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Strengh in Numbers

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Old 11-15-2002, 08:59 AM   #1
King of the Americas
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Post Strengh in Numbers

Yesterday, my significant other brought home her company's new health insurance policies and costs, along with some additional information about the company's make-up

The insurance agency offered several different plans with several different levels of coverage, different deductibles, and so on, with the company offering to pay the first $140 on whatever plan we choose.

Starting at a $1500 deductible, one month's coverage would cost my fiancee and I some $194 AFTER her company's contribution, and ending with a $250 deductible costing some $400 a month, neither plan (or any in between) sounding too affordable to me.

Moreover, it was noted that the only reason they were able to land these 'reasonable rates' was that the company now boasted a tally of some 20,000 employees.

The proposition I would like to pitch to the owner of said company is that he should considered localizing or privatizing the health coverage for all his workers, by creating his own 'insurance policy'.

I break it down like this:

IF all 20,000 workers were to contribute some $300 each (per month), in the first month alone there would be some $6 million collected in premiums to create a pot/titty. And in the first year, would grow to some $72 million. After reviewing the CDC website, I found that this would be much more than necessary enough to cover the 'average' medical costs that a population of 20,000 (living is this area) would incure. In fact, the numbers I found hinted that 20,000 people in this area (without inducing a deductible of any kind) would incure some $5-15 million in medical debt, thus still leaving the pot quite full.

However, I didn't want to stop here.

After a year of the normal premiums (those averge one offered by the insurance agency), I want to suggest that we STOP increasing the amount in the general fund, by decreasing the premiums to reflect only an eqaul distribution of the losses incured the previous year.

Such that:

In 2002, the pot garnered some $72 million in collected premiums, and paid out $15 million in claims, leaving only $57 million. And thus to recoup the losses, take the $15 million divide it by 20,000, and again by 12 to arrive at the cost per month for each policy holder. You could even add another million to costs incured to pay for some to literally cut the checks to the medical facilities and keep track of the account taking in premiums and paying hospitals.

The idea is as simple as discontinuing the concept of using insurance to create profits, and instead use it to insure the most coverage, with the least premiums and deductibles.

Why is this a bad idea?

What would be required to make it work?


Is this just a dumb idea from conception?

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Old 11-15-2002, 10:43 PM   #2
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Do you know all the rules and regulations necessary to carry this idea out. Do you have cost figures on what is a reasonable charge for a hernia surgery or to fix a broken arm?? Remember if you don't have a reasonable charge for each and everything that a patient might see the doc for then the doc can charge whatever he wants for his services. My dad ran into this years ago when his orthopedic doc submitted his bill to the company's insurance and the insurance refused to pay it because they felt it was an unreasonable charge. They haggled over this for months. You also have to know all the laws and regulations related to insurance, hospitals, doctors and what not. Personally the rates don't sound to terribly bad from what you posted. My first suggestion is to have your Significant other check around with her friends to find out what they pay for insurance each month and what kind of benefits they get for this money etc so she has an idea of how her company's proposed plans compare up.

Old 11-20-2002, 09:23 AM   #3
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Since my original post, I have done MUCH research on this issue.

Indeed injury caps, and an "eye wide open" policy should and would be a good issue for all policies to use, but they aren't some insurance companies set limits, and some don't.

My point is that these premiums amounts, while possbily in step with others that offer similar coverage, are bound by a profit motive. Whereas my contention is that IF a policy's purpose was simply to recoup last year's losses, the premiums would HAVE to drop drastically.

Moreover, the size of an insurance company, would force even higher premiums to pay said salaries. There HAS to be a minimal working number that would allow plenty of room in the pot/kitty to pay out the really big claims, and still small enough so that it could be operated with maximum efficiency.

I am still doing research, and have not yet completed my pitch plan to said business owner.

Old 11-20-2002, 07:36 PM   #4
Join Date: Jan 2001
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plymouth HB User

You don't have to re-invent the wheel.

A lot of companies nowadays are self-insured.

They pay claims as they come in and carry a
catastrophic type insurance policy to cover
the really huge unexpected claims.

Even individuals do this. They have medical savings
accounts and buy cheaper insurance policies with
large deductibles and just pay the smaller bills from
their own savings.


Old 11-21-2002, 11:50 AM   #5
King of the Americas
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Well, the point of my evolved plan is evidnece in the subject of my post.

Working together we can each share in a plan that allows for the lowest premiums, while paying out the most claims. As long as we keep the 'profit motive' out of the equation, we could easily afford and maintain a sizable kitty paying in less than $100 a month per person for full coverage.

Old 11-27-2002, 07:08 PM   #6
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EcoPunk HB User

Question: Were you counting on all 20,000 people to contribute? Because most likely half will decline coverage, simply because they don't want it, or because their spouse gets it from their company. The plan does sound good, though. I really hate profit-driven insurance. I feel really cheap now, though. The insurance at my other job was only $90 per month, and i was hesitant to take it because i thought it cost too much! (I'm just starting out in the work world).

Old 11-30-2002, 04:52 PM   #7
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Jaytor HB User


Look up SPSS, the company that develops and sells statistical programs for social sciences.

SPSS and its CEO were recently covered in 60 Minutes. Based on what I caught, I believe that this company did similar research and reached similar conclusions. In fact, in addition to having their own doctors, SPSS also has on-staff social workers [to help middle-aged employees find help/services for their aging parents], physiotherapists, dietitians, etc. SPSS also offers the more typical employee perqs [tennis courts, country club, daycare, dry cleaning, etc.].

SPSS is a private company, highly respected in its field and, apparently, has a very large share of this market and is very profitable. The sole shareholder/owner feels the best way to recruit and keep bright people working effectively - and efficiently - is to look after their needs.

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