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Author Topic: Health insurance companies  (Read 9459 times)

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Offline Turboguy

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Health insurance companies
« on: July 26, 2013, 07:14:10 AM »
I was just looking at Jack's Facebook page.  There were a couple of things in the comments section that I thought I would share.  One is that the plans are for the annual get together to continue with one of Jacks's brothers hosting the event. 


There was another comment that I found a little unnerving.   One of the comments was that Jack's chance of survival would have been better had his insurance company not played games calling it a preexisting condition.  The thought that he may have been denied care that could have saved him is unsettling.  I have not been a fan of Obamacare but that could have me rethinking my opinion.   

Offline Hammer2722

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Re: Health insurance companies
« Reply #1 on: July 26, 2013, 07:26:12 AM »
Its sad but there are lots of unscrupulous insurance companies that will use any excuse to not provide medical coverage it given the opportunity.... >:(
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Offline pitbull

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Re: Health insurance companies
« Reply #2 on: July 26, 2013, 10:38:19 AM »
Its sad but there are lots of unscrupulous insurance companies that will use any excuse to not provide medical coverage it given the opportunity.... >:(

This is called maximizing profit. Most of RWD membership (ardent conservatives and anti-Obama-ists) should have no problem with this.
 
Very sad news.... RIP Jack
 
 
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Re: Health insurance companies
« Reply #3 on: July 26, 2013, 11:05:10 AM »

This is called maximizing profit. Most of RWD membership (ardent conservatives and anti-Obama-ists) should have no problem with this.
 

If you think for a minute Obamacare will alleviate that aspect, you are living in delusion  :D

Offline GQBlues

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Re: Health insurance companies
« Reply #4 on: July 26, 2013, 11:16:10 AM »
This has me wondering if Jack would've disagreed with me if I told him to acquire PPO coverage instead of HMO. Probably...

TG-

There's a viable reason why OB-CARE is getting delayed, delayed, delayed...remember the 'Pass now, ask questions later' motto.
« Last Edit: July 26, 2013, 11:17:47 AM by GQBlues »
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Offline pitbull

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Re: Health insurance companies
« Reply #5 on: July 26, 2013, 01:01:14 PM »
If you think for a minute Obamacare will alleviate that aspect, you are living in delusion  :D

Prolly not too much since Obamacare is not a single payer system.
 
But it will for sure alleviate the "preexisting condition" issue which of all states, Texas has the most horrendous situation with  :(
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Offline Anotherkiwi

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Re: Health insurance companies
« Reply #6 on: July 26, 2013, 05:28:59 PM »
There was another comment that I found a little unnerving.   One of the comments was that Jack's chance of survival would have been better had his insurance company not played games calling it a preexisting condition.  The thought that he may have been denied care that could have saved him is unsettling. 

Seriously?  How can cancer possibly be a pre-existing condition?  :wallbash: Obviously I don't know the details of Jack's medical coverage, but how likely is it that he would have started a new policy within months of his death?
 
I have not been a fan of Obamacare but that could have me rethinking my opinion.

I know that there has been this type of argument on here before but, if true, this situation makes me glad that I live where I do, rather than in a country where worrying about insurance coverage will actually create far more stress and probably worsen an already grave situation.

Offline CaptB

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Re: Health insurance companies
« Reply #7 on: July 26, 2013, 07:07:48 PM »
Hopefully we have had enough "healthcare issue discussion" to quell everybody's thirst. Remembering Jack Bragg....should be the main focus of this thread.


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Offline ML

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Re: Health insurance companies
« Reply #8 on: July 26, 2013, 08:28:34 PM »

This is called maximizing profit. Most of RWD membership (ardent conservatives and anti-Obama-ists) should have no problem with this.
 
Very sad news.... RIP Jack

This is a common misperception about the goal of a well managed firm.

The goal is not to maximize profits (which is a short run concept), but rather to maximize the value of the firm.

The value of a firm is given by the 'present value of all future expected cash flows discounted to the present using a required rate of return (discount rate) that reflects the expected risk of those future cash flows and the rate obtainable on alternative investments.'

Now, the reason that values (as given by total shares outstanding times price per share) continually jump around is because all market participants are constantly changing their views on what are the future expected cash flows and what is the risk involved with those cash flows and what are the rates of return possible on alternative investments. 

The views on future cash flows are influenced by the business of the specific firm, by the general economy and by federal  fiscal policy, etc.  The views on required rates of return are influenced by risk of the firm itself and by federal monetary policy.

A firm that seeks to maximize current profits can change the investing publics view (specifically the big money managers) on what the future cash flows can be.

For instance:  A firm that is continually in the news for denying medical coverage will lead investors to think there will be many lawsuits coming, regulatory action, etc., which will decrease the future profits (specifically cash  flows) of the firm . . . even as current profits may be high because of decreased payment of claims, etc.

As investors bid the price of firms down because of perceived management focus on maximizing current profits at the expense of future profits . . . the firm becomes the target of takeover attempts which will lead to replacement of current management.

Yeah, yeah; I know . . . current management often gets huge payouts for getting fired.

But  anyway; the goal is not to maximize profits, but rather  to maximize the value  of the firm.

If anyone thinks an insurance firm can maximize long run profits by withholding payment of valid claims . . . then why wouldn't the company disallow all claims?  That would certainly jack up profits in  the short run.  i.e. take in all the premiums and pay zero out in claims.
« Last Edit: July 26, 2013, 08:35:48 PM by ML »
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Re: Health insurance companies
« Reply #9 on: July 26, 2013, 09:00:35 PM »

Seriously?  How can cancer possibly be a pre-existing condition?  :wallbash: Obviously I don't know the details of Jack's medical coverage, but how likely is it that he would have started a new policy within months of his death?
 

I know that there has been this type of argument on here before but, if true, this situation makes me glad that I live where I do, rather than in a country where worrying about insurance coverage will actually create far more stress and probably worsen an already grave situation.

Therein lies the crux of that question. I don't know that anyone has the answer to it or anyone that knows the particulars of Jacks case. Yes, it happens often but, it isn't exclusive to health insurance companies in America. In fact it is inclusive to insurance companies everywhere. I don't know that anyone other than Jack knows what his health insurance situation actually was. To extrapolate would be futile.

Companies claiming a pre-existing condition as a reason to not pay or limit coverage is generally the result of a lapse in insurance coverage. Lapses leave gaps. Seems unfair to the layman but, insurances companies see it all the time. Often, the first place an uninsured ill person suspecting something wrong will go, even before the doctor, is to get insurance coverage. It sucks but, it is also business. I am no fan of insurance companies and no fan of the total train wreck of Obamacare but, insurance companies function on insuring the insured.

Offline Anotherkiwi

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Re: Health insurance companies
« Reply #10 on: July 26, 2013, 11:47:50 PM »
...Companies claiming a pre-existing condition as a reason to not pay or limit coverage is generally the result of a lapse in insurance coverage. Lapses leave gaps. Seems unfair to the layman but, insurances companies see it all the time. Often, the first place an uninsured ill person suspecting something wrong will go, even before the doctor, is to get insurance coverage. It sucks but, it is also business. I am no fan of insurance companies and no fan of the total train wreck of Obamacare but, insurance companies function on insuring the insured.

This is one area where I do have detailed knowledge, having spent 12 or 13 years in the insurance industry, both as an administrator and as a life insurance salesman.  The last few years of that was as the Claims Manager for a healthcare insurance company, which also had a diminishing life insurance portfolio (the company had stopped selling life policies some years earlier, but let the division run down by attrition and death rather than requesting policyholders to surrender their cover).  I don't know what the situation is in the USA, but companies here will cover many pre-existing conditions through a combination of extra premiums and/or increased excesses against claims.  Obviously there are exceptions - nobody will cover a currently pre-existing cancer, although they might consider it with a huge loading on the premium if the person has been in remission for a number of years.
 
As far as I can recall, I rejected only half a dozen claims in that entire period.  They would almost certainly have been for non-disclosure of pre-existing conditions, but that small a proportion (one or two a year out of several hundred claims) should show that my company was pretty nice to its clients.  8)

Offline BillyB

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Re: Health insurance companies
« Reply #11 on: July 27, 2013, 07:18:29 PM »
There was another comment that I found a little unnerving.   One of the comments was that Jack's chance of survival would have been better had his insurance company not played games calling it a preexisting condition.  The thought that he may have been denied care that could have saved him is unsettling.  I have not been a fan of Obamacare but that could have me rethinking my opinion.

I don't know when Jack bought insurance but an uninsured guy can't wreck his car and then buy full coverage insurance to pay for the damages. Jack made his decisions alone and nobody should pity him. If a person doesn't want to buy insurance and use the money to make his/her life better in other ways, then that's their own decision. I'm sure Jack enjoyed his life in many ways and he did much good for people so he should have little regret for the path he's chosen.
 
Obamacare would probably now or in the future consists of doctors that can't make it on their own in the private sector. A patient may be entitled to only one opinion and if a doctor says you're going to die and nothing can be done, nothing will be done. A friend of mine's father had private insurance and he went to many doctors until he found some at a top 5 medical university University of Washington who gave him the answer he wanted. Life. They said they'll fix him right up and those other doctors are 5+ years behind the times and don't have the knowledge to take care of him. The doctors removed one lung and a third of the other lung to get rid of the cancer. 30 years later he's still living.
 
Although things could be better, let's not forget that America has the best survival rates due to it's excellent medical personel. If rich, powerful people in Europe or anywhere else wants the best chance at surviving cancer, they come to America. Change that and quality could go down. We have hospitals built in northern USA just to handle Canadian clients who are tired of waiting for their free government medical care.
 
There's no reason to be pissed off at insurance companies. They are a business and entitled to profit to thrive and prosper. Take those things away from business and what do you have? Out of business. If you're pissed off now, think about how pissed off you'd be if you didn't have establishments to buy clothes, food, cars, medical care and of course insurance.
 
 
 
Fund the audits, spread the word and educate people, write your politicians and other elected officials. Stay active in the fight to save our country. Over 220 generals and admirals say we are in a fight for our survival like no other time since 1776.

Offline Muzh

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Re: Health insurance companies
« Reply #12 on: July 29, 2013, 12:01:06 PM »

Seriously?  How can cancer possibly be a pre-existing condition?  :wallbash:

It is good old American capitalism. Anything to maximize a profit.
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Re: Health insurance companies
« Reply #13 on: July 29, 2013, 12:25:42 PM »

This is one area where I do have detailed knowledge, having spent 12 or 13 years in the insurance industry, both as an administrator and as a life insurance salesman.  The last few years of that was as the Claims Manager for a healthcare insurance company, which also had a diminishing life insurance portfolio (the company had stopped selling life policies some years earlier, but let the division run down by attrition and death rather than requesting policyholders to surrender their cover).  I don't know what the situation is in the USA, but companies here will cover many pre-existing conditions through a combination of extra premiums and/or increased excesses against claims.  Obviously there are exceptions - nobody will cover a currently pre-existing cancer, although they might consider it with a huge loading on the premium if the person has been in remission for a number of years.
 
As far as I can recall, I rejected only half a dozen claims in that entire period.  They would almost certainly have been for non-disclosure of pre-existing conditions, but that small a proportion (one or two a year out of several hundred claims) should show that my company was pretty nice to its clients.  8)

So then, aren't you pretty much answering your own question? I do not know what was the situation with Jack and his insurance company(or if there was even a situation) but, insurance companies around the world AFAIK operate on pretty much the same premise. They have more people paying in, than taking out. In essence, it's much like casino gambling favored for the house to win.

Offline Anotherkiwi

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Re: Health insurance companies
« Reply #14 on: July 29, 2013, 05:37:34 PM »
...insurance companies around the world AFAIK operate on pretty much the same premise. They have more people paying in, than taking out. In essence, it's much like casino gambling favored for the house to win.

Again, I don't know the situation in the USA, but here life insurance companies are very big players in the housing market through mortgages offered to policyholders.  The interest they earn on that, plus their earnings from premiums, means that the bigger companies are amongst the biggest companies in the country, full stop.

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Re: Health insurance companies
« Reply #15 on: July 29, 2013, 07:02:37 PM »
The reality is that cancer outcomes can't be predicted. 

Steve Jobs had a form of pancreatic cancer that is rare, only 3% of pancreatic cancers are like this....

(all quotes from http://abclocal.go.com/kabc/story?section=news/health&id=8382207 )

" But Jobs suffered from a rare form of it, one most people have never heard of. Of the 43,000 pancreatic cancers diagnosed each year, he had the rarest form.  It's generally more curable and the survival rate is much higher than the most common type called adenocarcinoma. "

...

"Wollin says thanks to proper treatment and good fortune he has many patients who have survived 20, 30 and even 40 years. "

Yet Jobs the billionaire succumbed after 7 years, despite his resources.

My own view is that the US healthcare market is seriously screwed up; however I don't believe single-payer or any other form of universal healthcare in the USA will EVER work - once it becomes a "right" then everyone will use it and it will either deteriorate in quality of service, and/or get rationed anyways. 

The demographics of the USA in 5 years will look like the demographics of the USSR during the years of stagnation (Brezhnev?  Andropov?) and bad things will happen as the human Ponzi scheme collapses.
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Offline Muzh

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Re: Health insurance companies
« Reply #16 on: July 30, 2013, 07:06:29 AM »


" But Jobs suffered from a rare form of it, one most people have never heard of. Of the 43,000 pancreatic cancers diagnosed each year, he had the rarest form.  It's generally more curable and the survival rate is much higher than the most common type called adenocarcinoma. "


Yet Jobs the billionaire succumbed after 7 years, despite his resources.



Jobs died because he was an idiot who refused treatment in favor of "herbs and honey."
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Offline Anotherkiwi

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Re: Health insurance companies
« Reply #17 on: July 30, 2013, 05:57:37 PM »
My own view is that the US healthcare market is seriously screwed up; however I don't believe single-payer or any other form of universal healthcare in the USA will EVER work - once it becomes a "right" then everyone will use it and it will either deteriorate in quality of service, and/or get rationed anyways.

The whole point of it being a "right" (e.g. New Zealand U.K., Canada) is that everyone DOES use it (Australia is slightly different).  Why should it then deteriorate in quality?  Of course you get occasional grizzles about quality of service, and (more seriously) occasional deaths from medical misadventure, but the rate of those is infinitesimal as a proportion of the total number of consultations/treatments/operations.  You can't possibly assert that the standard of medical coverage in these three countries is any lower than that in the USA.
 
As for rationing - everyone here has the choice of using private health care providers if they wish (and can afford it).  Most don't bother.

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Re: Health insurance companies
« Reply #18 on: July 30, 2013, 07:35:18 PM »

The whole point of it being a "right" (e.g. New Zealand U.K., Canada) is that everyone DOES use it (Australia is slightly different).  Why should it then deteriorate in quality?  Of course you get occasional grizzles about quality of service, and (more seriously) occasional deaths from medical misadventure, but the rate of those is infinitesimal as a proportion of the total number of consultations/treatments/operations.  You can't possibly assert that the standard of medical coverage in these three countries is any lower than that in the USA.
 
As for rationing - everyone here has the choice of using private health care providers if they wish (and can afford it).  Most don't bother.

I hesitate to claim a lot of knowledge about other countries' healthcare systems, I was expressing my opinion. 

However is it not the case that there have been some rather shocking NHS stories out of the UK?  And that in Canada, the scarce MRI machines meant a wait of up to 6 weeks to get e.g. a brain scan to rule out brain cancer ... that same machine was operated only 8 hours of the day due to the budget only allowing for 1 operator - but since pets can be scanned with an MRI without the same level of operator, the hospital was scanning pets for cash during the other times the machine was not in use.

I have no idea how accurate this article is, but, it is published by mainstream Canadian media and it would not be fair to call it a "kook" or "fringe" site:

http://www.encyclopediecanadienne.ca/articles/macleans/veterinary-care-faster-than-health-care-for-humans

Quote
If you are going to be sick in Canada, you are much further ahead being a beloved dog or cat. Even pet horses have far better prospects for healthier lives now than they ever had before. And where care for our dogs, cats and horses puts our own system to the greatest shame is in the domain of wait times and access to specialists. Our pets may not be able to talk, but they can get an appointment with a primary care vet within 24 hours and a specialist within the week. "I have a friend who had a dog with cancer and it got treatment within two weeks," says Tina Kelly, an IT buyer in Waterloo, Ont. "For something like that in a human, I bet the response would've been 10 times as long."

And how. There are just 10,800 vets in this country compared to over 62,000 human doctors. But try, as a human, to get an appointment with a specialist. Try, for that matter, getting a GP - five million Canadians, about 15 per cent of the population, don't have one, while 15 per cent of those who do still report trouble receiving routine care. And a referral from your family doctor to a specialist puts you in store for a new ordeal. According to the most recent edition of "Waiting Your Turn: Hospital Waiting Lists in Canada," the Fraser Institute's annual survey of wait times across the country, the number of weeks people waited to see a specialist rose from a median of 8.8 in 2006 to a median of 9.2 weeks in 2007. The journey from specialist to actual treatment took a median of nine weeks after that.
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Offline BC

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Re: Health insurance companies
« Reply #19 on: July 30, 2013, 09:34:58 PM »
The reality is that cancer outcomes can't be predicted. 

Steve Jobs had a form of pancreatic cancer that is rare, only 3% of pancreatic cancers are like this....

(all quotes from http://abclocal.go.com/kabc/story?section=news/health&id=8382207 )

" But Jobs suffered from a rare form of it, one most people have never heard of. Of the 43,000 pancreatic cancers diagnosed each year, he had the rarest form.  It's generally more curable and the survival rate is much higher than the most common type called adenocarcinoma. "

...

"Wollin says thanks to proper treatment and good fortune he has many patients who have survived 20, 30 and even 40 years. "

Yet Jobs the billionaire succumbed after 7 years, despite his resources.

My own view is that the US healthcare market is seriously screwed up; however I don't believe single-payer or any other form of universal healthcare in the USA will EVER work - once it becomes a "right" then everyone will use it and it will either deteriorate in quality of service, and/or get rationed anyways. 

The demographics of the USA in 5 years will look like the demographics of the USSR during the years of stagnation (Brezhnev?  Andropov?) and bad things will happen as the human Ponzi scheme collapses.

IIRC after reading his book, Steve procrastinated medical intervention and was drawn more into alternative therapies. In the end he simply waited too long for full blown medical therapy.

Offline GQBlues

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Re: Health insurance companies
« Reply #20 on: July 30, 2013, 09:38:42 PM »
Apparently, according to CBO, it's going to cost all of us another 12 billion dollars as a result of delaying this silly healthcare law.

http://www.reuters.com/article/2013/07/30/us-usa-healthcare-employers-idUSBRE96T1DI20130730

Many sources are citing the reason for delay is because there are loose segment of this silly law that would actually cause major problems within the system, and its sustainability, if not righted.

Equally, however, many point to the more obvious, the political posturing. The fiscal congressional budget is coming pretty close, and once again the proverbial tug-of-war between taxation and spending cuts is again on the table. Many believe that the administration will table up lifting the spending ceiling even more (translation: generate additional debt over what we already have so *he* can fund this silly law - which puts us all on the hook for even more debt).

On average, when a person buys a house and finances it for the customary 30 years, the cost of the loan, by the time it is paid off, should be anywhere from 3-4 times the original amount of the loan. Now picture our current debt, then picture adding more to it to pay for this silly law - then perpetually struggle to finance it while at the same time making payments to our debt. 

This may not necessarily be a doomsday scenario for the US, but you can sure see it from where we are at this point.
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Offline LAman

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Re: Health insurance companies
« Reply #21 on: July 30, 2013, 09:53:30 PM »
This is a common misperception about the goal of a well managed firm.

The goal is not to maximize profits (which is a short run concept), but rather to maximize the value of the firm.

The value of a firm is given by the 'present value of all future expected cash flows discounted to the present using a required rate of return (discount rate) that reflects the expected risk of those future cash flows and the rate obtainable on alternative investments.'

Now, the reason that values (as given by total shares outstanding times price per share) continually jump around is because all market participants are constantly changing their views on what are the future expected cash flows and what is the risk involved with those cash flows and what are the rates of return possible on alternative investments. 

The views on future cash flows are influenced by the business of the specific firm, by the general economy and by federal  fiscal policy, etc.  The views on required rates of return are influenced by risk of the firm itself and by federal monetary policy.

A firm that seeks to maximize current profits can change the investing publics view (specifically the big money managers) on what the future cash flows can be.

For instance:  A firm that is continually in the news for denying medical coverage will lead investors to think there will be many lawsuits coming, regulatory action, etc., which will decrease the future profits (specifically cash  flows) of the firm . . . even as current profits may be high because of decreased payment of claims, etc.

As investors bid the price of firms down because of perceived management focus on maximizing current profits at the expense of future profits . . . the firm becomes the target of takeover attempts which will lead to replacement of current management.

Yeah, yeah; I know . . . current management often gets huge payouts for getting fired.

But  anyway; the goal is not to maximize profits, but rather  to maximize the value  of the firm.

If anyone thinks an insurance firm can maximize long run profits by withholding payment of valid claims . . . then why wouldn't the company disallow all claims?  That would certainly jack up profits in  the short run.  i.e. take in all the premiums and pay zero out in claims.
ML....the goal of corporations IS to maximize profits mainly to please their shareholders which care more about short team profits and dividends. No?
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Offline BC

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Re: Health insurance companies
« Reply #22 on: July 30, 2013, 09:58:31 PM »

The whole point of it being a "right" (e.g. New Zealand U.K., Canada) is that everyone DOES use it (Australia is slightly different).  Why should it then deteriorate in quality?  Of course you get occasional grizzles about quality of service, and (more seriously) occasional deaths from medical misadventure, but the rate of those is infinitesimal as a proportion of the total number of consultations/treatments/operations.  You can't possibly assert that the standard of medical coverage in these three countries is any lower than that in the USA.
 
As for rationing - everyone here has the choice of using private health care providers if they wish (and can afford it).  Most don't bother.

Exactly.

How many healthy uninsured are out there, at the moment not contributing to healthcare?  Of course they do not want to pay..  but one day they will.  IIRC the majority of healthcare dollars goes to those in the latter stages of life, mostly on the government's dime.  Should they not be 'paying in' to the healthcare system just like they do for social security?

Many complaints about waiting lines for tests etc are most likely due to the fact that under a national healthcare system many more go to doctors!  Of course this requires a triage type environment where the most urgent cases go first, before elective treatment.

Now many may say that national healthcare overburdens the system with unnecessary visits, but at the same time I believe it is also a chance for early diagnosis of maybe a more serious condition, in the end saving a lot of money.

A broken leg will get an x-ray instantly.. someone with a sore wrist may take a bit longer.

In the end, no system will be perfect, but quite honestly the few times I have considered moving back to the US, the lack of affordable healthcare / insurance is a major minus... even a deal breaker.   

Offline Anotherkiwi

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Re: Health insurance companies
« Reply #23 on: July 31, 2013, 03:18:57 AM »
Exactly.

How many healthy uninsured are out there, at the moment not contributing to healthcare?  Of course they do not want to pay..  but one day they will.  IIRC the majority of healthcare dollars goes to those in the latter stages of life, mostly on the government's dime.  Should they not be 'paying in' to the healthcare system just like they do for social security?

I think I'm a perfect example of this.  I have dental checkups every six months (perhaps $200 to $250, because dentists aren't subsidised, and I've just had a filling replaced), and I get the occasional cold, but I haven't had a day off sick for 17 years (touch wood that it continues!).  I would far rather be paying towards our national medical service through a portion of my income tax than be paying what seems to be a hefty compulsory premium to a healthcare insurance company (even the one which I used to work for  8) ).
 
I agree that people here often have to wait for specialist consultations - it's happened to me as well - but at least those who need urgent treatment get it without having to wait forever.

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Re: Health insurance companies
« Reply #24 on: July 31, 2013, 08:48:20 AM »
BC, AK

You both seem to be on the idea that healthcare is a right. You should understand that everyone doesn't believe that to be the case. The majority of Americans still do not believe that it is a right. Just because you live in a country that has a nationalized system doesn't mean it is "better". There is no perfect system, that is certain.

Healthcare is no more of a right than is eating, home repair, having a home, dry cleaning or anything else where you purchase goods or services. In America, our rights are what is laid out in the Constitution. I realize the U.S. constitution means dick in NZ or Italy. It is a different mindset. I'm not saying either is right or wrong, just is, what it is.

That said, The majority of Americans would embrace (IMHO) a nationalized healthcare system if it was not the political football that it is and out of the reach of the government and not forced down the throats of taxpayers. Most Americans do want wish to see people suffer from lack of healthcare but, there could be another way of providing healthcare rather than on the backs of the taxpayers. What is the answer? I do not know but, it isn't Obamacare as that becomes more evident daily

 

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