UnThreaded | Threaded | Whole Thread (44) | Ignore Thread Prev Thread | Next Thread
Author: golfwaymore Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 744316  
Subject: Health Care Crisis: Open to Suggestions Date: 4/30/2001 9:53 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 15
As you know, I own and run a company that has between 50 to 100 employees, depending on how business is. We have provided very good group medical insurance for those employees, for quite some time.

To date, the annual cost of those policies has equaled roughly 25% of the average employees annual wage. The high cost of this comes from the overwhelming number of subscribers in our group who have family coverage vs. the low # of persons with individual coverage. Of that cost, the company pays roughly 85% of the total cost, employees pick up the balance. In other words, it costs us substantially more $ to subsidize an employee opting for family coverage than individual - but we cant legally suggest an employee to do one or the other.

We were informed just recently that our PPO is folding; not profitable. We have been given just a few months notice. To get "out in front" of the crisis, we began seeking other PPO's to enroll our group in, and the rating process has been underway.

The PPO that we had decided upon, conducted telephone interviews with all our subscribers during work hours last week. This was to be the final step of the underwriting process. We (owners), of course, were not allowed to "coach" employees in any way as to how to answer questions, so to allow the underwriter to make a fair assessment.

Today we were informed that our new rating will cost 200% of the current rate. It should be noted that comparably, our previous rate was already higher than the average PPO in our area. The reason for the high rating: The information gleaned in the telephone interviews.

The underwriter had concluded from the interviews that it is likely that 45% of our workforce needed a major surgery of some type; astonishing to us (the owners). We were given the names of those who needed major surgery and we followed up with them as we were startled as to how ill they were without our knowledge.

As it turns out, 45% of our workforce DOES NOT need a major surgery. The conclusion was drawn however based on a combination of (a) very loaded and leading questions by the underwriter and (b) employees that really like to exagerate their nagging pains and ailments.

Case in point: Several of the employees that supposedly needed major surgery really havent been ordered by a doctor to have surgery at all. For example, one lady who had knee trouble a few years back had a doctor tell her she may eventually have to have some type of surgery. She extrapulated this into telling the underwriter that she was going to have to have knee surgery, she had just been putting it off.

Case in point: One employee with a one time detected heart murmur over 10 years ago told the underwriters that he had heart trouble and would likely have to have heart surgery most any time.

There is a long list of examples of rediculous, and IMHO dumb statements that employees made to the underwriters. You get the idea.

I have long suspected that people like to make their doctor's prognosis sound worse than it is, now I KNOW they do. In almost all of the instances where the underwriter had identified a "bad apple", when it came right down to it and the facts were out, the employee did not have an order from a doctor to have surgery and had not been recently seeking treatment for the condition.

I'm not sure who to be most furious with, the PPO for asking ambiguous questions to draw the conclusions they wanted, or a few of our employees who have suddenly become experts in the medical profession. Why do people want to appear to be sicker than they know themselves to be?

I have a slipped disc. It pains me daily. A very smart neurosurgeon told me that while it was certainly severe enough to have it operated on, he had never seen or talked to anyone having back surgery who was completely cured by surgery. His point to me "if you're going to carve up your back, start doing it at 50, not at 30 - live with it".

I took the advice, and additionally found that by working out 1.5 hours per day, my disc hurts significantly less, though I know it's there. When the underwriter asked me if I had ever had a back injury, I said "yes, I slipped a disc years ago, it no longer greatly bothers me and I havent sought medical treatment in ages". I was not on the list of "bad apples".

So here we are, what to do? We cannot provide a benefit to our employees that is equal to or greater than their salary, the bottom line will not endure it.

We additionally cannot simply seek another PPO, and go back through a questioning process (and suggest some better answers) as we have been informed that the underwriter is the same for every PPO on the list.

An HMO is not an option, for a long list of reasons that I dont wish to get into.

The goal is to provide coverage that our employees can afford:

It appears that currently, our only option is to enroll at the inflated new rate, and impose higher costs to the employees. This is useless though, the average cost per employee policy is greater than $1200 per month. Who is going to pay even a fraction of that? None of my employees will subscribe. This would also gurantee that none of the individuals would subscribe for coverage...who's going to pay several hundred dollars for individual coverage? People arent stupid.

The other option before us is to either (a) raise the bar where the insurance company begins paying 100% or (b) raise the deductable to a very high level as many of us here plan to do in retirement. While in dollars and cents, this solves alot of problems for employer and employee, it would not be viewed as "competitive in the area" and we would feel a major impact in turnover.

One last option, delete coverage altogether, and subsidize hourly wages so that persons can get their own individual policies. Ironically, after this process, the rates for such would be more affordable than the group rate.

This option screws the very few who actually DO need to have surgery. If they went to get their own policy outside of work, the condition would be ruled pre-existing; groups can't exclude anything.

Who loses in this are the people on our payroll who are generally healthy, who dont use their insurance for every little sniffle, and who arent obsessed with having people believe that they need major surgery.

Several good employees will lose some or all of their medical benefit because of the insurance underwriter's misleading ways combined with people who like to run their mouth. Disgusting.

I have supposedly some of the best experts in the state working on this, and I've stated the options they've come back to me with.

As always, I'm open to suggestions.

Golfwaymore



Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: galeno Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37159 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 2:06 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
golfwaymore wrote:
lots

Whenever I read stuff like this about the state of medical insurance in the USA, I always have to pick my jaw off the floor. Crazy!!

With 75 employees at $1200 per head per month, that's $90,000 per month or $1,080,000 per year!! Holy moly!!

My (probably dumb) suggestion: throw that hot potato back to the employees!! If enough small employers throw in the towel, maybe that medical mess in the USA can get straightened out somehow? Thank God I don't live there!!!

Here in Costa Rica, state mandated social security / socialized medicine / unemployment insurance /disability insurance costs 21% of the employee's salary. The employee pays 9% and the employer pays 12%. The additional "social guarantees" are 1 month of paid vacation, 1 month of severance pay for every year worked, and one month of a "13th" month salary called an "aginaldo" which all employees get in December so they can go on a spending spree for Christmas.

To recap, a typical employer here in Costa Rica has to pay 11+25=31% in "benefits" over and above the nominal salary of his or her employees. Costa Rica is considered a very socialistic country compared to her other Central American neighbors.

I have another (probably smart) suggestion: sell the company and retire early!! (Sorry, I had to rub that one in!!) I wish you luck. Maybe you want to buy some Galeno Bonds?

Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: eurotrash01 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37162 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 2:44 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
Today we were informed that our new rating will cost 200% of the current rate. It
should be noted that comparably, our previous rate was already higher than the average
PPO in our area. The reason for the high rating: The information gleaned in the
telephone interviews.



And I thought it was going to be the program-sponsored, twice-quarterly, mandatory drug testing thingy. Shows what I know.

Good luck, gwm-

Euro

Print the post Back To Top
Author: fleg9bo Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37163 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 3:09 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 10
Galeno wrote: Here in Costa Rica, state mandated social security / socialized medicine / unemployment insurance /disability insurance costs 21% of the employee's salary.

When I was studying Spanish in CR in January, one of my intructors told me that she paid cash that she could ill afford for a gall bladder operation by a private physician in a private hospital. This in spite of the big hit in taxes she was paying for socialized medicine. The reason? She was afraid she would die waiting for the surgery and/or it would be done incompetently if it were done within the system. Such is socialized medicine everywhere. Beware.

Print the post Back To Top
Author: YvesManoover Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37177 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 11:30 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 7
galeno wrote, reacting to golfwaymore's comments on US hlth insurance:
Whenever I read stuff like this about the state of medical insurance in the USA, I always have to pick my jaw off the floor. Crazy!!

Amen to galeno's incredulity about a twisted system. As contrast and alternative, in Switzerland health insurance is mandatory, like a SSN. No one can be turned away; everyone is covered by law.

Responsibility for it localizes in individuals, not employers. So portability is not an issue. It also means you pay for it yourself.

The market (there are 7 Mill. people here) is covered by about 15 different major insurers. Each year you are free to switch insurers, without penalty, excluded pre-conditions, or any other legalistic hocus pocus. If you are not lazy, you switch because you have found the insurer with the lowest premiums for that year. (This tends to keep all the insurers honest). A lot of people are lazy though, and stay with the same insurer because they don't put in the effort of looking around.

You can choose among 3 levels of deductibles: 250, 500, and 1200 sfr.(that's swiss francs; latest exchange rate shows 1.7 sfr. per dollar); monthly premiums vary accordingly. (In 10 minutes you figure out that 1200 sfr. is the best deal: the premium differential over a year between the 250 and 1200 levels is greater than 1200 francs. So if you get sick in any year, you haven't lost anything; if you don't, you get to keep the difference).

So, what are the monthly premiums? Based on our experience, it's

Adults: about 100 francs each per month.
Kids: about 50 francs each per month.

So, supposing 2 adults & 2 children, that's 300 francs, or $175 per month. Not bad for a health care system I find compassionate and intelligent.

My 2 rappen.

Yves


Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37179 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 11:35 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 5
fleg9bo writes,

<<<<<<Galeno wrote: Here in Costa Rica, state mandated social security / socialized medicine / unemployment insurance /disability insurance costs 21% of the employee's salary. >>>>>>

When I was studying Spanish in CR in January, one of my intructors told me that she paid cash that she could ill afford for a gall bladder operation by a private physician in a private hospital. This in spite of the big hit in taxes she was paying for socialized medicine. The reason? She was afraid she would die waiting for the surgery and/or it would be done incompetently if it were done within the system. Such is socialized medicine everywhere. Beware.


How many Americans have the same fear with their HMO?

intercst

Print the post Back To Top
Author: sage370 Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37180 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 11:36 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 3
I've worked for small companies and have seen two ways that health insurance is dealt with. One, coverage is offered free to the employee, and if they elect to add a spouse or children to the policy, the employee covers the full cost of that addition (can be several hundred dollars for spouse and two kids). Naturally, employees with other options for covering their spouse and children will choose that route, and single people aren't forced to pay to cover other peoples' families. This also keeps the employees' total compensation more fair.

Another way I've seen it handled is that each year, the employees' contribution to the premium is determined by the total premium for the company, which was directly affected by the number of claims put in the prior year. (Of course, we're not talking about the kind of rates you were quoted.) This gave the employees an incentive to stay healthy and not use their medical insurance for every little thing. On the other hand, a single motorcyle accident or heart attack could raise the premium significantly for the whole group.

Isn't there another company that you can deal with? I'm concerned that they have violated your employees' privacy by sharing their confidential medical information with you. Should you need to do a reduction in staff in the near future, you would be doing so with the knowledge of medical conditions that should have no part in the decision, provided that they don't affect their ability to do their job at that time. Not only is this the employees' private medical information, but it sounds like a good way to open yourself up to a potential lawsuit or two.

Michelle



Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: ogrecat Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37181 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 11:40 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 2
One, coverage is offered free to the employee, and if they elect to add a spouse or children to the policy, the employee covers the full cost of that addition (can be several hundred dollars for spouse and two kids). Naturally, employees with other options for covering their spouse and children will choose that route, and single people aren't forced to pay to cover other peoples' families. This also keeps the employees' total compensation more fair.

How is more compensation to people with dependents fair to single people?


Print the post Back To Top
Author: galeno Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37183 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 11:46 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 8
fleg9bo wrote:
When I was studying Spanish in CR in January, one of my intructors told me that she paid cash that she could ill afford for a gall bladder operation by a private physician in a private hospital. This in spite of the big hit in taxes she was paying for socialized medicine. The
reason? She was afraid she would die waiting for the surgery and/or it would be done incompetently if it were done within the system. Such is socialized medicine everywhere.


Just as in the USA and probably more so in Costa Rica, there is a lot of mythology and misunderstanding about medicine, doctors and hospitals.

People are constantly talking to each other about all the medical tragedies that allegedly happen to friends and families. My father in law borrowed money to get castrated (for advanced prostate cancer) in a private hospital because of all the horrible stories he heard from his crazy friends in the park. Would he listen to me? No!! His buddies know better! I suspect the same hysterical logic happened with your teacher.

My mother in law will get operated for advanced breast cancer this Friday. Why advanced? Somebody told her long ago that her large fibrocystic breasts were too vulnerable to the radiation in a mamogram. Thus, she didn't get mamograms--she "settled" for advanced breast cancer. She listened to me. She's having everything done via the socialized medical system. So far, so good. Everything is being done correctly and in a timely manner.

The biggest myth in both countries is that "somebody else" should pay for my healthcare!! In Costa Rica, everyone thinks the government should pay for it. In the USA, the insurance companies (or the government if you're "poor" or old) should pay for my wrinkes etc.

I understand both the CR and the USA medical systems very well. I would have to say that although the USA has more exotic (wow me) type of stuff, the Costa Rican system is better all around.

You're HMOs boast the worst of socialized medicine with none of the benefits. The only thing that keeps them in check indirectly is the plaintiff lawyers' guns aimed at the heads of the HMO doctors. Now, maybe with your ERISA laws getting weakened because of HMO abuse, the legal guns will be aimed properly at the HMOs themselves.

Thank God I retired early from medicine. I really love the science of medicine. It's the patients I can't stand. In the USA the doctors get to hate the insurance companies, the plaintiff lawyers, and the patients. No wonder doctors in the USA have the worse life expectancies of all professionals!!

Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37185 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 12:13 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 3
Yves writes,

Amen to galeno's incredulity about a twisted system. As contrast and alternative, in Switzerland health insurance is mandatory, like a SSN. No one can be turned away; everyone is covered by law.

Responsibility for it localizes in individuals, not employers. So portability is not an issue. It also means you pay for it yourself.

The market (there are 7 Mill. people here) is covered by about 15 different major insurers. Each year you are free to switch insurers, without penalty, excluded pre-conditions, or any other legalistic hocus pocus. If you are not lazy, you switch because you have found the insurer with the lowest premiums for that year. (This tends to keep all the insurers honest). A lot of people are lazy though, and stay with the same insurer because they don't put in the effort of looking around.

You can choose among 3 levels of deductibles: 250, 500, and 1200 sfr.(that's swiss francs; latest exchange rate shows 1.7 sfr. per dollar); monthly premiums vary accordingly. (In 10 minutes you figure out that 1200 sfr. is the best deal: the premium differential over a year between the 250 and 1200 levels is greater than 1200 francs. So if you get sick in any year, you haven't lost anything; if you don't, you get to keep the difference).

So, what are the monthly premiums? Based on our experience, it's

Adults: about 100 francs each per month.
Kids: about 50 francs each per month.

So, supposing 2 adults & 2 children, that's 300 francs, or $175 per month. Not bad for a health care system I find compassionate and intelligent.


Thanks for posting this.

You'd be hard pressed to find a $700 annual deductible health insurance policy for a family of four for $175/month in the US. Also, while conservatives regularly lambast health care in Canada and the UK as "socialized medicine", I haven't heard or seen similar complaints about the Swiss system. Of course, if the Swiss system works well and keeps premiums low, the insurance lobby in this country will make every effort to ensure that a similar system is not adopted here.

intercst





Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: golfwaymore Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37188 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 12:24 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 4
Isn't there another company that you can deal with? I'm concerned that they have violated your employees' privacy by sharing their confidential medical information with you.

The underwriter is the same for all the PPO's on the list, so no. Regarding a violation of employee privacy, it was only stated that they were perceived to need surgery; extreme details and sound medical diagnosis was not part of that information - no violation.

Not only is this the employees' private medical information, but it sounds like a good way to open yourself up to a potential lawsuit or two.

I just sneezed 30 seconds ago here in my office. There are likely 47 different ways that I'm open to a lawsuit for doing so. Ironically, litigation is at the core of why the healthcare system is rotten.

Golfwaymore,
Who is numb to the threat of litigation as a business owner





Print the post Back To Top
Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37189 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 12:32 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
As always, I'm open to suggestions.

Retire and let the new management worry about it :-)

It seems that you have no choice but to find a reasonable cost HMO.


Print the post Back To Top
Author: duggg Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37190 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 12:34 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 12
Galeno writes,

Thank God I retired early from medicine. I really love the science of medicine. It's the patients I can't stand. In the USA the doctors get to hate the insurance companies, the plaintiff lawyers, and the patients.

I think you hit upon what will undoubtedly be a major, major crisis in our society---doctors will be retiring early in their careers, and medical schools will be getting fewer and fewer applicants. Why be a doctor if you have put up with all that nonsense?

Prior to the invention of widespread health insurance and the "care industry" as it has become, physicians were reasonably compensated, and most importantly, respected.

Nowadays, practically everyone and their brother has been spoonfed "free" health care from day one---something originally offered only by the largest corporations, then the various unions, and now every small employer is expected to provide it as well.

The health insurance industry, in turn, steers patients toward doctors with less experience, because they generally provide services for less money. The more experienced doctors are forced to join health plans as well to stay in business, because few patients are willing to pay outrageous out-of-pocket fees for services that their employers are now providing for "free", such as $10,000 pregnancies, etc.

Not only do physicians have to put up with this relentless armtwisting by the health insurance industry, career patients have become downright demanding, insisting on immediate service, seeking multiple referals for every malady, and dictating what drugs they need based on TV commercials they watch. In short, the doctor is there to serve them, and doctors are treated like fast-food workers.

The solution is to get rid of the corporate health insurance industry altogether. Doctors should compete with each other in order to reasonably price the services they perform. Employers should increase salaries so that employees can afford to pay reasonable out-of-pocket costs, or choose to pay for their own individual health insurance premiums. And employees should put an emphasis on getting exercise and eating more healthfully, to avoid additional health care costs.

Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37191 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 12:40 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 9
Amen to galeno's incredulity about a twisted system. As contrast and alternative, in Switzerland health insurance is mandatory, like a SSN. No one can be turned away; everyone is covered by law.

...

The market (there are 7 Mill. people here) is covered by about 15 different major insurers. ...
You can choose among 3 levels of deductibles: 250, 500, and 1200 sfr.(that's swiss francs; latest exchange rate shows 1.7 sfr. per dollar); monthly premiums vary accordingly. (In 10 minutes you figure out that 1200 sfr. is the best deal: the premium differential over a year between the 250 and 1200 levels is greater than 1200 francs. So if you get sick in any year, you haven't lost anything; if you don't, you get to keep the difference).

So, what are the monthly premiums? Based on our experience, it's

Adults: about 100 francs each per month.
Kids: about 50 francs each per month.

So, supposing 2 adults & 2 children, that's 300 francs, or $175 per month. Not bad for a health care system I find compassionate and intelligent.


So, doing the math, 7 million people - assume all adults paying 100 SF, the total collected is 700 million SF or about 400 million US dollars per month, or 4.8 billion US dollars per year.

I doubt that healthcare only costs Switzerland $4.8B per year. So, there is more money coming from somewhere (probably general taxation) and you are paying more than that 100 SF per month.

Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: mrhowell Two stars, 250 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37197 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 1:02 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
You'd be hard pressed to find a $700 annual deductible health insurance policy for a family of four for $175/month in the US. Also, while conservatives regularly lambast health care in Canada and the UK as "socialized medicine", I haven't heard or seen similar complaints about the Swiss system. Of course, if the Swiss system works well and keeps premiums low, the insurance lobby in this country will make every effort to ensure that a similar system is not adopted here.

intercst
**********************

Not necessarily. Big Business being what it is the insurance companies might leap at a chance for a true "stategic alliance" with The Government. They get the monoploy, the protection, and as far as rates and market share, well, they'll find a way to make their money by just shuffling the clientel back and forth and keeping everybody in "recycled mode". Like where the hell else they gonna go, right?




Print the post Back To Top
Author: YvesManoover Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37200 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 1:19 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 3
So, doing the math, 7 million people - assume all adults paying 100 SF, the total collected is 700 million SF or about 400 million US dollars per month, or 4.8 billion US dollars per year.

I doubt that healthcare only costs Switzerland $4.8B per year. So, there is more money coming from somewhere (probably general taxation) and you are paying more than that 100 SF per month.


You're heading somewhere interesting, but caution filling is hot:

--We're bottom fishers, always looking out for the best rate within the system. (As mentioned earlier, the figures were based on our experience). I don't know what the average family figures for the country as a whole are.

--Rates do vary according to age. Older couples (and there are a lot of them) pay more.

--We selected a high deductible. Other families choose a lower one, which is partly where the insurers make their money and helps with the subsidy you hinted at. Hence their monthly premiums are different (and higher).

--The insurance we have is "basic insurance", which is the insurance required by law. Other--supplemental--insurances ("private insurance", "half private", and so on), ensure that you get a private room, that your personal doctor attends you rather than the on duty hospital doctor, etc. In my view these are qualitatively no different from the boondoggle Americans undergo with accident, dismemberment, credit card, and other useless insurances. Needless to say, this area is where these companies make a lot of their money. Let them subsidize me.

The short of it is that extrapolating from the sample figures given earlier of our experience won't lead anywhere in the macro sense.

Yves


Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: golfwaymore Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37204 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 1:51 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
I think you hit upon what will undoubtedly be a major, major crisis in our society---doctors will be retiring early in their careers, and medical schools will be getting fewer and fewer applicants. Why be a doctor if you have put up with all that nonsense?

I agree wholeheartedly. Doctors are often lumped into the group of "high income" evil people in our society. Hogwash.

I think doctors are the most underpaid of all occupations, relative to the amount of training and education required, combined with the BS factor they have to endure.

We recently had a rash of local doctors get out of the practice, in favor of owning healthcare businesses. I suppose that shows us where the real money is.

Golfwaymore



Print the post Back To Top
Author: ariechert Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37208 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 3:12 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 3
So, supposing 2 adults & 2 children, that's 300 francs, or $175 per month. Not bad for a health care system I find compassionate and intelligent.

My 2 rappen.

Yves


Just out of curiousity what kind of income taxes do the Swiss pay? My old boss was German and she was offered a position back home in Germany and she told me there was no way she would go back. She said in the bracket she would be in she would be paying more in taxes than she made in the United States. She lives in a gigantic house in west Knoxville that is probably on the neighborhood of 4,000 square ft. She said in Germany she and her son would be living in small two bedroom house with barely enough room to turn around. She said a small pork roast costs over thirty dollars. The Germans too have all that socialized stuff and for the ones who are lazy (like me) it would be a good deal. They automatically get 6 weeks paid vacation every year. Can you imagine? I watch "Keeping Up Appearances" a British comedy; there is this guy on it named "Onslow" and he is on the "dole." He is my favorite character on the show and the one I most closely identify with. I kind of look like him to tell you the truth. - Art


Print the post Back To Top
Author: ariechert Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37209 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 3:15 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
Galeno wrote: Here in Costa Rica, state mandated social security / socialized medicine / unemployment insurance /disability insurance costs 21% of the employee's salary.

Can Americans who retire to Costa Rica get in on that deal? - Art


Print the post Back To Top
Author: tngirl74 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37216 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 4:04 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 2
who are lazy (like me) it would be a good deal. They automatically get 6 weeks paid vacation every year. Can you imagine? I watch "Keeping Up Appearances" a British comedy; there is this guy on it named "Onslow" and he is on the "dole." He is my favorite character on the show and the one I most closely identify with. I kind of look like him to tell you the truth.

- Art

You are a trip!

tngirl


Print the post Back To Top
Author: galeno Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37236 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 6:24 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
ariechert wrote:
Can Americans who retire to Costa Rica get in on that deal?

Yes. In fact, Americans can get a better deal. For an American to be a retiree here, he needs to prove a monthly income of $600 a month. When I RE'd, I went to the social security office and told them my retirement income was going to be $600 per month. I was going to say it was $400 but you know the old saying: "pigs get slaughtered".

Thus, I pay $46.13 per month. This covers my entire family (wife & 4 kids) and not only gives us complete medical protection but also a small contribution to the state pension fund which will entitle me to a small pension when I turn $65.

Print the post Back To Top
Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37237 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 6:28 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
galeno writes,

<<<<<ariechert wrote:
Can Americans who retire to Costa Rica get in on that deal?>>>>>>

Yes. In fact, Americans can get a better deal. For an American to be a retiree here, he needs to prove a monthly income of $600 a month. When I RE'd, I went to the social security office and told them my retirement income was going to be $600 per month. I was going to say it was $400 but you know the old saying: "pigs get slaughtered".

Thus, I pay $46.13 per month. This covers my entire family (wife & 4 kids) and not only gives us complete medical protection but also a small contribution to the state pension fund which will entitle me to a small pension when I turn $65.


galeno,

Is that age 65, or when taxes have reduced your net worth to $65? <grin>

intercst

Print the post Back To Top
Author: ariechert Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37240 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 6:40 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
ariechert wrote:
Can Americans who retire to Costa Rica get in on that deal?

Yes. In fact, Americans can get a better deal. For an American to be a retiree here, he needs to prove a monthly income of $600 a month. When I RE'd, I went to the social security office and told them my retirement income was going to be $600 per month. I was going to say it was $400 but you know the old saying: "pigs get slaughtered".

Thus, I pay $46.13 per month. This covers my entire family (wife & 4 kids) and not only gives us complete medical protection but also a small contribution to the state pension fund which will entitle me to a small pension when I turn $65.


Galeno, I absolutely despise cold weather (arthritis) but my wife would never permanently leave Tennessee. Is it possible to spend the cold winter months in Costa Rica and come back to Tennessee for the summers? Seems like that would be an ideal situation. I think I would really enjoy that. I also love to fish and dive and imagine there is some incredible fishing in Costa Rica! -Art

Print the post Back To Top
Author: rjm1 Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37244 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 7:04 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
One last option, delete coverage altogether, and subsidize hourly wages so that persons can get their own individual policies.
Ironically, after this process, the rates for such would be more affordable than the group rate.


This is probably your answer.

I would shouw the "extra" pay as a seperate line on the pay check as it will probably be forgotton quickly.

Also, look at medical savings accounts. This might let you shelter the money needed to pay premiums from taxes.

Print the post Back To Top
Author: pspercy One star, 50 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37245 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 7:05 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 2
We were given the names of those who needed major surgery and we followed up with them as we were startled as to how ill they were without our knowledge.


Good intentions but surely NOT ethical for the potential carrier to release names. I think that's appalling though somehow not surprised.

Reminds me of supposedly confidential employee opinion surveys taken by third parties, but somehow the results came back neatly broken out by department !

p.


Print the post Back To Top
Author: galeno Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37247 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 7:37 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
ariechert wrote:
Galeno, I absolutely despise cold weather (arthritis) but my wife would never permanently leave Tennessee. Is it possible to spend the cold winter months in Costa Rica and come back to Tennessee for the summers? Seems like that would be an ideal situation. I think I would really enjoy that. I also love to fish and dive and imagine there is some incredible fishing in Costa Rica

Statistics say there are between 30,000 to 90,000 Americans living in Costa Rica at any given time. That means 60,000 of them are already putting your idea into practice.

I don't know the exact particulars (or even if it is even a viable plan) but this is what a couple of the "snow-birding" Americans I know are planning to do. Since they are Costa Rican residents, they plan to buy a new travelerer's medical insurance from the INS (CR state-owned insurance monopoly). Allegedly, this insurance will cover them while they are "vacationing" in the USA.



Print the post Back To Top
Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37256 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 8:20 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
Yes. In fact, Americans can get a better deal. For an American to be a retiree here, he needs to prove a monthly income of $600 a month. When I RE'd, I went to the social security office and told them my retirement income was going to be $600 per month. I was going to say it was $400 but you know the old saying: "pigs get slaughtered".

Thus, I pay $46.13 per month. This covers my entire family (wife & 4 kids) and not only gives us complete medical protection but also a small contribution to the state pension fund which will entitle me to a small pension when I turn 65.


Is the health tax variable depending on income ? What would the health tax be on an income of $5000 per month ?


Print the post Back To Top
Author: golfwaymore Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37263 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 10:12 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
Yes. In fact, Americans can get a better deal. For an American to be a retiree here, he needs to prove a monthly income of $600 a month. When I RE'd, I went to the social security office and told them my retirement income was going to be $600 per month. I was going to say it was $400 but you know the old saying: "pigs get slaughtered".

Galeno - Does this mean that as a requirement of this process, you give up your U.S. citizenship or to you become a resident alien?

If you gave up citizenship, can you go into some of the drawbacks of such?

Many Thanks - Golfwaymore




Print the post Back To Top
Author: golfwaymore Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37266 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 10:27 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
Good intentions but surely NOT ethical for the potential carrier to release names. I think that's appalling though somehow not surprised.

I dont have an opinion on whether it was ethical of the carrier or not.

Frankly, my most immediate concern at the moment is to try to find a way to secure coverage at all for my employees; not focus on the aforementioned. (but yours is a fair point)

I suspect that the new, proposed carrier did so in hopes that those employees would have any pending surgeries taken care of while under the current plan, thus reducing the new co's expense (though it wouldnt change our rating).

Golfwaymore



Print the post Back To Top
Author: galeno Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37271 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 10:46 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
markr33 wrote:
Is the health tax variable depending on income ? What would the health tax be on an income of $5000 per month ?

This is not a health tax for me or would it be for you. This is a voluntary program. I opted to be in it. Lots of small business people here pay the voluntary insurance. The voluntary socialized health insurance will cost you about 8% of your monthly income.

If you live in Costa Rica, i.e. citizen or resident, and are not covered in the health care system either by your employer or voluntarily, if you use the system you will get billed for services.

Now, if you have a $5,000 a month retirement income but CR allows you to be a retired resident with $600 a month, why declare the entire $5,000 unless you like to brag or enjoy paying $400 per month instead of $48 per month for the same coverage?

There is a different program called "rentist resident" where you need a minimum of $1,000 per month. The only benefit this gives you as a foreigner is that you can own a business and work in it. A "retired resident" is not allowed to own a business and is not allowed to work. But...why would you want to come to Costa Rica and own a business? Almost every single one of my American, Canadian, and European friends who are involved in a business here wish they weren't.



Print the post Back To Top
Author: galeno Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37272 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/1/2001 10:54 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
golfwaymore wrote:
Does this mean that as a requirement of this process, you give up your U.S. citizenship or to you become a resident alien?

If you gave up citizenship, can you go into some of the drawbacks of such?


No. You simply become the equivalent of a Costa Rican green card holder. I.e. a resident alien.

As far as giving up your American citizenship, I believe it is not as simple as just going into the US Embassy or Consulate and just handing them your passport. Next Tuesday at "Gringo Lunch" I'll ask about the details.

Now, there are a lot of those "Black Helicopter" type of Americans down here. Unfortunately, (correction, fortunately) I don't hang out with them. None of the Americans I know would give up their American citizenships. They have a saying here, "don't tweak the great Eagle's beak".

Print the post Back To Top
Author: Nutcollector One star, 50 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37275 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 12:26 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 3
I think you hit upon what will undoubtedly be a major, major crisis in our society---doctors will be retiring early in their careers, and medical schools will be getting fewer and fewer applicants. Why be a doctor if you have put up with all that nonsense?

duggg,

You've read this doctor's mind. I'm a 42 year old physician, who has had it. Medicine, itself, is great but I can't put up with all the baggage anymore. Instead of spending time in the evenings reading medical journals, I spend my time learning everything I can about being frugal and retiring early. I hope to be out by age 50.

NC



Print the post Back To Top
Author: galeno Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37286 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 9:47 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
Nutcollector wrote:
You've read this doctor's mind. I'm a 42 year old physician, who has had it. Medicine, itself, is great but I can't put up with all the baggage anymore. Instead of spending time in the evenings reading medical journals, I spend my time learning everything I can about being frugal and retiring early. I hope to be out by age 50.

Good luck doc!! If you're anything like me, you'll really enjoy being retired.







Print the post Back To Top
Author: Pablum Two stars, 250 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37291 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 11:20 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 13
Following this thread, and the earlier one on "healthcare in retirement," has been fascinating. I'm simply amazed at how many either accept the inevitability of, or actually desire the eventual government takeover of medicine.

I don't believe this is an answer.

Golfwaymore, it's probably too late to suggest this, as you need an immediate solution I couldn't begin to supply, but looking toward the future, I suggest you contact Forbes magazine and learn about the insurance incentive program they intitiated several years ago. It may not be appropriate for a firm your size, but my understanding is that it has been very successful at Forbes.

It is market-based, and amounts to giving each employee a yearly dollar amount, then letting them shop for their own insurance. If they spend less than Forbes gives them, they get to keep the difference. There's clearly a great deal more to it than that, and I'm sure like every insurance plan it will have it's weak points, but the general concept is to provide an incentive to the employee to keep health expenses down.

To others on this board: I certainly don't profess to have many answers regarding health care in this country. But I can clearly state to all of you that government run health care is NOT an answer, and will be far worse that anything we have today.

What will rescue the health care / insurance industry is capitalism; market-based reforms that will remove many of the regulations that straight-jacket doctors, insurance companies and hospitals. The aim should be to allow each one of us to shop for health insurance and health care the way we shop for shoes or a VCR. Insurance needs to return to the more traditional (now outmoded) concept of protecting us from catastrophy, not paying for every routine exam, procedure or item. We should also be allowed to purchase the type and extent of insurance we want---if I don't want mental health benefits or drug abuse coverage, I shouldn't have to get it. I don't have that choice. Right now, I get insurance I don't want and don't need.

For all of you prone to debate: I know capitalism isn't perfect, but it sure as hell has proven to be better than anything else. Competition, freedom of choice, minimal regulation and less fear of litigation are the building blocks to successfully deal with this country's health industry problems.

That doesn't mean I'm opitmistic any of this will occur....

And BTW, duggg, I tend to think the opposite of your prediction:

<<....medical schools will be getting fewer and fewer applicants.>>

I don't think you'll see fewer applicants or fewer doctors, though I agree burnout is currently taking its toll on quality doctors. (My primary care physician was one. He left after 10 years as an intern to take a more sane job as a teaching professor.) I think there will be just as many or more, but the quality of the applicant will greatly decline, which will create more problems down the road. The industry simply isn't going to attract the best and brightest anymore.

Galeno is right, but I'd temper his comments as well: to most outsiders, our system looks absolutely crazy. Perhaps Costa Rica's system currently appears more sane by comparison. But with due respect, CR's system didn't produce the medical marvels, the sophisticated machines, the advanced surgical techniques or the birth of biotechnology. The US system of capitalist competition, freedom and profit did, and will continue unless the government regulates it all to death.





Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: 1HappyFool Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37293 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 11:55 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 6
Pablum:
What will rescue the health care / insurance industry is capitalism; market-based reforms that will remove many of the regulations that straight-jacket doctors, insurance companies and hospitals. The aim should be to allow each one of us to shop for health insurance and health care the way we shop for shoes or a VCR. Insurance needs to return to the more traditional (now outmoded) concept of protecting us from catastrophy, not paying for every routine exam, procedure or item. We should also be allowed to purchase the type and extent of insurance we want---if I don't want mental health benefits or drug abuse coverage, I shouldn't have to get it. I don't have that choice. Right now, I get insurance I don't want and don't need.

You've said a much needed mouthful here. IMHO, the corruption of the health insurance industry occured when businesses began to provide health insurance as an employee benefit. This may initially have helped businesses by encouraging people to seek care when they needed (thus minimizing absenteeism). Unfortunately, any benefit soon disappeared due to the introduction of three major corrupting influences. Insurance companies marketed their products to the purchasers (employers) instead of the consumers (employees). Consumers (employees) treated healthcare services as an entitlement. The government stepped in through the door opened by the disconnect between the taxpayers (employees) and the purchasers (employers). This changed the dynamics from providers-insurers-insured to labor vs. "those evil capitalists".

It's unlikely that it will ever happen, but getting employers and Uncle Sam out of the loop would do more for fixing this mess than any national healthcare plan could ever accomplish.

1HappyFool


Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: catvallou One star, 50 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37294 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 12:00 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
open to suggestions:

1. Combine very-high-deductible coverage with medical savings accounts. my workplace has passable coverage, but lots of incidental expenses are left to the individual: co-pays, drug co-pays, dental, vision, etc. BUT we are allowed a cafeteria option, pre-tax medical accounts. you set the amount once a year, it gets pulled off the top each month(they show new hires a video to make sure you understand the tax advantage). You submit claims to a small third-party firm, which pays quickly, against your year's total. (So if you bought 3 pairs of glasses and had 3 teeth fixed all in January, you can still get reimbursed, don't have to wait for accrual.) At the end of the year, you lose whatever's left in the accoutn, but it's not much because they remind you twice in the fall and it pushes you to go get exams and preventive care you tend to put off otherwise. At tax time your taxable income is whacked down by the amount you withheld, and it's nice.

2. Self-insure. I work for a state, which of course has a huge risk pool of people to work with. They set aside a truckload of money and then have a large insurer do the paperwork (but not carry the risk or skim off profit. I realize this is not feasible for a small company (or is it? For 1200 a month, one could cover a lot of contingencies) but maybe there's an industry self-insured pool out there somewhere? Just a thought. Costs are still rising for us, but this has helped rein it in somewhat.

3. Take a very hard look at the drug reimbursement factor. Many insurers are writing blank checks to the pharmaceutical houses whereas they strongly restrain doctors and hospitals. This is where the out-of-control increases are. Again, hard for one firm to combat this. But you might give the employees a choice of having a restrictive drug reimbursement policy or paying x-hundred extra to have no restrictions on drug reimbursement.

Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37297 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 12:23 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 6
>> IMHO, the corruption of the health insurance industry occured when businesses began to provide health insurance as an employee benefit. This may initially have helped businesses by encouraging people to seek care when they needed (thus minimizing absenteeism). <<

As I understand it, employee benefits like employer-paid health insurance became common during the World War II era, when there were wage freezes in place and competition for employees. The wage freeze only applied to cash payments to employees, so creative employers put more competitive packages together by adding things like medical insurance.

When that happened, suddenly being a cautious insurance consumer was no longer important. Suddenly the consumer was completely insulated from the cost of medical care; suddenly there was no longer an incentive to use it judiciously and not frivolously.

Imagine if we had employer-paid auto insurance with zero deductibles. Every time someone had a $50 ding in their car door, they'd file a claim. Drivers wouldn't worry about the effects of their driving record on their insurance rates, because they wouldn't have to pay the increased premiums!

And what would happen to the cost of such an insurance? If you said "it would skyrocket," then go to the head of the class.

If health insurance is truly "insurance," then we should treat it as such -- self-insure for small expenses, for most routine expenses, and only treat the coverage as a fallback protection against catastrophic losses. That's how you keep insurance costs down; that's how most auto insurance works (i.e. $500 deductibles, etc.).

What if most health insurance was consumer paid, and carried a $500 deductible (or even a $100 deductible) on claims? First of all, people would become price-conscious; second of all, we'd see far fewer people taxing the system for the equivalent of a $50 scratch in the car door. You don't usually need a doctor's visit for a hang nail.

But as you mentioned, this led to the "health care is a right" mentality, a feeling of *entitlement* (forgetting that true *rights* only come when exercising them doesn't "break the leg" or "pick the pocket" of others, as Jefferson once said). And once such a sense of entitlement is fostered in the population, it's hard to shake. To paraphrase Tocqueville from Democracy in America, the democracy will flourish until politicians realize people can be bribed with their own money. Or worse -- with other people's money.

#29


Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37315 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 1:32 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
Now, if you have a $5,000 a month retirement income but CR allows you to be a retired resident with $600 a month, why declare the entire $5,000 unless you like to brag or enjoy paying $400 per month instead of $48 per month for the same coverage?

So you aren't required to delcare your actual income, but can rather declare anything you want to. Is there any documentation required ?

Print the post Back To Top
Author: golfwaymore Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37319 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 1:59 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
It is market-based, and amounts to giving each employee a yearly dollar amount, then letting them shop for their own insurance. If they spend less than Forbes gives them, they get to keep the difference. There's clearly a great deal more to it than that, and I'm sure like every insurance plan it will have it's weak points, but the general concept is to provide an incentive to the employee to keep health expenses down.

In general, great post, and thanks for the thoughts...

I follow the concept and have contemplated it. The problem I see with it is many with legitimate conditions will have pre-existing circumstances that will not be covered when going from group to indivdual insurance.

But with due respect, CR's system didn't produce the medical marvels, the sophisticated machines, the advanced surgical techniques or the birth of biotechnology. The US system of capitalist competition, freedom and profit did, and will continue unless the government regulates it all to death.

I'm speaking for Galeno, but my guess is he'd say this is the point entirely. Yes, capitalism produced those marvels, and government/FDA regulation has brought innovation and affordability to it's knees.

American med research continues to develop amazing treatments which take a decade to be approved here, while they are on the foreign markets near instantly and at fractional costs. The rest of the world enjoys our innovation sooner and cheaper because their cost models dont include the FDA development allocation.







Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37358 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/2/2001 7:55 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 2
<<To others on this board: I certainly don't profess to have many answers regarding health care in this country. But I can clearly state to all of you that government run health care is NOT an answer, and will be far worse that anything we have today.
>>


Yes, I think there is a lot of tension between the desire for state of the art medical care and an unwillingness to pay for it. People want what they can't afford, and government steps in to blur what is delivered so that the quality of care can be degraded without people being able to affect that process.

Personally, I plan to insure what I can, and be prepared to pay for what I want or need beyond that. I'll only be POd if the government steps in to prevent me from getting good care if I want to pay for it myself.

The government is in the process of injecting politics into medical care decisions on many levels. It may totally corrupt the system in the end. We may find a health care system with a quality level similar to that of an inner city high school.



Seattle Pioneer





Print the post Back To Top
Author: RoseSmeller One star, 50 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37451 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/3/2001 2:54 PM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
One small company I worked for found that they could come out ahead by self insuring part of the deductible. They provided a $200 deductible to their employees but purchased a $500 deductible from the insurance company. When someone had a claim between $200 and $500, the employer reimbursed it. This was a company with a lot of young healthy employees, so most of us never had even $200 of claims in a year.

Depending on the cost difference between low and high deductible policies and your estimate of how many people will have how much expense, you might be able to save some money by accepting some of the risk.

Good luck.


Print the post Back To Top
Author: PK227 Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37585 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/5/2001 3:34 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
Golf: I'm sorry you're in this mess. I just have a few suggestions (as a RE HR person):

1. I don't know what kind of business you have but do look around (quickly)and see if there's a professional group you can join that will offer better rates because you will be part of a larger group offering you and your employees more protection from big bills. I assume you're working with an insurance broker who can research this for you....if so or not...get another one.

2. Give your employees ALL the facts. I have never understood why companies don't let the employees know what the problem is and why. You'll find you have lots of support, sympathy and they may have some contacts and suggestions you never thought of....

3. Check to see if you can get some stopgap insurance (Golden Rule maybe) so you have time to look at all your options.

4. A poster suggested that employees with families pay for the family portion of their premiums. If you haven't done this before, it'll come as a big shock. Do some checking (your broker, again) to show them that the vast majority of companies already do this. Your employees are hungry for information. Even if they don't believe you, if you're telling the truth, they will find that out when they go check it out.

5. If you have supervisors or managers....make sure they are with you on this. Their opinion, expressed to the employees, will hold a lot of weight. You don't want a revolt on an issue that is not your fault.

6. If your employees have all the facts, they may be comfortable with a larger deductible to maintain their freedom from HMO. If you have a more mature workforce, that's probably to your advantage. Seems like anybody under 35 thinks that doctor/hospital visits have always cost $5.00.

Good Luck!!

Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: YvesManoover Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37769 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/7/2001 4:59 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 0
Hi ariechert,

Just out of curiousity what kind of income taxes do the Swiss pay? My old boss was German and she was offered a position back home in Germany and she told me there was no way she would go back. She said in the bracket she would be in she would be paying more in taxes than she made in the United States. She lives in a gigantic house in west Knoxville that is probably on the neighborhood of 4,000 square ft. She said in Germany she and her son would be living in small two bedroom house with barely enough room to turn around. She said a small pork roast costs over thirty dollars. The Germans too have all that socialized stuff and for the ones who are lazy (like me) it would be a good deal. They automatically get 6 weeks paid vacation every year. Can you imagine? I watch "Keeping Up Appearances" a British comedy; there is this guy on it named "Onslow" and he is on the "dole." He is my favorite character on the show and the one I most closely identify with. I kind of look like him to tell you the truth. - Art


To your question:

The quick impressionistic answer is that the tax bite feels to me personally about the same over here as it did in the U.S.

If you're wondering whether Switzerland has all that "socialistic stuff" with high tax rates, the answer is no.

I come across articles in Swiss papers and mags every once in awhile about comparative European tax burdens, and the charts I've seen always have Switzerland listed at or near the bottom. Denmark, Germany, Sweden, etc. are way higher.

The bible on living overseas in Switzerland, Living and Working in Switzerland--David Hampshire, has a more concrete answer about tax burdens:

"Tax rates in Switzerland are progressive--the more you earn the more you pay. In 1996, the average income tax rate (including federal taxes) was as follows:

Income (sfr/yr.)......Tax Rate* (%)
50,000..............7.30 (3.80/9.52)
100,000..............14.59 (8.44/17.04)
200,000..............24.04 (15.69/27.48)

*Average tax rate (lowest/highest), including federal, cantonal and community taxes, based on the gross salary of a married man without children, living in a canton's main city."

The rate variation comes mainly from different cantonal tax rates. So high income folks do their best to live in tax-favorable cantons (eg. Zug, where Marc Rich lives).

Housing: yes, very expensive. Used to be worse before the real estate crash in the early 90's. Forget a house (1 mil. francs min.). Townhouse goes for 600,000 to 700,000 sfr. That's buying. To rent, figure 1000 sfr. (or about 650 US) per month for a place big enough for two people.

Meat: also expensive. We just eat less. Probably healthier anyway.

To a q. you didn't ask (retiring here): Have to be 55 & not working. Have to show yearly income of 80,000 sfr. per year (about 47,000 US). Loophole around the 55 rule: just invest in a Swiss co. (don't know more details). Have to have own health insurance before coming here. (That's based on my memory; a helpful article is at http://www.liveabroad.com/articles/switzerland.html)

Another q. you didn't ask: how much does it cost to live here? Answer based on our experience: we live here on 29,000 US per year. That's for 2 adults, 4 children (just had the fourth! thank you). That's being careful (we're still in the capital accumulation stage). Most everyone else manages to live on far more than that, but we found that to be true in the US also.

Switzerland is a wonderful country. Personally, I'd do a few years of RE here. Not there yet though. But it's definitely doable, & not just for the retired super-rich you normally think of, living in chateaux near The Castle of Chillon.

Yves


Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Print the post Back To Top
Author: mhtyler Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 37782 of 744316
Subject: Re: Health Care Crisis: Open to Suggestions Date: 5/7/2001 8:53 AM
Post New | Post Reply | Reply Later | Create Poll . Report this Post | Recommend it!
Recommendations: 1
"I watch "Keeping Up Appearances" a British comedy; there is this guy on it named "Onslow" and he is on the "dole." He is my favorite character on the show and the one I most closely identify with. I kind of look like him to tell you the truth. - Art
"

I know that show! I hope you aren't married to Hyacinth.

Although as a boat owner, I've decided to hold a dockside dinner with Riperian entertainment<g>.

mark

Print the post Back To Top
UnThreaded | Threaded | Whole Thread (44) | Ignore Thread Prev Thread | Next Thread
Advertisement