Rationing Health Care - it's a lie!

[Ziggurat]

Where can I read all about each company's track record in retrospectively cancelling individuals' insurance when they develop a big-ticket problem, and in causing trouble for companies when one or more of their employees starts costing a lot?

I'm not sure. But you seem to think it's common, and it isn't. In fact, it's generally illegal.

http://law.freeadvice.com/insurance_law/health_insurance/healt_insurance_cancel_policy.htm

What's not illegal is dropping a patient for a pre-existing condition which they did not disclose (ie, they lied) when they applied. Such people may appear in news stories complaining about the big bad insurance company, neglecting to mention why they were actually dropped. Given how sensitive you are to misrepresentations of the NHS, it's a little strange you don't consider that the US system has been misrepresented to you.

 

[Rolfe]

I'm considering it all the time. But nobody is demonstrating it. I've even seen footage of a health insurance company executive asked if his company would stop retrospectively revoking cover except in cases of deliberate fraud. He answered "no".

I've seen footage of former employees of health insurance companies who worked in these departments, who relate that they were given the files of people who had developed high-cost problems, and told that their minimum target was to find reasons for revoking cover in 10% of these cases. Employees who exceeded this got a bonus.

You have to find out how that footage was faked. By the way it was broadcast by the BBC.

Rolfe.

 

[Drysdale]

http://en.wikipedia.org/wiki/Health_care_in_the_United_States#System_efficiency_and_equity

Learn about basic facts in this. Why am I not surprised that people are unaware of even the most basic things?

Umm,what's the point of this link here? You linked me to a section stating the uninsured go to doctors less,less preventative care etc. I know that,
I think the majority of people know that.

What I'd like to see is this, number of GP's per capita in the UK,Canada,etc.
Also number of dentists and specialists.

Length of time to get treatment once diagnosed. Especially serious health issues. That treatment's effectiveness and result.

I've also heard the Uk has a very high infection rate post treatment. Is that true? Basically where do I find the more detailed stats? Is there a reliable source comparing countries in that aspect?

 

[Kestrel]

Umm,what's the point of this link here? You linked me to a section stating the uninsured go to doctors less,less preventative care etc. I know that,
I think the majority of people know that.

What I'd like to see is this, number of GP's per capita in the UK,Canada,etc.
Also number of dentists and specialists.

Length of time to get treatment once diagnosed. Especially serious health issues. That treatment's effectiveness and result.

I've also heard the Uk has a very high infection rate post treatment. Is that true? Basically where do I find the more detailed stats? Is there a reliable source comparing countries in that aspect?

The World Health Organization's health care statistics by country should answer some of your questions.

ETA: You should also check out the WHO Statistical Information System.

 

[Ziggurat]

I'm considering it all the time. But nobody is demonstrating it. I've even seen footage of a health insurance company executive asked if his company would stop retrospectively revoking cover except in cases of deliberate fraud. He answered "no".

I've seen footage of former employees of health insurance companies who worked in these departments, who relate that they were given the files of people who had developed high-cost problems, and told that their minimum target was to find reasons for revoking cover in 10% of these cases. Employees who exceeded this got a bonus.

The latter means little without knowing how prevalent fraud is on the part of policy holders in this situation. If it's above 10%, then this is entirely reasonable. Plus, of course, there's the issue of how representative this is (data is not the plural of anecdote), and even 10% is still a minority of such cases, contrary to the suggestion of kellyb that dropping people is the standard response.

The former means nothing, since it's not the insurance company's job to find out if fraud is deliberate or accidental.

You have to find out how that footage was faked. By the way it was broadcast by the BBC.

You'll have to forgive me for not accepting this as the word of God.

 

[kellyb]

and even 10% is still a minority of such cases, contrary to the suggestion of kellyb that dropping people is the standard response.

So the prevalence of dropping costly clients needs to exceed 50% for it to become unacceptable?

Is it ok if it's 5%? 15%? 25%?

How bad would our present system need to be for you to admit that something along the lines of single payer would be better?

In the whole of the developed world, we (the US) are suffering the most on almost every outcome that can be measured. New people are facing financial ruin over our healthcare system every minute of every day. Middle class families like mine, all over the US, can't buy **** because we're paying 50% of our income for health insurance.
I am not the only middle-classer in this situation, and I know it because I've talked to people on other US-based forums. LOTS of US citizens are in the same boat I am in.
Our healthcare costs are crushing our economy, and there is a better way. It doesn't have to be like this.

 

[Ziggurat]

So the prevalence of dropping costly clients needs to exceed 50% for it to become unacceptable?

No, I said nothing about acceptability. But if it's happening in a minority of cases (and this 10% figure is anecdotal, we should not assume it is this high), then it is not accurate to characterize the system as a whole as dropping coverage as a standard response.

How bad would our present system need to be for you to admit that something along the lines of single payer would be better?

And what would it take for you to realize that there are other ways to reform the system besides single payer?

In the whole of the developed world, we (the US) are suffering the most on almost every outcome that can be measured.

No, actually, we are not. We lag in some, and are doing quite well in some.

 

[Corsair 115]

You don't want these things, apparently, but none of us can figure out why.

As near as I can figure, it boils down to five words: It is against American ideology.

What I'd like to see is this, number of GP's per capita in the UK, Canada, etc. Also number of dentists and specialists.

In regards to dentistry, in Ontario it is not covered by the public health care system (I'm not sure if another province includes it; I don't think so). The only insurance coverage for dental work is private.

 

[Rolfe]

The latter means little without knowing how prevalent fraud is on the part of policy holders in this situation. If it's above 10%, then this is entirely reasonable. Plus, of course, there's the issue of how representative this is (data is not the plural of anecdote), and even 10% is still a minority of such cases, contrary to the suggestion of kellyb that dropping people is the standard response.

The former means nothing, since it's not the insurance company's job to find out if fraud is deliberate or accidental.

You'll have to forgive me for not accepting this as the word of God.

Well, I didn't record the news broadcast, so I can only tell you what I remember. However, I'm surprised that you as an American aren't aware of what I'm talking about. It was in June, I believe, and there was an official US enquiry specifically into the problem of recission. The footage broadcast was official internal footage of the enquiry. It involved a committee member questioning an insurance executive. The situation was made quite clear - that it was SOP to take the files of all people who had developed expensive health problems and go through them with a fine-tooth comb to try to find a technicality to use to rescind the policy and deny coverage.

The executive was asked if his company would cease this practice and confine recissions to cases where deliberate fraud had occurrred. He gave a one-word answer - No.

Two example cases were shown, that I remember. One was a woman who had been diagnosed with breast cancer. When her insurance company went through her medical records they found that she had consulted her doctor about a skin complaint some time previously. The skin complaint turned out to be nothing more than acne. However, the doctor had pencilled ?pre-cancerous? in his preliminary notes. The insurance company used that to refuse to cover her claim for breast cancer treatment.

The other was a man whose diagnosis I don't remember. However, his problem was that when his records were trawled, it was discovered that his doctor had ordered a particular test to be done (a blood test?) without telling the patient. The result was negative, and the patient was never made aware of the test having been done. So he answered "no" to that question on his application form. This "lie" was used to cancel his coverage years later, when he was sick.

You can call these isolated examples if you like, but your government was concerned enough about the practice to have an actual enquiry into it, just this year. The 10% figure appears to be the basic target to be achieved by all employees in the claims inspection division, and bonuses are payable for higher rates achieved. It has been claimed that the actual rate of recission in really expensive conditions is substantially more than this. (I might take issue with some of the figures in that article but I think he makes his point well enough.)

Rolfe.

 

[Rolfe]

And what would it take for you to realize that there are other ways to reform the system besides single payer?

Who is actually suggesting "single payer"? Kelly may have said she favours that, but it's not what's on the table for you people at the moment so there's not a lot to be gained by arguing against it.

Rolfe.

 

[Francesca R]

Because of the dysfunctional tax system, those customers are frequently not the people they insure (but rather their employers), so there's an argument to be made here for decoupling insurance from work. But that's for another time.

If it was decoupled from work and replaced with something totally optional, the selection biases that would kill off efficient pricing would be much worse than they already are. The argument pushes in the other direction--to make insurance mandatory and (regressively) state-subsidised if not fully funded.

 

[ddt]

And what would it take for you to realize that there are other ways to reform the system besides single payer?

Nobody's arguing for single payer per se. It just so happens that the British posters on this board are the most articulate, and that single payer, with the NHS as most prominent example, is held up as bogeyman by the health care reform opponents.

But other systems have been mentioned, e.g. the German system, the Swiss system, the French system which ranks first in the world according to the WHO, and the Dutch system as I've described it the other day here. All non single payer systems.

 

[DC]

Nobody's arguing for single payer per se. It just so happens that the British posters on this board are the most articulate, and that single payer, with the NHS as most prominent example, is held up as bogeyman by the health care reform opponents.

But other systems have been mentioned, e.g. the German system, the Swiss system, the French system which ranks first in the world according to the WHO, and the Dutch system as I've described it the other day here. All non single payer systems.

forget our system, we need a reform too. its not working as intended.

 

[ddt]

forget our system, we need a reform too. its not working as intended.

Could you elaborate on that?

 

[Rolfe]

My wife and I pay $60 per month. It is top shelf coverage. So by your statement pretty much all the countries with universal health care are paying $15 per month per person. Really?

No joke.
Ours is $1,200 a month.

I actually don't know what I personally pay. Because it's rolled up with taxes, it feels like I'm not paying, though of course I know I am.

I make £48,000 a year, which is about $80,000.

I pay £700 a month in tax, total. That's $1,170. That's all my tax. (I also pay half of that again in National Insurance payments, but that's supposed to be going towards paying for my pension when I retire. So $1,755 altogether if you like.)

So, Kelly, I'm paying just about what you pay just for healthcare insurance, as my entire tax bill. And I'm not on the breadline, as I imagine you can see.

However, I would point out that even if that were all you [the Painter] were paying for healthcare insurance for yourself and your wife (and with all due respect I don't believe you), I would remind you that the US taxpayer pays slightly more than we do to fund just Medicare and Medicaid. Which the US taxpayer can't actually access.

Come on, how much do you actually pay into healthcare, altogether? Including employer contributions and taxes as well as personal contributions. And is the healthcare you'd get for this contribution subsidised by the taxpayer in any way?

This kind of got buried. My original comment was that as well as liking our healthcare, we like only paying half of what Americans pay. Meaning, of course, that as a country we spend about half of what the USA spends per capita, for no worse outcomes.

The Painter thinks he and his wife only spend $60 a month between them, for "top" coverage. Am I the only one who wants to know more?

Rolfe.

 

[DC]

Could you elaborate on that?

would need a seperate topic.

the market should be regulating the costs, but it doesnt work.
while poor familys rightfully complain about the huge amount they have to pay, the insurance companys didnt even rise the prices enough, they are short alot money, this means next year we will have a rise of up to 30%.
(we still pay less than the USA)

http://www.tagesanzeiger.ch/schweiz...kt-im-Gesundheitswesen-versagt/story/25698023

only in german, but its about how the free market failed in healthcare.

 

[DC]

i pay around 300 Swiss francs per month only for myself.

 

[ddt]

would need a seperate topic.

Yes and no. It would be interesting to see how other countries tackle health care and what the problems are.

the market should be regulating the costs, but it doesnt work.
while poor familys rightfully complain about the huge amount they have to pay, the insurance companys didnt even rise the prices enough, they are short alot money, this means next year we will have a rise of up to 30%.
(we still pay less than the USA)

http://www.tagesanzeiger.ch/schweiz...kt-im-Gesundheitswesen-versagt/story/25698023

only in german, but its about how the free market failed in healthcare.

Thanks. I also read the (German) wiki page on it. One thing that struck me was, that there is a special fund for risk equalisation, but that it equalizes risks only partially. Another that you still have 90 (!) health insurers. For comparison, in Holland there have been a lot of mergers since the system was overhauled, and the 3 biggest corner 75% of the market.

i pay around 300 Swiss francs per month only for myself.

That's pretty hefty. And it's a flat premium, nothing income related?

 

[DC]

Yes and no. It would be interesting to see how other countries tackle health care and what the problems are.


Thanks. I also read the (German) wiki page on it. One thing that struck me was, that there is a special fund for risk equalisation, but that it equalizes risks only partially. Another that you still have 90 (!) health insurers. For comparison, in Holland there have been a lot of mergers since the system was overhauled, and the 3 biggest corner 75% of the market.


That's pretty hefty. And it's a flat premium, nothing income related?

http://www.commonwealthfund.org/Con...rage-and-Regulated-Competitive-Insurance.aspx

and interesting article about our 2 systems and the US.

and no its not income related. and its just (almost) minimal coverage there are meanwhile some cheaper insurers.

 

[Ziggurat]

Who is actually suggesting "single payer"?

kellyb, obviously. Did you not read what I was responding to?