Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[jgailla]

That is a pretty silly statement ornery. We're clearly in the Brave New World, not 1984.

 

[BiPolarMoment]

I must have missed where the US has a "free market" in healthcare (or in anything else to be fair)? I'm sure this news will shock the Regulatory and Compliance departments at my company.

 

[cranky108]

Those 'country club' doctors don't sound so bad do they. Beats black market health care because no one can afford to wait for the goverment health care system.

I agree it's the goverment that is the problem, not the solution to the problem.

However, local goverments can help, as long as they are restricted by the people in the community.

 

[glass99]

One fun fact is that health insurers only pay out 80% of their premiums in claims. What percentage of GDP is going towards health insurance OH&P?

 

[JohnRBaker]

I think you'll find that, at lesat prior to the Affordable Care Act going into effect, that this number was closer to 70%.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[KENAT]

"If I get a ear ache in Mexico I go to the pharmacist, buy some amoxil, go home and eat it"

Then it turns out I misdiagnosed myself and the amoxil doesn't do anything to help 'cause it was a virus. However, it has handily helped set up an antibiotic resistant strain of some bacteria that later cause me to have such a bad infection I have to have a several night hospital stay on the strongest antibiotics available which have nasty side effects/end up needing an amputation/end up dead.

Yep, no downfalls in that system beej67.

Posting guidelines faq731-376

http://eng-tips.com/market.cfm?

(probably not aimed specifically at you)
What is Engineering anyway: faq1088-1484​

 

[beej67]

beej67, applying this same logic to other countries such as Sweden or the UK, it would seem that they too would suffer from a “lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”. Being publically funded (socialized), they should be even worse than the US. However, this is opposite from reality.

No no no.

Single payer would be cheaper than what we have now. A free market would be cheaper than what we have now. What we have now is a perfect blend of the worst and most expensive elements of both systems, because that's what funnels the most money to the following groups:

Doctors
Hospitals
Pharma
Insurance

...all of which have lobbyists, and the lobbyists write the laws.

What we had before Obamacare was a very terrible blend of highly restrictive government regulations and for-profit cost sharing mechanisms that forced costs up. All Obamacare did was double down on the stupid. It was supposed to be a bill to address costs, but instead turned into a bill to broaden the number of things covered (which costs more) and to force everyone to buy it (which sucks in more money) and to fuel the buying spree with federal dollars (which drives prices even higher).

We took a terrible, broken system and turned everything that made it expensive in the first place up to Spinal Tap Eleven.

Only an idiot would think that the best way to reduce costs is to make the insurance cover more stuff and then hold a gun to everyone's head forcing them to buy insurance.




Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[beej67]

The free market is not the panacea of the health care system, quite the opposite. The free market is great at commodifying and profiting off things.

This sentence is contradictory, and speaks to your poor understanding of how business in the western hemisphere works. You say you're a mechanical engineer. What sort of engineering do you do? Do you bid on projects? Are they least cost bidder projects?

Let me break it down for you. The free market is great at commoditizing (not "comodifying") goods and services, but the act of commoditizing them reduces the profit to be made from them. In a perfectly elastic marketplace with perfectly robust competition, nobody makes money. Everybody saves money. You're falling into the common Blue Shirt trap of confusing free markets with capitalism.

Free Markets means you and I exchange goods or services for a price we both agree to.

Capitalism means I loan money to you and expect a return on my investment.

Capitalists are forever attempting to fight against free markets, because in a perfect marketplace there's no ROI. Capitalists want to corner markets. They want to be the only seller, or one of a very few sellers who can collude, so the buyer has to pay more than the product took to create. In a marketplace where 100% of the market share goes to the lowest price product, profits of all sellers shrink to the margin.

This is why ASCE wants to make all PEs get a masters degree. They want to reduce the number of 'sellers' to corner a market and drive the margins up. This is why the AMA has such a restrictive process to become a doctor, to create artificial scarcity of supply. This is why I can't just walk up to a pharmacist when I have an ear ache and buy the Amoxil that I know will cure the ear ache, without first going to a doctor, paying a copay, having the doctor bill my insurance, having the doctor refer me to an ENT, paying another copay, having the ENT also bill my insurance, getting a prescription for a highly proprietary and totally new version of Amoxil that costs ten times as much, going to the pharmacist, paying another copay, and having the pharmacist bill my insurance for the expensive alternative to Amoxil. All of those things obscure the marketplace, to drive up the margins.

If I was in Mexico, where there's a free market, I could walk up to to a pharmacist and buy the Amoxil, and my total cost to the system would be fifteen bucks.

See?

It's just like the car insurance analogy above.

Your comparisons to England and Sweden are hollow and pointless, because England and Sweden don't have anything like what we have here. Our laws are written by corporations.


Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[beej67]

Now, before you go there, rconnor, I will absolutely say this:

For many kinds of health care, the free market flat DOES NOT work. In order for a free market to work, you need to have two things:

1) the knowledge of what you're shopping for, and
2) the ability to shop at all

If I get in a car wreck, I can do neither. The free marketplace does not work for car wrecks. It doesn't work for heart attacks. It does not work for strokes. It does not work for any scenario in which an ambulance or helicopter shows up to rescue you from certain death and trucks you off to a pack of highly trained specialists. Trying to apply free market principles to that scenario is doomed to fail from the beginning.

If I were to craft the perfect system from scratch, all emergency services would be handled on a single government payer model, with the costs to the government published and critiqued by the media. Insurance would not cover emergency services at all. Taxes would.

On the other hand, prescription drugs are absolutely something that free market principles could be applied to, and the many layers of market obfuscation could be stripped out and replaced simply with education and individual responsibility. We could take 95% of the prescription drugs on the market today and make them over the counter. We could take the remaining 5% and allow them to be issued with merely the recommendation of a pharmacist, not a doctor. We could reduce the patent limit on drugs to 4 years. We could move cannabis off the schedule 1 list. Then once the costs plummet, we pull them off of the health plans.

Then, with no emergency services and no prescription drugs on the health plans, we make buying insurance optional again.

That's the kind of solution that would work. But look what it does:

Takes money from hospitals
Takes money from pharma
Takes money from doctors
Takes money from insurance companies

..which is why it won't be implemented. It won't be implemented because our very system of governance itself is completely rotten.



Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[zdas04]

I've been avoiding this discussion because it doesn't really have a solution, just a nearly infinite number of opinions.

The question I've never gotten an answer to is "exactly where in the U.S. Constitution is Obamacare, Medicare, or federal contribution to Medicade authorized?". I've read that document very carefully and I'm pretty sure that healthcare comes under the 10th amendment:

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people

That seems pretty clear. The ramifications of that is at least 50 different ways to skin this onion. It is very clear from the discussion above that a plan that works good enough in Alaska would really be a problem in Florida. OK. Fine. That is why we have states and the free will to choose where we live.

There is one reasonable role of the Federal Government in health care -- Tort Reform. When a Doctor in New Mexico must spend more on malpractice insurance than on rent, heat, light, and office payroll combined something is messed up. When a one-doctor medical practice must spend $500k computerizing their medical records to comply with Federal requirements something is messed up.

I'm one of those "free market" guys denigrated above, but there is so much noise in this discussion that "truth" is in really short supply. People can find anecdotes to support any position that they want to take. Bottom line is that people get medical advice from medical professionals, and then either follow it or don't. I can't find a single example of where providing health care (or most any other service) is enhanced by a central government getting involved.

David Simpson, PE
MuleShoe Engineering

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist

 

[JohnRBaker]

Try the 'Interstate Commerce' clause as well as shades of the 14th Amendment.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[JohnRBaker]

To say nothing of the ideal of "Life, Liberty and the pursuit of Happiness".

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[zdas04]

How the heck do you resolve your right to pursue happiness with my right to liberty not to pay for your pursuits? If I really need to strangle a prominent politician to be happy, how does that impact their right to life? That one simply does not work on any non-emotional level.

14th amendment? It says

Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Section 2. Representatives shall be apportioned [rest is about apportionment and qualifications or representatives]
Section 3. [Anti-insurrection clause].
Section 4. [allows the federal government to incur debt]
Section 5. The Congress shall have power to enforce, by appropriate legislation, the provisions of this article

Section 1 of the 14 amendment is all about states not revoking federal rights and privileges. To say it applies to health care is to say that Alaska is violating the 14th amendment because the Federal Government has provided subway's in Washington DC, but Alaska doesn't have any subways. Ludicrous on the face of it.

As to the Commerce Clause (Article 1 Section 8), the paragraph that people always point to is:

To make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other powers vested by this Constitution in the government of the United States, or in any department or officer thereof.

but for that to apply you have to somehow read the foregoing 17 paragraphs to include some mention of healthcare. I can see support for a Navy, the Patent Office, and the Post Office, but not Obamacare.

According to the Federist Papers, the very reason that the framers of the Constitution went into such tedious detail on the things that the Federal Government was allowed to do is because they weren't allowed to do anything else. Interpreting the Commerce Clause or the 14th amendment otherwise is trying to revise the Constitution by tort. That attempt happens all the time, and everyone who believes in this country should resist all of these outrageous attempts.

David Simpson, PE
MuleShoe Engineering

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist

 

[satchmo]

That's why the supremes called it a tax.

 

[zdas04]

That is my understanding as well. Seems like the definition of "tax" has more flexibility than the definition of "pornography".

David Simpson, PE
MuleShoe Engineering

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist

 

[JohnRBaker]

I'll admit that the 14th Amendment has been used as a bit of a catch all recently. For example, George W. Bush used it as the basis for his arguement that he had the right to demand that the courts halt the Florida vote recount in 2000 ostensibly because the outcome could potentially deny him the presidency. How that was an "equal protection of the laws" issue is beyond me, but five activist Supreme Court justices agreed with him, resulting in the 8 year disaster of the Cheney/Bush presidency.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[cranky108]

States regulate utilities, why not hospitals? Specific territories for hospitals. So if a privite company wants more patents, they can build more hospitals. Or mini hospitals that feed into larger hospitals for extreem cases. That would work for small towns.

Strange how my doctor recommends antibiotics for viral infections, so why do I need him if the same antibiotics seemly work for both types of infections?

Also why don't I see price lists in hospitals? It would make it easer to shop around for my next set of tests.

 

[CELinOttawa]

I'm a Canadian and I can tell you that your understanding of the 2000 Florida recount is flawed. A lot of myth, smoke and mirrors becomes "fact" in the US. I simply don't know why...

We suffer from the same self-deluding BS on other issues, but nowhere near as often as the average US citizen when it comes to politics. It seems that if you introduce politics, you drop thirty points of the mean US IQ. I can't explain why; some of the smartest people I know are Americans, but you guys and gals suffer crowd think like nobody's business!

 

[rconnor]

beej67, firstly, let’s clarify our terms. While certainly not the exact same thing, the free market and capitalism are not mutually exclusive terms. To say, “but the free market is when things are traded fairly, whereas capitalism is when companies try to cheat consumers for profits!” is analogous to my (mocking) definition that “the free market is when good things happen and when bad things happen it’s not the free market”. It doesn’t work that way.

Capitalism sets up the “market” and the “free” part comes from removing restrictions and regulations such that consumers and producers can operate independently. In reality, you can’t have a producer (of any substantially large size…to say produce drugs safely) that operates independently of a capitalist market. Therefore, the free markets operates within a capitalistic frame work and advocating for a more free market healthcare system is to advocate for a more capitalist healthcare system. The only way it isn’t is if you are advocating for market anarchism (which I mean in an ideological way and certainly not a disparaging way. In fact, it would be quite interesting if you were). However, you’d have to not just blow up the entire US healthcare system but fundamentally change the entire US economic system (in which capitalism is just a little, teeny, tiny bit rooted). The only practical way to limit the effect of profit-driven capitalism on healthcare is to limit participation in the market and move to a universal healthcare system.

What we have now is a perfect blend of the worst and most expensive elements of both systems, because that's what funnels the most money to the following groups…

I agree with this for the most part. However, your (and my) issue with the prime objective being to funnel money to individuals and corporations is an issue with a right end aspects of this blended system, not a left end aspect. Moving towards the left end, and a universal healthcare system, addresses this issue. This is one reason why universal healthcare systems, in the real world, continually rank head and shoulders better than a privatized system. The other is that whole equity thing and supporting the disenfranchised in your society...you know, leftist nonsense.

Your comparisons to England and Sweden are hollow and pointless, because England and Sweden don't have anything like what we have here. Our laws are written by corporations.

How so? All countries that have universal health care systems moved from non-universal health care systems to universal health care (UK – 1948, Sweden 1955, Canada 1968, etc).

If we can’t use universal healthcare as an option to compare against than what are you advocating for? What is your plan? What is a “truly” free market healthcare system? What it sounds like is “if you can pay for it directly, you can get healthcare.” No insurance companies, no middle men, no support for low-income. If this is correct then you’ve describe a system that is the most apathetic, inequitable system imaginable.

replaced simply with education and individual responsibility

So in this free market utopia every citizen has the access to proper medical education such that they can self-diagnose without error, won’t abuse an uncontrolled drug market and every citizen has the money to afford the drugs that they need (through accurate self-diagnoses). This system perfectly encapsulates the two fundamental and fundamentally incorrect assumptions of free market ideology:
1) Opportunity applies equally to everyone. There’s no such thing is social, cultural, economic impediments.
2) Once a fully free market is obtain, people will magically live altruistically, co-operatively, and efficiently. While under restrictions/regulations, people are selfish, greedy and lazy (“lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”).

I can't find a single example of where providing health care (or most any other service) is enhanced by a central government getting involved.

Honestly?

How the heck do you resolve your right to pursue happiness with my right to liberty not to pay for your pursuits

It’s not right to pursue happiness, it’s right to life. Access to healthcare should NOT be a purchasable privilege in the richest country in the world, it should be a right. But at the end of the day, if you feel you have the “right to liberty not to pay for” others right to life, then what can I say – we wish to live in different ethical worlds.

 

[JohnRBaker]

A paragraph taken from an appropriately named source (link provided below) which explains the outcome of the 2000 Supreme Court case 'Bush v Gore' (emphasis added):

The Court's third and final intervention in the 2000 presidential election came just days later. In its unsigned opinion, the Court explained that it had voted 5-4 to put a stop to the Florida recount. Allowing the recount to go forward, the Court said, would violate the Equal Protection Clause of the Fourteenth Amendment. The U.S. Supreme Court sent the case back down to the Florida Supreme Court, which had no alternative but to dismiss it. The presidential election of 2000 had been decided, in essence, by the vote of one Supreme Court justice.

For the full article, go to:

http://www.dummies.com/how-to/content/supreme-court-case-study-bush-v-gore.html

And if you'd like something from a source with perhaps a bit more credibility, here's a link to an item posted by Princeton University which reported the same bssic "facts":

http://www.princeton.edu/~achaney/tmve/wiki100k/docs/Bush_v._Gore.html

As for my humble opinion as to the consequences of the Cheney/Bush presidency, you only need to look at the recent headlines of any major newspaper in the world to see what they are.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.