A personal observation on health care coverage...

[brooklynite]

For 30 years, my insurance has come from a private provider through a plan negotiated by the State of New York, on behalf of all State employees. I can go to any GP or specialist without prior approval. My copays for visits are $20. I've never had a dispute on billings or coverage.

This is a key point: health insurance has two components -- coverage and customer service. While a Government plan may in fact cover everything, there will still be paperwork, and many people don't associate public sector employees with either efficiency, accuracy or caring (see: Post Office, DMV, Tax Office). That's why a lot of people won't happily give up their private sector insurance for MfA, at least until it's proven itself.

[Blues Heron]

1. I'd give up blue cross blue shield in a nanosecond for govt insurance

the absolute pits in customer service. Total snarling vipers, lying scoundrels, orwellian runarounders. Glad your anecdote is positive. Mine is 100 percent opposite.

[saidsimplesimon]

28. Arizona offers a BC/BS Medicare plan

and I am very happy with it.

[Ohiogal]

2. I can't believe

that in 30 years you've never had a dispute on billings or coverage!

My husband had BC/BS for 31 years as a public school teacher, and EVERY DAMN TIME he got a statement from them about ANYTHING it necessitated a phone call to either fight for something to be covered or incorrect billing. And you'd spend half the day trying to get ahold of someone on the phone.

[aidbo]

3. Well, lucky you.

[brooklynite]

10. yes indeed...

So explain why, as long as everyone who WANTS Medicare can have it, those who don't can't stay with what they have? I guarantee the General Election crowd will want to know.

[aidbo]

15. You seem like a smart person.

You probably already know how risk pools work and that the larger risk pools (for example state employees of New York) commands better outcomes than small risk pools. I'm sure you stan your health insurance, but it really only looks good when you compare it to the shitty insurance options that the vast majority of Americans have.

I've got a better question for you, why can't I get your health insurance? It sounds great, depending on what the premium is.
Mine costs $415 a month with a $3000 deductible, I give Pacific Source $4800 per year and all I get for it is $20 copay trips to the doctor and $10/ month payments for my 2 (cheap) prescriptions. I've hit a little more than half my deductible this year. I'm also lucky that I can afford to pay my insurance bills, but I also know that 40% of Americans can't cover a $400 emergency expense (https://money.cnn.com/2018/05/22/pf/emergency-expenses-household-finances/index.html).

I'm glad you're lucky enough to have great insurance, and that you are comfortable enough with that fact to brag about it online to people (who do not have that same luck).

And the premise that you're asking about, "..as long as everyone who WANTS Medicare can have it,.." is incorrect. We're talking about what Sanders and others have named Medicare for All which is not the same as Medicare as you put it in your question. From what I understand, it's much closer to Medicaid than Medicare as it currently is. Health care is free at the point of service (ie at the doctor's office, pharmacy, lab etc.) and paid for by payroll taxes. Most people that have coverage now would save money because they're paying less in new taxes than they would have paid for their health insurance premiums.

As for the "General Election Crowd", do you think that there are more Americans in your situation (awesome, sweet, great healthcare insurance) or more people in the position of having shitty insurance like mine?

[brooklynite]

22. If Warren wants to give you Medicare with full coverage, I have no objection.

Just don't insist that people who have something they like have to give it up. It's not a saleable message in a Presidential election.

[aidbo]

25. Were you also against the personal mandate in the ACA?

ie forcing people to 'give up' not paying for health insurance and pay for health insurance.

[brooklynite]

29. ACA and the mandate weren't components of the 2008 Election.

[aidbo]

35. That's an evasion.

[brooklynite]

36. No, the issue at hand is winning in 2020

Go back and read my OP; my point was not that you'd have to pry my insurance out of my cold dead hands; it was that there are people who aren't prepared to give theirs up, and that presents a political vulnerability in the upcoming Election. I have no objection in principle to MfA, but you have to win first to get it.

[aidbo]

37. And you still think that there are more Americans in your situation than there are in mine?

[brooklynite]

38. Yes.

Especially in the States that we need to win to get enough Electoral Votes to win the Election.

Poll: Michigan voters oppose Medicare for All as Democrats head to Detroit

Lansing — A majority of Michigan voters oppose a strict Medicare for All proposal that would eliminate private health insurance, according to a new statewide poll released Thursday ahead of next week's Democratic presidential debates in Detroit.

But the survey of 600 likely Michigan voters shows the government-run single-payer health care proposal is popular among "strong" Democrats and supported by a plurality of voters who "lean" Democratic, pointing to a challenge for presidential candidates attempting to win the primary without hurting their chances in a general election.

The July 17-20 poll was conducted by Glengariff Group Inc. and commissioned by the Detroit Regional Chamber, whose CEO and President Sandy Baruah said he hopes its various findings will encourage candidates from both political parties to “focus on the center” rather than the “fringes” of the Michigan electorate.

“Elections are still won in the middle,” Baruah said. “That would be my only advice.”

https://www.detroitnews.com/story/news/politics/2019/07/25/democrats-michigan-poll-medicare-all/1825930001/

[aidbo]

26. Oh, and how about it, can I get some of that sweet New York State sponsored health insurance?

[brooklynite]

30. Sure Can! Take a job with the State of New York

https://www.ny.gov/services/employment

[question everything]

31. +1

[BeyondGeography]

4. I laughed

Really, I’m happy for you. My employer-provided insurance forced me to give up the best doctor I could ever have, one that I saw for over 20 years, because he was out of network. You don’t want to see what those bills look like for anything more than a routine checkup.

[unblock]

5. ha ha ha ha ha ha!!!! right, because private health insurance paperwork is a model of efficiency!!!

the private sector isn't always efficient. their motive is to maximize profitability, not efficiency.

in many situations, efficiency means more profit.

but when it comes to shelling money out, companies have an incentive to be *inefficient*, and private insurance companies are masters at that.

they profit from delaying, denying, confusing, hoping you give up or die under an avalanche of paperwork and restrictions and appeals and nonsense and terrible customer service.


very low bar for the public sector to improve on.

[CountAllVotes]

33. It is a bad bad joke!

Last edited Tue Sep 17, 2019, 01:51 PM - Edit history (1)

These insurance companies are in it for one thing, money.

They don't care about anyone in particular.

They want all they can grab.

[Wounded Bear]

6. So, your "private" insurance has the power of the state legislature behind it...

I would argue that you don't really have a "private" plan. You have a 'government' plan. The state can decree that your ins be accepted by doctors and clinics. The state can regulate what types of claims and coverages must be covered.

Most people don't have those advantages. Most people on private insurance are on their own and must face their ins carriers individually and finance any claims and disputes out of their own pockets.

[brooklynite]

11. And 'most people' can go into Medicare if thats what they want.

Choice vs. mandate.

[Wounded Bear]

17. Not now, they can't unless they're over 65...

which leaves out most working people.

You've entered an orange in an apple comparing contest. I'll repeat, most working people don't have the advantages to their insurance plans that you do.

I'm all for universal care. The country desperately needs it.

[DrToast]

7. Another thing to consider

MFA would be run by Republicans when they’re in power.

[yellowdogintexas]

39. no it would be run by the employees of the entity

which is handling the claims.

Changes to Medicare go through a rigorous process to be added to the plan and are essentially driven by new advances in care and other medical issues. These changes usually start with the AMA and go through the Social Security Administration.

My Part B manual was huge - two volumes; one was the table of contents and the other was the index.

Once a rule change is approved, it is updated in the manuals which go to the various carriers.

[Hoyt]

8. I understand not wanting to change, but not sure about the inefficiency of government plans vs.

private insurance.

In fact, Medicare -- and many state Medicaid and state employee health plans are -- administered by subsidiaries of the same insurers who sale private health plans -- Blue Cross, Cigna, etc. Presumably, claims, beneficiary questions, etc., would still be administered by insurance companies under MFA or a Public Option (my preference because it's more likely to pass)

I'm also happy with Post Office, DMV, etc.

[yellowdogintexas]

40. Here is the straight skinny on Medicare re: efficiency

1. Lowest cost per claim
2. Fastest turnaround time
3. Lowest error percentages
4. No profit margin, just a 5% increase for overhead.

Claims examiners work hard for their money and are well schooled in medical terminology, procedural changes, and other aspects of the job

[Hoyt]

42. Problem with Medicare is that it will pay open heart surgery billed by a general practitioner.

It might get caught later, but might not.

That's why you see such high Medicare fraud settlements. Medicare pays just about anything to keep that cost per claim down. Not so sure about your Medicare efficiency claim.

The turnaround time is mandated by Congress. It used to take months to get Medicare claims paid. Then, Congress mandated payment of clean claims within 14 days or the government had to pay interest to providers.

Finally, private insurance companies adjudicate just about, if not every, Medicare claim.

[Hortensis]

9. Yes, this isn't an intrinsic problem to government.

However, I can tell you from personal experience about a private company that made it one. Long ago because of a sick relative I was doing temporary work, and one job took me into a large private carrier for companies with employees belonging to one of the largest unions in the nation. That insurance company maintained a 4-month backlog (the maximum allowed by law) before it would pay bills. (The money owed spent those 4 contemptible months in investments earning additional profits.)

The insurance adjusters were required to lie all day long to all the people calling anxiously, sometimes frantically, sometimes crying, because they were being dunned by providers and their bills were going to collection agencies and their credit ruined before they were paid. They were told the bills hadn't arrived, when actually they were sitting in the next room in long lines of date-organized hanging files.

Btw, I was offered the chance to train for a very well paying (union! ) job that officially required the college degree I didn't yet have, but I didn't spend a split second considering being any part of that operation. A couple of jobs took me into government offices, and their standards were the soul of integrity in comparison. Hurry up and wait for slow, deliberate service is not at all the same as being channeled helplessly into a barn and hooked up to a milking machine.

[MontanaMama]

12. I was an insurance biller for a cosmetic dental practice for 21 years.

The doctors I worked for did not provide medical insurance for employees so I had to buy health insurance in the individual market for my family as my husband was and is self employed. Because of these two factors, I have an insight to insurance plans that a lot of folks might not.

First, the best plans with the best service are negotiated and purchased by large powerful entities such as the State of NY. These groups are insanely profitable for the insurance corporations because of their sheer size. Companies will work really hard to keep those groups under their corporate umbrellas especially in states such as NY or CA where population is large and competition between companies is high.

In a state like Montana, with only million people in the whole state, insurance corporations get away with murder. There is no competition. Only two companies offer insurance plans here and because of that they can charge whatever they want and customer service is average to poor and they get away with that because they know these groups have nowhere else to turn. The large groups such as the State of MT or the MT University System can negotiate decent plans because of their size but even then, plans are expensive compared to similar plans in other states. I would imagine that these groups would welcome MfA because it would force insurance corporations to compete. They might even jump ship and negotiate directly with MfA....it’s possible.

One of the only two companies that sell insurance in MT to groups is Blue Cross Blue Shield of MT. They sell self funded plans and they insure the big groups such as the State of MT and the MT university system. They aren’t regulated by the state insurance commission which is a definite detriment to their insured. There is no one or no entity to hold them accountable....meaning, if they wrongly deny coverage, a policy holder cannot file a claim with the MT state insurance commission. The buck literally stops with the insurance company which is a huge disservice to everyone but BCBSH of MT.

Individual plans and small group plans are off the charts in terms of price and customer service is sketchy. Again, there are only two companies that sell health insurance in the state, BCBSH and Pacific Source. BCBSH doesn’t really want to play in the individual market and their pricing structure illustrates this. The least expensive plan they offer for my family of 3 is $2350 a month. As it is, I pay $1800 a month for a Pacific Source plan that has a $4000 per person deductible. Here is no other option in MT. If there were, I’d buy it. At least I can rely on the state insurance commission for support if my plan denies services that should be covered. I recently had to file a state insurance commission complaint because my insurance refused general anesthesia for a colonoscopy. Yep, they did that even though my doctor requested general anesthesia because my previous colonoscopy could not be completed because I woke up multiple times during the procedure with their “twilight anesthesia”. The insurance commission was successful and the general anesthesia was covered but the process took 4 months.

Don’t even get me started on insurance for small groups. My husband and I own a business that employs 7 people. We pay for insurance for our employees that want/need it. It’s exorbitantly expensive but we believe in covering employees so that they don’t have the worries and fears associated with being insured or uninsured. I cannot even access the best plans and prices because of the small size of our group.

I apologize for the long post, but I think it is important to point out that while you have excellent insurance coverage negotiated by a juggernaut such as the State of NY, these same benefits are just not possible in many other places for a myriad of reasons. States with smaller populations and or poorer states just aren’t able to access well priced plans for their groups let alone the folks swimming with sharks in the individual market. I’d bet a whole lot that once MfA or a public option became available, it wouldn’t take long for those groups from states and groups previously unable to participate in great group health insurance to find greener pastures.

[brooklynite]

13. Fair enough, but from a political perspective...

You don't get MfA if you don't win the election. And the path to winning the election doesn't pass through Montana. It passes through Pennsylvania and Michigan where, as I pointed out in another thread, Unions have the clout to negotiate good insurance plans and their members want to keep them.

[MontanaMama]

21. You're correct.

If a MfA candidate or public option candidate doesn’t win the WH, this is all moot. But, if it happens and a MfA/PO type of plan gets off the ground in a meaningful way then even unions will be forced to take a second look. Their premiums will be going up and benefits deteriorating as a result of fewer people / groups buying private insurance. It has the potential of being a free for all. Exciting and stressful to be sure.

[Amimnoch]

14. I've had "cadillac" coverage since 1996.

Private, and company provided. Small co-pays that covered 100% by the company provided HSA with compensation for the taxes.

I would give it up in a heartbeat for national coverage.
I realize that I am 1 bad accident, or 1 kidney failure, or 1 cancer, or 1 other major medical event from losing my ability to work and lose my coverage.
I also realize that it's not just about "me". It's about many of my family members, loved ones, network of great friends who aren't so benefitted.

I also think that what we really need is a Jobs + building/infrastructure + education + health insurance bill.

Jobs + building/infrastructure: Start by expanding and revitalizing the network of free clinics, university, and charity hospitals. Once upon a time this was actually a fairly robust network that people who were uninsured/underinsured could go to as an option. Around the country these have dwindled, disappeared, or got converted to at profit management systems. Create jobs by bringing these back, building new free clinics where affordable/free preventative care may be provided, and return to us a large network of hospitals by shoring up the university provided and training full hospital facilities. Incentivize philanthropists to invest heavily into this network while simultaneously building/expanding our university training networks.

Education: Build/expand government supported degree and certification programs. Start at the grade school level by increasing funding to underprivileged public schools but with the caveat that they must include medical field preparatory courses. Create scholarship programs for these same kids to have a path to become hospital techs, phlebotomists, hospital administrators, nurses, doctors. Much as the military does with programs like ROTC, tie these free/cheap education incentives to term contracts upon completion where they must work in the public healthcare sector (these clinics and hospitals listed above) for a certain number of years, but at a reduced, but still fully livable wage. For example someone who gets certified as an X-ray tech under the program must work at one of the clinics or hospitals for 4 years upon receiving certification for it to be valid in the private sector afterwards, a nurse make it 6 years, a Doctor 10 years, a MD specialist 12 years.. etc..

Health insurance: Focus our single payer system be it MFA or ACA around utilizing these facilities, and incentivize people who choose to maintain their private insurance by eliminating co-pays when using their insurance in these facilities.

I think expanding the roles and responsibilities for the Surgeon Generals office would be a great place to locate and manage this plan under.

Lastly, and probably most importantly: We need to stop focusing on this for our POTUS candidates, and really focus on the Congress critters we're putting in. They are the ones that will pass the bill to make any of this happen.

[Bettie]

16. Yesterday, I went to our local grocery store

THREE fundraisers on the bulletin board. Two were fundraisers for cancer treatment, one for surgery following an auto accident.

I know for a fact that two of them have supposedly "good" insurance. And yet, they have to look to the community to pay for their treatment.

Interestingly enough, to your other point. I've never had anything but good service or assistance when dealing with DMV/Post Office/IRS employees. IF you treat people decently they will respond in kind.

[BlueMississippi]

18. k&r nt

[Locrian]

19. people like ...

People like their doctors, hospitals etc. I don't know *anyone* who just loves their *insurance* company.

And "customer service" ?! OMFG how I ****HATE**** to call my insurance.
And efficiency?

yeah, I want a company that makes MASSIVE profits off insurance to be the ones deciding my healthcare.

[athena]

20. This country has the best post-office system in the world.

Seriously, I can't believe I'm reading someone attacking the USPS, and getting away with it, on a liberal message board.

As for the IRS, it does an amazing job given its limited resources. I've lived and had to file tax returns in other countries, and they are much more likely to make mistakes than the IRS. If you have a problem with government-provided services, perhaps you should be on a different message board.

As others have said, I would drop my "excellent" health insurance, which is always threatening not to cover things, for government-administered health-insurance, or even health care, in a heartbeat. And I don't appreciate liberals promoting right-wing talking points on liberal message boards.

[brooklynite]

23. So, Joe Biden is "right wing"? Thanks for telling us.

[athena]

24. Attacking the DMV, IRS, USPS, and other government offices as "inefficient" is right-wing.

I find it extremely hard to believe that VP Biden would do such a thing.

But you did in your OP. You voiced a harmful and damaging right-wing talking point, and I find that despicable.

Nice try, by the way, in trying to put words in my mouth in your post title. Pretty much the pettiest behavior one sees on DU.

[brooklynite]

32. Your reference to RW Talking Points was in the paragraph about having to give up private health care

That's a criticism that Biden has raised in discussions about MfA.

[question everything]

27. And they can intervene

My local paper travel section carries a column by Chris Eliot. People complain about airlines, hotels, car rentals and he manages to talk to them and to set things right. And every time I am thinking: why can't the travel industry do it right by the travelers in the first place? Why is there a need for a third party?

And I am thinking that when we have a dispute with a health care provider, we sometimes can get better results if the insurance intervenes. I posted several anecdotes of good results by the insurance companies and in one of them it was the rep who got the provider to fix things.

But, be aware of any scam call that starts by: This is Nancy, your healthcare, or Medicare advocate. In this case, just hang up!

[brooklynite]

34. If your response (as many were) was "I can't have your health care, so...

...I want to be covered by the Government", how is allowing people with private coverage that meets their needs to continue with it in any way inconsistent with providing Government managed health coverage to those who don't have or want private coverage?

[Hassin Bin Sober]

41. And now a different perspective

(Btw, I’ve always had great coverage)

This is in the USA, btw. Remote Area Medical. People camp out to get seen by a doctor. So much for “waiting times in Canada!1!”

[Gothmog]

43. Pelosi-here's no need to reinvent health care -- just improve Obamacare

I agree with Speaker Pelosi https://www.cnbc.com/2019/09/17/nancy-pelosi-no-need-to-reinvent-health-care-improve-obamacare.html?__source=sharebar|twitter&par=sharebar

Democrats should focus on making improvements to Obamacare instead of trying to reinvent the wheel with “Medicare for All,” House Speaker Nancy Pelosi said Tuesday.

“God bless” 2020 Democratic presidential candidates putting forth Medicare for All proposals, Pelosi said in an interview with “Mad Money” host Jim Cramer. “But know what that entails.”

Pelosi’s thoughts on how to improve the nation’s health-care laws appear to align with those of former Vice President Joe Biden, who in his 2020 presidential bid is calling for building on provisions of Obamacare, formally known as the Affordable Care Act.

“I believe the path to ‘health care for all’ is a path following the lead of the Affordable Care Act,” Pelosi told Cramer. “Let’s use our energy to have health care for all Americans, and that involves over 150 million families that have it through the private sector.”