Michael Moore's new film: Sicko

[Copernicus]

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There is COBRA.

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Only 7% of workers who are unemployed can afford COBRA. Doesn't seem like too good of a system.

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Really? Can you show real research and numbers on this because I have a hard time believing that a company who does this too often will stay in business. They will lose in court and they will lose customers.


I'm sure this happens now and then. That's what plaintiff attorneys are for. If you have a serious condition and it is covered in your contract but they deny it, you've hit the jackpot my friend.

natedogg

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I can give you a number of anecdotal stories since my mom is a doctor, but I'll try to look up some numbers for you. In the meantime, consider my points on this issue.

It is in the best interest of the insurer to deny coverage if you can get off on any technicality. They pay doctors and researchers to find reasons not to approve claims. They freaking pay people to find ways to deny care! I'm not only talking about people to investigate if the person is actually sick. I'm talking about people to investigate if the person dotted all their i's and crossed all their t's in their paperwork.It makes financial sense. Obviously they grant many more claims than they deny, so it's not some huge alarming percentage.

Also consider the fact that for the company to lose clients, the public will have to learn about their shadiness. Let's say .5% of the claims a company receives are actually fraudulent. If they deny a few more claims based on technicalities and "alternate" medical opinions and deny 1-2% of claims they make a ton of money and it still looks pretty reasonable. Why would they not do this? If companies are such rational actors and want to make as much profit as they can, it is in their interest to deny you care if there is any way they can get away with it.

Edit: I found some numbers on about.com, but they didn't give a citation so I'm wary. They said 10% of claims were unjustly denied and 1% of those were contested. No idea where they get these numbers so I'll keep looking. It's not as easy as I thought to find any statistics on denied claims.

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I cant speak to individually purchased insurance, but this is total hooey wrg to employer . The vast majority of employer provided health insurance is at least partially self-funded and administered by third parties, not by insurers. The TPA has performance incentives for accuracy on both approved and denied claims, and is audited annually. The employer has its own self-interest in having legitimate claims approved and I know of at least 4 TPAs that have gone out of business for denying claims too often. On the excess, truly insured portion of the coverage, usually 5 figure claims and up, 100% of claims are reviewed.

The general results of over 15 years of claims audits I was involved with are that claims are OVERPAID far more often than denied or underpaid. Pre-audit the average level of incorrect payments was on the order of 2%-3% of the number of claims were overpaid, with slightly higher percentages of dollar amounts of claims overpaid (bigger claims result in bigger overpayments).

[pvn]

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No, I'm saying universal health care provided by corrupt politicians is better than our current state. In my personal cost-benefit analysis, the benefit of universal health care outweighs the cost of an inefficient system.

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Ah ok. Well, suppose that the benefit doesn't outweigh the cost in *my* cost-benefit analysis. Why is yours better? They're both based upon our own subjective personal preferences. So why should I have to help you buy what you want?

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You're welcome to vote differently [img]/images/graemlins/smile.gif[/img].

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I don't vote. Why should the results of some decision 10 other people make be imposed upon me?

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I don't like a lot of stuff that the government does with my taxes. I don't think it's possible to agree with every action your government takes if you're educated at all,

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Ditto for me.

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so I don't think it makes that much sense to ask why I should pay taxes for some service I don't want/like.

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Let's say you like to drink coke. My friends and I decide you need to buy pepsi instead. We outnumber you. You have to pay for two cases of pepsi per month, whether you drink them or not. You can still buy coke and drink that, but you have to buy the pepsi even if you decide to not drink any soda at all and just drink milk instead.

Would it make sense to ask why you should do this?

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I think that this point may be where I'm differing from a lot of people here. I think maybe we just place different values on a healthy population and the taxes we have to pay. If that's the case, maybe we can't really come to an agreement.

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Maybe we have the same value on "a healthy population" (nice appeal to emotion there) but we have different ideas about how to achieve that goal. So why should I be forced to fund your perferrred method?

[pvn]

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I think maybe we just place different values on a healthy population and the taxes we have to pay.

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BTW, this is a motivation-attacking-argument; along the lines of "you don't want to pay for my tax-funded boondoggle, so you must be in favor of people being sick." I've written about these types of arguments before here .

[neverforgetlol]

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Minus . . . 40 million people have no health insurance. Lots of people with health insurance have awful coverage because most insurance companies suck balls.


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This is completely untrue. Health insurance is very affordable in this country. There are some problems due to it often being tied to your employment, but regardless, one can easily get cheap quality coverage for a great price as long as they're buying actual insurance and not buying a coverage plan after the fact.

Anyone without health insurance has chosen to do without it.

natedogg

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Wow, this is really terrible. Do you have numbers to back this up? Remember not all people are young with no dependents and no preexisting conditions.

[neverforgetlol]

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When people make hysterical claims about the health care crisis I simply have to wonder what they're talking about. Health insurance is cheap and available for the vast majority.

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You really don't know what they're talking about? If you believe that accessibility for everyone is required, accessibility for only the vast majority is clearly a problem.

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The few who have no access to health insurance are in that position due to govt regulation. Losing your health insurance because of a job change/loss is the only case where it is truly difficult to get insurance.

Yet even so, those numbers are few and hardly constitute the 'crisis' that everyone seems to accept as fact.

natedogg

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40+ million is "few?"

[pvn]

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Minus . . . 40 million people have no health insurance. Lots of people with health insurance have awful coverage because most insurance companies suck balls.


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This is completely untrue. Health insurance is very affordable in this country. There are some problems due to it often being tied to your employment, but regardless, one can easily get cheap quality coverage for a great price as long as they're buying actual insurance and not buying a coverage plan after the fact.

Anyone without health insurance has chosen to do without it.

natedogg

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Wow, this is really terrible. Do you have numbers to back this up? Remember not all people are young with no dependents and no preexisting conditions.

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Try getting fire insurance after your house burns down. Does the fact that it's basically impossible constitute a "crisis"?

[Taraz]

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I cant speak to individually purchased insurance, but this is total hooey wrg to employer . The vast majority of employer provided health insurance is at least partially self-funded and administered by third parties, not by insurers. The TPA has performance incentives for accuracy on both approved and denied claims, and is audited annually. The employer has its own self-interest in having legitimate claims approved and I know of at least 4 TPAs that have gone out of business for denying claims too often. On the excess, truly insured portion of the coverage, usually 5 figure claims and up, 100% of claims are reviewed.

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Doesn't this go more toward proving my claim than yours? If you personally know of 4 providers who've been denying too many claims, doesn't that suggest that it is relatively common to try to deny as much as possible?

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The general results of over 15 years of claims audits I was involved with are that claims are OVERPAID far more often than denied or underpaid. Pre-audit the average level of incorrect payments was on the order of 2%-3% of the number of claims were overpaid, with slightly higher percentages of dollar amounts of claims overpaid (bigger claims result in bigger overpayments).

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I don't deny this. I think I've already stated that I don't believe efficiency in this field is as important as making sure nobody is wrongly denied.

[Taraz]

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You're welcome to vote differently [img]/images/graemlins/smile.gif[/img].

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I don't vote. Why should the results of some decision 10 other people make be imposed upon me?

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Because you happen to live in a democracy. There are always going to be some people unhappy with some laws.

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so I don't think it makes that much sense to ask why I should pay taxes for some service I don't want/like.

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Let's say you like to drink coke. My friends and I decide you need to buy pepsi instead. We outnumber you. You have to pay for two cases of pepsi per month, whether you drink them or not. You can still buy coke and drink that, but you have to buy the pepsi even if you decide to not drink any soda at all and just drink milk instead.

Would it make sense to ask why you should do this?

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If pepsi saved lives and led to better health for our population I would say it is a cost that is worth it. I'm not saying that it's "free", I'm saying it's worth the price we have to pay. The lesser of two evils sort of thing.

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I think that this point may be where I'm differing from a lot of people here. I think maybe we just place different values on a healthy population and the taxes we have to pay. If that's the case, maybe we can't really come to an agreement.

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Maybe we have the same value on "a healthy population" (nice appeal to emotion there) but we have different ideas about how to achieve that goal. So why should I be forced to fund your perferrred method?

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But you haven't laid out any realistic way to achieve that goal. I've said on multiple occasions that I am extremely open to alternatives. I've agreed that we need to get rid of the price inflation that's in place because of the AMA. That doesn't really address the problem of insuring that people aren't denied care. I don't know how else to put it. I think that it is a worthwhile to make sure that everyone gets health care in this country as soon as possible. It seems like you don't.

I understand that you believe if we get rid of all government intervention the market will work it all out. Even if I grant you that there are no problems with that, how long would that take to accomplish? I simply haven't seen anyone lay out a plan of how we go from all this regulation to none whatsoever. This problem is big enough, in my mind, that we need to act now.

[Taraz]

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I think maybe we just place different values on a healthy population and the taxes we have to pay.

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BTW, this is a motivation-attacking-argument; along the lines of "you don't want to pay for my tax-funded boondoggle, so you must be in favor of people being sick." I've written about these types of arguments before here .

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I don't mean to imply that you are in favor of people being sick. I mean to imply that you think the taxes that are needed to pay for such a program constitutes theft and that this theft is worth than the health care problem.

It's sort of like if I had to choose between poisoning two Norwegians or stabbing two Italians. If I choose to poison, that doesn't necessarily mean that I'm in favor of killing Norwegians. Both options suck and we have to make a choice.

[mjkidd]

Are you kidding? Stabbing the Italians is such a superior option.