This is what I dislike most about this forum and why I seldom post here.
Why the hell do you think I have some sort of conservative vision??? While I am neither a liberal or a conservative I am very much in favor of health care reform including some form of UHC.
My only major issue with the bill that just got passed was that it mandates that people purchase something that just isn’t affordable on a middle class income. Upon further research, I can amend that to “it mandates that people purchase something that just isn’t affordable on a middle class income in New York State”.
There has to be a solution somewhere and I don’t doubt that it may even be buried somewhere in the bill. I don’t know that buying policies across state lines is answer and I doubt it is the only solution, the answer may lie in the structure of risk pooling or some other technicality of the insurance industry.
I was just disappointed that insurance costs weren’t addressed in the bill. I don’t think it’s unconstitutional to require that everyone buy insurance. However, when your insurance premium is larger than your mortgage and in some cases, your take home income there are going to be people that are unable to comply with this ruling, regardless of their patriotism or political leanings.
Because I read this forum a lot, and after 100+ threads on HCR and UHC a very clear vision has been laid out by both liberals and conservatives. What you posted fit very well with the conservative vision.
Think about what you posted:
(edited for brevity)
You then made the comment:
After reading through the posts here, and at a variety of other sites, it appears that the conservative vision is as follows:
The cost of private insurance policies varies from state to state, some times to extremes ($100min vs $1000min).
The variety and availability of private insurance policies varies from state to state (access to high deductible or HSA for example)
Cause: Individual state mandates forcing policies to include more.
Conclusion: Removing the barrier to interstate competition will bring the minimum cost down to the lowest currently available, and rise the variety up to the maximum available.
I consider that wishful thinking, along the realm of magic.
From all I’ve seen over the past 20 years, through a variety of successful and failed attempts at
deregulation I am quite certain that the most likely scenario is that it will NOT work out in your favour.
As you look out across state lines, there is a temptation to think, “if only I could get that guy’s policy at that other guy’s price. If the government allowed competition, all those polices in NY would be offered in NJ at NC low low prices.”
The most likely outcome is that it will not settle at the lowest policy price. In your example, you had three prices ($123 $196 and $368), if the result is that the final price is the $196, a few people above that get a better price, but then a lot of people blow that lost the option to get the lower price. It is wishful thinking to believe that you’ll (big you, not you specifically) be in the winner category, it’s more likely you’ll have your rates go up.
Secondly, you mentioned specifically that you want the availability of a high deductible plan, the most likely scenario is that you WON’T get that option The final two choices that the final 3 companies will offer is probably not going to include the policies you wanted.
I remember a few months ago when I made the suggestion that overall Americans would be better off under UHC I was laughed at for wishful thinking. A lot of conservatives felt it would mean a higher price for a lower product. That their premiums (and taxes) would go up, but their coverage would go down.
Well, as far as I can tell, allowing interstate competition means that those getting better coverage will suffer and end up with the lowest common denominator. And those with the lowest premiums will see it go up to what the industry decides.
It is possible, I suppose, that due to an utter lack of math skilled policy wonks, the Dems have constructed an onerous burden on the largest single voting bloc in America, one certain to enrage and infuriate that same ginormous voting bloc. Stupid, stupid Dems.
If everyone were forced to buy an expensive computer they would be getting a better computer but they would be missing out on whatever they would have bought buy with the extra money. I use a computer that has none of the features I listed but it serves my needs well. I know my needs better than the government so I make better decisions than they do.
Hotels are currently free to offer rooms without beds, yet few do so. In fact, I do not want to brag but I have been to hotels that even offer free continental breakfast. The reason they do so is not out of the goodness of their hearts but competition. The more competition they better the companies have to be at pleasing their customers. Competition between insurers in different states would likely improve customer service, not hurt it.
It is possible that a certain state will wish to attract insurance companies with favorable tax treatment. Since companies can move to that state to compete with the existing companies, any excess profits allowed by the favorable tax treatment will be competed away. The situation will then consist of one state subsidizing the health insurance policies of the rest of the country. This may be a bad deal for one state but it will result in lower cost for the rest of the country.
The question is who knows more about what you need in a health insurance policy, you or your state legislature. The incentives are all lined up for me to know since I am the one who will be for a buying an inappropriate policy, while if a state legislature picks a bad policy they face voters most of whom are rationally ignorant about the healthcare policy. If you give people the right incentives most of the time they can make a good choice, despite being as dumb as maceknight’s wife/
Oh, there’s no question about that. If there is one thing policy wonks are bad at it’s math. And war. If there are two things policy wonks are bad at his math and war. And the economy. Okay, three things policy wonks are bad at it’s math, war, and the economy.
Sure, in the case of computers. So you opted not to get a video card with dedicated memory, that choice saved you $500. I encouraged my mother-in-law to make the same choice, she’s never going to play a video game, or watch a movie, why does she need a high end video card?
Well, when we go back to health insurance, we’re talking about risk mitigation. The choice of video card translates into the choice of whether or not cancer treatment is covered.
So with your computer, what is the worst that can happen if you pick the wrong system? What is the absolutely most dramatic scenario that could play out? Oh, you don’t get to play a certain game. boo hoo
So what happens if you choose insurance without cancer coverage? What do you suppose the worst possible scenario would be? here is an entire group of Americans that don’t think they’ll get Parkinsons. If that was a choice on their insurance, they’d say, “That shit Michale J Fox has? Like hell I’m getting that.” And opt out.
It’s pretty unlikely I’m going to get tay sachs disease or sickle cell anemia, so there is a case to be made on one end, but then what are my chances for all the other things that might strike me down? Do you really think you’re ready for 15 pages of options over which conditions and procedures you have covered?
"Let’s see, I think I might get hit by a red truck, but there aren’t a lot of white cars in my area so I’ll opt out of that one. "
It hurts me, of that past few hotels I’ve stayed at I wasn’t able to make use of the “free” breakfast that was actually not free but merely included in my bill. See how competition can actually ADD things you don’t want? It’s actually hard to find places that don’t offer a breakfast. If you go shopping for a computer, you’ll notice how hard it is to NOT get things. Why the fuck is MS Works on every computer in the store?
Sadly, my wife is at the top of educated Americans. Did you know less than a third of the population has a university degree?
If you’re so smart, and I don’t doubt that you are in fact extremely smart, do you know your individual probability of developing heart disease, cancer, Parkinsons, dementia, and type II diabetes? Do you also know the invidiual costs associated with developing those conditions?
If you can’t enumerate your risk of developing pancreatic cancer vs lymphoma, as well as identifying the potential cost associated with those two conditions, how are you supposed to accurately select your insurance plan?
If they give you the choice to save $50 a month by getting coverage for B-cell lymphoma instead of T-cell, are you going to be able to make the right decision?
I’m probably naive or missing something important, but what is currently blocking interstate competition for health insurance? If it is state regulation, it seems to me that it is a good thing. I trust my state more than some other state or the federal government to best judge of local matters like medical costs - which can even vary by zip code (at least judging by insurance rates in my state).
Also, my understanding of the new reforms do not block the creation of multi-state insurance plans, so if several states wanted to create a exchanges with multi-state plans, they are free to do so.
These seem almost like ‘states rights’ issues to me and a national market might serve the insurance companies more than the states or citizens.
I have a question. If conservative states place less restriction on health insurance, and that is a net positive thing, then we would expect conservative states to be healthier. Is that the case?
Well, here is the list. The problem is that conservatives tend not to like lists.
You actually posed the right question, in a round about sort of way. What is the state with the ideal set of health regulations? Which state do conservatives intend for us to all submit to?
I realize I’m asking this in a snarky manner, but surely there has to be an answer. Allowing interstate competition is supposed to move all insurance companies to one state, right now, that would that state be?
Conservatives do not want one state to dictate everyone’s health coverage. We want people to be able to pick from many different state’s plan. It may come about that one state has such great regulations or a tax environment that insurance companies move there but that would be a result of people preferring one type of coverage over another. This would result in lower costs.
I notice that on the list of healthiest states Massachusetts and Hawaii are ranked three and four. Massachusetts has the most expensive insurance rates in the country and Hawaii some of the cheapest. If forcing people to buy expensive insurance made people healthier that does not seem to be reflected in that list.
Plans usually do not vary by the diseases they treat but by the amount of copays and deductibles, also additional things such as mental health counseling, chiropractic coverage, maternity, and other benefits. For example, when I was younger I chose a plan that had a lower deductible for injuries than for sicknesses. That was because I played sports and had a higher risk of injuring myself than of becoming sick. I also refused the fertility treatment coverage because I was celibate and planning to remain so for a while. Because I live in a relatively enlightened state I was able to customize a low cost plan that met my needs. If I had lived in a high premium state like Massachusetts I would have skipped health insurance all together. One size fits all healthcare usually means more money for special interests and more uninsured.
I have addressed the states rights issue. If requested, I could do it again using smaller words so more liberals can understand it.
Don’t be silly- of course the companies would move to the state which gives them the least amount of regulation and the lowest taxes. You know, just like the credit card companies have done. And don’t kid yourself that they would then pass the savings on to you, the consumer- they’ve got no vested interest in doing so. The more money they save means the more money they get. Credit card rates did not go down- in fact, they went up as a result of lowered state regulation.
Interestingly enough, both of the states you mentioned have government-provided health insurance or state-mandated insurance.
Let’s assume that interstate competition is allowed and we can buy from any company, in any state. I’m in Washington but I get a great deal on a policy in Delaware.
What happens to my physician or hospital? Will they accept the Delaware plan?
Are they forced to accept whatever the company in Delaware decides to pay or does my insurance pay what is asked? Does the Delaware company negotiate with each hospital or medical group in the nation?
What about forms and paperwork - is it different for each company (my doctor will love that!) or is it standardized? Who decides on the standard? I’m sure there there is more…
If you think the most likely scenario is that all the companies move to one state, then you are advocating for a system that puts all the power into one state, at the expense of all the others. Each state no longer gets a say over their health care. If you are serious about state’s rights, and not wanting to dictate everyone’s health coverage you should be AGAINST this form of deregulation.
It’s extremely disingenuous to say you are for state’s rights, but then also for a plan that would certainly remove those rights.
How do you know it will lower costs. Magic? When ever I suggest UHC some one always asks, “how, is it magic?” Well, here it is, I want a magic pony. Why do you think costs will go down?
So what does that list tell you? That we should all have access to Mississippi’s health care system? Deregulation doesn’t mean we get the best at the lowest price. We get the lowest common denominator, at a price the Big 6 decide to offer. Don’t like it? Tough, there aren’t any other choices left.
Sure you don’t want it, but that is the way it would be. There are a lot of disasters that come out of conservative policies (the first banking crisis, for instance) that you didn’t want. You just didn’t see the implications of the policies because of your touching faith that the free market will conquer all.
How do people control where a company moves? Do stockholders control where a company incorporates? If one state offers insurance companies laxer regulations and thus more profit, why wouldn’t they all move there?
Employers must provide insurance in Hawaii. Didn’t you see the Daily show segment where they were giving Republican delegates to some meeting grief about going to a state with socialized medicine?
I suspect there are many factors explaining why health care costs more in Massachusetts, ranging from weather to pay scales. Employer-based plans, which are usually cheaper than individual ones, do not allow picking and choosing in my experience. Bigger risk pools are better, and the more insurance companies allow people to self select, the more risky people will be in the pools and the higher the premiums will be for those who need them. In any case, today we have 50 states each setting policies, in the “interstate competition” case we’d likely only have a few. So, your choice would be reduced.
I think the saddest thing is that Americans aren’t allowed to move from one state to another. Nobody should be forced to pay the insanely high insurance rates that Massachusetts dictates. People should be free to move to Mississippi.
Does anyone have a stat comparing the cost of health care by state?
So you want the federal government to take away the authority of the states to regulate health insurance? And that demonstrates your support for state’s rights, how?
Conservatives want to do for health insurance what they did for banking.