Conservatives: What should we do about people who can't pay for medical care?

[Lobohan]

@The_Other_Waldo_Pepper

It’s not exactly that I’m fixating on a perceived insult; it’s that you see my satisfaction as irrelevant, because it has no bearing on the overall question for the nation – and that you also see the overall satisfaction of the nation as irrelevant, because you’re figuring it’s erroneous. I can’t readily prove they’re right (since I simply default to giving folks the benefit of the doubt) and can’t even combat the latter argument by claiming my satisfaction ain’t erroneous (since you simply don’t care whether it’s true in my case), which leaves me with precious little else to say.

Not at all. You can be satisfied with substandard service at twice the price. But that doesn’t speak to proper policy.

Do you agree that public policy should be to have the best benefit for the nation? You are advocating for a system that costs us more and has more people die early, simply because you personally fare well in the system.

Dude, that’s whack.

In any case, can you please address these points:

Car insurance has a maximum payout, so it is much easier to control for costs.

Health insurance can have a fit twenty-something get kidney failure and rack up 300 grand of bills one day without warning. It doesn’t respond to market forces the same way as widget sales.

Remember, paying someone’s medical bills isn’t profitable. So health insurance companies want to minimize the amount of payments necessary. Every sick person on the rolls is a net drag, and if a particular state allows you to snip them off the lists, that’s where they’ll go.

Competing against each other will have them lower costs for the healthy, it won’t have them insuring the sick.

Or not, it seems you’re using my saying that your personal experience isn’t relevant to a national issue as an out, so that you don’t have to answer questions that you find too hard.

[Tixenfleaz]

@Martin_Hyde

Take my “out there” solution above, of extending Medicare to cover everyone. That would institute massive savings in Administrative costs, because Medicare is vastly more efficient than any private insurer. It would also remove the profit motivation of private insurance, so there is no profit margin overhead.

However, unless you actually get serious about controlling that Medicare reimbursement rate, and unless you allow Medicare to say “no” to certain types of treatments, even that would just be an initial improvement. Over the long span it would still be unsustainable without serious rationing.

I’m not saying a 35 year old guy with a family of 4 who comes down with Non-Hodgkins Lymphoma is left to die in the street. We can go to bat for guys like that. For one, terminal illnesses are rarer amongst his age bracket. Secondly, there is a stronger societal interest in keeping him alive (he has working years left, his continued survival as a working member of society prevents his wife and children from potentially entering the ranks of the impoverished.)

For a 75 year old man? I just don’t think he should get the same level of care for NHL. For one, the survival rate with NHL goes down for anyone over age 60. For two, the societal interest isn’t there, any of his children will almost certainly be adults and most likely his productive years are long past.

Finally, the simple fact is the moral impetus is not nearly as strong. A 35 year old man has a lot of worthwhile life left to life, sure maybe one year in the 75 year old’s life is just as valuable as one more year to the 35 year old man, but the 75 year old already has 40 more of those years under his belt. The 75 year old man has already lived his life, and when dealing with limited resources there needs to be a limit, under societally provided health care, as to how much money we expend on people whose lives are already lived, just to try and keep them alive for a bit longer.

I, too, enjoy reading your posts, though I don’t always agree.

I’m not sure I agree with this one either, but it’s a moot point. Elderly voters would quickly defenestrate any politician who even suggested this in passing, though I have no doubt that you know this.

As a paramedic, I’m still suprised at the number of octogenarians who have no interest in Do Not Resuscitate orders, and who want all efforts made to preserve their lives even if they are already confined to hospital beds. I suspect that whatever we try will have to pass the older voter’s sniff test. And they will understandably put their interests first.

[Stratocaster]

@Lobohan

I told you I didn’t know. But to make it simple for you to follow, take rescission, which we’ve been talking about in the thread. Some states allow rescission and some don’t. Some have different levels of flexibility for rescission, so they would probably all go to the state that allows them to cut the most sick people from the rolls, right? State Health Facts | KFF

No, not right. Why is rescission the single most important factor? Why wouldn’t a market for coverage that excludes this emerge, appropriately priced in an open market?

As I said, I don’t know the specifics, but sticking with rescission, I assume they would move to one of the states that allows 3 years for misstatements. You can be fairly sure that no insurance company would run in New York, for instance, because it doesn’t allow rescission at all. Note that this means that people in New York would get worse coverage, because of that.

So, the protection you’re concerned with here is the ability to make misstatements without penalty? That’s the biggest gap in our health care infrastructure? Okay, gotcha.

[ElvisL1ves]

Scalia’s position is clear: “Well, don’t obligate yourself to that.”

IOW, fuck the poor.

[Lobohan]

@Stratocaster

No, not right. Why is rescission the single most important factor? Why wouldn’t a market for coverage that excludes this emerge, appropriately priced in an open market?

Rescission isn’t the most important factor, as I said upthread. It is a part of pre-existing conditions. It is the factor I had numbers on to satisfy your desire for explicit information. It is one of the factors, but they would congregate where the factors are best. And my chart shows that at the very least everyone in the country would be subject to rescission, since one of the 43 states that allow it to be practiced would be where the companies go.

Are we agreed that this is a problem? That it would not be cured by allowing the purchase of insurance across state lines? If so, good. That’s progress.

So, the protection you’re concerned with here is the ability to make misstatements without penalty? That’s the biggest gap in our health care infrastructure? Okay, gotcha.

No, it isn’t the biggest gap, and please don’t misstate what I’m arguing. You asked for specifics and I provided one. In my initial post I even said that I didn’t know the specifics, my argument isn’t about specifics, it is about that the companies will move where they can make the most money. Also known as the race to the bottom.

In any case, your inability to understand common English aside, the issue is that insurance companies will move where it is most profitable to operate. Paying sick people’s medical bills is by its nature unprofitable.

Make sense so far? Good. Since paying sick people’s medical care is by its nature unprofitable, insurance companies, if allowed to sell across state lines will go to where they can pay fewer sick people’s medical bills.

The market forces will make prices for healthy people go down, the market cannot incentivize, through competition, the coverage of sick people since sick people cost more than they pay in premiums.

That requires government legislation.

[Martin_Hyde]

@Tixenfleaz

I, too, enjoy reading your posts, though I don’t always agree.

I’m not sure I agree with this one either, but it’s a moot point. Elderly voters would quickly defenestrate any politician who even suggested this in passing, though I have no doubt that you know this.

As a paramedic, I’m still suprised at the number of octogenarians who have no interest in Do Not Resuscitate orders, and who want all efforts made to preserve their lives even if they are already confined to hospital beds. I suspect that whatever we try will have to pass the older voter’s sniff test. And they will understandably put their interests first.

Oh no, I’m absolutely aware that any meaningful reforms along the lines of controlling costs will be stopped by the strongest political group with the strongest lobby in the land (old people.)

[Stratocaster]

@Lobohan

Rescission isn’t the most important factor, as I said upthread. It is a part of pre-existing conditions. It is the factor I had numbers on to satisfy your desire for explicit information. It is one of the factors, but they would congregate where the factors are best. And my chart shows that at the very least everyone in the country would be subject to rescission, since one of the 43 states that allow it to be practiced would be where the companies go.

Most of the states permit rescission for misstatements. As is proper. The problem here is that you dismissed the suggestion originally made as a catchphrase, but then can’t support your own assertion beyond offering as a given that “most profitable” equals “state with least restrictive regulations” which in turn equals “worst for consumers.” The one example you provided is a weak one, if that’s the type of “protection” (the ability to make misstatements on your application with impunity) we’re concerned with. You were free with demands for details, but can offer nothing meaningful when called on it to support your own assertion. I’ll ask again, which is that “one worst” state, and what are the parade of horribles that will occur when companies stampede to sell only from that domicile? Again, saying “that state which increases profits, which can only occur by screwing consumers” is not an answer. Neither is “I don’t know” or “I don’t know the specifics.”

I’m telling you you’re begging the question. I work in this industry and have for a long time. Each and every state has several phone books worth of regulations that govern this industry. Every one. This industry is likewise rife with Federal and state regulations that do nothing but increase costs without any real benefit. “Most regulated” does not necessarily mean “best for consumer.” It almost certainly means “most costly.” Companies will NOT be most profitable denying claims and through rescission when a customer can FREELY purchase from a company that would offer something different, a possibility in a less restrictive market, but not so now.

I am unconvinced by your weak example and continued assertions that “this must be so.” Sorry.

[Fear_Itself]

@Stratocaster

Companies will NOT be most profitable denying claims and through rescission when a customer can FREELY purchase from a company that would offer something different, a possibility in a less restrictive market, but not so now.

Most people have insurance through their employer, so they have no freedom at all in which company they get insurance from, unless you expect them to quit their job in order to find an employer with a plan that specifically bans recission or other regressive practices.

[Stratocaster]

@Fear_Itself

Most people have insurance through their employer, so they have no freedom at all in which company they get insurance from, unless you expect them to quit their job in order to find an employer with a plan that specifically bans recission or other regressive practices.

I think that should change. I think it should be portable, like car insurance.

[Fear_Itself]

@Stratocaster

I think that should change. I think it should be portable, like car insurance.

I aree, but the devil is in the details. Would that mean the end of group insurance, where insurance companies base the premiums on projected health expenses of an employee group? Is everybody now buying individual insurance? Or do we create insurance exchanges?

[Lobohan]

@Stratocaster

Most of the states permit rescission for misstatements. As is proper.

I find it hard to believe that having your insurance canceled after you find you have cancer is proper, because you didn’t mention a rash you had at 16 when signing up for insurance.

The problem here is that you dismissed the suggestion originally made as a catchphrase, but then can’t support your own assertion beyond offering as a given that “most profitable” equals “state with least restrictive regulations” which in turn equals “worst for consumers.” The one example you provided is a weak one, if that’s the type of “protection” (the ability to make misstatements on your application with impunity) we’re concerned with.

No, it’s the right to keep your insurance when the insurance company decides that paying for your care is too expensive, and they go hunting for "i"s not dotted.

You were free with demands for details, but can offer nothing meaningful when called on it to support your own assertion.

I asked this:

You are an insurance company. Explain to me why you sell insurance from a state that requires you to be less profitable. Why don’t you move to the state with the most lax laws. If you’re publicly traded, explain to me why your shareholders think this is a good idea.

Explain it in detail please.

Which you ignored.

It’s obvious that you don’t have an answer for that, which is why you’re getting on this silly tangent.

I’ll ask again, which is that “one worst” state, and what are the parade of horribles that will occur when companies stampede to sell only from that domicile? Again, saying “that state which increases profits, which can only occur by screwing consumers” is not an answer. Neither is “I don’t know” or “I don’t know the specifics.”

As I said before, I don’t know what the one worst state is. But the insurance companies will surely figure it out. That’s a fact, and you haven’t explained why you think companies will decide to make less profit than they can.

I’m telling you you’re begging the question. I work in this industry and have for a long time. Each and every state has several phone books worth of regulations that govern this industry. Every one. This industry is likewise rife with Federal and state regulations that do nothing but increase costs without any real benefit. “Most regulated” does not necessarily mean “best for consumer.”

True. But “least regulated” definitely means “worst for consumer.” We have poor regulations now, and our system has worse results, for more money than any other first world nation.

It almost certainly means “most costly.” Companies will NOT be most profitable denying claims and through rescission when a customer can FREELY purchase from a company that would offer something different, a possibility in a less restrictive market, but not so now.

It is never profitable to cover the medical payments of a sick person. If your medical care costs more than you pay in premiums, no insurance company wants you.

You surely understand this, right? This means that you won’t magically find companies lining up for your business.

I am unconvinced by your weak example and continued assertions that “this must be so.” Sorry.

I can’t force you to reason this out. I can only show the peanut gallery how utterly wrong you are.

[Stratocaster]

@Fear_Itself

I aree, but the devil is in the details. Would that mean the end of group insurance, where insurance companies base the premiums on projected health expenses of an employee group? Is everybody now buying individual insurance? Or do we create insurance exchanges?

I don’t think it need eliminate the benefits of group insurance, though you’re right, the devil is in the details. Really, all insurance is group insurance to a large extent. Everyone is part of a pool of risks. I don’t see any insurmountable obstacle to making health insurance portable, and pooling risks in a manner that still provides sufficient diffusion of risk. At the end of the day, there’s not any less insureds, more or less.

[Fear_Itself]

@Stratocaster

I don’t think it need eliminate the benefits of group insurance, though you’re right, the devil is in the details. Really, all insurance is group insurance to a large extent. Everyone is part of a pool of risks. I don’t see any insurmountable obstacle to making health insurance portable, and pooling risks in a manner that still provides sufficient diffusion of risk. At the end of the day, there’s not any less insureds, more or less.

Without groups, the insurance companies won’t go for it. They will just charge individual rates, which are triple what group rates are.

[Lobohan]

@Fear_Itself

Without groups, the insurance companies won’t go for it. They will just charge individual rates, which are triple what group rates are.

But you forget, after across state lines is allowed, Magic Happens™ and the prices go down and some insurance companies decide to make less profit so they can give you an option or something.

Wait, how does this work again, Stratocaster?

[Stratocaster]

@Lobohan

It is never profitable to cover the medical payments of a sick person. If your medical care costs more than you pay in premiums, no insurance company wants you.

This is the foundation upon which your argument is built, and it’s where you keep coming off the rails. You keep making absolute statements, without support or nuance, and you’re wrong. It is absolutely profitable to cover medical expenses. In fact, it is essential to profits to cover medical expenses. If you don’t, you won’t have any customers. Take it from me, that’s unprofitable. Here, I’ll try again.

I reject the notion that there’s a “single worst state,” or one that would appeal to all insurers. A state that permits rescission might be extremely restrictive in other matters. Different companies have different product mixes with different features, and a given regulatory framework might be beneficial to one and not to another.

In a less regulated market, one with true alternatives, it is entirely possible, and even likely, the companies will be most profitable if they best meet the needs of their customers. I reject flatly your “all companies are evil empires looking to screw their customers” premise. If there are two companies, one of which is raked over the coals as screwing its customers, and another which has a reputation for providing excellent and fair coverage, why would you assume the the former would be more profitable in the long term–IF THE CUSTOMER HAS CHOICES?

I also flatly reject that there is a state out there that has an inadequate regulatory framework, until someone provides evidence to support such a ridiculous assertion. So, even if we accept as a given “most regulation is best for the consumer” (I do not), that does NOT mean “least regulation” is both inadequate and unappealing to a consumer for other reasons (e.g., lower costs).

That’s where you’re begging the question. Yes, if we accept the premise that there is some unnamed state out there with shitty regulations, where all insurers will flock, the better to increase profits and screw consumers, opening the state borders will produce a horrible effect. Unfortunately for your argument, that’s silly. You offer as a given that which you need to make an argument for. You are running around in circles.

[Stratocaster]

@Fear_Itself

Without groups, the insurance companies won’t go for it. They will just charge individual rates, which are triple what group rates are.

There’s no reason that has to be so. Think about it. What prevents the same number of people from being grouped in a manner that produces the same effect it does when it comes from a policy bolted to a company? Individual insurance is so expensive because almost everyone else is in group insurance, and because there’s been no compulsion to change the status quo. There is really no reason why “groups” can only magically exist for purposes of pooling risk when it’s defined by an employer. Why would it?

[Lobohan]

@Stratocaster

This is the foundation upon which your argument is built, and it’s where you keep coming off the rails. You keep making absolute statements, without support or nuance, and you’re wrong. It is absolutely profitable to cover medical expenses. In fact, it is essential to profits to cover medical expenses. If you don’t, you won’t have any customers. Take it from me, that’s unprofitable.

It is essential to cover as many as it takes to create a perception of caring. But that number isn’t 100%. Insurance companies deny things all the time. Allowing rescission nation-wide (as across state lines purchasing would do) would allow insurance companies to pluck the most costly people from their rolls and keep costs down.

Here, I’ll try again.

I reject the notion that there’s a “single worst state,” or one that would appeal to all insurers. A state that permits rescission might be extremely restrictive in other matters. Different companies have different product mixes with different features, and a given regulatory framework might be beneficial to one and not to another.

There might very well be no one worst state. Maybe there will be five worst states, that are roughly co-equal. Maybe Georgia will decide to take a stand against socialism and deregulate to the bones, thereby becoming the one worst state. In any case, the companies will move to the most profitable states because that’s what they are incentivized to do.

In a less regulated market, one with true alternatives, it is entirely possible, and even likely, the companies will be most profitable if they best meet the needs of their customers. I reject flatly your “all companies are evil empires looking to screw their customers” premise. If there are two companies, one of which is raked over the coals as screwing its customers, and another which has a reputation for providing excellent and fair coverage, why would you assume the the former would be more profitable in the long term–IF THE CUSTOMER HAS CHOICES?

Because they do it now. It’s not like US insurance companies are evil, I’ll grant. But they are self-interested and the tendency over time will be to limit care. If you are incentivized to do something you tend to do it. And the examplar company you suggest is going to have to explain to stock holders why fourth quarter profits are down, because it’s looking to build a long term reputation.

I also flatly reject that there is a state out there that has an inadequate regulatory framework, until someone provides evidence to support such a ridiculous assertion. So, even if we accept as a given “most regulation is best for the consumer” (I do not), that does NOT mean “least regulation” is both inadequate and unappealing to a consumer for other reasons (e.g., lower costs).

I find it highly unlikely that the states are exactly equal right now.

That’s where you’re begging the question. Yes, if we accept the premise that there is some unnamed state out there with shitty regulations, where all insurers will flock, the better to increase profits and screw consumers, opening the state borders will produce a horrible effect. Unfortunately for your argument, that’s silly. You offer as a given that which you need to make an argument for. You are running around in circles.

As I said, the rescission alone will make the country worse off. With 43 states to choose from, the remaining seven will suffer from rescission.

There are, I’m sure, many other issues as well. But none of that matters if you assume that via magic prices will lower when insurance companies get to decide which state’s regulations they want to have.

[Fear_Itself]

@Stratocaster

There is really no reason why “groups” can only magically exist for purposes of pooling risk when it’s defined by an employer. Why would it?

Because employee groups present a more attractive risk for insurance companies, because it avoids the problem of adverse selection. Groups that are selected because the members need insurance necessarily concentrates the risk, while groups selected for purposes unrelated to insurance, such as employee groups spread the risk among the members whose need for benefits varies. It doesn’t always need to be employees of course; unions, professional groups or other groups unrelated to the desire to buy insurance will work as well. But insurance companies shy away from groups formed specifically to purchase insurance, because they unrealistically concentrate the risk, because the members all recognize the need for insurance. Young, healthy people don’t participate, at least not voluntarily.

[Stratocaster]

@Fear_Itself

Because employee groups present a more attractive risk for insurance companies, because it avoids the problem of adverse selection. Groups that are selected because the members need insurance necessarily concentrates the risk, while groups selected for purposes unrelated to insurance, such as employee groups spread the risk among the members whose need for benefits varies. It doesn’t always need to be employees of course; unions, professional groups or other groups unrelated to the desire to buy insurance will work as well. But insurance companies shy away from groups formed specifically to purchase insurance, because they unrealistically concentrate the risk, because the members all recognize the need for insurance. Young, healthy people don’t participate, at least not voluntarily.

That’s a valid point. I’m not sure how material this would be in terms of cost, though. Most people have group insurance, and I’d wager that most would still want it individually in the new world order, making for a damn large group(s) to pool risk–there simply isn’t any precedent in our current structure to compare it to. Life insurance seems to manage using similar principles. And I, for one, would pay extra for an insurance policy that is not in danger of evaporating if I lose my job.

[Fear_Itself]

@Stratocaster

Most people have group insurance, and I’d wager that most would still want it individually in the new world order…

Do you think young, healthy people percieve the need for health insurance the same as older people with health problems? Given the choice, would young, healthy people voluntarily buy health insurance for the same premiums that older, sicker people pay?