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The Problem with Health Insurance
Posted by | Posted in Medical Health | Posted on 25-03-2009
Medical career workers hear constantly about the poor state of health care coverage in the United States. We hear about health care as a national item, on the agenda at every election. But why is it such an issue?
Insurance is inherently a poor investment, because when you buy an insurance policy, odds are that in the long run you’ll pay your insurance company more than they’ll pay you. It has to be that way, or else insurers would never be able to stay in their business. Insurers profit from the laws of probability in the same way as casinos. Consider an insurance agent as a bookie who lets you place long-term bets on whether you will come to misfortune.
But that doesn’t mean insurance isn’t worth having. The casino gambler places bets against the odds, on something that he hopes will happen immediately and not in ten years when he might really need his winnings. The insurance gambler, on the other hand, bets on something he hopes will never happen, so that he’ll be able to afford it in case it does. Thus the purpose of insurance is to reduce risk to an acceptable level, just like any security coverage. A corollary is that it’s not worth insuring something you can easily afford to pay for by yourself. People who do such things are generally the same kind of people who play lotteries.
Unfortunately, most health insurance policies seem to be designed by devout lottery followers. By involving middlemen in virtually every transaction in the process of getting medical treatment, they increase costs to both the patient and the practitioner. The only winners are the insurance companies, and some say the elected officials whose campaigns they funded.
For purposes of analogy, suppose you own your own home. Further suppose that your house is worth a lot of money, in fact, far more money than you have in your savings account. If the house burns down, you had terrible luck. You’ll most likely never be able to buy another one. So Bob the insurance salesman makes you a policy. If you pay him a hundred dollars a month, he’ll buy you a new house in the event that yours is destroyed. Maybe you accept the deal, because you’d rather make a poor investment than face the possibility of having to live at that scary motel down the street.
But Bob’s out to make money, of course. Catastrophe policies like yours are profitable, but they’re not the sort of thing that will enable him to retire to Tucson in ten years and live out his days in the better country clubs. So he also offers you a deluxe complete home coverage package. If you pay him five hundred dollars a month, he will still replace your house if it burns down; and now, for the price of a much higher premium, he’ll pay to fix just about anything else that might go wrong with it. Is the roof leaking? Find a roofer approved by Bob’s company, file a claim, and Bob will pay the roofer to fix it. You don’t have to negotiate the roofer’s rate, because Bob takes care of all of that. He might not be getting the best deal for the money, but you already paid him, so what should you care?
Even routine maintenance is covered, so every few years, your house is painted and your gutters cleaned at Bob’s expense. No matter what goes wrong, you don’t have to worry about such trivialities; you’re covered. And Bob is shopping eagerly for a new set of golf clubs. Then Bob starts to raise his rates, and pretty soon you can no longer afford his coverage. You go back to your original disaster insurance. The next time your roof needs fixing, you pick up the telephone book and decide to shop around for yourself.
To continue our example, you soon find that the rates roofers are charging nowadays are astronomical. This is because they’ve been dealing with insurance companies for so long that the notion of getting paid by a customer instead of an insurer is practically foreign to them. For many years, Bob and his friends have been telling roofers what they can do to fix people’s roofs, and how much they get paid for it. The upshot is that roofers don’t really have to compete with each other any longer to offer their customers lower prices. In the long run, people lose more than money by purchasing too much insurance; they lose their choices as well.
Most individuals aren’t foolish enough to purchase the sort of insurance we just described on their homes. And come to think of it, most people who actually purchase health insurance don’t get such a bloated policy either. You can get a deductible of a few thousand dollars. Instead of making insurance claims for something like penicillin or eyeglasses, you could easily write a check for it and be done with the matter.
But many people have wasteful insurance coverage anyhow. It has become standard practice for an employer to add health insurance as a benefit when hiring someone for any job designated as full-time. This is such a given that the employee usually doesn’t have any choice in the matter. In most cases, they can’t simply request the right to take care of their own medical needs in return for an increase in salary commensurate with their employer’s cost for the unwanted insurance. It isn’t really the employer’s choice either, as long as companies receive tax benefits for funneling their staff into the hands of the health-care system. If the guy with the IRS tells you he’ll take less of your money if you do things his way, you’ll do it if you want to keep your business afloat.
The overall effect is a vicious cycle in which the overhead and waste of insurance companies increase medical costs to the point where people without conventional jobs can’t afford treatment, and are thus forced into entering the system. This means more money for the insurance industry and higher medical costs for people working outside of corporate structures. This makes it ever more difficult for self-employed artists, writers, programmers, farmers, cab drivers, and so on to earn a living on their own. It makes a chilling effect on any kind of independent career such as freelancing, consulting, or small business start-up.
If there were easy solutions to the health care system, we would have found them by now. Other countries provide national health care for their citizens, but all that is is an extra tax placed on the income of it’s citizens. It still raises costs of health care coverage in the same way private insurance does, but without the extra drive to make it a profitable business. There are many models of health care providing throughout the world, and our country will have to look at them as time goes by and our citizens become more dependent on it. For now, all the medical career workers can do is continue patching the system as best they can.
Watch the video related to medical health
The first question you need to answer is whose birthday falls first in the year? Yours or your husband's? (It does not matter who is older, just which month you both were born in ) Whichever one of you has the first birthday in the year, that is the primary plan. Once you figure out which plan is primary, make sure they know that they are primary and the other plan knows it is secondary.
The second thing you need to do is to notify the providers that you are appealing the denials, and that you will keep them informed as to the progress. As long as you keep them informed as to what's going on in the appeal, as long as the providers are humans, it should keep you from being sent to collection.
Next: Call the primary plan and ask about an appeal. Ask them for the exact process – meaning what documentation you need, where it gets sent, and to whom it gets sent. Ask for a phone number you can call to follow up.
Send the appeal. Keep copies of EVERYTHING you send and mail the paperwork with a return receipt requested. This way, you know when it has been received and who signed for it. It will eliminate the "We never got your paperwork." problem. Once you know your submission was received, wait ten business days and start calling to check the progress. Call them every other day if you have to. DO NOT get frustated or give up. Insurance companies COUNT on that.
Once you have exhausted this option, then you file a complaint with the state. Otherwise, most states will not take action, they just sit on it.
In NY, it takes about 6 weeks for an investigation, but CA might be longer.
If you get a job that has group health benefits you will not have any problems, other than a 6 – 12 month waiting period (depending on your state) before any pre-existing conditions are covered.
If you try to get an individual policy, no matter your age, the companies will either place a permanent rider on the cataracts or will decline to accept you (again, depending on your state). A rider means they will accept you but not cover the cataracts or anything related to the cataracts. The rider will remain in place until you've had, and paid for yourself, corrective surgery.
They will deny your claim, and you will be liable for the full billed charges.
That's the risk you take when you deliberately commit insurance fraud.
You should be glad that you only have to pay a medical bill. Technically, your father's employer could take disciplinary action against him at work for defrauding the employer's benefit plan.
(Fortunately for your father, since you got caught a month after the fraud, he could play it off as an oversight if his employer gives him a hard time about it.)
Great presenter – what will happen when perhaps one day drugs are no longer available. Imagine all the insanity and crazy people who have become hooked on drugs to control there so called dis-orders . hmm. will make a great horror !!!!
I am a Biofeedback Trainer . It really works and is amazing. I just returned from working in Beijing, China for 6 months. I have been working with this tech. since 2006.
You have to contact the insurance provider. It varies from policy to policy but you can bet they won't want to spend a penny more than they must.
The Muse
We don't need to haggle over insurance. We need market pressures to drive prices down. Right now, we don't have any.
excellent worker!
Excellent! Very interesting. I wonder what the doctor has worked with EMDR.
We ought to launch you for overhauling health care reform. That is one mighty reasonable argument.
Insurance companies are making billions the way it is and will cry and moan should people want to interfere with their monopoly. There needs to be some sort of intervention to stop their ruthless practices upon the people of this society. With that said, there must be some sort of regulation.
Most people (individuals and families) would indeed participate if prices were reasonable and coverage was optimal. But that is not the way it is now nor do the big guns wish it to be. Drug companies are also billionaire monsters. Many elders of this society buy medications in lieu of buying groceries. That is simply not right.
The Obama plan simply wants you to die quicker, so you will not be one on the governmental roles that they are striving that you participate in.
Sort of contradictory, don't you think?
If these same people would get better jobs, they would have better insurance and not rely upon ME to pay for their medical bills.
Smoking weed does work. People that are brainwashed will always talk out their ass. Keep an open mind, don’t knock till you try it.
You are exactly right. It is unconstitutional. These "changes" are not some temporary solution to help out victims of a disaster. These "changes" are, if passed, going to forever chew up and spit out our Constitution and all our protections provided within it. Our original plan works. What doesn't work is shredding our Constitution and attempting to help those who won't help themselves. I am all for having some assistance to those who actually are in need but I am totally against the idea that we "unify" or pool all our funds together to help those "in need". It is ridiculous. It will not work. It is a scam and one that we will not fully recognize until we are deep in its clutches and left to realize what idiots we were for allowing it to happen to us. This whole league of new world order mentality nutbags wishes to devour us and leave us as a third world country. They have an entirely different agenda than they are telling us about and we, if we wish to survive, must reject their whole line of thinking and send them packing!
Very inclusive
Good presenter
School is so stressful for me, every summer I always wonder if I forgot to turn some homework in, pull my hair out about wondering about it, until finally realizing it’s summer, but I can’t imagine what I’d be like if I had been in a war.
I suggest that you google and check out VIRTUALLY BETTER; they provide virtual reality as part of the treatment for PTSD and it is my understanding they have obtained good results.
By the way, thank you for your sacrifices for this country.
I believe that this technology exists, but I do not know it exactly works or what companies provide it. Also, as far as I know you do not want the person to fall asleep while relaxing, because that means she is hypoactivated.