"Affordable" health care advocates explain this please.

"Affordable" health care advocates explain this please.

PostBy: jpete On: Wed Mar 04, 2009 11:16 pm

http://www.crainsnewyork.com/article/20090304/FREE/903049985

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(AP) - A New York City doctor's flat-fee, $79-a-month medical practice has run afoul of state insurance regulators who have told him to shut it down.

Dr. John Muney said Wednesday he's negotiating to try to keep the arrangement at his AMG Medical Group centers. The fee includes unlimited office visits, some tests and in-office surgeries. It doesn't cover treatment requiring hospitalization or specialized care.

Dr. Muney sees it as a formula for making health care affordable and patient-friendly at a time when many people are losing jobs and medical benefits.

But the state Insurance Department says Dr. Muney's system amounts to insurance and requires a license.


I know you all hate it when big "greedy" companies make money, but tell me why the government you trust to fix this problem would shut down a successful small businessman?
jpete
 
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Re: "Affordable" health care advocates explain this please.

PostBy: stockingfull On: Wed Mar 04, 2009 11:32 pm

What is it about a private citizen providing insurance without a license don't you understand?

Until this problem is solved -- and we (hopefully) get the insurance industry out of it -- healthcare insurance is subject to applicable state insurance regulations.

The obvious risk is that the guy collects the premiums and then either doesn't or can't provide the services he's promised.
stockingfull
 
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Re: "Affordable" health care advocates explain this please.

PostBy: jpete On: Wed Mar 04, 2009 11:40 pm

Was it insurance? Why isn't it simply a fee? Why shut a guy down who is doing what you Stockingfull claim is just what this country "needs"? And he's keeping the money out of the "greedy" insurance companies hands.

Is it because this guy was doing exactly what I have been saying and going back to the model used before Congress passed the HMO Act of 1973?

An American businessman, or his own free will, solved the problem of affordable healthcare for all and you can't take it because it wasn't passed down from the right hand of Nancy Pelosi.
jpete
 
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Re: "Affordable" health care advocates explain this please.

PostBy: jpete On: Wed Mar 04, 2009 11:41 pm

stockingfull wrote:The obvious risk is that the guy collects the premiums and then either doesn't or can't provide the services he's promised.


I'm sorry, didn't we just have a discussion about the big greedy insurance companies denying care to people?

What's the difference?

Because they have a license to screw you? That makes it better for you?
jpete
 
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Re: "Affordable" health care advocates explain this please.

PostBy: Black_And_Blue On: Thu Mar 05, 2009 12:18 am

I'll go out on a limb and guess that since it's voluntary and of the free will of the participants it cannot be condoned by the Socialist Elitists.
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Re: "Affordable" health care advocates explain this please.

PostBy: titleist1 On: Thu Mar 05, 2009 12:39 am

I used to sell insurance and financial products. One of the peripheral services offered was a legal aid package. Pay x$ per month and have access to an attorney for consulting, wills, threatening letters, etc. This was not under any license that I carried at the time. Sounds like the same idea to me.

Hmmmmm, the company I bought my appliances from offered a similar deal to this doctors. I pay $129 and if my refrigerator breaks they come out and fix it, no additional charge. I wonder if they have an insurance license. Jiffy Lube told me that since I paid them $37 to change my oil I can stop in any Jiffy Lube in the country and get my fluids topped off and air pressure checked in my tires for nothing, I wonder if they have an insurance license. I know you can pay $100 to a local HVAC company and they will come out and clean and tune your HVAC equipment and if it breaks will come out with no emergency call charge, I wonder if they have an insurance license.
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Re: "Affordable" health care advocates explain this please.

PostBy: jpete On: Thu Mar 05, 2009 12:41 am

stockingfull wrote:What is it about a private citizen providing insurance without a license don't you understand?

Until this problem is solved -- and we (hopefully) get the insurance industry out of it -- healthcare insurance is subject to applicable state insurance regulations.

The obvious risk is that the guy collects the premiums and then either doesn't or can't provide the services he's promised.


Also, can your local gym, AKA a "health club" be shut down for selling "insurance" in the form of monthly fees. I mean, we've all heard preventative care is the best care so why isn't a place where you go to stay healthy be charged with "selling health insurance"? Why can't the doctor just call himself a "health club" and get around this?

Where's Devil? Where's tvb? Where's Stockingfull?
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Re: "Affordable" health care advocates explain this please.

PostBy: mikeandgerry On: Thu Mar 05, 2009 12:58 am

It's my understanding that in NYS you can enter into a credit default swap in which two counterparties agree that in consideration of a premium, one party will pay a sum to the second party in the event of the credit default of a third and unrelated party.

In NYS that is NOT considered insurance. Nor is it considered gambling.

Perhaps we need to re-define insurance and gaming.
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Re: "Affordable" health care advocates explain this please.

PostBy: tvb On: Thu Mar 05, 2009 1:28 am

You are assuming that this has to do with universal healthcare when it doesn't. It has no more to do with universal healthcare than the price of band-aids does.

For those interested, here is another link to an article where the reporter actually decided to report the story rather than dribble out the headline like Crain's NY Business did -
http://www.newsday.com/news/local/wire/newyork/ny-bc-ny--doctors-flatfees0304mar04,0,271498.story
This link is broken, either the page no longer exists or there is some other issue like a typo.
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Re: "Affordable" health care advocates explain this please.

PostBy: photoboy On: Thu Mar 05, 2009 4:32 am

my wife and i live in germany. she survived malignant melanoma before we met. a bi-yearly visit to her doctor in january prompted the doctor to refer her to a specialist to get a spot looked at. the specialist's office can't see her until april, and that was after my wife fought to get in in april. a move to a european, single-payer system is not the answer. reagan said it best, "gov't IS the problem." we have the best health-care system. deregulate it, allow free market competition, and you will see costs go down by price-conscious consumers. that will equal more accessible, affordable health care. britain's system is falling apart, and sweden's "model" system has extreme waiting times.
this country was founded upon the idea of hard work, freedom of enterprise, and the promise of bettering one's lot in life by the aforementioned ideas; not by gov't providing a teat for us to "improve" our selves.
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Re: "Affordable" health care advocates explain this please.

PostBy: mikeandgerry On: Thu Mar 05, 2009 5:20 am

tvb wrote:You are assuming that this has to do with universal healthcare when it doesn't. It has no more to do with universal healthcare than the price of band-aids does.


Thanks for the article.

No one prior to your post mentioned "universal" health care.

We have been discussing affordable healthcare and insurance.
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Re: "Affordable" health care advocates explain this please.

PostBy: stockingfull On: Thu Mar 05, 2009 12:55 pm

Appliances have "warranties." They too are covered by state laws but not regulated like insurance. And how many of us think those "extended warranties" sellers offer you are a good deal?

Gyms have monthly fees for access to the premises -- and routinely go out of business and leave their paid members hanging.

Credit default swaps were invented to circumvent securities regulations and, if there ever were an instance of "leading with your chin" in a debate about the need for gov't regulation, they would be Exhibit "A" at this point in time.

So these are supposed to be convincing arguments for private, insurance-based healthcare? :verycool:

Conceptually, I have no problem whatsoever with doctors getting together to form provider networks of some kind, in order to reduce costs and get the insurance "middlemen" out of the business. Because, I hate to tell ya, but the insurance companies are just as good at saying "no" as the gov't is. Just because you're in an HMO doesn't mean that they'll approve a procedure you happen to want. To the contrary, the HMO's have elevated their denials on the basis of "pre-existing conditions" and procedures "which haven't been demonstrated to be efficacious" to art forms.

In the end, I still think Kerry's proposal was best. Preventative care saves a ton of money. And everybody in America should have the option to be covered by the same health insurance that our Members of Congress have. Start with those two concepts and work something out.
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Re: "Affordable" health care advocates explain this please.

PostBy: Paulie On: Thu Mar 05, 2009 2:18 pm

I agree with letting the market and enterprise play a larger role. But you need some regulation, field leveling,for the market
to work. There has to be basic rules, limits, etc. Not unlike ANY industry. Commerce as a whole has basic rules, always
has in any economy that works. The wild wild west thing is crazy. Too many ways to get screwed. Over regulation is crazy
as well, too many ways to get screwed. The solution is out there, it is not what we have, or what Europe has. We have to find a way ...........soon. As far as the doctors move in NY, sounds like a subscription more than anything else. And you
know what? For short money, you get to see some one, yesterday if need be, and the doctor is making more. Better service
at a lower cost, and the guy doing the work gets reasonable money, vs crappy service, stupid high premiums, and the provider
being an insurance company bitch, not to mention the paper work grief. Market can work, just have to allow it too. The trick
will be to unwind the mess we have now, to get the playing field we need.
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Re: "Affordable" health care advocates explain this please.

PostBy: mikeandgerry On: Thu Mar 05, 2009 2:54 pm

My point is that insurance is for a catastrophic calamity. It should have a high deductible and pay out only for catastrophic events in health that are clearly defined. Insurance companies should be regulated such that they have the reserves for such events. Part of the problem in our discussion is that insurance is becoming a catch-all term for many limited low end events while the legal framework for insurance intended a different risk and coverage level, i.e. higher amounts and lower risks of occurence. When likelihood of occurence is high and costs are low, you don't need insurance, you need to get your wallet out.

On the low end, warranties, subscriptions, and the like, are insurance but not against catastrophic calamity. While insurance-like contracts should have regulatory parameters including certain reserve requirements, it doesn't fall into the same category as true insurance.

The doctor in this case was merely offering a subscription to his service. Should the doctor default, a loss on such would be minimal to the patient as it covers low risk replaceble services. It cannot be compared with insurance.

At the low end of health care, sniffles, a boil on your backside, high blood pressure, etc are all non-calamities that don't require insurance. Insurance (both malpractice and health coverage) and litigation has driven the cost of doctor's visits and routine prescriptions to very high levels compared to personal earnings. What insurance has become is a dollar trade at the low end of services. Market forces would best regulate the pricing there. Insurance should be confined to calamities (major medical) as it was in the beginning of health insurance.

To remedy all of this the congress should limit awards in malpractice suits and establish the parameters for market forces to dictate low end services. Once direct payment is in the hands of individuals, the cost of service will decline at the low end.

At the high end, I don't have any answers as the cost of complex technology is high. Insurance spreads out the risks of high cost for calamity in this area while it cannot spread the risks in the widely used low end procedures.
Last edited by mikeandgerry on Thu Mar 05, 2009 3:03 pm, edited 1 time in total.
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Re: "Affordable" health care advocates explain this please.

PostBy: Richard S. On: Thu Mar 05, 2009 2:57 pm

jpete wrote: Why isn't it simply a fee?


I'll assume it's a monthly deal or a contract, which effectively in the eyes of the government is insurance. However it does bring up some interesting points as other industries can offer similar deals. Oil companies for example offer their contracts which from one perspective could be viewed as insurance against the inevitable rise in cost in the winter. Fine line I guess, the good doctor will most likely have to find himself a good lawyer to word his contract properly. :roll:
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