Jump to content
IGNORED

Another big insurance provider to pull out of the ACA marketplace


MorningGlory

Recommended Posts


  • Group:  Servant
  • Followers:  25
  • Topic Count:  275
  • Topics Per Day:  0.05
  • Content Count:  5,208
  • Content Per Day:  1.00
  • Reputation:   1,893
  • Days Won:  0
  • Joined:  01/02/2010
  • Status:  Offline

3 minutes ago, Out of the Shadows said:

These are great questions and if they are the place to start then we have to decide who answers them.  To take your example of "life saving" vs "quality of life" I will use an example I am familiar with.  For a Type 1 diabetic obviously insulin is without question life saving.  But then you get into the "delivery system" and it gets a bit more fuzzy.  Prior to the last 5 to 10 years the only choice was multiple daily injections.  Now they have pumps that allow a constant steady flow of insulin instead of a massive dose once a day of "long lasting" insulin as well as a way to administer insulin to cover food eaten and high blood sugar episodes without an injection.   There are also now glucose meters that constantly monitor your blood sugar and remove the need to prick a finger 6 to 8 times a day to check it.  

Some insurance companies see these as "quality of life" things as there is always the old fashioned shots that can be used.  Other companies have come to the conclusion that these devices (the pumps and CGMs) allow for better management of the disease and take away many of the high and low blood sugar episodes, which are what damage the body and cause greater problems later.  To these companies the investment now will save them the big bills later.  

So, in a system that makes things affordable, who would decide if the things above were really necessary or not?

I think the best case scenario in that sense would be to leave it up to the american medical association. This association already sets many standards that the insurance injury abides, such as percentages on disability through workman's comp claims and so forth. This would also allow for the standards to change with new treatment without a government bureaucracy or congress being involved if something new comes along that is better than previous. The fortunate thing is that, with things such as your above scenario, while the treatment can be not very costly or very costly depending upon the treatment. I think that a supplemental insurance option through the free market would be ideal in that scenario. The real question here, to me, is not between one treatment that may be better versus another, but getting the group of people not even receiving the first treatment consistently at least on that. That is sort of where I am going with this. In a question of what we can afford as a nation, i think the first option is better than none, though the second option is better than the first option. Right now, we should focus on getting people who don't even have option one yet at least on option one, in my opinion.

This is in opposition to trying to provide everyone the very best possible care in all areas, which really isn't going to be feasible in the long term. Even if we had a will to do so and a congress willing to pass comprehensive single payer healthcare or a partial single payer system for those who couldn't afford insurance, it's unlikely that our healthcare infrastructure would survive it while maintaining rigorously high standards. There are not just a finite number of doctors, there are a finite number of people who are able and willing to become doctors. There is the possibility of perhaps attempting to increase numbers of PAs and NPs with focused training for month to month management of chronic conditions that are stable, but even then, you it takes a lot of school and a long time to train these people.

The main question I have is, what is possible and viable long term? I'm philosophically opposed to single payer healthcare, but, from a practical standpoint, single payer may be possible, but only short-term. It would probably be the final push over the cliff fiscally. I doubt the government would survive a serious recession that resulted in a massive deficit over a two to three year period if it had that sort of program on the books. I also have concerns that single payer would drive many doctors out of the medical field as it is constituted due to much lower pay and would probably keep many away from medical school who may have had a mind to go otherwise. Even if it's not a massive swing, only say 5 percent, 10 percent, it doesn't matter how good your government provided healthcare coverage is if there are no doctors to see the patients.

Link to comment
Share on other sites


  • Group:  Royal Member
  • Followers:  6
  • Topic Count:  104
  • Topics Per Day:  0.02
  • Content Count:  2,923
  • Content Per Day:  0.62
  • Reputation:   462
  • Days Won:  2
  • Joined:  04/02/2011
  • Status:  Offline
  • Birthday:  03/22/1953

8 minutes ago, Out of the Shadows said:

These are great questions and if they are the place to start then we have to decide who answers them.  To take your example of "life saving" vs "quality of life" I will use an example I am familiar with.  For a Type 1 diabetic obviously insulin is without question life saving.  But then you get into the "delivery system" and it gets a bit more fuzzy.  Prior to the last 5 to 10 years the only choice was multiple daily injections.  Now they have pumps that allow a constant steady flow of insulin instead of a massive dose once a day of "long lasting" insulin as well as a way to administer insulin to cover food eaten and high blood sugar episodes without an injection.   There are also now glucose meters that constantly monitor your blood sugar and remove the need to prick a finger 6 to 8 times a day to check it.  

Some insurance companies see these as "quality of life" things as there is always the old fashioned shots that can be used.  Other companies have come to the conclusion that these devices (the pumps and CGMs) allow for better management of the disease and take away many of the high and low blood sugar episodes, which are what damage the body and cause greater problems later.  To these companies the investment now will save them the big bills later.  

So, in a system that makes things affordable, who would decide if the things above were really necessary or not?

Great example and good question.

Reducing the question to the basics - it's the old 'gold(en) rule.'  i.e. he who has the 'gold' makes the rules.

If we ourselves were paying out of pocket - we would determine based on our ability to pay and our own 'quality of life' factors.  

Since it's a third party that's paying, then the 3rd party makes the determination.  Bureaucrats - whether they be government or insurance company employees - will always strive for the one size fits all solution.  And the 'this is the way it's always been done' solution.

One hopes that whatever form 'single-payer' ultimately takes, that there is some kind of review board in place to address those factors.

Blessings,

-Ed

Link to comment
Share on other sites

Perhaps my own thoughts on this are a bit different. We all have a pre-existing condition, and that is being human.

So for me the question really centers on 1) to what extent should insurance cover us for being human, and 2) is it really the responsibility of the government to make sure that we are covered?

I honestly believe health services should be affordable, as we all have a stake in it by virtue of being human. I also believe government should have a role in how affordable it is, but not by getting into the insurance business. Whenever business is involved, money is always the bottom line, literally and figuratively. Governments have a role in how strong the economy is. If laws are crafted in such a way and the economy shaped in such a way that insurance companies see a benefit in lowering costs, then we all benefit. Or perhaps if insurance could be opened up across state lines and increase competition, that may work too.

But to say the government should be involved by providing its own healthcare is, in my opinion, not the right solution. Maybe if we didn't have so many laws and regulations that try to sterilize our public spaces, we'd have more God-given natural defenses to disease. I think there are better solutions for government to address the problem of healthcare costs than offering their own terrible insurance.

Link to comment
Share on other sites


  • Group:  Advanced Member
  • Followers:  2
  • Topic Count:  7
  • Topics Per Day:  0.00
  • Content Count:  312
  • Content Per Day:  0.12
  • Reputation:   140
  • Days Won:  0
  • Joined:  12/10/2016
  • Status:  Offline
  • Birthday:  09/05/1998

12 hours ago, SavedByGrace1981 said:

One can plead the case that people with 'pre-existing conditions' need access to healthcare - but having insurance companies provide it defies logic. It would be the same as this:

"Hello - ACME Car Insurance?  I'd like to purchase an automobile insurance policy.  My car?  It's a Ford - I just wrapped it around a tree and it's totaled.  Can you replace it for me?"

The fact that the car I want to insure is totaled is a 'pre-existing condition', right?  So why shouldn't the insurance company cover it?

Blessings,

-Ed

Exactly. That's why I said the insurance industry hasn't been able to insure people with pre-existing conditions. To avoid adverse selection, a company has to either refuse to insure such people or charge exorbitant premiums. My (very limited) understanding of the ACA was that it required everyone to get insurance, and also prohibited insurance companies from using pre-existing conditions when determining rates, essentially distributing their higher-than-average cost across all policyholders. And like I said, I don't think the solution has to be the ACA, but I do think there should be a solution. 

Link to comment
Share on other sites


  • Group:  Worthy Ministers
  • Followers:  29
  • Topic Count:  593
  • Topics Per Day:  0.08
  • Content Count:  55,864
  • Content Per Day:  7.55
  • Reputation:   27,618
  • Days Won:  271
  • Joined:  12/29/2003
  • Status:  Offline

letting insurance companies cross state lines might help, depending on whether or not the pool of healthier people is large enough.     Personally I don't see any way without mandating insurance.....   it was a conservitive think tank that brought out the mandatory insurance idea.

 

Personally if it were me I'd put everyone on medicare and let the insurance companies compete for the supplemental if people wanted it.  With everyone on it healthy or not, I think the doctors and hospitals could be paid enough to make money without raising medicare taxes.  I'd like to see a proposal for that and numbers that only the insurance companies could put together.

 

We could also keep the total cost of pharmaceuticals down.

Link to comment
Share on other sites


  • Group:  Servant
  • Followers:  25
  • Topic Count:  275
  • Topics Per Day:  0.05
  • Content Count:  5,208
  • Content Per Day:  1.00
  • Reputation:   1,893
  • Days Won:  0
  • Joined:  01/02/2010
  • Status:  Offline

4 hours ago, other one said:

letting insurance companies cross state lines might help, depending on whether or not the pool of healthier people is large enough.     Personally I don't see any way without mandating insurance.....   it was a conservitive think tank that brought out the mandatory insurance idea.

 

Personally if it were me I'd put everyone on medicare and let the insurance companies compete for the supplemental if people wanted it.  With everyone on it healthy or not, I think the doctors and hospitals could be paid enough to make money without raising medicare taxes.  I'd like to see a proposal for that and numbers that only the insurance companies could put together.

 

We could also keep the total cost of pharmaceuticals down.

That think tank should rethink calling itself conservative if it determines that forcing people into coverage through government action was a good idea. Putting everyone on medicare would mean raising taxes astronomically. 300+ million people on there as opposed to about 50 million now? It would require a massive, massive tax increase. I agree that the cost of pharmaceuticals would go down, but that would be because no new ones are being developed, because companies are not going to invest a bunch of money in creating new medications if the government decides how much they can charge for them.

Link to comment
Share on other sites


  • Group:  Worthy Ministers
  • Followers:  29
  • Topic Count:  593
  • Topics Per Day:  0.08
  • Content Count:  55,864
  • Content Per Day:  7.55
  • Reputation:   27,618
  • Days Won:  271
  • Joined:  12/29/2003
  • Status:  Offline

37 minutes ago, Steve_S said:

That think tank should rethink calling itself conservative if it determines that forcing people into coverage through government action was a good idea. Putting everyone on medicare would mean raising taxes astronomically. 300+ million people on there as opposed to about 50 million now? It would require a massive, massive tax increase. I agree that the cost of pharmaceuticals would go down, but that would be because no new ones are being developed, because companies are not going to invest a bunch of money in creating new medications if the government decides how much they can charge for them.

I used to think the same thing, but when I look at the drug my wife takes for MS, it first came out over 20 years ago and cost $1,200 a month.....   it now costs $6,700 a month.....   tell me how they can justify that besides the fact that they can.   Two companies bought the drug and they more than doubled the price every time the drug changed hands    Bayer was the last to buy it and they doubled it when they bought it and then two years ago they just added another $2,000 a month......   just because they can.

The epipens that I have to have to take allergy shots were $112 a pair a year or so ago and that's gone up to over $600....   which drives up insurance premiums.     The medical industry and Insurance needs to be closely controlled, for they all have a history of taking advantage of sick people, just because they can.

The only way we are going to get everyone medical coverage is to make it mandatory.....     and when people don't buy insurance and get sick they do the ER thing and when they can't pay we end up paying for them....    So until we can muster the courage to just tell the people without insurance to just go home and die, I'm for making it mandatory and do it over strict government control such as medicare.....    and if we have to raise taxes to do it, so be it....    but we need to do one or the other.

Link to comment
Share on other sites

  • Recently Browsing   0 members

    • No registered users viewing this page.
×
×
  • Create New...