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Joined: Apr 2002
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SENSational_AS_Kicker
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Strange thing about Tim Hortens though. They have really taken over here and yes, many other coffee shops have closed. However, Tim Hortens seem to be managing to enjoy this success without raising their prices. They still offer a pretty good product ( not as good as Stabucks mind you ) at a very reasonable price.


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Here is supposedly "The Plan" as it will be presented today. Reuters News

I guess I must be missing something after reading this I am more confused than before about what it is that Washington is trying to achieve.

The one glaring thing is that this "National Healthcare Plan" allows states to opt out of the public program. I thought we were talking NATIONAL as in the whole country.

This plan is going to be funded with a tax that will produce 460 billion dollars over 10 years. and a few smaller fees and penalties? I guess that the way it comes in under the 900 billion mark is the hope that half the states will opt out?

Nowhere does it mention a tax, or aid from the Insurance Companies. Instead they are aiming at Healthcare Providers, and and 20 billion over 10 years from Medical Device Manufacturers. Having background in Emergency Medicine and a business background, collecting fees from medical device compnaies is only going to pass those on to the end users, the patients, EMS Systems, and healthcare providers. All of the sudden that $48,000 spinal cord stimulator that I have costs $100,000 and my federal insurance plan says No Way That costs too much, here are some magic mushrooms instead. It will drive healthcare costs UP.

Businesses MUST provide healthcare or face penalties. My last employer was a large multi-state corporation with a payroll in excess of $750,000 per year. So the government can spank him to the tune of 8%. Well I know his insurance runs close to that 8% mark if not over. So sitting in his chair, I look at what I am paying for health insurance, someone to administrate it over several states, the complaining and having to shop for insurance every year, and you go, Hmmmmmm 8% isn't that bad afterall. Now there are about 100 people on their own to find heathcare and try to pay for it on top of their normal bills. The company lays the blame off on the economy or government and you wave good bye to your benefits. And that happens times how many companies? I don't think just one in todays world.

The bill will increase the poverty line to 150% for Medicaid, a State run system that is already full of its own problems. And will require insurance companys to accept pre exisiting conditions. GREAT! But there is no mention as to what they can charge me for having AS or any other condition.

In my opinion if we are wanting to bring down the cost of healthcare, you don't cut off the heads of the end users. The patients, or the healthcare system. You have to regulate the Insurance Companies that rake in billions to pay out millions. Look at your next EOB from your insurance company and look at what they paid versus what was billed to get that money. In looking at other countries plans you will see that the governments sat on Insurance Companies and not so much the Healthcare Providers. OK Insurance Companies have to charge too much, because the doctors charge too much, because they owe too much on student loans, etc, that are backed by the federal government..Hhmmmmmmmmm

Living in Ohio I am going to pick on NationXYZ Insurance. They operate out of Columbus. Last year they gave Columbus Children's Hospital a 50 million dollar grant. The second largest "Gift" ever given to a US hospital. I am sure that the hospital has put that money to good use. And a portion of it no doubt went to change the name of the hospital to NationXYZ Children's Hospital. Great PR move for NationXYZ, but Columbus Childrens was already one of the finest childrens hospitals in the country if not the world. That money plus the money that they use to sponsor a Professional Golf Tour and countless other PR events could have just as easily been used to lower premiums and make them a model company to be followed by other insurance companies. Instead everything stays the same so that nobody has to lower prices. Now if a group of small independent businesses did this the government would cry foul and scream price fixing. Funny how they don't scream when their heads are on the same pillow.

Just the early morning ramblings of another confused American AS Kicker just bouncing some thoughts..


Keep Kickin'AS
Chris

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According to figures from the National Compensation Survey by the US Bureau of Labor Statistics, in 2005 US companies paid between 6.6% and 16.5% of payroll on health coverage for their employees. The average was 11%. It is higher today. Basic laws of economics says that given a choice of an 8% penalty or 11% (and rising) cost, most companies will choose the penalty and will cut or eliminate health insurance. Who could blame them?

The average profit margin for health insurance companies in the US is 3.3%. That is hardly the outrageous profit margin portrayed by proponents of health insurance reform. (I can't call it health care reform as little to nothing has been said about reforming or improving the actual health care received by individuals.) Their profit margin is in stark contrast to the 25.9% earned by beer manufacturers, 22.7% by software companies, 17.4% by cigarette companies, 6% by sporting activities .......

A medicare for all type program will naturally develop as employers opt to pay the penalty and stop offering health insurance. In a medicare for all type program, average health care received by the average individual will actually decline. The average claim rejection rate by insurance companies is 4.05%. The average rejection rate by Medicare is 6.85%. The rejection rate would be even higher if providers did not "know" in advance what Medicare is likely to pay and not pay for (significantly less then the average policy) and so generally not ordering or offering those services to those patients. The reality in "Medicare World" is that a provider can not receive payment from the patient for a service that is denied by Medicare. (So your doctor may think that you need a specific test or procedure, but if Medicare guidelines say you don't, either you don't get it or the doctor eats the cost - more frequently then you would think.)

The funny thing about insurance EOB's is that the charges on them are nothing but leprechaun gold and fairy dust courtesy of the US government. Medicare and Medicaid legislation dictates exactly what the government will pay for specific services. At the same time, legislation requires that providers give a discount to Medicare/Medicaid. That discount must be greater then any discounts given to any other entity. The discount is large for Medicare and even larger for Medicaid. Take the Medicare allowable amount, add back the discount and voila you have the "fee". Insurance companies negotiate rates with providers - getting a discount because of volume and more guarantees of payment then they would have with an individual. The "fee" for service on your EOB is the "fee" inflated by Medicare/Medicaid rules. The amount paid on your EOB is the pre-negotiated amount. Leprechaun gold and fairy dust ...

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Silver_AS_Kicker
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Stormy, well written and concise.

I will dispute one figure. That is the profit margins. They are slightly higher than 3.3%. This article from Associated Press [Associated Press Article] states they are around 6% (give or take a point or two). Disappointing is the comment about give or take a point or two in that they didn't list the margins on the biggest (by revenue perhaps) insurers. Therefore, one must assume that the average profit margin is higher than 3.3%. This in my opinion is not excessive. However, I'm sure opinions vary. There is another article (still the AP source) [Additional AP Article] which starts out "Quick quiz: What do these enterprises have in common? Farm and construction machinery, Tupperware, the railroads, Hershey sweets, Yum food brands and Yahoo? Answer: They're all more profitable than the health insurance industry."

The other figures in your reply I cannot verify or dispute.

I, too, have seen the combination of a government option and a penalty as a way to siphon folks from private insurance to public insurance. One preliminary figure thrown out there was that employers would be hit with a $750 per employee penalty for not providing insurance to that employee. I thought to myself...are you joking? That's a complete no-brainer. Even the 8% penalty might be rather attractive as Chris pointed out (no need to administrate it, shop for insurance, etc.).

Also, regarding that opt out clause. That has me a little puzzle and I see it as self-defeating for what was trying to be accomplished. It also leaves me wondering if D.C. will "opt out". I've (secretly) said to myself regarding this whole health care thing that if it is good enough for the American public then it is surely good enough for the legislators that created and passed any health insurance reform. There's no way that they would not choose to take advantage of this health insurance reform by continuing to keep what insurance they already have, is there? What's good for the goose is good for the gander, right? Equality for all, right? Just that some animals...I mean people are more equal than others. Yeah, right.


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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Jay,
The concern that I would have about the Associated Press article is that they do not cite any reference for their 6% "give or take a point or 2" number. So do they think it is 4% or 8%?? Sloppy reporting on their part.

Remember the old adage: There are lies, d*&* lies, and statistics? There are several surveys and indexes that list different profitability margins. I used this one:
http://1.bp.blogspot.com/_otfwl2zc6Qc/SoMLoWBKM4I/AAAAAAAAK4g/wKdZyg5LxQ0/s1600-h/profits.bmp Which was based on this one:
http://biz.yahoo.com/p/522qpmd.html
There is also this one:
http://money.cnn.com/magazines/fortune/fortune500/2008/performers/industries/profits/ and many others.

You could also read this:
http://findarticles.com/p/articles/mi_m0EIN/is_2007_August_14/ai_n27342953/ or this:
http://www.usnews.com/money/blogs/flowchart/2009/08/25/why-health-insurers-make-lousy-villains.html

People can and do manipulate statistics to support their beliefs - whatever their beliefs happen to be. My point is this; there are multiple indexes out there, but no credible ones that actually show outrageous profits in comparison to other industries.

My other numbers and facts came from business knowledge working in the financial end of healthcare. Some of the information I can not link to the general public (privacy rules) but it is all available in places like here:
http://www.kff.org/insurance/snapshot/chcm030808oth.cfm or here:
http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

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Wow, Now I see why Anheuser-Busch & Phillip Morris were so upset when I quit drinking and smoking! They lost a bunch of money!!


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Chris

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Quote:

Here is supposedly "The Plan" as it will be presented today. Reuters News



Just one quick comment, Chris

The bill that just got passed through the senate vote is not necessarily "The Plan"

Just because the Democrats have been patting themselves on the back for getting it this far, doesn't mean it won't change, it definitely will

If it had been shot down, it would have had to either be proposed again, or a different bill would have had to be presented, start all over again

So now it goes to committee, and everybody gets to modify to their heart's (or their lobbyist's) content, and then it goes to the House

so still a long way to go before it reaches the President's desk

and I too hate the part about the mandate for all people to either purchase it or pay a penalty, a real sweetheart deal for the healthcare providers, certainly want to see that go away


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Warrior_AS_Kicker
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I try but don't understand the health care dilemma in the US. I research into it and I see it play out every night on CNN (the only station on every day) I don't think I will understand. What would the problem be if you just flashed a card and you're taken care of like us in Canada? My Grandma has been in the hospital for about 2 months (please pray for her) and we haven't payed a cent! Tests and care and tests and care... IMO if there should be anything that every citizen should have, this is by far the utmost important. More than education, more than crashin stuff into the moon, more than imperializing in other countries...IMO if you can't introduce anything new without cutting other programs, cut em all! Being a citizen of a country (belonging to a group) you believe in should be sufficient enough for anyone to receive care from its fellow people. Looking after one another...Screw that you shouldn't even have to believe in it, just be a fellow member of it!

As far as monopolies go, the only monopoly in the US is the FED. Look in to that one.(Maybe that's where the prob lies) Left and Right should be called stage left and stage right.

Last edited by moosekick; 10/31/09 12:51 PM.

Hey, somebody stole my quote! - Me
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Very_Addicted_to_AS_Kickin
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Adam, I have to say I'm with you. I don't get what the problem is either. What would be the horrible thing to tell doctors and HMOs/insurance cos. that they must now treat any and all citizens of the nation, simply because they are a citizen of that nation. Oh. Wait. I just clued in. The HMOs and insurance companies would all of a sudden have to find another way of "making a living".

Access to medical care is a human right, not just a perk for people who can afford it, especially in a country founded on the idea of equality for all. Equality doesn't mean that John Doe can get treatment because he can afford really good insurance, but Joe Schmoe can only get treatment from certain doctors and certain hospitals (even if they're 500 miles from where he lives), and Joe Public can't get treatment unless he happens upon a hospital that doesn't require specific insurance as a prerequisite to giving treatment. There's nothing equal about that.

And I have to say that he concept of "Why should I pay for someone else to get healthcare," is so completely alien to me as to be incomprehensible. Are you saying, then, that because you have a good job with good coverage your children and elders are more deserving than those of someone earning under the minimum wage at two jobs with no insurance? You need to read the book "Nickel and Dimed".

Sorry to be so opinionated on this. I just don't get that is all. A couple of years ago Parliament was bandying about the idea of a national daycare program so that all parents can have affordable daycare (including those living under the poverty line), instead of just those who have good paying jobs. A woman I know said, "Why should I pay for someone else's kid to be in daycare." There are two ways I could have answered that (but since I work with her, I didn't say either).

"Why should I pay into an education system that I will never be adding children to, so that your kid can get an education?"

"Why should I have to pay for your daughter's multiple heart surgeries? She's not my kid."

Of course, I would never say either of those things because they go against everything I believe, but I hope you get my point. The answer to both those questions is:

"Because it's the right thing to do."

It's not about richer or poorer, it's about true equality and human rights. If free education up to College/University is a human right, why is healthcare (good health being something without which you cannot live ... period) not?

Anyway, I'll shut up again. I'm sure it's none of my business.

Warm hugs,


Kat

A life lived in fear is a life half lived.
"Strictly Ballroom"

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Imperial_AS_Kicker
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I wrote a rather long (too long) response to Adam's post, in which I constructed a scenario in which someone with thoughts like his might be one of our US representatives, fighting the fight for those same ideals from within our system

Mainly to point out that there ARE people with exactly those same views, trying their best to make significant changes in this country, and to achieve some of the same goals that also Kat so very well expressed

and in doing so, tried to paint a picture of what opposition they face, but that's where it just got too complicated, I got too involved with specific examples, stories of people who were victimized by lack of health care, and particular legislation that guarantees those things will continue, blah blah blah


Now I'm thinking that I should try to say it in the simplest terms possible:


That we have with a country based on free-enterprise, and that it has resulted in a corporate power that rivals, in fact often EXCEEDS the power of our own government


that's it, my answer in a nutshell, the rest is all details about the interaction between those different forces, the profit-making entities on one side, and the people who struggle to get through the day on the other

I certainly like the ideal of capitalism, that each and every citizen has the same opportunity to pursue their goals without interference

but in it's extreme form, it stops working, things like monopolies and manipulation of media get constructed, and the wealth and power get put in the hands of too few people

just like one of the other ideals, that of communism, which in theory, is supposed to be be about shared wealth, but in reality, it destroys an individual's motives to work harder, because he/she ends up with same economic reality, no matter how hard they try

So that's why I feel that our system, which I think was built with many, many, great ideas, is still the best, but it will collapse without better regulation to make a more level playing field

and why I think it's time for the pendulum to start swinging the other way, and we citizens need to use our voices, our votes, our influence, to be part of the process, it won't work without the involvement of We The People, and why it was one of the key principles so carefully written into our Constitution by our founding fathers


Dow
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