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OP-ED | Doesn’t ‘Truth in Advertising’ Apply to Health Insurance Companies?

by Sarah Darer Littman | Aug 8, 2014 7:00am
(30) Comments | Commenting has expired
Posted to: Business, Health Care, Opinion, Health Care Opinion

Last year, I was one of the many small business owners and sole proprietors who had their health insurance cancelled, as the big insurers used the specter of approaching health care reform to clear their rolls. My brother and my boyfriend, also self-employed, were in the same boat.

I started looking for new insurance on Connecticut’s health insurance exchange, Access Health CT, but once I realized I wasn’t going to qualify for a subsidy, I decided to buy my insurance on the private market, because there were more options available.

After looking at various available plans, I decided to go with ConnectiCare, because I could get a plan that was comparable to my previous insurance coverage, and offered dental, which my previous insurance didn’t.

Before I signed up, I checked two things carefully: that my current doctors were in-network, and that all my current medications were listed in the formulary as being covered.

Everything checked out, so I bought the insurance.

All seemed well until last week, when a summer cold triggered the worst asthma flare-up I’ve had in years. I sounded like Darth Vader in the middle of a panic attack.

When I went to use my inhalers, they’d expired two years ago — thanks to taking generic Singulair daily, my asthma is usually pretty well controlled so I’d barely ever used them.

I called my doctor’s office and asked them to call in refills, which would normally be no problem. But then I got the calls back from the nurse. First my insurance wouldn’t cover Ventolin, only ProAir. My doctor tried to fight for Ventolin, because that has a dose counter, so you know when the cartridge is almost empty. ProAir doesn’t. But my insurance company wouldn’t budge.

The next day, as I was still gasping for air, apologizing to my students for my constant wheezing and coughing, and struggling to function, I got a message on my cell. “Your insurance won’t cover Advair — even though the doctor has argued with them.”

Advair was listed on the formulary before I signed up with ConnectiCare. But as it says on the bottom of the list, “This formulary list is subject to change.”

The day I found out that I wasn’t going to get my Advair, I left the house at 8:50 a.m. and didn’t get home until 9 p.m. because I taught morning and afternoon/evening writing workshops. When I returned home that evening, I collapsed into bed, feeling like I was about to die.

The next morning I tried to make an appointment to see my doctor to see if I could get some alternative steroid, because I wasn’t sure how I’d survive the weekend. Unfortunately, the only appointment he had was while I was teaching. I spent most of the weekend in bed, exhausted and gasping for breath.

On Sunday, my sister-in-law called me from England. When she heard that my insurance company wouldn’t cover something as basic as Ventolin or my usual steroid, she was gobsmacked. “Don’t they realize you could die from asthma?” she said, with no small amount of anger, followed by lengthy conversation about the insane healthcare system in this country vs. the National Health Service (NHS) in Great Britain.

People here love to bash the NHS and “socialized medicine,” but even conservatives in the U.K. look to our country and think our healthcare system is inhumane — particularly because they know that it’s still possible to get private insurance and see consultants privately — and that insurance is much cheaper.

The anti-Obamacare folks constantly use the catchphrase “the government will come between you and your doctor,” but they ignore the reality of what has been happening every day in the U.S. since long before Obamacare was even proposed — that it’s insurance companies who come between us and our doctors. What’s more, these same insurance companies are using the cover of healthcare reform to try and shaft consumers even more than they were doing in the past — and politicians are happy to pocket their campaign contributions and let them do it.

When I finally got to see my doctor on Monday, he gave me some samples of a steroid, because at that point he and I were both sick of playing games trying to figure out what my insurance company (the one to whom I’m paying monthly premiums) was going to cover, and he wanted me to be able to breathe again so I could function effectively at the many jobs I work to support myself and my family.

I also saw my neurologist last week for a follow up appointment, and she told me that she’s hearing similar stories from her patients.

What I want to know, from our legislators, our healthcare advocate, and the state insurance regulator is: How can insurance companies get away with listing drugs in a formulary before you sign up for their insurance, yet refuse to cover them after you’ve committed?

Doesn’t “truth in advertising” apply to insurance companies? Or do Connecticut’s politicians just pander to them, too?

Sarah Darer Littman is an award-winning columnist and novelist of books for teens. A former securities analyst, she’s now an adjunct in the MFA program at WCSU, and enjoys helping young people discover the power of finding their voice as an instructor at the Writopia Lab.

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(30) Comments

posted by: Fisherman | August 8, 2014  6:51pm

... well, its not education!

posted by: Politijoe | August 9, 2014  6:33am

Politijoe

Sarah, Thanks for sharing your personal healthcare fiasco, one which is unfortunately repeated thousands of times a day throughout our healthcare system. The take away here is your point that what stands between you and your doctor is not the bogey-man Socialism but the greedy for-profit insurance companies who are seeking to exploit the confusion for their own gain at the expense of the consumer.

If conservatives could redirect their misplaced anger long enough to objectively assess our healthcare system they would see that our employer-based, out-of-pocket, for-profit healthcare system is a fragmented, convoluted system that costs more than any other industrilized nation, provides less and still doesnt insure all of its citizens. The reality is the US healthcare system has incorporated rationed care, death panels and unsustainable rising premiums for decades.

The ACA (Obamacare) seeks to address these issues with legislation that based on fiscal soundness, fairness and sustainability.

posted by: Diogenese | August 10, 2014  8:31am

Ask a vet on a secrete waiting list which insurance system he would prefer.

That said, there absolutely should be transparency in the medication lists and networks. When a person buys a 12 month policy, the formulary in place should remain for the year.

posted by: Sarah Darer Littman | August 10, 2014  10:26am

Thank you, Fisherman, for that extremely astute observation. The rest of CTNJ’s readership and I would never have realized that without you pointing it out. Your critiques do much to further intelligent political dialogue.

posted by: Joebigjoe | August 10, 2014  11:17am

I don’t really have the time to research what the market cap of all publicly traded health insurance companies might be, but I would have to guess its near a trillion dollars when you combine all of them.

Now having said that, the day we decide to go single payer and crash the stocks of all of these companies, thereby impacting the ability of many of their employees that own their own company stock to retire, the impact on the mutual funds that many average Americans invest in, as well as the huge Pension fund holdings of unions, state, muni, and federal worker unions, can someone tell me how this all plays out?

Do you really want a permanent Lehman moment in payer healthcare firms? In CT we have Aetna, Anthem, CIGNA, UHC so what happens when those firms downsize dramatically and families have to leave the state because there are certainly no other jobs here? What happens is we lose tax revenue all throughout the chain starting with when that employee starts spending that paycheck. You also drive housing values down especially throughout the Hartford area which is already the hotbed of economic growth. NOT!! Look how much the City of Hartford would lose. How would that impact the suburbs. Do I really need to answer that?

Sure at times insurance companies can be incompetent and sometimes border on decisions that are evil. Yes a lack of truth in advertising is disgusting but why dont we hold everyone to the same standard in that regard? If we did, this country would have forced Obama to resign because of his blatant lies to get the Dems to vote for this bill in the first place.

if we want to fix this the answer is competition across state lines, a firm dose of regulation covering certain behaviors by these firms, and personal responsibility. Just like car insurance if I get in accidents I was at fault in I should pay more. If someone is obese or smokes and a whole litany of other things that they can change they should pay more and I dont mean just individual plans but a smoker shouldnt get the protection of a group plan where everyone pays the same which means a non-smoker pays more in their premium.

Joe, fiscal soundness?? LOL

posted by: Fisherman | August 10, 2014  11:36am

.. then you got the point.

posted by: Politijoe | August 10, 2014  6:32pm

Politijoe

Diogenese, Im not sure exactly what you meant when you stated “Ask a vet on a secrete waiting list which insurance system he would prefer”  Although,  as I understand it you’re advocating against a universal healthcare system. The VA issue was/is tragic however all systems have their problems and tragedies including our current system with patients dying because insurance companies denied treatment or unable to obtain treatment because they had “Pre-existing” illness, etc… but more relevant to the discussion is the costs and availability of drug therapies…..while were on the subject of the VA and Medicare why doesn’t the conservative right scream and protest against the fact the Republican congress denied Medicare the right to negotiate drug prices from the pharmaceuticals….instead Medicare must pay full retail price for the drugs they use which further pushes that program into financially unsustainable territory

posted by: Sarah Darer Littman | August 10, 2014  7:46pm

@Fisherman - if the education columns bore you, there’s a simple solution. Don’t read them. End of story.

posted by: Politijoe | August 10, 2014  8:06pm

Politijoe

Bigjoe, I know I’m going to regret having engaged you in this dialog however I’ll attempt to address your points.

“The day we decide to go single payer and crash the stocks of all of these companies…..”
You’re premise is based on several faulty assumptions such as: making the assumption this would happen overnight, the assumption universal healthcare could not be a combination of public/private and again an assumption that this hasn’t already been successfully accomplished in other countries.

“In CT we have Aetna, Anthem, CIGNA, UHC so what happens when those firms downsize dramatically and families have to leave the state because there are certainly no other jobs here?...…..”
Again your assuming this would be the outcome when there is no evidence that supports your claim

“At times insurance companies can be incompetent and sometimes border on decisions that are evil. Yes a lack of truth in advertising is disgusting but why dont we hold everyone to the same standard in that regard? If we did, this country would have forced Obama to resign because of his blatant lies to get the Dems to vote for this bill in the first place……. “
This is such a blanket inflammatory statement, what lies? The fact is the US healthcare system costs more than any other industrialized healthcare system in the world, with far worse outcomes and still doesn’t insure all its citizens. Prior to Obamacare healthcare premiums increased on average 8% annually over the last 12 years! Prior to Obamacare health insurance companies employed death panels, rationing and price fixing.

“If we want to fix this the answer is competition across state lines, a firm dose of regulation covering certain behaviors by these firms, and personal responsibility. ….. “
Explain how would this solution provide better outcomes, more affordable and accessible coverage at a less expensive cost than Obamacare?

“Fiscal soundness?? LOL…….”
Look at the comparative data, every other nation provides healthcare better, cheaper and universally therefore by default we are not operating a fiscally sound system are we?

posted by: Joebigjoe | August 11, 2014  6:36am

Thanks Joe. Just a few responses.

1) You don’t know how this will play out in the stock market, nor do I for that fact. That’s my opinion and best guess. As a CT resident, knowing both people on Wall Street and a number of executives in these firms, that’s where my best guess will fall. If your way of how this will play out was so easy, and not destroy all that wealth, don’t you think they would do that and just lay out that plan?

2)As for not knowing again I am not willing to gamble on this not happening. I can see ho a person in Alabama might say “the heck with these insurance companies, lets roll the dice” but I live in CT and my wealth (I wish) in terms of m housing value, my taxation, etc is intertwined with these firms even though I dont work at them. If these companies took a massive stock market hit and had to let go alot of people, they arent staying in CT. That one I will bank on. After all most people who are here dont want to be here according to Gallup, so if they dont have a job and no one is hiring they will go where people are hiring.

3)What lies? Seriously? You dont think Obama lied?

4) I will not argue with that 8% number but I guess that based on some false actuarial assumptions provided by the government there are going to be larger increases than that now. However, you dont see the insurance companies hurting because the idea was that if the government messed up in their numbers or if the people that signed up were in a higher category of illness that the Fed government would bail out the insurers. That’s happening which is why their stocks haven’t tanked. What happens if SCOTUS declares the most recent court disagreements in Virginia to be unconstitutional? It all comes tumbling down.

5) You keep mentioning this every other country is better concept. Did you see last weeks major research that talked about how in Europe, Germany specifically was one of the countries, that a woman with breast cancer has a shorter life span there than they do in the US. Not by days, weeks, months but a few years.

posted by: Joebigjoe | August 11, 2014  1:12pm

Joe this is for you. Copied from another source.

“Dr. Doug Gerard, an internist who practices in Hartford, Connecticut is an example of what is happening. When a patient sees him for a typical office visit, Gerard is reimbursed $100 or more for the visit by the patient’s insurance company. However, patients who have an Obamacare purchased policy, Gerard only gets reimbursed $80, the same as he gets from treating a Medicare patient.

You may not think that $20 or more per visit isn’t much, but realize that many doctors in private practice have a very narrow profit margin due to the high costs of running a medical office, complying with all of the new Obamacare rules and paperwork and the high cost of malpractice insurance.

Consequently, Gerard has opted to refuse to accept the insurance from two of the three companies that offer plans through Connecticut’s Affordable Care Act marketplace.

Gerard commented about this, saying:

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates. You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

“I don’t think most physicians know what they’re being reimbursed. Only when they start seeing some of those rates come through will they realize how low the rates are they agreed to.”

Many doctors have already stopped accepting Medicare patients for the same reason. A number of hospitals have also rejected many Obamacare plans because they are reimbursed too little. If more doctors follow Gerard’s example and reject Obamacare healthcare plans that pay doctors at Medicare rates, it could spell further doom for Obama’s flagship piece of legislation and cause it to come crashing down to the ground in ruins.

If Obamacare policies cost more and they pay doctors and hospitals less, where is all of the money going? Who’s getting rich off of the national socialist medical scheme?

posted by: Politijoe | August 12, 2014  1:39pm

Politijoe

Bigjoe, At this point I don’t want to get too far into the weeds addressing anedotal examples of individual reimbursement rates for primary visits I will however mention that this same problem has existed for years with Medicare and Medicaid reimbursements rates. My understanding is that Obamacare rates are actually reimbursed slightly higher than Medicare.

Let’s put that aside for the moment…. If you step back and consider the facts from a thirty-thousand foot perspective What you will find is that nationally our healthcare premiums have risen on average 8% annually for a dozen years. Combine this with the fact insurers have rationed care, denied coverage. More importantly and to the point, our national healthcare cost are higher than every other industrialized nation and in large part because 20% of our costs is administrative and profit.

Although Reimbursement rates are a valid concern-they have always been a concern the real issue which you don’t seem to want to accept is that nationally we pay more, get less and still don’t insure all our citizens. Our healthcare premiums are unsustainable and our national healthcare costs are unsustainabe.

Furthermore this is not news, it has been a slow moving train for well over two decades. Republicans acknowledged this issue in the early 90’s and proposed healthcare reform that was essentially Obamacare. MItt Rommney implemented the Commwealth plan is Mass which is similar to the ACA….. The point is republicans recognized the same problems and arrived at the same conclusions. This is not a spending problem it’s a math problem.

posted by: Joebigjoe | August 12, 2014  3:50pm

Joe we do have common ground on one thing you said as I agree with it.

“Our healthcare premiums are unsustainable and our national healthcare costs are unsustainable”

We just disagree on the fix.

Obamacare is not the answer. However, I would be willing to risk that if the Republicans had a chance at their fix and I dont mean Romneys Democrat legislature plan or anything bipartisan because Obamacare wasn’t supported by one Republican because they got nothing in the bill. If it was implemented and didnt work in terms of the success measures attached to it that were OK with the American people, then we can go single payer because at that point people dont want Obamacare and if the Repubs plan failed then they would just throw up their hands and say “whatever”.

Never happen though because too many Dems want to control peoples lives. Lets say the SCOTUS acts on the Virgina case and pretty much makes Obamacare financially impossible because of the subsidies, there would be no chance that the Dems would let the Republicans take a shot at it because it might just work. If they thought it would fail miserably they would encourage the Repubs to try it and own it.

posted by: Politijoe | August 12, 2014  10:47pm

Politijoe

Bigjoe you stated “Our healthcare premiums and our national healthcare costs are unsustainable, We just disagree on the fix. Obamacare is not the answer.”…. at this point you’ll have to elaborate on what the answer would be, its not enough to simply dismiss one policy without a viable recommendation or alternative.

You stated “I would be willing to risk that if the Republicans had a chance at their fix and I dont mean Romneys or anything bipartisan because Obamacare wasn’t supported by one Republican because they got nothing in the bill.”……… the challenge with this theory is twofold, as I previously mentioned Obamacare is basically a holdover from a Republican reform introduced by Bob Dole and the Commonwealth plan was modeled after that measure, therefore conservatives cannot rewrite history.
Obamacare and Rommneycare areRepublican reforms cut from the same cloth, therefore it strikes me as just a little disingenuios that suddenly their plan is now an evil, socialist attempt that will bankrupt the nation. 

For what its worth, its the kinds of inflammatory comments like this one that derail otherwise constructive dialog “Too many Dems want to control peoples lives”……. Again somewhat disingenious since Republicans have attempted to control a womans right to choose, womans healthcare choices and same sex marriage to name just a few examples of “wanting to control peoples lives”

Your comment “Lets say the SCOTUS acts on the Virgina case and pretty much makes Obamacare financially impossible because of the subsidies” ……. This is a much broader discussion that appears centered on an obscure interpretation of IRS tax code (IRS code 36b ) Specifically, whether tax credits (Advanced Premium Tax Credits or APTCs) are only allowed for insurance purchased on a state exchange or also allowed for insurance purchased on a federally established exchange. To rule against and not include Federal exchange enrollees would make many aspects of the law moot and would potentially affect citizens in 36 states who would lose eligibility for APTCs. This legal debate seems to be a political attempt to weaken the ACA by establishing a technicality in the fundamental interpretation of the law.  The argument appears centered on nuances of the Internal Revenue Code and two ACA sections. Specifically IRS code Section 36B-which provides tax credits as a form of subsidy to individuals who purchase health insurance through state exchanges versus insurance purchased on exchanges established by the Federal government under section 1321 of the ACA (when acting on behalf of a state) In contrast, the Fourth Circuit Court of Appeals upheld the IRS provision of APTCs for enrollees on both state exchanges and the federal exchanges, pointing out that to read the state establishment requirement too literally would be incorrect

posted by: Joebigjoe | August 13, 2014  9:03am

Joe, I cant get into the level of detail you did on the court case. I’m just going on liberal articles I read, that expressed great concern that Justice Roberts can bring Obamacare down.

As for women, give me a break please. I’m Republican, I’m Conservative, many of my friends are and only know one that is against abortion at any time and she’s a woman. The rest of us (including liberal friends and family) arent crazy about it but are OK with first trimester abortions because “things happen and some people just shouldnt be parents”. After that is unacceptable for most.

The libs like to say “war on women” but the fact is that women are the only humans that can kill another innocent human being because its inconvenient and not go to jail for that. Its the Right that is screaming now at Obama to stop the atrocities against women and Christians in the Middle East and the Left sits there wringing their hands as womans bodies get mutilated in the name of religion and power over women.

Finally as for the Dole plan, you need to read the truth from the people that actually came up with a plan and not the lefts spin to deflect the truth.

The plan was drawn up by the Heritage Foundation and I would be lying if I said it was a good plan. However, what it was, was a state plan with flexibility for individual states to do what they needed to. The left and Obama took parts of that plan and then juiced it up at the Federal level in horrible ways and ways that even Heritage said originally should not be done or you get a hybrid that wont work. If Obamacare was so great then Obama the King would not have changed the dates for the mandates as Dems begged him to because they know that America will get even madder at this when more people get impacted.

posted by: Politijoe | August 13, 2014  10:02am

Politijoe

Bigjoe, I have to apologize for the delay in responding, it appears the original response was inadvertently deleted, with that said…..

1) “You don’t know how this will play out in the stock market,. That’s my opinion and best guess”……. Exactly my point, you’re making an assumption absent any evidence-based data about the ACA failing and taking down the stock market, housing, jobs, etc…

2) “If your way of how this will play out was so easy, and not destroy all that wealth, don’t you think they would do that and just lay out that plan?......” valid question however I believe you know the answer to this question, there are moneyed interest and industry influence protecting the status quo at the expense of the greater good.

3) “What lies?  You don’t think Obama lied…..” Im assuming your referring to when Obama said “If you like your insurance you can keep it”  The fact of the matter is he misspoke-not lied. I have kept my insurance and so has everyone else who didn’t have a sub-standard healthcare plan. Those plans simply did not meet the threshold for standard quality of care. Thats mis-speaking and vastly different than lying.

4) “I will not argue with that 8% number but I guess that based on some false actuarial assumptions provided by the government there are going to be larger increases than that now”……... again this is not based on evidence its an anecdotal emotional response. 

5) “You keep mentioning this every other country is better concept. Did you see last weeks major research that talked about how Germany was one of the countries, that a woman with breast cancer has a shorter life span than in the US. …….?” Across the board, the United States has a higher five-year survival rate than the European average, according to a study in Lancet. For breast cancer, for instance, the U.S. survival rate was 84%, the U.K. rate was 70%, and the average European rate was 73%. Many factors contribute to survival rates, including being insured or uninsured, age, occupation, economic status or co-morbidities. Therefore, simply comparing survival rates isn’t necessarily an accurate measure, and it certainly isn’t a complete reflection of health care quality.  In large part because countries with more advance screening will have higher survival rates. Cancer screening, specifically mammograms and colorectal screening is less common in Europe and with the uninsured.

Breast cancer survival rates among the uninsured are similar to Europe, however
survival rates in Canada, Japan, Australia and Cuba were all comparable to or higher than U.S. survival rates on all types of cancer and those countries also have some form of government-provided health care coverage.

Again, the real question is whether you believe healthcare is a right of employment or a right of citizenship……?

posted by: Joebigjoe | August 13, 2014  1:40pm

Joe, thanks. I wont respond to the various points in your email as we’ll deal with some of those as other healthcare stories come up.

I will however respond to this question as it is a good one.

“Again, the real question is whether you believe healthcare is a right of employment or a right of citizenship……?”

My answer is I do not think healthcare is a right of employment meaning that you should not have to be employed to get healthcare.

On the other side though is I do believe that healthcare is a right of citizenship… with caveats.

You and I may disagree frequently but I can tell you have followed lifes rules and are a highly contributing member of society. You shouldnt be denied good healthcare if you lost your job tomorrow, or go broke paying for COBRA. You earned that right.

That’s where I know you and I will disagree. Every person legally a citizen or legally here in this country should get healthcare. However, I do not think, nor is there anything that you can say that will sway me, that people that dont contribute to society and are takers, should get anywhere near the same heathcare coverage and treatment quality as someone who has contributed.

If I end up on a gurney at Hartford Hospital after a life of busting my tail working and not being at family events because of work travel, I should not get the same level of doctor and treatment as the next person who may be an illegal alien or someone that has been on welfare for 10 years. Should the uneducated person that has worked 70 hours a week for years at manual labor jobs get the same quality as me even though we are very different socio-economically ? Absolutely. They earned it.

posted by: Politijoe | August 14, 2014  8:19am

Politijoe

Bigjoe, 
When I responded to your contradictory statement that “Democrats  attempt to control peoples lives”  you focused entirely on abortion which certainly falls into the category. However you sidestepped the broader systemic issue of the conservatives war on women and missed an opportunity to at least recognize the importance of the Lilly Leadbetter act or the violence against women’s act, or the childcare initiatives or restrictive preventive healthcare and instead focused exclusively on abortions. Unfortunately the dialog then took an arbitrary direction attempting to compare US women’s rights with mutilated women in the Middle East.  You also stated “If Obamacare was so great then Obama the King would not have changed the dates they know that America will get even madder at this when more people get impacted.”.......... Obama the King, seriously? Again this is conjecture-the delay in the mandates had nothing to do with avoiding citizens becoming angry as they realize the impact. I could get into detail but that’s another discussion.

Most fascinating however is your statement “I do believe that healthcare is a right of citizenship… with caveats….Every person legally a citizen or legally here in this country should get healthcare. However, I do not think, that people that dont contribute to society and are takers, should get anywhere near the same heathcare coverage and treatment quality as someone who has contributed.”............ Joe, this is an interesting philosophical point. If we agree healthcare is a right of citizenship I don’t believe there can be caveats. If this same argument is applied “They” as you have defined takers, have a right of citizenship with some caveats which could be used with few limitations. For instance “they” can’t own property or can’t vote. They can join the workforce but not earn the same salary for the same job, they can have a loan but at a higher interest rate. They are afforded a public education but with substandard resources….etc as you can see it quickly becomes a punitive and oppressive solution. The larger question of course is your definition of “They-those who don’t earn their way”

In order to understand the true costs and the comparative burden this group places on society we need to remove any personal emotion, assumption and conjecture from the equation. Lets establish first who “they” are who don’t earn their way, how many are in our society and what is the annual cost associated with providing support for this cohort. This will establish a framework of evidence based data to better determine the cost, their contribution and perhaps causation. So joe if you can provide who they are and how they don’t earn their way, the size of this group nationally and what you think the overall cost associated with supporting them is that would be a great first step to begin looking at this issue of morality-healthcare-costs-citizenship 

posted by: Joebigjoe | August 14, 2014  10:04am

Joe, very interesting piece in todays WSJ. It gave me some facts to share with you and others.

1) Commonwealth Fund ranks US healthcare last out of 11 of the worlds most advanced nations. NHS out of the UK is best. Now lets look at the peer review findings and not the spin put out by this foundation that progressives like to latch on to.

2) NHS 3.2 million people waiting for treatment after diagnosis and 508K waiting for operations. Cancer patients being referred by their GP for Urgent treatment are waiting 62 days for first treatment.

3) 6 million Brits are fed up with the system and own private health insurance now and 250K choose to pay out of pocket for private treatment even though NHS insurance costs 3500 annually for every man woman and child.

4) It isnt just the UK. Sweden is in trouble . The average Swedish family spends 20,000 annually in taxes towards healthcare and 12% bought private insurance last year which is a number that has increased 67% in 5 years. 600K Swedes now use private insurance even though they have guaranteed government healthcare.

Things arent as great elsewhere as some would make it look. I still stand on what I said before and that is that everyone who is here legally should get some form of healthcare but not everyone should be equal. You contribute by working hard to get better healthcare.

posted by: Joebigjoe | August 14, 2014  11:30am

So Joe, you are touching on the major issue in our society and one of the main issues between people you and people like me. That would be work.

You see when this country was founded and for almost 200 years after that everyone pretty much worked. There were no handouts, no programs and no excuses.

Too bad our society makes it unacceptable to have the conversation you and I are having because when someone tries to they get shouted down and called every name in the book.

The fact is that as it relates to better healthcare, if you are able bodied and you want it, you should work or show a long history of work. There is nothing more viral than to give people stuff for free that most people work for and sacrifice for. If there arent enough jobs then follow the Constitution and shut down the border.

As for voting I’m not crazy about people that dont work being able to vote and I dont mean temporarily unemployed. They’re just going to vote for more of what they get for not working.

I’ll tie this to the 2nd amendment argument used by anti gun people where they say that the founding fathers could have never foreseen society today. Using that logic they certainly could have never foreseen able bodied man and woman not working their tails off. Dont forget the lessons of the early Pilgrims where they decided to farm as a collective and found that personal incentive to work was diminished because people knew that they would get the same for less effort.

Liberals try to redefine the human brain and the human spirit and the fact remains that people lose motivation to contribute when they get what they need for free and those that do work hard get discouraged and fed up when they see how people that dont work get far too much for their lack of effort and sacrifice.

As for the cost of “they.” Every dollar they get can be and is measured so we do have hard dollar facts. Those numbers though are dwarfed by the soft dollar impact on society where you get millions of people not pulling their own weight in society, the breakdown of their families, the breakdown of their neighborhoods, the breakdown of their culture and ethics.

As for the women thing give me a break. By preventative healthcare you mean contraception. The fact is that most Americans think women and men should pay for their own contraception.  Why dont we means test contraception so we know that if its not provided by an employer plan that the person truly lacks the funds to pay for it? As for violence against women you are talking to someone who got in a brawl years ago over a slap of a woman that I wasnt going to stand by and watch like everyone else. Society needs to address the root issue which is men should never hit women and women should never hit men. From a reliable source, Ray Rice got a 2 lousy game suspension for knocking out his fiancee because she hauled off and hit him in the face first. People should not be hitting each other period end of story.

posted by: Politijoe | August 14, 2014  10:51pm

Politijoe

With regards to the stats you cited regarding British citizens waiting for treatment, what the statistic dosent mention is how long are they waiting for treatment and what types of treatments? Typically routine treatments and procedures such as joint replacements and non-emergency surgery do have longer wait times. Your references to the number of Euroeans who opt out of public healthcare for private insurance misses the point, which is European healthcare is cheaper, has better outcomes and insures all their citizens. And your stance that “ everyone who is here legally should get some form of healthcare but not everyone should have equal care unless “They” contribute by working hard”  is a misguided belief that actually increases our costs because “THEY” end up using costly ER visits for routine care and absent preventative care significantly increase costs associated with treating expensive illness. Not to mention the punitive, oppressive and subjective approach associated with such an implementation. 

Regarding preventative healthcare for women: This addresses more than simply contraception, there are mammagrams, STD testing, pregnancy, and cervical cancer testing and prenatal services for starters. Violence against women isn’t just expecting everyone to play nice, it’s comprehensive federal legislation that addresses a whole host of measures designed to protect women against domestic violence. Lilly Leadbetter is more than insurance, it ensures equal pay for equal work. Republican Opposition to every one of these measures indicates there is a real bias towards women in the conservative party,

Therefore, in spite of the fact we pay more, have poorer outcomes and still don’t insure all our citizens you have consistently opposed ACA healthcare reform on a variety of anecdotal grounds including: reimbursement rates, wealth destruction, negative impact on all Americans, European survival rates and unworthy undesirables. Yet with all due respect you haven’t established exactly who “they” are, how many are in our society and what is the annual cost associated with providing support for this cohort. What you did say was “Every dollar they get can be and is measured so we do have hard dollar facts. Those numbers though are dwarfed by the soft dollar impact on society where you get millions of people not pulling their own weight in society….”  BJ this costs and definition needs to be established to determine the impact and burden society is bearing and perhaps the causation. The same is true when you stated “There is nothing more viral than to give people stuff for free that most people work for and sacrifice for.”........What “stuff” are we referring to and what is the economic and social cost to society you referred to compared to other burdens?  

The answers to these questions may help me better understand your perspective with regards to healthcare. 

posted by: Joebigjoe | August 15, 2014  12:42pm

Joe I’ll catch up with you in the next heathcare discussion. Going to be taking some R & R so time is at a premium. Enjoy your weekend

posted by: Politijoe | August 15, 2014  3:58pm

Politijoe

BJ
I have to admit Im more than a little disappointed in your sudden departure. We’re all busy so I can respect that. However, when you are engaged in a dialog and introduce ardent and convicted claims regarding your theory and a couple of fundamental points regarding that theory are  challenged (more than once) and you respond with “I’ll catch up with you in the next heathcare discussion, going to be taking some R & R so time is at a premium”  this immediately raises some concerns regarding your theories, your knowledge and your willingness to share ideas and learn from one another. I would assume that given your strong convictions on the matter you have the data to support your premise. However, I certainly won’t press you further on this matter suffice to say that if your beliefs are based on emotion, assumption and conjecture instead of evidence, data and facts there may be some solace in recognizing that.

For what it’s worth I’ll leave the question with you again should an opportunity arise that allows you some time to respond. Thanks again and be well. 

In spite of the fact we pay more, have poorer outcomes and still don’t insure all our citizens you have consistently opposed ACA healthcare reform on a variety of anecdotal grounds including: reimbursement rates, wealth destruction, negative impact on all Americans, European survival rates and unworthy undesirables. Yet with all due respect you haven’t established exactly who “they” are, how many are in our society and what is the annual cost associated with providing support for this cohort. What you did say was “Every dollar they get can be and is measured so we do have hard dollar facts. Those numbers though are dwarfed by the soft dollar impact on society where you get millions of people not pulling their own weight in society….”  BJ this costs and definition needs to be established to determine the impact and burden society is bearing and perhaps the causation. The same is true when you stated “There is nothing more viral than to give people stuff for free that most people work for and sacrifice for.”........What “stuff” are we referring to and what is the economic and social cost to society you referred to compared to other burdens?  

posted by: whatsprogressiveaboutprogressives? | August 16, 2014  8:41am

Truth in advertising. Now there’s a funny one. Let me see. Politicians create these laws who themselves are able to lie about political issues just to get re-elected with absolutely no consequences.

posted by: Joebigjoe | August 18, 2014  6:55pm

Joe it was my only day off this summer so give me a break buddy. You know I dont back down from a good online argument.

I’ll answer part of your what you asked with a very specific example.

One example of “they” are the looters in Ferguson and those people we now have very strong reason to believe have lied to get people riled up. “THEY” dont deserve the same healthcare I do, you do, or anyone on this web site does.

How is that for a direct answer? Now tell me why people that do that deserve anything other than very basic treatment.

As it relates to cost, remember my opinion that if you are here legally you should get basic heathcare. What you get beyond that is up to the way you live your life. As for the cost, if we arent treating people that are criminals and people that arent supposed to be in the country I would have to say we could save alot of money and improve treatment for people that deserve it. I know you wont buy that concept because people on the left like to think we are all really equal which we are, until we make personal decisions to change that which is the part the left doesn’t like.

You want another cost saving measure? If a doctor said “JoeBigJoe I’m sorry but you have 6 months to live”  how about this option.

The doctor and others trained in the situation estimate that it will cost 500K to keep me alive 6 more months. How about I roll the dice and have the insurance company give me 250K and I dont get treatment other than something for the pain. My family gets 250 which would help the economy and my family and the insurer takes part of that other 250 so that a sick child that hasnt lived the life I have gets money towards their treatment?

posted by: Politijoe | August 19, 2014  5:04pm

Politijoe

Bigjoe,
Good to see you’ve responded, however keep in mind that my intention is not to grill your position but to simply better understand your perspective regarding your stated opposition to healthcare reform. Unfortunately there appears to be a fair amount of vague definitions associated with your positions. With that said,
you have thus far opposed healthcare on the grounds of reimbursement rates, wealth destruction, negative impact on all Americans, European survival rates and undesirables defined as ‘They” who, as “one example of “they,” are the looters in Ferguson and people that aren’t supposed to be in the country …….. therefore as I understand this, criminals and illegal immigrants should not be provided basic healthcare.

We may be getting closer and therefore the obvious questions are:

1.  What constitutes or is defined as “basic healthcare”

2.  What LEVEL of criminality meets the criteria for the definition of basic healthcare?

3.    What exceptions if any are applied to illegal immigrants eligible for basic healthcare….. ie: adults who crossed the border recently, children brought here as infants and now young adults, incarcerated immigrants?

When you stated..”people on the left like to think we are all really equal which we are, until we make personal decisions” therefore……

  4. Are there any underlying factors within an individual’s life, (environment, resources, personal safety, persecution, education, etc..) which contribute to an individuals “choices” that would be an exception to the rule as applied to healthcare?

As for the cost you stated “if we aren’t treating people that are criminals and people that aren’t supposed to be in the country I would have to say we could save alot of money and improve treatment for people that deserve it”….. Again how do you define criminal, illegal immigrants, what percentage of our national healthcare cost or GDP is “alot of money” would be saved and when you stated “improve treatment” - what is improved treatment mean to you?

Again you stated “There is nothing more viral than to give people stuff for free that most people work for and sacrifice for.”........

5. What “stuff” are we referring to and what is the economic and social cost to society you referred to compared to other burdens? 

Finally, you provided the scenario regarding a six-month diagnosis and a subsequent $500K health insurance bill……. What if that scenario was reversed….your child had 6-12 months to live and your doctor said we have an experimental treatment that has had some success with this type of diagnosis problem is your insurance company denied coverage for the $150K worth of treatment.

if you could assist with providing some additional perspective and detail regarding your opposition that would great as we continue to move forward.

posted by: Joebigjoe | August 20, 2014  6:31am

1) Joe, basic healthcare would be anything that a GP/primary care doctor can provide. I dont intend to design an entirely new heathcare plan on this message board but in general if a GP can help you with it (whatever it is) and CVS or Walgreens can fill any prescription then you should get it.

2) As for criminality we would have to decide as a society what is an acceptable transgression as people arent perfect and what represents things that are detrimental enough to warrant this penalty. The purpose of this is deterrence. If you dont think deterrence works then go check out Singapore which is an advanced economy and will whip people for certain crimes. Funny how people dont like that option to the point where their society is incredibly safe.

3)Joe, I’m Ok with the kids getting the full treatment yet after they are healed they and their family need to get deported. Does this apply to people here today? No. We need a date where we say, if you come into this country illegally after say Jan 1, 2016 you dont get squat, we dont care if you and your children get sent back in 15 years and your child doesnt speak the language of the country you came from. Its called deterrence. Also if you havent noticed we have a major problem in the southwest especially where many illegals could care less about America. You cant tell me that this is the same as it was when people came to Ellis Island. Why are we paying anything for people like that and I dont just mean healthcare? You don’t want to stand for the Pledge of Allegiance,do school reports on American History because you hate America, punch out teachers, and think its Mexican land then I’m good with rounding up people like that up and sending them back. Aren’t you?

4) Those would all be defined Joe.

5) Do you really not know what “stuff” is. Let’s see…rent, money, food, cell phones, healthcare, clothes etc. Not that any of those stand alone should not be provided but there are too many people that take the whole gamut of things and are comfortable enough that they don’t work and they are gaming the system.

As for the experimental treatments I would be in favor of providing that for all children here legally. However these treatments need to be peer reviewed so some quack doesnt make a ton of money and everyone dies anyways. However in this category the tort laws would have to be changed or it wouldnt work.

posted by: Politijoe | August 21, 2014  10:27am

Politijoe

Bigjoe, thanks for the response I had replied earlier unfortunately the post was somehow lost in the upload so I apologize for the delay. It’s worth repeating that my intention is not to grill your positions and beliefs but to simply better understand your perspective regarding your opposition to healthcare reform.

With regards to defining basic healthcare as you see it, you stated
“Basic healthcare would be anything that a GP/primary care doctor can provide and CVS or Walgreens can fill any prescription.”………… for the sake of discussion what you have described is healthcare reform as we have it, basically Obamacare.

Regarding criminality and eligibility to basic healthcare you stated
“We would have to decide as a society what is an acceptable transgression and what is detrimental enough to warrant this penalty. The purpose of this is deterrence”. ……… Based on this statement I believe that it’s not actually the concept of healthcare reform (Obamacare) that you oppose but instead the eligibility requirements for basic healthcare. With that said, it would be helpful as we move forward to further articulate the eligibility as you see it. For instance would it be traffic violations, trespassing, shoplifting or homelessness? Perhaps drug use, addiction or public intoxication. More serious criminality such as: child abuse, assault, arson, racketeering or extortion or even manslaughter or murder, or perhaps multiple counts of these charges similar to a three strikes rule that would exclude an individual from healthcare coverage?

You have articulated your position on immigration well enough for me to understand and although I don’t entirely agree with you it’s certainly clear enough.

The issue regarding the definition of “free “stuff” as you defined it…”rent, money, food, cell phones, healthcare, clothes etc. “……... so this point is a little confusing, when you stated “Not that any of those stand alone should not be provided”……Again I believe the same argument is presented that your not necessarily opposed to assistance it’s the eligibility that your opposed to. In this case you articulated it as “ there are too many people that take the whole gamut of things and are comfortable enough that they don’t work and they are gaming the system”…….. therefore, it appears its not healthcare (Obamacare) or government assistance (free stuff) its WHO is eligible for these services that is the central point of contention.

I think this helps in my understanding of your perspectives regarding healthcare reform. Therefore, without venturing too far into the weeds on these issues, at a minimum, would you agree we have established an understanding of these definitions?

posted by: Joebigjoe | August 21, 2014  3:25pm

Yes Joe I would agree with your comment on definitions and also eligibility (but I would have to throw in freedom into the bucket too.

As I said in previous comments in various stories I feel we do far too much for those that can help themselves or got themselves into their predicament and not nearly enough for those that really cant help themselves.

posted by: Politijoe | August 22, 2014  6:40am

Politijoe

Bigjoe, I think im begining to comprehend your perspective and perhaps the broader conservative perspective as well. This dialog has been helpful in understanding that its not really about healthcare (Obamacare) or government assistance (free stuff) and instead all about WHO is eligible for these services.

What remains unarticulated is who are these people. Based on your definition thus far its inviduals who have engaged in criminal behavior, however we remain uncertain what level of criminality would exclude services and Unfortunately this would seem to be a BIG gap that is critically important in defining and supporting.

Aside from criminal behavior the other caveat to the healthcare eligibility issue
Is determining the difference between someone who got themselves into their predicament versus those that really cant help themselves.

Let me know your thoughts on these questions as we continue to move the healthcare dialog forward