patrick.net

HousingWatcher says

Oh wait, Rick Perry already thoght of it:

http://www.huffingtonpost.com/2011/08/25/rick-perry-texas-life-insurance-scheme_n_935666.html

Oh, yeah and what did the teachers get out of the deal...

50-100 bucks up front and that warm feeling inside knowing that the state and rich investors need you to die ASAP to get a return on their investment.

leoj707 says

Come on let's be fair, they never said that they would deny health care. They just stood to profit 100's of millions on the death of retired teachers, and the quicker they died the better for their bank account.

I would agree that there must be a little more to this story, not to be in any way defending it, or Perry.

Buying insurance on a pool of old people shouldn't be profitable. That's what actuaries are for, to make sure it's slightly profitable to the insurance companies. Unless they knew for some reason that teachers in retirement have especially lower life expectancy.

As for the idea that they planned on denying health coverage, that's pretty hard to believe. Even if Perry were a total dirt bag, he would have to have the political savvy to know how that could hurt him. Not to mention the fact that it would be a huge crime.

IT was a stupid idea though. Maybe secretly they figured that buying life insurance on old people for other's benefit would cause the insured to die of paranoia.

leoj707 says

Yep, this is more or less how it works. Very few medical providers will give quotes on costs for procedures, but in my experience this for out-of-plan providers, and there is no way to compare cost with in-plan providers because the in-plan providers will not give you an estimate.

This really should be addressed. I do think this is a big contributor to the problem. People don't know what they are paying or will pay.

I once showed up to a doctor, it took almost an hour to get an estimate out of those people.

leoj707 says

That is not the way medicare works. Medicare sets their own rates and is often 20-30% cheaper than private care.
http://www.cbo.gov/ftpdocs/99xx/doc9924/Chapter5.9.1.shtml
Scroll down to the section on "Comparison of Public and Private Payment Rates "

I know they do. But often it costs more than in private sector because of the subsidy. It costs less to the patient because their bill is less, cumulatively it adds to a bigger number.

leoj707 says

So, you are saying that this is medicare's fault? There are many factors that are contributing to this problem in US medical care, medicare is not one of them.

It's how government pays for medical care. It directs how medical field goes. Look if they'll start paying subsidies for you to make IBM computers, all computer tech field will go in that direction for "free" uncle Sams sugar. Thats how our medicine works.

leoj707 says

Kind of like how removal of government intervention, and encouraging competition has created innovation and lower prices in industries such as: fire services, police services, roadways, etc.

Fire services and police services are state, not federal. Freeways which are federally sponsored is a totally different topic, taxpayers paid for commerce when private sector could not do the job yet.

Problems in medical industry need to be addressed though, and not by simple tax more and spend more. That's just wasteful.

bdrasin says

It is true that there are some market inefficiencies caused by having state-level regulation of health insurance (just like any other product which is regulated at the state level) but you are being wildly unrealistic in assuming this is more than a minor factor.

You are being wildly presumptuous in assuming that I believe it is a major factor vs. a minor factor. But I am happy that you do acknowledge it as a factor.

bdrasin says

I don't have a problem in principle with replacing state-level regulation of health care with a nationwide regulatory system, but
1) Its unrealistic to think that the savings will be enough to deal with the scale of the problem, and
2) It will be a long, long difficult process to get all of the states to agree on such a system. And I think this is the point; the republicans who favor this basically want to do nothing.

This is not about replacing a state system with a national system, but even using that assumption: you don't have a problem with it in theory, but you do in practice, because:
1) Even though there might be some savings involved, it is not enough for your liking, and
2) You think it would take too long because of the difficulty getting all the states to agree, although this is completely irrelevant to allowing individuals to purchase plans from wherever they want?

In other words, you are for only major, revolutionary changes, not minor changes even if you agree they may have minor positive impacts. And since Republicans are not for the revolutionary change you want, then their proposal for a minor change - that you acknowledge might be helpful - counts as not wanting to do anything.

Another example of ideology first.

marcus says

Even if Perry were a total dirt bag, he would have to have the political savvy to know how that could hurt him.

Maybe... but he should have had the savvy to know that betting on old people dieing would not looks so good politically.

marcus says

Buying insurance on a pool of old people shouldn't be profitable. That's what actuaries are for, to make sure it's slightly profitable to the insurance companies. Unless they knew for some reason that teachers in retirement have especially lower life expectancy.

Yeah, that was very strange to me. The only way to profit through a life insurance scheme is to know something that the actuaries don't.

Paralithodes says

In other words, you are for only major, revolutionary changes, not minor changes even if you agree they may have minor positive impacts. And since Republicans are not for the revolutionary change you want, then their proposal for a minor change - that you acknowledge might be helpful - counts as not wanting to do anything.

Not really--there are a lot of things that might be helpful. This idea also might be detrimental by segmenting the population and drastically raising rates on older folks, allowing private insurance to cover only the "healthy" folks and pushing the rest onto Medicare.

How about we talk instead about ideas that have already been proven successful in other countries? You know, where healthcare costs are half of what they are here.

leoj707 says

Maybe... but he should have had the savvy to know that betting on old people dieing would not looks so good politically.

My point exactly. That's why I think there is something missing here, in spite of the fact that I don't like Perry at all. Then again, who knows ?

FortWayne says

I once showed up to a doctor, it took almost an hour to get an estimate out of those people.

Wow, that was quick, and was that before getting care? Usually you don't know the cost until you get the bill weeks later.

FortWayne says

But often it costs more than in private sector because of the subsidy. It costs less to the patient because their bill is less, cumulatively it adds to a bigger number.

Yes, it costs less for the patient:
"...on average, Medicare’s payments were about 9 percent below the costs of serving Medicare patients, whereas pri­vate payments were about 30 percent above costs."

But, also the total cost is less for medicare than the private rates:
"Private rates are noticeably higher than Medicare’s rates in areas with less competition among providers... ...the rates paid to physicians by private insurance plans are an average of 30 percent higher than Medicare’s rates in small metro­politan areas and rural areas, 10 percent higher in medium-sized metropolitan areas, and 1 percent higher in large metropolitan areas."

I would be interested to know you source for Medicare costing more than private care.

FortWayne says

Fire services and police services are state, not federal. Freeways which are federally sponsored is a totally different topic, taxpayers paid for commerce when private sector could not do the job yet.

Well, while those are run at the state level there are federal agencies (FBI, etc.) and regulation of those state projects. There is a reason why you can take a fire hose from California, and it plugs right into a fire hydrant in Florida.

Why could medical care not be run the same way?

FortWayne says

Problems in medical industry need to be addressed though, and not by simple tax more and spend more. That's just wasteful.

I agree that we need to cut the waste. That is one of the reasons why I think that universal health care is the way to go. Delivery system aside, we spend over twice as much for health care than other industrialized "modern" nations. For all this extra cash we get worse outcomes than the "cheaper" systems; we have a lower life expectancy and a higher infant mortality to name two undesirable outcomes.

Why, as a nation are we wasting so much money on a health care industry that gives us shitty returns? Why don't we "shop around" and find out how other countries provide better care for half the price?

Paralithodes says

In other words, you are for only major, revolutionary changes, not minor changes even if you agree they may have minor positive impacts. And since Republicans are not for the revolutionary change you want, then their proposal for a minor change - that you acknowledge might be helpful - counts as not wanting to do anything.

Another example of ideology first.

*sigh* Our system is not working; its too expensive for us to afford (and getting worse) and and its not particularly effective. I'd say lets look at countries which have systems which DO work by this measure (cost and effectiveness) and try to copy what they are doing. This isn't ideology, it isn't revolutionary, its common sense. Follow the evidence, I say.

Again I ask you - what country has a health care system closest to what you think we should have? It sounds like you think a completely unregulated market would be best (i.e. let the states conduct a "race to the bottom" in insurance regulation). What country does this, and how is that working for them? If the answer is "none", then what makes you think this is what will work?

It really astonishes me that you would think that looking around the world for what is working IN PRACTICE and using that as evidence is an "ideology first" approach.

gromitmpl says

Patrick - where are you getting quotes. I find it hard to believe what your saying.

My actual Blue Shield rates:

And it's not due to anything medical in particular. They showed me it's the same outrageous rate hikes for everyone in my age group.

Other quotes were from http://www.healthcare.gov/

leoj707 says

Why, as a nation are we wasting so much money on a health care industry that gives us shitty returns? Why don't we "shop around" and find out how other countries provide better care for half the price?

Because of American exceptionalism. Obviously if we pay so much more it HAS to be because we get so much more. (kidding).

leoj707 says

That is one of the reasons why I think that universal health care is the way to go.

Everyone with the slightest intelligence knows this to be true, and also knows that it's inevitable that we will have universal health care. But unfortunately we have this money sucking monstrosity in place and a corrupt government beholding to it.

tatupu70 says

The total bill for our last child delivery was over $30K. I'd call that pretty expensive

My assumption is that the 30k was not for the delivery but was for complications arising from or after the delivery.

Also was that from your OB or from some one else.

I know many many many many people who have more than your average number of children and that 30k is more than any one of them have spent for the delivery of all their children combined.

That number is either not for the delivery or because you stayed at the Beverly Hills Wilshire to deliver the baby.

My actual Blue Shield rates:

That is expensive but of course expensive is relative to what your getting. I assume you have a fairly basic plan though since your rates in 06 were fairly low.

Maybe its because you are in California? I just checked a couple weeks ago for my own family and saw several plans in the $3-$400 range that would be fine. More or less these might be considered catastrophic loss type of insurance but in my experience even high deductible plans have hidden beneifts like negotiated rates which help in cases of even more normal medical care.

If you absolutely need it I'd start with high deductible plans and pay for regular care out of pocket. In my experience Doctors love working with people who actually pay cash and give steep discounts (%30- 50%).

Why should Patrick pay for healthcare out of his own pocket? He should go to the ER and let the govt. pay.

marcus says

Everyone with the slightest intelligence knows this to be true, and also knows that it's inevitable that we will have universal health care. But unfortunately we have this money sucking monstrosity in place and a corrupt government beholding to it.

I would like to think that a universal system is inevitable, but with the way things are going I am not going to hold my breath.

gromitmpl says

My assumption is that the 30k was not for the delivery but was for complications arising from or after the delivery.

Haha... hahaha... maybe there were complications, if so they we very minor. I don't remember the exact number, but for my kids the (cesarean) delivery was almost 30k. Then the immediate complications were about 850k. The cost for the first year of life was close to 1M (this was with only one surgery required). They were however twins that each get there own deductible upon birth.

gromitmpl says

That number is either not for the delivery or because you stayed at the Beverly Hills Wilshire to deliver the baby.

Funny thing is that staying in a luxury hotel and hiring a private nurse is cheaper than a hospital stay, but I don't think insurance covers that.

leoj707 says

Wow, that was quick, and was that before getting care? Usually you don't know the cost until you get the bill weeks later.

I was referred to a specialist (his name is Michael J Hollander, a money grabbing bastard). Came in for an exam and xray. It was almost impossible to get the price out of the office staff, their hourly rates, etc...

Nightmare. And that was not the worst case either. Just going to a hospital, one gets to run into tons of staff that show up for under a minute but bill you for an hour of their time.

leoj707 says

I agree that we need to cut the waste. That is one of the reasons why I think that universal health care is the way to go. Delivery system aside, we spend over twice as much for health care than other industrialized "modern" nations. For all this extra cash we get worse outcomes than the "cheaper" systems; we have a lower life expectancy and a higher infant mortality to name two undesirable outcomes.

Why, as a nation are we wasting so much money on a health care industry that gives us shitty returns? Why don't we "shop around" and find out how other countries provide better care for half the price?

I don't have a solution either. But I really do not trust our government to do it. Their track record of selling out to special interests is very consistent.

gromitmpl says

My assumption is that the 30k was not for the delivery but was for complications arising from or after the delivery.
Also was that from your OB or from some one else.

It was a C-section. No complications. That was the cumulative cost for everything.

Just the local hospital with nothing special--no extra stay or special room or anything...

FortWayne says

I was referred to a specialist (his name is Michael J Hollander, a money grabbing bastard). Came in for an exam and xray. It was almost impossible to get the price out of the office staff, their hourly rates, etc...

Yeah, what a nightmare.

I have gotten the run around between insurance the hospital where the only answer I could get after several hours on the phone was, "The prices are confidential."

FortWayne says

leoj707 says

...
...

Why, as a nation are we wasting so much money on a health care industry that gives us shitty returns? Why don't we "shop around" and find out how other countries provide better care for half the price?

I don't have a solution either. But I really do not trust our government to do it. Their track record of selling out to special interests is very consistent.

What? He just told you a solution, and you say you don't have a solution "either"!

In a way this is refreshingly honest, you saying that no evidence will ever convince you that a "government-based" solution is the way to go. You are just shrugging off the example of all of the other countries. Why is it that they can do it but we could not make it work by doing what they are doing? Is there some sort of american-exceptionalism-in-reverse going on here?

The underclass does not need healthcare or education. They just need to breed faster.

If only there was a candidate who opposed healthcare, education, and demonstrated support for teen pregnancy. He would be my man.

tatupu70 says

It was a C-section. No complications. That was the cumulative cost for everything.

Tat - this is why my wife and I are leaving the country soon. We can't afford to have children, as our medical insurance sucks balls, even if there are no complications.

Or rather, we can afford to have a child - if we give up most or all of our savings so far ($15k), which we want to use to start a business and have as a reserve.

leoj707 says

I would like to think that a universal system is inevitable, but with the way things are going I am not going to hold my breath.

I didn't say soon. For all I know the pendulum swings all the way to fascism, and it takes many decades or even hundreds or thousands of years for us (humans and specifically the U.S.) to get their act together.

Still, it is inevitable.

Moneyworth's Financial Advice #573:

If you desire a child to give your nanny something to do, consider adopting a Bohunk from Tsarist Russia. They are the lightest of the Colored races and can subsist on a diet of hearty potato alcohols. Good in science and appreciates stern and unyeilding fathers.

Your wife may want an Oriental doll from Peking China. While they are the most industrious of the Colored races, it can be difficult acquiring fish and rice while your family is traveling, and you do not want your almond eyed baby to starve. Plus what ultimate purpose does a female serve?

Adopting is much preferred to losing your trophy wife's vagina to the devastation of childbirth. Good luck!

FortWayne says

Just look at Obamacare. Insurance rates skyrocketed with it.

Liar. Anything that would increase rates hasn't gone into effect yet.

Insurance rate went up because the economy sucks. This is how insurance works -- when times are good, the insurance company can invest the premiums and get good returns. When the economy tanks, they don't get sufficient returns, and actuarial math says they need higher premiums. Obamacare hasn't caused rates to go up yet, regardless of whether it ultimately might do so (a dubious claim based on current projections).

FortWayne says

You'd be surprise how much stupidity you'll run into. People stop by for headaches, sneezing, aches, etc... And most get sent back often with prescription for tylenol at most.

Prove that it's the case. There are many many many studies done on ER usage. Find me one that says a substantial number of people go to ERs for headaches or the common cold and are sent back with tylenol. This should be easy to prove, right?

Reality says

The reporting of infant mortality (government statstics issue; in Cuba, a person is not officially born until he/she is 10 months old, as a way of keeping infant mortality statistics down)

This should be easy to prove right?

http://www.google.com/search?hl=en&q=cuba+birth+statistics+%2210+months%22

Nothing. Hmm. Am I doing a bad search? What's your source? This should be easy to find, right?

Reality says

Which is why the decision should be left to the individual instead in the hands of monopolistic bureaucrats. Do you honestly think a monopolistic bureaucrat would refrain from spending $1M of your money to get a 20% chance of extending the life of his mother or his son for 1 day at your expense?

Why can't it be? If it's part of basic coverage and the government plan covers it, then it covers it. If not, the individual has to pay for it (as you suggest). How is the government making a death decision (a la "death panels")? I'm not sure what you're asking -- either the care fits within plan standards or it doesn't.

The government is guaranteeing a basic standard of healthcare for a particular price. If you want something outside of that standard, you pay, just like you are suggesting. There is no "death panel" decision involved. Only ideologues suggest this crap as if it's an analytical complication.

Reality says

The life expectancy issue is a red herring. That of the US is weighed down by recent immigrants and poor families that have theoretical access to free health-care but do not or can not actually use them, especially in pre-natal care. That leads to higher infant mortality among particular groups. Infant mortality is the biggest factor in "average life expectation," not longevity of the elderly per se.

If what you're saying is true, then California should have the highest infant mortality rate because it has the highest number of immigrants, right? New York should be second highest? Maybe Florida should be third highest?

FAIL: http://en.wikipedia.org/wiki/Infant_mortality#United_States

When we're saying "recent immigrants," we're talking about Mexicans right? That means Latinos should have a higher infant mortality than whites according to your premise:

FAIL, again: http://www.statehealthfacts.org/profileind.jsp?ind=48&rgn=1&cat=2

In addition, you're suggesting that poor people willfully don't get prenatal care even though it's available to them and that's what raises infant mortality. If so, that means that, poor blacks who do get prenatal care in the first trimester should have the same infant mortality rate as whites who get prenatal care in the first trimester right?

FAIL, striiiike 3, you're out: http://www.arc.org/racewire/030210z_kashef.html

But thanks for playing our game and giving us talking points that aren't true.

@corntrollo

>very sane plan involves rationing. There are cost-benefit analyses that must be made in all plans. It is not cost effective to spend $1M to give a 20% chance of extending someone's life 1 day.

Agreed. By nature any service or product that is limited is "rationed" in some way. That's what most Americans don't get.

tatupu70 says

It was a C-section. No complications. That was the cumulative cost for everything.

Just the local hospital with nothing special--no extra stay or special room or anything

Ok wait a second though. Your saying this was a scheduled C-section?

Also when you say the "cost" was 30k are you actually out of pocket for or on the line for 30k or is your insurance company paying?

Hospitals play games with insurance companies so while they may put 30k down as they bill they have a negotiated rate with the Insurance company - or will so what we should be talking about is not the numbers on some piece of BS paper but what your insurance company actually paid.

In anycase 30k sounds about double what the normal putative cost of a c-section is, at least in these parts, and ultimately I think most insurance companies pay far less than that.

bdrasin says

For example, Blue Cross of Texas sells health insurance in California (I know this because a company which recruited me here in CA used them for coverage).

Odd... When I visited the BCBS Texas site this morning to get a quote, it kept telling me to enter a valid zip code for Texas! Perhaps CA allows some type of exception for corporate purchases vs. individual purchases? If so, why the rule, and why the exception?

bdrasin says

It sounds like you think a completely unregulated market would be best (i.e. let the states conduct a "race to the bottom" in insurance regulation). What country does this, and how is that working for them? If the answer is "none", then what makes you think this is what will work?
It really astonishes me that you would think that looking around the world for what is working IN PRACTICE and using that as evidence is an "ideology first" approach.

I never once said anything about a "completely unregulated market." Nor did I say anything about looking or not looking around the world. I addressed one small component of something that could be done right now, even if it had just a minor positive effect. However, the fact that you must attribute multiple arguments to me that I did not make at all, is unfortunately not astonishing on this site.

Meanwhile, isn't CA itself similar in population and economy size (or bigger) to many of the countries you would compare for health care? What is preventing the implementation of a state wide program similar to one of the western european countries? You have the perfect place for a proof of concept for the US.

gromitmpl says

Also when you say the "cost" was 30k are you actually out of pocket for or on the line for 30k or is your insurance company paying?

I had decent insurance, thank goodness.

gromitmpl says

In anycase 30k sounds about double what the normal putative cost of a c-section is, at least in these parts, and ultimately I think most insurance companies pay far less than that.

So, $15K to have a baby seems OK to you then?

Paralithodes says

bdrasin says

For example, Blue Cross of Texas sells health insurance in California (I know this because a company which recruited me here in CA used them for coverage).

Odd... When I visited the BCBS Texas site this morning to get a quote, it kept telling me to enter a valid zip code for Texas! Perhaps CA allows some type of exception for corporate purchases vs. individual purchases? If so, why the rule, and why the exception?

Let me repeat this as clearly as possible: there is not, and never has been, any rule forbidding you, me, Patrick, or anyone from purchasing health insurance across state lines. Any policy sold in California has to conform to California law of course, but that is it.

There really are only so many ways to do this:

1. Regulation at state level based on where you do business (what we have now)
2. No regulation (you say you don't what this, neither do I)
3. Regulation at state level, based on where your headquarters is (will cause a race to the bottom and we'll end up with effectively no regulation)
4. National regulation

Thats really it. This is why I keep rephrasing the proposition as "get rid of state-level regulation", because that is in fact what you are proposing (perhaps without knowing it).

If BCBSTX doesn't want to sell an individual policy outside of Texas you'd have to ask them why they choose not to, I have no idea. They obviously provide coverage in lots of states; go to http://bcbstx.com//onlinedirectory/index.htm and select "BlueChoice PPO Plan" then search by provider type. You will see they have doctors all over the country.

Paralithodes says

Meanwhile, isn't CA itself similar in population and economy size (or bigger) to many of the countries you would compare for health care? What is preventing the implementation of a state wide program similar to one of the western european countries? You have the perfect place for a proof of concept for the US.

Not out of the question at all. Massachusetts has [R|Ob]omneycare which from what I understand is working pretty well. There was a statewide health care system on the California ballot in 2004 (I don't remember the details) which didn't go through. I'd wager that if the Republicans or the courts succeed in overturning PPACA that its somewhere between likely and certain that we'll see CA enact some sort of statewide system.

OK I do see a legitimate problem with "free" medical care.

Namely I was in a meeting about Estate Planning. And one thing the lawyer for the seminar kept going on about, was the many ways to avoid or minimize cost recovery for end of life care so the children can inherit. You know preserve the house so they get the Prop 13 rights in perpetuity, all kinds of things. It sort of made me ill after a while. I mean, on Medi-Cal the person might have racked up a SIZEABLE bill for all that care, and then the goal seems to be stiff the system. My feelings on this are mixed, but still it seems to me if you had to sell off your house to afford comfortable nursing home care well that's sort of the deal right? That's why so many people refer to their house as a retirement savings plan? I'm probably in the minority, who would prefer to let a lot of the loopholes be closed.

bdrasin says

Let me repeat this as clearly as possible: there is not, and never has been, any rule forbidding you, me, Patrick, or anyone from purchasing health insurance across state lines. Any policy sold in California has to conform to California law of course, but that is it.

You deny and affirm the existence of the argument in the very same response. Let me repeat this as clearly as possible: The argument of those for allowing the competition is not, and has never been, purchasing a health insurance policy from a company that simply happens to operate in more than one state. The argument is one of allowing individual choice nationwide. The argument hinges precisely on your last point (the policy must conform to the law of that state - removing individual choice).

Agree or disagree with the conclusions, the following article describes fairly well the position of those making the argument:
http://online.wsj.com/article/SB10001424052970203550604574360923109310680.html

bdrasin says

Regulation at state level, based on where your headquarters is (will cause a race to the bottom and we'll end up with effectively no regulation)

Your "race to the bottom" argument assumes that either (a) no providers in certain states will offer anything other than the most very basic plan, or (b) no individual will purchase anything but the most basic plan.

Both are extremely unlikely, since (a) companies will offer different levels of plans, just as many do now, and (b) there will be plenty of people who will purchase plans of all sorts and sizes, depending on their individual needs, just as they do now. The difference, of course, is that now instead of just being allowed to purchase a plan allowed in CA, you could purchase one in CA or in OR, depending on which better suited your own needs. What exactly would be objectionable about that?

Your argument that this would result in "no regulation" might be valid if all other products and services that were bought and sold more easily across state lines had "no regulation" on them by the states. But that's not true either, and your attempt to re-define the argument with this assumption is invalid.

bdrasin says

Thats really it. This is why I keep rephrasing the proposition as "get rid of state-level regulation", because that is in fact what you are proposing (perhaps without knowing it).

Again, it is not. Clearly, states would have to re-work some of their legislation to ensure they're not at extreme competitive disadvantages, but as above, there is zero reason to believe that this would result in zero state regulation.

bdrasin says

If BCBSTX doesn't want to sell an individual policy outside of Texas you'd have to ask them why they choose not to, I have no idea.

I think you do know why. You've essentially acknowledged it already. This is what we have been discussing. And if Patrick, as a small business owner, found a plan that better suited his needs through BCBSTX, or some other company in TX, your position would object to him being allowed to purchase that plan, thereby forcing him to pay more money for a plan that may be more than he needs - or to forego insurance altogether.

bdrasin says

They obviously provide coverage in lots of states; go to http://bcbstx.com//onlinedirectory/index.htm and select "BlueChoice PPO Plan" then search by provider type. You will see they have doctors all over the country.

This has absolutely nothing to do with the issue we are discussing.

Vicente says

Namely I was in a meeting about Estate Planning. And one thing the lawyer for the seminar kept going on about, was the many ways to avoid or minimize cost recovery for end of life care so the children can inherit.

There's a law firm that used to advertise this all the time on the Howie Carr show, a regional talk program in Mass.

Their schtick was that they would help you give your assets to your kids, and then have you go on every government program possible was, as their catchprase said, "Moral, Legal, and Ethical." and something like:
"Shouldn't you be able to pass along a lifetime of savings?"

I have mixed feelings about this. On one hand, you want to leave something to your kids, and the other not to pay something is kind of self-serving.

Maybe we can exempt one piece of property but all other assets must be sold to pay for the care?

I think Florida does something like this with the Florida Homestead Exemption, you can't lose your house for any kind of debt.

On the other hand, there's a reason why a lot of shady characters buy Florida properties... I think of McNamara, a shady car dealer from LI in the 80s who defrauded GM and the IRS. He had a big palace in Florida in his wife's name, immune from seizure.

Paralithodes says

bdrasin says

Regulation at state level, based on where your headquarters is (will cause a race to the bottom and we'll end up with effectively no regulation)

Your "race to the bottom" argument assumes that either (a) no providers in certain states will offer anything other than the most very basic plan, or (b) no individual will purchase anything but the most basic plan.

No, no, its a regulatory race to the bottom. In other words, the state which provides the regulation a health insurance co's like the best (i.e. next to none) gets their headquarters. We should never allow companies to play the states against each other in this way.

Paralithodes says

bdrasin says

If BCBSTX doesn't want to sell an individual policy outside of Texas you'd have to ask them why they choose not to, I have no idea.

I think you do know why. You've essentially acknowledged it already. This is what we have been discussing. And if Patrick, as a small business owner, found a plan that better suited his needs through BCBSTX, or some other company in TX, your position would object to him being allowed to purchase that plan, thereby forcing him to pay more money for a plan that may be more than he needs - or to forego insurance altogether.

No, I just think that if the company in OR/TX or wherever wants to sell him a plan they have to follow the law in the state they are selling in. If we want to have one national standard instead of a bunch of state standards that's fine with me in principle but probably unworkable in practice.

Paralithodes says

bdrasin says

Thats really it. This is why I keep rephrasing the proposition as "get rid of state-level regulation", because that is in fact what you are proposing (perhaps without knowing it).

Again, it is not. Clearly, states would have to re-work some of their legislation to ensure they're not at extreme competitive disadvantages, but as above, there is zero reason to believe that this would result in zero state regulation.

If you mean CA could impose some additional restrictions on top of what this company in OR did, then that's not any different than what we have today. Now the company would have to comply with CA laws; if they had to comply with OR + CA then how is this better? If they only had to comply with OR then that's just no good. Oregon lawmakers should not be responsible for protecting consumers in California! The natural thing to expect is that some small conservative state would give the health insurance industry the laws it wants, and viola, tehy would get the company's headquarters (even if it was only a mailbox)

It seems clear to me that this isn't a real proposal its a talking point to distract from real health care reform. I'm done with this thread, you can have the last word if you want it.

thunderlips11 says

I have mixed feelings about this. On one hand, you want to leave something to your kids, and the other not to pay something is kind of self-serving.

Yes! You said it better than I did.

The whole thing makes me uncomfortable. My goal as executor of my parent's estate and Golden Years is to spend everything they have to make them comfortable for that period. I just don't get the desire of some people to inherit money, they worked for that it should be their benefit. Shoot I'd have a yard sale of the heirlooms except for maybe the coin collection if it'd help pay final bills. I find it sad so many get obsessed over all the money and things really, I dread the possibility of sibling issues over it.

The way to prevent this is to control profits in the senior care sector and also mandate some sort of elderly care set-aside, like Medicare, for all workers.

I don't begrudge the 3% I've been paying for the past 25 years since this is how it should be.

If all taxes come out of rents then we should not fear the higher taxation that this hits us with.

When we get down to it, health care should be a central focus of our economy and too important to leave to the free market fairy.

tatupu70 says

So, $15K to have a baby seems OK to you then?

I am just saying your numbers are wrong. You admitted your insurance pays. That 30k number is a fiction. So is the 15k unless your talking about some sort of complication.

As for babies - let me break it to you. Women have been giving birth for thousands of years. Giving birth is not a sickness it is a natural process. Many babies have been born at virtually no cost in the front and back seats of cars on the way to the hospital.

So what is the point you say? If you want to spend 15k to have a baby be my guest. If you want to spend 1k then I know a good midwife who's delivered more babies than most OB's. There is a whole other world out there Tatapu where people are having babies and enjoying life and they are not spending 15k a pop.