Why on Earth should Insurance companies have to cover pre-existing conditions?

[francoHFW]

Universal Health Insurance in Massachusetts: Yes, We're Better Off ...
bostinno.com/.../universal-health-insurance-in-massachusetts-yes-were-better-off/ - Cached
Jan 3, 2013 ... Back in the late 90's, Massachusetts flirted briefly with a health uninsurance
problem. The reason? In 1996, the state put into place a series of ...

 

[francoHFW]

I'll go with the new PBS Report over your OLD Pubcrappe...

 

[healthmyths]

Not just in health care. 50 or 60 years ago, a CEO's pay averaged about 30 or 40 times the salary of the average worker. They paid more taxes. More people were employed.

Now they make 300 to 400 times the average worker or more. Republicans think if we can just pay them more and redistribute more wealth to them, they will "create jobs" because they are the "job creators". We just haven't moved quite enough money into their pockets. Oh, but it will happen. Just keep shoveling it their way.

A) He received $1.1 million in salary, $2.75 million in incentive pay, an additional
$2.3 million in pension value and other compensation of $299,838. a total of $6.1 million SALARY incentive and other compensations!
Being obviously IGNORANT as you read the above "Unexercised Options.. as a salary... it is NOT he has to pay out of his pocket to buy
that stock at a discount THAT's if he EXERCISES his options!

Idiot IT IS NOT paid out of operating expenses you dummy!!!!
His total salary deducted and paid out of operating expense is $ 6 million!

I can't believe you are defending this. 6 million is the bare minimum. Say he did only get 6 million a year. In 10 years, that's 60 million. Well we know it's a lot more because he is in the top ten of Forbes' "$100 Million CEO Club." You're not in that club on a measly 6 million a year.

And explain to me. What is he doing for that huge salary???? He is a middle man. He takes some of that money and pays doctors and nurses and keeps the rest. People are paying for nothing. And Republicans call that "capitalism". It's a "SCAM". It's not capitalism. It's DEATH PANELS, it's not capitalism. Try to figure out why.

IDIOT because you are so f...king stupid!

How much do you THINK Aetna pays out in claims as a percent of premiums collected???
FACTS Aetna Reports First-Quarter 2012 Results | Aetna News Hub

In 2012 of every dollar in premium 81.5% went out in CLAIMS!!! It's called Medical liability ratio.. i.e. how many dollars paid out to dollars coming in!
Revenue $8,864.1m
Net income $511.0m or 5.7% of gross revenue as profit!

If 81.5% paid out in claims and 5.7% net profit or a total of 87.2% that means 12.8% was overhead, salaries etc.

YOU are a f...king idiot! "Takes some pays the doctors,etc. keeps the rest"... fu..king idiot... PAID 81.5% in claims you understand??
Paid salaries,etc. 12.8% YOU comprehend concept of overhead don't you???

NOW for total expose of your ignorance... GUESS what you dumb f...k!
STATES where insurance companies SELL REQUIRE RESERVES to pay future claims! Dummy!
Where do you think these reserves come from??? PROFITS!!
Without profits of 5.7% Aetna would NOT be allowed to sell! They would be shut down by the respective states immediately if they did not have
reserves to pay FUTURE CLAIMS!! And these reserves come from YES those evil capitalistic PROFITS!

Geez.. you idiots are so pathetic FACTS... how insurance works profits... all such alien words to you dummies!

 

[percysunshine]

Does Obamacare cover pre-existing stupidity?

It must, or no one would have voted for it.

 

[Remodeling Maidiac]

Op you really shouldn't post this type of common sense. It makes the heads explode on the left.

 

[healthmyths]

Does Obamacare cover pre-existing stupidity?

It must, or no one would have voted for it.

Obamacare passed by 6 votes.

I am confident that more then 6 yes voters honestly believed there are 50 million uninsured!
These "yes" voters evidently NEVER knew there were actually less then 8 million that truly need some type of health insurance.
With 10 million counted as UNINSURED.. NOT American citizens, and
with 14 million who said they were uninsured but were ACTUALLY covered by Medicaid... Obama et.al counted this group..
18 million under age 34, earning over $50K who couldn't justify paying MORE in employee share health insurance then the
$1,000 they paid out of pocket each year for health services... Obama to pass the bill counted them!

Thus there were after subtracting these 42 million truly 8 million that wanted and needed health insurance!

OH and those 18 million that they counted to get the bill passed ???

AFTER it was passed Pelosi et.al. call them "FREE-LOADERS"!!! Why? because they don't want to buy health insurance.
And so Pelosi et.al. say they are "free-loading" by going to emergency clinics etc..
WELL this just showed Pelosi et.al. total ignorance.
YOU can't LIE on the hospitals forms with out some penalty! Hospitals find out you ARE capable of paying they will hurt your credit especially if you are making +50K like these 18 million do.
So they weren't free-loaders but Americans that chose NOT to buy health insurance!

The truth is if Congress really wanted to help the truly 8 million uninsured the simplest way was to tax lawyers that are causing
the health costs to skyrocket as the doctors attest... $850 billion a year ! Duplicate tests,etc. all out of fear of lawsuits!
That 10% tax on the lawyers $250 billion would pay the premiums for ALL the 8 million uninsured!

 

[rdean]

YOU said "No CT Scan is $43. First, it's an incredibly expensive piece of equipment. It's takes a lot of power to operate and a highly trained technician to maintain and in a room where the temperature and humidity are regulated."


IDIOT HERE is the table that I got that information from:

Look at this screen shot from the report I have for
Florida Hospital Tampa
3100 East Fletcher Avenue
Tampa, FL 33613
Telephone Number: (813) 971-6000
Hospital Website: www.elevatinghealthcare.org/locatio...
CMS Certification Number: 100173

What you are looking at in the below colored row is the CT without Contrast
The above hospital was paid on 1,362 claims by Medicare an average of $3,463!
Medicare KNOWS the hospital's average cost to perform the service is $57!
So if the costs the hospital reports is $57.. all that expensive equipment etc....per claim
and dividing $3,463 the hospital was paid on average by Medicare by the average of $57 cost.. 6,075%!!!!!

YOU tell me differently OK.. This information comes from this source:
Medicare OPPS claims data are for calendar year ending 12/31/2011.

View attachment 24540

Profile Definitions and Methodology

Outpatient Utilization Statistics by APC


All information in this report is taken from the Medicare Hospital OPPS Identifiable Data Set which is updated annually by CMS based on the service year (i.e. calendar year). The file includes hospital outpatient billing data for 100% of all Medicare fee-for-service claims for outpatient services provided during the twelve months ending December 31. The report is consistent with CMS Data Release policies.

Information is reported for the twenty Ambulatory Payment Classifications (APCs) representing the highest Medicare payment to the hospital. APCs are defined by the procedures performed according to definitions published by CMS for the corresponding service year.
A list of APCs is provided for reference.
Note that the Number of Patient Claims may be less than the Units of Service provided (i.e. one claim may include multiple units of service for a procedure).
Average Charges are based on both covered and non-covered charges for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
Average Costs are based on charges adjusted to cost using the hospital's specific cost center cost-to-charge ratio.

DO YOU KNOW UNDERSTAND how stupid,complicated,convoluted, DESTRUCTIVE Obamacare is IF right NOW Medicare agrees to a 6,000% Markup!!!

Hello, knock knock. Duh!

A service contract is used to continue revenue.

But you can't use that as the "cost" of operating such a piece of equipment. I'm sure you realize your mistake. Only a completely brain damaged drooling moron would think such a thing. Just the cost of paying the operator for one 20 minute scan has to be between 50 and 150 bucks. Then you add in the cost of the building. The temperature and humidity control, the administrative costs and on and on and the cost skyrockets. Who doesn't know that?

HELLO... IDiOT you have NO IDEA of what the costs are do you? Yet you could have done what I did and a little research shows the cost to do
per hour 24 hours/7 days a week 52 weeks is $94/hour..! NOW dumb ass. here is how that breaks down.. EASY to find if you are a dumb shiTT
Operating and Ownership Costs
Service contract, including x-ray tube, years 2 through 5 = $137,836/year

Salary and expenses for three full-time equivalents = $231,000/year

Contrast media = $500,500 /year
Total operating costs = $720,350 for year 1; an average of $823,969/year for years 2 through 5
Source of data: https://www.ecri.org/Documents/HPCS_Scanning_Systems.pdf

Average operating cost,contract,salary,media.. $823,969.

They operate 24 hour a day 7 days a week 52 weeks per year.. operating costs therefore per hour: $94/ hour!
If they do two test per hour the costs are $47 per test!!

NOW you dumb fucking idiot!!!
If the system costs $47 per test and they charge $3,436 Medicare.. WHAT THE F...K markup is THAT you dumb ASS!

7,311%!!!

The one at St. Joseph's in Chicago is only used Monday thru Friday from 8 to 3:30 and on Saturday morning. No regular appointments on Sunday. I suspect emergency use and the cost skyrockets.

Try again.

 

[barry1960]

I agree re the op ed. But by the same token, if you get diagnosed with a 'condition' after you have signed up with the insurance company, they shouldn't be able to start changing the rules to suit...

AND THEY CAN'T unless they find you have LIED for example said you weren't a smoker and then you get cancer and they find out oh.oh...

AND people are so ignorant about insurance companies as to WHY THEY HAVE to make a profit which averages about 4.6% BEFORE Taxes is because state insurance regulations require RESERVES which only come from PROFITS!!!

NO reserves can be created unless there are profits and states require if you sell insurance you can pay the claims!!!

Reserves are money that is set aside by an insurance company to satisfy claims and pay liabilities. Reserves come from insurance premiums.

 

[Antares]

Legally they can't.
Insurance plans use something called Durational Rating....usually deterined by zip codes...in essence the people living inside of a certain area are a part of their own "group".
The insurance companies are bound by the terms of the Delaration page of that "group" policy.
They cannot by law single anyone out for canncellation OR rate increase unless they do the same things to everyone in the group, including rate increases.
EVERY change has to submitted to the insurance commissioner of the state they are doing business in.
The commissioner must approve of the changes BEFOREthey can actually make any changes.
Now, and I don't condone this, sometimes a group gets toexpensive for the Company to manage and they can cancel the ENTIREgroup, or simply pull out of the State for a time in order to get the costs back in line.
They then must wait to get through a waiting period determined by the commissioner before they can again do business in that State again

I agree re the op ed. But by the same token, if you get diagnosed with a 'condition' after you have signed up with the insurance company, they shouldn't be able to start changing the rules to suit...

 

[lynn63]

Just like car insurance they want your money but God forbid if you have a claim because in reality you will pay more on top of what you already have giving them. Health Insurance is becoming no different, they want you to pay but they don't want us to use it.

 

[Antares]

No, not all but most involve a deductible and then coinsurance up to the policy maxium...everybody knows that going in.

 

[healthmyths]

Just like car insurance they want your money but God forbid if you have a claim because in reality you will pay more on top of what you already have giving them. Health Insurance is becoming no different, they want you to pay but they don't want us to use it.

GEEZ... are you now just catching on???

The issue though is NOT the insurance companies fault!
They pay the claims that are sent.
$850 billion a year in defensive medicine out of fear of lawsuits are paid by Medicare/insurance companies and people who pay out of pocket!
Why have YOU not addressed THAT?

Insurance companies WANT more customers BUT not if it is NOT profitable.. I.E. STATE laws require profits!

So ATTACK the costs that are totally unnecessary due to fear of lawsuits!

Why don't you attack the lawyers that TRIGGER these duplicate claims?

Insurance companies/Medicare/out of pocket just pay the bills... THEY don't have anything to do with creating the claims!

Simple solution is tax lawyers 10% like Obama did tanning salons... after all salons caused cancer..lawyers cause "Defensive medicine"!

That tax would be used to pay the premium for the truly 8 million "uninsured" that want but can't afford!

THEN hospitals would send these "uninsured" claims to the company that received the $25 billion on the $250 billion lawyer income!
AND the hospitals could NOT then "pad and pass" on to Medicare/insurance companies to make up the "unreimbursed" expenses.

So with ONE tax of 10% that would reduce if the $850 billion in defensive medicine reduces and by auditing hospitals claims to Medicare,etc.
to make sure no padding and passing occurs..
The amount of health care claims will REDUCE easily 20 to 40%!!! Easily $300 billion reduction a year!

 

[Procrustes Stretched]

Just like car insurance they want your money but God forbid if you have a claim because in reality you will pay more on top of what you already have giving them. Health Insurance is becoming no different, they want you to pay but they don't want us to use it.

GEEZ... are you now just catching on???

The issue though is NOT the insurance companies fault!
They pay the claims that are sent.
$850 billion a year in defensive medicine out of fear of lawsuits are paid by Medicare/insurance companies and people who pay out of pocket!
Why have YOU not addressed THAT?

Insurance companies WANT more customers BUT not if it is NOT profitable.. I.E. STATE laws require profits!

So ATTACK the costs that are totally unnecessary due to fear of lawsuits!

Why don't you attack the lawyers that TRIGGER these duplicate claims?

Insurance companies/Medicare/out of pocket just pay the bills... THEY don't have anything to do with creating the claims!

Simple solution is tax lawyers 10% like Obama did tanning salons... after all salons caused cancer..lawyers cause "Defensive medicine"!

That tax would be used to pay the premium for the truly 8 million "uninsured" that want but can't afford!

THEN hospitals would send these "uninsured" claims to the company that received the $25 billion on the $250 billion lawyer income!
AND the hospitals could NOT then "pad and pass" on to Medicare/insurance companies to make up the "unreimbursed" expenses.

So with ONE tax of 10% that would reduce if the $850 billion in defensive medicine reduces and by auditing hospitals claims to Medicare,etc.
to make sure no padding and passing occurs..
The amount of health care claims will REDUCE easily 20 to 40%!!! Easily $300 billion reduction a year!

Fuck for profit health insurance

... When you said to the insurance companies, "No more profit on the basic health plan," what did they say?

They accept it; they have no choice. And [all these] companies are [heirs] of former social companies. For instance, the Groupe Mutuel ... was built on this idea: no profit; everything must be given to the people who are members of it. So there is a tradition of social attitude in these systems.

I am not systematically against the idea of having profits in the health insurance system, but if we introduce it, it is more with the idea to balance the power in the health insurance system, because now there is a lack of balance of power.

Who has the power?

Who has the power? The small group of the people who leads these companies. And it is something for me which can be dangerous, because it is a business with a billion of Swiss francs, and the check and balance is not optimal in the present system. ...

But you have government regulation, what we might call regulated competition. Does that work?

It is regulated competition. It is in order, but I think, as a Democrat, ... it could be not bad that once a year they [the company managers] have to go in front of a public assembly to answer questions about their salaries, about the way they see the future, about improvement in the quality of the services. It would be, my opinion, not so bad. And it could be possible through a system of shareholders, but not for profit, more for control.



http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/couchepin.html

 

[konradv]

We ALL have a pre-existing condition, mortality. That's why. What makes one person's mortality less important than another's?

 

[Little-Acorn]

... When you said to the insurance companies, "No more profit on the basic health plan," what did they say?

They accept it; they have no choice....

....Who has the power? The small group of the people who leads these companies.


....It is regulated competition.

It's always a hoot to watch the self-contradictory nonsense pile up as these do-gooders try to "explain" their plans.

BTW, has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

 

[Procrustes Stretched]

I could agree to something that worked best for everyone. That is why I am against obamacare, or Romneycare for that matter.

Canadian system works pretty well. They're more satisfied with it than Americans have been under our system. Still to be determined if we'll like ACA. The major problem with the situation, as I see it, is that we've still got insurance companies involved. When you have a situation where everybody's going to eventually need benefits, it's going to be rife with corruption when the profit motive's on the line.

If you advocate we in the United States completely abandon the free market model that has worked for over 200 years in favor of a socialist health care system, you need to hear about Shona Holmes experience with the government health care system in Canada....

...

bullshit. This worshiping at the altar of a mythical system that works well...


Five Capitalist Democracies & How They do It

Switzerland

... So if you ask the people of Switzerland, is everyone entitled to decent health care, the Swiss would say?

Everybody has a right to health care.

You would say, yes, they have a right, and you provide it.

Yes, and high quality. Naturally, you can have a better quality. To be in a room with only one bed, you have to pay something supplementary. But even that, I see in my own canton, which is not a rich canton -- and hospitals belong to the cities or to the canton now; they belong to the canton -- they intend to improve the system so that the people can be alone in a room when they are in hospital, rich or poor.

... One of the problems we have in America is that many people -- it's a huge number of people -- go bankrupt because of medical bills; some studies say 700,000 people a year. How many people in Switzerland go bankrupt because of medical bills?

Nobody. Doesn't happen. It would be a huge scandal if it happens.

Even to one?

... You [can] go bankrupt because you're not [able to] pay your premium, 2,000 or 3,000 Swiss francs, but it is not because of that but because of your general situation. But that the normal situation [is to] become bankrupt of health costs, it would be for us something absolutely unbelievable. ...

... We have big drug companies in America, and they say, "Americans should pay high prices because that's the price of innovation." ... Do you buy that argument? Is it legitimate?

Partially. But if you look at the expenses of a great pharmaceutical company, ... they pay between about 10 to 15 percent of their expenses for research, but they use 30 to 40 percent of their incomes for marketing and promotion. ... It is not completely wrong that they spend so much, but it is not correct to say that there is a direct connection between the price of drugs and the cost of research. It could be more between the cost of marketing and the cost of the drugs.....

 

[Procrustes Stretched]

... When you said to the insurance companies, "No more profit on the basic health plan," what did they say?

They accept it; they have no choice....

....Who has the power? The small group of the people who leads these companies.


....It is regulated competition.

It's always a hoot to watch the self-contradictory nonsense pile up as these do-gooders try to "explain" their plans.

BTW, has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

Of course they do. Insurance companies introduced the issue into the market place

 

[Greenbeard]

BTW, has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

Because they're the way we finance treatment.

 

[Little-Acorn]

BTW, has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

Of course they do. Insurance companies introduced the issue into the market place

They did nothing of the kind. They introduced the idea of betting that you wouldn't get sick or injured, while you bet that you would. If you win (you get sick or injured), they pay, hugely if necessary as your policy describes. If you lose (you don't get sick or injured), they keep taking your monthly payments.

And they specifically did NOT include pre-existing conditions, for the obvious reason that betting you wouldn't ge a condition you already have, was nonsense. So they declined to do that part.

Insurance companies have NEVER dealt with pre-existing condition. Anyone with even half a brain knows that they CAN'T possible deal with those... and they know why.

So, once again:
Has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

 

[Procrustes Stretched]

BTW, has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

Of course they do. Insurance companies introduced the issue into the market place

They did nothing of the kind. They introduced the idea of betting that you wouldn't get sick or injured, while you bet that you would. If you win (you get sick or injured), they pay, hugely if necessary as your policy describes. If you lose (you don't get sick or injured), they keep taking your monthly payments.

And they specifically did NOT include pre-existing conditions, for the obvious reason that betting you wouldn't ge a condition you already have, was nonsense. So they declined to do that part.

Insurance companies have NEVER dealt with pre-existing condition. Anyone with even half a brain knows that they CAN'T possible deal with those... and they know why.

So, once again:
Has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

by specifically inserting it into policies, they introduced it into the market