Dental Insurance

AAQ

Happy to help

Explain to your kid that society needs certain things to function. roads is an easy example that he can see. We all need roads, to get to school, work fun places. Even someone how doesn’t have a car needs roads for the bus that he takes.
Even someone who says I’ll never take busses still needs roads for deliveries to his local store, and of course for emergencies like fire department.

so how should we pay for roads? We can’t just hope everyone will on their own understand this. Many have trouble with this simple concept. so we have the government in charge they collect taxes from everybody and use that money to pay for things that we all need including roads.

S oalthough it feels free to use roads, they do in fact cost money, this is a cost that is paid by all of us

where it gets a little trickier is what “jobs” fall into the governments purview.
Many believe healthcare is such a thing. Just like we all pay taxes to be used for roads that we as a society need, regardless of how much you personally use the road. Same thing for healthcare we all pay taxes to fund healthcare that we as a society need.

now before you get nervous that this would cause taxes to go up by a lot, keep in mind we already pay a ton for healthcare it isn’t “free” I pay 11,000 in premiums my employer (boss) pays the same for me. My taxes could go up by a bit over 20,000 dollars and I’d still end up ahead

hope this helps, Once your kid gets it have him explain it to you.

“I can get behind increased government oversight on diet/exercise etc”

Next the government can get into the shidduch scene and have their shadchanim making shidduchim.

AAQ,

Ask your son a simple question. Remind him of any friends or acquaintances that have special needs.
Does he believe that society should just abandon these people since they are incapable of taking care of themselves or does he believe that he should contribute together with other people in order to enrich their lives?

Then ask him if he feels that it is fair that he should contribute the same amount as bill gates and elon musk.

@jackk

“He has also described every day scenarios where nobody was willfully negligent but still was caught in the death trap of our capitalistic system of healthcare.”

That wasn’t what my question. Answer my simple question and we can move on to the scenarios @ubiquitin brought up.

“I do not understand how anyone can believe that government is NOT supposed to help the population.”

Again- the goverment IS supposed to help the population, what we disagree on is to what extent.

“I do not understand how anyone can believe that Selfish Capitalism is the Torah view.”

If you can show me where in the Torah it says to pay people not to work so that they should vote for a political party that promotes actions that the Torah calls abonimable and murder than we can discuss that.

@Always_Ask_Questions

“why discourage him?”

Because when well meaning people have tried that in the past the results were catastophic- the companies became insolvent and were liquidated while the providers were out hundreds of thousands of Dollars for services they rendered but didn’t get paid for and the policy holders had to start their massive deductibles all over again in the middle of the year (and then again in January).

DRP

“..to admit that there are times when the govermnent shouldn’t step in (i.e. when Mr. A and his family would suffer the loss of their house and savings due to the shear utter irresponsibility of Mr. B).”

I don’t think anyone here has ever suggested anything like that. that you needed them to “admit” they wouldn’t support that. T ohave one neighbor “chosen” to sponsor his neighbor ? Thats a made up thing that doesnt happen in any socity and I dont think has ever ben seriously suggested to happen

Dr. Pepper, this is how free market works – people are trying to do things, some more, some less risky, and some of them work out. You mentioned insurance problem. We, “the people”, had lot of unsolvable problems – horses were hard to feed, wheat was hard to mill, houses were only 2 floors high, and cows were killed to write on scrolls… somehow, people solved many of these problems, so don”t be so upset about the remaining ones.

@Always_Ask_Questions

The way to solve a problem is to think of something new- not try something that others have already tried and failed catastrophically at.

Unfortunately, the design of the ACA does not allow insurers to put the health of the policy holder first. (I doubt it was intentional but as Nancy Pelosi famously said, “ You need to pass it to see what’s in it”). There have been insurance companies set up to put the health of the insureds first and the outcome was devastating to everyone involved.

(I read a long white paper sent to the architects of the ACA, I think through CMS, outlining why the ACA couldn’t mathematically work out and their one line response was something to the sort of “we read your concerns and they aren’t true”, of course without providing any explanation.)

DrP,

I’m also sorry to hear about your hardship.
We should not be discussing the ACA.

We are discussing basics of government’s responsibility to ensure that Americans do not need to travel to Hungary in order to get dental care because insurance is too expensive, does not cover everything and the premiums are through the roof.
.

DrP

Glad to hear things are doing better

To answer your question
Yes without question We should collect from the A’s (and the B’s) to fund the healthcare of the B’s (and the A’s).

The reason for this is I don’t think there is any realistic way to ensure the B’s behave. Nor is there a real way to sepperate health costs based on “irresponsible choices” vs “bad luck” That said, As I mentioned I could be convinced to have more government oversight on behavior to ensure the B’s “behave” perhaps some financial penalty for smoking, not excercising , eating too much meat etc etc .

I cant say I love it, but if this would get you on board I’m in. Is that your suggestion?

@jackk

“I’m also sorry to hear about your hardship.”

So now that you see the devastating effects that the ACA had and continues to have on millions of hard working families, who were struggling beforehand to pay for their own healthcare, do you still think it was the right decision?

“We should not be discussing the ACA.”

Technically this discussion is about Dental care so you are correct but it would be foolish to not learn from the mistakes of the ACA.

“We are discussing basics of government’s responsibility to ensure that Americans do not need to travel to Hungary in order to get dental care because insurance is too expensive, does not cover everything and the premiums are through the roof.
.”

The governments responsibility needs to stop somewhere already. The government should be in the business of building infrastructure for everyone, showing citizens at a young age how to be responsible for themselves later on and being there for those who physically or mentally can not take care of themselves as well as those who are temporarily down on their luck.

I explained earlier what the problem is with dental insurance. Insurance companies are a business that makes money by calculating risk and charging a premium to take the on the risk. The nature of dental claims is that large claims can sometimes be pushed off until the insured temporarily purchases a higher level of coverage. This behavior changes the “risk” into a “known” and the insurance company needs to raise the premiums through the roof and only cover part of the claim.

Let’s say drivers could look into a crystal ball to see if they’re going to be at fault for an accident for the upcoming year and only purchase insurance if they’re going to need it. Do you see why the insurer would need to dramatically raise the premiums and cut down on coverage in those cases?

As far as why the Hungarian dentists are so much cheaper- maybe the standard of living is less in Hungary so they could afford to charge less, maybe education is cheaper since they’re only paying for their education and not for all those people who took out loans for $400,000 to get a degree in gender studies and have no plans on paying it back or maybe they don’t have to spend enormous amounts on malpractice insurance as the population there isn’t so trigger happy to sue.

Ask your dentist next time you go.

“Next question- could the government collect to the extent that a hard working family would lose their house?”

No
Though taxes will go up if as a result of that Their mortgage is too expensive then I guess yes.
Of course some would argue that Having gotten a mortgage that leaves Them so vulnerable to a tax increase is irresponsible behavior what we would expect from Mr. B not A. nonetheless even though some would call him irresponsible I still think he should have access to affordable health care

Dr. P
Here in CT, yesterday the Governor announced a plan to pay off individual’s medical debt. We as a community have an obligation to provide healthcare for all.

Mrs. CTL’s final hospital stay in August resulted in a bill of $198,000. My share after insurance and adjustments was a number of thousands of dollars. B”H I can afford to pay this, but it could put some people over the edge and cause loss of home. Medical debt is an obligation of both spouses, by law. Take a lower middle class working or retired couple hit with a large medical bill, couple it with death of a spouse and loss of income (paycheck, social security, pension) while fixed housing expense continues and it is a recipe for disaster.
I am not dependent on the lost income, but the almost $4,000 a month in retirement income she received is no longer funding it’s way to Tzedaka each month.

@ubiquitin

“Of course some would argue that Having gotten a mortgage that leaves Them so vulnerable to a tax increase is irresponsible behavior what we would expect from Mr. B not A.”

There’s got to be a line drawn here as well. Would you say that someone who can’t afford a $100 annual tax increase without defaulting on their mortgage is irresponsible? Definitely.

How about $10,000 – Possibly.

How about $100,000 Definitely not.

Where do you draw the line?

“nonetheless even though some would call him irresponsible I still think he should have access to affordable health care”

I agree to this 100%, but the money needs to come from somewhere and we seem to disagree on where it should come from.

there are 2 questions here:
1) why healthcare is so expensive
2) how to pay for it

for one, US spends more than others, but not astronomically (I recall 17% of GP v 12% for other OECD countries). This is not that bad. And other than Torah learning and defense, what else should country spend on? Even if some of that is waste, still it is an indicator that the country throws money at people’s health.

2) You can’t convince me that a fully socialized medicine does not create moral hazard – for not taking care of themselves and not working to cover expenses. When we show kids dental bills – they start brushing more often for a week or two. So, covering catastrophic cases and showing chesed – yes, but making it free-for-all – no. One less explored direction is to make capitalism work rather than trying to socialize it –
allow insurances compete across state lines
transparent pricing rather than secret bargaining between large groups. Under Trump, there was a new rule requiring hospitals to post their prices. I believe it went into affect at the early months of Biden, and that was the last time I heard about it. Not sure what happened.

ubiquitin,

I thank you for going back and forth about taxation and healthcare with DrP. He is getting answers that are very close to what I have written but I simply do not have the patience to go back and forth.

My 2 cents are that the Government has an infinite ability to spend money that it does not have. It simply prints it.
When it does , it is called a deficit. The current deficit is 31 Trillion. If we wanted to pay it all off, the government could raise taxes on everyone this year to raise it. That would never be done, because it would cause the economy to tank, impoverish everybody and cause a civil war.

The standard options to pay for what the government spends are either raising taxes or let the deficit grow and hope that tax revenue will also grow without the need to raise taxes.
There is never a one to one relationship between new government spending and raising taxation.

@ubiquitin

“oh fur sure theres a line.
Though probably more of a percentage than a real number. MEaning
If a person makes 100,000 one year then 1,000,000 then next year yes his taxes should go up by > 100,000.”

Agreed, but that’s not what we’re talking about and you know that.

“no politiican would dream of raising taxes that much (for the average worker who didnt get a 10 fold increase in salary .”

Do you recall a former President named Barak Hussein Obama? He did exactly that. It may not have been in income tax or sales tax but it was a forced tax on the hard working makers to pay the premiums for the lazy takers and yes, my salary remained relatively the same but my health insurance costs skyrocketed by around $10,000 a year.

“However as I mentioned before there is an easy solution
I pay > 11K in premiums my boss pays the same
My boss pays me that money I sto ppaing private company. My taxes go up by 20K I pocket the remaining `3 K win win win”

As I mentioned before that’s not going to work. Your expensive health insurance plan is cheaper because they know that you’re working which puts you in a healthier and more responsible class (which is a reason employers offer it in the first place). Once you don’t get insurance through your employer you’re not in that same group anymore.

“Again. I f you dont think the government should be involved in health care this comment is crazy. As I said that is the starting point”

I’ll mention again what I’ve been writing all along. The government should be involved in health care for those who (for mental and physical reasons) can not take care of themselves as well as those who are temporarily down on their luck, I.e. as a safety net. Not for lazy people who want society to do everything for them.

”Exactly s Ive been saying I think it should be government run with the money coming from taxes, think of an expanded medicare”

Again, this will not work until people start taking responsibility for themselves and the ratio of avoidable medical expenses to unavoidable expenses gets flipped.

“Do you recall a former President named Barak Hussein Obama? He did exactly that. It may not have been in income tax or sales tax but it was a forced tax on the hard working makers to pay the premiums for the lazy takers and yes, my salary remained relatively the same but my health insurance costs skyrocketed by around $10,000 a year.”

This is not true
The increase in tax was $695 that is ti . And it ONLY applied if you dindnt have health insurance .

“Once you don’t get insurance through your employer you’re not in that same group anymore.”

right , a complelty insane system. so if I change jobs I may need a new doctor. If my employer gets a better deal I and chanegs companies I may need a new doctor it is crazy.
what on Earth does my insirance have to do with my employer

“I’ll mention again what I’ve been writing all along. The government should be involved in health care … Not for lazy people who want society to do everything for them.”
Yes youve said that the problem is it isnt the just the “lazy” who get cancer . Read the recent Propublica story “UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.” The fellow involved doesnt sound lazy.

“Again, this will not work until people start taking responsibility for themselves and the ratio of avoidable medical expenses to unavoidable expenses gets flipped.”
and Again if it got you on board, Id support increased oversight on halthier diet/excerices increased regulations on smoking etc

@ubiquitin

“This is not true
The increase in tax was $695 that is ti . And it ONLY applied if you dindnt have health insurance .”

Again- you’re purposely totally missing the point. I specifically wrote that it wasn’t an “income tax or sales tax but it was a forced tax on the hard working makers to pay the premiums for the lazy takers”. My portion of the monthly premiums went up by around $200 and my employers portion went up by $200 as well. The annual deductable went from $250 to $7,500. Again- this was not a typical tax per se but an extra expense forced on me by the ACA through former President Obama.

“right , a complelty insane system. so if I change jobs I may need a new doctor. If my employer gets a better deal I and chanegs companies I may need a new doctor it is crazy.”

Complain to your employer if they keep switching insurers or complain to your doctor if he / she isn’t in enough networks. Insurers attempt to keep premiums down by agressively negotiating with providers who want to be in network. If your provider is too greedy to agree to the insurers terms you can’t blame the insurer.

“what on Earth does my insirance have to do with my employer”

As I explained earler- the fact that you can report to work makes you appear healthier than the general population and makes the premiums cheaper. If you’d rather pay more to have a consistent policy that doesn’t change from year to year go ahead a buy one on your own. The percentage that the premiums increase from year to year will be significantly higher.

“Yes youve said that the problem is it isnt the just the “lazy” who get cancer .”

I’m not sure what you meant to write over here. But again, too much of health care costs in the US are avoidable if people were to ask responsibly. Some costs are unavoidable and the government should be there if the patient was someone who for reasons beyond their control couldn’t get adequate coverage.

“and Again if it got you on board, Id support increased oversight on halthier diet/excerices increased regulations on smoking etc”

Yes, that would get me on board.

“Yes health insurance companies are greedy. I hate them too.”

Health insurance companies are there to make a profit just like any other company. Their business model is to take payments to assume a risk. Why do you consider them any more greedy that any other company that wants to make a profit?

“Not sure why you blame that on Obama.”

I don’t blame Former President Obama for insurance companies wanting to make a profit- I blame him for forcing me and tens of millions of other hardworking people to pick up the slack for those who choose not to work.

“If you dont mind my asking what was the change in benefits? Why dd it go up so much?”

Any changes in the benefits were negligible. The extra premium was to cover the premiums of those who aren’t going to be paying the premiums on their own. A deductible (and copayment) is to discourage people from calling an ambualnce to be rushed to the emergency room for a paper cut. The skyrocketing deductibles were to cover those who don’t have a deductible (or copayment) and will be calling an ambulance to be rushed to the emergency room for a paper cut. (As it’ll be cheaper for them than buying a Band-Aid from CVS.)

@jackk

As I’ve mentioned before and I’ll mention again- insurance companies are in the business of collecting premiums to assume risk. The higher the risk the more premiums they charge.

Insurance companies lost hundreds of millions of Dollars due to the ACA and many companies were put out of business causing providers and their insureds to lose additional hundreds of millions of Dollars.

Why do you consider insurance companies any more greedy than any other corporation that’s trying to make a profit (e.g. a car dealership, a cruise line, and an amusement park…)

“There is nothing stopping them from raising premiums and lowering coverage.”

That’s another one of your lies! Insurance companies have to file proposed rates hikes with the state, justify them and wait until they get approved. Check out the CMS website for more information.

“All this was happening before Obama.”

That’s true- he didn’t invent the freeloaders, he just came along and exasperated the problem exponentially.

“Individual Americans have no recourse.”

That’s another lie! Just because you don’t want to do something doesn’t mean that you can’t. Individual Americans can go ahead and vote Republican.

jackk > The insurance companies are part of our capitalistic system. There is nothing stopping them from raising premiums and lowering coverage. All this was happening before Obama. Individual Americans have no recourse. The insurance company lobby will destroy all dissent.

jackk, do you have your degree from Havana University? Competition is the “thing” that typically stops suppliers from raising prices. Econ 101. It is harder in some industries than others, but it works better if you increase fair competition by providing markets (midrash says this is what Yaakov did, forgot exact citation). Excessive regulation and government intervention limits competition and allows near-monopolies to raise prices indeed. This way, it seems that the progressives are sneaking in their market-destroying policies in order to then tell people – see, the markets do not work. I think freedom, like education, are expensive – but cheaper than slavery/ignorance.

@ubiquitin

“no, I’m mising YOUR point. yo uare trying to make this about Obamacare and your specific circumstance (not that I blame you)
reread my comments, I am not discussing Obamacare.”

My point was specifically regarding the catastrophic consequences on hard working families caused by the ACA and I explicitly mentioned that.

If you were referring to a different point can I respectfully suggest that you mention that instead of saying that something I wrote wasn’t true? It disturbs the peaceful flow of this discussion.

“I did but they don’t care. and there is not much I cna do about it other than quit. and a system where you have to quit to keep your doctor is even crzier than finding a new doctor in my opinion.”

I feel bad for you, it’s definitely not a good situation, but it seems like this issue is caused by your employer and providers, not the insurance companies. When my employer switched insurers the providers were in both networks so I’m wondering what’s going on as it seems like the premiums you and your employer are paying are much higher than the premiums paid by me and my employer (I.e. the networks should be around as good)? Do you work for a Frum place? Frum employers tend to have higher premiums.

The only doctors I recall switching from where two that weren’t honest (one billed me for a sick visit by my annual physical even though I felt great and one diagnosed me with a disease I didn’t have).

“Great We agree then!
Medicare for all!!! Huzzah”

Whoa- not so fast. It’ll take generations to implement. First we need to get people to take responsibility for themselves. A major part of that is getting rid of the culture embedded into the youngest of our citizens that their health isn’t their problem. Keep in mind that there’s a major political party paying people to be takers and vote for them. Even if the makers are still a majority the takers are reproducing at a much faster rate.

uniq, I agree re: market distortion in healthcare, and I also mentioned transparency regulations by Trump. The answer to that is improving the markets as much as possible – publishing prices, enabling competition.

I did not study healthcare, but I studied defense industry under Reagan – who introduced competition by partitioning weapon development into R&D and production, and bidding them separately, with government fully acquiring R&D results of the bidder after Phase 1 and making them available to all competing companies. During Phase 2, several companies get part of production, and deciding on one contractor after a couple of years of competition.

DrP

The only point I said wasn’t true was this
““no politiican would dream of raising taxes that much (for the average worker who didnt get a 10 fold increase in salary .”
Do you recall a former President named Barak Hussein Obama? He did exactly that…”

That wasn’t true. He didnt Do “EXACTLY THAT”
As you acknowledged in your post. I didnt say you were a liar, becasue you knew what you were saying, I would characterize it as misleading more than lying. I pointed out that what you were saying was “not true” it wasnt and isnt

” from my point of view this thread has run its course”
Yep along time ago

“I didn’t read the story you mentioned but I’ll agree with you that there can be some bad apples out there just like there is in any industry, that doesn’t mean that the insurance industry is rotten to the core”
you should read it.
I deal with insurance companies multiple times weekly (more often as a provider) . rotten to the core is an understatement

@ubiquitin

I read the article (it’s long) and I was shaking and fuming. I’ll get to that later on.

“The only point I said wasn’t true was this”

Can we hit the reset button on this? I was having a pleasant discussion with you where, although we didn’t agree on everything, we discussed things peacefully and respectfully. What I meant to say what that there possibly could have been a better choice of words. You probably didn’t mean any harm but comments like that can potentially be perceived as a personal attack and disturb the flow of the conversation.

Most of the complaints against healthcare were, in my opinion, unfairly pointed at insurance companies. As I mentioned earlier, they cannot raise premiums at their whim and 80% or 85% of premiums must go to providers, any additional premiums collected are returned.

As far as the government providing free health care and dental care- I think theoretically a government should but given the culture of the citizens here we’re way too far away from that becoming a reality. (The money has to come from somewhere and people need to take more responsibility for their health. Until that happens any attempt will implode pretty fast.)

I feel bad for you for the trouble you’re going through with health insurers- I normally don’t have those kinds of stories. The issues I’ve had normally begin with a claim being denied due to a provider putting an incorrect diagnosis code or procedure code (they’re extremely confusing) and then the insurance company not paying until the error is corrected. I then get the run around from the provider who wants to get paid (their billing department says that they can’t change what the doctor wrote) and the doctor who doesn’t have time to call back or review / correct the records. These could take months to resolve and even get sent to collection agencies (I know it’s frustrating) but ultimately, it’s not the insurer at fault.

As far as the story you mentioned is concerned- I hope that’s the exception and not the norm. I found it sickening that they were willing to save money by taking a business risk at the expense of a different human’s quality of life. Equally as sickening was the immature giggling you can hear in their phone conversation when they came up with the excuse to discontinue his drug coverage. (Even if they had a valid reason to deny the claim- any human that can laugh at saving money at the expense of another human has no business being making any health decision for anyone else.)

If this unfortunately does go on on a regular basis then I take back what I wrote earlier and agree that health insurers share a larger percentage of blame in this mess than I earlier attributed to them.

Have a Gut Shabbos