US Elections (& Politics) :)

We're the lucky ones.

Imagine being independent paying open market rates, either ACA or private insurance. I know 3 people doing so, 2 Private and 1 ACA.
All 3 are paying in excess of $800 p/mo with one 62 year old single Mom with a small business is paying $1600 p/mo BEFORE '26 increases for her and her daughter (well the one with ACA will without subsidies)
 
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Our economy should be measured by how the bottom 30% are doing in the supermarket, not how the top 1% are doing in the stock market.

 
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bigredfish said:
Currently by LAW they have to spend 80% min. on actual claims/care.
Click to expand...
Assuming that's correct, the insurance companies' profit skyrockets when the cost of medical care skyrockets, giving the insurance companies an incentive to at least hope that costs go up. Aside from that I wonder how much of claims/care goes to actual care? ACA forced a lot of extra administrative work on the care providers, and the insurance companies add to that. Plus I'd be pretty sure that the insurance companies consider all of their expenses as part of claims/care, so if they can skim 20% of the premiums as profit, that's a pretty good return.
 
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While they are companies doing business for profit, I'm sure they take advantage of every loophole they legally can.
They are more regulated than you may think, and their liability insurance must be outrageous.
I still say the majority of the costs are from the healthcare companies themselves. They set the price of a $25 tylenol and a $10 cotton swab

www.healthinsurance.org

Billions in ACA rebates show 80/20 Rule's impact

Since 2012, health insurance customers have received almost $11.8 billion in medical loss ratio rebates from insurers, who refunded portions of prior-year premiums that were essentially too high.
www.healthinsurance.org www.healthinsurance.org

What is the minimum medical loss ratio for the ACA?

The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans. Congress
insuredandmore.com insuredandmore.com
 
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bigredfish said:
I still say the majority of the costs are from the healthcare companies themselves. They set the price of a $25 tylenol and a $10 cotton swab
Click to expand...
Getting to the bottom of this could be a very long debate, a fact finding one, not a fighting one. Yes, the companies set the prices, but the insurance companies pay a contracted rate, often much smaller. I only have details of my own medicare bills. In one example, the MRI provider billed $1,594 and medicare approved $206. For a doctor visit, the bill was $559 and medicare approved $136. On the opposite side, my cancer pills are billed at $16,534/month and medicare pays $13,227 thanks to a newer "manufacturer discount program". Last year medicare paid $17,459/month. In Canada, the manufacturer price is $10,503 usd per month, and in the UK $12,763. At one India pharmacy, a generic is $700 usd per month. Generics not available in US, Canada, etc. because of patents.

I totally agree that the pharma company has sunk a huge amount of money into R&D and clinical trials and deserves to have this paid back and earn profits from it. I just can't help feeling that they're unreasonably milking it to line their pockets to the fullest extent. This whole medical cost system is so screwed up and complicated that I don't think any of us here can figure out who the good guys and the bad guys are.
 
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Agreed.

And but think Medicare plays by a different set of rules than Private and Employer Insurance which is, combined with ACA, 185 million people
 
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It’s like talking to a toddler …


Reporter: What is your message to the 24 million Americans who will see their insurance premiums go up?

Trump: You make it sound so bad. Obviously you are a sycophant for Democrats, you are obviously a provider of bad news for Republicans.

 
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bigredfish said:
We're the lucky ones.

Imagine being independent paying open market rates, either ACA or private insurance. I know 3 people doing so, 2 Private and 1 ACA.
All 3 are paying in excess of $800 p/mo with one 62 year old single Mom with a small business is paying $1600 p/mo BEFORE '26 increases for her and her daughter (well the one with ACA will without subsidies)
Click to expand...

Come to think of it why couldn’t we divert some of the hundreds of Billons $$$ we’re sending to Israel, Afghanistan, NATO, Argentina, and god knows how many other programs that don’t help Americans, and enable Medicare for ALL Americans?
 
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