Reply
 
Thread Tools Display Modes
  #1  
Old 08-02-2019, 08:17 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320

I get the argument for Medicare for all, but what is the argument for abolishing private insurance?


While I can't say I read policy papers on health insurance, I certainly keep up with the daily news. I certainly understand why Warren and Sanders would want Medicare for All, but I don't know their argument for abolishing private insurance. The only arguments I've seen thus far just state an aversion to insurance companies making billions on the backs of the sick. I'm guessing that's not their real argument because if Medicare for All were actually better than private insurance, then people would drop their private insurance insurance anyway. I'd think a politician would welcome private insurance to ease the burden on the government. My guess is these pols believe that somehow private insurance would interfere with the administration of MFA or the ability to negotiate with pharmas and doctors, but I'm not sure,. Can anyone please clue me in? Thanks.
  #2  
Old 08-02-2019, 08:31 AM
UltraVires is offline
Guest
 
Join Date: Jul 2007
Location: Bridgeport, WV, US
Posts: 15,782
From my understanding, Sanders (and others) want an expanded version of Medicare that would cover absolutely anything and everything with no deductibles and no copays. I think the only exception he said was for elective cosmetic surgery.

So, under such a plan, there would be no need for private insurance because, what is there to insure?
  #3  
Old 08-02-2019, 08:38 AM
Wesley Clark is online now
2018 Midterm Prediction Winner
 
Join Date: Aug 2003
Posts: 22,348
I assume it's just disgust at how private insurance acts, and a feeling that based on their behavior of making money by being an unnecessarily middle man who makes money by causing suffering, the industry deserves to die.

However most nations with UHC have a role for private insurance. If anything systems without private care options are the exception rather than the rule.
__________________
Sometimes I doubt your commitment to sparkle motion
  #4  
Old 08-02-2019, 09:19 AM
naita is offline
Guest
 
Join Date: Jun 2002
Location: Norway
Posts: 6,640
As far as I can tell there is no plan to directly abolish private insurance, but I can be wrong since I'm just going from the statements I can find on the presidential campaign websites. It's just that with a system covering the vast majority of medical needs the medical insurance industry as it exists today would be gone.

There are in fact potential issues with private insurance in a system of UHC. It can be observed in practice in Norway, where the public option is not an insurance system at all (unlike many countries with UHC). But I think that's a topic for a thread that doesn't start with a misunderstanding of the policy positions of Warren and Sanders.
  #5  
Old 08-02-2019, 09:43 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
Mathematically: Insurance is a pooled risk program. For the insureds, the pool works better the larger it is and the more representative of the population of a whole. In the arena of health care, where there does seem to be a general consensus towards the necessity of health insurance coverage, having private insurance breaks these pools apart, decreasing their financial stability, increasing the costs on the enrollees, and imposes additional costs by the duplication of effort - especially managerial and executive level effort - needed to run 6 major insurance organizations instead of 1.

Personal: Delores Claireborne works at The Texas Mental Health Association, a non-profit which is the major mental health services provider for a three-county area in Texas centered around Cotulla. Delores gets paid 26 times per year, has 1 child, and per her divorce agreement from that drunken bastard, has to provide the child with health insurance.

Delores has the following employee+child options (Plan, per paycheck, annual premium, deductible, Out of Pocket Max, amount paid out of pocket before insurance covers 100% of medical expenses)

1. High Deductible, $234.06, $6,085.56, $5000.00, $5,000, $11,085.56)
2. Medium Deductible, $295.34, $7,678.84, $2,500, $5,500, $13,178.84)
3. Low Deductible, $362.57, $9,426.82, $1,000, $4,000, $13,426.82)

Oh, in addition to this, her employer covers $4,919.78 for her medical and life insurance. Group life is $20/month/enrollee (it's cheap), so the employer pays, in addition to the 2nd item in each of the rows above, $4,679.78.

Total cost of insurance if Delores never goes to the doctor and has the cheapest plan: $10,765.34 ($6,085.56 out of Delores's pocket)
Total cost of insurance if Delores has $5,000 of expenses: $15,765.34 ($11,085.56 out of Delores's pocket)
Total cost of insurance if Delores has $700,000 of expenses: $15,765.34 ($11,085.56 out of Delores's pocket)

Median household income in Cotulla is $34,567 - Delores earns $40k pre-tax, $37,500 after tax.

Out of pocket health insurance premium as a % of take-home income: 16.22%
Out of pocket health insurance as a % of take-home income, assuming Delores hits the out of pocket max: 29.56%

Notes:

1. These are real numbers. Names are made up, I mixed and matched clients, we do business in Cotulla but not with anything called "Texas Mental... whatever". But the numbers are real.
2. This is, in no way, unusual for small business group medical insurance rates for the state of Texas.
3. The employer is rather generous here - they effectively pay for the employees insurance, meaning this is the cost to cover her 1 child.
4. The most expensive plan: $763.20 per pay period, $19,843.20, annually for employee, $24,522.98 total annual premium

The above is repeated... 4.7 million times... across Texas.

That's my argument against.

Last edited by JohnT; 08-02-2019 at 09:48 AM.
  #6  
Old 08-02-2019, 09:49 AM
PastTense is offline
Guest
 
Join Date: Jan 2013
Posts: 7,733
Suppose you see a surgeon about whether or not you need an operation.
1. Private insurance--you see him tomorrow
2. Medicare for all--6 week delay for appointment

Surgeon says you need surgery immediately, sets up operation. If patient has Medicare for all pay for the operation then his private insurance has allowed him to jump the queue.

So with a private insurance option you would need complicated rules for a patient about switching between the two payment methods.
  #7  
Old 08-02-2019, 10:03 AM
steronz is offline
Guest
 
Join Date: Feb 2007
Location: Oh-hiya-Maude
Posts: 5,057
I got a little bit of clarification in the Elections thread, but I'm still confused by Sanders' push to actually ban most private insurance.

I understand making MFA mandatory -- right now Medicare acts as the insurer of last resort for a population that probably couldn't get private insurance at any cost, and the result is that private insurers get to make billions of dollars on younger, healthier people while the government foots an increasingly large bill for older, more expensive people. If we're going to have a shared risk pool, let's not let people opt out of it just so a private company can make a profit.

I also understand that making MFA mandatory would effectively destroy the market for most private insurance. But banning it? Certainly enterprising insurance companies could find a way to offer supplement insurance for those who want it, even if Sanders' MFA is the Cadillac plan of all Cadillac plans.
  #8  
Old 08-02-2019, 10:10 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by naita View Post
As far as I can tell there is no plan to directly abolish private insurance, but I can be wrong since I'm just going from the statements I can find on the presidential campaign websites. It's just that with a system covering the vast majority of medical needs the medical insurance industry as it exists today would be gone.

There are in fact potential issues with private insurance in a system of UHC. It can be observed in practice in Norway, where the public option is not an insurance system at all (unlike many countries with UHC). But I think that's a topic for a thread that doesn't start with a misunderstanding of the policy positions of Warren and Sanders.
How exactly is this a thread that starts with a misunderstanding of Warren's and Sander's policy position? When Lester Holt asks in the debate "Who here wants to abolish private health insurance?" and they both raise their hand, I shouldn't interpret that to mean they don't want to abolish private health insurance?
  #9  
Old 08-02-2019, 10:17 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
Again, since the general consensus appears to be that all Americans deserve health coverage of one sort or another, mathematically when the pool is 100% of the population, you don't want to break that pool into separate pools as it does nothing but decreases financial viability, and vastly increases administrative burden.

OTOH, if we decide that health insurance should be like chocolate - something you get when you want to pay for it - than separate pools might make sense (as they do with life insurance - but try to get an affordable life insurance policy if you have type-2 diabetes). But when the consensus is that everyone should be covered, they do not.

Last edited by JohnT; 08-02-2019 at 10:18 AM.
  #10  
Old 08-02-2019, 10:23 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by JohnT View Post
Mathematically: Insurance is a pooled risk program. For the insureds, the pool works better the larger it is and the more representative of the population of a whole. In the arena of health care, where there does seem to be a general consensus towards the necessity of health insurance coverage, having private insurance breaks these pools apart, decreasing their financial stability, increasing the costs on the enrollees, and imposes additional costs by the duplication of effort - especially managerial and executive level effort - needed to run 6 major insurance organizations instead of 1.

Personal: Delores Claireborne works at The Texas Mental Health Association, a non-profit which is the major mental health services provider for a three-county area in Texas centered around Cotulla. Delores gets paid 26 times per year, has 1 child, and per her divorce agreement from that drunken bastard, has to provide the child with health insurance.

Delores has the following employee+child options (Plan, per paycheck, annual premium, deductible, Out of Pocket Max, amount paid out of pocket before insurance covers 100% of medical expenses)

1. High Deductible, $234.06, $6,085.56, $5000.00, $5,000, $11,085.56)
2. Medium Deductible, $295.34, $7,678.84, $2,500, $5,500, $13,178.84)
3. Low Deductible, $362.57, $9,426.82, $1,000, $4,000, $13,426.82)

Oh, in addition to this, her employer covers $4,919.78 for her medical and life insurance. Group life is $20/month/enrollee (it's cheap), so the employer pays, in addition to the 2nd item in each of the rows above, $4,679.78.

Total cost of insurance if Delores never goes to the doctor and has the cheapest plan: $10,765.34 ($6,085.56 out of Delores's pocket)
Total cost of insurance if Delores has $5,000 of expenses: $15,765.34 ($11,085.56 out of Delores's pocket)
Total cost of insurance if Delores has $700,000 of expenses: $15,765.34 ($11,085.56 out of Delores's pocket)

Median household income in Cotulla is $34,567 - Delores earns $40k pre-tax, $37,500 after tax.

Out of pocket health insurance premium as a % of take-home income: 16.22%
Out of pocket health insurance as a % of take-home income, assuming Delores hits the out of pocket max: 29.56%

Notes:

1. These are real numbers. Names are made up, I mixed and matched clients, we do business in Cotulla but not with anything called "Texas Mental... whatever". But the numbers are real.
2. This is, in no way, unusual for small business group medical insurance rates for the state of Texas.
3. The employer is rather generous here - they effectively pay for the employees insurance, meaning this is the cost to cover her 1 child.
4. The most expensive plan: $763.20 per pay period, $19,843.20, annually for employee, $24,522.98 total annual premium

The above is repeated... 4.7 million times... across Texas.

That's my argument against.
The risk pool element only matters for a private insurer to reduce variance of earnings. For free healthcare, a smaller pool makes budgeting a bit more difficult, but makes the avg cost lower. I'm sure the Federal Govt would rather not be sure if it's going to pay between 4 and 7 billion then know for sure it's going to pay 10.
  #11  
Old 08-02-2019, 10:24 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
Lol, you're arguing that what Humana can do, the Federal government can't do. How does that even make sense?
  #12  
Old 08-02-2019, 10:26 AM
ElvisL1ves is online now
Charter Member
 
Join Date: Jul 2000
Location: The land of the mouse
Posts: 50,549
We keep hearing from the capitalist-libertarian faction that private enterprise can do anything more efficiently and cheaply than government. So private enterprise should always be able to outcompete Medicare in the market, right?

Except it doesn't and can't.
  #13  
Old 08-02-2019, 10:27 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by UltraVires View Post
From my understanding, Sanders (and others) want an expanded version of Medicare that would cover absolutely anything and everything with no deductibles and no copays. I think the only exception he said was for elective cosmetic surgery.

So, under such a plan, there would be no need for private insurance because, what is there to insure?
I don't think they would be specifically against a public option if that were the case. If the public option were good enough, private insurance would die a natural death.
  #14  
Old 08-02-2019, 10:29 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by JohnT View Post
Lol, you're arguing that what Humana can do, the Federal government can't do. How does that even make sense?
Is this addressed at me? Because I'm not remotely making that argument.
  #15  
Old 08-02-2019, 10:32 AM
glee is online now
Guest
 
Join Date: Aug 1999
Location: Obama country
Posts: 15,608
Here in the UK our UHC is the wonderful NHS.
We also have Private Insurance schemes.

I've paid taxes all my working life to help find the NHS.
A couple of my jobs also offered me Private Insurance.

There is no problem having both.
  #16  
Old 08-02-2019, 10:34 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by PastTense View Post
Suppose you see a surgeon about whether or not you need an operation.
1. Private insurance--you see him tomorrow
2. Medicare for all--6 week delay for appointment

Surgeon says you need surgery immediately, sets up operation. If patient has Medicare for all pay for the operation then his private insurance has allowed him to jump the queue.

So with a private insurance option you would need complicated rules for a patient about switching between the two payment methods.
This would definitely be a potential problem and is the first reasonable criticism I've heard. This could be dealt with by legislation but it would come with extra cost to enforce it.
  #17  
Old 08-02-2019, 10:35 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
This one sentence:

Quote:
The risk pool element only matters for a private insurer to reduce variance of earnings. For free healthcare, a smaller pool makes budgeting a bit more difficult, but makes the avg cost lower. I'm sure the Federal Govt would rather not be sure if it's going to pay between 4 and 7 billion then know for sure it's going to pay 10.
Does just that. "free health care"? Who say's it is going to be free - for Delores, her taxes will go up... but will they go up by 16.8% of her take home pay? "Earnings" are an additional burden placed upon the insured by a private industry, so not too sure why that first sentence even exists. Yes, the "risk pool" disappears if the pool is the entire population... but that is the entire point of getting rid of private health insurance - so they can't game the pools to improve private earnings.
  #18  
Old 08-02-2019, 10:36 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
I am still not hearing any arguments for keeping Humana alive. I am quite interested in them, especially ones that aren't based on faith-based systems like "capitalism is always good" 'n stuff.
  #19  
Old 08-02-2019, 10:39 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by ElvisL1ves View Post
We keep hearing from the capitalist-libertarian faction that private enterprise can do anything more efficiently and cheaply than government. So private enterprise should always be able to outcompete Medicare in the market, right?

Except it doesn't and can't.
Well I do think the private sector would certainly be more capital efficient. The problem is healthcare's primary philosophy shouldn't be efficiency.
  #20  
Old 08-02-2019, 10:41 AM
SanVito is offline
Member
 
Join Date: Jun 2005
Location: Bristol, UK
Posts: 4,762
Quote:
Originally Posted by glee View Post
Here in the UK our UHC is the wonderful NHS.
We also have Private Insurance schemes.

I've paid taxes all my working life to help find the NHS.
A couple of my jobs also offered me Private Insurance.

There is no problem having both.
Yeah, this. Private Insurance performs some useful, if luxurious, options for those that can afford it.

A more 'hotel-like' in-patient experience, with nicer rooms and menus.
Shorter waiting times for non-urgent consultancy or surgery.
Additional procedures which may have limited or no coverage under the NHS.
  #21  
Old 08-02-2019, 10:43 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
Lastly, since Kid doesn't seem to know this, in Texas, group insurance for businesses with 49 and fewer employees are table-rated based upon age, gender, and zip code.

These rates are filed by each of the insurance companies (in this market we have four: UHC, Aetna, Humana, BCBS), reviewed by the Department of Insurance, and approved. When a firm decides they want to offer benefits, including health insurance, they have a choice:

1. To be community-rated (above)
2. To be self-insured (meaning the premium is based upon the individual health of the members of the group, ala how it was done pre-ACA. But what usually happens is one of the group has type-2 diabetes, or had cancer in the past 5 years, or something, and their rates are even higher than poor Delores, above.)

Regardless, the health insurance business, even in Tejas, already has a vast level of government involvement in the financing and pricing of insurance plans.

The argument that the government can't budget for a national insurance program is silly.

Last edited by JohnT; 08-02-2019 at 10:44 AM.
  #22  
Old 08-02-2019, 10:44 AM
Chronos's Avatar
Chronos is online now
Charter Member
Moderator
 
Join Date: Jan 2000
Location: The Land of Cleves
Posts: 85,081
The way that insurance is supposed to work is, you pay a fixed, predictable amount, so that if you suffer some calamity, you'll be able to afford it.

If that were the way that it actually worked, then there would be no problem in letting it continue to exist.

The way it usually actually works, though, is that you pay a fixed, predicable amount, and then if you suffer some calamity, the insurance company comes up with some damned fool excuse for why they don't have to pay out (the janitor who sweeps up the doctor's office is out-of-network or something), and now you're stuck with the cost of the calamity, and whatever you've already paid to the insurance company.

People want to ban insurance for the same reason they want to ban those e-mails from Nigerian princes.
  #23  
Old 08-02-2019, 10:46 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
To Chonos's point, I would like to note that the abolishment of private health insurance carriers means the abolition of private insurance health networks: If there is only one network, then the only way your doctor is out of network is if they decide to go pure capitalist and take no insurance at all.
  #24  
Old 08-02-2019, 10:48 AM
Kevbo is offline
Guest
 
Join Date: May 2005
Posts: 5,907
If everyone has the same insurance, then there is strong incentive for those in power to make sure it works. If the people who are part of "the powers that be" mostly have Cadillac plans, then the have-nots end up with the leftovers...because they are "those people."
__________________
-Never tell a politician they are a two-bit whore, unless you want to be beaten silly with their bag of quarters.
  #25  
Old 08-02-2019, 10:51 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by JohnT View Post
I am still not hearing any arguments for keeping Humana alive. I am quite interested in them, especially ones that aren't based on faith-based systems like "capitalism is always good" 'n stuff.
Ummmmm, wtf makes you think I want to keep private healthcare alive or that I subscribe to the notion that "capitalism is always good?" Where in my op is there even a scintilla of evidence to suspect im questioning MFA by asking what the reasoning is for abolishing private insurance? In fact I considered putting this question in GQ but had a feeling it would be sent here so I reconsidered. Honestly, your suppositions are just plain weird.
  #26  
Old 08-02-2019, 10:54 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by JohnT View Post
To Chonos's point, I would like to note that the abolishment of private health insurance carriers means the abolition of private insurance health networks: If there is only one network, then the only way your doctor is out of network is if they decide to go pure capitalist and take no insurance at all.
Finally you say something reasonable. Doctors should already have to take Medicare now. This loophole would have to be remedied.
  #27  
Old 08-02-2019, 10:59 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by Chronos View Post
The way that insurance is supposed to work is, you pay a fixed, predictable amount, so that if you suffer some calamity, you'll be able to afford it.

If that were the way that it actually worked, then there would be no problem in letting it continue to exist.

The way it usually actually works, though, is that you pay a fixed, predicable amount, and then if you suffer some calamity, the insurance company comes up with some damned fool excuse for why they don't have to pay out (the janitor who sweeps up the doctor's office is out-of-network or something), and now you're stuck with the cost of the calamity, and whatever you've already paid to the insurance company.

People want to ban insurance for the same reason they want to ban those e-mails from Nigerian princes.
But again, a public option covers this. I'm with you on why a private healthcare only system is bad - what I don't understand is the need to proactively abolish it. If the free option is remotely decent, then sure as hell no one is gonna pay for it.
  #28  
Old 08-02-2019, 11:01 AM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by Kevbo View Post
If everyone has the same insurance, then there is strong incentive for those in power to make sure it works. If the people who are part of "the powers that be" mostly have Cadillac plans, then the have-nots end up with the leftovers...because they are "those people."
This is certainly a reasonable argument. If Republicans want to sink the ship then at least they go down with it.
  #29  
Old 08-02-2019, 11:09 AM
naita is offline
Guest
 
Join Date: Jun 2002
Location: Norway
Posts: 6,640
Quote:
Originally Posted by KidCharlemagne View Post
How exactly is this a thread that starts with a misunderstanding of Warren's and Sander's policy position? When Lester Holt asks in the debate "Who here wants to abolish private health insurance?" and they both raise their hand, I shouldn't interpret that to mean they don't want to abolish private health insurance?
To quote myself: "As far as I can tell there is no plan to directly abolish private insurance, but I can be wrong since I'm just going from the statements I can find on the presidential campaign websites."

I was wrong, as I admitted ahead of time I might be, and as you could have figured out from reading my whole post.
  #30  
Old 08-02-2019, 11:16 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
Quote:
Originally Posted by KidCharlemagne View Post
Ummmmm, wtf makes you think I want to keep private healthcare alive or that I subscribe to the notion that "capitalism is always good?" Where in my op is there even a scintilla of evidence to suspect im questioning MFA by asking what the reasoning is for abolishing private insurance? In fact I considered putting this question in GQ but had a feeling it would be sent here so I reconsidered. Honestly, your suppositions are just plain weird.
I'm not asking you to make this argument, I'm asking anyone to make this argument. Apologies for being unclear.

Current conversation on this topic tends to focus on the hypotheticals of "what if's". They are framed from a Right perspective - even your title to this thread has a Right-tilted framing - "abolish private insurance". Perhaps instead of asking why we want to "abolish private health insurance", perhaps we ought to frame the question as to why we want to "keep the current system"?

Anyway, I'm pretty sure I answered your question: the above responses are my reasons for abolishing this shit, and I make a nice living selling it.
  #31  
Old 08-02-2019, 11:19 AM
Bone's Avatar
Bone is offline
Extrajudicial
Moderator
 
Join Date: Jul 2003
Posts: 10,849
Because if there is private insurance, it would likely carve out the most profitable group of people, and exclude those that aren't profitable. What is left in the M4A program would be high cost individuals, making the overall program more expensive. By eliminating private insurance, the government would force those that have lower expected costs to subsidize others with higher expected costs.

Risk pools in insurance are more predictable if the risk is roughly equivalent among members of the pool. If my insurance company only insured low risk, low cost individuals, then their costs would be lower, and I'd be able to pay a lower premium. Once higher risk people are introduced in the pool, then the overall cost will rise.

If you are a person who is in the lower risk categories, like, age 24-40, non smoking, no previous health issues, you really don't cost much to insure. Why would you want to be pooled with 70 year old smokers with a history of heart disease and cancer? Eliminating private insurance forces you to throw in your lot with everyone else.
  #32  
Old 08-02-2019, 11:24 AM
steronz is offline
Guest
 
Join Date: Feb 2007
Location: Oh-hiya-Maude
Posts: 5,057
Quote:
Originally Posted by Bone View Post
Because if there is private insurance, it would likely carve out the most profitable group of people, and exclude those that aren't profitable. What is left in the M4A program would be high cost individuals, making the overall program more expensive. By eliminating private insurance, the government would force those that have lower expected costs to subsidize others with higher expected costs.

Risk pools in insurance are more predictable if the risk is roughly equivalent among members of the pool. If my insurance company only insured low risk, low cost individuals, then their costs would be lower, and I'd be able to pay a lower premium. Once higher risk people are introduced in the pool, then the overall cost will rise.

If you are a person who is in the lower risk categories, like, age 24-40, non smoking, no previous health issues, you really don't cost much to insure. Why would you want to be pooled with 70 year old smokers with a history of heart disease and cancer? Eliminating private insurance forces you to throw in your lot with everyone else.
But making participation in M4A mandatory solves this problem without necessarily requiring private insurance (to go above and beyond what M4A covers) to be banned.
  #33  
Old 08-02-2019, 11:27 AM
Snowboarder Bo's Avatar
Snowboarder Bo is offline
Member
 
Join Date: May 2005
Location: Las Vegas
Posts: 27,516
Quote:
Originally Posted by Bone View Post
Eliminating private insurance forces you to throw in your lot with everyone else.
Is having to "throw in your lot with everyone else" a good idea or a bad idea, in your opinion?
  #34  
Old 08-02-2019, 11:28 AM
Bone's Avatar
Bone is offline
Extrajudicial
Moderator
 
Join Date: Jul 2003
Posts: 10,849
Quote:
Originally Posted by Snowboarder Bo View Post
Is having to "throw in your lot with everyone else" a good idea or a bad idea, in your opinion?
Bad. That's why to do so it would require force by the government. If it were good, people would have done so voluntarily.
  #35  
Old 08-02-2019, 11:32 AM
Bone's Avatar
Bone is offline
Extrajudicial
Moderator
 
Join Date: Jul 2003
Posts: 10,849
Quote:
Originally Posted by steronz View Post
But making participation in M4A mandatory solves this problem without necessarily requiring private insurance (to go above and beyond what M4A covers) to be banned.
I suppose if those that opt out would still be forced to pay for a service they weren't using it would solve the adverse selection problem.

There would still probably be people who would be opposed to private insurance because they don't want anyone to get anything better than them.

Consider, Canada has banned much of private insurance, what are their reasons?
  #36  
Old 08-02-2019, 11:37 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
Quote:
Originally Posted by Snowboarder Bo View Post
Is having to "throw in your lot with everyone else" a good idea or a bad idea, in your opinion?
It is, literally, the entire theoretical and mathematical basis of pooled risk.
  #37  
Old 08-02-2019, 11:51 AM
Wrenching Spanners is offline
Guest
 
Join Date: Jun 2011
Location: London
Posts: 538
With any publicly funded benefit program, the program has to have rationing. It costs some amount to provide typical cafeteria style school lunches. It would cost much more to provide restaurant style and restaurant quality school lunches. It would cost even more to provide each student with a personal chef. Similarly, allowing supplemental health insurance creates tiers of medical care. The societal risk is that those at the lowest tier receiving "basic care" will be receiving insufficient care that wouldn't be acceptable to those in a higher tier. In other words, I don't care if food in the employee cafeteria is shit because I'm eating in the managers' restaurant. Banning supplemental insurance mitigates that risk. However, it doesn't stop people from paying directly for additional health services, so it doesn't remove it. It also takes freedom away from companies that would like to offer supplemental health insurance, and from consumers who would like to purchase it. Is the mitigation worth the denial of freedom? I personally think it isn't.
  #38  
Old 08-02-2019, 11:59 AM
JohnT's Avatar
JohnT is online now
Charter Member
 
Join Date: Jul 2001
Location: San Antonio, TX
Posts: 23,543
I love how people who live in a world with $7,500 deductibles and $15,500 family max out of pocket, with "my insurance company denied X!" as a constant daily refrain, with the concept of co-insurance a thing, and doctors and clinics split into a bewildering array of networks...

I love how they warn us of "rationing" in a public system.
  #39  
Old 08-02-2019, 12:00 PM
k9bfriender is online now
Guest
 
Join Date: Jul 2013
Posts: 11,425
Quote:
Originally Posted by Bone View Post
If you are a person who is in the lower risk categories, like, age 24-40, non smoking, no previous health issues, you really don't cost much to insure. Why would you want to be pooled with 70 year old smokers with a history of heart disease and cancer? Eliminating private insurance forces you to throw in your lot with everyone else.
Because, if all goes well, that 20-40 year old will become a 70 year old. Even if they do not smoke, they may still end up having heart disease or cancer.

As it is, private insurance doesn't have to pay for 70 year olds, those are already paid for by the govt system, and yet, insurance is still barely affordable.


Quote:
Originally Posted by Bone View Post
Bad. That's why to do so it would require force by the government. If it were good, people would have done so voluntarily.
They do do so voluntarily, that's exactly what insurance is. If you work for a company with health benefits, then you pay for the treatment of someone who is sick, even if you are not. That is how the vast majority of people currently get their insurance. The bigger the company, usually the better the benefits, specifically because they have a larger pool of people who have thrown their lot in.

The number of people who forgo insurance due to not wanting to "throw in their lot" is a much smaller number than you may think. Definitely far fewer than those who forgo insurance because they cannot afford it.

MFA would just be a larger collective bargaining.
  #40  
Old 08-02-2019, 12:23 PM
Bone's Avatar
Bone is offline
Extrajudicial
Moderator
 
Join Date: Jul 2003
Posts: 10,849
Quote:
Originally Posted by JohnT View Post
It is, literally, the entire theoretical and mathematical basis of pooled risk.
This is over simplified. Pooled risk can also mean pooling of similar risks. This is how insurance rating works. Good driver discounts for auto, home security discounts for home, lower rates for life insurance for non-smokers, etc. All of these are means to segregate populations into similar risk pools and charge a commensurate premium. It's still pooled risk, but it more normalizes the risk profiles of those in the pool.

All other things being equal, the group of homeowners that have home security systems are paying less than the group that doesn't, because the risk profiles are different. Eliminating this discount would group all homeowners together and the premium would be more of a blended rate than it would be if they are segregated. Those with home security systems would subsidize those without.

Quote:
Originally Posted by k9bfriender View Post
Because, if all goes well, that 20-40 year old will become a 70 year old. Even if they do not smoke, they may still end up having heart disease or cancer.

As it is, private insurance doesn't have to pay for 70 year olds, those are already paid for by the govt system, and yet, insurance is still barely affordable.
People who are 70 can still pay for insurance, if they choose. They don't have to pay for Medicare.

In any event, I think people should pay commensurate with their risk. If you have a group of low and high risk people, creating a separate risk pool for each would yield lower and higher costs, respectively. Blending them into a single risk pool would yield somewhere in the middle. Disallowing people to opt out of the combined pool and form their own low risk pool means that those in the lower risk pool would pay more than they otherwise would.
  #41  
Old 08-02-2019, 12:46 PM
UltraVires is offline
Guest
 
Join Date: Jul 2007
Location: Bridgeport, WV, US
Posts: 15,782
Quote:
Originally Posted by SanVito View Post
Yeah, this. Private Insurance performs some useful, if luxurious, options for those that can afford it.

A more 'hotel-like' in-patient experience, with nicer rooms and menus.
Shorter waiting times for non-urgent consultancy or surgery.
Additional procedures which may have limited or no coverage under the NHS.
But doesn't this cause the same issue that is the #1 complaint in the US? That the rich get to see fine doctors and specialists with little wait time while the remainder of us are in a cattle line waiting for the scraps?
  #42  
Old 08-02-2019, 12:50 PM
Shodan is online now
Charter Member
 
Join Date: Jul 2000
Location: Milky Way Galaxy
Posts: 39,964
Quote:
Originally Posted by KidCharlemagne View Post
Finally you say something reasonable. Doctors should already have to take Medicare now. This loophole would have to be remedied.
Do you mean doctors should have to accept Medicare patients, or accept being reimbursed at Medicare rates? They're not the same thing.

If you mean patients, doctors lose money on average on 65-80% of their Medicare patients. So the more Medicare patients they accept, the more money they lose. If you mean rates, then the more patients they treat, the more money they lose.

"Buy at seven, sell at five, make up the difference with volume" isn't exactly a loophole.

Regards,
Shodan
  #43  
Old 08-02-2019, 01:01 PM
UltraVires is offline
Guest
 
Join Date: Jul 2007
Location: Bridgeport, WV, US
Posts: 15,782
Quote:
Originally Posted by Shodan View Post
Do you mean doctors should have to accept Medicare patients, or accept being reimbursed at Medicare rates? They're not the same thing.

If you mean patients, doctors lose money on average on 65-80% of their Medicare patients. So the more Medicare patients they accept, the more money they lose. If you mean rates, then the more patients they treat, the more money they lose.

"Buy at seven, sell at five, make up the difference with volume" isn't exactly a loophole.

Regards,
Shodan
This is something always overlooked in these Medicare threads.

I don't think you stated it entirely correct, though. Doctors take Medicare patients because that is who the vast majority of sick people are: old people. They can supplement their income by taking Medicare. They make their money on private pay clients through insurance reimbursement rates. As most costs are fixed, they are then able to make a little bit on the lower Medicare rates.

If everyone was on Medicare, you are right, they would definitely go out of business.

But to the thread, my response in post #2 was what I thought the answer was. If a plan is out there to cover everything, and I mean everything, absolutely free at the point of payment, paid for by a tremendous tax increase to boot, why would I want to pay for private insurance? What would it be doing for me?

If the new health care is so bad that people would rather pay for something that is already "free," then that seems like a bad plan.
  #44  
Old 08-02-2019, 01:03 PM
neutro is offline
Guest
 
Join Date: Apr 2019
Location: Redmond, WA
Posts: 123
Quote:
Originally Posted by JohnT View Post
I love how people who live in a world with $7,500 deductibles and $15,500 family max out of pocket, with "my insurance company denied X!" as a constant daily refrain, with the concept of co-insurance a thing, and doctors and clinics split into a bewildering array of networks...

I love how they warn us of "rationing" in a public system.
Yeah, the current system is super garbage. That's not to say that a public system is perfect btw, there will be people that get bad care in a public system. For example in Canada they are having issues with getting enough practicing doctors in rural areas of some provinces. Getting a family doctor can also just be generally tricky in some provinces even in a city.

Delivering healthcare to a population is hard. All I know is that the current "insurance" system is complete garbage. I would take the Canadian system in a second over what we have.

As for the OP, part of it is simple practicality. The money that employers are currently paying into those private insurance schemes is going to have to go into the public system.
  #45  
Old 08-02-2019, 01:05 PM
neutro is offline
Guest
 
Join Date: Apr 2019
Location: Redmond, WA
Posts: 123
Quote:
Originally Posted by UltraVires View Post
But to the thread, my response in post #2 was what I thought the answer was. If a plan is out there to cover everything, and I mean everything, absolutely free at the point of payment, paid for by a tremendous tax increase to boot, why would I want to pay for private insurance? What would it be doing for me?
Generally you are paying for perks. Better rooms, better food etc. In practice you can cover "everything" but not all supplied services are of the same quality level. Personally I have a high level of expectation for service in general and would gladly pay extra for more room, better food, better amenities etc. Why not make this a profit center to subsidize the care itself which is the same for everyone?
  #46  
Old 08-02-2019, 01:08 PM
Manda JO is offline
Charter Member
 
Join Date: Jul 1999
Posts: 11,436
Quote:
Originally Posted by Bone View Post

In any event, I think people should pay commensurate with their risk. If you have a group of low and high risk people, creating a separate risk pool for each would yield lower and higher costs, respectively. Blending them into a single risk pool would yield somewhere in the middle. Disallowing people to opt out of the combined pool and form their own low risk pool means that those in the lower risk pool would pay more than they otherwise would.
But then high risk people can't get medical care at a price they can afford--and anyone can become high risk at any time through no fault of their own--simply by aging, if nothing else. Does your ideal low risk pool kick people out when they become high risk?
  #47  
Old 08-02-2019, 01:13 PM
ElvisL1ves is online now
Charter Member
 
Join Date: Jul 2000
Location: The land of the mouse
Posts: 50,549
Those are the policy reasons. The political reason is that the private insurance companies are pretty generally hated, and proposing their elimination will get votes.
  #48  
Old 08-02-2019, 01:15 PM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by JohnT View Post
I'm not asking you to make this argument, I'm asking anyone to make this argument. Apologies for being unclear.

Current conversation on this topic tends to focus on the hypotheticals of "what if's". They are framed from a Right perspective - even your title to this thread has a Right-tilted framing - "abolish private insurance". Perhaps instead of asking why we want to "abolish private health insurance", perhaps we ought to frame the question as to why we want to "keep the current system"?

Anyway, I'm pretty sure I answered your question: the above responses are my reasons for abolishing this shit, and I make a nice living selling it.
I only used the term "abolish" because that was the term used in the question at the first debate that made the headlines and started the recent discussion about the details of Dems' healthcare plans. It was politically neutral on my end, though I can see now how it would be seen as inflammatory. Lester Holt isn't exactly a right-wing pundit so it slipped through my connotation radar - though, looking back, I'm sure Holt intended it to be inflammatory.

Ok. Moving on. I still don't understand how the pooled risk argument applies here. Here are the two options as I understand them:

1. MFA, no private insurance: Government collects x taxes and has to use it to pay for everyone's healthcare.

2. MFA, private optional:. Government still collects x taxes but only has to pay for those who don't opt for private.

Under Medicare the government wouldn't really be "insuring" anything in the traditional sense, they would just be outright paying for it. There's no need for risk mitigation except for budgetary purposes. What am I missing? <- That's intended sincerely.
  #49  
Old 08-02-2019, 01:35 PM
KidCharlemagne is offline
Guest
 
Join Date: Apr 2001
Posts: 5,320
Quote:
Originally Posted by Shodan View Post
Do you mean doctors should have to accept Medicare patients, or accept being reimbursed at Medicare rates? They're not the same thing.

If you mean patients, doctors lose money on average on 65-80% of their Medicare patients. So the more Medicare patients they accept, the more money they lose. If you mean rates, then the more patients they treat, the more money they lose.

"Buy at seven, sell at five, make up the difference with volume" isn't exactly a loophole.

Regards,
Shodan
Well like we agreed yesterday, doctors are gonna take a shellacking. Going over some stats it appears that doctors in countries with socialized medicine make about 2/3 of what US doctors do. I don't know what other reforms would be required to make it work but it does work elsewhere. I, for one, would welcome a new wave of doctors who are in it for service to society rather than the title and BMW. With places like NYU Medical School offering free tuition maybe we can at least move towards lowering the debt burden for young doctors.
  #50  
Old 08-02-2019, 01:41 PM
UltraVires is offline
Guest
 
Join Date: Jul 2007
Location: Bridgeport, WV, US
Posts: 15,782
Quote:
Originally Posted by neutro View Post
Generally you are paying for perks. Better rooms, better food etc. In practice you can cover "everything" but not all supplied services are of the same quality level. Personally I have a high level of expectation for service in general and would gladly pay extra for more room, better food, better amenities etc. Why not make this a profit center to subsidize the care itself which is the same for everyone?
I would think that those things would (or at least should) be so relatively inexpensive in comparison with buying an insurance policy that insurance wouldn't be needed.

I mean, what are we talking about? An upgrade from baked steak to T-bone, or are we talking Gordon Ramsay sit down dining with fine wine (if your health permits)?

Private rooms meaning the same room which usually houses 2 patients now houses one, or are we talking the Four Seasons?

And wouldn't these things be inversely proportional to your length of stay? If I have a minor health issue, I won't be in the hospital long so a few nights wouldn't be worth buying a policy, just paying as you go. Conversely, if I am so sick I am in there long term, I probably won't be eating much or enjoying any extra amenities.

And I've always thought that hospitals could be more profitable by offering extra amenities. I mean, I've spent several nights in hospitals visiting people and when I want to eat, I have the same shitty cafeteria food and have to drive to a hotel (or usually motel) not affiliated with the hospital down the road. It would seem to be that a hospital could be profitable by operating a hotel on the grounds with restaurant options.
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 09:59 AM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2019, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@straightdope.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Copyright 2019 STM Reader, LLC.

 
Copyright © 2017