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Thread: Obama calls for overhaul of U.S. health care system

  1. #111
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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by Coolguy View Post
    That isn't my understanding.
    The coverage is being denied because it really isn't covered.
    It is being denied because of the minutia of the details in the contract. Experimental treatment. Treatment that really wouldn't extend a persons life.
    Patient really did not fit the criteria even though it would extend their life.
    Cost caps. Etc..
    This is what insurance companies want you to believe. As a provider, I can tell you of NUMEROUSexperiences when an insurance company over ruled a treatment that was absolutely covered in the patient's insurance plan because they believed that it wasn't necessary...even after I sent documentation proving that it was. Why did they do this? Only one reason: greed.

    If this is what is happening, then by all means, yet somehow it seems that it would be more vulnerable to fraud.
    It's what's happening. And, to me, it is an example of unethical business practices.


    Ok.
    I do have a problem with this because when you change to a new insurer you are receiving insurance from them for the first time.
    It isn't there problem that you have a preexisting condition, so they should be allowed to charge higher premiums to provided cover that obviously they would have to start paying out if they accepted the person.
    I suppose I could be persuaded to agree to this, if the pre-existing condition clause was totally eliminated, and the premium increase wasn't so ridiculous that it was untenable.

    Ok. Agreed to disagree.
    Less regulation should result in a lower overall cost that would then be transferred to the insurer, and on to the insured.
    The "trickle down" economic theory always fails because of greed. We will have to agree to disagree.
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  2. #112
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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by WI Crippler View Post
    I'll go over some of these things again, as I have done a few times.

    I agree that there needs to be more regulation in the healthcare system, not less, but only in some areas. But the focus needs to be in the relationship between the provider and insurer, because this is a two way street. Yes, insurance providers do have people looking at treatments and rejecting payment of those treatments to the provider, based on what they believe to be treatments that are unecessary. While its true that these people do not see the patient, the treatment is reviewed by a liscenced medical professional. The insurers pay good money to these people. In the case of an RN, he/she could make well more than they could working at a hospital. However, providers are more willing to do "more tests" for insured patients, than they will for uninsured patients. Because the insurance companies have the deep pockets. This back and forth fight between health insurer, and provider over what is necessary, is a HUGE part of the problem IMO. This is an area that needs regulation. However, it is my opinion that the regulation needs to come from the states and not the federal government. Insurance laws are written by state legislatures and are overseen and enforced by a commisioner of insurance in each state. Devising a national regulatory system would infringe on the ability for states to retain control over the health care providers and insurers under their rule.

    The payment situation is absurd, and its because of the back and forth struggle between insurer and provider. I received a bill for $350 almost a year after my son was born, from my wifes anethesia. I called to find out why I was getting a bill for $350 dollars, since we hadn't been to the hospital for nearly a year. Supposedly there was a dispute between the two that had to be settled before they could bill us. Now thats not a huge bill in this case, but its an inconvience for sure.

    If we were to remove the stipulation that pre-existing conditions have to be covered, then insurers will have to be allowed to charge additional premium because of pre-existing conditions. Insurance by definition is the transfer of risk. The greater the risk they assume, the greater the premium they charge. Thats the insurance market in a nutshell. The reason they do not cover pre-existing conditions, is because they are trying to keep the premiums lower. Anybody who seeks to reform this, had better be careful because if they try to be noble and force insurers to cover pre-existing, and deny them the ability to charge for it, will seriously screw everything up and insurance companies would either collapse(more unemployment for you to deal with Mr. President) or they would find a way to increase premium in an "unrelated" way, to cover costs.

    Also I remember reading on Obama's website during the campaign season, that he would essentially remove the cap on insurance policies. I do not know if he still seeks that, but that would be a disaster of epic proportions. As I said before, insurance is a transfer of risk. If we tell insurance companies they must take on an infinite amount of risk, what do you think that will do to premiums? ALL insurance policies, regardless of what kind of insurance it is, has a policy limit. The higher the limit, the higher the premium. Insurance companies have deep pockets, but not that deep.
    I can agree with much of what you say except two points:

    1) Those that the insurance companies employ to review treatments are indeed trained professionals. It is still irrelevant. They do not see the patient. Reviewing files or hearing reports is completely different. As a provider, I see my own patients. If a colleague goes on vacation and asks me to cover, I am very uncomfortable doing that. Though they may tell me about them, and I may read about the case, I will NOT make any major treatment decisions, unless their is a major crisis. There are nuances that go along with working with a patient that don't go in the record. These people at insurance companies don't see these nuances. Further, it is not the job of these people to help provide the best care; it is the job of these people to save their company money. This aspect of insurance-provider care needs to be eliminated.

    2) It needs to be in the hands of the federal government, not the states in order to provide conformity amongst policies, to head off confusion. I work in NJ, and my patients come from NJ. However, I deal with insurance companies from at least 10+ different states, as the companies these patients work for may have their home office in other states. Each of these states have different regulations, different paperwork requirements, etc... This is just another way for the system to break down and for payment to get denied. I once sent a request for service to an insurance company in Pennsylvania. After receiving no payment for 2 months (it takes that long or longer), they told me the home office was in Missouri. So, I sent it there. Same thing...2 months later, they told me that this patient's divisional home office was in California. So I sent it there. Same thing...2 months later, they told me that Pennsylvania was wrong, that that was where it was to be sent. This "round and round" process went on for 8 months. Further, each state had different regulations on how the paper work needed to be handled, requiring it to be sent back, more times, especially when they gave me wrong information. And all the while guess what? I wasn't getting paid for treatment. If this was an isolated incident, I wouldn't be complaining. But it's not. This is why many people in the medical field no longer accept any insurance...and why many cannot afford health care.

    More regulation on the federal level, taken out of the states' hands in order to avoid the kinds of manipulations that occur, and to avoid the lack of conformity in dealing with companies is what needs to happen.
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    This is what I hate about politics the most, it turns people in snobbish egotistical self righteous dicks who allow their political beliefs, partisan attitudes, and 'us vs. them' mentality, to force them to deny reality.

    Quote Originally Posted by Navy Pride View Post
    You can't paint everone with the same brush.......It does not work tht way.


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    See with you around Captain we don't even have to make arguments, as you already know everything .
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    Had you been born elsewhere or at a different time you may very well have chosen a different belief system.
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    It a person has faith they dont need to convince another of it, and when a non believer is not interested in listening to the word of the lord, " you shake the dust from your sandels and move on"

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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by Harry Guerrilla View Post
    The poor can rise to another class if they put the effort in to it.
    It is not in the realm of fantasy.
    There are many barriers to social mobility: income, education, access to suitable employment, family obligations (poor families distribute more duties among themselves instead of hiring out), language (immigrants), racial biases, etc.

    I don't think it's as easy as you make it seem. The rich don't want the poor to rise, they want them to stay right where they are.

    Quote Originally Posted by Harry Guerrilla View Post
    Health insurance is affordable if most people buy it. They just choose not to buy it. People do not have their priorities straight that is why we should not support UHC.
    Some people who need health insurance because of illnesses cannot get their foot in their door with insurance companies due to a pre-existing condition. That is a huge difference between UHC and private health insurance: regardless of pre-existing conditions, you get treated.

    Many people who do get their foot in the door get slapped with ridiculous policies and restrictions after the fact. The insurance companies are corrupt and need regulation.

    It's not so one-sided that you can JUST blame subscribers.

    Quote Originally Posted by Harry Guerrilla View Post
    If you can afford cable or satellite television but you won't get rid of it to get your health insurance then that is your problem and not anyone elses.
    This is a straw man if I ever saw one.

    Quote Originally Posted by Harry Guerrilla View Post
    Lastly what is more important your stuff or your life? It seems your friend values material things more than his life.
    Why should you have to choose between something you have worked your entire life to achieve and a recent health condition? Why should you have to throw it all away because the system is so anti-socialist and won't help you?

    It makes no sense.

  4. #114
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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by Orius View Post
    There are many barriers to social mobility: income, education, access to suitable employment, family obligations (poor families distribute more duties among themselves instead of hiring out), language (immigrants), racial biases, etc.
    You must not know about all the social programs to help poor people then.

    The federal government pays for food, higher education, job assistance, childcare, states and local governments in a lot of places offer free language training.

    Racial biases are largely extinct and hardly play any role.

    Quote Originally Posted by Orius View Post
    I don't think it's as easy as you make it seem. The rich don't want the poor to rise, they want them to stay right where they are.
    I never said it was easy. Do you think all the rich people got that way so easily?

    Quote Originally Posted by Orius View Post
    Some people who need health insurance because of illnesses cannot get their foot in their door with insurance companies due to a pre-existing condition. That is a huge difference between UHC and private health insurance: regardless of pre-existing conditions, you get treated.
    If they had it before hand it wouldn't be a problem. It's called balancing risk.

    **** happens and if you take a risk and fail there is no one to blame but yourself.

    UHC will restrict access because of over consumption in the end its like being uninsured.

    Quote Originally Posted by Orius View Post
    Many people who do get their foot in the door get slapped with ridiculous policies and restrictions after the fact. The insurance companies are corrupt and need regulation.
    Insurance companies are the way they are because of the government.

    It is a long history of government stupidity that started during WW2 and some of the regulations are completely asinine.

    Quote Originally Posted by Orius View Post
    It's not so one-sided that you can JUST blame subscribers.
    I'm not blaming subscribers, they actually bought the insurance.


    Quote Originally Posted by Orius View Post
    This is a straw man if I ever saw one.
    If I had $100 to lay down on a bet that nearly every single person who doesn't have health insurance has cable or sat tv I would so do it.

    Quote Originally Posted by Orius View Post
    Why should you have to choose between something you have worked your entire life to achieve and a recent health condition? Why should you have to throw it all away because the system is so anti-socialist and won't help you?
    Why should people throw away their hard earned money to support a socialist institution when they labored so long to get it?

    Piss poor planing. Life is not a fairy tale, it can be cruel and people should plan for unexpected situations.

    Quote Originally Posted by Orius View Post
    It makes no sense.
    To me it makes perfect sense. People should be held accountable for their decisions.

    If you enable crappy decision making it will never change.
    I was discovering that life just simply isn't fair and bask in the unsung glory of knowing that each obstacle overcome along the way only adds to the satisfaction in the end. Nothing great, after all, was ever accomplished by anyone sulking in his or her misery.
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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by Orius
    It's because of the corrupt corporations that UHC is on the table in the first place, since the insurance companies make it so complicated and unaffordable to use their services.
    Exactly!!!!

    If the current system is the 'best in the world', as some claim, health care would be another one of those things we never think twice about.
    “We just simply don’t know how to govern” - Rep. Steve Womack (R-AR) a member of the House Budget Committee

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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by Orius View Post
    Why should you have to choose between something you have worked your entire life to achieve and a recent health condition? Why should you have to throw it all away because the system is so anti-socialist and won't help you?
    Because you are responsible for you, and I am not?
    How do YOU have a right to MY money, epecially when YOU have money of your own?

    It makes no sense.

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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by Goobieman View Post
    Because you are responsible for you, and I am not?
    How do YOU have a right to MY money, epecially when YOU have money of your own?

    It makes no sense.
    What the heck do you think insurance is? It is a pool of money that people pay into. The ones that get sick use other peoples money the one's that don't don't use the money.

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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by winston53660 View Post
    What the heck do you think insurance is? It is a pool of money that people pay into. The ones that get sick use other peoples money the one's that don't don't use the money.
    Yes it is. A pool of money that they chose to put into.

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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by Coolguy View Post
    Yes it is. A pool of money that they chose to put into.
    Doesn't change the fact that it is people using other peoples money.

  10. #120
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    Re: Obama calls for overhaul of U.S. health care system

    Quote Originally Posted by BWG
    Exactly!!!!

    If the current system is the 'best in the world', as some claim, health care would be another one of those things we never think twice about.
    Your health is a bit more important than purchasing a television or choosing what color to paint your house.

    That is why people think about it.

    I don't understand why people are so willing to turn over heath care to government, when government hardly does anything right.

    Can you name a successful program that government does right that everyone uses?

    Quote Originally Posted by winston53660 View Post
    Doesn't change the fact that it is people using other peoples money.
    It is a significant difference though.

    If you want to not use a health insurance plan you can.

    If you want to self insure you can.

    If someone wants to come up with a new business model to address health related expenses they can and people can voluntarily use it.

    There is a difference between voluntary socialism and forced socialism.
    I was discovering that life just simply isn't fair and bask in the unsung glory of knowing that each obstacle overcome along the way only adds to the satisfaction in the end. Nothing great, after all, was ever accomplished by anyone sulking in his or her misery.
    —Adam Shepard

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