They are not because they have begun taxing that pot. Big time. Then they started requiring all kinds of subsidized service out of that pot which is effectively like a tax.
It's mostly people who don't pay into the pot but take out that are the problem. Mostly since Obamacare. Which hopefully ends soon.
Used to work. It is no longer a truly free enterprise world.
The private arrangement worked very well until Obamacare came. Which is where politicians started to tell plans what they must cover and whom they must cover, and myriad other things such as extra taxes.
Same here in this case. They didn't want to cover something that contractually clearly was under preventative care (screening). In the end they did cover it but only because I filed a grievance. Most people I know don't do that, they just pay.
No, it never did work, from an individual's view. (It does work from the corporations' POV).
I first heard of this problem on a radio program last millenia. The insurance industry spokesman admitted that this is how it works...
Note that each step is individually justifiable and reasonable. Note that the progression from each step to the next is also justifiable and reasonable. The end result is not, IMNSHO, reasonable.
1) Each insurance company contains a large number of "plans"
2) Each plan is self-financing and ringfenced from all the others. If one plan fails, the others are unaffected.
3) People can choose which plan they join, and they mainly choose based on coverage and premiums.
4) When you join a plan, you take a medical and pre-existing conditions are not covered.
5) Companies continually introduce new plans, often with better coverage and/or premiums.
6) People can choose to leave one plan and join another. If they do so then they take a medical and pre-existing conditions are not covered.
7) That includes people who are still healthy after paying into an "old" plan for, say, 30 years.
8) The people who have developed conditions during that 30 years cannot transfer into a new plan because their condition would not be covered.
9) Hence over time, "old" plans tend to have a concentration of unhealthy people, more than would be expected by looking at the stats for the people of that age.
10) Hence the "old" plans outgoings become higher than expected for people of that age.
11) Since each plan is self-financing, that means the "old" plan's premiums have to cover the plan's outgoings
11) Since the outgoings have gone up significantly, so the premiums have to go up. Tenfold in some cases.
12) The rational choice is to choose a plan with a wide range of people with a wide range of ages. The insurance companies have that information, but the individuals do not. Hence the individuals cannot make a rational choice of plan.
And that's how the commercial industry is rigged so that people can find that strangers have drained their plan's pot and that their premiums have gone up tenfold.
Have you ever lived in the US and had health care here? I do, for a long time. I have also lived in Europe so I can compare. It certainly did work in the US. And yes, I mean as an individual because I bought insurance on the free market as a self-employed individual.
European media? Be careful, many there are biased.
Here is where some of the propaganda starts. We had pre-existing and got coverage for everything. But yes, there were cases where pre-existing was excluded. That's a problem and is something that needed and needs fixing.
Rarely.
Then do not switch. Simple.
If they are healthy they have no pre-existing issues.
All a matter of negotiation. I know lots of people who got coverage anyhow. Else insurance companies could hardly sign up 50+ year olds. Yet they did.
Then why is our plan _way_ lower in recent increases than the Obamacare plans? Our plan was forced to close by the Obamacare law so cannot have signed up any younger people and, therefore, the whole pool must now be >6 years older than it was. I guess the plan participants must all be totally buff athletes.
To put some numbers behind this: Our plan goes up 2.2% for next year. A comparable Obamacare Plan goes up 15%. That really hurts the middle class and is one of the reasons why Hillary lost the election.
Didn't happen in our plan.
Sorry, but that's pure spin.
I can compare prices and service levels. That tells the story.
It's not true. Don't listen to biased media so much :-)
Why? I've not run into anybody in the UK or the Netherlands that complained about not getting a treatment because it was rationed. My next door neighb our in the UK had to wait some six months for her hip replacement (but this was when Thatcher was still the prime minister). The Dutch system is a bit more expensive per head, and does include some spare capacity, though they have been known to ship patients over to Germany to beat occasional bottle necks.
Sure, and the drugs don't help at all, though if you're prone to fainting (and you _do_ know it) activities like driving are out. The feds have a problem with A-fib in pilots, too. ;-)
No, not controlling. My cell phone is my Internet television. It's one reason I'd never be without one. Why do you need a keyboard? There is nothing I want to do on my television that I would even want a keyboard for. Remotes are bad enough.
I live out in the boonies. Nothing here but windey roads, no shoulders, and lots of traffic.
My wife like the recombinant bikes at the gym. I just never got into them. I'd rather use the treadmill. I do about 1:20 a day, though only 1:05, today (pushed it too hard yesterday).
Yep. Though they did most of it (CABG, MAZE, and LAAC) when they had me cracked open.
All my wife had to do is point it out the insurance company and they went after the hospital like a shark in deep chum. The insurance company told her not to pay the bill under any circumstance.
I watch what/who is billing the insurance company and challenge anything that doesn't look right. They go back and get all the detail. I do care what they pay and their system works.
The problem is all yours. Tom Gardner has spelled out exactly what's going on in that particular situation several times and the fact that you haven't processed and stored the story comes as no surprise.
Not in this case. Of course in krw-speak "you're wrong" means "you disagree with what krw thinks is true", so it's scarcely worth noting.
I've just outlined, again, the sequence by which it *does* happen in response to Joerg's message.
So far Joerg's rebuttal amounted to "it didn't happen to me" and "that's biassed". In particular he wasn't able to provide evidence why that chain of events doesn't happen in some cases.
Yes, as an infant and later when I worked for a US corporation.
I also talk to natives about their experiences.
US media when I was working in the US.
That statement of fact should not be glossed over.
Please explain why the insurance industry spokesman admitted that the steps I outline do happen.
The rational action is for healthy people to switch. I would, so would you.
Of course, but they aren't the issue.
Don't be silly. Not everything is subject to negotiation, and not everybody is a salesman.
Shrug. That's a completely different issue.
Good. Lucky you. But others do get screwed.
I didn't get run over when I walked into the road without looking.
Please explain why the insurance industry spokesman admitted that the steps I outline do happen.
It is useful to be able to provide an alternative to corporate spin.
But that's not the key information you need.
The key info is the number of people in a plan and their age distribution - and for obvious reasons that is commercially confidential.
Please explain why the insurance industry spokesman admitted that the steps I outline do happen.
Note that your rebuttal amounted to "it didn't happen to me" and "that's biassed". In particular you weren't able to provide evidence why that chain of events doesn't happen in some cases.
Then you were never in the market for an individual policy. I am. Corporations cover you with their group policy.
So do I and there is hardcore bias in many. A lot of them fail or refuse to see one major factor: Individuals foregoing health insurance because they used the money to buy a car, house, boat, whatever. _Then_ they got sick, waited until it was really bad and later started complaining that they couldn't get coverage, the "system" being unfair and blah-blah.
They are on average not as bad but almost.
There is the fact that there are honest health care organizations. Just like there is with most other sectors.
Probably for the same reason a "mortgage officer" for a loan shark will tell you how they ripped people off.
Why? I have not switch in well over a decade. In fact never after becoming self-employed.
Pre-existing is a problem, just as a fouled up tort law is. The new administration has promised to tackel the first, the latter will probably never be fixed. Or maybe it will because Trump is not beholden to campaign "contributors" unlike pretty much all presidents of the last decades.
I am not a salesman yet got it done. One of the major issues back then was that our health history was partly in a foreign language and partly unavailable. Initially they wouldn't have any of it and that took some serious lifting.
The numbers are fact and are _the_ issue in Obamacare. Or in insurance lingo it's about to death-spiral.
Not lucky. You need to pick a good and large plan. The horror scenario of tenfold increases and such is a myth. It didn't happen in competing plans either.
I don't know him. Which _major_ health insurer did he work for?
Media mostly won't do that.
Insurance plans must file Form 5500 and the number of plan particpants must be accurately disclosed on those. Same if a large company decides to self-insure.
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See above.
I live here for a long time, you don't. Nearly all my friends have and had health coverage. A few decided not to but that was because of a IMHO false sense of frugality or because they wanted the money for something else.
So your philosophy is that if there are a handful of accidents with a particular car, largely because of aggravated stupidity of some drivers, the whole series is junk?
Quote "Some people experience dizziness or even fainting with their AFib
Not sure why you'd want that, vs. an Amazon Fire Stick, Roku, or some
But I have, a lot. For decades I worked in high-end med devices design where you get around a lot. The topper were all the Canadians at Mayo which is fairly close to the border. They were on waiting lists or certain procedures were denied to them. The well-heeled once quietly carried a Mayo Card.
Netherlands was mostly ok but I met a lot of UK folks as well who sought private treatment because their glorious health system had them on a waiting list. Sometimes people on waiting lists die needlessly.
I know that you tend to even blame rainy weather on her but this happens regardless of Thatcher. Waiting lists are a serious problem in the UK. If your hip is shot and you can't move for half a year, maybe even lose your job over it, is that good health care? None of my friends here in the US with hip issues had to wait much.
Canada sends nearly all tough cases to the US. And it's no wonder.
Being on a waiting list isn't being denied treatment. Not getting the treat ment you want implies that your doctors had a different idea of what would work for you than you did. Sometimes the patient does have a better idea of their needs than their doctors, but it doesn't happen often.
If you are likely to die, you normally get treated as an urgent patient and jump the waiting list.
Kidney and heart transplants don't work that way - there aren't enough dono r kidney's and hearts to meet the demand, so dying while waiting for a dono r is the mechanism that matches supply and demand.
Thatcher quite deliberately starved the National Health Service of funds an d encourage people to buy into BUPA - private medical insurance. She also l ied about it - if the NHS closed down a hospital and sold the site to a dev eloper, Thatcher's accountants claimed this as a government contribution to the NHS, on the grounds that the government had owned the ground and the N HS had got the money. Comedians had a lot of fun with this and similar dece ptive practices.
It took Blair's Labour government years heavy spending to get the NHS back into adequacy.
She was a vicar's widow. No job to lose. Nobody is arguing that it was good health care, but Thatcher was paring the NHS back to the bone at the time.
Blair's Labour government published the waiting lists, and got them down to tolerable levels over a few years of steady spending.
The Netherlands has a population of 17 million, Germany of 60 million. Germ any has enough low frequency cases to keep a couple of groups of surgeons i n practice, while the Netherlands has to send them to university hospitals.
Canada has 36 million people (spread over a much larger area than the Nethe rlands). The US has 320 million people.
It's not so much the "tough" cases - open heart surgery is about as demandi ng as surgery gets, and even the Dutch do enough of that to have plenty of hospitals who do it often enough to be good at it - as the rare cases that put smaller countries under stress. To keep in practice you need to do abou t one operation a month, and if there aren't enough people who need the ope ration it gets shunted off to a university hospital where they will take tw ice as long to do the operation as a practiced crew would, and make appreci ably more mistakes.
Why not sub-contract the job to another government? Pretty much every other advanced industrial country does as well - for everybody - at two-thirds or less of the cost per head.
National pride is all very well, but if your institutions turn out to deliver a dubious product that is half again dearer than even the most expensive of the competition, give the job to somebody who can do it better.
Sure it is. It's being being denied treatment in due course and that can and has resulted in needless death or longterm consequences.
This is about waiting lists. The doctor's hands are bound by a health system usually administered and steered by bureaucrats and politicans who are often inept.
This is about treatments that could be performed immediately, and generally are in the US. When somebody needs CABG they do not dilly-dally out here.
Even the NHS admits it.
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Quote "Cardiac surgery waiting times remain a cause of significant mortality & morbidity since they were first highlighted in 2002. Subsequent remedial actions in Wales, including temporary outsourcing, have been largely ineffective in improving access sufficiently".
Similar in Canada and there I have had direct contact with affected patients who travbeled to the US to get treatment that would have toaken forever or come too late in Canada.
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Now you can stick your head back into the sand about this :-)
Yeah, yeah, we've had that discussion before. Next you say that Fidel Castro's health "system" is the best?
It's the same today and Thatcher is long since retired. It also was the same before Thatcher.
ROFL!
You also believe in the tooth fairy?
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That's got nothing to do with the topic.
They have enough problematic pregnancy cases, complicated cardiac problems and so on to keep scores of local docs busy. But they don't. To me that became instantly obvious when I looked at the sales numbers of machines with the population difference factored in. They simply don't have them. When I was in Minnesota it became clear how Canadians solve that deficiency. Problem is, for many medical conditions only the well-heeled can do so.
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Not much has changed since then according to folks I met from the UK.
It is not that the US system pre-Obama was the best. Yes, it largely had better outcomes in cancer cases but it had its flaws such as making people with pre-existing condition pariahs. However, socialized medicine is not the answer. Time and again that has result in what socialism also result in. Waiting lists and paltry care.
There is a legal maxim that justice delayed is justice denied, and the medi cal system should be designed like the phone system, with four more surgica l teams than are actually necessary so that there's a 99% chance of having access to the surgery you need when you need it.
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There are a lot of surgical procedures, and surgeons hate not being busy, s o it doesn't seem to happen.
The delays don't usually result in "needless death". If a patient is at ris k of dying, they become an emergency case and jump the queue.
People do die while waiting for operations, but usually from causes unrelat ed to the operation - I'm 74 and can expect to live another 15 years, which means that I've got a roughly 5% chance of dying in the next year.
It's more about economics. Nobody likes paying for services that aren't bei ng used. European health systems are administered by doctors, but they don' t get as much money as they could spend. There's no evidence that the polit icians or bureaucrats involved are particularly inept - they perform the ba lancing act that they are supposed to, and nobody gets exactly what they wa nt but nobody is wildly dissatisfied.
And the US system costs half as much again per head as European systems, an d doesn't do much for the uninsured. Having expensive spare capacity on han d to keep the well-off happy isn't cheap.
Tony Blair's Labour government replaced John Major's Conservatives in 1997. As I've mentioned, it took years to rebuild the NHS after Thatcher's delib erate starvation of the service. By 2002 the NHS had got the idea that it w as allowed to talk about its inadequacies, and was well on the way to getti ng the waiting lists down to respectable lengths.
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I don't. The Huffington Post piece makes it clear that Canada under-resourc ed its health service, and allowed waiting times to go. Other countries tha t run their health services on a similar basis weren't making the same mist ake - as the article makes clear.
If you elect somebody like Trump where the government can save money by che ap-skating on health service spending, you've got a problem. Since Trump se ems to be planning to dismantle Obamacare, the Us has got exactly this kind of problem right now.
Nobody says that.
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France tends to win that kind of competition. In the list I've posted, the USA cones in at 37 and Cuba at 39, which makes the Cuban system a whole lot more cost-effective.
It wasn't, and things improved quite a lot after Thatcher
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The tooth fairy is rather less well documented.
thing
That doesn't report the Thatcher-to-Blair change, but more Cameron's rather less enthusiastic cheap-skating. It's not in the same league, as you'd kno w if you'd ever looked at the figures.
You were carrying on about tough operations, where the actual problem is ra re operations. Open heart surgery is tough, but it's required frequently en ough that everybody can do it and has enough teams doing enough operations that keeping supply and demand in balance isn't a problem, even the Netherl ands, with only 17 million people.
When I was working at EMI Central Research from 1976 to 1979, individual US doctors were buying EMI body scanners. Those doctors figured that they cou ld churn enough patients through their $1.5 million dollar machine to make money on it. What was well-known at EMI at the time was that body scanner w as uniquely good at one task - telling somebody with lymphatic cancer that they were going to die. It was the only way of diagnosing lymphatic cancer that really worked, but it couldn't detect it before it was inoperable.
The machine sold because it produced pretty pictures that everybody could u nderstand, even if they were pretty much useless.
The number of high tech machines around isn't any indication of the number that are useful and necessary.
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Quite a bit was changing in 2002, and kept on changing
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The people you talked to presumably got their information from the Daily Te legraph, which revered Thatcher's legacy, rather than regarding it as an ex ample of criminal irresponsibility.
This has been argued, but churning PSA tests puts a lot of prostate cancer cases into the US statistics that are never going to die of prostate cancer .
That wasn't a flaw - it was criminal stupidity.
Any system is susceptible to cheap-skating - the US system cheap-skates on care for the less well-off, which exposes the rest of the population to mor e infectious disease. Socialised medicine deals with that problem, and deli vers better health care - at about two-thirds of the price per head - for t he population as a whole.
You do have to keep pressure on politicians to prevent them from "saving mo ney" where they shouldn't, but health care is just one of many areas where short-sighted politicians have cheap-skated their country into trouble. The US has the same kind of problem with education, where providing the best e ducation in the world for the children of the well-off doesn't produce the kind of skilled work force that allows Germany to export as much as the US while only having a quarter of the population.
...and I never would have pegged you as a Trumpist.
Or more billionaire politicians so they don't have to be as corrupt as Hillary to make a subsistence living. Remember, when Bill and Hill left the White House, they were destitute.
Not necessarily, but if the lack of insurance means that they were late in looking for medical attention, it can contribute to a fatal outcome.
As before, lack of insurance can contribute to sub-optimal exploitation of medical resources.
Trump isn't the only politician to have noticed that the US has more lobbyists than pretty much anywhere else, and US companies spend a lot more on lobbying than anybody else.
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They were in debt, but scarcely destitute. Bill Clinton's presidential pension was worth almost a million a year, and Hillary got a bundle of money from the book "Living History"
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There's nothing corrupt about writing a book. Trump's antics are less easily defensible.
While I agree with many of the motivations that lead to Trump/Brexit, I think those "cures" will be /much/ worse than the "disease". I think both are a symptom of the end of US/Western dominance, and both will hasten the decline.
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