Gut Punch - Insurance - "Use of any tobacco product."

[warren]

Many insurance companies supported the government health act. They threw large amounts of money at it and testified in favor of implementation.
I've experienced medical treatment in both Canada and Europe. Trust me, in my experiences unless your injury is very minor or your illness easily treatable, you do not want anything to do with government health care as provided in either. Countries with government health operations also have a thriving practitioner community. Those that can afford it, pay for it. I saw enough to know that should I contract lung cancer I'd head for Texas and MD Anderson for treatment not Europe.
I want the best care possible, not the cheapest. This is not to say that there are not competent doctors and staff in Europe, just that there are now insufficient practitioners, beds, equipment, etc. now that the governments run the system. Over there it is all about costs and service. I find costs are the over riding consideration, especially true when revenues are down.
Nope! I want doctors and facilities that will do their damnedest to heal me, forget the cost. I'm paying for it and I don't want them dithering around with what Uncle Sam is or is not covering this month. And, I sure do not want an operation I need now, to be scheduled 6 months from now. Sorry, the last people I want in charge of my health care is the entity that brings us the EPA, CDC, FCC, etc. And it really doesn't matter which party controls the congress or the presidency.

 

[johnnyreb]

It's all about economics and not about reducing mortality rates thru better health care. For years everything was about preventative medicine, but that costs money. Now they say women no longer need yearly mammograms for example; every five years is good enough. Men no longer need colonoscopies every 5-10 years depending on previous results. Now it's one at age 50 & none after 60 if the results are negative. Who is advised to have a yearly physical anymore? That was discontinued a few years ago. All because that kind of preventative medicine costs money and probably isn't cost effective. The "new preventative medicine" is all about living healthy lifestyles & healthy choices. The insurance companies are behind that because it saves them money. Your employer is behind that (or soon will be) because it saves them money so they can continue to offer healthcare coverage (for now).

 

[johnnyreb]

"In fact I can remember my father advising me that there were people who would attempt to take advantage of me as I went through life."
Mine told me that too. He said just make sure it's the females who do!

 

[warren]

Ah! Advice to live by!

 

[snagstangl]

I think it is called tobacco abuse disorder or some such thing by the Veterans administration. But it sounds like a pre existing condition to me.

 

[conlejm]

Gigger48 asked:

I want to know what the insurance companies demand of their own employees, including top management.

I work for one of the largest for-profit health insurance companies in America. Regardless of position, smokers pay more for their health insurance benefits, as do people with high BMIs, high blood pressure, high cholesterol, high blood glucose, and if we don't get a flu shot. I believe next year they are going to stop penalizing for high cholesterol and high blood glucose, but the penalties remain for all the rest.

 

[bulldogbriar89]

i'm sorry to hear that it is a sad thing. I hope to not see an auction or sale of your stuff

 

[frank13]

Orwell was a prophet. Welcome to 1984. Doubleplus ungood, comrades.

 

[doctorthoss]

I understand the concerns about health care in other countries. BUT ….

The horror stories you describe happen every single day in the United States. Every day. Ive seen them myself. The couple we rent to has not been able to pay rent for three months (yes, we're basically letting them live free). Why? Despite the fact both are employed, neither has health insurance. She broke her back and left foot on July 4th and still can't get the necessary surgeries to return her to work and NO PROSPECT OF DOING SO. She has a social worker trying valiantly to deal with this, but no success yet. As a reporter, I routinely met and wrote about people with diabetes and heart problems that were untreated because they couldn't afford both the meds and food. No health care is worse than slow health care. There are a lot of people in the US with no access to doctors or medicine except in immediate emergency situations, with no way to treat their chronic illnesses. And, again, when we talk about long waiting lists for surgeries, do you really believe that doesn't happen here?
When you talk about all the great life-saving procedures we do for severe diseases here, bear in mind that many Americans can't access those. Even with health insurance. Insurance companies deny to pay for those treatments every day, and there are no legal sanctions for doing so, even if the patient dies. Some Americans worry about long waiting lists, but I wonder if they have ever been told they have six months to live if a surgery is not performed and their insurance company just says "No."
We talk about lack of beds and doctors in Europe, which is true. But it is actually worse here!!! Check the news about all the hospitals closing their doors and the massive shortage of doctors we are about to confront. It makes Europe's shortage look positively benign.
Plus, I've known plenty of people in Europe who really like their health care. Plus, it's really hard to convince me that health care in Europe or Canada is below ours in quality when their life expectancy is so much higher than ours. They seem to be doing something right. The impression I get is that they do a very good job at preventative medicine and treating certain diseases, especially chronic health conditions, by ensuring access to meds and doctors. We do a great job at treating severe illness/injury (if you are fortunate enough to have not only insurance but good insurance) at a lot of other things.
Also, a government run health program you have a right to cannot reject you because you smoke. Or drink. Or are fat. At least, not as it stands now - which is how this debate started.

 

[mortonbriar]

I do like to see people putting their families first, good on you...but having your hobbies messed with!!!! sorry to hear. In New Zealand healthcare is available to us all, whether we have insurance or not so this is not a decision i would not ever have to try and make, I pay $70 a year to cover 3rd party (paying for the other guys car if i ever get into an accident) and that is my entire insurance bill. Obviously people who own houses and nicer cars than I have more insurance to pay over here too.

 

[warren]

doctorthoss: I wouldn't live like that. I'd be looking for a second or third job. Now, don't get me wrong, I am totally in favor of the government providing some services for those that are unable to provide for themselves. I am not in favor of government providing any services for those that are unwilling to provide for themselves.
And, don't compare life spans with medical care only. There are many more variables that must be in the equation.
I have been in a hospital in the Russian Far East. Fortunately my partner there was a former police officer and had access to the hospital designated for party members. This was in the 1990's and a lot of the Communist system was still in place. I had a private room, an assigned doctor, etc. It was nothing like the treatment the run of the mill Russian could get with respect to care and treatment. In Ireland I was treated very well and paid in dollars. My Irish friend was impressed. His father had to be moved to another town as there were no beds available in his town. That hospital was understaffed and daily care was abysmal.
The Canadian hospital I took my wife to was very well equipped to handle victims of vehicle accidents, farm mishaps and the like. It was sadly equipped and in the past held raffles and other fund raising to purchase badly needed items. In effect the citizens of the area paid their national taxes and then taxed themselves again for necessary equipment which should have been provided by the central government.
There's a good reason we are and will experience a doctor shortage. Money! Med schools cost big money. Doctors go where there is money to be made so as to pay debt and raise their standard of living as quickly as possible. I admire the GPs who wish to toil in poverty and provide for the needy. Much as I admire them I want the best care available. I want the standard of care that the politicians in Washington will provide for themselves. Not the standard of care they will finance for the rest of America. I repeat, neither Democrat nor the Republican Party get the blame for this. There is enough for everybody. The problem is the size of the bureaucracy, the layers and levels which make it neigh impossible to establish responsibility.
Also, you don't really believe that in the near future the government will not begin to penalize, i.e. with-hold services, to smokers and others of whom the government has decided does not live a responsible lifestyle.
By and large governments do very little well. At best they just muddle through, hoping that the minimum will keep the masses content. Excellence is not something that government, by its nature, can achieve. Government rarely, in my opinion, achieves even mediocrity regarding level and quality of service it has charged itself to provide. Do you really believe the VA will improve? A bit maybe in the near future but, then it will regress back to a comfortable level of mediocrity.
The USPO probably delivers the best bang for our buck if you are honest about it. The military does a good job of fighting, it's the R and D that gets out of hand and that mostly because of Congressmen trying to get moneys to their constituents.
America is a large country with many distinct regions and rarely is a one-size fits all answer to a problem going to work. National health care might have a chance if the government pushed the money and the authority down to the state level. It most definitely will not work well if it is purely the providence of Washington bureaucrats. A tiny country like Ireland or France can't do it. Why should we think we can?

 

[brian64]

Insurance. What a racket. Must be nice to be selling a product that the masses are required to purchase by force of law. That's not free-market capitalism, and it's not socialism...it's fascism: the merger of state and corporate power.
Whether the government runs business or business runs the government, the end result is the same: organized crime.

 

[doctorthoss]

I understand that it's very popular to say the government does very little well. And there is some truth to it. But really, it doesn't do half bad does it? We agree we have a good military. But we also have decent cops, police, fire departments. And Social Security and Medicare seem to work, even if we struggle to fund it. We have a great transportation system and government funding of our universities has caused us to be the most technologically proficient country in the world. None of these institutions work perfectly, but compared to the experience of others throughout history I think we've done pretty good.
Is the government the answer to all our problems? Hell no. We have far too much corruption, and I'm afraid the love affair with the dollar means our politicians will eventually allow all those things I just described to decay. But the government wouldn't be corrupt if the private sector wasn't willing to fund the corruption, would it?
I don't trust the private sector one whit more than the government, and in many ways I trust it less. In theory at least (even if it often fails in practice), the government is responsive to the voters and their wishes. A private entity has no responsibility whatsoever except to its stockholders. The government can break even and be okay. If a corporation doesn't have increasing profits every year, it "fails." I prefer to trust myself to the guy I voted into office and whose job depends upon my voting him in again to some guy whose only interest in me is in how much cash he can take from my pocket.
It's why we don't trust the private sector to run, say, the police departments, courts and the military. The profit motive doesn't square well with concepts like "justice for all" and national defense (where the success of the military is more important than the bottom line of a contractor). It seems to me that the heath care industry faces the same problems, in which a quest for profits in the only consideration. And I don't see why people trust state governments over the federal government. In my personal experience, the federal government is far more responsive and effective (of course, it might be because I live in a state that ranks 49th out of 50 in education and 1st in roads LOL).
Interesting experience in the Canadian hospital. We have a 11 hospitals in our metro area, and only one of them is equipped as a Level 1 Trauma Center. Some of the others are pretty good, but others are flat-out scary and unable to handle most serious emergencies (for instance, heart attack and stroke victims are automatically transferred to one of the larger facilities). The companies that own them either don't want to fund them or cannot afford to fund them. Of course, every one of them has a CEO that makes seven or eight figures and nurses who make $10 an hour (some of them, believe it or not, do not have even have health benefits even though they work at a hospital).
BTW -- you wouldn't live like what? Why are you assuming that a second or third job is possible, or would help? When you have a broken back you simply cannot work. End of story. And even working three jobs won't pay for a serious health problem. A simple bout with pneumonia can cost you $50,000 if hospitalized, and for all of that time you can't work or earn money, either. The fact is that, in Europe, if you get hurt or ill you don't necessarily lose your job, house, car, and everything else. In the United States, you can work hard all of your life, follow the rules, blah blah blah -- and find out that everything you have worked is lost because you decided to please your boss by working in the office when a co-worker had the flu.

 

[doctorthoss]

Sorry -- one more thing.

None of the European governments have tied health benefits to smoking, and government health plans in America don't. Can it change? Sure, but it hasn't happened yet and it might not survive a court challenge. The courts are clear that a private company can do what it wants in these cases. If it's a true national health plan then that would mean every American has a right to access it -- and no court has ever ruled that the government can withhold any right because you smoke. If smoking becomes a criminal offense that might change, but otherwise I don't see it happening any time soon.

Besides, if the government decides it wants to eradicate smoking, then I'm not half as worried about the health insurance angle as I am about the "SWAT teams battering down the door in a search for contraband" angle.

 

[gregprince]

+1 doctorthoss on all counts. I have heard many Canadians and Europeans complain about their health systems but not one who would trade what they have for ours, which they consider barbaric. Obamacare was a gift to the insurance industry, but far, far better than the failed system that preceded it.

 

[warren]

You're conflating the arguments by mixing apples and oranges. The Federal Government does not control local police departments, fire departments, parks and recs, etc. That is except when providing so-called funding. Which I find fascinating, as they take the taxes out of a region and then return a portion to the place from which it originated with all sorts of stipulations attached. You are mixing certain responsibilities with which the national government is charged with providing, with areas for which it has no business in.
It sounds as though you have a choice in a good hospital or a number of not so good. I'd choose the good one were it I. That's simplistic I know but your city fathers should be addressing the problem, figuring out how to attract better services such as hospitals or create tax breaks to encourage the other hospitals to improve. Or, are the voters content with how things are today?
We are struggling to keep Social Security afloat because it is simply a pyramid scheme that is running it's course, less is being paid in that is out-going. My police retirement plan is over-funded and growing. When the retirement plan was adopted the members opted for an equal say in the operation with the Municipality. At the same time we opted out of Social Security and we are doing quite well thank you. All investing is done through reputable private companies. So it is in much better condition that the retirement programs run by the state and other municipalities.
My doctor does not see medicare or medicaid patients. More power to him. He's skilled and quite capable. We have two extremely well equipped hospital in Anchorage. The Feds built a new hospital for the natives of the state as they are provided with free medical attention, routine and emergency. Both privately owned hospitals do well financially. My city is prosperous and does not, at least at this time, spend more than comes in.
I was referring to the healthy partner when I suggested another job or two. When things go bad you have to do what you have to do. Churches can provide assistance. Family? Other charities? If they are relying strictly on the government to see them through they have my sympathies.
If you have a simple bout of pneumonia you should be under a doctor's care, at home, in bed and not in a hospital.
And yes of course if you work and do not save or invest so as to have money for a catastrophic illness you most certainly can lose your house, boat, TV, RV, summer home, airplane, cell phone, fur coats, golf clubs and all of the rest of the things you purchased rather than setting some moneys aside for emergencies. It's called planing!
And if your state is 49th in education and 1st in roads the electorate of your state is either very complacent or the priorities are skewed. That didn't happen over one election cycle. That situation has deep roots. Why has the electorate endured the situation for so long? Sounds as though your region needs to shake off its lethargy and hold the politicians' feet to the fire.
It sounds as though the state in which you reside has a very poor economy, small tax base (high taxes?) and/or high unemployment with low incomes for those employed. I suggest it needs to grow the tax base to increase the moneys and then the voters have to demand that the funds are spent as they wish. Although that may already be the case. They may prefer under educated children and good roads.
Disclaimer: I am not an economist, nor do I play one on TV.

 

[bphilli75]

Thanks for the discussion, well wishes and thoughts to consider. My wife stays home with our kiddos, so no dice on her having an alternate plan option. Regarding minimal use, they carefully worded the verbiage to include any use of any kind of any tobacco product, including cigarettes, pipes, cigars... What's frustrating is that I exercise and stay very fit, could run a 10k on demand, and only smoke maybe ten bowls a week. I have no addiction, don't inhale, and I suspect the peace it brings me outweighs the potential negative side effects. Funny how I could eat a gallon of I've cream, and that would be fine. But smoke a bowl of fine tobacco, and I am a high risk to the system. I could go on and on though, and it would make no difference. It is what it is. I sure appreciate all your replies though.

 

[warren]

Billp: If your skills and knowledge are in demand in the market, it may be time for a change of scenery. I say this knowing nothing of your situation other than what you've presented. But, this may be good time to change gears if you can afford it, and look else where. Are you an employee that your company would pay more to keep? A raise could off set the insurance increase should you wish to keep smoking.
I know people that took a similar situation as yours, terminated employment and started their own enterprises. Sadly, not all were successful. But none regretted taking the chance. Only one had children at home though. Always a consideration when accessing risk.
I don't know you, but I'm pulling for you. A pipe is a terrible thing to waste!

 

[doctorthoss]

Both were employed. She lost her job as a waitress when she broke her back. He works as a construction worker in the day and a pizza delivery driver at night.

Obamacare is trickier than that. They might get a big tax subsidy come next year because of their income and her injury, but nothing as of now. My wife (who used to be a social worker and is now a teacher) has also tried to help them enroll. Bear in mind that states are responsible for implementing large portions of Obamacare, and Tennessee (which has a Rep. governor and legislature) has simply refused to do it. When we try to enroll her through the Obamacare website, we are told because she is in Tennessee that they are too poor for Obamacare and should receive state-funded Medicaid, which hasn't been funded and won't accept them. So no -- their problems are legit.

This is one of the problems with Obamacare. And I don't see how "planning" would have made a difference to them (or for us). Neither my wife and I -- and only very few people we know or associate with -- owns anything you listed (or anything like it) except for TVs and cell phones. The cell phones are absolute necessities for my wife's work (and mine when I could work), and I doubt our $200 TV would make the difference in a catastrophic medical situation. The simple fact is I don't know many people who can afford to pay rent, buy food, own a car (which enables us to work) and have savings at the same time. It's pure math. Our parents and grandparents could, and they worked far less hours than we do, so I don't think the problem is with us. They worked for companies that treated their employees well and lived in a society that had a safety net. We've dismantled ours, however, to pay for trillion dollars wars and tax breaks for those who got richer from them. Sorry to ramble, but it seemed to me to be an extremely transparent and straightforward process of wealth redistribution from the low and middle classes to the upper classes from 2001 on.
We are the most Republican state in the union, politically. We have the lowest tax rate in the country, and we are praised by conservatives all over the country for how great we are and how are priorities are wonderful. Mind you, 25 percent of the state is on food stamps (only 6 percent are unemployed, which shows what low wages get you) and just under half are uninsured. We have low unemployment, but that's achieved by low wages and massive tax breaks to the companies who move here. Is it a problem with the voters? Sure, to a point. But just try to run for office if you aren't bought and paid for by a massively wealthy company or interest group, you simply won't be elected.

I doubt there is a solution to that problem, esp. since the Supreme Court legalized the outright buying of politicians as free speech (it remains illegal to bribe a cop, but not to bribe a lawmaker at the local, state or federal level).
Warren, I am glad you have a good police retirement plan. Some of the law enforcement officers in this area don't get health insurance with their jobs at all, much less retirement. We live in a conservative wonderland, as our happy politicians and suburbanites like to point out to us all the time. We have tons of jobs coming here, which is good. There was a time when strictly free enterprise with little government involvement made sense, namely back when there was seemingly infinite land and resources. Don't like the city? You could always push west and start a farm. That's not an option now, and every developed country in the world but us has decided to take a rational mixed model approach. And the vast majority are doing a lot better than we are. Every single country that hasn't adopted that model looks more or less the same, and they are all third world hellholes where people work for a couple of dollars a day and no benefits or safety net. That might, of course, be what we as Americans choose -- it is, after all, the conservative/libertarian utopian model. I just hope not.

BTW -- you live in Alaska? I just caught that. That's the state which is basically subsidized by oil, isn't it? That's not an economic model anyone else in the US enjoys. You have to pay high wages to draw people there, and you also don't have the number of children or elderly to care for due to the demographics. You simply don't face the kinds of problems that other states do, and you have what is in effect an economy supported by an oil bubble.
When it comes to the general government functions like fire, police, etc., I was talking about general attitudes toward government. I might have been unclear or misspoken. Sorry!

 

[lordnoble]

As great as this discussion is going and that both sides are being adults about the discussion, it breaks the forum rule of no political discussions. Yes, if I squint my eyes and tilt my head to the side enough, I might be able to see how this relates to tobacco legislation... Nope. Nevermind. Can't see it.
-Jason