Insurance as maintenance
04-15-2006, 03:27 AM
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Insurance as maintenance
Comments about health insurance in the "office peeves" thread got me to thinking...
What we now think of as health "insurance" has changed in my lifetime (I think) from insurance in the car insurance mode (i.e., in case of an accident or other "illness") to a way to pay for routine maintenance (i.e., for annual checkups and other routine procedures). Given the cost of some of those procedures, and given the cost breaks that the carriers have negotiated, it's a good thing, too (a colonoscopy via insurance just went for about a factor of ten less than the original billing -- not my cost, the whole thing). But, clearly, using insurance for maintenance adds to the cost of the coverage. On the other hand, surely it's wise, for either carriers or individuals, to spend money on preventive care rather than waiting for something bad to happen.
But this attitide is contagious. Here in Florida, people use their homeowners policies in the same fashion. Need a new roof? Wait for a big storm and make a claim and get one. I could create a long list. Add this to fraud (a neighbor had a couple of ripped screens in a pool enclosure after Wilma, got a check for replacing the entire enclosure, fixed only the screens, and pocketed the difference, for example), and you get astounding homeowners' premiums.
So, what's with this? Is it just part of our entitlement culture, or what?
HPH
What we now think of as health "insurance" has changed in my lifetime (I think) from insurance in the car insurance mode (i.e., in case of an accident or other "illness") to a way to pay for routine maintenance (i.e., for annual checkups and other routine procedures). Given the cost of some of those procedures, and given the cost breaks that the carriers have negotiated, it's a good thing, too (a colonoscopy via insurance just went for about a factor of ten less than the original billing -- not my cost, the whole thing). But, clearly, using insurance for maintenance adds to the cost of the coverage. On the other hand, surely it's wise, for either carriers or individuals, to spend money on preventive care rather than waiting for something bad to happen.
But this attitide is contagious. Here in Florida, people use their homeowners policies in the same fashion. Need a new roof? Wait for a big storm and make a claim and get one. I could create a long list. Add this to fraud (a neighbor had a couple of ripped screens in a pool enclosure after Wilma, got a check for replacing the entire enclosure, fixed only the screens, and pocketed the difference, for example), and you get astounding homeowners' premiums.
So, what's with this? Is it just part of our entitlement culture, or what?
HPH
04-15-2006, 04:12 AM
#2
I think some people have the mentality that they get tired of paying premiums and never receiving anything back. A small claim comes along and they look to make a profit on it, and to get some of their premiums back in the process.
04-15-2006, 04:52 AM
#3
Don't get me started. Insurance companies use to fight these bogus claims tooth and nail. However, over the years the attitude in this country changed from one that values personal responsibility to one that celebrates excuses and the shift of blame. Today, insurance companies have a very difficult time enforcing the policy provisions and juries and judges alike are willing to apply very liberal rules of contract construction to find coverage. In the end, it has become much simpler for the insurance companies to raise the premiums to pay for the expanded coverage.
04-15-2006, 07:10 AM
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I think this is another perception that has become reality. My father's (age 83) answer is "everybody does it" to issues like: drive in the left hand lane because it's smoother, get a handicapped sticker when you don't need it, having cheated on your taxes, low-balling means testing to get services, I deserve it because I went through the Depression and fought in the Big One, I deserve my social security even though his contribution petered out a dozen or more years ago, Bill C. not telling the truth about Monica, etc. I think it has become part of our culture to play "revenge of the nerds." I think our "media" supplies us with daily and endless examples of people "sticking it to the man."
Last year one of our condo members - who works in Hungary - forgot to turn off his water during one of his extended absences. Short story is that the toilet supply line upstairs started leaking and slowly over a period of who-knows-how-long cascaded 56,000 gallons of water down to the crawl space. The heating system evaporated water and it condensed everywhere resulting in 2000 sqft of mold. Even though he previously was a Trustee and helped draft the "negligence rules" for the association he threatened legal action. The insurance company ponied up over $70k cleanup and repairs saying that regardless of the rules, we/they will lose in court.
It's one thing to talk about "personal responsibility", it's quite another to walk the walk.
Last year one of our condo members - who works in Hungary - forgot to turn off his water during one of his extended absences. Short story is that the toilet supply line upstairs started leaking and slowly over a period of who-knows-how-long cascaded 56,000 gallons of water down to the crawl space. The heating system evaporated water and it condensed everywhere resulting in 2000 sqft of mold. Even though he previously was a Trustee and helped draft the "negligence rules" for the association he threatened legal action. The insurance company ponied up over $70k cleanup and repairs saying that regardless of the rules, we/they will lose in court.
It's one thing to talk about "personal responsibility", it's quite another to walk the walk.
04-15-2006, 12:44 PM
#6
I have nothing but anger for those people who cheat at any and everything they can possibly "get away with". It never occurs to me to even think of turning in an insurance claim for something that isn't a fair claim. It galls me to think that I'm paying for all these low-lives who cheat, but the same is true for even groceries, clothing or anything we buy. We're paying for the scammers, thieves and scum who steal, lie and cheat. Honesty is becoming rare. 
04-15-2006, 02:05 PM
#7
You know, there really is enough blame here for everyone. There are lots of sides to the story and lots of reasons that we've ended up where we are.
Don't blame the middle class wage earner for trying to take advantage of the HMO when he is paying $11,000 a year for coverage and has a $200 claim denied. You'd feel taken advantage of too.
Don't blame the tax payer for trying to sneak in another $500 deduction when he sees rules written allowing the business owner to expense his entire SUV on his company. You'd feel like a fool if you didn't try too.
Don't blame the motorist for being angry about $2.75 dollar a gallon gasoline when he hears that ExxonMobil has just had record profits right after he hears an executive from ExxonMobil say that the oil companies have nothing to do with the price increases. You'd lose faith in everyone's word too.
Don't blame your average citizen for not wanting to live by the rules when he sees how the rules get bent by people in government and big business. You'd bend them too.
I'm not saying it's right, just that it's understandable. If you want to straighten things out, and you want people to live by the rules, you have to have all people live by the rules. And, you have to be consistent.
Don't blame the middle class wage earner for trying to take advantage of the HMO when he is paying $11,000 a year for coverage and has a $200 claim denied. You'd feel taken advantage of too.
Don't blame the tax payer for trying to sneak in another $500 deduction when he sees rules written allowing the business owner to expense his entire SUV on his company. You'd feel like a fool if you didn't try too.
Don't blame the motorist for being angry about $2.75 dollar a gallon gasoline when he hears that ExxonMobil has just had record profits right after he hears an executive from ExxonMobil say that the oil companies have nothing to do with the price increases. You'd lose faith in everyone's word too.
Don't blame your average citizen for not wanting to live by the rules when he sees how the rules get bent by people in government and big business. You'd bend them too.
I'm not saying it's right, just that it's understandable. If you want to straighten things out, and you want people to live by the rules, you have to have all people live by the rules. And, you have to be consistent.
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04-15-2006, 02:42 PM
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VAL: You get the grand slam for that one!
Rob: I see your examples and points too, but unfortunately that's how it is seemingly become culturally acceptable. Rationalization and equivocation doesn't make it right. It seems to be an acquired trait, being that for many or most persons these are parental priorities. The real issue is how do we get back to "I will not lie, cheat, or steal nor tolerate those who do." Too idealistic I suppose? I sure don't have the answer.
Rob: I see your examples and points too, but unfortunately that's how it is seemingly become culturally acceptable. Rationalization and equivocation doesn't make it right. It seems to be an acquired trait, being that for many or most persons these are parental priorities. The real issue is how do we get back to "I will not lie, cheat, or steal nor tolerate those who do." Too idealistic I suppose? I sure don't have the answer.
04-15-2006, 04:18 PM
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Originally Posted by RC-Ryder
The real issue is how do we get back to...
No, wait. They have their issues, too, with various sorts of intolerance. Hmm.
One of the things that turned me off about Santa Fe (I think you've probably read that I think of it as a GREAT place to visit...) was this business of taking advantage, lying and cheating to get an edge.
Well, here in the affluent suburbs, it's truly an art form. For example, very rich people bought very expensive automated home generator systems after the hurricane, got reimbursed by FEMA, and turned around and sold the systems to the highest bidder, because the generators they already had worked just fine, thank you. There's more, but I won't bother. The west looks better and better than scam-ville on the Atlantic.
Rob's point is well taken, though. At the same time, what you can do and retain some semblence of integrity is to push the rules to their limit (but not beyond). Of course, that's just what good tax accountants have been busy doing for the past few months.
HPH