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Author: Subject: Health Insurance / Health Care and you?

Maximum Peach



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  posted on 3/27/2017 at 08:14 AM
I saw Kathleen Sebelius on Don Lemon I think it was the other night. And Lemon posed her a question, "some people complain that they are forced to pay for things they don't need or want in their insurance policies, as in mental health care, maternity care for a man, etc". Sebelius' response is "those people don't understand how insurance works" (kind of laughing while she is saying it).

With all due respect to Mrs Sebelius, I remember how private health insurance plans worked before ACA when premiums were lower and when many people got the appropriate coverage for their needs (without having ACA mandated provisions in the plan).

I wonder if Mrs Sebelius understands how insurance works? Because choice in what you want to pay for and what you want covered is found in all other forms of major insurance.

Take home insurance. First of all, wide ranging choice of deductibles are available, in either dollar amounts or percentage of home value (and when deductibles go up, the premium goes down - in inverse was true with ACA). Then, you can insure the home for market value or replacement cost; and within this you the homeowner can submit a professional appraisal or quote from a certified home builder to determine the replace cost coverage you want (as in you don't just have to rely upon the insurance company to tell you how much it will take to rebuild your home). You can work to set a customized value for contents, with special provisions for collectables. You can choose different coverage levels of liability coverage. You can purchase earthquake coverage, or special policies for additional high wind/hail or flood/water backup coverage. Mold remediation coverage can be increased. If you have detached building on the property, coverage levels for those buildings can be selected. So many varied choices to customized coverage to suit one's needs or wants with different price points along the way.

Let's look at auto coverage. Again, off the bat, you can choose a deducible that fulfills your objective and the premiums is priced accordingly (higher deductible = lower premium, the way insurance pricing is supposed to work). I can have comprehensive, liability only, or fire & theft only. I can determine what extent of liability coverage I want to pay for. I can select or reject under insured / uninsured motorist coverage. I can pick certain coverage for hail damage or cracked windshield replacement. I can get a premium discount for safe driving record.

There is alot of choice in home and auto policies and alot of opportunity to save in not paying for coverage that one doesn't need or want. It doesn't sound to me like Mrs Sebelius is very familiar with how other insurance works. Thankfully she wasn't in charge of changing the home or auto insurance industry.

 

Zen Peach



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  posted on 3/27/2017 at 06:14 PM
quote:
The Trump supporters weren't duped. They never cared whether he could enact his policies or not. They just admired someone who was willing to be as hostile as he was/is. They just want the hostility - nothing more, nothing less. Accomplishments? not important.


Not so, he had and has a platform of changes he wants to make, and that is why people voted for him. People want tax reform, and he is on that right now. People want the illegal immigration to be effectively dealt with, it is my understanding bids will be accepted in April for the building of the wall, and construction can begin within 6 months. Trump is a man of action, and he will try his hardest to make America great again. I will concede that the health care proposal needs more work.

 

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"Mankind is a single nation" "Allah did not make you a single people so he could try you in what he gave you, to him you will all return, he will inform you where you differed". Quran Chapter 2 Sura 213

 

World Class Peach



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  posted on 3/27/2017 at 08:14 PM
quote:
I saw Kathleen Sebelius on Don Lemon I think it was the other night. And Lemon posed her a question, "some people complain that they are forced to pay for things they don't need or want in their insurance policies, as in mental health care, maternity care for a man, etc". Sebelius' response is "those people don't understand how insurance works" (kind of laughing while she is saying it).

With all due respect to Mrs Sebelius, I remember how private health insurance plans worked before ACA when premiums were lower and when many people got the appropriate coverage for their needs (without having ACA mandated provisions in the plan).

I wonder if Mrs Sebelius understands how insurance works? Because choice in what you want to pay for and what you want covered is found in all other forms of major insurance.

Take home insurance. First of all, wide ranging choice of deductibles are available, in either dollar amounts or percentage of home value (and when deductibles go up, the premium goes down - in inverse was true with ACA). Then, you can insure the home for market value or replacement cost; and within this you the homeowner can submit a professional appraisal or quote from a certified home builder to determine the replace cost coverage you want (as in you don't just have to rely upon the insurance company to tell you how much it will take to rebuild your home). You can work to set a customized value for contents, with special provisions for collectables. You can choose different coverage levels of liability coverage. You can purchase earthquake coverage, or special policies for additional high wind/hail or flood/water backup coverage. Mold remediation coverage can be increased. If you have detached building on the property, coverage levels for those buildings can be selected. So many varied choices to customized coverage to suit one's needs or wants with different price points along the way.

Let's look at auto coverage. Again, off the bat, you can choose a deducible that fulfills your objective and the premiums is priced accordingly (higher deductible = lower premium, the way insurance pricing is supposed to work). I can have comprehensive, liability only, or fire & theft only. I can determine what extent of liability coverage I want to pay for. I can select or reject under insured / uninsured motorist coverage. I can pick certain coverage for hail damage or cracked windshield replacement. I can get a premium discount for safe driving record.

There is alot of choice in home and auto policies and alot of opportunity to save in not paying for coverage that one doesn't need or want. It doesn't sound to me like Mrs Sebelius is very familiar with how other insurance works. Thankfully she wasn't in charge of changing the home or auto insurance industry.



Not to repeat myself too much (which I've been known to do) but if you elect not to insure your car for replacement value and it is totaled you are not driving away with a new one. If you underinsure your health and show up at the ER at 3:00AM you are going to be treated by the hospital and its physicians for whatever ails you. Yes; it may bankrupt you. But one can't get blood from a stone.

And down to detail. If a Jehovah's witness signs up for insurance that doesn't cover blood transfusions and/or organ transplantation and changes their mind it is malpractice to deny them the service

 

Maximum Peach



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  posted on 3/27/2017 at 09:15 PM
quote:
quote:
The Trump supporters weren't duped. They never cared whether he could enact his policies or not. They just admired someone who was willing to be as hostile as he was/is. They just want the hostility - nothing more, nothing less. Accomplishments? not important.


Not so, he had and has a platform of changes he wants to make, and that is why people voted for him. People want tax reform, and he is on that right now. People want the illegal immigration to be effectively dealt with, it is my understanding bids will be accepted in April for the building of the wall, and construction can begin within 6 months. Trump is a man of action, and he will try his hardest to make America great again. I will concede that the health care proposal needs more work.


For 8 years the Republicans made it priority #1 to repeal, and sometimes, to repeal and replace "Obamacare". And Donald Trump is the Republican President, the Republicans have a majority in the House of Representatives and have previously passed ACA repeal bills.

I'm not vested in this, but Trump and the Republicans are certainly vested in this...neck deep. 8 years, Eight Years...they told people they would do this, and they - or he - couldn't. "People" may want tax reform and "people" may want immigration reform, those issues strike much closer to my area of interest, but you just can't say 'oh well' and move on now and act like nobody else is watching or cares.

quote:
Not to repeat myself too much (which I've been known to do) but if you elect not to insure your car for replacement value and it is totaled you are not driving away with a new one. If you underinsure your health and show up at the ER at 3:00AM you are going to be treated by the hospital and its physicians for whatever ails you. Yes; it may bankrupt you. But one can't get blood from a stone.

And down to detail. If a Jehovah's witness signs up for insurance that doesn't cover blood transfusions and/or organ transplantation and changes their mind it is malpractice to deny them the service


I don't mind repetitive posts as it shows conviction and consistency and helps remind people who quickly scroll through posts of important points you want to make.

The current health insurance industry in this country is not capable of enacting the kind of changes that a person like Kathleen Sebelus wants to set forth. She says 'we' don't understand how insurance works, well if she was setting the parameters for home owners insurance 'we' would all have hurricane and earthquake coverage on our homes, regardless of location. That is the same thing as requiring me to pay for drug rehab or maternity costs - something I will never use.

People need to have skin in the game, people need to budget and save for their medical costs. Nobody should get a free ride. If you have income of 20k or 200k some portion of that should go towards medical expenses that you incur.

You know really, alot of the people complaining about ACA now are complaining because their deductibles are too high and they can't "use" the insurance, as in they are having to pay for too much.

That is a good thing, people having to be accountable for their costs up to the deductible and make decisions and form habits accordingly. Health insurance should not be an all-expenses-paid vehicle. It should cover events and circumstances that are unforseen and unexpected in our lives.

The problem that I see with the ACA is that if you are searching for an individual policy and make too much money to get a subsidy then you find premiums on $6000 deductible plans too high. I mean, why we have to subsidize up to 400% of federal poverty level points to another underlying problem, the sh:t is too damn expense in the first place. 400%. I think federal poverty level is 12,500, so if you make $50k as an individual you are still eligible for subsidy. Why? A $6000 deductible plan should have relatively low premiums, that essentially is a catastrophic plan and should be billed as such. But no, we have some people paying several hundred dollars per month for that and then still have to pay out of pocket for everything up to that point. I don't know exactly, I think I have an idea, but something after ACA made high deductible plans have the same premium as previous lower deductible plans. And as deductibles rise, premiums should decrease - the inverse was true with ACA. People paid more and got less - atleast some of them.

And then there is that. This is hardily the first time and won't be the last time, but ACA has divided us as so many other things in our history has.

Middle class people buying individual plans not eligible for subsidy assistance are seeing their premiums go up and they get pinched more, while somebody on Medicaid can just walk into the ER and get what they need and walk out with no bills.

Resentment is building from the middle down. Surely we've had resentment from the lower tier of society upwards, and to an extent alot of people resent somebody else for what they have or where they are in life.

But here the example is, work hard, save when you can for your medical expenses and then somebody else in society doesn't have to work and doesn't have to save for their expenses. Medicaid certainly has it's drawbacks, but then again, when you look at it this way it has it's benefits too. When working middle class people would rather have Medicaid then their private plans we have a problem with how this system is constructed.

 

Zen Peach



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  posted on 3/27/2017 at 11:02 PM
Why I understand what you are saying, this line from you always bothers me about republicans/conservatives...

"But here the example is, work hard, save when you can for your medical expenses and then somebody else in society doesn't have to work and doesn't have to save for their expenses."

This seems to always be code for 'lazy people' and usually minorities... I hear all the time from a few libertarians that I know that 'I worked hard for my money, why can't they'.... well, maybe they weren't a privileged white person who was able to get a good education and had a network of friends and relatives to help them get a good job.....

It's always "they" that just don't want to work .... and I don't think it's that simple.

I know that's not what you meant...... but if you listen to Paul Ryan and the other republican mouthpieces on the healthcare issue, you wonder if they know how the real world works and how most people struggle to pay just their very basic bills....

 

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Maximum Peach



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  posted on 3/28/2017 at 08:05 AM
I think that something we rarely stop to do or talk about is that there are all different types of people in any group. Not every person in whatever category is the same with the same circumstances or background or feelings.

So ofcourse, there are many people that have been less fortunate in their lives which hasn't been of their own doing. Life's circumstances, or luck as it is, has put them where they are - not that they want to be there, or stay there...it's just the facts of life. They aren't bad in any way. Just like there are many people who through no good special efforts of their own have found themselves in better circumstances, these people aren't better in any way. It is just the way life works.

What I feel related to medical expenses is that everyone needs to have an appreciation and exposure to the costs they are creating through their use of products and services in our health care system.

Even if a medicaid recipient was responsible for say 10% of their billed cost and the government would pick up some larger portion...it doesn't have to be the same % or amount that somebody more financially stable is responsible for, it just has to be some amount that makes people realize and think about their actions and the consequences of choices and different types of services they use. There should not be a total disconnect between the ones receiving the care and the ones paying for the care.

 

World Class Peach



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  posted on 3/28/2017 at 08:41 AM
Almost all Insurance companies now make the consumer responsible for an increasing amounts of their bill - for just the reason you stated. Charging Medicaid participants even $5 would make them more responsible. A few don't have even that.

I think we all agree that the system is broken; the question is how to fix it. I think the middle class felt a bit thrown under the bus with ACA when it found out it was going to pay the bill for the poor. The definition of rich is akin to the definition of promiscuity (AKA anyone who gets laid more than you do.) Everyone thinks those who make more than they do should pay.

 

Zen Peach



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  posted on 3/28/2017 at 01:42 PM
A $5 fee to someone living on $7,000 per year is not reasonable. That's what public assistance recipients in New York have who are on assistance only and covered by Medicaid receive. Medicaid is income based. There are working poor people and families, the qualifying income is not much above migrant worker incomes.

The insurance companies need to stop the greed, and their executives do not need triple digit incomes off the backs of the poor and the working class. Just like the oil executives who were getting 300-400% profits back in 2008, I don't even know what it is now, it is wrong.

Here's a novel idea, insurance and housing costs based on a person's income. So if you have almost nothing, you do not pay the same as someone else who has a lot more. Minimum wages need to be indexed to the costs of living in different parts of the country, one size does not fit all.

http://www.universallivingwage.org/

If people earned a LIVING WAGE, they could pay something towards their health care, as things are now, they cannot. Multiple problems, common sense solutions.







[Edited on 3/28/2017 by gina]

 

____________________
"Mankind is a single nation" "Allah did not make you a single people so he could try you in what he gave you, to him you will all return, he will inform you where you differed". Quran Chapter 2 Sura 213

 
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