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Re: PREEXISTING CONDITIONS ...

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@GraysonL320504 wrote:

@john258 wrote:


@GraysonL320504 wrote:



WROOOOOONG on every point.  For example, if everyone is covered it would produce the cheapest rates you could get by covering everyone under the ACA but there are other ways covering everyone that has the potential of producing lower rates.  BUT rates and cost of healthcare are two different things.  Rates, or premiums, are what it cost people to buy insurance.  The cost of healthcare is what insurers use to set the rates.  Regardless of how much the cheapest rate is, reducing the cost of healthcare will reduce the rate.

 

__________________________________________________

Well you just showed that you do not understand health Insurance period. The people who do the rating will tell you, and every one who teaches insurance will tell you with all in the rating pool you get the best rates. The ACA was to cover all not in Medicaid. The cost of health care is different from the cost of Insurance. The cost of Insurance is part of the cost of health care. Take a course on the subject.



Since I worked in the industry I actually took MANY courses on it and retired as a VP of a major insurance company.  And I do not wish to spend my time listening to someone who OBVIOUSLY doesn't understand the business so this is my last attempt to explain it to you.  See if this works.

 

If a risk pool covers every single person in the country it would be best case for rates under the ACA.  Whatever the premium (rate) is, it has to be enough to pay all the claims.  To keep the math simple by using round numbers, pretend there are 300 million people in the country.  According to CMS, healthcare costs roughly about $3 triilion/year or about $10,000/year per person.  Therefore, to pay the claims, forgetting any overhead or profit, the monthly premium per person would be a little over $83/month.  According to NUMEROUS studies, the average cost of healthcare in other developed countries averages one-third of what it is in this country.  (With better outcomes, incidentally.)  If the cost in this country was reduced to that average, the cost would be $1 trillion instead of $3 trillion and the monthly cost of premiums would only have to be about $27/month per person to cover the claims instead of $83.  It's really just simple math and you don't really have to know anything more than simple math to understand it so good luck.  It doesn't matter who pays the bill, whether it's a private insurance company or the taxpayers.  It's just simple math.  The premiums (rates) required to bring in enough money to pay he claims depends upon the amount oif the claims.  If that helps, good.  If it doesn't so be it because I don't care to spend anymore time on sheer nonsense.


I can understand why you do not want to spend time on sheer nonsense, and that is what you posted. Basically after taking out the nonsense you said the same thing I did. Looks like you missed some courses.

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Re: PREEXISTING CONDITIONS ...

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@Olderscout66 wrote:

GraysonL wrote IP: According to CMS, healthcare costs roughly about $3 triilion/year or about $10,000/year per person.  Therefore, to pay the claims, forgetting any overhead or profit, the monthly premium per person would be a little over $83/month.

 

Sorry, but $10,000/year is $833.33/MONTH not $83/month. If you were an insurance exec, I now understand why we pay twice as much for the 37th best outcomes in health care.


Good catch on the math but it doesn't change the point I made:  The best way to reduce premiums is to reduce cost.

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Re: PREEXISTING CONDITIONS ...

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GraysonL wrote IP: According to CMS, healthcare costs roughly about $3 triilion/year or about $10,000/year per person.  Therefore, to pay the claims, forgetting any overhead or profit, the monthly premium per person would be a little over $83/month.

 

Sorry, but $10,000/year is $833.33/MONTH not $83/month. If you were an insurance exec, I now understand why we pay twice as much for the 37th best outcomes in health care.

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Re: PREEXISTING CONDITIONS ...

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Graysonl wrote IP And the 20% cap you mentioned is meaningless because the private sector pays more which means they have the smartest people, which means they will always find a way to get around regulations that artificially limit them.  For example, my brother had insurance thru a company that stayed below the 20% by paying for him to belong to a gym.  Of course they had set up the gym as an independent company and made a ton of money from the gym while keeping under the 20% profit. 

 

If meaningless, then why did I get that rebate check and why have rate hikes been the smallest in decades? You cannot distinguish profit from overhead, so further discussion is futile.

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Re: PREEXISTING CONDITIONS ...

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@john258 wrote:


@GraysonL320504 wrote:



WROOOOOONG on every point.  For example, if everyone is covered it would produce the cheapest rates you could get by covering everyone under the ACA but there are other ways covering everyone that has the potential of producing lower rates.  BUT rates and cost of healthcare are two different things.  Rates, or premiums, are what it cost people to buy insurance.  The cost of healthcare is what insurers use to set the rates.  Regardless of how much the cheapest rate is, reducing the cost of healthcare will reduce the rate.

 

__________________________________________________

Well you just showed that you do not understand health Insurance period. The people who do the rating will tell you, and every one who teaches insurance will tell you with all in the rating pool you get the best rates. The ACA was to cover all not in Medicaid. The cost of health care is different from the cost of Insurance. The cost of Insurance is part of the cost of health care. Take a course on the subject.



Since I worked in the industry I actually took MANY courses on it and retired as a VP of a major insurance company.  And I do not wish to spend my time listening to someone who OBVIOUSLY doesn't understand the business so this is my last attempt to explain it to you.  See if this works.

 

If a risk pool covers every single person in the country it would be best case for rates under the ACA.  Whatever the premium (rate) is, it has to be enough to pay all the claims.  To keep the math simple by using round numbers, pretend there are 300 million people in the country.  According to CMS, healthcare costs roughly about $3 triilion/year or about $10,000/year per person.  Therefore, to pay the claims, forgetting any overhead or profit, the monthly premium per person would be a little over $83/month.  According to NUMEROUS studies, the average cost of healthcare in other developed countries averages one-third of what it is in this country.  (With better outcomes, incidentally.)  If the cost in this country was reduced to that average, the cost would be $1 trillion instead of $3 trillion and the monthly cost of premiums would only have to be about $27/month per person to cover the claims instead of $83.  It's really just simple math and you don't really have to know anything more than simple math to understand it so good luck.  It doesn't matter who pays the bill, whether it's a private insurance company or the taxpayers.  It's just simple math.  The premiums (rates) required to bring in enough money to pay he claims depends upon the amount oif the claims.  If that helps, good.  If it doesn't so be it because I don't care to spend anymore time on sheer nonsense.

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Re: PREEXISTING CONDITIONS ...

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@GraysonL320504 wrote:

@john258 wrote:

@GraysonL320504 wrote:

@john258 wrote:

@GraysonL320504 wrote:

@mickstuder wrote:

@ChasKy53 wrote:

They are so Afraid of the Word - Socialism - instead of embracing it when it's a Winner - who cares about the Word


It is socialism and socialism has not worked anywhere it has been tried.  But that's not the real problem.  Medicare for all opens up many problems and does NOT solve the real problem.  Medicare for all is about where the bill will be sent.  The real problem is how much the bill is, not where it should be sent.  Following is an article my brother wrote las t year on the subject.

 

Sometimes liberals have good intentions. At least that's what I tell myself. But they screw it up in the end and then argue to the death that they saved all us little people from ourselves. For example, they decided we needed “comprehensive health care reform” so they gave us the ACA and now they keep arguing how great it is because fewer people are uninsured. But the ACA did not reform healthcare. It made it easier for a minuscule percentage of the population to buy health insurance and penalized everyone else. But having insurance and getting healthcare are two different things and having insurance does not mean you can get healthcare. Just one obvious example is all the people who were required to buy insurance under the ACA but can't use it because they can't afford the deductibles.

 

Now Bernie Sanders has introduced a single-payer bill. Strike two. Single-payer only makes the problem worse. For one thing, the cost would be astronomical, a minor point which is seldom considered by liberals until it is too late and we're stuck with the bill. After years of trying, California passed single-payer earlier this year. According to the LA Times, 65% of voters were in favor of it. Then the cost was revealed, which would more than double the budget of the state with the highest state income tax and the 65% in favor changed to 80% against and it was dropped just like it was dropped in Sanders' home state. But liberal states like California are rooting for Sanders. Like all good socialists they believe someone else should pay for what they want. Why else would they be in favor of something they already discarded due to cost unless they thought tax money from other states would offset their cost? And all that money does little more than pay for a giant quasi-insurance company run by the government. It still does not address healthcare.

 

When I was young, my family could not afford health insurance and Medicare and Medicaid did not exist. Yet we got the healthcare we needed because it was affordable. Today it is not and that's the problem. Of the top thirty-five developed nations, healthcare cost per person in the U.S. is far greater than any other country and close to three times the average of the other thirty-four countries. A doctor summed up the problem in an NBC interview: “We have crappy outcomes for a huge price tag. We do all kinds of stuff that doesn’t really work that’s expensive. We are wasting a ton of money and probably not helping people.” Sanders attempted to use cost to justify single-payer by saying we will spend $49 trillion over the next ten years if something isn't done. But single-payer doesn't address the cost. It just addresses who sends the check.

 

Medicare rates are set by a panel of doctors appointed by the AMA. Insurance companies negotiate rates with healthcare providers. Neither seems to get it right. The rates are all over the place and healthcare providers always overbill anyway. For example, according to the HuffPost, a woman was billed $135,000 by a hospital. Per an agreement, her insurance paid $45,000. But the average price the hospital was paid for that procedure was $37,000. According to CNN, an echocardiogram costs $1,714 in Massachusetts, $5,435 in New Jersey and less than $100 in Japan. In some cases, insurance companies pay more than Medicare. In some cases, Medicare pays more than insurance companies. In some cases, both Medicare and insurance companies are paying more than rates set by the healthcare providers themselves. For example, the LA Times reported that a hospital had a set price of $1,054 for a CT scan. Per a “negotiated” agreement a woman's insurance paid $2,336 for that CT scan.

 

Democrats and Republicans can argue the merits of their various plans forever but it's all meaningless until something is done about healthcare cost. The good news is there are lots of things that could be done. For example, rates could be set by law for providers. Personally, I'd hate to see that but we do have laws against price gouging during emergencies. What's a bigger emergency than a life threatening illness? My preference would be a “most favored nation” law that says healthcare providers cannot charge anyone more than the lowest price they charge anyone else.

 

With that and a couple more equally simple laws, healthcare would take care of itself and the government could get out of the healthcare business and stop punishing us for their incompetence. But don't hold your breath. For anything reasonable to happen, liberals would have to admit that the ACA is not the answer. Fat chance. Besides, the AMA has one of the most powerful lobbies in Washington, closely followed by the AHA and some other healthcare associations. And their goal is to keep those rates as high as possible.


You have good and bad in what you say. The ACA was a good start and could have lead to the problem being solved. Since everyone today can get health care just go to the ER, and you are correct on the cost part. You need everyone insured as a start and as little ER care as possible. The ACA would do that. Health care will never take care of its self. It will always require a lot of policing from some form of Govt panel. There are experts out there that can solve this. After reading your brothers article he is not one of them, and neither am I even after working for years in this industry. There is no simple answer. By the way. The ACA now has the highest approval ratings from the public it ever has. We see the Reb. running for office telling all how they love it. They lie as actions speak louder than words.


You missed the point.  The problem is the COST of healthcare.  The ACA and single-payer do not address that.  They address who pays.  A couple other points:

 

1.  People like to compare single-payer in other countries to what could be done in this country.  That's an apples-to-oranges comparison because of the cost.

 

2.  If every single person in  this country was insured, the cost of health insurance would still have gone up higher due to adding the people with illnesses that cost millions of dollars, which are the illnesses that are referred to as "existing conditions." A real simple example is an insurance company that has a risk pool of 1000 people who are reasonable healthy for which they are charging a premium of $10/month to cover the costs.  Adding a single person who has an illness that costs a hundred twenty thousand dollars a year to treat doubles premiums for everyone.  But if healthcare costs were reduced to what they are in other countries, which is about one-third of what they are in this country, the premium after adding the person with the major illness would be under $7/month for everyone.


No I did not miss the point. the ACA if fully implemented would have lowered the cost of health care some what. It would have produced the cheapest insurance rates due to everyone being covered.


WROOOOOONG on every point.  For example, if everyone is covered it would produce the cheapest rates you could get by covering everyone under the ACA but there are other ways covering everyone that has the potential of producing lower rates.  BUT rates and cost of healthcare are two different things.  Rates, or premiums, are what it cost people to buy insurance.  The cost of healthcare is what insurers use to set the rates.  Regardless of how much the cheapest rate is, reducing the cost of healthcare will reduce the rate.

 

__________________________________________________

Well you just showed that you do not understand health Insurance period. The people who do the rating will tell you, and every one who teaches insurance will tell you with all in the rating pool you get the best rates. The ACA was to cover all not in Medicaid. The cost of health care is different from the cost of Insurance. The cost of Insurance is part of the cost of health care. Take a course on the subject.


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PREEXISTING CONDITIONS ...

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William, those were excellent points. There is no perfect solution for our health care system, but one area I always try to emphasize is the following. Comparing health insurance to auto, home, or other types of property insurance is a big mistake. Health insurance is unique and very different than being insured for a financial loss. We're talking about people's lives and their overall health.

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Re: PREEXISTING CONDITIONS ...

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CT, been reading some of the posts over the last hour. I think that there are some very insightful views on the subject of healthcare. It does seem counter productive to claim everyone is wrong and call others names. 

If we ever have some solutions to this, neither side will probably get everything that they want. 

Yes, pre existing conditions should be covered. 

As an overview of society, do we want others around us to be healthy or to be sick?

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It's fascinating to watch Grayson attack every opposing idea as one created by left wing liberals (his ultimate insult), therefore their argument is wrong. Anyone who disagrees with his view of the world is described as a flaming liberal. That's the extent of his arugments. Forget substance and logic which do not exist in the world of Trump Cult members.

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@Olderscout66 wrote:

GraysonL wrote IP if everyone is covered it would produce the cheapest rates you could get by covering everyone under the ACA but there are other ways covering everyone that has the potential of producing lower rates.  BUT rates and cost of healthcare are two different things.  Rates, or premiums, are what it cost people to buy insurance.  The cost of healthcare is what insurers use to set the rates.  Regardless of how much the cheapest rate is, reducing the cost of healthcare will reduce the rate.

 

if everyone is covered it would produce the cheapest rates you could get by covering everyone under the ACA. No. Covering EVERYONE means the insurance company can offer things like coverage of pre-existing conditions and still keep the insurance AFFORDABLE. You get the lowest price for the insurance by requiring all the providers to accedpt the lowest negotiated price for the service, and capping the "overhead", (which includes profit) that the insurer can include in the price of the policy, just like PPACA did to restrict the overhead for all health insurance to 20% of the total premium revenue.

 

Regardless of how much the cheapest rate is, reducing the cost of healthcare will reduce the rate. Until PPACA there was NO connection between the cost of insurance and the cost of the healthcare. The cost of insurance was whatever the traffic could bear, including "overhead" that was considerably above the 20% "cap" PPACA installed. I got a nice refund check for the amount ABOVE 20% my insurance company (Aetna) had charged that first year under Obamacare.

 

And the cost (the amount demanded from the customer) of healthcare was designed to maximize profits for the provider and had NOTHING to do with the actual cost of delivering the care.

 

First thing Universal Coverage/Single Payer/Medicare For All does is slash OVERHEAD by standardization of FORMS.

 

Second it eliminates RISK from the system so doctors, clinics and hospitals don't have to increase rates for paying customers to cover those who don't pay.

 

Third is reduces the cost of treating the patients BECAUSE now they can go to the doctor when they feel sick, and not have to wait untily they're sick enough to get in to the ER.

 

Forth, it reduces the spread of disease because people are getting treated and vaccinated in a timely manner.

 

Fifth, it uses the Insurance Industry to negotiate the lowest possible cost for both medical care and prescription drugs, just like they do now.

 

So "Medicare For All" may be a slight misnomer, but it is STILL the only solution for improving our 37th ranking for health care outcomes.


Sorry, you're in waaaaaaaaaaaaaaay over your head.  Health insurance rates have ALWAYS been based on the cost of healthcare and still are. And by the way, most people seem to forget that due to a bill passed by Democrats, insurance is controlled at the state level.  Each state has to approve what's in a policy and the rate prior to it being sold in that state.

 

And the 20% cap you mentioned is meaningless because the private sector pays more which means they have the smartest people, which means they will always find a way to get around regulations that artificially limit them.  For example, my brother had insurance thru a company that stayed below the 20% by paying for him to belong to a gym.  Of course they had set up the gym as an independent company and made a ton of money from the gym while keeping under the 20% profit. 

 

Do you get the idea yet?  You should try to understand the FACTS prior to posting.

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