What health insurance reform?

DSGamer wrote:

To me this was utterly fascinating.

http://www.cbsnews.com/8301-18560_162-57451721/insiders-the-road-to-the-stock-act/?tag=contentMain;contentBody

60 Minutes did a piece on insider trading in congress. During part of the segment they mentioned that as the health care bill was being debated members of congress were buying stock in health care companies. :)

Isn't that totally illegal?

LeapingGnome wrote:
DSGamer wrote:

To me this was utterly fascinating.

http://www.cbsnews.com/8301-18560_162-57451721/insiders-the-road-to-the-stock-act/?tag=contentMain;contentBody

60 Minutes did a piece on insider trading in congress. During part of the segment they mentioned that as the health care bill was being debated members of congress were buying stock in health care companies. :)

Isn't that totally illegal?

Congress explicitly excluded themselves from insider trading laws until last month. Rules are for us peasant-types.

I don't think Congressmen and other Federal officials were "explicitly excluded" from the insider trading laws, but it was notoriously hard to prosecute them.

Robear wrote:

I don't think Congressmen and other Federal officials were "explicitly excluded" from the insider trading laws, but it was notoriously hard to prosecute them.

Hmm, some googling shows both responses (not illegal and not prosecuted). Regardless, they got away with it all the time and very little ever came of it (I saw Rep. Bachus' name come up, but nothing else of note).

Robear wrote:

I've already done so, back in May I think; individual mandate goes down, everything else is kosher.

Unfortunately without the mandate it's not going to be affordable. I don't see how they could strike it down anyways. You're required to pay into FICA, medicare... I don't see what the basis would really be.

Here is some "Health Insurance Reform". http://money.cnn.com/2012/06/21/pf/health-care-rebates/. Assuming the Supreme Court doesn't overturn the entire law some Americans will be getting rebates because their health insurance company was not able to spend 80-85% of premiums collected on actual health care.

While it may be appalling to some that the government is dictating the amount of profit a company can make, I think it makes sense with health insurance. 20% is a bit too generous in my opinion (of course, my preferred overhead would be the 2-5% we see in Medicare).

PoderOmega wrote:

Here is some "Health Insurance Reform". http://money.cnn.com/2012/06/21/pf/health-care-rebates/. Assuming the Supreme Court doesn't overturn the entire law some Americans will be getting rebates because their health insurance company was not able to spend 80-85% of premiums collected on actual health care.

While it may be appalling to some that the government is dictating the amount of profit a company can make, I think it makes sense with health insurance. 20% is a bit too generous in my opinion (of course, my preferred overhead would be the 2-5% we see in Medicare).

If we were savvy we'd write the law such that if they reduced overhead with technology innovation they could make more margin and have it scale down back to 80-85% on a sliding scale.

So if you automated a lot of stuff, saved 10%, you could get 10% more profit in year one, 6% year 2, 3% year 3, etc. Reward efficiency, keep costs down.

Unfortunately without the mandate it's not going to be affordable. I don't see how they could strike it down anyways. You're required to pay into FICA, medicare... I don't see what the basis would really be.

While I agree with you on both points, I can tell you skipped whole swathes of the previous debates on the topic.

I don't see how they could strike it down anyways.

They have explicit power to tax. They do not have the power to force you to enter into contracts. They can offer and/or withhold a benefit if you do so, but they can't punish you for not engaging in a commercial transaction they want you to engage in.

If they'd structured it as a tax hike and then a refund for people with health insurance, that might have worked, and of course single-payer would have worked, but the setup as structured has no Constitutional basis.

Or, he could just go back and read the thread, Malor, and we would not have to repeat it here.

If we were savvy we'd write the law such that if they reduced overhead with technology innovation they could make more margin and have it scale down back to 80-85% on a sliding scale.

So if you automated a lot of stuff, saved 10%, you could get 10% more profit in year one, 6% year 2, 3% year 3, etc. Reward efficiency, keep costs down.

I like this idea, but being in the industry, I don't see insurance companies/payors as the biggest tech laggards, it's the providers. Hospital systems are *very* slow to change and a lot of the business still runs on the phone and fax machine, and whenever the government tries to get the doctors to modernize the AMA kicks their lobby machine into gear.

Insurance companies would love to have more automation, but sadly until the government steps in and enforces some interchange standards I don't see it happening any time soon.

Looks like the Supremes are going to wait until at least tomorrow to deliver their ruling on the ACA.

Tanglebones wrote:

Looks like the Supremes are going to wait until at least tomorrow to deliver their ruling on the ACA.

Mass Effect extended cut DLC AND the Obamacare ruling drop on the same day?

The Supremes. That is a fantastic way to refer to them.

In other news, your health care situation sucks. I'm in the 100% of people should have health care camp. It costs Americans too much money when those people have to get treated anyway. I don't know enough about that sector to have a much better opinion than that though.

Consensus seems to be Thursday for the decision.

I stumbled onto this thread, so I shall have it rise up!

Bandit, if you're still having trouble finding a policy. I'd suggest joining a Chamber of Commerce. Most Chambers of Commerce have a group health policy you could join just for being a member.

You pay the couple hundred bucks for your business to be in the CoC and you have access to what is typically a pretty decent health product.

Hope that helps!

It's really stunning how few people realize that healthcare is now big business. Sadly, in some cases your right to live or die is tied directly to the depth of your savings account.

#4 on their rheumatology list:

Don’t prescribe biologics for rheumatoid arthritis before a trial of methotrexate (or other conventional non-biologic DMARDs).

This is definitely not a cut-and-dry claim, and should be determined based upon the acceptability of side-effect risks.

Methotrexate was one that I skipped past in my own treatment because of the very serious risks associated with long-term use. When weighing the potential benefits of the treatment against the risks, I decided that the risks outweighed the potential benefits. This was before biologicals were even an option; I wound up depending on NSAIDS, which were only helpful enough to keep me functional, not to fully treat my arthritis.

Biologics like Enbrel and Humira, however, treat the source of the disease rather than the symptoms. And while they aren't a cure in the sense of there being a point where you no longer need the treatment, the long-term potential benefits outweigh the risks.

I trust the list you linked less than I trust my doctors.

Farscry wrote:

I trust the list you linked less than I trust my doctors.

So do most people -- which is one of the hazards of the situation. We have countless threads talking about doctors prescribing unneeded treatments, billing for things that never happened, and being ignorant to new developments in every important field they should be aware of. Your chances of dying in a hospital due to negligence, errors, or ignorance is far, far greater than the chances of you dying from an actual disease.

Yet the trust between the doctor and the patient is -- and, in my opinion -- should be -- sacred. So somehow we need to divorce the big business aspect of healthcare away from the...healthcare aspect of healthcare.

Seth wrote:

Yet the trust between the doctor and the patient is -- and, in my opinion -- should be -- sacred. So somehow we need to divorce the big business aspect of healthcare away from the...healthcare aspect of healthcare.

I don't fully agree with the rest of your post, but you are 100% spot on with this.

The reason I trust my doctors more than LarryC's list is because I take time to research and educate myself, and my doctors listen to my input in making treatment decisions. I specifically try to avoid unnecessary tests and treatments, but I also argue to bypass things where the risk/reward ratio is off-kilter (like the methotrexate example).

Trading one blanket statement (I always trust my doctor more than anything else!) for another (Follow these guidelines instead of your doctor!) isn't a solution.

Farscry:

It's not my list. The list was released by the various medical societies in your country about tests and procedures that they think are being overused. I don't know whether or not that's actually true. Don't let my personality color your opinion on the list. I in no way formulated it, and I only endorse it insofar as your medical societies have endorsed it. Don't shoot the messenger; and don't let the messenger's ugly, rude face affect your opinion. You guys let the personality saying the word affect your opinion on the word far, far too often.

In one way, I'm against this list in that it promotes "de-kahon" treatment or "boxed/prepackaged treatment," as it would translate in your vernacular. Premade treatment schemes are good for cutting costs, standardizing care, and helping doctors who are too incompetent to have a license; but it's not a substitute for a personalized health plan.

Currently, your treatment plans are dictated by insurance companies and lawyers. Having them be dictated by doctors is at least a step in the right direction. Bear in mind, the list is meant to inform patients so that they ask. It is not meant to be Clinical Practice Guidelines, nor a part of Clinical Pathways.

LarryC wrote:

Farscry:

It's not my list. The list was released by the various medical societies in your country about tests and procedures that they think are being overused. I don't know whether or not that's actually true. Don't let my personality color your opinion on the list. I in no way formulated it, and I only endorse it insofar as your medical societies have endorsed it. Don't shoot the messenger; and don't let the messenger's ugly, rude face affect your opinion. You guys let the personality saying the word affect your opinion on the word far, far too often.

No worries, I know it wasn't a list generated by you. And don't think I was going after you, I was just pointing out that such blanket lists like that are no more trustworthy than saying "my doctor is always right".

On further consideration, I'd say you ought to look at the list a bit closer and pay attention to the tests included there. There is a reason for why the list might be good: your doctor works under the medical system you have and is subject to the same stick and carrot routine every doctor in it is. That is, if he advises you to skip a test he might be opening himself up to legal liability; and he gets paid for any tests he orders. Either factor alone could sway the good judgement of otherwise good professionals. Together, they make a very compelling pair.

The motives of the medial societies are more disinterested and long-term. They know the current state is ethically unsound and probably unsustainable, so they're covering their asses by issuing statements that say they didn't endorse this sh*t. I like that motive, as a patient.

Unexpected Health Insurance Rate Shock-California Obamacare Insurance Exchange Announces Premium Rates (Forbes)

Upon reviewing the data, I was indeed shocked by the proposed premium rates—but not in the way you might expect. The jolt that I was experiencing was not the result of the predicted out-of-control premium costs but the shock of rates far [em]lower[/em] than what I expected—[em]even at the lowest end of the age scale[/em].
Sarah Kliff at The Washington Post reveals just far off the prognosticators have been.

“The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.”

The actual costs?

Kliff continues, “On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium. For the 2.6 million Californians who will receive federal subsidies, the price is a good deal less expensive…”

As you can see, the actuaries missed by a huge percentage.

Hypatian wrote:

Unexpected Health Insurance Rate Shock-California Obamacare Insurance Exchange Announces Premium Rates (Forbes)

Upon reviewing the data, I was indeed shocked by the proposed premium rates—but not in the way you might expect. The jolt that I was experiencing was not the result of the predicted out-of-control premium costs but the shock of rates far [em]lower[/em] than what I expected—[em]even at the lowest end of the age scale[/em].
Sarah Kliff at The Washington Post reveals just far off the prognosticators have been.

“The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.”

The actual costs?

Kliff continues, “On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium. For the 2.6 million Californians who will receive federal subsidies, the price is a good deal less expensive…”

As you can see, the actuaries missed by a huge percentage.

Wow, that is good news!

So the headline for conservatives is "Obamacare Destroys Healthcare: Regulations Slash Economic Activity by 40%, Kills Jobs"?

OG_slinger wrote:

So the headline for conservatives is "Obamacare Destroys Healthcare: Regulations Slash Economic Activity by 40%, Kills Jobs"?

*facepalm* Probably, though hopefully the liberal spin could include something about how this is only affect insurance company profits... something I'd be willing to be (much like oil companies), most people would not be panicking or crying about too much.

I know that for my wife and I, going through healthcare.gov has been a huge savings. It is a 50% savings for my wife to not have to pay in at work, and 200% saved compared to putting me on her Blue Cross plan. All told to buy in on her work plan, would cost us 600 bucks a month, the plan I found for us is 160 a month.

Now that said, she and I are healthy, young 30's, with no kids. I imagine that the Blue Cross Family plan pays more dividends when you have kids-the birth process, costs of doctor visits, etc.

By getting to shop around, we are not locked in to a big group health plan. But that said, we do get Delta dental through her work, because it is the best around us, and it is only 7 bucks apiece.