Universal Healthcare

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I was under the impression that the healthcare bill was under heavy attack from Democrats on the left wing of the party as well? (For other reasons obviously.)

 

Yeah, but it's the low-level pencil pushers that apply them.

And that's my point. The policy probably didn't say anything about a special condition for newborns, but anyone thinking for 5 seconds would see that the same standards don't apply.

I think the current one is, simply because it's so terrible. We'll see if they settle for 'just anything' or actually demand something that works, though.

Incidentally, this is exactly why I didn't want Congress making a health plan to begin with. This is the kind of stuff I feared (though this isn't that bad).

 

Yes, that is their job description, to apply company policy.

Well, you obviously did not get the CEO's point, that the "underlying policy" was flawed, not that it was improperly applied. If they could have hung out a low-level employee to dry on this one, they would certainly have done just that. But they couldn't, since it was the policy that was at fault.

It's good to see you on our side of this issue. Welcome to the good guys, NOG But don't give up yet, the PO is still being fought for on a couple of fronts. The House will certainly fight to change the Senate bill. But it's hard to say if the PO will be in the final bill. It's almost certain that there will be a trigger for a PO, but a trigger is not really that helpful in the larger scheme of things. Nevertheless, this bill is a long way from being complete.

 

I think we're agreeing from opposite directions. I'm saying it's a natural consequence of the low-level pencil-pushers not thinking, and that this is why we see some really stupid stuff (exactly like this) from time to time in corporations. It's not exactly the fault of the company (beyond them not considering every possible application of their policy) so much as the system. This company has refined that policy, and now that particular problem won't (hopefully) happen again. I'm guessing it won't be more than a month or two before some other policy in some other company (probably in some other industry) sees a similarly stupid application (it just won't be on-button for a hot-topic issue).

I'm not much more confident in a public option, either. Yes, it could be done well, but it could also be done terribly, and leave the people to pay. Think about it this way: this is regulation gone bad (and honestly, not that bad all things considered, just not good). You're dream-bill is PO gone good, but PO gone bad will be just as bad as this.

 

My dream pill is that every American has the choice of Medicare, regardless of age, which has a 90 percent approval rating by its clients. Yep, NOG, that's just a dream.

Let me come at it from a different direction, one that I should have in the first place, since I understood this from the start as a business decision, as well as a moral one. The "low level pencil pusher" you are referring to is more than likely a salesman, or what they call agents in the insurance business. Agents are in the business and -- get their commissions -- for SELLING policies, not for turning them down.

The client in question was shopping for a policy outside of employment, so it probably meant a nice fat commission for the sales guy (agent). What he more than likely encountered is what is famously known as "corporate red tape," which any sales person is familiar with who has tried to do business in a large company.

The agents work off tables that insurance companies develop very carefully, so there was probably no way the agent could get around it. They are like the Holy Bible in insurance companies, as is explained in the link below:

This is what they had to change to be able to sell the policy. If these agents could bend these tables, they would make a ton of money more than they already make. Good insurance agents do pretty well as sales guys, but being able to sell outside of these tables would make them massive commissions (of course, the insurance companies won't be in business very long either).

http://en.wikipedia.org/wiki/Life_table

 

http://www.thedenverchannel.com/news/21343449/detail.html

Another reason why we need reform. My oldest daughter fits this girl's description to a tee. She is 2, as of last friday and only weighs 21 lbs. Guess who our healthcare provider is???? You guessed it.... United Healthcare's Golden Rule!

I can't believe they would deny coverage to a 2 year-old with no major health concerns. A gag reflex issue is common amongst youngsters. How do you know this Blades, you ask? Because my 2 yr fought it up until about 3 months ago. No more issues now. Easily solvable with basic instructions from your Pede. All of our literature on this showed it as a commonly fixable issue for toddlers. Over 99% of the time it is corrected within 12 months.

 

Yep, Abigail is at the bottom of the chart for Height and Weight. But our Pede says she is doing just fine. She is pretty tiny, but she was a premey, born 7 weeks early, at 5'2 lbs, dropping to 4'6 the 1st week. She still kicks butt at daycare though. She is the resident bully toward all of the boys! She eats like crazy. She must have an incredible metabolism going right now. At dinner last night, she ate an entire chicken breast. With a little pasta and yogurt. So, no worries on our end. At 24 months, she is still fitting into 12 month clothes, though some are too small. We are currently changing her over to 18 month. Amazing we can talk babies in this thread and FOOTBALL!!!!! in another....

 

Honestly, I'd consider being a premey a pre-existing condition for at least the first few years (not necessarily one to deny coverage over, but one that may influence costs). There are high enough risks of enough different problems that I'd have no problem with an insurance company being cautious over it.

I don't think something like that should be enough to deny coverage outright, but definitely enough to warrant further inquiry. Blades, in your case (and in the case you link), it sounds like that 'further inquiry' would result in the companies discovering you have a perfectly healthy, just quite small, child.

 

Being a Premie should have no factor in being denied insurance. Once they release the kid from the NICU, it is pretty much a done deal, otherwise the don't clear the baby. The main reason for the NICU is to get the child back up to par with their birthweight, oxygen level and ability to take a bottle/nipple. Once a standard criteria is met, you will get the release from your doctor. If the child has other issues that don't stem from being premature, they can hold that against you, but being a Premie isn't on the application form.

 

Your comments reflect exactly why we need a government option for health care. The only way that some children can become healthier is to have the access to health care that the insurance companies are trying to deny. With insurance companies profits come first, while the health of a child is a poor second, and may be denied completely.

 

I don't think "subsidies" is the right word. In most cases these insurance companies themselves have been paid to provide healthcare payments under certain conditions. How is that a subsidy?

 

Or for a more generic term, "Coverage".

 

If you can't afford it, what's the difference?

 

All I'm saying is that insurance companies should be allowed to manage their risks within reason. I agree there should be regulation, and maybe even a gov't-provided base option, but nothing more drastic than that.

 

I guessed that we would agree on the PO part of the issue, because it would force insurance companies to be more competitive, and at the same time allow access to care. But the regulation part surprises me, since I thought (it appears in error) that you would have opposed regulation. I guess we agree .

I believe that opening up the market with choice, (and a PO), would make most regulation irrelevant. But I would just like to see the anti-trust exemption removed. Why should the insurance companies have it while no other industry does?

 

Some regulation is necessary, but I think the disagreement between you and I will be how much. Regulations on costs, claims response practices, coverage denial/dropping, etc are probably very good ideas (if done right). Regulations on who they can offer to (in-state limits, for example), where they can offer them (this "exchange" idea stinks to me), what they need to offer, and what they can make decisions based on (a druggy should pay more for his health than a fitness expert, and companies should be able to deny crack-heads coverage if they want) are a different matter. There may still be good ideas among them, but much fewer and farther between.

 

Blades is correct - once a premie is healthy enough to leave the hospital, their medical costs are similar to that of any other child.

The thing is though, infants have HUGE medical costs. I remember when my son was 3 months old and we took him for his first set of shots at the pediatricians office. The bill for the office visit, checkup, and shots was a little over $500, with the shots alone accounting for more than $400 of the total bill.

(Slight tangent: There are around 4 million babies born in the US every year, and nearly all of them receive vaccinations. Most injectable vaccinations (compared to the oral polio vaccine) cost about $100 each, and you usually get each shot three times in the first year. That means pharmaceutical companies need to produce about 12 million vaccines of each type annually. Many of these vaccines have been around for decades. My son is getting many of the same vaccines I received as an infant. I find it impossible to believe that a vaccine which is mass produced to this extent, and has remained virtually unchanged for decades costs $100. Sure, pharmaceutical companies have the right to make a profit, but I'd love to see the markup. We now return to you to your regularly scheduled thread...)

But that's the thing - what would be the purpose of "further inquiry" if not for the reason of denying coverage. Premies do require more medical care of at the time of their birth. Many of them spend several days (and in the case of extremely premature babies weeks) in the NICU. Being premature is not a pre-existing condition - it is THE condition for which they are being treated.

It also seems very strange to call it a pre-existing condition if the mother was insured for the duration of her pregnancy, and was receiving regular checkups. It could be argued that the baby was covered and was receiving care from the moment of conception.

Besides, almost any ailment or malady that can befall a person is usually caused by something else that if we could have avoided it, we would. A person who goes to the emergency room because he fell off a ladder and broke is leg cannot be denied coverage on the basis of "you should have had the good sense not to fall off a ladder". Similarly, to deny coverage to a premie because they are a premie is like saying, "You should have had the good sense to wait for 40 weeks of gestation before being born".

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Well yeah, but that the basis of how all insurance works - whether you're talking about home owners, auto, life, etc.

Well, one other industry has it - major league baseball.

What do you not like about the exchange? The exchange would be the mechanism by which you would select your health insurance. Since a personal mandate appears to be what is getting passed you need some mechanism by which people without insurance can get insurance, and by which people who are dis-satisfied with their current insurance can go to find alternatives.