patrick.net

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.

gromitmpl says

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.

Admit? I wasn't hiding anything. And my numbers weren't wrong. You can claim that hospitals or doctors jack up their costs on the bill knowing that insurance companies won't pay it. Maybe you're right, maybe you're not. And there is certainly no evidence that the costs are jacked up by 100%.
$30K is what the hospital/Drs/labs charged. That is a fact.

gromitmpl says

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.

Of course. It's called Canada, Europe, Australia, etc. The rest of the civilized world really.

The $15k out of pocket isn't crazy for a C-section, especially if you have individual health insurance or work for a small company that can only afford shitty plans.

gromitmpl says

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.

Which countries on this map represent places where hospital births are the norm, and which are where hospital births are less frequent?

Until the last century, there were more a lot more old men than old women.

Edit: WHO map added.

Vicente says

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.

Yeah, this happened in my family. It sucked, even though none of the other siblings cared or needed what little money there was, or about the last minute changes to the will and executor, which nobody was told about, including the person who was replaced (the elder brother).

What pissed everyone off was my Uncle's bizarre behavior regarding the sentimental stuff: The Photo Albums, Keepsakes, Old Toys, etc. He never told anybody what happened to them, whether they were kept, sold, or trashed. He constantly evaded giving an answer about them.

Even though all the siblings offered to pay or share the cost of the funerals, and shared the care of my grandmother in the few months between her death, he had a sudden snit seemingly out of the blue, wrote all of his siblings a nasty-gram about them taking advantage of him, and hasn't spoken to anybody in the 15 years since.

I guess years of resentment just boiled over.

thunderlips11 says

Which countries on this map represent places where hospital births are the norm, and which are where hospital births are less frequent?

Until the last century, there were more a lot more old men than old women.

Yep, it is a natural process that has a relatively high mortality rate when it happens without modern medical care.

Nice map, it is interesting to see what other countries are out "peers" when it comes to maternal mortality.

leoj707 says

Nice map, it is interesting to see what other countries are out "peers" when it comes to maternal mortality.

But, but, but other countries lie about their health care results, only America tells the truth. America has the best health care in the world, those socialist countries in the blue can't have better results, Fox says so.