Insurance is to cover risk if not it is a club membership for cost sharing.

Task a day insurance: How far can we anticipate what kind of insurance coverage we need? The circular reasoning of the insurance industry is that we should all buy the kind of insurance we anticipate needing and supplemental plans to fill in the gaps and long term care insurance for additional prospective payments. By changing the dialogue and having us imagine what kind of insurance coverage we might need and then selling policies for all those ifs, the insurance companies are shifting their responsibilities as businesses to the consumer.

If we must anticipate every possible event for which we do, may or anticipate needing, then we get what we have, niche insurers those that give coverage for the healthy (including check-ups and wellness fluff features), those that target people with present risks whether behavioral (such as smoking), physical (such as asthma, high blood pressure, heart disease on and on), temporal (age, childbearing). Instead of insuring against the risk of something occurring, insurance companies are providing cost-sharing for medical care, we'll pay a certain percentage of your treatment for x. This is fine, but it is not insurance and therefore, premiums should instead be more like membership dues like the Costco's of the world, pay a certain number of dollars a year and get a discount on your costs for x.

Insurance on the other hand, is supposed to pool resources from premiums in order to cover the costs of all those in a group. If everyone pays and one person has cancer, the insurance company pays the costs for that cancer patient and those who did not get cancer, will not have optimized their insurance benefits by using them. But if all cancer patients are only sold "insurance" at astronomical prices because of their cancer then their premiums are not covering risk, they are covering actual expenses. In that case, the plan is not insurance but is a group of cancer patients paying for membership in order to share the costs of their treatments.

Insurance is supposed to cover risk, that is it's only purpose. If the industry is trying to reinvent itself as a co-op of like-conditioned individuals, then membership dues should reflect actual costs. In this latter model, all unused funds would be returned to members at the end of the year.

Perhaps the answer is not to buy health insurance, but to find niche providers of cost-sharing for those services you currently need.

Marketing Health Care Reform--Puppies and Children

http://www.nytimes.com/2008/01/04/washington/04health.html?_r=1&th&emc=th&oref=login
is an article about President Bush putting the kabosh on an attempt by states to raise the income level for determining eligibility for Medicaid. States rely on the Federal government for funds in administering their programs and therefore, the Federal government has a say. But with all the money blown by our administration (you have kept track of the debt accrued in fiscal irresponsibility gone wild, office of management of the budget has some figures for you math types http://www.whitehouse.gov/omb/), {still not convinced, look at today's job's report, the economy is in trouble, jobs growth was way under what it should have been with one exception--Government}, health insurance coverage for Americans has not found a way to market itself effectively.

This leaves us with the unpleasant and unsophisticated marketing of those who seek election by describing the "uninsured". The faces of children...always children, unable to get decent medical care can bring a tear to the eye of any voter, and though we know that our healthcare crisis is really not about these children, the same way we know that the candidates picking up babies as a symbol of hope, rebirth is also phony, we love it, it works, our heartstrings are pulled and we're sold. If we don't resist the marketing, we ourselves, the real faces of the health care crisis, the individuals who pay for insurance but have had the rude awakening that our co-pays, co-insurance, experimental, and uncovered services have left us drowning in medical costs, paperwork, limited access to physicians and limited quality of medical care, will silently leave this situation for our children...and they too will become the faces of a nation that has put perverted notions of the "free market economy" ahead of the obligation of a nation's government to its citizens. I'm with you, the haggard face of a middle class person complaining about our health care system is far less persuasive than the American version of an impoverished child with flies on his eyelids--but that's the point. We are not supposed to be an emerging country, we are supposed to be a leader.

The cite to the article that appeared in the Times is important because in knocking down the attempted expansion of Medicaid, the real issue was addressed, that private insurers would be "squeezed out." Good, squeeze. Then squeeze the doctors whose ridiculous complaints about cost and insurance for malpractice have cut into their bottom lines. Then squeeze the pharmaceutical programs jumping onto the Medicare bandwagon. We have lots of national programs, we have lots of national budgets. It is ridiculous to wave the flag of fiscal responsibility in taking care of access, affordable and quality health care for all citizens while we blow dollars on wars, and Congressional investigations of whatever the scandal du jour is.

So let's focus on marketing reforming health care from the middle class outward instead of selling the same old, get them some coverage and you're a hero, approach to health care reform.
Let's squeeze before we all end up throwing up our hands and using hospital emergency rooms as our primary doctors.

How? Easy. Nothing technical or arithmetic. Call your insurance company with your greatest fear---whatever it is--cancer? broken bone? alzheimers? Walk yourself through your ailment from start to finish, ask about how you get admitted to the hospital, what would be covered, what if the other physicians in your treatment are not part of your plan, how will it impact your insurance costs if you survive and want to buy insurance next year, what percentage of your tests including catscans, mris and everything else will be covered. Then make the new ad for national health insurance: I have health insurance and I needed medical treatment. My medical costs to date have exceeded $_________. Health reform from the middle.

Happy New Year Health Insurance for the Young and Healthy

If you're about to be booted off your parents' insurance policy, don't fret if you are young and healthy. You probably will not be bankrupted by insurance "coverage" yet. It is not a good idea to have no health insurance.
If you are still in school, look into a school-promoted insurance policy. Universities in our state now automatically enroll students and bill them for coverage (about $600 a year) unless the student opts out.
If you are out of school, look for insurance companies that do business in your state (just do a general search or go to your state insurance department). You are looking for coverage for hospitalization, medical, dental, psychiatric (we all need this dealing with insurers) and whether there is a prescription plan for reimbursement. Ask these companies for quotes on the same.
Remember, you are in a better position now as a young healthy person to purchase insurance, statistically, you are the dream customer so ask each company what it offers young people.
If you've gone around your college town, you've probably seen signs for pretty cheap physicals offered by some of the Doctor kiosks, like the urgent care centers. This is relevant because you aren't interested in the fluff stuff like a reward of a rebate (not much compared to premiums) for using dietitians and reporting on your gym attendance, you are interested in medical insurance coverage in case you get sick.
If you are lucky enough to find a job that provides you with health insurance, compare prices, but this is still often a good bet.
Find out how you submit claims--if your insurer is a PPO, then before you see a doctor you will find out if he/she is a Participating Provider, if yes, you will pay a copay and paperwork will be filed by provider. If the provider is NOT a participant, you will be given a receipt for payment in full and you will have to submit that paper to your insurer (on a separate form) for reimbursement. Reimbursement will be about nothing (if amount goes towards deductible) to about a third.
Get ready to change insurance during the fall of each year. Do not automatically renew your policy, there are too many changes each year.
If you can, get a copy of your insurance plan, not just the insurance card, the plan is your contract.
Be well and welcome to the world of health insurance.
As a side note, you are also a prime target for life insurance. Most of this insurance is now term life insurance, it covers you for a specific time period and then lapses. Whole life insurance used to be marketed as an investment, you're probably better off investing your money for investment and buying life insurance if you need life insurance.

US ranks 42nd In Life Expectancy

In August, the US was ranked as 42nd in terms of life expectancy for its citizens.

http://www.cnn.com/2007/HEALTH/08/13/life.expectancy.ap/index.html

Whether the statistic is used to blame US citizens for obesity, laziness, or failure to have screenings or sufficient insurance, the facts are the facts and while we distract ourselves with blaming the citizenry for getting sick and dying, we are number 42. NOT in the top 10, not some super-power example of how fabulous life is here, FORTY TWO.

The same report cited above notes that "A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier.."

So when people give the pep talk about us being the greatest nation in the world, that every person has a chance in America, let's encourage them to use that patriotism towards something meaningful, what are you doing to maintain that status for our country? Using it as an excuse to dismiss those who are slipping through the American dream? Using it as an excuse to advocate that we continue wars or using it as an excuse to make fun of those who are noting that there are issues in the US that must be addressed?

It's not unpatriotic to note that our health care system is broken, it's not laziness nor is it self-centeredness--it's reality and arguing that it is the citizens' fault that we die younger than those in 41 other countries is unpatriotic. No insurance company can persuade this patriot that our citizens are lazier than citizens of other countries, no government can argue that any of our citizens is less deserving of health care than citizens of other countries, and no special interest should be able to argue that we are best if we are Darwinian and support a system that only supports the survival of the fittest.


National health insurance is the acknowledgement that OUR government exists because of its citizens and it is responsible to and for each of them.

Health Insurance "Reform" and the idea of Play or Pay

The crushing impact of the health insurance industry is the combined effect of increased premiums for less coverage. While there are numerous proposals for saving costs in terms of premiums (high deductibles, lower contribution rates for employers, ever-widening groups excluded as "high risk"), the bargain basement approach does not address the other part of our health care crisis, less coverage, the COST of medical care from endless testing to actual treatment when necessary. These costs should be the target of health insurance coverage and health care reform. The shift of how to "insure" the healthy on the cheap will not solve the inevitable cost of treating individuals when they are ill. The idea of play or pay health insurance where companies can opt out of offering insurance to their employees by paying a certain amount of money is idiotic because it assumes that companies have been the "middlemen" between insurance companies and insureds. In fact, companies were originally supposed to use their bargaining power as a GROUP of individuals to negotiate a better insurance rate based on the increased customer base. While the trend is every man for himself, which will tend to equalize the cost of health insurance among comparatively equally healthy people, the ultimate effect of extreme cost for minimal coverage will ultimately INCREASE the number of uninsured as individuals realize that they can afford inoculations and general health exams and it will cost them less than thousands paid in premiums that will not cover them in the event of actual medical need.