A child is diagnosed with diabetes and gets treatment under his parents insurance. When that child hits the age where he has to get his own insurance...how is that going to happen???

We've long since misused the term "insurance". My "insurance" covers my annual check-ups. In what way are they unlikely events?

Um, health insurance is nothing like car insurance. Everyone is going to get sick at some point. I've never made a car insurance claim in 18 years of driving. I've been to a doctor about a dozen times during that period, and I only see a doctor if I absolutely have to. And yet the government forces me to buy car insurance!

If health care should be compared to anything, it should be something like clean air or water. The demand for health care is inelastic. At some point you've got to admit that health care is nearly unique, and you're attempt at free market comparisons must fail. It's inelastic and, currently, it isn't even subject to market conditions. Can you see any doctor you want Amy? Or just doctors in your network? Imagine only being able to buy soup from a single grocery store. I could go on forever, but I need breakfast. At least I need it more than car insurance.

There really are 2 issues that should be fixed when it comes to our existing system. 1 is the "pre-existing condition" thing but not the way Wendy describes it.
Wendy is correct in how she describes that version of a pre-existing condition and I agree with her reasoning.
However, what about someone who has insurance, pays premiums and then gets some lifelong disease? In our current system that person damn well better make sure they keep their job because it's more than likely that their insurance is tied to their employer. If they change jobs, the next employers plan will reject them due to their pre-existing condition.
That leads to item number 2 that needs to be fixed. Insurance portability. Your should be able to take your insurance with you when you change jobs.
Address those 2 things and you've greatly improved our current system without taking over 1/6th of the economy.

"Um, health insurance is nothing like car insurance. Everyone is going to get sick at some point."

Well, over the course of a lifetime your chance of having at least one car accident is quite high. So it's not that different. But that is beside the point. Whether the risk is higher or lower doesn't change the fact that you cannot insure after the fact. Just as I can't wait until I have a car accident and then take out insurance, so I can't wait until I have an illness that needs treatment and then insure for it.

With Car insurance vs Health insurance there is an argument to be made that Health insurance should be more like car insurance.
Why cover routine stuff like checkups? Your car insurance doesn't cover oil changes + tune-ups. If it did
it would be a lot more expensive.
The analogy isn't perfect though. When your car gets old and breaks down your car insurance doesn't kick in like your health insurance will when you get old and break down.

The people advocating for reform are really advocating for a net income transfer from healthy people to the unhealthy people via health care spending. Fine, you can make that argument as a reasonable person interested in social policy. That does not mean the arguments are convicing to those opposed, only that you *can* make them withou being a crank. In short, it is a type of welfare, one which many other countries currently employ. It is something we could do, and something other people in other nations currently do.

But please, please, please, spare us the stupid shit like this, okay?

"If health care should be compared to anything, it should be something like clean air or water."

Oh? Really? Anything? Health care services and products are like nitrogen, oxygen, etc. on the one hand and distilled H20 on the other? Oh, wow, why didn't we realize that health care services and products are like elements and simple compounds existing everywhere all around us? /head slap

"The demand for health care is inelastic."

No, it ain't. Demand for a product can be said to be inelastic if consumers will pay almost any price for the product. When people pay for their own health care, they are typically damn picky about prices. When OTHER people pay for their health care--as we generally have now--people don't care nearly so much. But how the hell is that latter category said to be "inelastic"? That is just spending other people's money for your benefit. For example, I would not spent ten cents of my own money for a lapdance, I would happily spend $500 of your money. Is my demand therefore inelastic? Of course not.

Yes, my health care demand gets inelastic when my very existence is at stake, but the current programs pushed as reform are not being sold as catastrophic care insurance, are they? Nope, we are talking much more about garden-variety take care of the geezers who want their aches addressed and appointments paid for. You know this because everyone in support runs screamng from the room with fingers in ears when you start to explain that rationing by age would necessarily be part of any income transfer program.

"At some point you've got to admit that health care is nearly unique, and you're attempt at free market comparisons must fail."

I've got to admit that? I've got to? Why, because you so earnestly and imperiously demand it, without a single thing that looks like, well, an argument? Jaysus fucking christ! At least have some understanding of all the many, many ways health is part of our mixed economy system, and how that cannot be removed from ordinary incentives operating on the tens of millions of people currently involved in trading within that system.

"It's inelastic and, currently, it isn't even subject to market conditions."

Oh, health care is not subject to market conditions? That one is hysterical. Again, an earnest assertion, utterly divorced from reality. Hey, folks, newsflash! Wages paid to health care workers are not subject to market conditions! Gnomes determine those wages! Utilities companies cannot charge regular rates to health care sector! Fairies provide the energy. Medical supply companies pay different prices for gas! Paper and printers bought by doctor's offices are free! Basic commodoties inputs used in the production proces for medical devicses are priced on Mars! Etc. Etc. I'd cry if the ignorance wasn't so damn funny.

"I could go on forever,..."

Seems like you did.

The govt. doesn't force you to buy car insurance to cover your own losses; comprehensive coverage is not mandatory. You're required only to buy insurance protecting others - those you might injure in an accident. The comparison to health insurance is not apt.

So-called health insurance is similar to welfare in other ways too. People are incentivized to consume as much care as possible, which does not affect their (current) premiums. The majority expects to eventually receive more in benefits than they pay in, much as (some) people expect Social Security to support them when they get old and retire.

It's clear that direct feedback between care and pocketbook is necessary to rein in costs. Leaving the above unchanged is unaffordable.

Guys, the "pre-existing" exclusion only kicks in if you go without insurance for a certain time and then try to get it back. I have several non-lethal "pre-existing" conditions such as migraines. I have changed jobs and insurance multiple times during the last decade. My pre-existing conditions are still covered. Why? Because I purchased COBRA coverage whenever I was going to be without insurance for a time.

Now, I'm not saying that affording COBRA is always easy (quite the opposite). And if you develop a pre-existing coverage during a time period in which you don't have insurance, you're screwed. And health insurance shouldn't be tied to jobs. But this isn't a case where people with pre-existing conditions are stuck with one employer for the rest of their lives.

The demand for health care is inelastic.

Ohhhh, no it's not. There have been multiple studies indicating that when people bear less of the financial burden of going to the doctor, they go to the doctor more. If you get the sniffles and know that going to the doctor will only cost $10, you're fairly likely to go. It's the equivalent of car insurance offering oil changes for $1 apiece; you'd be getting your oil changed all the time. All of that adds up. Significantly. And, do you really think that if people had to bear the full cost of non-catastrophic care, they wouldn't make *any* changes to their behavior? They wouldn't smoke less? Drink less? Eat less? Sit around less? If you had to pay far more of the cost for being significantly overweight, you'd do something to reduce that cost.

The problem is that health insurance DOESN'T work like car insurance or home insurance. If my transmission stops working, I have to pay to get it fixed, but if a drunk driver smashes my car tomorrow, my car insurance will write me a check for an effective replacement -- I may not be getting a Rolls-Royce, but I'll be able to afford a useable car. If my A/C stops working, I have to pay to get it repaired, but if my home burns down in a fire, my homeowners insurance will kick in and I'll be able to get replacement lodging. My health insurance will pay virtually the whole cost for visits to the internist and even for things such as emergency room care, but if I get diagnosed with cancer, at some point my insurance is likely to run out and I could be bankrupted. People typically pay insurance to avoid scenarios such as bankruptcy.

Again, this isn't to say that there's not an inelastic *component* to health care demand. There is. But to say that real health care demand is totally unaffected by financial factors is inaccurate. And I, of course, agree with the main point that insuring after the fact is a bad idea. That's why it's best to get insurance for the first time when you're young and healthy, pay more in premiums than you're costing at that time, and then make it a priority to keep that insurance in case one day you do develop a condition. (Not sure what the case is if you're diagnosed with diabetes as a child.)

I adore this post. I adore this post. I adore this post.

Amy,

So I've made that point for several weeks here, and that is exactly why insurance is the absolute wrong way to think about health care.

So you're right, get rid of the notions that health care is rare, that health care is unlikely, that health care isn't some lifelong necessity and that we have to protect insurance companies, after all, there is NOTHING in the constitution that protects that industry, and you suddenly have many more ways to think about how health care is paid for.

Or Amy, answer me this, regardless of any other factor in the health care debate, why should anyone morally or legally give a shit about what happens to health insurance companies?

jerry:

Or Amy, answer me this, regardless of any other factor in the health care debate, why should anyone morally or legally give a shit about what happens to health insurance companies?

It's not that anyone gives a fuck about insurance companies.

It's that any option that involves the government paying for everyone's care, or the government having an even greater role than they already do is terrifying on so many fronts.

There is no organization in the United States more incompetent than the federal government.

I would rather the entire health-care enterprise be run by autistic ferrets than by Washington bureaucrats.

Brian,

If everyone then agrees, as you apparently do, that a) insurance is the wrong model for health care, and b) we owe nothing to the insurance companies,

Then why aren't you looking at other mechanisms to pay for health care? Utilities, public or private. Fire Departments, public or private. Police and Security, public or private. Member owned coops like credit unions and REI. Member subscribed service stores like Sam's Club or Costco.

There are lots of ways to pay for healthcare without the insurance company middlemen, and without locking citizens to employers, or forcing employers to provide health care.

"why should anyone morally or legally give a shit about what happens to health insurance companies?"

Do you own anything? Anything at all?

I assume so. Now then, why should anyone morally or legally give a shit what happens to what you own? If a few of us decide we want it, we vote on it, and then we take it, who can object, in your world? Better yet, your grey-haired parents have a nice house. We want it! It is ours. The common good demands it. /sniff

Insurance companies are no different than you, me, or your parents. The capital those companies husband is not owned by martians. That capital is owned by people called shareholders, who expect to receive some respect for their property just like I do and you do. Who are shareholders? Trust fund kids? Not really. Try union pension funds, college endowments, work-a-day-joes with individual 401(k)s, charities. That is who you are talking about taking from when you say "who gives a shit?"

Morover, if you get busy stripping away capital from insurance companies, you are almost certainly going to adversely impact the companies' ability to pay out on claims to insureds. So you are not only taking away shareholders, you are screwing consumers who really need their claims paid.

Your concept that insurance companies are entities which should not enjoy common legal protections of property we all enjoy is harrowing. You see a large store of value in insurance companies, carefully collected after hundreds of thousands of market transactions, and through the efforts of thousands of people. But unlike me, you think it can be taken and redistributed, without the consent or input of those who carefully, and no one should give a shit.

You think like a pirate, sir.

Jerry,
I care because everything the government touches "breaks."

We don't need that spendaholic Nobama destroying our present (and very fine) health care system.

I believe that the destruction of said system would start with the health insurance companies.

Put them out of business (as the anti-capitalistic Nobama desires), then we're only left with a government run health care system to "choose" from.

If he starts sprinkling his progressive and socialistic fairy dust on the health insurance companies, he'll do even more damage to this country. That, by furthering his self-serving and "Jeremiah Wright induced" political agenda.

I'm sorry, but you don't spend 20 years and willingly listen to the teachings of a "pastor" whom you suddenly claim to "disagree" with.

I've seen enough of his failed policies to be fully convinced that either A. He's hates capitalism and is therefore intentionally destroying this country, or B. What matters most to him, and above all else, is cramming his illogical, uninformed and threadbare agenda down our throats.

That, because he "thinks" he's right and that we're too stupid to know "what's best for us."

So he'll "tell us" what is, by creating yet another government bureaucracy that will have failed at its ideological conception.

That failure will be clearly evidenced when shortly after it manifest, a new bureaucracy will then "have to" be created to "fix" it.

Therein lies the inherently grave danger of allowing simple-minded people to occupy the offices of powerful political positions.

By waving their magical political wands of legislative power, they can bring us all, even the unwilling, into their fairytale lands of legislative utopia.

Even worse,is that by threatening to sanction those whose fear of reality would otherwise cause them to relinquish their fairy roles; they're forced to do so, and thereby become unwilling participants.

Right. All the more why health insurance should be continuous and ubiquitous. No dropping in and dropping out. All in.
How is it after 50 years on increased worker productivity, we can afford less health insurance for employees, and a smaller minimum wage (adjusted for inflation)?
Scary to project forward--no more employee health insurance, and a minimum wage of $4 (adjusted for inflation). While per capita income soars (although handily concentrated among a few).
Friends, that is an ugly country.
Sometimes I think private schools and health insurance should be forbidden. Then, the elite would make sure public schools and insurance worked, at a good price.
Explain to me the concept of patriotism, where the key goals are to 1) pay less taxes 2) never serve in war 3) cut off public health insurance and 4) make public schools cruddy.
But, we are patriots. Because we wave flags.

"A child is diagnosed with diabetes and gets treatment under his parents insurance. When that child hits the age where he has to get his own insurance...how is that going to happen???"

So the kid or the kids parents, need to be sure he always has a policy in place.

As I understand it, pre-existing conditions are rarely excluded if you have continuous coverage (and it doesn't always have to be with the same insurance company). As long as you have continuous coverage (meaning, you've been paying for an insurance policy your whole life, or prior to the condition, without any gaps). Normally, they will add you on (possibly) for a higher premium.

I've never had a problem switching insurance carriers and not having things paid for - I think that is because I've always chosen to remain covered - even if that meant I had to eat Top Ramen through college.

Most of the people who run into this situation, are people who decided not to pay COBRA when they left their job. If someone chooses not to pay for COBRA until their new policy kicked in at their new job their pre-existing condition is often times excluded. They should have bitten the bullet and kept their COBRA premiums paid if they valued it so much - paying for COBRA is also a good motivator to find a job soon and quit sucking off unemployment.

I've been covered (without lapse) since I was born. I hardly use my plan at all.

I do however, go outside of my doctor network and pay out of pocket for one particular health visit, once a week. Primarily because my network didn't offer a health professional specialized enough to work with my condition. I could have used one from the plan, but that would be a waste of my money as well as theirs.

I am actually kind of happy about this. They shouldn't have to employ "specialty" type health professionals and charge everyone else for them just because of a few people. Also, this meant I could get someone who came highly recommended, and I was able to choose this option without restrictions.

I look as it more or less as an "investment" in myself, and not an entitlement - I am happy to pay for it. I value it more - and I believe, in part, that this perspective on things helps me get better too - it's a good motivator to get better.

People who get things for free or at little cost not only get what they pay for, but have little motivation to get better.

Interesting take Spartee but was that your point of view when deregulation gutted the airline industries, or when free trade gutted American Manufacturing, or when the repeal of Glass Steagal enabled the finance industry to gut us, or when software engineers asked congress to stop H1-B visas?

Is that your take regarding downloading of music, that 90 year copyrights are something natural that people owe to Disney, and the RIAA, and the MPAA?

There is nothing in the constitution protecting any industry apart from the Press. There is no reason to protect an industry that serves us poorly.

Nofantitti, the history of universal healthcare starts with that Republican, Teddy Roosevelt.

"Morover, if you get busy stripping away capital from insurance companies, you are almost certainly going to adversely impact the companies' ability to pay out on claims to insureds. So you are not only taking away shareholders, you are screwing consumers who really need their claims paid."

This is why insurance companies purchase insolvency and reinsurance policies.

"There is nothing in the constitution protecting any industry apart from the Press. There is no reason to protect an industry that serves us poorly." -Jerry

Please define "us" Jerry. It appears to me that a minority sharing your views desires to force them upon those who don't.

Given you're obviously well-versed in constitutional matters, please explain by what constitutional authority the government can decimate an industry that "serves us poorly."

What does deregulating the airline industry have to do with destroying the insurance industry?

Given that deregulation "removes" government controls to expose an industry to market forces, I missed your point, please elaborate.

Or, do you define "deregulation" as placing a taxpayer funded and poorly performing entity, such as a government health care option into a pool with publicly traded corporations?

That's destruction, not deregulation.
A government entity (IE the Post Office) can forever run at a loss (while providing poor service)at taxpayer expense.

Name for me one industry that was "deregulated" through a forced competition between it and a government entity.

Forcing insurance companies to compete against a wasteful government "option" is NOT deregulation, it's a socialistic means to destroy a capitalistic enterprise.

Keep sailing pirate...

"Nofantitti" -Jerry

Fantitti??? As God as my witness, the last time I heard that one, plaid pants, disco, and striped tube socks (pulled up to the knees) were vogue.

Now your "logic" is starting to make some sense. Therefore, I no longer question your intellectual capacity.

What I do question however, is whether it's a mindless progressive that logic and reason has smoked out, or just a child wanting to play with the adults.

Either way, it's past your bedtime...

FWIW

Workers' Compensation insurance was deregulated in the early nineties. But since it's a government mandated coverage for all employers, there are government run alternatives in every state...here in California, it is The State Fund.

When the insurance market was deregulated, all the business dispersed throughout the competitive market and thereby, we saw a rate reduction and increase in customer service satisfaction (better claims handling, monitoring etc). However, The Fund here was left to insure high risk accounts (police, firefighters, football players) no one else wanted to take because they knew the government would write them.

The State Fund then started to go under because 1) they had a larger concentration of higher risk accounts and 2) they decided to drastically drop their rates to become competitive with the marketplace in order to bring in lower risk accounts to balance out their pool. For profit companies would not have done this because they did not have the luxury of an unlimited supply of resources like the government did (tax payers).

Ultimately, we (Californians) paid anyway - and The State Fund is still writing insurance policies on high risk accounts because it is a mandatory coverage. They are still a competitor, albeit, a poor one if you care to have decent customer service.

Keeping the majority of insurance coverages from being mandatory is a wise decision to avoid government ineptitude costing us one way or another.

I am curious as to what this crowd thinks my solution should be:

I've been insured on my own since age 18, sometimes through corporations, often on my own, as I am now. I was impossibly healthy for decades, and then I wasn't. Surgery, chemo, radiation, and, knock wood, the all clear. My insurance company just informed me that my policy will now cost in the four figures a month -- A MONTH. With a high deductible and out of pocket expenses. Sure I can try to change companies -- but anyone here who thinks that doesn't require underwriting hasn't investigated changing policies. I did -- and the new quote was A THOUSAND DOLLARS HIGHER than the one I have now. No way. Plus I live in California, am self-employed, and my insurance isn't portable to another state -- where, by the way, I could find work and pay these premiums much more easily. I look at my little girl and wonder whether I'll get to see her grow up, because the choice will soon be her food or my medical. I'm not looking for welfare. But I have paid taxes since I was 12, forged a work permit, and got a job waitressing at Bob's Big Boy.

So I think I've earned the right to ask whether society's only obligation to me in return is to let me die.

P.S. Hi Amy. My first post.

MomofRae:

Who is your current carrier?

MomofRae: While I'm sorry you went through cancer and I'm glad you are all clear now, the fact of the matter is you used a ton of resources during radiation, chemo and surgery. The insurance company is trying to recoup and hedge their losses based on the possibility your cancer might come back. While it seems outrageous price wise, you are really getting a steal.

The insurance company is trying to recoup and hedge their losses based on the possibility your cancer might come back.

That risk should have been, and no doubt was, factored into the premium MomofRae paid. The company has no business shafting her with higher rates now to recoup their earlier outlays.

Feebie: Blue Shield. Which I like to think of as BS.

And Casey, I paid thousands and thousands of dollars in premiums over the years, and when I had cancer I paid $10,000 out of pocket before my insurance kicked in and then another $20,000 so I could have treatments that are now considered standard (including one that let me cut my number of chemo treatments in half, saving BS tens of thousands of dollars) but that major insurers pretend are experimental.

By your measure, insurance is great until you actually use it. And then you're screwed.

And Kishke they're not trying to recoup their rates, I fear. They're trying to get me to drop the policy.

Also -- and then I'm done with private details because I'm, well, private -- if I do drop the medical, the cancer returns and I die as a result, my daughter will be eligible for $2000 a month in SS benefits for twelve years. She'll also qualify for a slew of other subsidies. How exactly does paying twice as much for my death as my life benefit society? Of course I could spend down my remaining savings, go on welfare, and use the emergency rooms for medical treatment. That should cost society a pretty penny.

MomofRae:

There are a few plans in California that you may be able to check into for alternate options. You say you haven't tried? I think some posters here or Amy could probably give you some advice.

I've never gone this route myself, however, a friend of mine was able to get a claim resolved through this website:

http://www.hmohelp.ca.gov/

It's run by the state, but in cases where something is being done in bad faith, if you are patient, they may be able to help.

I know she had help with getting her claim paid (it was a bad faith claim denial). Her's did not involve a massive premium increase. I am not sure if they handle your type of complaint but I think they would probably be the best people to speak with to get you headed in the right direction.

Even if they cannot help with this, ask to speak with someone who can give you more information on who can help.

I hope this helps. Best of luck to you.

MomofRae one other reason you are going to pay higher rates is you are still a big risk. You had cancer, your got treated and survived, and the odds are you will likely have cancer again. Sorry to be a buzz kill.

So the insurance company could be looking at the past and a Casey commented maybe they are trying to recoup losses but me I think the company is looking at the future and hedging its bets on you. So they raise the price! Good Luck and stay healthy.

Thanks so much, Feebie. But while I'm not quite up there with Amy in my ability to make corporations bend to my will, I did teach investigative reporting and know where/how to get the top folks' attention.

For instance, a tip: If a hospital has screwed up your bill and absolutely refuses to rectify it, find out where the head of billing has his/her office, arrive with magazines and your toddler daughter, casually remove your wig, and wait. It's surprising what an effect seeing the person you're blithely killing will do to a bureaucrat!

Another tip: Always ask pharmaceutical or other medical companies whose products/services are deemed experimental if you can have them for free. They want the data to be declared standard more than they want the money at this point.

I complained to the state -- quite eloquently, I might add. No luck. But those bills are at last paid. It's just the premiums that have me panicking now.

So John Paulson, you agree then that insurance is only good until you actually use it?

My original question though is: What should society do about folks like me? I have paid taxes -- tons and tons of them, trust me -- for, gasp, 38 years now. I can cost you a fortune in SS benefits for my kid, or ER losses I'll ring up without insurance, plus welfare since I'll have to live it up on my savings for a year while spending now.

How the hell does that make any sense or do anyone any good?

Oh, and Feebie, no one else will have me for less than $2000 a month. Amy's beloved Kaiser included.

I would rather the entire health-care enterprise be run by autistic ferrets than by Washington bureaucrats.

That's a threadwinner.

++++

MomofRae:

You embody a true problem with health insurance (which is not the same as health care).

With car and house insurance, risk pricing makes sense. Drivers with clean records tend to have fewer accidents, and people who don't live in flood plains tend to spend less time de-mucking their houses.

However, to a great extent, the diseases we get are either random, or encouraged by family history. For those kinds of diseases, people should be charged the same amount of money as everyone else. Why? Because a decent society subsidizes misfortune.

As for those who engage in high risk - high cost activities (over eating, riding motorcycles) they need to pay a premium that covers the losses for their entire group.

Post hoc rate increases are just as wrong as free riders expecting post hoc coverage.

Just a quick point, that addresses a couple of posts (like that of MomOfRae):

The government has one central role in health insurance - or any other industry: regulation. One example are the COBRA policies that allow transferability despite pre-existing conditions - if the government did not require this, insurance companies would not honor it.

I could imaging a regulation restricting rate increases - if someone is covered when a serious condition is diagnosed, the insurance company must abide by their earlier rate schedule. After all, that's what insurance is about - they don't get to adjust their rates when lightning does strike.

In other words: free market health insurance, with a minimum of regulation to ensure fairness and usability.

Bradley13 - Other issues that need to be addressed are portability -- just because you get sick shouldn't mean you can never take your business to another state because you're uninsurable anywhere else -- and what happens when COBRA coverage ends. People seem very confused about this so just to be clear: Cobra guarantees you coverage; it does not guarantee you affordable coverage. Underwriting is required. So let's say you've worked 30 years for a company and beat back cancer 20 years ago. You lose your job. You get underwritten after 18 months. And suddenly you're faced with $1500 a month in premiums. There are very few people who can afford that.

Again, there are many many middle-class people in straits like me who did everything they were supposed to, never took a dime from the system, and kicked in well over $200,000 to government coffers over the years. What happens to us?

Skipper:
However, to a great extent, the diseases we get are either random, or encouraged by family history. For those kinds of diseases, people should be charged the same amount of money as everyone else. Why? Because a decent society subsidizes misfortune.
- - - - - - - - - - - -
... but insurance companies are businesses, not charities.

That's why they ask about your family history, and check for overweight and smoking.

We may, as a society, want to provide support for people in these situations, but there's no reason why this should be dumped on insurance companies. Part of the current problem is that the health insurance industry has been hamstrung by such requirements for "compassionate coverage".

There are two issues here:
1) Catastrophic health insurance - which is about pooling risk, and accurately assessing risk. People with elevated risk will inevitably pay more. In a more open system, it will be easier to spread the risk over larger groups of people, and get lower rates even for those with higher risk.

2) Ongoing health care - which should be a regular consumer transaction, with a host of options. I can pay a "membership fee" for rolling access to services (like leasing a car or joining a gym) or I can decide to pay as I go for what I need.

Yes I believe insurance should be used when needed. But people will have to cover what is calculated to be needed to cover them. If I smoke I will have to pay more, if I am fat - once again pay more. If I have survived three cars accidents in the last two years I would not be surprised to pay more.

Good for you MomofRae you paid 38 years of taxes! But what the hell has that go to do with health insurance. Why does paying 38 years of taxes mean the government should paid for your healthcare. I love it when people say hey I pay taxes and that is why I should get something for free. Now if you had said you paid 38 years of insurance to the same company I would support you in your outrage. But taxes is not the same as paying for health insurance. Honestly would your 38 years of taxes cover what was spent on your health. Let's not forget the money that was spent on the roads you drive on. The cops who protects you neighbourhood.

Honestly, I believe the government should not even pay for your son's survivor benefits or even pay for the ER hospital bills. But in the US the taxpayer pays for it. Hell the only thing I thing government should pay for is protecting the country, upholding laws, and maybe just maybe build some roads.

Also, the government should not be in the role of doing everything for people. That just starts the government of having provide for all the bad things. Ahh, you have no house let us subsidized you. Ahh, you have a booboo lets us fix it for you. Oh no you don't have a digital TV here is a nice certificate for you to get a free or save money on a converter. Blah Blah and I can go on.

In the end you said "society" as to what should society do to help you. Here is the question when did society become synonymous with government. To me society means the people in a country or civilization. In the grand scheme of things society has the choice to ignore you or to maybe help you. But we should not be forced to help you by government! In a "caring" society we help people but we try to provide it with charity or its provided by family. Thru others feel we have to mandate caring by government.

Question, you having been paying taxes since you where a baby? Or are you 54+.

Ben-David:

Actually, I pretty much agree with you.

However. Some people are represent a higher loss risk through no fault of their own: women who inherit two copies of a certain gene are practically guaranteed to get breast cancer, for instance.

Further, some personal habits despite being unhealthy (smoking, for instance) may impose, on average, absolutely no additional life-cycle cost on the health care system compared to non-smokers.

Risk pricing is something of a minefield. My sense is that rules governing businesses that choose to provide health care insurance should guarantee access to coverage under the broadest possible terms (ie, rather less emphasis on risk pricing), and then allow those companies to compete by providing required services as cheaply as possible.

You are exactly on point, though, in distinguishing between true risk and foreseeable costs. Insurance is all about the former, and has not heck-all to do with the latter.

She's 50. Can't you add? Maybe you'll learn how when the shoe's on the other foot.

Explain to me the concept of patriotism, where the key goals are to 1) pay less taxes 2) never serve in war 3) cut off public health insurance and 4) make public schools cruddy.

The concept you describe has as its goal achieving the greatest net good, ultimately helping more people in the long run than alternative approaches. I don't agree with their approach 100% but I understand it, and so I will explain it to you:

Paying lower taxes helps because that money instead goes to build the economy, providing jobs, decreasing the number of poor people and so on. Also, lower taxes lead (in their view) to a government that ruins fewer lives. Minimizing foreign wars builds the economy and decreases deaths that disproportionately hit people just entering adulthood. Those who oppose the insurance-provides-all-health-care model favor allocating resources towards cost competition and R&D, making more people able to afford health care without the overhead of the current inefficient insurance bureaucracy, in the process improving the economy and providing jobs that in turn allow more people to afford the now-cheaper health care. Opposing failed school policies and supporting successful school policies is simply common sense. Public schools that are cruddy are so because they have low parental involvement and low quality teachers and administrators.

So in summary, the people who take the point of view you criticize believe that those things will improve the well-being of as many people as possible.

Cobra guarantees you coverage; it does not guarantee you affordable coverage.

I think that Cobra coverage is the closest thing we have today to accurately priced health coverage, and that it's ridiculously expensive indicates how out of whack most of our payments are, and why costs are rising so quickly. That's why we need reform, but not reform that makes the situation worse, as Congress proposes, but reform that will actually make health care more affordable to more people in the long run.

If I were a cancer survivor paying $4000/month in insurance premiums I would want to be allowed to buy a less all-encompassing policy that didn't cover cancer, and I would bank the rest; that kind of money adds up fast. If I got cancer again 10 years later, I would spend what I've saved on it, and then I would die. Or maybe I'd put that money to better use and then die; it's hard to decide that sort of thing ahead of time. The important thing is that it would be my choice.

Yeah muggle I can add. It just sounds weird when you look at her name and her comment she has a young child.

I was going 18 (likely age of starting paying taxes) + 38 years of paying taxes would mean she is about 56 years old. If she is calling herself MomofRae to mean means that her (likely only) child is from 2 to 8 years old. Which means she had her kid pretty late in life around 45 to 56.. I was erroring on the side of caution because I did not see a woman in her 50s having a child. So I thought she was saying she was paying for 38 years from since she was 1. So I thought maybe in her 30s. Because of my generalization I thought she would be younger.

Please MomofRae please DO NOT tell me your age. I was taught not to ask a lady her age.

Skipper:
However. Some people are represent a higher loss risk through no fault of their own: women who inherit two copies of a certain gene are practically guaranteed to get breast cancer, for instance.
- - - - - - - - - -
Nobody's blaming them - so what is that phrase "through no fault of their own" doing in this discussion?

That's the Oprah-esque culture-of-victimhood squeeze play - an emotional set-up to justify taking money from innocent bystanders who "through no fault of their own" have not incurred those health costs.

When I hear talk like that, I check my wallet.

The soft-headed expectation that all of life's inequities can be smoothed out by government involvement got us into this mess, elected us this awful president, and is compromising our liberty.

Let's be clear: I am a religious Jew, not a rabid I'm-alright-Jack libertarian.

But:

1) There are methods of local communal action, spreading the risk, and insuring basic care that are worlds away from massive federal spending programs.

2) A paradoxically infantilizing sense of entitlement is equally dangerous morally/spiritually.

As far as pre-existing conditions goes, what about the person who gets a life long disease such as diabetes while employed with a company that offers health insurance and then ends up at another job that doesn't offer health insurance? Or they loose their job and are unable to find a job after COBRA runs out? Private insurance companies do not offer affordable health insurance for diabetics who need to switch companies, even if they are current on their health insurance.

I'm pretty astonished at the tone of some of these responses to MomofRae, and their flippant indifference to anyone with a serious health problem. Kids with diabetes... tough luck, suck it up big guy! We sure don't wanna pay for YOU! And all those fat people? Let's just shoot 'em all and melt them down for soap, why don't we? After all, WE'RE such skinny, superior, health-conscious citizens... at least for now.

Hostility and contempt for the ill is a hallmark of a ruthless society. Yeah, the Spartans were badasses. But do we want to be like that?

Identifying OTHER people with any sort of condition as "defectives" is easy enough till YOU have the cancer, or the pneumonia, or your child is the one fighting for its life on a respirator.

I just want to point out that COBRA is not 'more expensive' than other insurance. It is the cost of your health plan through your employer. Why it seems so expensive is your employer was typically picking up a huge amount of that cost, so while you were paying $50-$150 of premium a month, your employer was paying $300-$1500. That is why COBRA is 'expensive'. It is just the cost of your medical plan.

Thanks Vi. My favorite was the guy who told me I'd get cancer again and wrote, "Sorry for the buzz kill."

I'm glad you all feel immortal. I did, too. I didn't drink or smoke, I was impossibly fit. I ate right. My genetics are impeccable; both my grandmothers lived well into their 90s. My grandfathers into their 80s. Not a one of them had cancer. Shoot, I was 42 when we decided to get pregnant and was pregnant without intervention within weeks.

And then one day I felt a lump.

Good luck to all of you. I hope if you are ever sick and on the road to healing you meet people who have more to say than tough luck.

Well, nofantitti, you think nofantitti is juvenile? Yeah, so is nobama.

Wyahh, I guess you can dish it out.

"When that child hits the age where he has to get his own insurance...how is that going to happen???"

Oh noes ZOMG the tragedy!! Please. Maybe that child has to work a bit harder, and can afford fewer luxuries than the average person, to pay for medicine and/or higher-risk coverage. Boo hoo hoo, that's life. Why is it so horrific to you? Same happened to me, except I didn't whinge that anybody else owed me anything - I just pay for my chronically higher health costs, I always have. That's what a salary is for, to pay my costs. I still manage to live a relatively decent life.

"Hostility and contempt for the ill is a hallmark of a ruthless society."

I don't think people are expressing contempt for the ill 'per se', they're expressing contempt for those who are grabbing at their wallets for a handout.

Yea MomofRae I am going to say that you could get cancer AGAIN (God forbid No that you do) is maybe one reason that you are finding your premiums so high. Here in Korea they sell cancer insurance. Recently many companies that sell them here are upping the premium prices, as more people are getting cancer and getting paid out. One of the back stories is once you are paid out for surviving cancer you are not going to get cancer insurance again with ANY company. Can you sign up for insurance but opt out for cancer related illnesses? Maybe you can still get covered if you get into a major car accident. Good Luck I still hope you can find some sort of affordable coverage and you continue to stay healthy.

Ya Vi, I am bit of an asshole. Plus selfish. If I was closer to or family of MomofRae. I would probably care a lot more. I do care a little enough to hope the woman can find some sort of coverage that she can pay for. That she will not ever be cursed again with cancer. But the caring and sympathy does not mean that I want to be the one that gives permission to say okay "I'll pay" OR "Yes, I want to pay more to cover for her". In the end I am not the one responsible for her.

Also VI I am a fat guy plus I drink and smoke cigars and you know what I expect from anybody other than family and friends when I get a heart attack ....... is a hard time. I expect - "loose weight fatty and stop eating so many hamburgers you tubbo". Hell I would not be surprised if my doctor bitchslapped me and told me to smarten the hell up. It's my choice(overall) to be fat and it my ass if things go wrong. As to other people with problems I can care and have sympathy and heck even lend a helping hand or a buck or two. But as above, giving that sympathy or donation does not mean I want to FORCED to give more or to give a break or a mulligan or my precious time or one more try or so on.

Good example from something posted on Amy's before
http://www.advicegoddess.com/archives/2008/04/23/go_ahead_buy_an.html

I can fell sympathy for some girl from Mexico who needs an kidney transplant. But why should Americans have to pay for and give up a kidney because she is suffering. Three times the government paid for and found a kidney for this girl. It is a real shame she is that sick she needed a kidney thrice. But the shame does not equal let us fix the problem.

True this kind of behavior is ruthless and society that is ruthless is probably not one I would want to live in. That is why we in a society form religions or develop some levels of spirituality or even community and kindness or hell social mores. We have that in the west. But that does not mean I want legislation to mandate how I should feel or act. It's my right to care or not.

Vi in end "Life is not fair". I have to accept that and do MY best to protect MYSELF (and those I care about) from life's arrows of misfortune.

MomofRae: "My insurance company just informed me that my policy will now cost in the four figures a month -- A MONTH."

This is pretty disgusting of them, as it conceptually goes against how we generally view risk pooling products. But surely - and I'm not defending the practice - this was in the 'fine print'? What I mean is, the contract you signed with them allowed them to do that ... so what I'm wondering is, why do people sign contracts like that if they know that's what the insurance company will do if they run into trouble? Is it because there is no real competition between providers (and if so, why not?), or do "they all do it"? If they "all do it", doesn't that mean the market "wants" an insurance company that doesn't? Or is the real problem that people sign up with insurance companies for lower rates based on "blindly hoping" that nothing bad will happen to them thereby causing hiking of premiums (customer base with short-term thinking), thereby forcing providers to compete on short-term-thinking-based marketing strategies? (Sorry, I must admit I know little about the US health insurance industry. If it's anything like where I live though, I'm guessing that a large part of the problem is that most people just don't even bother to read the fine print on such things, and just blindly hope for the best while worrying about other things like luxury cars and big houses while they're healthy.)

Mom of Rae -
Not to tempt fate, but did you ever ask one of your doctors what your risk is of recurrence?

How does that compare with the risk of the general population for this cancer?

Does the increase in risk roughly correlate with the increased premiums - say, a doubled risk and a doubled premium - or are they price-gouging?

vi "Yea MomofRae I am going to say that you could get cancer AGAIN (God forbid No that you do) is maybe one reason that you are finding your premiums so high."

Of course - she's no doubt in a much higher risk group - thus a pooled higher risk = higher premiums.

"True this kind of behavior is ruthless and society that is ruthless is probably not one I would want to live in."

You're way too apologetic - you've bought into the argument that Aabiding by the principle that people pay their own way is somehow vile. Sorry, I find the idea that people should be entitled to take money from one person (food out of the mouths of their children etc.) to pay for someone else's health problem far more "ruthless", it's stealing and makes me sick to my stomach.

"Vi in end "Life is not fair"."

Yup, life isn't fair. It sucks, and we all do what we can to improve the world, but stealing from people to try "make life more fair" makes no sense. Frankly I'm thankful that we live in the world we do; health-wise, the options we have today are incredible compared to anything any of our ancestors ever had before --- and that's thanks to the hard work of millions of people, and no thanks to any kind of theft.

"Does the increase in risk roughly correlate with the increased premiums - say, a doubled risk and a doubled premium - or are they price-gouging?"

Yup --- important question. What I was kind of trying to get at two posts back was, *if* they are price gouging, then that represents a potential market opportunity for a competitor to provide lower premiums ... and what I'm wondering is what is preventing that from happening, i.e. why no competition.

If they are not price gouging, however, and the premiums do correlate with the actual statistical increased risk, then you're just paying higher because your risk portion does cost more.

Ideally selling contracts with some kind of "no premium hike" clause would again represent a market opportunity --- unless most customers mistakenly assume "it won't happen to me" when they sign up.

"I'm glad you all feel immortal. I did, too."

Wrong assumption, I do NOT "feel immortal", I rationally realize that (as with everyone else) there is a real, non-negligible risk that I may need expensive medical treatment someday, and I continually put away some amount of my money accordingly into a savings account. I work hard for that, and make sacrifices to do that, and I don't think that someone else should be entitled to take my hard-earned medical-emergency savings for their medical emergency just because they "felt immortal" and didn't think ahead.

>>Can you sign up for insurance but opt out for cancer related illnesses?

I don't remotely understand how this is supposed to work.
(For the record, I also thought the "buzz kill" comment was beyond the pale.)

Illness symptoms do not always obviously proclaim themselves "cancer-related" and "definitely not cancer-related", especially for those who have already been horribly unlucky.

Though I could take a wild guess which box the insurer would tick for someone who had managed to get limited coverage.

I can only see a limited policy turning into a nightmare of paperwork for the patient for any claim.

DavidJ:
Ideally selling contracts with some kind of "no premium hike" clause would again represent a market opportunity --- unless most customers mistakenly assume "it won't happen to me" when they sign up.
- - - - - - - - -
It doesn't matter what they assume as long as the insurance company has done their actuarial homework.

That product will obviously cost more - and a certain percentage of people who buy it will never need its extra protections.

They will have paid to lower potential loss - just like bonds yield less than stocks.

Buyer's choice.

Ben-David:

That's the Oprah-esque culture-of-victimhood squeeze play - an emotional set-up to justify taking money from innocent bystanders who "through no fault of their own" have not incurred those health costs.

...

2) A paradoxically infantilizing sense of entitlement is equally dangerous morally/spiritually.

No, it is not. Rather, it is a proper understanding of what risk -- which is what insurance is supposedly all about -- within the realm of health care.

Everyone born dies. During everyone's lifetime, they will present some costs to the health care system.

Those life cycle costs are almost completely unpredictable, even where it appears they are.

The woman with the breast cancer gene is part of a risk pool of similar women. Let's say that 2/3 die of the disease. So, of course, since we know in advance of that cost, they should pay more, right?

Wrong. Because as a group, those women are 2/3 less likely to die of something else, and all those other somethings have a cost associated with them. For instance, those women will not die from Alzheimer's, or MS, or heart disease.

Smokers are an even better example. There is precisely zero evidence that an average smoker costs the health care system any more than the average non-smoker. It is true that smokers have shorter lives, but their life cycle costs remain the same.

Therefore, there is simply no way to risk price health insurance. It is essentially impossible, a priori, to assign any statistically meaningful notion of risk to an individual. And, even in those rare instances where you can, it is impossible to say whether those people will, at the end of the day, cost the health care system more.

I wasn't asking for a handout. I was asking what reasonable tack someone in my position can take -- beside die if the cancer returns, which, knock wood again, the analysis of my tumor, treatment protocol, etc., heavily indicate it will not.

I'm not a much greater risk than any woman between the ages of 45 and 60. I know this because one of the joys of cancer is having little pieces of paper with your possibility of death quite coldly analyzed on them handed to you at various times.

How about this: I'll take whatever percentage more I paid in taxes than this cold-hearted crew (with some wonderful exceptions) -- and I bet it's a lot over the years -- and put it toward my insurance. After all the thing I'm most sick of subsidizing are the lower salaries of people who no doubt earned much less than me over their lifetime.

And one last point: the fine print of pretty much every insurance policy I've ever read says they can change the rules to suit them at any time. $2000 deductible. Yes, unless they raise it. $5000 out of pocket max? Yup again. Unless they raise it.

And insurance is the only business I know of where your cost is not locked in. You buy a car, they don't raise your monthly payments cause sales are off. Same thing when you purchase life insurance. The quote is the price.

And, again, when your wives and sisters and daughters start dying of breast cancer -- and they will -- because they're priced out of their policies, maybe your humanity will start to thaw.

This was my first time posting. I'm pretty sure it's my last.

This was my first time posting. I'm pretty sure it's my last.

Posted by: MomofRae

Perhaps thats for the best, though I must say for a person who beat back cancer you certainly are quick to run away from words.

I have a better suggestion, tell the people who piss you off to go fuck themseleves and keep posting.

Its a stategy that seems to work for everyone else around here.

And so far there has only been one regular poster that people really dont like but he is just an 'i-'jackass

Lujlp - I have made my living with words. I'd never run from them. But I wrote seeking actual advice. Instead I got told I'd get cancer again (buzz kill!) and that pity on me but this is my problem. It's not. It's increasingly lots of people's problems. Trust me, I wasn't anyone people ever thought would be in this position. Which makes it possible for anyone to be where I am. As a semi-regular reader of this blog and a fan of Amy's even when we disagree (email me, I just a friend's upcoming book to all the right reviewers!) I'd just hoped for better from this crowd. I learned nothing. I got no ideas. For all the complaining about the numbskulls in Washington, I didn't see one instance of original thinking on the health care issue here.

And I've always thought the person whose best argument was fuck off was the person who lost the argument.

Going back over your first post you did ASK for advice. Me bad! At times I read quickly, I think some of your later posts - irked me and perked my curiosity. Sorry I have no "specific" advice all I had was some observations and thoughts.

- Your rates are higher because you survived cancer.
- Your wonder about society and its attitude to your situation. My opinion that why should society have to care. Also that society is synonymous with government.
- Paying taxes does not mean you get a break elsewhere. Paying taxes does not mean I should get my next car cheaper. The insurance company is not a separate department of the US government (YET).

Still come on back! Post some more! Hell tell me to FUCK OFF and we can concede that neither of us won the argument. I might not go but it better then saying the forum was too mean or nasty. Just remember your are going to get nice responses, nasty responses and at times some down right insane answers. This is a place of discussion and debate not the mutual masturbation forum.

Hell we may not have answered you question to your satisfaction but maybe us posters at another times can answer other questions or even my goodness make you can help answer some of our questions about life.

Good Luck MomofRae

Ok, like many of you I believe in personal responsibility. I save money, make sure I get all the appropriate preventative care, eat clean, exercise. I feel great and look better than 90% of women my age. I do my best to take care of myself both physically and financially.

But all that good nutrition, exercise and saving isn't going to do me much good if I become seriously ill and am unable to work any longer. I could pay COBRA as long as it lasts, but then what?

I have disability insurance which would cover my living expenses, but what will I do about health care? What about paying for my on-going treatment?

My neighbor has a teenage son who had cancer when he was four years old. He is now 15 and has been cancer-free for 10 years. The family owns a small business, so they are in the private insurance market. Several months ago, their insurer stopped doing business in our state, so they had to find new insurance. They were unable to find a company who would cover their son. They didn't just refuse coverage for a recurrance of his prior cancer, but for anything. Because he had cancer when he was 4, he can't be insured for breaking his leg? How is that right?

MomofRae, I am sorry you have had such a bad experience here. I hope you will consider commenting again.

momofrae...i do feel sorry for your plight, however, the reason you are being charged as much as you are is because you are in a risk pool of one-you. Just as I can not go to a auto insurance company and say here is my wrecked car, I want to buy a policy so you can fix it, you can not go to a health insurance company and say cover me for a low cost. It has never happened and will never happen, it is called risk. you as a cancer survivor are a risk. Because you are self employed this is a problem. However, you may have to consider finding employment with a medium to large corporation where you can obtain group coverage. Many companies do not have pre-existing clauses in their coverage. In fact my adopted mom survived cancer, was let go from her company and was without coverage for months, was hired by another company and got insurance with out any difficulty. My wife and I discussed the topic of cancer this evening...our insurance coverage has a $1 million lifetime cap...what happens then? This type of problem above or yours I can agree that there should be some assistance with...not these fat, lazy 2-3 generation welfare junkies who go to the doctors and ER 10-15 times a month. I work at a hospital and have seen it happen. In other words, I dont have sympathy for people who milk the system, I do have sympathy for people who fall thru the cracks...

momofrae, the problem is there's no sense of community in this country. Everyone's on their own. You've certainly given enough to be given the respect of getting a little back and still... see the attitude. Sadly, they won't see it until it is them and then they'll rage about how unfair it is nobody cares. Hope you stop by but I wish you the best and I wish I had a solution for you. I don't. I worry about being in that kind of situation myself should I ever fall too ill to work and keep my much-used insurance.