If a public option fails, how can we fix the insurance industry?

[TheMadHun]

1. I think if they just make all insurance companies mutuals, as some already are, but add a salary cap so they can’t skirt past the idea of mutual benefit and run it for private gain.

2. They should have explicit options for end of life treatment, of the living will legal structure, that would bar hospitals from soaking the grieving families by prolonging the life of hopeless patients.

[IAmNotSpartacus]

@Squink

How so? States typically contain millions of consumers apiece. What about them makes them too small to support real competition?
Is there any evidence that the nation as a whole is large enough to support the competition you claim will come to exist?

Millions of consumers? Do you understand how group health plans work? 25,000 employees covered at a single employer is not 25,000 consumers, it’s 1 consumer.

[MOIDALIZE]

Healthcare consists of a complex blend of goods and services, the demand for which is commonly sudden, unplanned, and very expensive. These characteristics don’t make the provision of healthcare very amenable to a free market, and you can’t compare healthcare to other goods and services that are. If I know I spend $60 a week for groceries, I can budget that. If I want to purchase an MP3 player, I can leisurely research competing models and slowly save enough money to purchase one. If I get a heart attack, I don’t know how much my treatment is going to cost, and I can’t research competing hospitals or doctors or treatments because I’ll die if I wait. If I need to get my knee replaced, my ability to comparison shop is still limited because I don’t have the medical expertise necessary to intelligently do so.

Despite these facts, if we nonetheless decide against a single payer or public option, I think we need (aside from all the other suggestions) beefed-up antitrust enforcement and national standards.

[Squink]

@IAmNotSpartacus

25,000 employees covered at a single employer is not 25,000 consumers, it’s 1 consumer.

Ah, so the lack of free competition is caused by the insurers defining themselves out of a large enough market for there to be competition. Perhaps rather than opening up to out of state insurers, who will after all still be shackled by the small market size*, we should make everyone get insurance individually. With no more groups, the market would be HUGE, and competition could fluorish, even within individual states. Or something.

Sorry, group pooling doesn’t seem adequate to explain the lack of competition. Until we know the reason for that lack, there is no reason to think that opening states to out of state insurers will cure the problem.
*the number of consumers per state is independent of the number of states a company can compete in.

[Crafter_Man]

1. Get the federal government out of the healthcare industry.

2. Encourage and foster competition amongst providers.

3. Encourage hospitals and physicians to post prices for all goods & services.

4. Eliminate government rules & regulations at the federal level.

[gonzomax]

@yorick73

Yet they are still the leader in low prices. They are giving the CONSUMER what they want and it is the suppliers that have to figure out how to keep prices low. But this is my point…if Walmart completely took over then they could charge whatever they want for their products.

Nope, it is called ,or was when I was in college many years ago, the marginal propensity to consume. That is when you raise prices until you get to a level where people quit buying and you actually start to lose money. You search for they level then stay within it. Without competition there still is a price level that can not be passed.

[gonzomax]

Whats wrong with our system

1. It costs more than any other country by a large margin
2. It provides bad care, 37 th in the world. (not getting much for our money are we)
3. The companies reject people for whatever reasons they deem fit. There are no guidelines or regulation on that.
4. They can refuse to pay for services that a doctor performs or refuse to allow then to do perform them. That is our equiv. to a death panel, but is determined by cost.
5. They suck about 30 percent of the cost for administration
6. They don’t believe in preventative medicine. All they see is immediate bottom lines. If you need to be on a regime to stay alive , they don’t want to pay for it. If you last til 65 they will be rid of you. So they don’t care about you at 66, or 80.
7. They overcharge . They continually jack premiums up and cut services. They will double their prices by 2020.
8. The execs are making enormous salaries and benefits. We love to overpay execs.
9. They spend millions and millions lobbying politicians. That is an expense that does not help the care they are supposed to be providing.
10. They routinely jettison people who need care. If they might cost money they will drop you. Of course the majority of bankruptcies have a medical component and most of them had coverage.
11. All politicians are aware that with the continuous raising of health costs, the system will fail. It will take 40 percent of our national wealth to sustain it.
12. Doctors have to hire a staff to fight with them over payments. Every company has their own paperwork and requirements. They also pay differently for the same services. This expense does not enhance coverage. It is a waste.
13. It is part of the employment benefits. that means we have to fold the cost into the price of our products and it hurts every company that pays it in competing. Also, lose your job. lose your coverage. yopu can not afford to pay for it on unemployment or a low paying job.
    We can not fix them. They are the problem.

[yorick73]

@gonzomax

Nope, it is called ,or was when I was in college many years ago, the marginal propensity to consume. That is when you raise prices until you get to a level where people quit buying and you actually start to lose money. You search for they level then stay within it. Without competition there still is a price level that can not be passed.

Okay…that was poorly worded. My point is that if Walmart controlled the entire market there would be no reason to keep prices so low. Walmart certainly does not have a monopoly on the market.

[yorick73]

@Squink

Ah, so the lack of free competition is caused by the insurers defining themselves out of a large enough market for there to be competition. Perhaps rather than opening up to out of state insurers, who will after all still be shackled by the small market size*, we should make everyone get insurance individually. With no more groups, the market would be HUGE, and competition could fluorish, even within individual states. Or something.

Sorry, group pooling doesn’t seem adequate to explain the lack of competition. Until we know the reason for that lack, there is no reason to think that opening states to out of state insurers will cure the problem.
*the number of consumers per state is independent of the number of states a company can compete in.

This doesn’t make sense to me. In the current environment the company that charges the lowest rate to employers, regardless of whether they fuck the individual, will succeed. This can and does result in one or a few companies that control the market. If individuals are making the choice between different insurance companies as opposed to one large employer then this seems to allow for smaller companies to take root and grow by attracting more individuals.

[Trepa_Mayfield]

IIRC, the basic non-government based plan goes something like this:

1. Remove state boundaries for insurance.
2. Remove employer subsidies.
3. Massive tort reform

at which point all of the insurance companies will start competing with each other, the prices will drop, and people will be happy.

[Der_Trihs]

@Crafter_Man

1. Get the federal government out of the healthcare industry.

2. Encourage and foster competition amongst providers.

3. Encourage hospitals and physicians to post prices for all goods & services.

4. Eliminate government rules & regulations at the federal level.

And watch people die right and left, and the industry collapse because only the desperate and impoverished ( who can’t go get care out of the country ) will go to it at all. Those regulations were created because the medical industry has never hesitated to defraud its patients to their deaths if it could do so profitably. Under your system they’d just go back to the good old days of selling poison and calling it medicine. And the only competition would be over who can cheat the patients most efficiently; that’s what you get without regulations.

[Fear_Itself]

1. Force insurance companies to take who ever applies.
2. Ban pre-existing conditions exclusion.
3. Fix prices.
4. Mandate benefits.
5. Lift the ERISA ban on punitive damages against health insurance companies.

[Damuri_Ajashi]

@yorick73

Let insurance companies compete across state lines. More competition certainly couldn’t hurt. I don’t know how easy this would be since every state has its own set of rules.

Also, why not let insurance companies offer plans that only cover catastrophic events instead of covering basic preventative care. I think if the government did not mandate so much we would have a lot more choices in the type of plan we could purchase…much like auto insurance.

Oh, and we have to get rid of linking health insurance to employment.

Almost every major insurance carrier is licensed (or has subsidiaries) licensed in every state. It would do NOTHING to let insurance companies sell across state lines. There is a reason why insurance costs more in NYC than in Omaha.

Insurance companies ALREADY offer catastrophic coverage plans (they are called high deductible health plans and they have been around since the beginning of the second Bush administration.

Right now it is illegal for the federal government to regulate insurance in any way.

You do realize how silly you sound when you put forward auto insurance as an example of insurance without a government mandate right?

[Wesley_Clark]

@pedescribe

IIRC, the basic non-government based plan goes something like this:

1. Remove state boundaries for insurance.
2. Remove employer subsidies.
3. Massive tort reform

at which point all of the insurance companies will start competing with each other, the prices will drop, and people will be happy.

Why would that make people happy? Here is what would happen

1. Removing state boundaries will make it easier for insurance companies to deny care and rescind policies once people start to use them.

2. Removing employer subsidies will make healthcare unaffordable

3. Tort reform doesn’t do much of anything to cut health costs. The CBO studied it and found it didn’t make a difference. Texas implemented it and it didn’t matter. Even under the most liberal of estimates, defensive medicine only makes up 3% of all health spending in the US.

[Wesley_Clark]

@yorick73

Umm…people being able to take their business elsewhere. The current system does not allow this. Compassion from a company is only PR and this only works if you have the ability to tell the company “Fuck you…I’ll go elsewhere for my insurance”

Regulations force insurance companies to cover pre-existing conditions and not rescind policies. If you eliminate government regulations, then people become dependent on one insurance because no other company will cover them.

[elucidator]

The stream of revenue that the insurance companies have fattened upon during the years of deregulation are not legitimate, in that they are not in the best interests of the American people. Any regulation worth the word must, by necessity, mean a lessing of that revenue stream, well, duh.

I think what the problem very well may be is that the insurance guys lost a buttload of money just like everybody else. And their scenarios for a return to rosy fiscal health depend on that revenue stream continuing as before.

Hence, they cannot compromise, they can only lose, or win. To win they must defeat any significant regulation on their industry. Which explains why they are absolutely pulling out all the stops.

In a moment of snark, I suggested they would be willing to accept a compromise that guarantees them the same revenue stream or better. Like the government pays for the premiums, and they get to play cute games with whether or not they pay out for claims.

But I may have been more right than I realized.

[yorick73]

@Damuri_Ajashi

Almost every major insurance carrier is licensed (or has subsidiaries) licensed in every state. It would do NOTHING to let insurance companies sell across state lines. There is a reason why insurance costs more in NYC than in Omaha.

And why, pray tell, do policies cost more in certain states? If you said state regulation you would be correct. The whole idea of buying a policy from another state means that the insurance I purchase in Omaha does not have to cover everything that a New York policy would have to cover. Maybe it’s a trade-off many are willing to make…save money every month but I’m SOL if I want a gender reassignment surgery.

@Damuri_Ajashi

Insurance companies ALREADY offer catastrophic coverage plans (they are called high deductible health plans and they have been around since the beginning of the second Bush administration.

I’m not aware that catastrophic coverage is an option through an employer sponsored health plan. Usually I hear about these plans available to the uninsured or unemployed. If I am incorrect on this point please point this out.

@Damuri_Ajashi

Right now it is illegal for the federal government to regulate insurance in any way.

I said government, not federal government. I should have been more clear. Nonetheless, the feds certainly do regulate health insurance to some extent. Or, are you suggesting that HIPAA, COBRA and ERISA are illegal?

@Damuri_Ajashi

You do realize how silly you sound when you put forward auto insurance as an example of insurance without a government mandate right?

Not really…could you please enlighten me? Or do you live in an area where collision is mandated?

[yorick73]

@Wesley_Clark

Regulations force insurance companies to cover pre-existing conditions and not rescind policies. If you eliminate government regulations, then people become dependent on one insurance because no other company will cover them.

No question. Not all regulations are bad. But, if the state regulations on what MUST be covered were relaxed then I think we would see many different policies that we could choose from. This effect would be magnified by being able to purchase insurance from another state.

[Fear_Itself]

@Damuri_Ajashi

Right now it is illegal for the federal government to regulate insurance in any way.

This is factually false. Federal ERISA statutes control all employer-offered group health insurance, and supercede any state laws that may appear contradictory.

[Brainiac]

They are the only industry other than major league sports to enjoy exemption from anti-trust laws. That’s a good place to start. There are no free market options at the moment.