Healthcare Reform: Oh Yeah!

As some may know I have for years been advocating for a three part reform of the healthcare coverage: insurers must cover all comers for the same price (no cherry-picking except perhaps for things like smoking); mandatory insurance; sliding scale tax credits to help affordability.

Now comes this offer from the insurance industry.

Oh yeah. Now we are making some progress!

Will this indeed “reshape and advance the debate over universal health insurance just as President-elect Barack Obama prepares to take office”?

Sounds good to me. And really, enforcing it is easy. You just give everyone a deadline by which they need to register with someone and after that any citizen who isn’t registered and isn’t newborn has to pay a fine to get insured.

I’d be okay with that if there was some sort of price cap. “Accept all customers” could mean that people with pre-existing conditions are only offered insurance at exorbitant prices. If they are then required to have insurance, that could be a recipe for disaster.

Meanwhile, Ted Kennedy plans to submit a universal-health-care bill. I guess the Liberal Lion wants one more achievement before his brain tumor puts him on the sidelines.

Full healthcare coverage will never be extended to all until a mechanism is in place to control costs.

No mechanism (short of complete government takeover) to control costs will work unless the patients themselves receive a direct benefit from consuming more limited care and pay a direct penalty for consuming more care. In other words, the patient has to be the one demanding less expensive care for a particular situation. Patients will not do so simply to control the healthcare costs of the next guy over, so the only thing that will work is to shift enough cost burden to the individual to incent them to consume less healthcare.

Universal health insurance with a requirement to participate is a good idea but it’s workable only if the premium is a payroll tax. Else there is no mechanism to extract money from those who simply don’t pay the premium.

Not sure I would see this as progress. What this means is that healthy people who do not want coverage will be required to purchase health insurance that they do not want in order to pay for others. It also means that poor people, who cannot afford it will be required to buy it anyway.

The biggest market segment for the insurance companies that they can’t tap is the 20-30 year olds. Healthy people who, rightly or wrongly, choose not to pay thousands of dollars a year for insurance that they feel they do not need.

It also takes away the last bit of downward price pressure for health care. People with health insurance don’t usually shop around. People without it do.

Why couldn’t this be accomplished the way it is handled in practically every insurance plan I’ve ever had, i.e. via a system of copys/coinsurance with a reasonable annual out-of-pocket max? That way, people don’t have an incentive to consume resources that they don’t need, but they also aren’t bankrupted if something awful happens to them.

How do you propose to handle coverage for people who aren’t employed, or are self-employed? They are some of the people who need the coverage more than anyone.

Agreed that this is only a starting point. The same price all comers bit needs to be agreed to as well - no cherry picking for lower risks or discounts to Megacorp or it won’t work. This coming from the insurance industry does give the Obama administration the cover it needs to go for mandatory coverage after all. I also feel that McCain’s wanting to disassociate healthcare coverage from employers and from tax subsidization via being in pretax dollars is good. Perhaps not the whole way, but at least limiting the maximum benefit that qualifies as pretax benefit to an amount that makes buying it as an individual with after tax dollars but with a tax credit (sliding scale to inverse to income) a competitive option.

Sinaijon, as an employer we shop around constantly. As an employee of the corporation that own I shop around between the plans offered to me each year.

How have the Canadians managed to solve the UHC problems mentioned in this thread, such as lack of downward pressure on prices? Anyone know?

Sorry, I mean for the actual services, IE, the doctor, the prescription, etc.

Different stores charge different prices for drugs, etc. A small town doctor’s clinic might charge less than a megahospital, etc.

Health care costs in both countries increases about 6% a year, which greatly exceeds inflation.

But, doesn’t EVERYONE want health insurance - when they are sick? Isn’t the result of the current system that some ppl get to save the cost of health insurance, but still reap the benefits when they get into a car crash, get caught in a drive-by, etc? They get the medical help they need, probably don’t pay much of the tens of thousands in health care bills they rack up, and the cost of that is passed on to people who DO have health insurance, thus raising costs.

As far as I’m concerned, the top 5 major insurers should be able to form a single company, underwritten by the gov’t that provides insurance to those that need it and don’t have it. The aim, unlike the major insurers, is not profit, but maintenance of people and policies. Through gov’t oversight and direction, the group must take all comers, have mandated price controls, and be taken at every single licensed medical facility. Further, that insurance should have first crack at experimental treatments and drugs if the insured chooses to partake but that should not be mandatory. The people who have bad insurance through their own employers or those self-employed or unemployed can take advantage of the group rate as well on an individual basis but not as an employer. In 10 years the plan could almost pay for itself. As far as drugs go, well, that group must have the ability to negotiate with the drugcos for best price and, if they get the best price, the drugcos can charge no more than that to a private insurer/customer/pharmacy etc. That way we can still support competition in the marketplace AND get coverage where it isn’t.

To take this further-insurance only really works if you have a group of insureds who aren’t all likely to make claims at the same time-the whole point of insurance is to pool risks.

The reason insurance is less expensive than treatment is because it’s pooling risks across people and time–I have auto insurance for many years, even though I don’t have a crash–those payments are used to cover a large claim. Similarly, insurers insure lots of people, and use the premiums of the whole group to cover the subset of that group who makes a claim.

Simple example: if everyone only got health insurance when they got sick, the insurance cost would be the same as the cost of treatment. The insurer knows how much treatment costs, know what the person buying insurance has (presumably, we have no right to defraud an insurer by lying about our medical history).

Similarly, If I only get car insurance when I was about to total my car, nobody would insure me for less than the cost of a new car-as the insurer would know how much they’re going to get hit for.

I’m not sure I agree with the insurers’ proposal (the big issue is how much you charge, and what happens if someone can’t afford the mandatory insurance-which may suggest that the government, not private insurers, should run such a plan), but their point makes sense-it’s not practical to have a system where insurers have to insure everybody who asks, but where people can choose whether to get insurance. Under that rule, we’d be forcing them to take bad risks (or rates would be so high nobody would get insurance).

No. Some people are quite capable of paying per incident. Paying $2000 to get a broken arm fixed up is cheaper than paying $6000 a year in insurance premiums.

As far as the rest of us picking up the tab when they can’t pay for it, wouldn’t the obvious solution be to make it harder for them to skirt their payment responsibilities? Besides,even if they have insurance, we’ll still be paying for it.

Well, some people just don’t have the money to pay for the services they receive. Others might, if you bankrupt them, but policy precludes taking their home, food, etc, etc.

One could take a “they bought their tickets, I say let them crash” approach. But I doubt that would do so well-we passed EMALTA specifically to avoid the problem of hospitals doing a “wallet biopsy” on someone coming in with a heart attack.

And how well are you going to be able to pay for treatment on that brain tumor that’s been slowly growing behind your eye? How about that mole on your back, that you never see, that’s getting larger and scary-looking? How about if you start to feel run-down, and a good weekend of rest doesn’t fix it? Wonder what that will turn into.

One solution to ppl that absolutely don’t want to pay for insurance is to make them sign a paper saying they don’t want insurance. Then they don’t get help when the unexpected happens and they can’t pay for it. That’s freakin’ harsh, and I can’t imagine why ppl would sign up for that, but I’m starting to see there are ppl that just want NO PART of insurance. That being the case, let them opt out, with the understanding that they will truly be on their own. Give them the ability to rejoin, but at increased rates according to how long they’ve been without insurance, and only after passing a comprehensive exam.

Being without insurance is a fool’s game. I’ve known a very healthy, active guy who was dead in six months because of a mole on his back. I’ve known someone who just got their RN degree only to drop dead of a brain aneurysm(age 30). In her case, insurance wouldn’t have helped, but it illustrates how you just can’t know what’s around the corner. You can congratulate yourself for saving a few thousand this year, but when the unexpected happens, that little bit of scratch you saved will be gone, and everything else you saved - unless you drop dead.