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What Happens if You Have a Catastrophic Injury?

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October 15, 2009 – Comments (19)

And you have private insurance from Guardian?

Before you die,

could the rates for your policy be raised to $3700/month?

Until no healthy person would choose it?

And Guardian ends your policy type in your State

Legally of course, because there is no legal requirement that Guardian honor their commitment,

Leaving you with medical bills of $1,000,000/year.

Which is exactly what you thought Guardian would provide because you contracted with them to do so.

Perhaps there is a taxpayer funded organization that would pick you up.

Or not.

 

19 Comments – Post Your Own

#1) On October 15, 2009 at 4:46 PM, maxnik0215 (65.01) wrote:

that nice insurance company just said  - screw it, let's kill him....

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#2) On October 15, 2009 at 4:55 PM, devoish (98.35) wrote:

Apparently there is evidence that they said some pretty crappy things. 

There is however, no recorded evidence that they actually said "let's kill him".

Possibly it was "his bills are killing us".

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#3) On October 15, 2009 at 5:40 PM, whereaminow (26.80) wrote:

"As a last resort, Mr. Pearl would be admitted to a state hospital under Medicaid. But the Pearls consider that a death sentence."

Now that's funny, considering the hopes and dreams of the blog poster. 

In a pre-Capitalist society, he would have been dead about 37 years ago.  Today they've kept him alive for almost 4 decades, despite massive regulation and intervention in the medical industry.  That's pretty good.  I hope he keeps up the fight.  

David in Qatar

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#4) On October 15, 2009 at 5:55 PM, devoish (98.35) wrote:

David,

I never thought I'd hear you describe a massively regulated industry as "pretty good".

How's things going for that Stephen Hawking fella in his government run, socialist, no freedom except to live healthcare country?

You know, just by way of comparison.

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#5) On October 15, 2009 at 6:00 PM, ozzfan1317 (81.08) wrote:

If this happens and your insurance screws no worries sell everything and pray you become poor enough for medicare or just crawl in a corner and die. See I just described the conservative solution.

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#6) On October 15, 2009 at 6:01 PM, nottheSEC (78.66) wrote:

 The make money is our state and should be required to        treat everyone in our state with an existing policy or get out. Health care like pharamaceuticals deals with lives and should be heavily regulated. My opinion and I really like making money just some things I would not do or expect others to do.....J

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#7) On October 15, 2009 at 6:02 PM, jstegma (29.25) wrote:

This is the kind of thing that needs to be addressed in the health care reform bill.  But it isn't.

Consider this guy's case in terms of the bill under consideration

1.  The insurance company can't deny him insurance because of pre-existing condition.

2.  The insurance company can't charge him more than other people because of his illness.

So what is that going to do to premiums?

Under those rules, health insurance will be extremely expensive and will only make sense for extremely sick people.  You can't expect young healthy people to spend a third of their income on health insurance that costs far more than any actual health care they are likely to require.  When the rules of "insurance" are rigged like that, it isn't insurance any more - it's just a tax.

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#8) On October 15, 2009 at 6:06 PM, nottheSEC (78.66) wrote:

 We accept that police and fire departments are a public service that probably cannot be a going concern and are too important to be so  We should see health care in the same light or at least understand like the related phramaceutical industry they should be regulated. Lack of treatement kills as much as bad drugs.

The make money is our state and should be required to        treat everyone in our state with an existing policy or get out. . My opinion and I really like making money just some things I would not do or expect others to do.....J

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#9) On October 15, 2009 at 8:15 PM, devoish (98.35) wrote:

jstegma,

Isn't the whole idea of insurance that a large group of people prepays a set amount of money, so the few that need it can have a much larger amount if neccessary? I mean what you described. If you decide insurers are not going to pay for injured people, and in this case they didn't, then every person should decide not to buy it, young and old.

Seriously, help me out here. Make me understand why I have to pay the worlds highest price for healthcare to get coverage for less than 100% of the risk of getting sick.

And if I am not covered for 10% of the risk, does that mean that my actual cost is 10% higher than my premium and instead of understanding that my healthcare cost is double a Canadians I should think of my cost as double plus 10%? 

And if 80% of the people who are dropped from individual healthcare plans are those who need expensive care does that mean no matter what my premium is, I don't actually have insurance against catastrophe?

And does that also mean my true costs is actually exponentially higher than a Canadians because I am actually buying almost nothing compared to what they get?

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#10) On October 15, 2009 at 8:32 PM, starbucks4ever (98.10) wrote:

Actually, this case is less straightforward than usual. There are cases when any system, whether Communist or ultra-Libertarian, has to pull the plug on a terminally ill patient. When his bill reached $10^6 a year, his insurance company pulled the plug on him, and so would any responsible public plan. For all my contempt toward HMOs, I insist that in this particular case Guardian has nothing to blush about.

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#11) On October 15, 2009 at 8:53 PM, Tastylunch (29.30) wrote:

I hate hate insurance companies.

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#12) On October 16, 2009 at 12:28 AM, nottheSEC (78.66) wrote:

Tasty agreed. Separately Devoish good point you pay for nothing or at least you pay to defray. You and/or your employer pay 4k-10k  per year per person in groups of tens of thousand as one of a few dozen plans in the state. When one get really sick caps, limits and denials are put using every excuse in the book.

Those who disagree with a public option should note that when business can no longer make the profit they want they resort to the government anyway. For example most flood insurance is only available through FEMA. So get in regulated or get out quick.

Also life or death  of a terminal illness is an individual choice and to suggest anything else is the " nanny" state some complain of in other government  programs like taxes on food , drinks, etc.You cannot have it both ways. If the government says no you cannot have trans fat or this or that but you CRY but you WANT the government to say now you must die.   My 2 cents....J

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#13) On October 16, 2009 at 9:09 AM, devoish (98.35) wrote:

Separately Devoish good point, you pay for nothing...

Thanks. 

Tasty,

http://mobilizeforhealthcare.org/ 

 

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#14) On October 16, 2009 at 10:20 AM, Gemini846 (58.84) wrote:

The problem with health insurance is that eventually these companies have to pay out benefits. There is no real aggregate risk because sooner or later nearly everyone needs thier services.

Pooled risk only matters when we are discussing catastrophies such as car axcidents and other non-controlable events. Outside of that it's cheeper and more efficient to self insure.

The system, however, is broken in that by sweeping primary care into the contract, it encourages people to go and therefore should theoretically reduce cost in the long term (however all that extra paperwork increases cost in the short term).

Then you've got chronic cases like this guy. There is NO option that is good for everyone.  It would be one thing if he was overweight and had high bloodpressure and diabetes and they jacked up his rates saying hey you ate McDonalds every day for 10 years. However this isn't a situation he's got control over.

The Insurance company is guarenteed to loose money. That's not aggrigate risk, its indirect taxation. If they made his premium fair then he couldn't afford it.

You can argue moral responsibility here right? Surely we the people are responsible for protecting this guy's right to life and liberty (at the expense of our communal property)?

Sure I'll buy that, but then what happens? As soon as ANY patient becomes chronic the insurance companies drop people into the public pool. (Hello Citizens Home Owners Insurance of FL). Then they start looking at the most risky. Hey if the government will pick them up we just have to figure out a way to get them into the public pool.

Before too long nearly everyone is in the public pool and it can't handle the weight. It's no wonder liberals just want to "get it over with".

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#15) On October 16, 2009 at 10:30 AM, weg915 (< 20) wrote:

I believe most people do not want to go to the doctor or take medical tests unless it's necessary.  It's almost always difficult and unpleasent.

I believe, even just a small co-pay cuts down on use.

However, we have a lot of people, many of whom need or will need heath care and that costs money.  There is no way to get around it.

 

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#16) On October 16, 2009 at 2:24 PM, devoish (98.35) wrote:

Weg,

I agree with your first sentence, and that it probably represents 95% of us.

However, once we get to the Doctor there is incentive to overuse the system. Most of the time that incentive is to be thorough and accurate. Doctors will tell you approximately 10% of the overuse is appeasing patients, or covering a**es against liability.

Your second sentence is true, but also a large part of the problem. The $20 copay stops the guy earning $12/hr from going, not the guy who is getting a $350k bonus this year. The problem here is that the guy getting the $350k bonus is handling my paperwork somewhere. The guy at $12/hr and not going to the Doctor is handling my food.

Third, healthcare costs money, I agree. What do the insurers provide at this point except problems to be overcome?

Gemini,

It's no wonder liberals just want to "get it over with". I am not sure what you mean here. I don't know any Liberals who are knowledgable about healthcare issues who are happy with the plans coming through Congress. And I might add that yesterday I was jokingly and unanimously asked to leave a room because my opinions were too Conservative. I am not bragging, I felt embarrassed. I like antagonizing Republicans/Conservative/libertarian/Free Marketeers/ who swear Greenspan wasn't really them, and Bush wasn't really them, and Reaganomics wasn't really them, but keep not being smart and try to elect a McCain.

The Insurance company is guarenteed to loose money. That's not aggrigate risk, its indirect taxation. If they made his premium fair then he couldn't afford it.

No. This is the risk. It is the risk they took when they wrote this man's father and 50,000 other people who do not cost $1mil a year a policy thirty seven years ago. This company is not guaranteed to lose money. They are very profitable and provide 8 figure salarys.

You can argue moral responsibility here right?

Yes. But I am not. I am arguing they are violating the contract they wrote this family thirtyseven years ago. And if you have a catastophic injury they will violate the contract they have with you too.You should dump them.

Right now the insurers are getting a gift from Baucus. If his version passes it will mandate I buy insurance and offer a public option designed and run by insurers to fail, or catch the pool of sick people at taxpayer expense.

One House version is much better with a public option that is a buy-in to medicare at cost plus 5% or something similar. No tax money.

I would like to see wording that guarantees a States right to enact Single Payer alone or through the Medicare system on the same terms.

I would like to see wording that guarantees the Federal Medicare buy-in as a minimum coverage level and require all private policies offer equal or better so we at least have a clue what we are buying.

And for Medicare beneficiaries I would like to remove the restrictions on price negotiation, fill the donut hole, and add a public option to part d.

And finally make the intelligent choice that has been denied us since 1993, and would have been cheaper then. Pay for Medicare solvency with taxes, not Reaganomics.

And then one thing that might happen is the Democrats get re-elected, and one thing that might not happen is insurance executives getting pitchforked.

It is time to acknowledge that their business model is unsustainable in America. They should leave with the money they've gotten and be glad they get to keep it. And that is a gift.

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#17) On October 16, 2009 at 6:38 PM, nottheSEC (78.66) wrote:

devoish  on 16 . ( stand up slow clap). YEAH! In fairness you heard about an Arkansas blue dog who said we should expand medicare. I think thats a decent compromise. I would have preferred  lowering the medicaid threshhold. All best....J

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#18) On October 16, 2009 at 7:54 PM, devoish (98.35) wrote:

not,

Actually months ago I may have called an Arkansas Blue Dog and a few other phone numbers, and told him I wanted the States right to single payer as my first choice, (believe it or not David in Qatar and a few others have convinced me a States right to single payer is preferable to a National) national single payer as my second, and medicare buy in as barely acceptable. I tink i heard the idea from Thomas Hartmann first.

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#19) On October 20, 2009 at 7:04 PM, Recover22kplan (44.98) wrote:

What happens if you have a catatrophic illness ? What happens is you just get sick ?

What is so great about having health insurance ?

There is no refund of your premiums when they decide they are not going to pay for whatever it is the doctor ordered, please just die and get it over with is basically what it is. There is a huge pool of money being paid for premiums, I have been paying mine for years and for years I haven't needed to go to the doctor for anything the one time I did, they (the insurance company) had a doctor, (doctor who?) over look my bill and he decided that I really didn't need a CT scan. So I am now stuck with a 3,500.00 bill and I have no chioce but to pay my premiums every two weeks right out of my paycheck. So you know what I say this enrollment period SCREW you Health Insurance Companies. I'll wing it for a year and see how it goes I'll use my extra $123.00 a month to pay down the $3,500.00 I owe to the wonderful angels of mercy at the catholic hospital I went to, who btw will not budge on the price of a CT scan - if I die I die - who cares anyway

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