2011 MT legislature

[Brudno]

Brudno,

Insurance works fine?

My aching ass it does...if it works so well, why is it in need of serious reform?

Insurance...they need to come up with a different name for what they "provide".

What a joke.

You have insurance you break your leg, they pay for a portion of your medical bills as agreed to in your policy.

You have a serious injury or illness, and dont have insurance, but expect to get it all of a sudden, what in all seriousness can they possible do for you? Offer you the same premium as a healthy low risk client? They could, but there not going to make money that way. What happens to a company that doesnt make a profit? Im not sure what so complicated about that. If there out of business what kind of service can they possibly provide any longer?

 

[BuzzH]

Brudno said, "they pay for a portion of your medical bills as agreed to in your policy."



I can only think of two possibilities to that quote of yours.

1. You've never filed a claim.

2. You live in fantasy land.

For starters...lets discuss this.

A few years ago, some guy smashed into my truck that was parked in front of my house. The insurance "adjuster" was trying to tell me the damage wasnt that bad...while determining that from my neighbors FRONT LAWN where my truck ended up.

He offered up a sweet settlement on the spot. If I would have taken that sweet deal, I'd of been driving a truck down the road with a bent frame and coming up with an additional 3k to fix it out of my pocket.

Care to hear more...or are we done about the integrity of insurance, their agreements to coverage, and maximizing profit?

Fortunately, that case only involved a truck...and nobody needed medical attention. I'm sure I would have gotten the same "coverage" for any injuries from that adjuster.

There needs to be reform, and Bigfin has it dialed in...the reform needs to be to insurance companies.

 

[Brudno]

Brudno said, "they pay for a portion of your medical bills as agreed to in your policy."



I can only think of two possibilities to that quote of yours.

1. You've never filed a claim.

2. You live in fantasy land.

For starters...lets discuss this.

A few years ago, some guy smashed into my truck that was parked in front of my house. The insurance "adjuster" was trying to tell me the damage wasnt that bad...while determining that from my neighbors FRONT LAWN where my truck ended up.

He offered up a sweet settlement on the spot. If I would have taken that sweet deal, I'd of been driving a truck down the road with a bent frame and coming up with an additional 3k to fix it out of my pocket.

Care to hear more...or are we done about the integrity of insurance, their agreements to coverage, and maximizing profit?

Fortunately, that case only involved a truck...and nobody needed medical attention. I'm sure I would have gotten the same "coverage" for any injuries from that adjuster.

There needs to be reform, and Bigfin has it dialed in...the reform needs to be to insurance companies.

I've had 3-4 auto claims, having a child, a $16,000 appendix removal bill, crushed my ankle, broke my hand a few times, numerous ER visits for miscellanous things. Insurance cleary works as intended being that I've only paid a tiny fraction of what my medical bills should be. I've had 1 bad experience, with an auto insurance company after hitting a deer, I got what I needed done and fired them afterwards. Me only being 24 now and having insurance from 16-24 as well as having a taste for nice vehicles, means I've paid my fair share of high premiums, but I've never told myself its the governments responsiblity to change that, and make sure everyone has to pay a higher bill so I dont have to pay a higher bill because I belong to a higher risk group.


You've told me about a bad experience with your auto insurace. Ok...Your the holder of that policy you employee the insurance company, were you looking for the lowest rate when you bought insurance? Did you look for customer quality as well when shopping? Did you fire them after that? Or did you stay with them? Insurance companies dont need reform as much as they need to be accountable to the free market. No reason health insurance providers cant be held to that same business model.

 

[belly-deep]

The worst thing about that health care reform bill is the fact that those voting for it never read it, don't have to subscribe to what it entails, and added so much other BS to it, it became a monster.

+

Buzz, I agree with you that Rehberg is not a model of honesty as to his true intentions, but how can you blast him and completely ignore the political process used by the democrats to get this bill through? Talk about corruption, bribery, and every other dirty political tactic known to man...

 

[belly-deep]

This thread will stay right here, Rocky. It is not a political post. It is a good fireside topic. It will get political as we debate it, as the two parties have made this very important topic their currency for repaying their debts.

It will stay in this section. Thanks for posting it.

Ok, the boss has spoken.

Rockydog, I retract my statement as to the appropriateness of this topic, you have my apologies as the "hall monitor"

 

[mdunc8]

I think the debate breaks into two issues. Whether everyone should be forced to have insurance and who should pay for it.

I don't think you should force anyone to get insurance. I think WE should cover anyone will a legitimate disability or a minor whose worthless parents won't get it for them. With that said, if a fat arsed smoker walks into the ER for any reason, but doesn't have insurance because they couldn't afford it since they've been smoking and eating ding dongs for 20 years, I say let them sit there are rot. On the other hand, we should be doing whatever we can for people who have no control over the situation they've been put in see. I think it basically boils down to whether you want to be a good neighbor or continue to whine about helping other folks out as you drive your overpriced car to your third home in Aspen. I don't like paying higher rates for lazy bums who don't want (different from can't) to work, but I definitely don't have a problem paying higher rates for a kid with cancer or for someone who gets runover by a drunk.

 

[Big Fin]

Insurance companies dont need reform as much as they need to be accountable to the free market. No reason health insurance providers cant be held to that same business model.

My point is that their is NO true free market with health insurance companies. How does one hold them accountable to the free market, when no free market exists as it relates to health insurance?

Yes, some options exist among different companies, but options are limited by laws that the insurance lobbies got passed. Competition has been reduced heavily and the free market has been compromised to the point that we really cannot study the current system in a free market context, as such does not exist.

I would agree that their is no reason health insurance providers cant be held to the same business model"........ except for the fact that the same business model would need an Act of Congress and some state legislatures.

So I would disagree that this is a free market. If it is a free market, I would be able to be part of a group sponsored by the American Institute of CPAs, having a risk pool of 30,000 members, rather than a risk pool of twelve employees because we are a small employer participating in a small state group.

Maybe I am wrong but insurance is not merely a function of a single party funding their costs. It as much the act of combining multiple parties to fund a pool of costs to share risk.

This is not something new to the world. Many of the early models of statistics and risk analysis were developed far before any of us were around. The size of the pool and the numbers sharing risk, result in a lower risk to each of those involved. Lots of math and science about that.

But, the health insurance companies have worked to get laws passes that has less to do with the pooling of risk, and more toward the assessment of individual cost by being able to cut the insured pool into small pieces.

So, the health insurance company benefits from the lowered risk of a very large pools, a well known concept. They incur the insurance risk of that large pool.

And rather than increasing the pool size and further reducing risks, they have found ways to break the world into "sub pools" or "insured groups" and charge way more to those smaller groups than would otherwise be needed if everyone was part of the total insured pool.

Result - a cost/liability that is low due to the large pool of covered people, offset by the much higher revenues provided by slicing and dicing the other side of the pool into small pieces and charging more for that. Greater revenue with lower cost, results in more profits.

How did they do it? They convinced Congress to mess with the free market you and I would advocate for. And they didn't mess with it to our favor.

Most would call government intervention on behalf of a party to be a subsidy. These bills that give insurance companies the right to slice, dice, and filter the risk pool is a subsidy. It prohibits the insured from joining together to minimize their risks, resulting in higher costs to the insured and higher profits to the insurer.

Politics pays, no doubt about it.

There is more of a free market toward property, life, and casualty insurance. They have not been successful in convincing Congress to work on their behalf. Health insurance companies have written the manual on getting Congress to carry your water.

Unfortunately, health insurance is more important and a larger part of the American household budget than is property insurance.

 

[Brudno]

My point is that their is NOt true free market with health insurance companies. How does one hold them accountable to the free market, when no free market exists as it relates to health insurance?

Yes, some options exist among different companies, but options are limited by laws that the insurance lobbies got passed. Competition has been reduced heavily and the free market has been compromised to the point that we really cannot study the current system in a free market context, as such does not exist.

I would agree that their is no reason health insurance providers cant be held to the same business model"........ except for the fact that the same business model would need an Act of Congress and some state legislatures.

So I would disagree that this is a free market. If it is a free market, I would be able to be part of a group sponsored by the American Institute of CPAs, having a risk pool of 30,000 members, rather than a risk pool of twelve employees because we are a small employer participating in a small state group.

Maybe I am wrong but insurance is not merely a function of a single party funding their costs. It as much the act of combining multiple parties to fund a pool of costs to share risk.

This is not something new to the world. Many of the early models of statistics and risk analysis were developed far before any of us were around. The size of the pool and the numbers sharing risk, result in a lower risk to each of those involved. Lots of math and science about that.

But, the health insurance companies have worked to get laws passes that has less to do with the pooling of risk, and more toward the assessment of individual cost by being able to cut the insured pool into small pieces.

So, the health insurance company benefits from the lowered risk of a very large pools, a well known concept. They incur the insurance risk of that large pool.

And rather than increasing the pool size and further reducing risks, they have found ways to break the world into "sub pools" or "insured groups" and charge way more to those smaller groups than would otherwise be needed if everyone was part of the total insured pool.

Result - a cost/liability that is low due to the large pool of covered people, offset by the much higher revenues provided by slicing and dicing the other side of the pool into small pieces and charging more for that. Greater revenue with lower cost, results in more profits.

How did they do it? They convinced Congress to mess with the free market you and I would advocate for. And they didn't mess with it to our favor.

Most would call government intervention on behalf of a party to be a subsidy. These bills that give insurance companies the right to slice, dice, and filter the risk pool is a subsidy. It prohibits the insured from joining together to minimize their risks, resulting in higher costs to the insured and higher profits to the insurer.

Politics pays, no doubt about it.

There is more of a free market toward property, life, and casualty insurance. They have not been successful in convincing Congress to work on their behalf. Health insurance companies have written the manual on getting Congress to carry your water.

Unfortunately, health insurance is more important and a larger part of the American household budget than is property insurance.

I think you misunderstood me. I think they need to be held accountable to the free market and not be a protected industry, which is why in my other post I stated companies, groups, etc, need to be allowed to shop across state lines. Somthing many of the people trying to repeal this stated they wanted in the health care reform bill, but didnt make it.

 

[RockyDog]

Alot of well meaning responses here, much appreciated. It was nice to see the professor (Big Fin) weigh in with the greatly knowledgeable and respectful post, as usual. He obviously has his own struggles with health insurance. I sware if only we could have guys like Big Fin in congress.

Im an engineer and my wife is an accountant, but i admit we know very little about the poolitics of health care or health insurance. I dont listen to Glenn Beck, Rush Limbaugh or NPR much if at all. But our life does revolve around hospital visits, medicines and finding a way to pay for our share. We actually have very good insurance, which used to not be the case when i was in a smaller pool.

I realize that businesses cant handle extreme burden all our health care costs. But i cant help but feel that if republicans like Rheberg had their way, they would squeeze little guys like me/my son every bit they could to maximize profits for companies. Obviously democrats dont grasp reality of paying for all of their programs, but at least they are fighting for me. They also fought for the 25 year old girl who had the lung transplant, if they hadnt passed the reform she would be much worse off. She is the girl quoted at the end of this article http://www.mtstandard.com/news/loca...a-2777-11e0-96e4-001cc4c03286.html?mode=story

 

[Randy11]

The health care reform has completely saved my ass-

I cost roughly $150,000 a year to be kept alive, so for all intents and purposes, I`m uninsurable.
Because of the reform bill, I`ve been able to stay on my dads old insurance policy as my own card holder. So I`m spending ~$300/month rather than $12k. This deal is running out on me here in a couple months anyways, but its definitely helped while its lasted.

 

[Brudno]

Theres a drug, that doesnt treat cancer, but stops the growth of late stage cancer for a time. It costs upwards of $8,000 a month to administer, health insurance companies cover the cost of this expensive drug, even though it doesnt cure cancer, but makes the lives of those affected by it easier. The drug is Avastin. You think the government panel would cover that? Not likely seeing as how the FDA pushed for a ban of it. Stories are always one sided when dealing with health care unfortunately people often dont talk about much of the good they do as well.

 

[BuzzH]

Brudno,

It wasnt my insurance I was fighting...it was the guy that ran into my parked truck...I was "dealing" with his insurance company and adjuster.

Again, Bigfin has this problem dialed in...insurance is rigged from the get-go...and it isnt rigged to care about the people they insure.

 

[Devil Diver Down]

Rocky Dog, sorry to hear about your son's condition and best of luck on the path forward.

Insurance...they need to come up with a different name for what they "provide".

Buzz- They were going to call it "Screwing You Over" but the marketing people scrapped it.

Brudno- sounds like you've had good experience with a good insurance company--good for you. Not enough of that going around lately.

My household is currently minus insurance and holding our breath--2 teenage boys that like to play rough--but it's better than the $1,000+ a month we were getting tagged with. And that's with none of us having any health issues. We're looking for better options but none of them are very good. Most of them only want to talk about what they won't cover.

My wife had a minor surgery a few years back, which the insurance company (Bleed Cross, Bleed Shield) approved. Then we get a bill from the surgeon for almost the whole thing--almost $3k. Check with the insurance company and they say they paid the surgeon the "allowed amount"...about $300. WTF? You couldn't even get a red neck to cut you in a bar fight for $300. Fired them but still had to pay the $3k.

 

[RockyDog]

The health care reform has completely saved my ass-

I cost roughly $150,000 a year to be kept alive, so for all intents and purposes, I`m uninsurable.
Because of the reform bill, I`ve been able to stay on my dads old insurance policy as my own card holder. So I`m spending ~$300/month rather than $12k. This deal is running out on me here in a couple months anyways, but its definitely helped while its lasted.

sorry Randy. That does not sound good. You or your wife got a job prospect with insurance? If not hope you can use COBRA, going without insurance and getting into that "existing condition" status would be terrible. I assume rhebergs health care reform bill will pass so things are gonna be tougher. But hey, at least we wont be dragging down as much the ones who dont have life threateninging health expenses.

 

[sweetnectar]

What were people doing before the health care bill passed? I'm sure there where "uninsurable" people that would die if not treated before this health care bill. Were they being treated by docs anyway with the medical industry picking up the bill or was our government taking care of them? Did very sick have to deplete their assetts down and then government pick up the tab or did doctors and hospitals just do it for free or both?

I don't know a lot about this subject other than I've watched my premiums over the last few months increase over $130 a month and I'm told by my insurance they are expected to go up again.

 

[montanadogs]

I think the debate breaks into two issues. Whether everyone should be forced to have insurance and who should pay for it.

I don't think you should force anyone to get insurance. I think WE should cover anyone will a legitimate disability or a minor whose worthless parents won't get it for them. With that said, if a fat arsed smoker walks into the ER for any reason, but doesn't have insurance because they couldn't afford it since they've been smoking and eating ding dongs for 20 years, I say let them sit there are rot. On the other hand, we should be doing whatever we can for people who have no control over the situation they've been put in see. I think it basically boils down to whether you want to be a good neighbor or continue to whine about helping other folks out as you drive your overpriced car to your third home in Aspen. I don't like paying higher rates for lazy bums who don't want (different from can't) to work, but I definitely don't have a problem paying higher rates for a kid with cancer or for someone who gets runover by a drunk.

I agree with you mdunc8. There are situations were good people who work their butts off have a child with medical problems and can't afford to flip the bill. But I think that we will start seeing lazier and lazier people if Obama care continues. I personally am getting tired of paying for lazy people, or for people who spend every penny they get on crap instead of the necessities. I don't agree with the new health care plan. It's crap. If the insurance companies would quit worrying about lining their pockets and start help those who need it I think they would still see their pockets get fat but they would also have that tingling sensation inside when you help someone truly in need like the college student.

 

[MattK]

Sweetnectar- It's a bad deal but a lot of people who didn't have insurance and currently don't have insurance waited too long on life threatening illnesses and would simply die. It's a sad day that a country can spend billions/trillions on a war in an area that means little to nothing to the United States but can't get that same "war machine" running to keep it's own citizens healthy. The United States will send it's soldiers to protect US interests over seas...but can't seem to protect those same citizens with the same zeal against disease because "capitalism should take care of them". Republican's love to speak about a "free market" but thats nothing but a red herring. It sounds great in principal but doesn't exist and wouldn't work. As a matter of fact, very few industries are in a "free market". I can't even think of a true "free market" in the United States...something that is not regulated or benefits from the government in some way.

I just hope that Brudno doesn't lose his job and then lose his insurance as he is a horrible risk to insurance companies...he has taken much, much more out of the system than he has ever put in....and probably will ever put in. If it were solely up to insurance companies or the insureds...no one would want to be part of his "group". Even now without regulations forcing companies to insure him, he would be dropped like a hot potato at renewal time.

I still haven't figured out how "health care reform" is an insurance problem. If you want to have true Healthcare reform...the first step is to make citizens healthier. Give incentives for people to lose weight, quit smoking, quit drinking, etc. Have people see physicians on a regular basis which hopefully will catch problems earlier and thus reduce the long term costs. As i was told...it's less expensive to change the oil and grease the chasis on a regular basis than to replace the engine because maintenance was never done. Most people go to a mechanic on a new pickup more often than they have a physical...and the cost is probably comparable on a yearly basis (even if you don't have insurance).

 

[belly-deep]

I still haven't figured out how "health care reform" is an insurance problem. If you want to have true Healthcare reform...the first step is to make citizens healthier. Give incentives for people to lose weight, quit smoking, quit drinking, etc. Have people see physicians on a regular basis which hopefully will catch problems earlier and thus reduce the long term costs. As i was told...it's less expensive to change the oil and grease the chasis on a regular basis than to replace the engine because maintenance was never done. Most people go to a mechanic on a new pickup more often than they have a physical...and the cost is probably comparable on a yearly basis (even if you don't have insurance).

There already exists the ultimate incentive to live healthier--its called good health.

And people still ignore it.

So your solution is to force everyone to live how the government tells them to? Thats a huge infringment on freedom...HUGE.

Being healthy is great, but the govenment's job is not forcing you to make such decisions. And that is where the whole health care thing drops in to a real quagmire. Government supplies the health care, which will encourage a percentage of the population to lead even riskier/unhealthier lives. And so in the name of reducing medical expenses for the population, you stipulate how people must live? I'm not a fan of that.

It could be stipulated that if someone wants to be on government-sponsored healthcare, they have to meet certain health requirements. But how would you do that? Have a govenment employee follow everyone around and make sure they don't eat any fast food? No thanks.

Take a look at our welfare system. If it was up to me, everyone on umemployment/food stamps/etc would have to submit to regular drug testing. But that will never happen. The govenment won't even restrict people relying on government programs to abstain from illegal substances, and so without removing fast food or soda or alcohol from access to the ENTIRE population, the government will never be able to restrict it for those on healthcare.

MattK, I agree with you in that it would be great if everyone was healthy. And that would certainly solve some of our problems. But it is just not a realistic solution.

 

[cowboy]

I am going to give you a personal opinion on health care costs that is never ever talked about.

If you truely want to get to the bottom of health care cost it is my opinion that you need to go the source of the problem. I am not defending or saying that the insurance industry isn't a monopoly or that it may or may not need a complete overhaul, or they have the legislature in their hind pocket but they do not become involved until the invoices or bills are received - Now there is our major problem.

When you try and reduce cost in business you do not go to accounts payable and tell them what or what not to pay because you do not like the amount.

I would guess that the vast majority of hospitals/healthcare facilities fall under a non profit status. I have worked on most hospital sites in the State of Montana and quite a few in Wy. and if these facilities are non profit - "I'm the Pope". Here in Billings I have seen literally dozens of times where one of the hospitals have purchased a 1950's-1960's type 900-1000 sq. ft. peter tumble down shack for mid to upper 6 digits. We then go in and either move them or tear them down. Would you like to know what one of our hospitals paid for a chunk of ground on the out skirts of Billings in case they need more ground in the future? Non profit my butt. They can afford whatever/whenever they want something. Maybe if they paid some taxes they would have to be a little more efficient.

Where do you go in life for any service where you have no idea what the final costs are going to be? I'll tell you - your doctor or hospital.

I had a surgery almost one year ago. Couldn't get a "Quote" from either the doctor or hospital before the procedure. Went into the business office 48 hrs. after being released and they couldn't give me my bill. When the bills started trickling in - it took 45 days from receiving the first bill to receiving the last. You have to be a Harvard lawyer to figure out what you are being billed for. Guess what I was billed for a box of cleanex tissues? Would you like to know what a sleeping pill is worth?

If you really want to get health care reform - there is more than the insurance companies to look at. I now understand why insurance companies do not pay 100% of a hospital/doctor bill.

PS: After 3 personal visits and I don't know how many phone calls - the total bill "was adjusted" down almost 30%. They couldn't verify/prove that portion of charges.

Our health is an emotional issue and most of us will pay anything for a loved one when the time comes for the need. Then when the bills come we take it out on our insurance carrier for not paying. If the doctors/hospitals charged a "REASONABLE" price then maybe we can get the insurance companies to pay without such a fight. The whole damn system from the doctors to the hospitals to the insurance companies needs overhaul. Don't get me started on the ambulance chasing lawyers.

 

[shoots-straight]

I'd like to say this about "Hunt Talk". This forum is full of friends. Anything that a poster want to ask, or to post for advice IMO, is a go. If you don't like it, you don't have to read it or follow it. Just my .02 cents. That's why I call this place home.