# Down the Insurance Rabbit Hole



## DanYo (Jun 30, 2007)

Read the article and now you can too if you want. Good topic.

*Down the Insurance Rabbit Hole*
By ANDREA LOUISE CAMPBELL
Published: April 4, 2012

Cambridge, Mass.








Vivienne Flesher

Related in Opinion

Op-Ed Contributor: Toward Universal Health Coverage (April 6, 2012)
More on Health Care »

ON the second day of oral arguments over the Affordable Care Act, Solicitor General Donald B. Verrilli Jr., trying to explain what sets health care apart, told the Supreme Court, "This is a market in which you may be healthy one day and you may be a very unhealthy participant in that market the next day." Justice Antonin Scalia subsequently expressed skepticism about forcing the young to buy insurance: "When they think they have a substantial risk of incurring high medical bills, they'll buy insurance, like the rest of us."

May the justices please meet my sister-in-law. On Feb. 8, she was a healthy 32-year-old, who was seven and a half months pregnant with her first baby. On Feb. 9, she was a quadriplegic, paralyzed from the chest down by a car accident that damaged her spine. Miraculously, the baby, born by emergency C-section, is healthy.

Were the Obama health care reforms already in place, my brother and sister-in-law's situation - insurance-wise and financially - would be far less dire. My brother's small employer - he is the manager of a metal-fabrication shop - does not offer health insurance, which was too expensive for them to buy on their own. Fortunately, my sister-in-law had enrolled in the Access for Infants and Mothers program, California's insurance plan for middle-income pregnant women. AIM coverage extends 60 days postpartum and paid for her stay in intensive care and early rehabilitation.

But when the 60 days is up next week, the family will fall through the welfare medicine rabbit hole. As a scholar of social policy at M.I.T., I teach students how the system works. Now I am learning, in real time.

For health coverage, the baby fares best. He is insured through Healthy Families, California's version of the Children's Health Insurance Program, the federal-state plan for lower-income children ineligible for Medicaid whose families cannot afford private insurance. California is relatively generous, with eligibility extending up to 250 percent of the federal poverty level of $19,090 for a family of three; 27 states have lower limits.

When the AIM coverage expires, my sister-in-law will be covered by Medi-Cal, California's version of Medicaid, because she is disabled and has limited income. But because my brother works, they are subject to cost-sharing: they pay the first $1,100 of her health costs each month. Paying $1,100 leaves them with a monthly income of just 133 percent of the federal poverty level. If my brother makes more money, their share of the cost increases.

They must also meet the Medi-Cal asset test: beyond their house and one vehicle, they can hold $3,150 in total assets, a limit last adjusted in 1989. They cannot save for retirement (retirement plans are not exempt from the asset test in California, as they are in some states). They cannot save for college (California is not among the states that have exempted 529 college savings plans from their asset tests). They cannot establish an emergency fund. Family members like me cannot give them financial help, at least not officially. If either of them receives an inheritance, it will go to Medi-Cal. Medi-Cal services that my sister-in-law uses after age 55 will be added to a tab that she will rack up over the rest of her life. When she and my brother die, the state will put a lien on their estate; their child may inherit nothing. Even my brother's hobby runs afoul of the asset test: he enjoys working on old cars, which he can no longer keep.

These are the limitations under which 7.5 million Medi-Cal recipients live. Nationwide, more than 50 million people are covered by their states' version of Medicaid. Some states are more lenient in their income and asset tests, others less so. Nowhere is life in these programs a picnic.

That said, Medicaid is an important safety net for the poor, and the Obama reform would expand the program to cover all Americans under 133 percent of the poverty level (currently one has to be both poor and categorically eligible - a child or a pregnant woman, for example). But for the middle class who are thrust into Medicaid by circumstance, the program's strictures are truly life-altering. My brother and sister-in-law desperately wanted to buy insurance and now wonder how to escape Medi-Cal's forced penury. My sister-in-law will qualify for Medicare after the mandatory 24-month waiting period for disabled people, but Medi-Cal will be the secondary payer.

Their best hope is the survival of the Obama reform. Perhaps my brother can get a job that offers health insurance for the family, but without the reform's protections, like the prohibition on denying coverage for pre-existing conditions, removal of annual and lifetime insurance caps, and reinsurance for large claims, there is no guarantee that they could obtain insurance. More likely, they would buy insurance on a health exchange. Here in Massachusetts, where such an exchange is in place, they could have purchased a plan with an affordable premium (at their income level, the monthly premiums range from $39 to $91 per adult). And these money and insurance issues would not have added to the other stresses in their profoundly changed lives.

Instead, their financial future is shattered. Family and friends are raising money to buy a wheelchair van and to renovate their home for accessibility. The generosity of the local community is stunning. One incident in particular struck me to the core. A woman from a small community nearby had something for us. A cancer survivor, she had decided to "give back" by placing donation cans in stores around town. She had finished her drive and consolidated the money. The small coffee can she handed over to me and my sister-in-law had a slit in the lid and was decorated with pink felt and ribbons, now a little smudged from handling. Inside were several hundred dollars in small bills. We burst into tears. This is social policy in the richest nation in the history of the world.

Andrea Louise Campbell is an associate professor of political science at the Massachusetts Institute of Technology.
A version of this op-ed appeared in print on April 5, 2012, on page A23 of the New York edition with the headline: Down the Insurance Rabbit Hole.


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## FatherHooligan (Mar 27, 2008)

That is horrifying. I really do not understand your health business system there. ...I'm speechless and despair for her and all like her and her family…


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## derosa (Aug 21, 2010)

Sucks when it hits home and you get to see the results of a system that doesn't care about people. I went 16 years without insurance and thankfully the worst I got was a compound fracture in one arm, I couldn't afford to go to the hospital and so after several months of it slowly healing on its own I regained full mobility in the arm but if I sleep on it or hold it certain ways for a little too long the pain still shows up in that spot. When my wife was ready to get pregnant we bought her health insurance due to the possibility of something happening, cost almost 600.00 a month and financially hurt us. My wife didn't work towards the end, her contract ended and wasn't extended since it was known we were looking for our permanent position in the ministry. At the same time my hours were soon cut back and in the month between when we accepted our job offer and when we could take my hours were completely removed. We scraped together enough to keep paying the insurance, auto, and food and everything else we were still trying to get ahead of a year later. In the end we broke even because nothing went wrong. 
Now I have an amazing insurance policy, no payments for my daughter's care for the first 3million in care. I'd trade all the insurance I have for a socialized system that offers care to all who need it without bankrupting them.


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## DrDirt (Feb 26, 2008)

A question I have is…is the problem with health care costs….the insurance company?
There are plenty of horror stories about denial/pre-existing conditions/ dropping the sick.
-> The Profits are not huge - so the increases in the graph are not due to premiums - but rather PAYING OUT ON CLAIMS. Why did actual cost of CARE go up a factor of 10 (1000%) in 20 years?

Who generates the 2.5 trillion in actual medical bills? the top three insurers all spend 81-83% of their premiums on claims…so basically they have always been on the 80:20 Rule…... so how did the 80% piece get so huge?










Profits -http://larrycheng.com/2010/03/08/just-how-profitable-are-healthcare-insurers/
•Aetna: 3.7%
•Wellpoint: 7.3%
•Cigna: 7.1%
•United Health: 3.7%
•Humana: 3.4%
•Healthnet: -0.3%
•Healthspring: 5.0%
•Coventry Health Care: 2.3%
•Molina Healthcare:0.8%
•United American Corp: 2.7%
•Unum Group: 8.4%
•Median: 3.7%


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## 33706 (Mar 5, 2008)

As an American living in Canada, I'm often under attack about the status of healthcare in the U.S. ll I can say, in one generic sweep, is 'Hey, you wouldn't think of driving without insurance, right?" To maintain your health insurance is just one of those necessary evils. Everyone's lifestyle is somewhat dictated by what you do to provide coverage for you and your family. If that means opting for the job that provides the optimum insurance benefits , then so be it. For the government to subsidize irresponsibility on the part of the wilfully uninsured…well…I suppose. but when I was laid off, I took on a BC/BS policy with a $5000 deductible… just in case of a catastrophic event, just to protect my Real Estate assets. Fortunately my heart attack event occurred once I was again insured by an employer, $62,000 worth of care, everything covered except for one ambulance shuttle between hospitals, $500. To have socialized health insurance is indeed the utmost benevolent program that a government can give its people. But it's not to say that we don't pay for it, because we do. Instead of tri-monthly premiums, we pay through taxation. Some give a little, some give a lot. The California model is indeed terrifying, however. It's just got to be the worst of both worlds. Though I understand that the Federal gov't screwed California over badly by mandating healthcare for illegals for many years.


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## DaveMu (Jan 4, 2012)

Interesting read thank you!


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## patcollins (Jul 22, 2010)

I for one would like to know how much that the manager of the metal fabrication shop made. This would tell me what "couldn't afford" means. To some people "can't afford" means "there are things I'd rather spend my money on".

This story is terrible, however there is so much social engineering going on with stories like these where certian facts are omitted to trigger a certian emotional response.

The affordable health care act would have fined this couple had they chose not to buy insurance btw.

What does California consider "middle income"?

Update: I took the cost sharing amount and the federal poverty level poverty level and came up with approximately $33k/year. Not sure I would consider that middle income for California.


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## RockyTopScott (Nov 16, 2008)

The cost of health care and health insurance are driven by many factors which i have 30+ years experience with, but an explanation would bore this forum to death.

A big snoozer.


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## jeepturner (Oct 3, 2010)

I would say only in America, but that would be wrong. I should be only in the United States, but we have some lovely company when it comes to a system where anyone at anytime can lose the health care lottery. Most of the countries in the third world share this system. In our country where everything is biased towards how much one makes, losing your economic freedom to earn more takes an even higher toll. The truly sad part is that this story is not unique. It happens everyday. And what is also even sadder is it only took six post before someone started blaming the sick for their condition.

I would doubt that health care insurers would give out unbiased information, freely. So basing profit margins off of what amounts to company propaganda means nothing. They are corporations and they do have certain requirements for publishing, but to think they don't try to game the system is naive.


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## RockyTopScott (Nov 16, 2008)

This will help explain alot of the problems from a less than conservative site.

The key of the article: "If Americans behaved just a little differently, our health care costs could settle down to a sustainable growth rate that matches the economy's growth, or could even fall further. "

finance.fortune.cnn.com/2012/04/25/health-care-costs-debate/


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## RockyTopScott (Nov 16, 2008)

@jeepturner said : "but to think they don't try to game the system is naive."

Care to give us an example?


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## jeepturner (Oct 3, 2010)

@RTS or celebrity du jour thumbnail. Why would I want to provide information to you. Would it change your mind? Would you consider looking at the world from a different point of view? Or would you play semantics with words to keep from considering any view point but your own. 
(Best Darth Vader voice) "Confirmation bias runs deep in this one" 
Come on go a head and bore us with all the details a man with 30 + years experience knows.


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## RockyTopScott (Nov 16, 2008)

No, what I would do is guide you to the correct answer based on my time spent in this market.

I think it is you that may fear the facts that might confuse your bias.

The only bias I have is I do believe in profit, which is always a good thing.


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## wormil (Nov 19, 2011)

•Aetna: 3.7%

Which equated to over $10,500,000,000. 
The CEO, Ronald Williams, was payed over $72,000,000
Aetna also overstated it's losses by around $4,900,000,000 and had to file amended returns

Also, linked from the link you posted:
http://www.economist.com/blogs/democracyinamerica/2010/03/health_care_reform

Profit is a deceptive measure when used with insurance, because the amount of money that flows through insurance companies is vastly disproportionate to the work they do or the value they add, just by the nature of the business. To put it more simply: private insurance companies' "costs" are probably about half of all the healthcare spending in America, since that's the proportion they cover. And their revenues are somewhat higher than that (currently about 4.3% higher, according to Yahoo business). But it's not as if they're actually doing half the work in America's health-care system; they're just collecting premiums and paying bills, plus a lot of administration and advertising.


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## RockyTopScott (Nov 16, 2008)

Yes, the folks at ABC and Ezra Klein, now those are unbiased opinions I am sure.

Pick up a copy of Aetna's audited financials and tell me what page the deceptions are on.


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## jeepturner (Oct 3, 2010)

"The only bias I have is I do believe in profit, which is always a good thing." 
So, when a drug deal(read ground floor entrepreneur) makes a drug deal he makes a profit. Always a good thing?
When a trader in white slaves sells a "house mate" in a third world country he makes a profit. Always a good thing?
When an insurance company accepts money for a service and then finds a legal loop hole the company makes a profit.
Always a good thing.
When the largest GDP in the world spends sixteen percent of that GDP on health care and a good chunk of that goes to companies who do nothing to treat the misery of the folks who are forced to buy into the system, and they make a profit everyday on it. Always a good deal. We spend more because of the insurance industry. Our system allows folks to make a profit while producing no product, and that system feeds on misery. Always a good thing? More misery equals more profit.


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## patcollins (Jul 22, 2010)

jeepturner you could say that about anybody not actually in manufacturing.

In the end it is the insurance companies that pay the bills so they have to take in more money than they put out or they wouldnt exist. Part of the problem is the cheapness of Americans.

About 6 years ago my father passed away at 55, I was looking for health insurance for my mom. She was more concerned about paying for $20 perscriptions and $50 dr visits than anything else, so much so that she was willing to pay $200 extra a month for 100% perscription coverage, in 6 years she has gone to the Dr once and had one perscription.

Insurance should be to pay for the $100k cancer treatement not the $50 dr visit, part of the problem is just the way Americans think, insurance is basically a perk of the job so they want everything out of it that they can get.


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## GregD (Oct 24, 2009)

The account of Ms. Campbell's sister-in-law is thought provoking.
Her accident is tragic, so of course one wants to be sympathetic.
But come on now; a couple - in their 30's no less - decide to have a child even though they have concluded that they cannot afford health insurance? How was that a responsible decision? Whom did they think was responsible for covering health care costs for themselves and for their child?

It would be great if our society could do better than to let those people die that cannot afford the health care that they need. But it is not possible for us to design and fund a system that will protect a person that is determined to make bad decisions for themselves, or to protect a person that is extremely unlucky. The best we can do is offer some level of safety net and accept that some people - due to very bad luck, irresponsible behavior, or a bit of both - are going to be left in severely unfortunate circumstances.

I agree with patcollins - insurance is most appropriate for major medical expenses and not so appropriate for routine medical expenses. My impression is that covering routine medical expenses keeps people from considering cost/benefit when considering treatment options and that results in a lot of unnecessary expense.

So I support Obama's desire to construct a health care safety net. But I have no doubt that the law that was passed has some very ugly sides to it. I can't say whether - on balance - I think it is a good thing.


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## RockyTopScott (Nov 16, 2008)

Absurd examples jeepturner, I am not for illegal gains by anyone.

Do you call contract provisions legal loopholes? If so, please get a freshman business law textbook and educate yourself a bit.

So if an insurance contract/policy says it will not cover lasik, you consider it a legal loophole?

You have some good points Greg.


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## jeepturner (Oct 3, 2010)

So Greg you are saying that because she was pregnant it showed that they had bad judgement? 
I don't get why people have to marginalize people who have bad things happen to them. The medical cost of having a child are high in this country, but compared to being a quadriplegic recovering from an auto accident they would pale by comparison. 
Insurance companies don't pay the bills. We pay the bills, they just skim the "big" off the top like any other scam. This one is legal because our government is largely bought by the very corporations who are doing the scams. 
Not all legitimate businesses are in manufacturing, but businesses who produce a product are legitimate.

Think of it, sixteen percent of the largest GDP in the world, and we cover less of our population than the other developed countries with universal healthcare. Of course this guy would agree with RTS that all profit is good.
According to bizjournals.com the country's highest-paid CEO, Stephen Hemsley, made $101.96 million in 2010.
I wonder just how far a day of his pay would go to make Andrea's sister in law just a little more comfortable?

Of course, I am not trying to convince folks like RTS, or patcollins, some dogs just wont hunt. So you don't have to reply to me. I am just posting to let other know that there are folks on this site that don't watch fox.


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## RockyTopScott (Nov 16, 2008)

The only people that should be concerned about the pay of a publc company CEO are the shareholders.

If they don't like it, they should vote thier shares differently.


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## GregD (Oct 24, 2009)

jeepturner -

I guess what it comes down to is that I think an adult that chooses to not buy health insurance is choosing to be reckless. An adult gets to make his/her own decisions and also gets to live through (or not) the consequenses of them. Bad stuff can happen at any time and the financial consequences can be devistating - this is well known.

From this perspective the definition of poverty would be income below the level required for a frugal individual or family to pay for food, shelter, basic routine heath care, and major medical insurance. If routine health care and major medical insurance aren't available because of inappropriately high cost, or inadequate availability, then I'm all for working those issues. And I think we should try to reduce the number of people in poverty.

In the end I don't much care one way or another whether we take away an individual's ability to make a stupid decision about their health care. Whether through individual mandates of Obamacare or by (the far less convoluted option of) socializing basic health care and major medical insurance, we can take away someone's right to not take responsibility for themselves on this one facet of life. Or we can make sure everyone has a realistic opportunity to be responsible for themselves while allowing them to be stupid if they so insist. I'm more interested in whichever option is most economically effective and financially sustainable.

But of course people with more money should be able to buy better health care.
I don't think we should eliminate capitalism entirely from health care.


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## ssnvet (Jan 10, 2012)

the day is fast arriving when the only people with health insurance in this country will be

1. Union employees (an ever shrinking #)
2. Government employees
3. health care system employees
4. highly compensated employees (>$100K)

I don't fit into any of these catagories but am one of the "lucky" ones who has an employer offers health insurance benefits… they pay 70% of the employees premium. To insure my family, lucky me has to pay $1,000 / month. And my deductable is $5,000 (my employer will help pay some of this).

WITH employer provided insurance, I still pay more for health insurance than I do my mortgage.

And I'm one of the lucky ones.

I'm getting tired of my unemployed friends telling me all about how great medicaid is, or how the hospital wrote off their entire bill, because they are unemployed.

No such think as a free lunch…. guess who's really paying their bills for them?

I'm also getting tired of interviewing people for jobs in my department, only to have them laugh at our starting offer of $15 / hr., because their making more on unemployment.

I think it may have been Maggie Thatcher that once said, socialism is great, untill you run out of people to pay for it.


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## jeepturner (Oct 3, 2010)

Greg, If government or a private company ever figured out how to stop all people from making bad choices they could bottle it and make a fortune. It's never going to happen and I agree that not having health insurance in our system is asking for trouble. I wasn't coming down on you personally for the comments about the lady being pregnant, I was just pointing out that the story stated she was pregnant and healthy. Pregnancy without health insurance is not uncommon in this country.

I hope we get something better. Something like a single payer system. I like the plan that Cheny has, and if I ever need a heart I would get one quick.

We can look the other way when less than one percent of the population is making hundreds of times more than the people making product. We do so at our own peril. Go out and look around in your cities. Every car, every bicycle, every piece of clothing, every thing you see is a product of someone's labor. Our demand for the things we beleive we need is what drives our economy. If a small enough minority controls a large enough slice of the wealth, then the demand for these things we want goes down. Demand for air travel drives my industry, and a large portion of that demand comes from middle class people with disposable income. If that demographic becomes too small then my industry will shrink and more middle class people will sink to where they don't have the income to buy furniture. Our consumer economy is made possible by people with disposable income, not by people who don't have to make choices on how much of their income is disposable or than can be invested. Without a robust economy we would all suffer because it is all interlinked. So one could say it matters only to the stock holders what a CEO makes, but that is sticking your head in the sand and ignoring the forest for your favorite tree.


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## RockyTopScott (Nov 16, 2008)

What any CEO makes anywhere will not have an affect on my ability to succeed.

My success depends on my investment in me.

Tell me Jeepturner, If Stephen Hemsley would have made $90 million less than he did, how would it have changed your lfe?


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## patcollins (Jul 22, 2010)

No matter how much you make there is someone somewhere that thinks you make too much and they deserve some of what you make.


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## GregD (Oct 24, 2009)

Mel -

It is not possible to have a free society unless people are allowed to make decisions for themselves, and in that situation a certain fraction of them are going to make bad decisions. I don't like watching people screw themselves, but we have to accept that it is going to happen. The alternative is an autocratic system, and that would be much worse. The information provided by Ms. Campbell about her unfortunate sister in law is, in my estimation, a better example of a couple screwing themselves, than an example of what is wrong with the current state of health care in the U.S. In fact, in that situation the system worked - she did get and is getting the health care that she needs thanks to the State of California. That their financial decision to forgo health insurance has resulted in devastating their family finances is extremely unfortunate, but this is the gamble that they took.

ssnvet's experience is very clearly an example of problems in the U.S. health care system.

But again, being autocratic and forcing everyone to have at least basic health care and minimal major medical insurance would be OK by me if the resulting system is financially sustainable. But that should be the end of the entitlement. Providers should be free to refuse further treatment unless the patient can demonstrate an ability to pay, by being rich, or by having been responsible by providing themselves with insurance with a more complete benefits package.

I'm in favor of "Compassionate Conservatism" or "Tough-Love Progressiveness". I also believe that anything that is not financial sustainable is stupid.

The 1% and CEO pay are interesting topics, but not so relevant to this one, as far as I can see.


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## ssnvet (Jan 10, 2012)

*ssnvet's experience is very clearly an example of problems in the U.S. health care system*

The main problem, as I see it, is the government dictating that care be provided to people who can't pay for it…. with no porvision to compensate the providers for this care.

So the cost gets spread out over the ever decreasing pool of people who can pay for it…. artificially inflating the cost of care…. creating even more people who can't pay for it.

The new trend is an end run around hospitals - who provide "emergency" services and are thus req'd to treat everyone who walks throuh the door - by way of walk in clinics.

Here's a quick anecdote…
The cost of getting an MRI at a walk in clinic is 1/4 that of getting same MRI at hospital, and the clinc has newer and better equipment, operated by specialist who are more experienced, because they do a lot more of them. But the hospital has to charge much more to defray their losses in emergency and indigent care.

But this is a short sighted quick fix, that will only exaspetate the situation as the hospitals lose more revenue.

IMO, as long as we view health care as a "rite" and put it on a pedistal next to our constitutionally protected rights, we will not solve the problem. I do not believe the government can legitimately declare something a "rite" if that something requires them to take resorces away from another citizen, thus making him unable to provide that same thing for himslelf or his family.

My Primary Care Doc is an insightful guy, and told me that "uniniversal health care will always lead to a shortage of health care". This is the what my wife experienced while working in Moscow for 3 years. Health care is provided free of charge by the state. But the hospitals don't have any meds and don't even feed the patients (family has to bring you your food). The UK denies certain procedures to people over 60 because they already lived a good long life, and in British Columbia, they send pregnant women over 40 to the Washington state for delivery, as the risk of complications is higher and they don't have enough neo-natal intensive care facilities to meet the need in their own community. (I'll be Justin Beiber boy isn't bragging about that one).


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## jmos (Nov 30, 2011)

I agree with Greg, I'd like to see a system where everyone receives basic healthcare as part of their tax dollars, and the private insurance market served those who wanted and can afford a higher degree of coverage. I also agree it has to be 100% self funded. We do currently ration healthcare in the US, don't kid yourself, we just do it in a much less logical way.

If the SCOTUS strikes down individual mandate, I'd like to see Congress immediately repeal the laws requiring medical providers to provide care to those that can not pay. Perhaps that will properly incentivize those who can afford coverage but choose not to to get it.

I do, however, have a lot of sympathy for the couple described in the article. We can stand back and say they should have had insurance, and they should have, but it's not so easy to justify paying huge chunk of your income on insurance when you're young, health, and feel invulnerable.

Another thing I'd really like to see is divorcing health insurance from employment. It's an odd system that I don't believe any other first world country has. It imposes a large burden on businesses, and makes it a lot harder for people the change jobs and start businesses, and reduces consumer choices. Any group should be able to negotiate for group insurance coverage (AAA, AARP, trade Unions and trade groups…). It would give consumers a lot more leverage with insurers and help level the playing field.


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## GregD (Oct 24, 2009)

+1 on divorcing health insurance from employment.


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## RockyTopScott (Nov 16, 2008)

@jmos said: Any group should be able to negotiate for group insurance coverage (AAA, AARP, trade Unions and trade groups…)

All of those you mentioned do negotiate as a group.


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## Eddie_T (Sep 23, 2012)

How Obamacare Almost Killed My Wife

My wife was admitted to the hospital via the ER for intestinal bleeding. A colonoscopy revealed a mass near the appendix which appeared benign but removal was recommended to prevent future problems. To be safe the surgeon recommended a colon re-section taking six inch margins. Five or six days after surgery the case manager was pushing for discharge to a skilled nursing facility, however her primary care doctor did not feel she was doing well enough for release. On the ninth day the fascia stitches failed due to infection and emergency surgery was required. Since she also has congestive heart failure the dual surgeries took their toll and she took on some 20 pounds of fluid and was too weak for any real therapy. To make matters worse she was confused, unable to clear her throat, had difficulty swallowing and could hardly talk. I prayed about the situation and was led to see what was different about her meds. With the help of Google I found that a simple med to keep her from coughing was a serious problem. The med was Tessalon Perles and she was exhibiting all side effects with no one taking notice. I got the med stopped and she made slight progress. After a couple of weeks the case manager said she had to be discharged. The skilled nursing facility's doctor did not see her for three weeks and then because I wanted her discharged to home care. It seems the facility had only one diet and it was not low sodium so the majority of the fluid was still being retained. By taking her home I put her on a low sodium diet and she has lost the fluid but still has not recovered from the dual surgeries.

What did Obamacare have to do with this? In order to make it appear affordable Medicare was cut to help pay for it. Medicare now requires higher co-pays which my co-insurance covers but something called the DRG Prospective Payment System sets per ailment ceilings on Medicare's payment to a hospital. When the ceiling is reached the hospital has little choice other than discharging to a lower cost nursing facility. Also doctor's visits in the hospital end up being about five to ten minutes with the patient plus a mess of paperwork. Although four doctors were involved Medicare permits no consultation time thus problems such as the Tessy Perles situation can go unnoticed. My wife has now essentially lost four months of her life to this mass removal and it ain't over yet.


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## Redoak49 (Dec 15, 2012)

I do not trust any of the politicians as I do not think that any of them make a decisions based upon anything but there own well being. If Obamacare is good enough for everyone else, how can the politicians exempt there own.

Is there a need for some kind of universal health care…probably yes. How do we get there….nobody knows. I am certain it is not to vote on some type of universal health care and then after it is made law you can read it to find out what is in it. What are the politicians doing? After the issues with Obamacare and the current VA, I can be certain that the answer does not belong in the government hands.(Please read this as a blast at all government and not just the current party in power.) Somehow, a much better thought out solution is needed as the current one will not work. If one of those insurance CEOs came up with a solution, then you can pay them as much as they want.


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## DanYo (Jun 30, 2007)




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## Bonka (Apr 13, 2012)

The only two things the federal government does well is grow and take something at the point of a gun.


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