.
I worked as a computer programmer in the medical insurance field for 5 years. This does not make me an expert, but I had to get very close to the inner workings of many aspects of health insurance. Even when I explain aspects that should be alarming, people don’t understand how bad the scam is. Yes, one of the most important services you purchase, is a complete scam.
One simple scam is the 80/20, where you pay 20% of the bills(plus your deductibles and not covered procedures). If your bill is $100, you pay $20 and fair is fair right? Not at all. You pay $20, but the 80% is lumped in with all of the other bills of the insured in your plan. The insurance company then tells the provider that they are going to negotiate the bill. First they run the bill through sophisticated software that searches for any errors or charges that are “higher than customary”. Then they negotiate with the provider on an angle they can find to bring the amount owed down. That $80 could easily get down to $40. If fair is fair, you should be included in these discounts and you should only pay 20% of what the bill is negotiated down to. The provider knows that they needed to make $60 off the service, so they charged $100 so that they could get $20 of that from you and $40 from the insurance company. You’re 20% was actualy about 33%! Not to mention any services you needed that were not covered.
The insurance company covers for this by saying that they keep the price of the insurance plan low with their negotiations and this is where you see your benefit. This is nonsense, otherwise they would just pay on the up and up and the need for this shell game would be eliminated. The money is moving in so many ways that nobody can nail down what is really happening. Combine this with employer self-funded and partially funded insurance where sometimes the employer is actually a part owner of the insurance company and you have an unbelievably corrupt system with very little oversight.
This is just one example. If you look up who is on your state’s governing insurance board, most likely you are going to see that your government has appointed someone associated with a health insurance company to take care of complaints about insurance companies. The fox is guarding the hen house. The government’s excuse is that the laws that they created are so complex that it takes an insurance company to figure them out.
If you speak to anyone who works in the health care industry in any capacity, they are going to tell you about extreme waste and borderline fraud. Doctors office employees get many perks from drug companies like catered lunches daily, gifts, etc.
Now, the government wants to step in with a plan to offer? Can you imagine the waste, fraud, and bad coverage that this will bring about considering the ethics of our elected officials? The current companies will lose their position of power and it will be shifted to politicians. The politicians only want this to remove the insurance company’s power to control the flow of the money.
The only thing that our government should be doing to ensure a good health care system would be making laws that are fair and sensible. There is no such talk and never has been as far as I know. As you stated, the money spent is astronomical. There are so many vultures involved that the politicians would never do anything to stop this flow of money that has such a strange untraceable money trail that they can get their hands on.
Our US Health system is broken completely. And compared to what the other first-world nations have ,we really look bad. We pay far more than any other country for much poorer results. We rank 37th in the world in Health care. Our life expectancy and infant death mortality rate is one of the worst in the first world countries. When other countries have considered changing their Health care programs,they ALL rejected the US System. Almost all economists state that unless the US changes our system,the present one will doom the country economically. THIS ISSUE IS BY FAR THE #1 DANGER TO THE SURVIVAL OF THE COUNTRY.
And what do the Ins companies add to the situation-nothing
I’m sorry Sam, I know the stats you are reading, and I don’t believe one number in them. WHO is not a reliable source of information because it’s participants and funding have a political agenda that involves nationalizing our health care system. If we nationalize, things will get worse and drag the U.S. down to a level playing field with our competition, which is where they want us. Health is that last thing that WHO is concerned with.
Part of the reason Canada, Italy, France, Japan, Germany, and England can provide the services that they provide is because the U.S. bears many of the costs of protecting them. Did you know that under trade agreements we have with these countries, health care must be provided for the workers? It’s complicated to explain, but if you want to see the research, you will see where the U.S. is in a very unfair situation.
Please read my post again and try to understand what it is saying. Our system is failing due to corruption and legal issues that actually make corruption legal. I have seen it first hand and I know exactly how it works.
I won’t call you a liar, you believe the stats you are shown that appear to come from reputable sources. Just the fact you take interest in the subject, shows that you do care about the system. I wouldn’t call you stupid either, not by a long shot. I would say you and many others are misinformed and it’s costing us dearly. Please take a long logical look at this.
What do the insurance companies add? They add quite a bit actually. If the laws were changed and the corruption removed, it is a very important service that they provide. A service you would not want to trust government with for certain. They are the only check on the cost of a vital service. In a fair marketplace, competition would allow the best insurance companies to keep those cost very low. Managing a plan, calculating the cost(actuaries do not have an easy job), and other functions performed are very a very important and understated service. If you don’t understand the value of an insurance company, keep up your studies of the subject until you do. Just because they all currently must be corrupt to compete, does not mean they are not a valid service. This is a difficult concept to understand.
Believe it or not, I have seen an insurance company pay huge sums that they were not required in certain life threatening situations. These cases are rare and purposely unpublicized for obvious reasons, but where possible they do happen.
The government is to blame for the mess that our system is in already. They make the laws, the impossible bureaucracies, take payoffs, and add costs to the system we already have. Do you expect the entity who tightly regulates the current system to provide you with a better one? They want a government system for total control of massive funds. I understand that those believing in a government system think that this will solve a serious problem and give to those who cannot afford proper care, but it just isn’t true. A government plan will drastically reduce the care for all while only raising the level of care for very few.
It should be obvious what the insurance companies are worried about if there is a government plan. The government plan will be subsidized by the taxpayer! The insurance companies will not and will also have taxes added to the cost of the plan making it even more unfair. This is a real problem that people do not understand such simple economic and business rules. I am astonished at this brainwashing taking place. It has to be something happening for people to be blind to this.
If you are very wealthy, you will still have private health insurance. These are the only people that will be able to afford a better plan.
Look at other government services and decide if this is how you want health care. Do the best firemen rise to the top? I think the cases where race is more important than test scores. Do you want medical equipment purchased the same way that the military purchases parts? $100 screwdrivers come to mind. Do you want the government deciding who gets expensive treatments? Payoffs to officials come to mind. I could go on and on.
Exactly right, Mark! I worked for one of those employers with a self-funded plan-and paid what I believe was the majority of it as a payroll deduction for many years. After I hurt my back, I really tried to figure out the bills and money angle-and I’m no dummy. But it was quickly obvious I was paying far more out of pocket than the insurance plan was. . .and still paying the premium, only now, I was paying all of it. Then, the hospital couldnt seem to keep the bill straight-I know we were playing the ‘cost-plus’ game where I was paying a portion of every other unpaid bill in the office!
The hospital, which continues to expand constantly (we must provide every possible service on-site even though we’re less than 15 miles from the best two hospitals in Michigan-and we just built the helipad) and the doctors on their staff sent me to every new department they had-all to suck more money out of me. They kept sending me to their pain clinic for epidurals-which the best reviews say only work somewhere around 50% of the time-at an unGodly cost! The insurance company didnt bat an eye-after all, I was going to pay most of it anyway. In between visits, I got sent to the brand-new rehab facility with the community fitness rooms and Olympic-size pool to roll around on some damned ball to the tune of $185 a visit! So I was paying for their community fitness facility and calling it ‘preventative medicine’? Then their special ‘back clinic’ doctor started trying to get me on all kinds of prescription pain killers. I didnt want narcotics-I need what few wits I have just to stay ahead of the hospital and the insurance scammers. He, of course, is getting perks and maybe kickbacks from Big Pharma. When I objected that I didnt seem to be getting any better and didnt want to just cover up the pain but fix it, he tried to give me Prozac. I didnt want that either. We also had a couple of conversations about universal health care (actually, every time I went in, he’d bring it up after he found out I didnt agree with him/it). To get even, he screwed me on the Workers Comp report by saying I was ‘uncooperative’-because I wont take all the pain killers. At the end of it all, after eighteen months, there’s no difference in my back, I’m not on their stupid drugs-and I also quit paying for the COBRA so now have NO insurance. . .and can afford my chiropractor out of pocket! The doctor also quit taking the insurance company that administered the medical insurance plan (United HealthCare. . .can I even say that here? Is that one of George Carlin seven deadly words?) because they would pay one visit-and double-shuffle and take it back the next month. The carriers is one of the worlds largest total truckload carriers (and they’re orange-hint) and I’ve been convinced their entire self-funded health insurance was a scam ever since I managed to see enough figures to figure out their total cost budgeted was about half of what a cheap BCBS plan cost over 20 years earlier! So much for rising health care costs. Its more about absolving themselves of paying for ANY health insurance and still pretending they provide benefits.
Did you ever see a hospital that wasnt under construction? We how have a brand new hospital-in a seriously depressed county with nearly 20% unemployment-and the administrator just got a raise-salary is now $800,000/yr! The other hospital-the one I went to because its definitely better care-in the next county has a beautiful hospital, and beautiful grounds (they display art for sale in the halls-nothing under $200) insists they need a new hospital-because it was built on what they called the hotel model and they want the new nursing hub model. Kinda like demanding somebody build you a new house on their dime because you have a ranch and really want a split-level!
We are being scammed on every level here-and government just wants to wrap its greedy hands around the scam! The US health care system is NOT broken-what is broken is the payments and kickback system. It’s greed, graft and undue influence from Big Pharma, medical equipment providers and health insurers. We’re not talking about cleaning up the double-billing, the over-use of expensive pharmaceuticals, the un-necessary tests and procedures-we’re talking about rationing care based on age and lifestyle. Personally, at 62 and not highly educated, the govt sees me a a net loss-the same way our already self-rationing Medicare system treats the elderly-like my mother at 83 in perfect health who had a slight stroke and they made it perfectly clear they would just leave her in the bed to die-in diapers she didnt need! Incidentally, she’s back to teaching piano lessons-with her affected right hand-six months later, no thanks to them! We are not well-served by a replay from the Obama “gimme the cash” universal health care playbook, Sam. EVERY SINGLE STATEMENT YOU’VE MADE IS A LIE, PURE AND SIMPLE!! We actually look very good compared to Great Britain and, now Canada-your ‘statistics’ are comparing apples to oranges. When over 100,000 people die every year from medical mistakes (usually from wrong medication/improper dosages), when I get nearly daily recall notices from the FDA on problems with drugs, medical equipment-and blood products (my God-NEVER get a transfusion!!), it should be very clear where the real problems originate. If it’s so bad, why do the leaders of other countries come HERE for medical procedures? And, if you’re quoting the same economists that are pushing Cap & Trade, we know they’ve got an agenda! The #1 danger to the survival of the country is NOT healthcare-its healthcare where government influence and inept management has allowed costs to run this high simply because they have agreed to pay them and are incapable of managing a lemonade stand. Congress takes in more money from healthcare-related lobbying than anything except the banksters that played fast and loose with the economy under Congressional oversight. And, who are they taking input from in terms of their single-payer system? Big Pharma and Big Insurance! Much of the push for universal health care is coming from the under-forty crowd who cant envision the cost of this. . .they hear FREE and think it really is (dummies) and the elderly that have been terrified by that liberal lobbying organization, AARP,that they think is actually looking out for their interests . The kids also dont get far enough away from their little cloistered university campuses to see the reality: the vast majority of people do very well with self-pay health care-as long as they arent convinced to over-utilize it when it’s not really necessary. The whole thing is being propagandized unbelieveably.
The only way to instill honesty in this system is to require all health care providers to post their fees for everything. Then, if they’re overcharging, you’ll know it and act accordingly. And dont provide health insurance for the daily visit-type stuff. Only insure for the big stuff-it would become affordable automatically. Do something about the huge mark-up on drugs. Put some real oversight into the FDA. And get government out of the entire health marketplace, except for perhaps Medicare-and that needs some serious oversight. And provide some retraining for all of the unemployed insurance employees who’ll now be out of a job-it just wont be as profitable to employ them all.
Very, very good observations. You’re not the only one that notices these things friend. Sometimes I feel like a conspiracy theorists that can’t understand why nobody else can see the problem.
You are very wise not take the pain and happy pills! The pain pills maybe, but Prozac?
Something else nobody notices. If health insurance is such a good payoff and a such a great business to be in, when was the last time that you’ve seen a new competitor enter the market? No new competitors would stand a chance as the big players have this business locked in and the politicians in their pocket.
As for the doctors, only those that play the game well do well financially. How rare is it that you see a good family doctor operating his own practice these days? They team up so that they have negotiating power. A team of doctors operating on the same set of rules is required to work with insurance companies and politicians.
There is more, more than I can tell here. For example, providers have a business tax ID. I wrote software to try and figure out what doctor had what tax ID. Some providers would change this number monthly and many times, these doctors would have names that changed. The names always had the name “Mohammed” in them. Think about it, and you can figure out that there are very few reasons a business would change their tax ID monthly.
As I mentioned, there is no talk of simply fixing the system we have with fair laws and common sense practices from any political party. Things are going to continue to decline.
I do not appreciate the comment that every “single statement statement “I made is a “lie”. I have been studying this issue for years. Some of my stats come from the World Health Organ- on the the USA being rated 37th in the world.They also confirm on our life expectancy stats. Even the AMA is supporting Obama’s plan in many respects.The American College of Physicians is also open to a single-payer system or a public ins.plan.That is also supported by the Am.Medical Student assoc.. By the way I believe France has the #1 Health system in the world .
And if the Ins companies are doing such a great job then they shouldn’t worry if the Govt comes in and competes with them. After all ,many folks believe the Govt is so incompetent. They should be able to clean the Govt’s clock easily. But of course that simply may not be true.Medicare has a 2% average cost for admin that program and I believe private Ins companies are much much higher than that.
What statement do you believe I lied about????
OK, SAM-I could have worded that statement a little better. I didnt mean to call YOU a liar-but I still maintain all the quasi-facts you are presenting are lies. In short, you’re being lied to. For instance, you cite WHO for your infant mortality stats. But not all countries count live birth the same way. Many of the high-ranking third-world countries dont count premature births that die, or stillborn, or severely defective at all, so it screws the numbers. The United States counts even premature still-born babies in infant mortality statistics.You find those kinds of statistics all through both WHO and CDC reporting. The problem is, they’re both political organizations who are pushing an agenda. . like the latest CDC efforts to declare a swine flu ‘epidemic’. That declaration opens the door for all sorts of government funding for vaccine makers-and the inevitable push for vaccines that are unnecessary and likely dangerous. The current swine flu appears less dangerous than the average seasonal flu-but they still call it a pandemic. It’s the same with the huge numbers purported to have HIV/AIDS in Africa: if there’s no testing, you can call any malnourished, ill, sexually active adult as having AIDS-and get international aid for it. Way more people are dying of malaria there and countries are begging for help to eradicate the mosquitoes since international outlawing of DDT (very effective). Instead, the world gives out a few mosquito nets and tons of money for AIDS they don’t have. Longevity has far more to do with ethnicity and genetics than anything else, assuming you dont starve first. Scandinavian countries have a very pure genetic pool-and a genetic make-up allowing for longevity. So does Japan, parts of Russia, etc. These are long-lived people with little third-world immigration. And, when you get to the lifestyle issues, the US has a huge amount of medical-related deaths each year from mis-and over-medication-and they try to hide that by concealing all drug deaths in with illegal drug overdoses.We also eat a seriously deficient diet made up of untested genetically-modified foods-foods that are outlawed in most of the world. Even a poor but adequate diet is better than the abundant foods that can and likely do create DNA mutations in the gut. Look it up. We dont get enough sleep, we stress too much, we dont get exercise on a regular basis and we eat lousy food-it shortens the lifespan (as proven by truck drivers dying almost 20 years before their peers-they’re an extreme case but the effects are the same). We also have tons of immigrants from third-world countries who arrive here with chronic disease-which we treat-and when treatment isnt successful, it’s counted as a failure of OUR medical care. Longevity? How much can be lain at the feet of choices made in Medicare? A great deal, I imagine. I’ve seen it with both of my parents. My father didnt survive it, my mother did-but she comes from a genetically long-lived family. And, both according to Obama’s speeches and Tom Daschle’s book, we’re going to cut costs by rationing care to only the young and relatively healthy with no ‘lifestyle’ issues. You got a mother, Sam?
Countries dont want our system because, once they have socialized medicine in place, nobody wants to take on the outright cost of medical care. They simply cant envision it. They’d have to sort the entire medical cost out of the whole tax system-and people would figure out just how expensive it really is. If they did, people would start to demand care they dont get now-and that would create a real problem! The US has the best research and the best technology-and we pay for that. But Canadians often come here for critical medical care as they have far fewer drugs and medical technology available there. As Mark explained, the problem is in the corrupt payment system. That’s what needs to be fixed. But you cant have expensive medical care and not pay for it. Medicare is NOT an effective system-the fraud and losses because of graft and paperwork are overwhelming. So the 2% figure is disingenuous-and probably made up by some bureaucrat in Washington (in fact, they were reporting 4% last year, so the numbers change to suit the agenda). Medicare is nothing I want to see replicated on a grand scale. If we cant afford the current Medicare system for a limited number of people, how will we ever afford the far bigger pool of people who would over-use it. And they will over-use it as long as every tv commercial, every magazine ad is for this miraculous new drug or that new treatment and government-sponsored medical care is designed to keep Big Pharma’s profits up. The insurance industry needs an overhaul. The health industry needs an overhaul. Our attitudes need an overhaul. Pharmaceutical oversight needs an overhaul. And government needs an overhaul in terms of honesty and lobbying dollars. Socialized medicine doesnt cure any of these problems: it just makes sure everybody gets a little, and most people get less-for more money. I’ve already had enough of having my medical care determined by a bunch of non-doctors sitting in an office with a calculator. The idea that this is all anybody is going to get from now on ought to frighten everybody!
As for AMA and MD support, that really isnt true-reporting is being twisted on all levels to match the Dem agenda-many, many doctors dont intend to continue practice if we go this route. Since you only know whats reported on the slanted media reports, it would behoove you to realize they’re singing to the agenda and do a bit more research-look for the other side. It’s there.
Guess you will believe your sources and I will believe mine. Just one final point – the goy who created the Natl Health System in Canada is a revered national figure. We have no such person-the system just evolved to one that is the most expensive in the world with poorer results than virtually any of the first-world countries . If you can show me where the USA’s system is the best in the world by comparison,I would love to see it. Most people in the medical field use the World Health Organ ‘s stats as their bible. Thats what I used.
I was going to show you some information showing that the US rates top in nearly all categories. I did a Google search to find the stats for you and I found that I can find any stats that I want you to see going either way. It depends on your source. Do a search for “US health care compared to other countries” and take your pick.
You just have to use your common sense. Why do doctors from these other countries come here to practice. It’s difficult to find an American doctor, especially in rural areas that lack the big city glamour and money. Simple, they want to work in the best environment they can. Go to the UK or Canada and try to find an American doctor. If you do, better check how his license was revoked back home.
I would suspect you are going to see you wish of government care come to fruition. I want to hear more about these stats then and tell us what they mean to you at that point.
Just a few comments. There are no stats showing the USA leading the world in Health Care. We do not.France has the #1 rated system.The US is rated 37th. The USA pays about 30-40 % more on Health care with worst results. As for Doctors incomes,you will find that docs in other countries often times make more than they make here. They are incentifized to help their patients to healthy lives-with diets,better health styles,etc. Most Docs are very happy staying in their own first-world countries. That is a myth that they all want to come here.
As for a single-payer /Govt type system,we already have that here today in the USA-Medicare and the VA system. And they are pretty well run. Nobody is asking Medicare to be removed and have Aetna run the system for profit.
Sam, I just finished reading your post and you worry me. I found http://socialentrepreneurship.change.org/blog/view/the_danger_of_too_much_information while looking for old newspaper stories from my hometown newspaper.
An 1893 newspaper reporter worried that everyone will have something to say, but it will not have much meaning. We have arrived. You have searched and found information to support your opinion. There is so much “information” that you easily found it. I found many “facts” supporting the opposite and your point of view. I’m not going to argue the point anymore, we can all use a search engine, so no need to bother. If you have read our founding documents, you should know how and why systems like government health care are not legal.
Why are all the foreign doctors here then? Do they feel sorry for us and want to offer services? You have told me nothing convincing here, you have merely quoted stats from a flawed source.
I do think that you are so convinced there there is a government solution that you want to believe anything that will tell you so. I’ve been to Europe and if there is one thing I walked away with, it was knowing that the US should NEVER want to do anything like they do it over there, especially government systems.
It is my understanding and many others, that the very premise of a government entity overthrowing a private and legal business is illegal. That is what the government is doing here, regardless of the rhetoric. These pretty boys can’t succeed in the private sector, so they’ve become politicians where they can play dirty pool all they want. You and me are going to pay.
Your passion and good intentions are very misguided and they are the road for the demise of our great country. As I stated, you are going to see where your stats lead us soon.
I was watching Pete Peterson on Charly Rose the other night in a i hour interview. He was discussing the extreme indebtedness of the USA and how it is the most critical issue the country faces today. Peterson worked in the treasury under Nixon,was Pres of Lehman Bros,formed the Blackstone group and made billions. He has taken one billion of his money to educate the USA people on how critical the indebtedness issue is to the survival of the country. And ,as he says,without correcting the Health Care System,in the USA,you cannot correct our National Debt problem. It is Medicare,medicaid and SS that will bury this country. And you CANNOT solve the mediacre/medicaid without solving health care. So you can live in your belief that this is just some “Socialistic Program” without merit and ignore the problem. Or face the FACTS that our Health System is completely broken and needs a replacement that is less expensive with better results.
Medicare, medicaid and Soc Sec = all socialist government programs. Which proves the government can’t fix anything.
Just like those other socialist programs like -schools ,police,Fire Dept,libraries, Hwy Depts,etc. Thanks for that great insight,Joe-you really added something to the solution.