I Was Wrong. The Insurance Company Was Evil.

Resetting this thread's indentation at the end of the discussion.

As a former insurance insider, I can guarantee you that literaally not decisions are made based on moral obligations. There have been bad faith laws on the books for many years in many states, yet very few such claims ever come to fruition. They are difficult to prove and expensive to pursue.

As a matter of course, a large percentage of claims are denied initially with the expectaton that the claimant just doesn't want to fight for their rights. Most people in fact have no idea what their rights are. Insurance companies generally have the funds and the will to outlast most people. Even if the insurance company ultimately is required to pay the claim and some penalties, they generally have made enough money by delaying that they don't really suffer a loss. It's all about profit. Without the profit motive the whole approach to claims would change. And by the way, no solvent insurance company is going out of business if we reform health care coverage. They make the bulk of thier money in other investments.

No, I don't think I misunderstand what for-profit vs. non-profit means. I read the article you posted and I see the problems with the employer-based insurance system we have and agree that this system is unsustainable.

However, there are certain things that don't work in an extreme free market model represented in the article. So health care may not be a "right" in the constitutional sense or in the sense that the author articulates. It is a human need. Just as water is, just as is food, and in modern times, electricity. We are willing to pay fair rates for health care, just as we are for water and power. We cannot afford to pay for these needs when people try to game the system, when there is no regulation, or when responsibility for the servicing for human need is handed over to companies with a profit motive, who have to answer to Wall Street. (Witness Enron's attempt to privatize electricity, falsely increasing demand and prices and the devastating effects in California, Oregon and Washington, or Bechtel's attempt to privatize water in Bolivia- rates went up over 300% and the local people rose up and tossed Bechtel out of the village. I think we could learn something from these villagers).

When people are so wedded to a certain economic theory that you think it should apply to everything, I have to wonder if it ceases to become just an economic theory and becomes some sort of religion. Certain things don't work in this free-market utopia. Water, electricity, and health care are among them.

As a former insurance insider, I can guarantee you that literaally not decisions are made based on moral obligations. There have been bad faith laws on the books for many years in many states, yet very few such claims ever come to fruition. They are difficult to prove and expensive to pursue.

As a matter of course, a large percentage of claims are denied initially with the expectaton that the claimant just doesn't want to fight for their rights. Most people in fact have no idea what their rights are. Insurance companies generally have the funds and the will to outlast most people. Even if the insurance company ultimately is required to pay the claim and some penalties, they generally have made enough money by delaying that they don't really suffer a loss. It's all about profit. Without the profit motive the whole approach to claims would change. And by the way, no solvent insurance company is going out of business if we reform health care coverage. They make the bulk of thier money in other investments.

No, I don't think I misunderstand what for-profit vs. non-profit means. I read the article you posted and I see the problems with the employer-based insurance system we have and agree that this system is unsustainable.

However, there are certain things that don't work in an extreme free market model represented in the article. So health care may not be a "right" in the constitutional sense or in the sense that the author articulates. It is a human need. Just as water is, just as is food, and in modern times, electricity. We are willing to pay fair rates for health care, just as we are for water and power. We cannot afford to pay for these needs when people try to game the system, when there is no regulation, or when responsibility for the servicing for human need is handed over to companies with a profit motive, who have to answer to Wall Street. (Witness Enron's attempt to privatize electricity, falsely increasing demand and prices and the devastating effects in California, Oregon and Washington, or Bechtel's attempt to privatize water in Bolivia- rates went up over 300% and the local people rose up and tossed Bechtel out of the village. I think we could learn something from these villagers).

When people are so wedded to a certain economic theory that you think it should apply to everything, I have to wonder if it ceases to become just an economic theory and becomes some sort of religion. Certain things don't work in this free-market utopia. Water, electricity, and health care are among them.

I believe this trip from Alan Grayson because it's true. Did you read the part of the article where it says that the insurance company didn't think Ian Pearl would live that long?

Anyone who sides with insurance companies who treat people like "dogs" or try to find ways to get them off of their rolls when they live longer than expected (in essence, who root for people to "die" and "die quickly") is guilty. That includes Republicans and Democrats, anyone who is siding with the insurance companies by blocking reform.

No, you're right, I don't see members if Congress complaining about their health care coverage. I wish we could all have the same coverage they do and support those in Congress who say the same, such as Ron Wyden and Anthony Wiener.

FYI: Not all Republicans are siding with the insurance companies. I agree that by and large the politicians do; if only we could get a conservative party up and running that actually valued conservatism itself. I'm convinced that the political system's focus on money is something that needs to be reformed - perhaps even more than healthcare does.

hihttp://www.milq.salexmeds.combest regards, jarrbear05@aol.com

When you have people working more than 40 hours a week at the minimum wage and there is nowhere for them to live with their roommates where they can still afford to eat, the system is broken.

40 hours at minimum wage is illegal... Do lawbreakers really indicate a broken system? EDIT: Wait, I'm thinking of getting overtime or not. Apologies, I'm a fledgling libertarian.

If you lose your health insurance when you change jobs, and you are then uninsurable, the system is broken.

Insurance shouldn't be attached to jobs. It should be as cheap for the individual as for the employee. I don't recall the logic, but I believe someone in this thread or its predecessor explained how regulation caused this.

When mom and dad have both run out of unemployment benefits, and collecting pop cans for the deposits doesn't pay the rent, welfare isn't the problem.

If there were no minimum wage, jobs would be easier to find - and money would be worth more. I can't tell for certain whether this would cause food to be easier for the poor to buy, as I'm not an economist. Maybe one of the libertarian gurus can correct me or expound.

When no one wants to hire you because blacks all have victim syndrome because of the welfare state, and they make everything about race, welfare didn't break that system.

Hard to tell who's persecuting whom in this scenario, but no I don't think welfare broke that - slavery did. I'd prefer to clean up after slavery without ruining the economy.

Americans don't care what works everywhere else in the world. We're still praying for your health.

Don't put words in my mouth. I don't care to discuss other countries because I don't know their histories. Perhaps (I doubt it) their welfare is sustainable; ours isn't.

Resetting this thread's indentation at the end of the discussion.

I was actually talking about America... I don't have much context to put international info into, although that's an interesting piece that I might research. But I want to talk about the American system rather than try to abstract something away from others.

"Fix the system" means different things to different people. We say welfare broke it.

The first politician to implement universal healthcare, in Saskatchewan, Tommy Douglas, also eliminated the large deficit left by the former Liberal party government in that Canadian province. In a recent poll related to a TV documentary series Tommy Douglas, who also was a member of the Canadian Parliament, was voted the "Greatest Canadian". Why is is not moral that the citizens who have more contribute more to the necessary functions of society than the poor? Healthy, well-fed, well-clothed and well-educated families will do better work and everyone gets a better country. The moral is: when you see your neighbor at the side of the road without medical coverage--fix the system, don't call him a cab to an emergency room that will send him a bill he will try to pay, but that will add one more bankruptcy to the pile.

Very true, in terms of insurance companies having the resources to outlast most people. What are the levels of typical penalties for bad-faith denials? IMHO it should be at least 3X to 10X the legitimate claim, in order to serve as a deterrent.

Now, something else that could work would be maybe some sort of informal (or maybe even formal) insurance company rating scheme. In the case of cars at least, I know relatives who get insurance from a large, well-respected national chain who do pay higher premiums (than from smaller insurers). In return for the higher premiums, they get no-hassle service and claims are typically paid in a timely manner. If insurers are required to publish data on the number of claims paid, as well as the number denied, people can more reasonably compare firms.

FYI: Not all Republicans are siding with the insurance companies. I agree that by and large the politicians do; if only we could get a conservative party up and running that actually valued conservatism itself. I'm convinced that the political system's focus on money is something that needs to be reformed - perhaps even more than healthcare does.

See my comment right above yours in terms of costs.

I'd be glad to read an explanation of how the government hasn't raised costs... I also wonder whether anyone supporting government-led reform cares about the national deficit at all.

Another example. I purchased private health insurance and they put a pre-existing clause in it for my son. I told the agency that we should tell them that I wouldn't take the insurance unless he was covered. Her comment was that they didnt' care!!!!!!!!!!!
They put a pre-existing clause in for your son? I didn't know they could change the policy per customer.

As for the general thrust of your post: I don't respect the companies either, but neither do I trust the government as much as you seem to. Government might not deny any claims, but, because of the accountability measures built into welfare, government will meddle in whatever system gets tax money. Of course this is a good thing in principle, but the results are horrible. I say keep the government as an observer rather than a participant so it remains as neutral as possible.

Thank you for the additional information. It's hard to believe that anyone could forget that each case is an actual human being, but it happens all over. And, while, yes, this insurance company is pure evil, I think this only drives further home your point that the system that allows the companies tasked to care for us to put profits above human lives has to be changed. Only by taking the profit motivation out of the system can we hope to put an end to this "loophole" behavior.

hihttp://www.milq.salexmeds.combest regards, jarrbear05@aol.com

hihttp://www.milq.salexmeds.combest regards, jarrbear05@aol.com

Thank you for the additional information. It's hard to believe that anyone could forget that each case is an actual human being, but it happens all over. And, while, yes, this insurance company is pure evil, I think this only drives further home your point that the system that allows the companies tasked to care for us to put profits above human lives has to be changed. Only by taking the profit motivation out of the system can we hope to put an end to this "loophole" behavior.

Probably you are right that the problem could be tacked via regulation. However such regulation would have to be complex and subtle (because the insurance companies will be complex and subtle to try to find loopholes).

In the current case, the company dropped coverage a whole condition (with the intended side-effect of shedding coverage for an expensive individual case). Would regulation deny that companies can ever drop coverage for a whole condition? Probably that would be too intrusive, so instead we have to craft various "grandfather" clauses.

I foresee a newly emerging industry equivalent to interpreting the tax code. That's a lot of overhead. Maybe some not-for-profit model would work better than playing these games. I don't know the answer, but "regulation" is not a gimme.

The inexcusable behavior by the listed insurance companies can be remedied w/o abolishing the profit motive. Namely, through some sort of effective regulation. Insurance policies are contracts, and companies ARE both morally and legally obligated to fulfill their end of the bargain. IIRC there are (and hopefully will continue to be) substantial penalties for any insurance company that denies any claim in bad faith, since yes, otherwise there would be the temptation to deny everything and sort it out later.

Here's one lesson that you can borrow from Australia. Our insurance companies are legally obliged to offer insurance on the basis of 'community pooling'. That means they must offer the same insurance product for everyone at the same price, regardless of your medical history, current health or age. When you join a fund for the first time, there are exclusion periods for pre-existing conditions, but these are mostly only 12 months and they don't stop you getting coverage for other issues eg. if you're pregnant when you join, you can't get obstetrics care for 9 months but you can still get all the other benefits. And if you have family cover, then it works for the whole family regardless of how many children there are.

If they want to withdraw coverage for one person, they have to do it for everyone - and would instantly lose customers as people would just move over. Generally premiums are pretty close anyway - when you compare there are always pluses and minuses in premiums, and coverage.

In fact, don't borrow that idea - take it for free!