As a single man with limited culinary skills, I eat out frequently and as a result waiters and waitresses know me as a regular customer. Those who serve me often talk about their work and I ask about their working conditions. They have tough jobs—on their feet for many hours at a time, wages are not generous, and customers can be demanding.

Now many of them are having their hours cut to less than 30 hours a week so their employers will not have to give them healthcare as the new law requires. For some it means they will have to look for a second job to make ends meet and will still not have health care. I have talked to a waiter and a waitress at different restaurants about this and have the impression it is becoming widespread.

Views: 396

Reply to This

Replies to This Discussion

There are many difficulties with private health insurance and almost everyone will encounter them. The reason is that they save money by refusing reimbursement and their motivation is to deny care. That's why there should have been a public option in Obamacare. However, the problem is not with Obamacare per se—it happens with any kind of private medical insurance.

The problem you describe is common. A medication is approved for use in treating one condition and the insurance company will reimburse only when it is prescribed for that condition. However, doctors often find that a drug useful in treating conditions for which it has not been approved. The difficulty is that pharmaceutical companies may not find it appealing to have the drug re-tested for a new condition unless there is a large patient population to use it.

If you have a condition that makes you chronically ill, you probably ought to have health insurance if you possibly can get it.

The problem you describe is common. A medication is approved for use in treating one condition and the insurance company will reimburse only when it is prescribed for that condition.

That is not limited to private companies, medicare has similar restrictions. The FDA tolerates but does not approve off-label use.

there was a recent major article in Time (I believe it's available online) showing the relative costing to charges in hospitals (both non profit and for profit) and the margins were astronomical. Health insurance companies have a 5-8% profit margin, trivial compared to hospitals.

It sounds as though no health insurance plan addresses your current special needs, but that is not the case for most people who are now without health insurance.

The reason the system is such a mess is the need for everyone to make a profit—doctors, hospitals, pharmaceutical companies. Their primary interest lies in making money.

Our medical care is incredibly expensive, and Obamacare isn't addressing the underlying causes.

No legislation in effect now does that except Medicare, which pays only a percentage of costs. The only reason the Affordable Care Act passed was because the medical community and the insurance companies did not lobby heavily against it. They were assured that there would be no public option, that it would be an entirely private insurance system and would not attempt to address costs.

If you want to lower costs in a system where insurance covers most people, you need ways of standardizing and systematizing costs across geographical regions and multiple insurance plans. Medicare does that to some extent now and has helped to hold down costs for services and procedures, but it's not enough.

The cost of pharmaceuticals is unregulated and the drug companies pricing schemes are hidden. Congress, in trying to pass an "orphan" drug law a few years ago, put a requirement in the legislation that pharmaceutical companies which participated would have to reveal their pricing structures. They all said they would refuse to participate on those terms. The cost of pharmaceuticals is not in the manufacture, but in development and marketing. They are extremely difficult to estimate accurately.

The pharmaceutical industry is the second most profitable industry in the US. Only the financial industry exceeds it. In 2012 there were eight pharmaceutical companies with profits over $1 billion. They had total revenues of $395 billion and profits of $45.2 billion.

The only real solution is universal health coverage, a single payer system for the entire country, but it won't happen in the United States because it would put the health insurance companies out of business.

It sounds as though no health insurance plan addresses your current special needs, but that is not the case for most people who are now without health insurance.

If the govt truly intends to force me to let a health insurance co. stick its straw into my financial resources and slurp them up, to the tune of $10,000 a year or more ... I'll likely emigrate from the US to another country.  Or maybe just pay the fine for not getting full health insurance. 

However, my situation CANNOT be dismissed as so idiosyncratic as to be irrelevant! 

There is a huge problem with insurance-driven medical care.  That is, it results in medical care "by the numbers" - similarly to painting by the numbers, it is dumb medical care. 

I've heard horror stories about medical care in Britain's nationalized health care system.  For example, I got into an online conversation with someone in the UK who said he had gotten tested for celiac disease by the NHS and it was negative.  It turned out he had been on a gluten-free diet for a long time when he was tested.  You have to be eating gluten to get the tests, otherwise they will be negative!  The NHS doctor didn't even ask him whether he had been on a gluten-free diet before doing the test!

Unfortunately I don't see that Obamacare has been designed with this very fundamental consideration in mind. 

I've experienced a similar problem to yours with my secondary insurer. My cardiologist does not want me to take Nsaids for arthritis and the rheumatologist prescribed a natural remedy classified as a medical food, not a drug. However the insurance company would not pay for it since I have no nutirtional deficiencies. This was absurd because the remedy is only for arthritis pain, not for deficiencies. I appealed and submitted all my cardiology records and was refused even though the review was done by a rheumatologist.

This kind of thing is going to be a problem as long as insurance companies control the healthcare market and increase profits by denying care.

$10,000 sounds like way too much. Private healthcare policies do run that much and more, but the cost of mandated coverage is supposed to be a lot less or else supplemented by the government.

Insurance companies were very reluctant to go along with the ACA plan, but agreed in view of the enormous numbers of new customers they would gain.

Again, I think universal healthcare coverage is the only rational answer, but no system will ever be perfect. Drug pricing needs some serious attention, but the commitment to free enterprise will probably prevent that.

On the other hand, do we want the government (or insurers) paying for not-scientifically validated products? We see a more extreme version of that in UK where there is enormous pressure to include homeopaths, naturopathes and other woo into the publicly paid healthcare system.

When it's government running the whole show, you don't have to option to move to another provider.

There is a huge problem with insurance-driven medical care.  That is, it results in medical care "by the numbers" - similarly to painting by the numbers, it is dumb medical care.

This is very true. But unlike what people seem to expect, it would NOT be alleviated by 'single payer' systems. Indeed Medicare is deeply immersed in that mentality .. EVERYTHING is coded, and treatments are either approved or rejected according to the codes. There is NO ROOM for personaliztion.

On another point, here are 2008 profit reports for major insurers:

Cigna: 3.50%

United Health Group: 4.56%

Aetna: 3.64%

WellCare:  4.08%

Amerigroup: 3.51%

Humana 2.56%

WellPoint: 5.49%

I doubt that cutting these profits will make a huge difference in our medical costs.

Indeed Medicare is deeply immersed in that mentality .. EVERYTHING is coded, and treatments are either approved or rejected according to the codes.

That is true, but Medicare seems to work much better than private insurance. In twelve years on Medicare, I have never had a denial of treatment or payment, but the previous six years on private insurance I had three denials and always lost on appeal.

In one case an opthamologist sent me to a neurologist with instructions to do tests to rule out a certain rare condition. The insurance company denied the claim on the grounds that the opthamologist had not himself specified the expensive tests given. I refused to pay and expected to be sued, but in fact the neurologist came back with an offer to settle for 20% of the bill and I paid.

Unfortunately this option is prohibited under Obamacare. Only certain levels of coverage are permitted.

True or False: Insurance is "Love your neighbor as yourself" made real.

I say it's true because only once during my working life did I benefit from the health care insurance my employers provided. Other things being equal (which they never really are), self-employment and being uninsured would been to my benefit.

Obamacare is far from ideal; we do live in a for-profit economy, and one in which those with money can and do invest by contributing to the costs of election to public office. They invest and the thirty-hours-per-week work requirement is one of many ways their investments are rewarded.

So, make noise, lots of noise, about Obamacare's limitations. If we, all of us, make enough noise about Obamacare's limitations, we will make America a tiny bit more resident-friendly.

Postscript: a doctor once told me I have designer genes. Please don't hate me; hate my parents...and their parents, etc, etc, etc.

All previous attempts—over a hundred years of them— to move toward universal coverage have failed for political reasons. Imperfect as it may be, Obamacare is a step in the right direction and could pave the way for a better system. On the other hand, if it is repealed, I believe the United States will never have a good system.

One out of six in the U.S. is not without health insurance. They crowd emergency rooms where they can receive stabilization for crises in their chronic conditions, but not the care that would prevent further crises. In the richest country in history, a country which spends on health care twice the average of other developed countries, this is a scandal. It leads to ruined lives and death for many.

I agree, Dr Clark.  There is no reason universal health care cannot work in the US and no reason we should not have it.  It is the right thing to do.  Remember the right thing, that right thing we say you don't need religion for?  There are smart people out there (me not included) who can work this out if politics would stay out of it.

And for those of you young people who say you are never sick and don't want to pay for the illnesses of others.  Guess what.  Your day is coming.  I worked for 20 years and never used my health insurance once.  Then father time caught up with me.  I am now totally dependent on that very same insurance.  It was a good investment.

RSS

Support Atheist Nexus

Donate Today

Donate

 

Help Nexus When You Buy From Amazon

Amazon

AJY

 

© 2014   Atheist Nexus. All rights reserved. Admin: Richard Haynes.

Badges  |  Report an Issue  |  Terms of Service