Y&R Discussion Group

Topic: What Does The Term 'Insurance', Mean, Exactly?

"Insuring someone means assessing a risk".  If that risk is already damaged, then it is not insurable, right?

If your vehicle has been in an accident and you take it to Mr. New Insurance Company, they will not pay for prior damage.  Why should they?

It is the same with people.  If the insurance industry is mandated to take all sick people, and the healthy ones would not have to sign up, but only pay a fine, then who in their right mind would bother to take out insurance when they are well?

With Obama's mandate, the insurance industry would have to pay for people that are already ill.  It then could be considered "charity".  What would be the difference?  They would collapse under the weight of it, because as I said, well individuals would probably not take it out until they became ill.

Obama knows exactly what he is doing.  Unless he is brain dead, and I don't think he is, he knows that the insurance industry will collapse under the weight of this mandate.  NO matter how high they raise their premiums, they probably will still get the short end of the stick.  No, I don't feel alot of pity for them.  But, fair is fair. 

Another example would be House insurance.  If your home is on fire, would a new insurance company take it on?  Of course not. 

The term "health insurance" means that a company will insure a healthy body and if that body becomes sick, (and risk assessment can make a pretty fair determination) of when and if, then the ins co will pay that claim).  But if only sick people sign up, as I said, then it becomes charity.

So next time the president says "if you like your present insurance you can keep it", he knows otherwise.  We had slick Willy in the Whitehouse at one time.  Now you are looking at "slick Bary".  Only, he isn't so slick.  Most Americans can see through this and that is why they are so afraid.

Convince me I am wrong.

AJ, I think I understand what you are trying to say, and I do somewhat agree with it.

I am an Obama supporter, but do not entirely understand, or agree with all the healthcare programs that are being proposed/ voted on.

I worked in Human Resources/ Benefits Administration for many years, and have dealt with employees, doctors, insurance companies, etc.

If someone has never ----- repeat NEVER---- had health insurance, and developed a serious illness or was in a terrible accident, and then decided to get health insurance, no, I don't think it's fair for those that have always paid their premiums.  

However, if someone is being treated for an illness, has health insurance (using DebS below as an example), then loses their job, then YES they should be able to continue their health insurance coverage, or get coverage through a new employer ----- pre-existing should not be a factor.

The way I am understanding the proposed Health Care reform, anyone can ''opt out'' of paying health insurance premiums and pay a fine instead.  Then, if they get ill/ injured they can then take out health insurance.  Somehow, that just doesn't seem right.  For the ''pre-existing'' issue, I think you're talking about NEVER had medical insurance vs. ALWAYS had medical insurance. 

I am a cancer survivor, and my treatment was $150,000 +.   Fortunately for me, I had insurance.  But, if I had never had insurance, and went out the day I was diagnosed and got medical insurance,  would that really be fair?  Yes, it would be great for anyone that never had insurance, but I'm trying to look at the big picture.

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HI Kentucky - I'm also in HR as you may know and have also dealt w/ employees, insurance carriers, etc. I guess I see this issue as more of a humane one than insurance/$$ one. Yes I've seen many employees try to sign up for benefts AFTER they or their dependants get ill. And they usually can't, because there is no qualifying event. In those cases, where they had the opportunity to sign up when hired or during open enrollment, yes, it's their own fault. But aside from that, more important to me is helping people to pay for their medical issues. Because when it comes between life and death or the insurance company getting (more) money, I choose the life and death. I think the problem is that the insurance industry is all for profit - it's a business - and it needs not to be. There are too many lives at stake for things to remain as they are.............DebS

I agree with everything you said, but that's not the point I was trying to make. When I was BM, I occasionally ''fudged'' just a little on dates, just to be sure our employees got their medical benefits. But, as I said above, should someone who has never had medical be able to get it when they decide to, only because they have developed a serious illness? I can see how that could be the end of private insurance companies, and we may have no choice but have a universal health plan, and I'm not sure I am totally on board with that. Believe me, I am in no way for the insurance companies, and yes, there needs to be a lot of changes made...but I'm still not sure what all the answers are....KY

....I guess my point is, Yes, the humane side of me wants everyone to be treated regardless of when they obtained medical (no pre-existing any time, for any one, for any reason?) but, I can also understand the other side and can see how it could lead to another corporate collapse, which I don't think our country needs. I really haven't made up my mind about Health Care reform....KY

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Posted by: farmer brown
Date posted: Mon Oct 19 21:48:20 2009
Message:

I have no interest in convincing people who think they are right in their opinions that they are wrong.

Hell, on this board, you can't even convince people who are wrong about FACTS that they are misinformed.

So why on Earth would any sane person try to convince you to change your opinion? You can hold any opinion you wish to have.

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Bravo, farmer brown! ~ Duffy

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Posted by: DebS
Date posted: Mon Oct 19 20:20:36 2009
Message:

Ok, AJ - you convince me:

So I'm diabetic. I have (crappy) insurance through my current job. I have been relatively healthy all through my 40 years of life. Now, say I lose my job, for whatever reason. And I'm unable to obtain other insurance because of my pre-existing condition....

are you saying that because car insurance and health insurance should be managed exactly the same - that I should be denied coverage because I am "damaged goods"? And so should everyone else w/ pre-existing conditions?!

So forget that I need medication, testing supplies, diabetic management monthly and dr's visits every few months. Those of us w/ chronic conditions are not worth insuring - so to hell with us?!

Wow - how cold can you be? No wonder this country is so messed up.

I take it you are young and have never had health issues. Ok, well give it 20-30 years (if you're lucky) and let's see if you feel the same way.

Unbelievable!

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Posted by: Mitch
Date posted: Mon Oct 19 14:32:29 2009
Message:

Stupid me.  I was unaware that the health insurance industry enjoys, and has been enjoying, an exemption from the federal anti-trust laws for the past 30 (+/-) years.

That's absolutely obscene.

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Forgive my ignorance Mitch, but what exactly is your point?//AJ

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Posted by: SusieB
Date posted: Mon Oct 19 14:26:02 2009
Message:

I have said many times that the US needs to get away from the concept of health INSURANCE and embrace the concept of health CARE.

Insurance, in any form,  is a game of risk and the only way to make money is to either avoid the risk or charge higher premiums for potentially riskier situations.

I dont think other countries that provide their citizens with health benefits call it isurance...I believe they call it health CARE or maybe health PROGRAM.

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If people could AFFORD to go see a dr. regularly and catch potential problems before they get out of hand, maybe expenses could be cut....to me, that's what CARE is all about. Right now, the uninsured don't see a dr. until they need to be rushed to an emergency room and treated at great expense. Maybe a 1/2 hr dr. visit years before would have caught the condition so it could have been treated before the 'expense' got so great. I have insurance but I don't always go right away because of the deductables and copays. Elaine

SusieB, you are exactly right about what the concept of the term 'insurance' means. But, I can't see where we need health ''care'' reform. This country's health care system really is deemed to be the best in the world. We do need some reform, and I believe it should be in the areas of tort reform (which would lower costs), and also the ability to be able to buy insurance across state lines. Also, if I may add, to elaine, alot of the so-called ''un-insured'', choose to remain that why for a variety of reasons. Some because of the reasons you stated, and others, not because they can't ''afford'' it, but they would rather spend their money on something more 'tangible'. If one is healthy, it is hard for them sometimes to justify spending monthly premiums on coverage they think they do not need, which of course, is unfortunate. And the other group could be comprised of illegals, which is not our concern anyway.//AJ

Actually, a number of studies have shown the U.S. healthcare system to be mediocre at best, hardly ''best in the world.'' In fact, life expectancy in the U.S. (especially for infants) is much lower than in many countries. That is not due to a lack of technology or medical knowledge, it's due to a lack of access and affordability. You should read up on it before making assumptions that just because this is the U.S., we must have the best system. Far from it. ~i&b

I have yet to have a pap smear or a mammagram this year because of the copays I have to pay. I can only afford to go to my one specialist for a chronic medical condiditon that I have that I have to take a prescription for. So I fogo my preventative healthcare and just pray I dont develop cancer. I think preventative things like paps and mammos should not be subject to deductibles and copays so lower income people like me, the working poor , can have access to prevenative care. What good is health insurance if you cant afford to use it ////SusieB

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Posted by: H20
Date posted: Mon Oct 19 14:19:10 2009
Message:

Tangent, in Canada they have risk assessors that deal with numbers and it's a huge accomplishment to be this type of risk assessor.  I think it starts with an 
"A."  Does anyone know the name?  One of my cousins achieved this level of education.

Risk is assessed not damaged, and insurance is provided based on the level of risk, higher cost, higher risk.   

Would you buy a car that was already wrecked, flood damaged, et cetera?  Can't compare health and car, flood, insurance, things versus people.

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Actuary? ... Ricky

You are right Ricky. And they are all really brainy! (I worked for years for an Assurance Co). - Pronoun

Again, the concept is the same. Damaged goods vs damaged people. To insure someone they have to be ''insurable'', and if they are already ill, then they are not. It really is as simple as that.//AJ

Actuary, thank you. Very impressed by those persons. H20.

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Posted by: Elaine
Date posted: Mon Oct 19 14:11:05 2009
Message:
I hope you're darn good and healthy and have NEVER had any preexisting conditions (read very young).  In my 62 years I have been treated for Graves Disease (thyroid condition) and had a cancerous gall bladder removed.  Now, the doctors tell me they feel that they caught the cancer in the gall bladder early and it was removed. I also had radio frequency ablugation of the gall bladder bed just incase any stray cancer cells had escaped. They feel they hadn't but one can never tell. Chances are good I'll never have another bought of cancer from that gall bladder. Insurance companies tell me I'm 'damaged goods'.  Uninsurable in there words because I 'might' have cancer again.  Also, since I had problems with my thyroid, even if it was 30 yrs ago, I might again have problems...again uninsurable.  Thank god that the government regs. require that my husbands union health insurance keeps me in the group.  Should I be denied insurance because of my past history?  there aren't too many people except young people perhaps that are totally without some sort of health issue.  Maybe we should all just die?  I've had insurance through my hubby for 30 some years and never used it except for yearly physicals...I think they made their cash on me and I don't 'feel guilty' because I needed them to pay 'something'.  Actually, a lot but that's what all the premiums are for.  Do their CEO's need million $ a year salaries while they quibble about who gets some form of treatment and how much they'll dole out?  Fair is fair....I don't mind the insurance co making a resonable profit and CEO's getting fair compension, but when they need obscene profits on the misery of their insured, that's where we have to draw the line. Same goes for the overly compensated hospitals and doctors.  JMO

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''obscene profits'' vs. ''reasonable profits''. so you ''don't mind'' if they make reasonable ones? what is obscene and what is reasonable is in the eye of the beholder. would you enlighten us to the amount of profits that you ''wouldn't mind'' the insurance companies, doctors and hospitals make?

Elaine, this is why it is so important for EVERYONE to take out insurance BEFORE they become ill. In most cases, the system will work. Group insurance is different, though. When insuring a large group, like a corporation of employees, the ins co will get a cross-section of well employees to offset the sick ones. But, in individual cases, if everyone was required to take out insurance (even the well ones), then it would balance out - at least, better than things have been. We need some insurance reform, but we also need tort reform, and we need to be able to buy insurance across state lines. We do not need to lower the hammer on insurance companies, unfairly. And, as far as the proft the CEO's make? So what? Since when has it become illegal to make good profits. So long as the company performs as promised, then good risk assessment should be rewarded. But, consumers have to do their part, too, which is all I am saying.//AJ

AJ, you must be very young if you think it's possible that people can take out insurance (and keep it all their lives without changing jobs or being dropped or having their premiums raised beyond affordability). That is just not reality. If you have never had an ongoing medical condition then consider yourself extremely lucky. Many people are born with them and never have the chance to ''plan for'' their medical problems ahead of time. ~i&b

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Posted by: ingyandbert
Date posted: Mon Oct 19 14:10:28 2009
Message:

People are not cars or houses.  You're comparing apples and oranges.  Simple as that.

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Exactly....cars and homes are disposable items. Are people? Lots of the very wealthy feel that the 'peon' class are and that if you're not wealthy enough to pay your own way...just like Scrooge said...'they should die and decrease the surplus population'. A very Christian, moral judgement. NOT. Elaine

ingy&bert, yes, ''people'' are not ''stufff'', like cars and houses. Nevertheless, the concept is exactly the same. The word ''insurance'' by definition means that all insurance companies, whether insuring people or ''stuff'', can not be expected to bear 90% or so, of the cost of repairing someone's sick body right off the bat. How then, could that company make a profit on that person, or person(s)? That was/is my point.//AJ

No insurance makes profit off every insured. The entire concept of insurance assumes risk. If there was no risk there would be no need for insurance. ~i&b

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