Friday, October 23, 2009 

A Rant on Expectations of Health Insurance (Answer to Last Entries Comments)

I'm just going to throw in something that will probably make people angry.

Pure insurance, the most fundamental concept, doesn't generally include compassion and is not conceived to take on risks that have pre-existing conditions. Houses that have fucked up plumbing systems, bad fire hazards, etc. etc. will not be covered by a company. Business that run the risk of hurting tons of people will not be accepted by a company.

The differences between a house and a person is that house isn't alive and the only real obstacle to getting it insurable is the cost to fix it up. A business can change its practices to become insurable.

A person, on the other hand, when they get injured or many diseases, it's stuff that doesn't go away. A body can't get fixed up or necessarily change how it functions to make it insurable. Then there's genetic cases, etc. etc.

As my dad says: "Insurance is not a charity. These companies are in it to make money." These companies are for-profit companies, they're not non-profits or charitable organizations. They are beholden to their stockholders, their policyholders and the almighty dollar. And for the policyholders, they need to make sure they have money ready to pay eligible claims.

Even if they weren't for-profit, the other issue with pre-existing conditions and such is that without underwriting, declining, exclusions, etc. etc., premiums go sky high!

In the case of homeowners policies, they do not cover damages from floods. The government has to pick that up through the National Flood Insurance Program under the Department of Homeland Security (the NFIP was before Homeland, but that's just a part of history), and even NFIP policies have maximum limits of $250,000 on dwelling limits against floods.

The reason why homeowners policies don't cover flood and NFIP policies put a maximum limit is that floods and water damage are huge losses. If homeowners policies covered floods, premiums on the policies would be almost as much as the cost of the home. There would be no point to getting the insurance if the cost of it is the cost of your home pretty much every year.

If health insurance covered everything and accepted everyone, premiums would be sky high. It would essentially be a scheme of funneling healthy people's money to help sick people. That's not insurance. Insurance is essentially a gamble of a company accepting premiums from a lot of good risks & paying out when one of the good risks has a loss and hopefully a catastrophic loss, not a small loss. That's why there's deductibles, to discourage people making small claims & wallowing away the reserves of insurance companies or, in other words, money that other insureds paid to build up those reserves.

I still think healthcare needs some major reform and that there needs to be some resort for majorly sick people, people who have been raped, etc. etc. Nonetheless, that would be charity or some kind of government program, not private for-profit insurance.

Yeah, I think there have been some corrupt insurance companies and executives and other insurance companies have done some dumb shit (ahem, AIG). I think things get lost in the bureaucracy. I think there's a whole bunch of things that deviate away from the ideal that need to be corrected on the level of automation, processes, quality control, information management, decision making, etc. etc.

Nonetheless, I don't believe for-profit insurance companies are the place to make things better. In many ways they have done much good for their insureds. Insurance companies act in some sort as a form of collective bargaining to bring the costs down on in-network providers, which is probably the major benefit they've provided for people. I think this automatic collective bargaining has actually contributed to making people a little lazy about not doing their own bargaining, and that's what the new HSA-compatible plans are supposed to address.

As an attempt at controlling costs and trying to advance relationships between doctors and their patients, I actually think HMOs work as a good model. The consumer end user doesn't like the lack of choice, however. We also don't have enough doctors in the field to make HMOs work well.

In all honesty, I've read in industry magazines that all the different programs in private health insurance are still being explored and in something of an embryonic stage. The people have a demand for it, so the companies and the think tanks have pretty much put stuff together as a patchwork to give them something. Of course it won't necessarily work right because they need time to work out the kinks and issues.

Basically, in the long run, when the private insurance companies work right, I don't think they're meant to address the far out cases that generally get brought up in the news or the cases that stand out as the stories that seem typical. Yeah, some of the cases are dumb shit & the insurance companies do dumb shit because they're a bureaucracy.

In the long run, though, unless my conditions do get met, I believe that helping people that can't get private insurance pay their health bills should be taken up by the government or by some sort of charitable organization. Health insurance is just not conceived originally to address those cases.

And being in the insurance industry, I can also cite the case of Massachusetts as an attempt to both cut costs and to try cutting down on the cases of people trying to take advantage of the insurance industry by trying to get it when they need it to pay for something. That is not the intent of insurance. Intent of insurance is to have it before anything arises that needs to get paid.

It's not a black & white issue. There's expectations on both sides and both sides have also abused their responsibilities in the matter.

I really just had to get some of that out after having been exposed to people this morning having expectations for insurance higher than reality can meet.

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Entry By The_Lex

Monday, October 19, 2009 

New debate, old fucking news.

I think it's time for some good old fashioned discussion, so this time we'll be chatting each other up about the healthcare debate. I'll begin by throwing this out there: it's pathetically stupid to even call it a debate. Cuba, poorer than dusty shite, can afford healthcare for all it's citizens but we're too strapped? How much did we give those bastard banks for their bailout again? And why can we still afford two wars and the damn Pentagon?

Please remember, I've already made up my mind and I can give you the answers to all those rhetorical questions. I want to read what you think...
Entry By helioshamash