zzrhardy: Why does the USA tie health insurance to employment? I just don't see why they should be linked. Health insurance should just be between the individual and the insurer.

Your system sounds... anti-competitive, and it seems that you are not the customer that the insurer needs to keep, instead your boss is. Wouldn't that promote kickbacks?

It's actually kind of an accident of a system in the first place. During WWII the US had wage controls in place, but benefits like healthcare were excluded, so companies started offering insurance to attract employees instead.

But like a lot of things we put in place at that time, it's become entrenched and now has entire lobbies dedicated to perpetuating its own existence.

WhyteRaven74: relcec: http://www.law.uh.edu/healthlaw/perspectives/HealthPolicy/070404revi se derisa.pdf

I'm familiar with ERISA, however arguing bad faith wouldn't necessitate arguing injury or death due to the insurance refusing to cover something. The simple run around people get, the inability to clearly see what will and won't be covered, that it seems to change from plan to plan offered by the same insurer etc. That doesn't even get into ERISA issues. It gets into the integrity of the actual policies issued.

more might be getting preempted by erisa than you think:

Applying early Supreme Court precedent, most courts have held that ERISA preempts state law bad-faith claims arising from ERISA-governed health care and disability benefit plans, even though the act itself does not substitute comparable federal remedies. The righteousness and strength of the crusade for consumer protections, however, offer hope that courts may yet reinvigorate the bad-faith remedy in cases where plan participants struggle to receive fair treatment from ERISA-plan insurers and HMOs.3

ERISA expressly supersedes "any and all state laws [that] . . . relate to any employee benefit plan" (the preemption clause), except "any law of any state which regulates insurance" (the savings clause). However, self-insured plans are not "deemed" to be insurance companies or insurance contracts for purposes of any state laws that purport to regulate insurance (the deemer clause).4

In 1987, during the era of expansive ERISA preemption, the Supreme Court delighted the insurance industry by ruling that the statute preempted a state common law bad-faith claim filed against an ERISA-plan insurer. In Pilot Life Insurance Co. v. Dedeaux, the Court held that Mississippi's common law bad-faith remedy "relate[d] to" an ERISA plan, and, therefore, fell within the scope of the preemption clause.5 The Court also found that the bad-faith law was not saved from preemption as a law that regulates insurance because, in Mississippi, the bad-faith remedy is available for any aggravated breach of contract, not just the breach of an insurance contract.6
Saving state law bad-faith claims from preemption


that said IIRC some circuits do allow bad faith in their jurisdictions, others continue to hold it is completely preempted. then again I took a class on this almost 8 years ago so my knowledge could be dated or even misremembered.

I think all this screwing over the middle, younger class by the government is their way of trying to keep people reproducing to keep the population level up. I'm 30 and it seems like the only way I will ever be able to live comfortably is to get married to someone else working full time so combined we have a decent living. Then when married, most people will reproduce more little taxpayers.

ExperianScaresCthulhu: (Is the US covering for Canada, or is Britain covering for Canada, or does Canada go it alone defense wise and the US and Britain provide token assistance? What happens to Canada when the US and Britain go belly up?)

Or it could be that no one really dislikes Canada or has reason to cause trouble for them. Mostly 'cause, unlike us, they aren't usually dicks. There are no roving hoards of Visigoths or Mongols anymore, only a handful of small minded people in EVERY country making life hell for the rest of us. Even Canada can handle that, because, also unlike us, they don't over-react to every perceived slight.

uttertosh: Here's a real head-scratcha: Whatever happened to the notion that we should all be allowed access to healthcare, regardless of social status? Is that not some anciently established human right in the '1st' world?

It's always been a relatively fringe belief, sadly. Greed and selfishness are much more universal.

Snarcoleptic_Hoosier: If Boomers would start dieing or retiring, I'd be more than happy to get a better job and buy health insurance.

Don't hang your hopes on that, sonny-boy. All those great jobs us Boomers used to have? Yeah, we still have, and will vacate, a few of them. But they are mostly just gone - for good. And when we die, we won't just leave a productivity slack for you to take up - we will also stop consuming, leaving a huge smoking crater in the middle of the economy. As usual,praying for someone else's death will bring no good to you.
If you young folks don't grow a brain (and a pair) and kick these right-wingers out of power, and soon, you are f**ked. Sitting around biatching about "Boomers", reading Ayn Rand, and voting Republican will only bury you deeper in the hole you're in right now.

Snarcoleptic_Hoosier: If Boomers would start dieing or retiring, I'd be more than happy to get a better job and buy health insurance.

I'm 48 with a family to support with my health insurance. How would my dieing or retiring help the situation? Don't make this a generational war. Make this about getting affordable healthcare for all generations.

Tumunga: meh.

I didn't have health insurance until I got married, and had kids. Didn't need it. Wasn't going to pay for it. If something bad happened, all I needed to do was go to Wishard and tell them I was broke.

That's called free medical care. Shove that up your libtard, single payer bullshiat sphincters.

you ignorant farking symptom

No_Good_Name: Don't make this a generational war. Make this about getting affordable healthcare for all generations.

Actually we have to be damn careful in Australia with all our social safety nets - the big push is to remove them for future applicants but leave them grandfathered for current benificiaries.

Ie, the Boomers are trying to roll up the benefits behind them for new users but keep them for themselves into the future.

It's all done in the name of keeping the "grey vote" of baby boomers who are over represented on the ballot generation wise.

How can I afford healthcare when I've got a cell phone, iPad, cable TV, and a TV bigger than my car to take care of.

Nothing is free. You paid for it in other ways, and other people helped you pay for it.

According to this article:

http://www.huffingtonpost.com/2011/05/16/us-healthcare-costs-double-r e port_n_862677.html

American families pay on average $19,000 per year in health insurance.

Since the average family here in New Zealand (with State-funded healthcare) only pays around $20,000 in total taxes per year, then American families must be paying through the nose when you add federal and state taxes to their health insurance bill.

Sure, we may not get 'average' medical procedures actioned as quickly as American's can, but since we're only paying about half as much to get a pretty similar service, I know which system I prefer!

The system has reached a point of intolerable evil, and a few people (very few) are starting to refuse to play along.

uttertosh: batcookie: uttertosh: Here's a real head-scratcha: Whatever happened to the notion that we should all be allowed access to healthcare, regardless of social status? Is that not some anciently established human right in the '1st' world?

It's always been a relatively fringe belief, sadly. Greed and selfishness are much more universal in America

FTFY

Nope. Lack of acknowledgement that the problem is human nature, no matter what the cultural affiliation, is also part of the problem. Our nature is something to be overcome by rationality. Unfortunately, for many humans, globablly speaking, they just don't care to overcome it.

Bathia_Mapes: One thing I noticed the article didn't delve into is that some young people don't get health insurance because they can't. Some people have a pre-existing medical condition and there are insurance companies that will refuse them coverage just for that reason. If they do offer them coverage it will be significantly higher.

Right now there is little someone can do when they're refused coverage because they have a pre-existing condition. Many of these conditions are ones that can afflict anyone at any age and are not the result of use tobacco, alcohol or drugs . Some can be congenital as well. Some of these pre-existing conditions include:

diabetes
heart problems
mental illness
asthma
hemophilia
epilepsy
multiple sclerosis
allergies

Combine pre-existing condition clauses with employer-based insurance and you've got the kind of clusterfark that people are faced with far too often.

When my "young, healthy" boyfriend was diagnosed with cancer at the age of 27 he had insurance coverage through his employer... But as his condition worsened and he could no longer work, he lost the job and the coverage along with it. As it turns out, private insurers do not find cancer patients particularly desirable customers and we were left with literally no option but to run out 18 months of COBRA coverage and then wait for bankruptcy or death.

Seriously, if you showed up one day in a sane, alternate universe and proposed a system that works like this, people would slap you.

No_Good_Name: Snarcoleptic_Hoosier: If Boomers would start dieing or retiring, I'd be more than happy to get a better job and buy health insurance.

I'm 48 with a family to support with my health insurance. How would my dieing or retiring help the situation? Don't make this a generational war. Make this about getting affordable healthcare for all generations.

The Boomers already made it a generational war when they fought tooth and nail to screw over everyone younger than they are, while making sure they still get theirs.

Insurance costs alot of money and, when your paycheck already costs close to the bone, its a painful sacrifice.
Some people will opt to play the odds (And there will be tragedies as a result).

The politicians could have just fixed the system, but its not in their interest either.

Smeggy Smurf: Fark that I want no mandates and the option to purchase across state lines. The free market will provide better options than a one size fits all ass raping. The government can't even run a goddamned whorehouse let alone provide decent health care.

You really think the free market will work when the choice is quite literally "Purchase our product or die?"

erik-k: Smeggy Smurf: Fark that I want no mandates and the option to purchase across state lines. The free market will provide better options than a one size fits all ass raping. The government can't even run a goddamned whorehouse let alone provide decent health care.

You really think the free market will work when the choice is quite literally "Purchase our product or die?"

If someone is defending "free market" in any way, it means they lack a fundamental understanding of human psychology and it's pretty pointless to try to argue.

filter: America! Can put a man on the moon, but cannot solve basic issues that every other country has solved.

U.S.A! U.S.A!

relcec: WhyteRaven74: relcec: , at the very least it is serving the function of negotiating a fairly significant discount for you from the provider.

That does people soooo much good when the insurance refuses to actually cover claims. It should be illegal for any medical insurance to refuse to cover any claim, from any doctor or hospital, period. No "Well it wasn't life threatening so we're not covering your ER visit" crap, no pre-approvals, no referrals, none of it. As it stands now insurance companies are practicing medicine by proxy and that can not be tolerated.

if you knew more about healthcare you wouldn't be pissing on the discounts.

they are often massive, and depending on whether it is a for profit or community/catholic hospital you are unlucky enough to run up your $57k bill in, they will try their damnedest to get you to pay the full amount if you don;t have insurance.

just staying 4 days in a hospital could make all that premium paying for the last 10 years worth it just for the discount that gets lopped off the top, never mind if the insurance never pays a dime.

discount rates for big insurance companies as a percentage of total charges can range anywhere from 60% to 76%. that means even if the you insurance doesn't pay one red cent, on a hospital stay with $50k total charges, the insurance company probably has negotiated a rate with the provider to lop anywhere from $30k to $38k off the bill before you even look at it.

So you're defending discounts or contract rates, or are you just explaining them? They are basically collusion and drive up healthcare costs. But the free market is great and all...damn near infallible.

kmmontandon: Lando Lincoln: Good thing we won't have an individual mandate to force these freedom-loving kids to buy health insurance.


That's exactly right, we don't, not for two more years.

We do have a law that allows anyone up to the age of 26 to remain on their parent's insurance, of course, which I'm sure you will now express support for.

That works great if your parents have a policy that will cover you. But if your parents have blue-collar jobs with no benefits, then the whole family is screwed.

some_beer_drinker: what does eschewing mean?

Avoiding

Any farmer knows, that to get the best coverage, he's got to spread his fertilizer to every corner of the field.

Yeah, 28, uninsured, mountains of medical debt from emergency surgeries when I was 18. I haven't ever really been able to make enough to pay it off. I had (what was sold as) medical insurance for a few years, through work (30 bucks from me, 30 from my employer a month.) But it turned out to be a scam. Tried to get insurance at a recent job and my portion was 75 a paycheck. Oh, well. I have had a sore on my leg for five years that won't go away, but I can't afford to do anything about it beyond when I went to a clinic and the doctor looked at it for two seconds before telling me to put some antibiotic cream on it, and if that doesn't work try an antifungal. Arseface then sent me a bill that was as huge as you'd expect for not fixing my problem.

I am certainly glad that we on the internet are FINALLY discussing healthcare and costs .. I look forward to our resolving this problem today with our ill-informed, simplistic opinions and anecdotal evidence.

MayoSlather: relcec: WhyteRaven74: relcec: , at the very least it is serving the function of negotiating a fairly significant discount for you from the provider.

That does people soooo much good when the insurance refuses to actually cover claims. It should be illegal for any medical insurance to refuse to cover any claim, from any doctor or hospital, period. No "Well it wasn't life threatening so we're not covering your ER visit" crap, no pre-approvals, no referrals, none of it. As it stands now insurance companies are practicing medicine by proxy and that can not be tolerated.

if you knew more about healthcare you wouldn't be pissing on the discounts.

they are often massive, and depending on whether it is a for profit or community/catholic hospital you are unlucky enough to run up your $57k bill in, they will try their damnedest to get you to pay the full amount if you don;t have insurance.

just staying 4 days in a hospital could make all that premium paying for the last 10 years worth it just for the discount that gets lopped off the top, never mind if the insurance never pays a dime.

discount rates for big insurance companies as a percentage of total charges can range anywhere from 60% to 76%. that means even if the you insurance doesn't pay one red cent, on a hospital stay with $50k total charges, the insurance company probably has negotiated a rate with the provider to lop anywhere from $30k to $38k off the bill before you even look at it.

So you're defending discounts or contract rates, or are you just explaining them? They are basically collusion and drive up healthcare costs. But the free market is great and all...damn near infallible.

.
.
FYI - The whole discount shceme BS was created because of government rules created after Hillary tried to "help us" when her husband was president. The prices are required to be jacked up so that they can show that Medicare and Medicare are receiving bigger discounts than the insurance companies. Yah government!!!!! Many of the other rules are also why healthcare is so damned high today. What is the solution? More rules of course!! Bwahahaaha!

batcookie: uttertosh: batcookie: uttertosh: Here's a real head-scratcha: Whatever happened to the notion that we should all be allowed access to healthcare, regardless of social status? Is that not some anciently established human right in the '1st' world?

It's always been a relatively fringe belief, sadly. Greed and selfishness are much more universal in America

FTFY

Nope. Lack of acknowledgement that the problem is human corporate nature, no matter what the cultural affiliation, is also part of the problem. Our nature is something to be overcome by rationality. Unfortunately, for many humans, globablly speaking, they just don't care to overcome it.

had to do it

the ha ha guy: No_Good_Name: Snarcoleptic_Hoosier: If Boomers would start dieing or retiring, I'd be more than happy to get a better job and buy health insurance.

I'm 48 with a family to support with my health insurance. How would my dieing or retiring help the situation? Don't make this a generational war. Make this about getting affordable healthcare for all generations.

The Boomers already made it a generational war when they fought tooth and nail to screw over everyone younger than they are, while making sure they still get theirs.

I could wish that you young farkers would all commit mass suicide too, so you'll free up more jobs for the rest of us. What then? I'm sure the rich just love it when fellow 99%ers fight amongst themselves for the scraps that the 1% throw on the ground too.

The problem isn't that the boomers or any other particular demographic exist(s); the problem is that the medical coverage system is hosed.

I have a friend that got an extra 11k in salary for not taking the company's insurance.

Which seems very irrational on their part, since he was able to buy an individual plan for less than half of that.

If you're healthy and young, this makes sense. The first time I went to a doctor after high school was when I was 28 and I needed surgery. And I still probably just broke even for all of those early 20s premiums. Company insurance generally forces you to subsidize the older workers.

Gulper Eel: Likwit: Yeah... Socialized medicine isn't always great, though. I think we need reform, but we need to be careful about what we do... Systems like the Canadian one seem great, but it blows over here in Japan. I'm a 25-year-old, fit, non-smoker and I pay 200 bucks a month (using a 100yen to 1dollar exchange rate). 200 a month and I still have to pay 30% of whatever my hospital bill is.

Plus, the doctors blow... Man, do I have some stories, boy. I tell you what, kid.

But taking all this money and power out of the insurance industry's hands and putting it in politicians' hands will make everything peachy, you hater.

The person who's mainly responsible for health care is looking at you in the mirror. Anything health-related which that person is unable to handle themselves...or unwilling to handle, and given the number of fatasses, smokers, tanners, drunks, drug users, nutcase drivers, and people who make maladaptive sexual choices, there are a LOT of the unwilling...becomes either a business decision or a political decision (or both). Through our actions we have placed a major financial and political value on having somebody else maintain our health for us.

We want to have our cake and eat it too and have more cake.

The only way to knock that dollar/political value down is to take better care of yourself so that the most common and most preventable high-dollar problems like cardiovascular disease and diabetes don't get you.

/slowly losing weight

This is one of the most judgemental posts I've read in a while with spectacularly ill conceived conclusions. A touch of truth with a giant helping of spin.

fark'emfeed'emfish: batcookie: uttertosh: batcookie: uttertosh: Here's a real head-scratcha: Whatever happened to the notion that we should all be allowed access to healthcare, regardless of social status? Is that not some anciently established human right in the '1st' world?

It's always been a relatively fringe belief, sadly. Greed and selfishness are much more universal in America

FTFY

Nope. Lack of acknowledgement that the problem is human corporate nature, no matter what the cultural affiliation, is also part of the problem. Our nature is something to be overcome by rationality. Unfortunately, for many humans, globablly speaking, they just don't care to overcome it.

had to do it

Yes, but corporations are made up of... say it with me now... PEOPLE.

MayoSlather: This is one of the most judgemental posts I've read in a while with spectacularly ill conceived conclusions. A touch of truth with a giant helping of spin.

Upon further review did I just bite on a good example of poe's law?

AlteredChemical: There's absolutely no way in hell this can end well

relcec: that is why healthcare *reform* bill will very soon force these very people to buy full priced insurance (cheap catastrophic insurance which is basically all a young person really needs is being prohibited in the future, the only choice will be full cost insurance), because they will be made to take the loss so that the private insurance industry can reap windfall profits, and in turn will be willing to insure less profitable patients.

Nothing ends well with catastrophic/HSA "coverage".

The extra-high deductible farks people over, and wiping out and a HSA balance makes things worse after it is wiped out. In addition, such an inferior plan skews things towards the cheaper solution versus the medically correct decision.



WhyteRaven74: How about mandating all employers above a certain size provide top shelf insurance, actual insurance not PPO or HMO crap, with employees picking up no more than 5% of the premium?

As long as it is neither HSA nor Catastrophic, and it has a anti-structuring provision(see banking regulations) that prevents the employer from just hiring N-1 employees to stay under the limit.

That said, PPACA needs to have its loopholes closed if it even has a chance to work, such as:

• Grouping one set of employees in one company while grouping another set in another company to dodge comparison rules.
• The insufficient penalty for not insuring employees/etc.
• Allowing employers to use contractors/temps/etc. to dodge the costs.

There are probably more that I've not thought of, but the law is not likely to work.



/PPACA is just a scapegoat for businesses to not hire or as an example of regulatory "uncertainty"
//It may not even be intended to work as a conduit for insurance/coverage
///HSA's need to die a very nasty, painful and brutish death