So now that health insurance reform is law and insurance companies cannot deny coverage to you based on pre-existing conditions, shouldn't everyone just cancel their policies and only buy insurance when they get sick or injured? What are the pros and cons?
Cancel Your Health Insurance Policy?
By HousingWatcher Follow Fri, 1 Oct 2010, 4:50pm 4,415 views 44 comments
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Insurers are not required to cover adults with pre-existing conditions until 2014.
The new rule for now is just that they have to cover children under 19 regardless of pre-existing conditions. Adults who have been without insurance for at least six months are eligible to join a "temporary high-risk pool" but I'm not sure what that means.
See: http://en.wikipedia.org/wiki/Obamacare
Anyway, you'll be required by law to buy coverage of some kind to avoid exactly the gaming of the system that you point out. Though I'm not sure the fine will actually be any higher than insurance premiums, so maybe it will still be financially worthwhile for people to refuse coverage until they get sick...
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Patrick says
They must have been uninsured AND have been turned down for insurance because of a pre-existing condition to qualify for the subsidized pool. The state will pay (federal money) the difference between their actual cost of coverage and the cost to cover a comparable person who does not have the pre-existing condition.
The program is underfunded and has been delayed:
http://www.pcip.ca.gov/Home/default.aspx
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howard.roark says
Sure, there are "mild" diseases or conditions that can be managed without medication -or by mind over matter. But a friend of mine was experiencing severe stomach pain - had labs drawn ($700 billed charges), physician visits (full cost $500) followed by chemotherapy (according to http://www.jlsfoundation.org/expect/parents.html cost is $150,000 followed by bone marrow transplant of about $250,000). These aren't all-inclusive, there are multiple hospital admissions, blood transfusions, lab tests...
Add to that the cost of driving to/from the cancer treatment hospital 500+ miles away from their home for pre-transplant visits, then 6-8 weeks of hospital admission, time off work for patient and family members, hotel accomodations, food, etc. The information asked every time is about the insurance - the case managers are helping to schedule the treatments for him. Without insurance, it would be much harder and possibly wouldn't happen. Everyone isn't eligible for Medicaid, even if they're poor. And Medicaid has its limitations...
My point is that some diseases can't be wished away. The cost of treatment can be substantially more than the cost of the premiums. One catastrophic event can wipe you out financially.
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Ellie,
Sorry to hear about your friend. I hope his/her treatment is going well.
This situation illustrates why insurance is so important. It is reasonable that a person who wants assurance that they can get the care they need (in the event of an emergency or disease as your friend fell victim to) pay into a program that will cover his expenses. It is not reasonable however for everyone to expect that the cost of their care is the responsibility of everyone else. Furthermore insurance ought not to be for routine outpatient visits/maintenance medications but rather for catastrophic event such as accidents and cancer etc... And it is perfectly reasonable for insurers to charge higher rates for demographic factors such as age, medical history and current health status just like motor vehicle insurers do in their rate calculators.
But I believe that if insurance were reserved for emergencies rather than utilized routinely for everyday visits and medications that costs of health care start to level off or fall rather than rise.
Now I know the argument, then people will neglect their health until it is an emergency. Well perhaps for some this is true, in fact it is true for many people already. Most of us don't know we are sick until our body breaks down in some way. But the reason insurance should not cover routine office visits and procedures is because it removes the accountability of the providers to their patients with respect to price. For example, a veterinarian can do a lot of work on an animal for a relatively small amount of money compared to physicians' charges to services on humans. What is the main explanation as to why it is so expensive to see a physician vs. a veterinarian? Is it that human doctors are smarter than animal doctors? No, actually it is more difficult to earn a spot in Vet school than Med school. The main difference is that insurance/government intervention has not driven up the cost of animal health care.
The fact that in countries like India you can get top notch health care for a fraction of the price of here in the US is further evidence that it is health insurance for routine maintenance and the entitlement mentality that comes with social programs like medicare that have driven up the cost of health care in the US and will continue to drive us all into poverty rather than prosperity.
The wealthy love insurance (they make money whether you use it or not). In fact, if they invest wisely in health care related industries they make more if you use it that if you don't. The debate ought not be about who pays for health care, or health insurance, but whether anyone should have health insurance at all. A system where profits are privatized while risk is socialized (perhaps the best definition of fascism there is) can only benefit the elites. That is what we have here in USA.
However a system where health care is monopolized by a "non-profit" such as it is in countries with a state run health care system is actually exactly the same as described above with two small differences. State run systems disguise the fact that they are shills for private organizations who supply them, and state run systems completely remove any accountability to the patient with respect to cost/quality of service. Do you want to visit the doctor who gets paid the same whether his attitude and service is good or bad, or a doctor who knows he can increase his income by providing better service?
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elliemae says
Middle of the night in a surgical waiting room in an Ivy League medical school hospital. My father's doctor sat down next to me. We were about the same age and she had told me a few days earlier that my father's case was especially interesting to her because her father had the same form of cancer. After telling me about my father's condition she sat back, stretched out her legs and quietly rested for a few moments. It was late and she was in no rush to go anywhere.
Then she asked me a strange question. She wanted to know if my dad was a really nice guy. Genuinely nice, she repeated. I said that he is and told her a story about how a few of my high school friends told me how lucky I was to have such nice parents. She nodded knowingly and said she thought so.
I asked her why she had asked. She smirked and said there is a woman in radiology who can predict the results of a cancer scan with uncanny accuracy without actually seeing the scans, simply by talking to the patient for a few minutes before hand. She said that everyone who works in oncology knows that mean people do not get cancer very often. Those crotchety old people who complain about everything and never bottle up their emotions almost never get cancer. And when they do they generally fight it away.
My dad was dead within a week. My mom died two years later from cancer as well. Both had the "Cadillac" heath insurance policies that everyone is talking about.
Granted, I could get squashed by a car. It is possible. I accept the risk of being financially ruined. I would prefer to purchase a super high-deductible plan that is comparable to the cost of actually providing that coverage. Trouble is - as AdHominem pointed out above - I must pay to cover ever person in my age group regardless of whether they abuse their body and eat Cheetos for five meals a day or eat healthy and exercise five times a week. I am forced to subsidize the willfully unhealthy.
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howard.roark says
howard.roark:
I've been a medical social worker for 25 years. I've worked with dying and/or critically ill people for the majority of my career - and I can tell you that my observation is that statement is a pure, unadulterated crock of shit.
Cancer doesn't happen to people based upon their attitude, their lifestyle, whether they're nice or not. Cancer doesn't only happen to people who have insurance or live stressful lives...
I've seen people with horribly poor lifestyle choices live cancer-free lives, only to die in accidents (ironically, a fairly healthy life-long smoker died after dropping a lit cigarette on his lap and get in a wreck). I've seen many an asshole die alone.
Cancer just happens. Mean people don't fight it off any better or worse than nice people, and that physician's license should be pulled for make such egrigious statements.
There are chronic diseases that require treatments well beyond the normal person's ability to pay out of pocket for medications and treatment. Insurance is meant to act as payment for such conditions, because healthcare for these purposes is out of reach for the average consumer.
Take Rheumatoid Arthritis for example. The labs used to diagnose this disease are in the $600 range. The treatment includes anti-inflammatories, pain medications, R.A. medications, etc. Without them the patient can't function at all; with them they are able to work and maintain a fairly normal lifestyle. If the disease isn't treated, joints break down and create more of a problem later on as the disease progresses. R.A. is an autoimmune disease that has treatment breakthroughs that might someday stop the progression of this debilitating disease. But without insurance coverage, people suffer horrible effects and become disabled.
This is yet another example of why insurance is necessary. There are millions of examples out there - and if insurers were to charge based on each person's potential for costs to the insurance company, they couldn't afford it. Why do you think there are jars at gas stations asking for donations to offset the cost of treatment? It's because our current system is so screwed up that people have to beg for help.
Medical care should never, ever be an option.
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elliemae says
Forcing Peter to pay for Paul's "medical care" should never, ever happen.
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Adhom:
You'd change your mind if you needed help and it wasn't there. If your wife, or your child needed help, and all it would have taken was a few dollars to ensure that they had their medications, you'd rob a bank or do whatever it takes.
The money spent on lobbyists to keep healthcare private and stupid wasteful programs would more than fund healthcare in this country. All we have to do is allocate it properly, like pulling it out of the military budget for projects that will never work or having a military presence in countries where we don't need to be. How about taking some of the monies from the endless layers of oversight for medicare & medicaid programs that really don't do anything more than create more paperwork.
Instead, we're creating more medical problems with the returning military men & women - they have all sorts of illnesses including PTSD and hearing loss...
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elliemae says
One of the first things an oncologist talks about on that first visit is the importance of mental wellbeing. In your considerable experience I am sure you have come across one of the many studies linking attitude with outcome. You may not believe it - perhaps because it is inconvenient to do so in this discussion - but it is a scientific fact.
Here is one recent study: http://www.sciencedaily.com/releases/2010/03/100303131656.htm
It is a short step from attitude/outcome to attitude/cause. People naturally shun the latter connection because they see it as blaming the victim and they react as you did with anger and denial. It is not blaming the victim. It is looking for the truth.
Rheumatoid Arthritis is a perfect example. It is, as you point out, an autoimmune disease. For some unknown reason the body's immune system turns on itself and begins to attack important tissues. Here are a few studies showing that the mind is indeed linked with RA.
Prozac Induces Anti-Inflammatory Effect
http://www.sciencedaily.com/releases/2010/02/100225082441.htm
Brain Pathways Linking Social Stress and Inflammation Response.
http://www.sciencedaily.com/releases/2010/08/100809133323.htm
Childhood Physical Abuse Linked To Arthritis, Study Finds
http://www.sciencedaily.com/releases/2009/11/091102121718.htm
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elliemae says
This is timing at its best. This also seems to be the earliest date my doctors can squeeze me in their busy office schedule. :)
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You said that the oncologist stated that nasty, mean people have less incidences of cancer. Then you say that attitude can help to alleviate symptoms. You said that I reacted with anger & denial - but I reacted with a statement about the detriments of a physician who would dare to tell a patient's family member that being an asshole is one way to stave off diseases for which there has been no definitive cause. To make such a statement, if indeed he/she made it, is inappropriate and unethical.
I do believe that a positive attitude can do wonders for patients, that hope is good.
howard.roark says
People who "complain about everything" often have no social support system, live miserable solitary lives and their anger perpetuates itself. People who have been nice and kind and happy don't necessarily bottle up their emotions - they often deal with them in healthier ways than do the people of your example.
The first study to which you referred explores the anti-inflammatory effects of SSRI's. This isn't attitude, it's an off-label use for a medication that might help patients with different types of arthritis. There are many medications with off-label uses.
The second study states that it is the first study (to their knowledge) that links inflammatory responses to acute social stress - but it fails to define acute social stress. What is stressful to one person isn't to another. For example, some people love public speaking while others would rather be dead than to get up in front of a group. The study, which consists of 124 subjects, might lead to a breakthrough in treating diseases such as R.A. but it falls far short of proving attitude is the cause of R.A.; it fails to link cancer and attitude. There are much more likely causes, such as the rampant use of chemicals in engineered foods, aspertame, infectious agents such as viruses/bacterial infections/fungi, and genetics.
The third example explores the connection between childhood physical abuse and osteoarthritis - a disease that is different than the autoimmune disease Rheumatoid Arthritis. This hypothesis of study isn't a stretch - any physical traumas can result in osteoarthrits later on in life. Athletes and workers who have repeated stress injuries have a greater chance of developing osteoarthritis at the scene of the trauma.
Again, I do believe that attitude is important when dealing with disease processes. My observation has been that a good attitude can result in less pain medication (possibly because the patient isn't focused on his pain/problems), more tolerance toward medical workers resulting in a happier healthcare experience, etc. A good attitude, at the very least, means less emotional stress - which can't be bad.
But to say to a patient that being an asshole is the recipe for not having cancer? I've seen too many lonely assholes die of cancer to even allow for the possibility of this being correct.
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vain says
Ti-i-me is on my side (yes it is)... :)
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elliemae says
I'm glad to hear just one of you say it.
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Many of us have said it. where ya been tpb?
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Howard Roark is a character from Ayn Rand's "The Fountainhead", one of the bibles of a special brand of libertarian-fascist dipsh*ts from everywhere.
Somehow it does not surprise me that he thinks getting sick is your own fault. Don't you know, you are supposed to be a perfect ubermensch that never gets any diseases. Or else it is just tough luck.
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Oh, I should have realized that I wasn't speaking with some heartless, sadly misinformed asshole. I was speaking with some heartless, sadly misinformed asshole who can't think for himself.
Unfortunately, professionally I've dealt with sadly misinformed people. There have been those who refused to allow their parent to have sufficient pain medication because they didn't think mom was in enough pain to warrant it.
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I think the fine for not having insurance is only $750. So it is far more economical to pay the fine than to buy insurance.
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howard.roark says
Howard, positive thinking is great, but it's not voodoo magic. People are made sick every day due to physical and environmental stimuli that the may or may not know about. Having a good attitude is shown to go a long way and these people are statistically healthier, but people from all walks of life develop diseases. I'm no doctor, but the sniffles and the flu are not the same. You either had the flu, or you didn't.
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elliemae says
You said it! Love you social workers by the way, you are life savers!
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howard.roark says
People like this always end up as wards of the state. Sad but true; I see it every day.
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PasadenaNative says
Yea, that's me. Saving the world, one old person at a time. :)
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I've seen a lot of people die from cancer. Mostly children.
There is one necessity to beat a major medical illness.
Fight it with all you got.
I think that the oncologist that made the comment about 'nice' people was really talking about docile people. I am a very happy, nice quiet person in general. Get me in the hospital and all of a sudden I am not *just* nice, but inquisitive, and completly un-merciful about any and all mistakes.
Gotta chest x-ray? Tell the tech you will walk out if they don't get the first right.
Need a blood gas? Tell that intern he gets one shot.
Shit goes wrong? RAISE HELL!
I am not saying be an ass hole, but you have to make it clear what you will and will not put up with.
Best chance of survival will be a patient (Nice or Rude) with a fighting spirit and a full time advocate.
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Amen, brother!
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The health care "debate" in this country focuses on the wrong issue. The real issue is our food supply, diet and life style. The USA has diseases of king and queens because we are gluttons. Why are we gluttons? The food we eat has no nutritional value so as our bodies starve for nutrients we grow fat on a diet that slowly kills us. Our food supply is controlled by corporations who enjoy massive government subsidies and do everything in their power to crush the small, local farmer. GMO frankenfoods are untested yet are in nearly every food product that has corn, soybeans or wheat (about 98% of what we eat). You want to farm next to a GMO farm? Don't even try to save your seed for your next crop. Chances are it is cross-pollinated with GMO plants that don't produce any viable seed. If you do get seed, get ready to be sued by Monsato for using one of their patented genes that you didn't ask for.
Our food should be our pharmacy, instead it's our poison. Our government is complicit as these big agri corporations run the FDA, USDA and even sit on our supreme court (see Clarence Thomas). Economic Fascism (as someone alluded to earlier).
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The health care "debate" in this country focuses on the wrong issue. The real issue is our food supply, diet and life style. The USA has diseases of king and queens because we are gluttons. Why are we gluttons? The food we eat has no nutritional value so as our bodies starve for nutrients we grow fat on a diet that slowly kills us. Our food supply is controlled by corporations who enjoy massive government subsidies and do everything in their power to crush the small, local farmer. GMO frankenfoods are untested yet are in nearly every food product that has corn, soybeans or wheat (about 98% of what we eat). You want to farm next to a GMO farm? Don't even try to save your seed for your next crop. Chances are it is cross-pollinated with GMO plants that don't produce any viable seed (this is scary). If you do get viable seed, get ready to be sued by Monsato for using one of their patented genes that you didn't ask for.
Our food should be our pharmacy, instead it's our poison. (Hippocrates had it right) Our government is complicit as these big agri corporations run the FDA, USDA and even sit on our supreme court (see Clarence Thomas). Economic Fascism (as someone alluded to earlier). See King Corn, Food Inc. Buy local/organic, plant a garden. Petition to have GMO foods banned. Turn off your TV. Start a revolution! Your $ talks.
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You can talk about "risk compensation" but honestly if you have young kids or babies...do you really want to take a chance on "risk compensation" and not having major healthcare coverage? I doubt it. I sure wouldn't.
Considering if there is a major illness or injury, it can totally bankrupt you. I've paid a fortune in health care insurance premiums over the past many years and never had to use it but I can't in good conscience not have coverage with a family.
On that topic, I have read a few of your posts Patrick on Blue Cross Blue Shield and how horrible they are. Do you have a recommendation or others on this board of the best medical insurance coverage company in California? I will be moving to San Diego in August and will need coverage as I don't plan to work for the next year. Maybe not ever. Possibly early retirement for me.
I'm looking at some costs for a family of four with 2 small kids and for decent coverage it's like $2,000 a month. Is that right? Do any of you have any recommendations for good plans or companies?
I currently live outside of the USA and have full coverage that is excellent. They cover everything with no out of pocket co-pays. I'll keep it until we move to the USA and maybe even a few months after we move back to the USA.
I'd appreciate any advice on companies.
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bubblesburst says
They all suck equally. sorry.
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bubblesburst says
Your best bet is going to be health insurance provided by your employer. Your second best bet is an HMO like Kaiser.
The situation in the states is really very sad however.
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Kaiser has gone up about 50 bucks a month since i first went with them in 2006. I have been to their facility once for a badly swollen throat. The service was decent, but 177 bucks a month is a bummer....I'd hate to see my bills if I was in a bike crash or something similar though.
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Well, I don't have an employer as I recently sold a company and thinking about early retirement so I'd have to pay it on my own. I really HATE HMO's vs. PPO's but it sounds like recommendations for Kaiser's HMO plan would be much more cost effective....
These days one of the most important components of a job these days is the good insurance component. It's easy to forgot how valuable/important that is until you're not working for a company and have to pay it on your own....
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FYI....I just priced out a fairly decent HMO plan for myself, my wife and our 2 young kids with Kaiser's HMO plan in San Diego. For the COPAY25 plan which looks fairly decent it's coming out to $1100 for the family each month which is much less than a good PPO plan with others.
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Remember that HMO's are fine as long as you're not traveling much - you are limited to treatment in the areas that the HMO has contracts. I personally don't like HMO's because, as long as you're healthy they're fine - but if you're chronically (or critically) ill they spend an awful lot of time case managing your denials.
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b o n !
see "tri care" it pays for mil. retirees over seas. m.care
does not.
NJ plans to chop $500mil (mike) from m.caid.
2 j udges ruled a c a (h.care reform) UN constitutional. . .
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People who complain often do get sick less. I have observed this.
The reason being, people who complain often take matter into their own hands as early as possible. Take my FIL for example, doesn't get sick, because when there is one symptom or two, off to the doctor he goes with a whole stack internet researched materials and he DEMANDS blood test, X-ray, Cat scan, whatever diagnostic tools they have to find out the root cause. He sees the GP every month just as a routine to go over things, and uses the emergency room casually if he doesn't feel right. He does check up religiously, has a little chart he abides by like a bible for all his medicine and vitamin supplements, seeks specialist opinion whenever possible (in fact he was told by a specialist that he shouldn't be in his office).
And guess what, he fought off THREE, not one, two but three cancers because he caught them at very early stage.
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Curiosity overwhelms me. What would you actually consider sick if you say someone who has had 3 cancers doesn't get sick?
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He caught these cancers so early that they were barely classified as cancer, some were at pre-cancerous stage. No symptoms whatsoever, eating well and sleeping well. Some cancers are completely symptom free in the very early stages, and if someone was not relentless in extensive checkup for no reason at all, he would not have caught it.
Sick people have symptoms, reduced appetite, losing weight, not sleeping well etc., not in his case. He just likes to go to the doctors for extensive checkup and scans on a regular basis.
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I thought not having health insurance, living healthy, and saving my money for future health needs was a doable option until in the last six months i developed a "simple" staph infection that required months of treatment, lots of doctors visits ,tests and medications that costs thousands of dollars. Fortunately I had insurance through my employer.
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Buy insurance with the sky high deductible and have some liquid assets to sell just in case.
Having lived in England and visited Canada frequently, there are serious negatives to their health care. I won't elaborate here.
Essentially all significant useful medical procedures, devices, drugs, diagnostic equipment were invented in our "evil profit centric" system.
e.g. Davinci robotic surgery.
I think I saw a health plan sold by Aetna or some other Co. with an $8000 deductible.
Unfortunately I believe Obamacare outlawed Health Savings Accounts.
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http://www.nytimes.com/2010/03/27/your-money/health-insurance/27money.html
There are tax breaks for HSA's; that was on the table to be done away with. But according to what I've read, the breaks remain. They're limited to putting $3,050 in 2010 for one person, or $6,150 for a family - and the money must be spent on medical bills only or you'll be taxed and penalized.
Remember that, if you spend 7.5% of your Adjusted Gross Income on medical expenses in a given year, you can deduct them from your income. For lower income people, this isn't a lot of money and it makes a huge difference.
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clambo says
Everyone agrees NIH is the worst public health system on the planet. Poorly designed, poorly implemented, always underfunded since day 1. What about the 40 something other countries with public health systems, the large majority that work very well? Is the average American better off, especially for twice the money?
clambo says
Pure BS. Medical research is being done all over the world. A lot of medical research in the US is done with public funding. Go look up what NIH does for a start. The amount of medical research funded by government is 30.2% for the entire OECD and 31% for the US. Over half the drug companies are foreign, but they base r&d in the US so they can get NIH research funding. FYI drug company's spend a lot more on advertising than R&D. Here is an excellent article on what really goes on in pharma. http://www.nybooks.com/articles/archives/2004/jul/15/the-truth-about-the-drug-companies/
clambo says
Most high deductible (catastrophic care) plans won't meet the Medical Loss Ratio (MLR) under obamacare. This is the stupidest part of a very poorly written plan.