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Joined: Sep 2001
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Lon Offline
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Hi Stormy,
Thanks for that link.
My wife has usually been the one receiving insurance, and it has usually been from a self insured group. After reading some of the posts here and reading a lot of other things; it seems that there is a bit of truth in many places but to apply this truth to someone / everyone can be the rub.

You did not give an opinion. I admire your wisdom.

Have you seen any government run health program effectively care for someone who later becomes self sufficient? and caring for them selves?


I keep the New Covenant,
when I fail....I am pulled
back into place by HIM.
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Black_Belt_AS_Kicker
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Dow,

I did realize that you were referring to liability coverage - but relating it to healthcare. Just as most large employers are self-insured for healthcare, they are also self-insured (or self-funded if you prefer) for liability, theft, damage and most other casualty losses. Have you ever wondered why most University based physicians do not carry malpractice insurance? ... They don't need it...

I also understood the point that you were trying to make. I just think that you are totally missing the mark. Yes, insurance companies are (for the most part) for-profit corporations. So are doctors, drug companies, cigarette manufacturers, auto makers, movie theaters and film production companies. The cold harsh reality is that companies need to make a profit to survive. Could we honestly expect to attract the best business minds to the insurance industry if no profit was to be made? Could we attract and retain the best doctors if they had to moonlight at the local Jiffy-Mart to feed their children? Would we see good film or schlock if there was no profit to be had in film production? The reality is that Health Insurance is profitable in the US, but at an average of 3% to 4%, not egregiously so. Companies in the pleasure businesses make much more substantial profits. Personally, I am disturbed by the out-of-control profits in the sports and entertainment industries, beer and liquor distributorships, cigarette manufacturers, etc. At the same time, I don't think the government should take over Budweiser to protect the average Joe Six Pack from prices higher then he wants to pay.

Since the University that employs your wife is probably self-insured, the details of their liability protection - and the restrictions your wife's students are chafing under - were determined by someone at the University; probably the Comptroller or the Comptroller's office. (Even if it was a true insurance policy, the ultimate purchaser of the policy - again probably the Comptroller - made a business decision.) Since the concept of insurance is something that people think they understand, (key word here being "think") the University, like most companies, continues to refer to it as insurance. There are probably fewer then 10 people at the University that actually have true knowledge of the details of the liability, healthcare, casualty, etc coverage. The average employee (even highly placed employees) will tell you that "of course" it is traditional insurance. ... Oh yea, and that the insurance company is doing everything it can to deny claims! In fact, in this type of arrangement, they only make money when they pay claims.

When I said that the key word in the paragraph above was "think", I was not trying to be offensive. I do know a lot about this. I work in this arena every day. (I do NOT work for an insurance company). Frequently, when I read the message boards, and especially threads like this one, I struggle with my desire to jump in and correct people's misconceptions about HOW the healthcare and healthcare funding industries actually work in this and other countries. I think you would be amazed at how unhappy the average American would be with a health care system controlled in whole or in part by the federal government (any more then it already is) ... something that will happen if there is any form of "public option". Ultimately, I usually bite my tongue and move on to another thread. Perhaps that is for the best.

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Hi Lon,

You are in good company. More then half of Americans receiving their insurance through an employer actually have a self-funded plan. My employer's plan has been self-funded for the decade I have been employed by them; and I could not be happier with my coverage. My co-worker on the other hand is terribly unhappy. ...You can't please all of the people all of the time ...

You are right, I have not explicitly stated my opinion. Working in the industry, it seemed somewhat unfair to do so. I am starting to think that it is time to "stand up and be counted" when it comes to an opinion on healthcare reform that has the potential to impact not just my family, not just my country, but the future healthcare and economies of the rest of the world. I'll have to get back to you on that though. I have two financial reports to plow through before I leave work for the day.

I have seen a few success stories for people who have come out of Welfare and public assistance situations. I have to admit though, that I have seen more success stories coming from situations involving heartfelt charitable assistance from individuals and foundations. Perhaps more on that later too...

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Dow Offline
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Well, maybe I shouldn't have brought it up..

not because I don't think I made a good point, but because I can't post all the details on this public forum.

Suffice to say, I do understand that a private insurance company will have to be making a profit in order to survive, but it's the fact that THEY get to dictate to their customers (the University in this case, the citizens of the US in the example of health care) the conditions under which they function, restricting what the customers can and can't do, because otherwise the insurance companies will have less-than-huge profits (and they ARE huge, that's easy to prove) and the customers will lose their coverage-is a big problem

a situation that could be helped if a non-profit entity would replace or at least compete with the for-profit insurance companies, which is how it's done in other countries, like Canada and Japan, who have nationalized health insurance, that's my point...

Last edited by Dow; 12/17/09 10:44 PM. Reason: huge profits

Dow
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Originally Posted By: Lon
You did not give an opinion. I admire your wisdom.


I think we knew on which side of the fence Stormy was on as soon as we read:

"...they are just blaming the "big, bad" insurance company."

Not that there is anything wrong with that, glad to be having a healthy debate on health care!


Dow
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Lon Offline
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Dow,
There is a lot of emotion in this topic. I have enjoyed some of the discussion, but far too much for me to read through; and for you to post....lol
I do agree that you have had a rousing discussion on this topic. Agreeing to disagree can be a solution sometimes. When we come from a basic predisposition that is so much different from the person we are refering too it seems difficult at times not to be negative or to add adjectives.
I enjoy having friends that I disagree with. It is a choice.
I hope you and yours have a good holiday! If ya come this way, call ahead I make up the bed and put one the hot cidar, bake some tollhouse cookies and we will talk up a storm!


I keep the New Covenant,
when I fail....I am pulled
back into place by HIM.
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Silver_AS_Kicker
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I fail to understand what would be unfair about you, or anyone for that matter, stating an opinion on this issue. Who cares if you are in or close to the industry? I'm not sure why that would disqualify you. It seems that you have interjected some pertinent information. Stoke the fire!

Also, I was one of those individuals that was extremely happy with my health care coverage at my last employer who was self insured. Never a problem to my recollection. Premium increases over that time was steep, but nothing beyond reason.


Kind Regards,
Jay

Almost all of us long for peace and freedom; but very few of us have much enthusiasm for the thoughts, feelings, and actions that make for peace and freedom. - Aldous Huxley

Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now. - Thomas Jefferson
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Dow Offline
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Hi Lon:

that would be a treat, expect to visit to South Dakota again this spring, hmm, how many antelope steps is Gillette from there?

Yeah, I know, this topic is a little troublesome, not exactly suitable for light reading, nor is it as entertaining as the other forums! But I think we handle it well, considering the truth of what you said, about people coming from different predispositions

and I do have a definite predisposition to tollhouse cookies


Dow
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Well, Dow:

I am an evil “R,” and take issue with a few distortions You have exposed.

Quote:
Senator Lieberman, of course, who does have a "D"

It is 2009 and Senator Liberman actually has an “I” after his name now, just like Socialist Bernard Sanders, who always sides with the angelic “Ds.”

The “Clinton surplus” was actually the Reagan “peace dividend,” now squandered by the effects of those seeds sown by Clinton himself (war on terror, real estate bust, and deals with China that have cost US millions of jobs and deals with multinational corporations that have locked out US competition).

Trickle-down “theory” might be that a rising tide lifts all boats. This was patently true in our former representative republic. In fact John Stossel did a story comparing the living standards of “poor” in the USA versus actual poor people in India and other places. The poor almost anywhere else in the world would rather be “poor” in the USA than where they are. Having seen these levels of true poverty first-hand, living and working in countries like India, Philippines, and S. Korea, I got an education and a renewed appreciation for our socially responsible, trickle-down structure we provide to our less fortunate in USA.

The gap between rich and poor widened most during the greedy Clinton era, but he gave us so much more—that oh so shining paragon of “D” virtues, who:

1) Provided, in concert with Bernard Schwartz of Loral (formerly Ford Aerospace), sensitive military information to enemies in exchange for money and trade incentives.
2) Took $10M cash bribe to protect Lippo Group market in low sulfur coal from US-produced coal based upon fraudulent environmental claims (a forged EIR).
3) Started a war using cluster bombs against innocent civilians.
4) Never brought the attackers of USS Cole to justice—that would almost certainly have prevented 9-11.
5) Gutted the most important banking regulations that had previously prevented de facto conflict of interest.
6) Told the Taiwanese that he supports a “one China” policy.
7) Forced banks to stop ‘red-lining,’ and provide poor-risk loans that are now in default.
8) Pardoned major tax-cheat and oil dealer to embargoed enemies Marc Rich.
9) Enriched his friends in Little Rock who built a disastrous boondoggle coal-fired plant in India that never worked, and they have also produced one in China, thanks to the Lippo bribe. That plant does finally work, but only thanks to the French engineers called in to rescue the project.
10) Travelgate, Whitewatergate, Vince Fostergate, Mena AR, and the list goes on and on while his capital “L” Liberal True Believers and Fellow Travellers have a big blind spot. Hypocrisy of this magnitude is, in my opinion the real evil.

And today we are again taxing and spending ourselves into oblivion just as if we never learned the lessons of fascism, communism, or the Jimmy Carter years. What our country is currently engaged in is self-destruction and it will be “Healthcare” that breaks the camel’s back.

Of course nobody knows what is in the bill, but from some accounts we pay now and don’t get covered for another four years. Tell everyone in your family to get sick later…

Many years I lived amongst Liberals and counted many as close friends. Eventually all but one lied to me—not big lies that mattered, but time-wasting lies that I consider evil. At the core of every capital “L” D is a lie that emanates a first moment about the mean of hypocrisy that leads to the second node of cruelty and the third result is always the lack of personal responsibility—wimping out and never properly owning a problem, but they are first to take credit for anything good (like the internet, surpluses, and Nobel Peace Prizes for stuff that never even happened).

I am also probably evil for even observing the attributes of the committed L (always a D), but I fight this problem all the time. While science begins with the most liberal positions on everything, the goal of science is to evaluate and eliminate as many theories as possible until there is just one theory left that becomes a law. Whenever this is finally accomplished, there are complaints from people who “can’t handle the truth,” because a truth seems just too dogmatic, too unforgiving and cruel—the truth is fully tyrannical.

Regards,
Evil John

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Black_Belt_AS_Kicker
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Originally Posted By: Dow
Well, maybe I shouldn't have brought it up..
not because I don't think I made a good point, but because I can't post all the details on this public forum.

I don't think the details are necessary. I do think your example and your correlation to health insurance was valid. It did however unequivocally show me that you do not have a true understanding of the issue.

Originally Posted By: Dow
Suffice to say, I do understand that a private insurance company will have to be making a profit in order to survive, but it's the fact that THEY get to dictate to their customers (the University in this case, the citizens of the US in the example of health care) the conditions under which they function, restricting what the customers can and can't do ...

Hmmm ... the first part of that would be the very nature of "insurance".
Insurance
–noun
The act, system, or business of insuring property, life, one's person, etc., against loss or harm arising in specified contingencies, as fire, accident, death, disablement, or the like, in consideration of a payment proportionate to the risk involved.
If there is actually an insurance company calling the shots (highly unlikely - it is much more likely they are self insured with an insurance company processing the paperwork), the insurer is not really dictating that the students can't do something. They are just saying they will not pay the bill if there is a loss due to defined actions that are outside the scope of the insurance contract. As I previously pointed out, it is likely that the University is self-insured and that a University representative defined the unacceptable actions.

Originally Posted By: Dow
... because otherwise the insurance companies will have less-than-huge profits (and they ARE huge, that's easy to prove) and the customers will lose their coverage-is a big problem

If it is easy to prove that the profits are huge (from a recognized standard business perspective) please do so. The Senate Finance Committee was unable to do this when they had the insurance company executives testifying before their committee earlier this year. Currently, it is well accepted that health insurance company profits are approximately 3% to 4% of gross revenue. That is not egregious or "huge". It is in fact pretty moderate. If you want to see huge, look up the the profit percentages of tobacco companies, software developers, and entertainment industry related businesses.

Originally Posted By: Dow
...a situation that could be helped if a non-profit entity would replace or at least compete with the for-profit insurance companies, which is how it's done in other countries, like Canada and Japan, who have nationalized health insurance, that's my point...

Do you honestly think that would help the situation?

If the insurance companies were "replaced" by a non-profit entity, we would have a single-payor system that, because of its enormity, would be government run. Regardless of previous claims to the contrary, national independent polls show that a single-payor government run health care system is NOT what the majority of Americans want - Nor has it been truly effective in other countries that currently have similar systems. I am not trying to start an argument with those that are happy with their systems (they are welcome to their system - it is just not what I want or feel would be in my family's best interest). The fact remains that all of the socialized systems are chronically underfunded and teetering financially. The wait times for care and services are significantly longer then they are in the majority of the US. Patients in these systems have much less choice and fewer treatment options then the majority of Americans are accustomed to.

I have no problem with a non-profit entity being set up to "compete" with for-profit companies. The more, the merrier. However, it should be fair and equitable competition: No special treatment, No government subsidies, No government employees or advisors, No government bailouts. Unless Congress is going to suspend the laws of economics, I predict that this non-profit agency will quickly and catastrophically fail - just like the Kelki Care program in Hawaii a few years ago. Although it would be nice, it is just not possible to provide equal or better healthcare to more people for less money. Americans would want pesky things like TNF drugs and MRI's within a week or less of being ordered. Those things don't come cheap.

Since you mentioned how things are done in Canada, let's address it. The Canadian government collects income taxes at their standard tax rates from their citizens (and non-citizen workers). In turn, the government redistributes the money at an equivalent rate of approximately 11% of GDP to regionally based Medicare agencies in each province. These agencies are government departments not non-profit entities. The Provincial Government oversees the Provincial healthcare systems with mixed results. Some citizens are happy with their care and treatment. Others are desperately unhappy. Search some of the posts on his forum. I believe that Megan has been shortchanged by the system in her provence. Others leap to mind. Although Canadian citizens are not forced to participate in the Medicare system, they are forced to pay for it through their taxes. At the moment, we do not force people to spend their money on health insurance if they don't want to. If we have any hope of achieving universal healthcare coverage, we will have to demand universal healthcare payment and participation.

Originally Posted By: Dow
Originally Posted By: Lon
You did not give an opinion. I admire your wisdom.

I think we knew on which side of the fence Stormy was on as soon as we read:

"...they are just blaming the "big, bad" insurance company."

You would be surprised. I am not an insurance groupie and I was not making a statement (intentionally or otherwise) by employing the phrase "big, bad" insurance company. I was merely using the phrase to point out the common current trend of passing the buck and blaming insurance companies for all of society's ills. I do believe that we have a crisis in healthcare. I don't agree with with your assessment of what the crisis is or what the solution should be. I definitely do not agree with the "solution" currently being put forward by Congress. From my business, economic and healthcare prospective, this solution will only make the situation worse. Buckle up - it is going to be a long, bumpy, and uncomfortable (for a Spondy) ride.

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