Pick your health insurance poison!

MaggieD said:

I spent four years as a trustee in a small town in Wisconsin. People who said, "We tried that," "It's already being done," and "We'll just have to live with it," were impeders of progress. So much so, that our Board of Trustees used to roll our eyes in unison.

As to your commentary that others know better, I'm sure that's true. But anyone advocating no more specialists as in cardiologists, pulmonologists, otorhinolaryngologists, orthopedists, obstetricians, heart surgeons, brain surgeons, cancer specialists, pediatricians, etc., is ONLY interested in saving money and not quality of care. I have no idea why specialists would increase the cost of care, but I'll bow to that narrow expertise you claim. Even if specialists do increase cost of care, I think the results are worth it. Saving money by decreasing quality care is plain stupid.

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No one said 'no specialists'.

But there's a reason HMOs have always used a primary care physician as a 'medical home' and required referrals to specialists. Because it saves a ton of resources.

Cardiologists don't need to manage most people's blood pressure and lipids. Surgeons will treat with surgery by default- primary care physicians will consider more cost effective means.

MaggieD said:

I'd imagine decreasing regulations on hospital construction would be a factor. And perhaps having hospitals justify their major equipment purchases would help. When hospitals are five miles apart and each has a half-million-dollar piece of equipment that's only utilized 25% of the time, there's room for consolidation.

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Presumably the regulations you're talking about the state-level ones requiring hospitals to justify new capital expenditures--which exist for exactly the reason you're re-proposing them literally a sentence after rhetorically repealing them.

Treating insurance companies similar to utilities that have to justify rate increases might help.

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We do that right now.

There are challenges with the thread-poll's leading answer, individual mandate -- it needs to be higher to be effective: To work as intended, Obamacare needs a bigger, more unpopular mandate - Vox.

The ACA is a lot like Las Vegas -- for the comparatively fewer winners to get paid, in addition to those who think they may win but way more than often don't, a lot of people who see themselves as likely losers have to play the game too. Tweaking around wth the "rules of the game" is often about attempting to convince, persuade, or compel those who think they'll end up losing to play anyway .. and, indeed, lose. Of course, the difference ends, as Vegas can be exciting and fun even if you know you'll likely lose -- playing the ACA isn't as fun.

One suggestion I read earlier in this thread was to have essentially two systems: 1) the one prior to the ACA as it was, and 2) a public single-payer one only for "emergencies". Very interesting. The details would really need to be worked out.

Regardless, it's important not to forget that the ACA was never about getting everyone covered for getting everyone covered's sake. It was about preventing ERs, urgent cares, and trauma centers -- absolutely essential to communities -- from going belly-up from lack of payment for services. Though the ACA helped to increase payment amounts to something above zero from certain people, it is only barely shoring these institutions up because the continuing defaulted consumer co-insurance amounts are still quite high in bronze/subsidized plans.

If we really wanted everyone to be covered, I would think we would have succeeded .. unless, of course, the individual mandate penalty that needed to be high enough to do so was politically reduced back then .. which it was.

Heck, if I was young and healthy, I'd want to take the risk and not have insurance .. but if I was getting killed on April 15th, I might think differently. Of course, then there goes the consumer economy bolstered by young people with money, as they would then direct their free-spending dollars to health insurance .. and a number of other industries would fall.

Within the capitalist framework, I don't see a universal coverage situation occurring. Not everyone likes to gamble .. and I doubt you can really communistly compel them to play health roulette without having a national revolt on your hands.

Threegoofs said:

LOL. This is a good one.

Dont allow the premiums to increase to what insurance companies need to cover for pre-existing conditions, and make it illegal to deny coverage... yet who is going to pay for those patients who will be loss leaders?

Hey! I have an idea! Why not make sure ALL the healthy people have insurance and they can help cover the increased costs of those patients? We can call it an 'individual mandate'.

And decreasing the cost of medical school might help decrease cost of health care? How does that magic happen?

Maybe we could encourage more doctors to go into primary care, and discourage specialists, since thats where a lot of cost is sunk in - that will also decrease costs to physicians for going thru school since they spend less time in residency/fellowship.

Oh, wait, The ACA thought of that, too.

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You didn't even read what I wrote.

Neomalthusian said:

The fact that you think the health insurance industry has a 20% profit margin is very sad. I mean how embarrassing that you actually thought that. Wow! But hey, look on the bright side, you learned something just now.

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It isn't profit, but if you cut out the entire insurance industry, you will have saved a ton of money for the consumer. How much, I have no idea, but certainly not having to pay all of that infrastructure saves costs.

Greenbeard said:

If you want health insurance to cover pre-existing conditions through no fault of their own, you need to figure out how to avoid creating an incentive for healthy people to free-ride by waiting to buy coverage until they get sick.

Politico did a decent round-up of the available options a few days ago: GOP boxed in replacing unpopular Obamacare coverage mandate.

There is, of course, the individual mandate--an annual penalty for failing to buy insurance.

Or you could give people one chance to sign-up and, as long as they never have any lapse in coverage (say, going insured for a few months because one is between jobs, etc) there are no pre-existing condition exclusions. Health insurance then works sort of like a door that locks behind you--as long as you don't ever exit it for any reason, you're fine.

Or you could let people go uninsured if they wish, but penalize them--permanently--with higher premiums through an extra surcharge if they ever decide they do want to buy insurance.

Or you could just enroll people into coverage without their permission, on the theory (with some backing in behavioral health economics) that they'll just go with it.

Or you could subsidize coverage to the point it's so cheap, why wouldn't you get insurance? Of course that's kind of expensive.

Or we could give up on the whole idea and just bring back pre-existing conditions and potentially lock a fair number of folks out of the market.

Anyway below is some of Politico's preliminary descriptions of those options. What's the best way to go?

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I was going to make this exact same thread...

Not sure what I was expecting but I don't think it was for the individual mandate to be the most appealing option to folks.

Greenbeard said:

Not sure what I was expecting but I don't think it was for the individual mandate to be the most appealing option to folks.

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The poison you know is always better than the poison you don't.

Greenbeard said:

If you want health insurance to cover pre-existing conditions through no fault of their own, you need to figure out how to avoid creating an incentive for healthy people to free-ride by waiting to buy coverage until they get sick.

Politico did a decent round-up of the available options a few days ago: GOP boxed in replacing unpopular Obamacare coverage mandate.

There is, of course, the individual mandate--an annual penalty for failing to buy insurance.

Or you could give people one chance to sign-up and, as long as they never have any lapse in coverage (say, going insured for a few months because one is between jobs, etc) there are no pre-existing condition exclusions. Health insurance then works sort of like a door that locks behind you--as long as you don't ever exit it for any reason, you're fine.

Or you could let people go uninsured if they wish, but penalize them--permanently--with higher premiums through an extra surcharge if they ever decide they do want to buy insurance.

Or you could just enroll people into coverage without their permission, on the theory (with some backing in behavioral health economics) that they'll just go with it.

Or you could subsidize coverage to the point it's so cheap, why wouldn't you get insurance? Of course that's kind of expensive.

Or we could give up on the whole idea and just bring back pre-existing conditions and potentially lock a fair number of folks out of the market.

Anyway below is some of Politico's preliminary descriptions of those options. What's the best way to go?

Click to expand...

Why isn't "single payer" an option? It'd be emotionally unsatisfying to me, but it's the 'better' option... relatively.

Greenbeard said:

If you want health insurance to cover pre-existing conditions through no fault of their own, you need to figure out how to avoid creating an incentive for healthy people to free-ride by waiting to buy coverage until they get sick.

Politico did a decent round-up of the available options a few days ago: GOP boxed in replacing unpopular Obamacare coverage mandate.

There is, of course, the individual mandate--an annual penalty for failing to buy insurance.

Or you could give people one chance to sign-up and, as long as they never have any lapse in coverage (say, going insured for a few months because one is between jobs, etc) there are no pre-existing condition exclusions. Health insurance then works sort of like a door that locks behind you--as long as you don't ever exit it for any reason, you're fine.

Or you could let people go uninsured if they wish, but penalize them--permanently--with higher premiums through an extra surcharge if they ever decide they do want to buy insurance.

Or you could just enroll people into coverage without their permission, on the theory (with some backing in behavioral health economics) that they'll just go with it.

Or you could subsidize coverage to the point it's so cheap, why wouldn't you get insurance? Of course that's kind of expensive.

Or we could give up on the whole idea and just bring back pre-existing conditions and potentially lock a fair number of folks out of the market.

Anyway below is some of Politico's preliminary descriptions of those options. What's the best way to go?

Click to expand...

I selected option #2:

Or you could give people one chance to sign-up and, as long as they never have any lapse in coverage (say, going insured for a few months because one is between jobs, etc) there are no pre-existing condition exclusions. Health insurance then works sort of like a door that locks behind you--as long as you don't ever exit it for any reason, you're fine.

radcen said:

Why isn't "single payer" an option? It'd be emotionally unsatisfying to me, but it's the 'better' option... relatively.

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The premise of the question is that we're going to stick with a near-universal system based on private coverage.

So this is the question the GOP has to answer this year: bring back pre-existing conditions and take away people's coverage, or put in place something to prevent insurance markets from imploding (well, or just keep the individual mandate in place--perhaps strengthening it as some have suggested above). So what is "something"?

I don't expect that their answer to that question will be single-payer. So realistically the available options are in the poll.

Greenbeard said:

If you want health insurance to cover pre-existing conditions through no fault of their own, you need to figure out how to avoid creating an incentive for healthy people to free-ride by waiting to buy coverage until they get sick.

Politico did a decent round-up of the available options a few days ago: GOP boxed in replacing unpopular Obamacare coverage mandate.

There is, of course, the individual mandate--an annual penalty for failing to buy insurance.

Or you could give people one chance to sign-up and, as long as they never have any lapse in coverage (say, going insured for a few months because one is between jobs, etc) there are no pre-existing condition exclusions. Health insurance then works sort of like a door that locks behind you--as long as you don't ever exit it for any reason, you're fine.

Or you could let people go uninsured if they wish, but penalize them--permanently--with higher premiums through an extra surcharge if they ever decide they do want to buy insurance.

Or you could just enroll people into coverage without their permission, on the theory (with some backing in behavioral health economics) that they'll just go with it.

Or you could subsidize coverage to the point it's so cheap, why wouldn't you get insurance? Of course that's kind of expensive.

Or we could give up on the whole idea and just bring back pre-existing conditions and potentially lock a fair number of folks out of the market.

Anyway below is some of Politico's preliminary descriptions of those options. What's the best way to go?

Click to expand...

I am not by any means an expert on this topic.

However, it seems that if you want to maintain some level of competition in the healthcare market, and at the same time ensure that people with pre-existing conditions can have healthcare coverage, you're going to end up subsidizing those people in some way in the end.

Perhaps an automatic enrollment in some kind of basic healthcare at, say, age 21 (before that, on parent's HC), with subsidies to ensure you can pay for it.
Allow people the option to upgrade their healthcare if they desire, so long as they can afford it.

The problem is, you could not allow an opt-out, because if you did, it would make the whole thing pointless. So I'm not sure that would be constitutional. Is it constitutional to require people to pay for something?
Meeting the constitutionality requirement might require that people pay taxes to the government, then the government purchase the healthcare for them.

Not sure.

I live in Saskatchewan. Like all residents of the Province, I am covered by Saskatchewan Health (Government). We pay no premiums. It is all paid for by our taxes out of general revenue. If I need to see my doctor or have to go to hospital, there is no extra charge. Certain procedures such as cosmetic surgery are not covered, but for the important things, I don't have to worry. Yes, for some non-emergency procedures, there is a wait time.
The U.S. could emulate our system by taking money from the bloated defence budget.
It is your country, but I'm just pointing out an obvious solution.

Greenbeard said:

The premise of the question is that we're going to stick with a near-universal system based on private coverage.

So this is the question the GOP has to answer this year: bring back pre-existing conditions and take away people's coverage, or put in place something to prevent insurance markets from imploding (well, or just keep the individual mandate in place--perhaps strengthening it as some have suggested above). So what is "something"?

I don't expect that their answer to that question will be single-payer. So realistically the available options are in the poll.

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I get what you're saying, and you narrowing it down does make sense.

To me, though, this "hybrid"... this unnatural balance between government control, semi-free market, protectionism, etc... is a big part of the problem, and if we continue with any type of hybrid we're just going to keep having the same problems.

I voted for the Continuous Coverage Requirement but it should have read Continuous mandatory Coverage Requirement in insurance policies.

If we are going to keep the private insurance market, then automatic enrollment is the way to go.

It is Behavioral Economics 101. You make the default what you want people to do. For example, if you want more people to save for retirement, you automatically enroll them in a 401k and let them opt out if they want. Similarly, if you want more young people to have coverage (to make the insurance market more actuarial sound for everyone else), you automatically enroll them in a catastrophic plan and give them the option of leaving it if they want.

queenmandy85 said:

I live in Saskatchewan. Like all residents of the Province, I am covered by Saskatchewan Health (Government). We pay no premiums. It is all paid for by our taxes out of general revenue. If I need to see my doctor or have to go to hospital, there is no extra charge. Certain procedures such as cosmetic surgery are not covered, but for the important things, I don't have to worry. Yes, for some non-emergency procedures, there is a wait time.
The U.S. could emulate our system by taking money from the bloated defence budget.
It is your country, but I'm just pointing out an obvious solution.

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If the US took money from defense to pay for a system like Canada who would defend Canada? Germany? Japan? and so on?

My main concern with a requirement to have insurance is that people will not be able to afford it, and being required to pay for would cause issues in other areas.

It's not like the requirement for car insurance (in my state), where you can opt out of having a car, and avoid the costs.


Well...I mean, technically, you CAN opt out of being alive, but...

antiquity said:

If the US took money from defense to pay for a system like Canada who would defend Canada? Germany? Japan? and so on?

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Canada has only been attacked twice; both times by the United States (American Revolution and 1812). Our other two major wars were both World Wars and Canada was at war for three years in both conflicts before the United States entered the war. Without a doubt, the American entry into the wars tipped the balance for the Allies and we are very grateful. The point is, we should not depend on the USA to save us next time.
Back to the point, the United States has the greatest military in history and is capable of destroying any combination of opponents with only half it's defence budget. I respectfully suggest a portion of that money would be sufficient to pay for universal health care.
But then, as Trudeau said the other day, it is not for non-Americans o lecture you on how to govern yourselves. No matter who you elect or how you run your country, you are still our best friends.

queenmandy85 said:

Canada has only been attacked twice; both times by the United States (American Revolution and 1812). Our other two major wars were both World Wars and Canada was at war for three years in both conflicts before the United States entered the war. Without a doubt, the American entry into the wars tipped the balance for the Allies and we are very grateful. The point is, we should not depend on the USA to save us next time.
Back to the point, the United States has the greatest military in history and is capable of destroying any combination of opponents with only half it's defence budget. I respectfully suggest a portion of that money would be sufficient to pay for universal health care.
But then, as Trudeau said the other day, it is not for non-Americans o lecture you on how to govern yourselves. No matter who you elect or how you run your country, you are still our best friends.

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Opinions not based on facts. The fact is when the Germans and Japan declared war and attacked England and English military forces, they declared war on the entire British empire which includes Canada.

Another fact is the Obama administration degraded and downsized the US military capacity, especially our air force. I doubt the US military would be battle ready if two major conflicts broke out at the same time.

queenmandy85 said:

Canada has only been attacked twice; both times by the United States (American Revolution and 1812). Our other two major wars were both World Wars and Canada was at war for three years in both conflicts before the United States entered the war. Without a doubt, the American entry into the wars tipped the balance for the Allies and we are very grateful. The point is, we should not depend on the USA to save us next time.
Back to the point, the United States has the greatest military in history and is capable of destroying any combination of opponents with only half it's defence budget. I respectfully suggest a portion of that money would be sufficient to pay for universal health care.
But then, as Trudeau said the other day, it is not for non-Americans o lecture you on how to govern yourselves. No matter who you elect or how you run your country, you are still our best friends.

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We are getting our asses kicked by the JV team.

A rather attenuated assumption. You've not any fact presented to support your claim. Do tell.

In 1914, Britain declared war for Canada. In 1939, Canada was independent and did not declare war on Germany until a week after Britain.
Enough of thread drift.