This is why credit cards can charge 29% interest.
Thanks, Delaware.
The idea is that the federal government sets minimum standards, which it has. If states want higher standards and this policy undercuts them, sure, that’s by design. I’m not sure what’s wrong with people voting with their dollars. Yes, most insurance companies would just incorporate in Delaware or something, but they’d offer widely varying levels of coverage and service, so there’d be plenty of diversity, just like there is with credit card companies.
But if we’re negotiating here, how about allowing states to set up public options if they want, which I’m pretty sure is already allowed.
That cap is federal. If you want it lowered, all you have to do is call Liz Warren, rather than 50 state legislators.
Now this might seem anti-conservative, just having one federal standard, but there are two competing conservative philosophies here. The first, obviously states rights, and no one is advocating outlawing states setting their own standards for credit card or health insurance companies. The second principle though is free interstate trade. The interstate commerce clause does not actually exist to give Congress the ability to regulate whatever it wants. That was a novel interpretation of the New Deal court. The clause actually exists to empower Congress to overrule attempts by states to restrain trade with other states.
So race for the lowest regulations is the point then. What “minimum standards” do you see the current legislative and executive branch implementing nation wide?
It would neuter the states from being able to set up their own regulations on health care. I thought you guys were all about empowering the states though? This would seem to be counter to that philosophy.
As I said above(we probably posted at the same time), free interstate trade is a competing conservative principle.
I’m also a bit confused about why Democrats would want 50 different standards for an issue that is clearly an interstate issue.
Anyway, the idea here is that the coverage mandates increase costs, which makes people who are healthy not want to buy insurance. Insurance companies would still offer generous plans, because many people want generous plans. Consumers would have more choices and overall costs would go down.
I’m wondering why our resident Trump apologists haven’t chimed in on this?
This bill is a disaster. It targets those who are the most vulnerable among us. If you think it’s tough to get into the ER now, just wait.
Sorry, I just don’t want my Health insurance being controlled by the politicians in Alabama, or whatever state would first rush to eliminate as much regulation as possible. You sound like you’re talking about a fantasy place called conservatopia. We’ve already seen what happens when this kind of thing is allowed. Intelligent people try not to repeat the mistakes of history.
Okay, so that’s a Delaware law. And nothing prevents the federal government from capping interest rates. I’m not sure what great consumer interest is achieved by forcing people to only buy credit cards in their states. You’d just end up with fewer people with credit lines, which could be fine for credit, but disastrous for health insurance.
I think we could all agree that if the upshot of selling insurance across states lines was 100% coverage, even if some of that coverage was poor, that it would be better than what we have now.
Why not make all products and services state-based then? Because that would be a disaster. What’s happened with health insurance is the same thing that would happen with any product that can only be sold within state borders: it’s more expensive and there are fewer choices. If we did the same thing with credit cards we’d have monopolies there too.
Poor coverage is essentially no coverage. It disappears just when its needed. So no, I don’t think that’s automatically better. Plus soon all plans would be poor since they’d all be based in whatever state follows Delaware’s example. To deny this seems like wishful thinking.
I am always puzzled by the “sell across state lines” solution. A common criticism of the ACA is narrow networks - which I thought were due to the complexity of insurers negotiating favorable fee structures with a multitude of hospitals, physicians and other providers. So, why would a Delaware insurance company want to negotiate with multiple provider networks in fifty states?
Also, when it comes to a premium surcharge to encourage coverage without a mandate - why not use the same stick as Medicare? If you delay Medicare, your premium goes up 1% for each month of missed coverage - AND - that premium surcharge is permanent.
Not if you have federal standards. ACA already has those standards, and I’ve only called for eliminating the free stuff and allowing companies to charge normal co-pays for them. There would still be no maximums and no dropping of coverage when you get sick. And of course states could set up public options or even single payer if their citizens are willing to pay the taxes for it.
Fair enough. 
If it’s a failure of leadership, it’s one that goes back a ways. For all their talk about ‘repeal and replace,’ it’s been seven years since Obama signed the ACA into law, and if they had been taking the notion of an Obamacare replacement seriously, they’d have had plenty of time to investigate and figure out why the only replacements for Obamacare were (a) single-payer, which they are firmly opposed to, (b) nothing at all (i.e. the status quo ante), or (c) something that was basically the same idea as Obamacare: community rating (no discrimination against people with pre-existing conditions), some mechanism forcing universal or near-universal participation (e.g. the individual mandate), and subsidies for those who couldn’t afford the insurance.
But acknowledging that would have forced them to go down one of two paths: (i) the “Obamacare is OK, just needs tweaking” path, or (ii) the “Obamacare is awful, let’s go back to the way things were before” path. I think you can see the reasons they didn’t want to go down either of those, but they had to basically lie about the realities of health care for the past seven years to avoid that choice.
Now they’re stuck in the corner that their lies have backed them into.
The ACA doesn’t have any fundamental flaws. It has aspects that need to be modified or tweaked, for sure - and in the past, that would happen in the natural course of things after a program as significant as the ACA was set up. Once the program itself was in place, nobody would bother fighting over technical adjustments. But during the past seven years, that has not been possible with the ACA due to unyielding GOP opposition. We’re stuck with the ACA as originally written, other than the modifications the Supreme Court has imposed on it.
He wants the $600B tax cut that this gutting of the ACA would pay for. Making the ACA work better in the ways that people complain about - deductibles too high, copays too big - can only be fixed with larger subsidies - exactly the opposite direction.
Not to mention, the entire right-wing noise machine - GOP politicians, Fox News, talk radio - has spent eight years working the base into a froth over Obamacare, and they expect it killed, dammit. What are they going to say now, “Oops, we didn’t mean it, we’re going the ‘mend it, don’t end it’ route”? Most GOP Congresspersons would be primaried next year.
But like I said, they’re stuck in the corner that all those years of lies have backed them into. And Paul Ryan hasn’t exactly been a bystander to all that.
I guess lying can be smart, as long as you keep getting away with it.
“Has your luck run out?” she laughed at him, “well, I guess you must’ve known it would someday.” - Dylan
We’ll see if Paul Ryan fares better than the Jack of Hearts.
I think we could all agree that if the upshot of collecting unicorn droppings was abundantly productive rose bushes, that would be good.
What can an insurance company compete with? The math is the math, the risk, the benefit, the premium is the central fact that all must adhere to. There are no miracles, nobody has a bold new innovation that bends those central facts.
The person who thinks they have good, cheap health insurance almost certainly does not. That person may feel he has been robbed if his substandard plan is not permitted. He was already being robbed! And the people who sell that ought to be ashamed of themselves.
We know its wrong to take somebody’s money by force or fear. Why do we continue to think its OK if you just outsmart them?
For improving the mandate, I say to do away with penalties and enrollment periods. Instead, pre-existing conditions are not covered for some amount of time proportional to how long you had been without insurance (min 6 months, max 12 months). That would discourage people from signing up only after they are sick since they would have to wait a long time to get care. Switching from one plan to another should still be done with enrollment periods rather than at any time.
I also agree coverage requirements should be reduced to make the program more feasible. I personally am fine with the level of coverage, but many people resent it and are electing representatives to fight it. Certain treatments are lightening rods for critics regardless of their cost, so removing them means the program has a better chance of success.
ACA standards are much, much higher than most people need. No one needs free preventive care or free birth control. If your plan covers all proven technologies and there are no maximum payouts, and your out of pocket maximum isn’t awful, you’ve got pretty decent coverage. That’s all I’m advocating for, not a total gutting of ACA’s regulations. Just let insurance companies charge co-pays for preventive services and birth control, that’s all. They should also have the option of not covering things like mental health or prescriptions, as long as that’s transparent and consumers know what they are buying.
They don’t necessarily have that choice when there is a public interest involved – for example, I’m pretty sure that auto liability insurance is mandatory in many states and every Canadian province. And the public interest in question is quite similar on at least the level of public liability: if an uninsured motorist is at fault for causing a lot of property damage or personal injury, the affected party may have no protection from huge financial losses, or may have to be compensated from public funds or his own insurance if he’s lucky. Likewise, if some genius who thinks he doesn’t need health insurance suddenly winds up in the ER because he’s been in a serious car accident or just had heart attack, guess who’s stuck with the bill?
It’s actually even worse than that because there’s also precedent for laws that just protect people from their own irresponsibility, like seat belt laws and drug laws, but the public liability argument may work best for the strict bean counters.
Yeah, that didn’t make a lot of sense. Maybe they meant to say that “Keeping **good **drivers out of car insurance pools or healthy people out of health insurance”; if people most likely to make claims were the only participants, the insurance business would not be viable.
But let me make a more fundamental point here. Yes, insurance is only viable if there is broad participation across the whole spectrum of risk, but health care has a lot more unique issues that simply make the traditional insurance model completely unsuitable. To begin with, no civilized society should (or, one hopes, willingly and knowingly would) deprive someone of necessary health care for lack of ability to pay. One can extend this to say that if everyone is covered, then the system is enormously more efficient if everyone’s rates are the same and simply set for average costs over the entire population. If this is the case, and everyone’s rates and coverages are the same, then there’s no need for bureaucratic meddling between the doctor and his patient. Treatment is then driven entirely by medical need and not by some meddling insurance company bureaucrat whose interference costs time and money while actually impairing medical practice. In what other industry would you pay someone to make things worse? With these greater efficiencies, the cost of health care becomes a lot lower.
The underlying point here is that it all dovetails together into a model that practically screams “functional efficient health care does NOT follow a free market model – it’s pretty much the exact opposite”, for the very simple reason that everybody gets sick at some point and everybody needs to be treated accordingly as a matter of basic human rights. It’s really a lot more like an essential public service, like police or fire services. Trying to force-fit health care finance into a free-market model just doesn’t freaking work because the value proposition is all wrong. That’s why any health care system set up by Republicans or with the influence of Republican free-market ideology is like a broken tent with big holes in it that somebody pitched upside down – it’s going to need a hundred tent poles trying to prop it up and it’s still going to be collapsing all over the place – and every one of those useless tent poles is extremely expensive. The present health care system is so expensive, in a nutshell, because the traditional insurance model simply does not work, never did, and never will.
Before the ACA, insurers could sell “catastrophic coverage” policies, which were like this. I work in advertising, and at that time (about 10 years ago), I had a big regional health insurance company as a client (I have a different regional insurer as a client today); they sold those catastrophic policies, which we would sometimes refer to as “falling off a mountain” coverage – they didn’t cover everyday medical stuff (like preventative care), but they’d keep you from going bankrupt if you were a 26 year old who, say, liked mountain climbing, and had an accident.
But, under the ACA, all individual policies had to cover a broader range of things, as you note, and that largely killed off the catastrophic policies.
The car insurance argument is interesting, in that better enforcement of traffic laws would reduce rates for everyone as the bad drivers were removed from the pool by losing their licenses and everyone drove more carefully due to the higher risk of getting caught and punished.
That obviously doesn’t really tell us much about health insurance, and of course no one is required to buy car insurance as a condition of being a US citizen. I don’t own a car, so I have no car insurance.