I’m not well versed in Canadian law so take this with a grain of salt, but the analogy is still poor. The reason it is a poor analogy is that you aren’t required to purchase auto insurance if you don’t drive. The criticism of Ryan in the linked article and from the other sources quoted in that article are hollow. In their attempt at a gotcha they made themselves look foolish.
I don’t think so. The price would just rise to accommodate for the increased risk.
I don’t think this is right either. If risk pools are populated by folks with similar risk levels, then pricing would be more even across the pool and one group within the pool wouldn’t be heavily subsidizing any other group. When risk pools have disparate amounts of risk across the participants, if the pricing is similar then to accommodate the higher risk individuals the lower risk people would be paying more. It’s like a junk CDO being rated AAA because 80% of the pool is normal folks and the other 20% are all NINJA loans. That’s the source of the complaint that young people are subsidizing older people.
I do agree that healthcare does not always behave like a regular market good. I disagree that the previous model pre-ACA didn’t work. It worked for the vast majority of people. And even with Canadian or other single payer models, there are winners and losers - the choice is just who those winners and losers should be.
Could someone explain to me why it’s necessary to single out lottery winners?
I thought Medicaid benefits were already means-tested. If you’re on Medicaid, and make a million dollars by signing with an NBA team, or striking it rich in the stock market, or recording a million-selling record, I assumed your benefits were yanked. Is this not the case?
It’s almost like there aren’t 30 perfectly viable, mature variations on a successful theme among developed countries that put the lie to Paul Ryan’s rolled up sleeves Powerpoint presentation.
As an elected politician drawing a public salary, who is it he represents exactly?
The really sad thing is that if this is going to screw up health coverage for my family I hope my spouse will die before it takes effect. Because while I am currently confident he’ll get the care he needs this year I am not so sure about down the road. I’d rather he go quickly than linger in agony. He’s had enough of that already.
(He has stage IV metastatic bladder cancer - he’s unlikely to make it to 2020 although I’d be happy if he “wins the lottery”. That is the sort of odds we’re looking at.)
Some states already allow selling across state lines. The people who don’t want to do it? Insurance companies. “Insurance” is not the product. The network is the product. Insurance companies cannot make money unless they have the network.
And you aren’t required to purchase health insurance if you don’t have a body.
You do realize that in some instances that would pretty much guarantee death? Some diseases and disorders can’t wait months for treatments.
If you take the position that life-saving care MUST given by ER’s or hospitals then who is going to pay for it when the patient goes broke? That was bankrupting hospitals before the ACA, want to go back to that?
How about birth defects? There was an attempt some years ago by some insurance companies to consider birth defects as “pre-existing conditions” and refuse to cover surgery treatments to make the kid functional or save his/her life. You OK with that or not?
You do if your income is low enough. And there are people who have next to no income. If you don’t treat or screen them for treatable disorders (which you then treat) then they are very unlikely to get better and increase their income. Is that where you really want to go?
Contrary to the far-right party line, most poor people aren’t poor because they’re lazy - often there are physical or mental problems that could be treated and make the person more functional. Then there are accidents that screw people up for awhile.
Birth control is a proven technology - why aren’t you willing to cover that? Preventive medication is of benefit not just to the individual but society at large, in other words, that is also a proven technology. Why are you excepting that?
The POINT of covering those things is to reduce the costs of unwanted pregnancies (even the more pro-choice person would prefer conception be prevented rather than aborted later) and the costs of treating illnesses in later, more expensive stages. Why are you opposed to investing a little now to save money down the line? How does that make fiscal sense?
That’s gutting the usefulness of health coverage. How about a policy that covers everything but heart disease? That would save money! Would suck to have a disease that is controllable with medication but not be able to afford it - why are you opposed to prescription coverage, you think all drugs are bad or something?
Health coverage that doesn’t cover those things is bullshit and a garbage policy.
It is certainly the case in my state - doesn’t matter what your source of income is, if it exceeds a certain amount you’re off Medicaid. Could be wages, investment income, gambling winnings… which is what a lottery payoff is, it’s gambling income.
The parts referring to lottery winners are, to my view, pretty much a political sop to someone. I’m not sure who, but it’s ridiculous to include it when access to Medicaid and other government subsidized programs are means-tested.
What would be the point? You get some disease that can be managed or maybe even cured with a $1000/month prescription, but you didn’t buy prescription coverage and can’t afford the pills, so now you’re left with excellent coverage for all your doctor visits where the doctor can tell you you’d be fine and dandy if only you’d take GreatMedication. You’ve also got good coverage when you show up in the ER because of the symptoms that you wouldn’t have if you’d take the pills, but instead all you’re doing is running up your copays and deductibles and the cost of insurance generally when your insurer has to pay for those doctor and ER visits. Or you end up having to be admitted to the hospital (where your pills are covered by the insurance), instead of having outpatient treatment.
Some of the new chemo drugs, for example, are $65,000/month. How much is your cancer treatment going to cost, and what are the chances of success, if the most successful treatment options are not even options for you?
If this is what’s preventing a person in Paterson from buying insurance from a carrier in Manhattan, that’s friggin’ pathetic. Set common minimum regulatory standards, for Christ’s sake. If you’re going to let this theoretical problem prevent Americans from buying insurance from their provider of choice just because it’s in another state, you have legislative myopia of the worst sort.
The problem is that the prime motivation for the insurance company to go to another state is a different (read, weaker) regulatory climate.
If I’m an insurance company, it costs me money to enter a new state–I’ve got to establish contracts with the medical providers in that state, obtain a business license and comply with the various regulations surrounding that (e.g., registered agent for service of process), market my plan to that state’s residents, etc. Right now, as an insurer I can open up shop in as many states as I want, as long as I am willing to go through the process to do so.
The benefit from “selling across state lines” is having ONE regulatory regime with which I must comply–I can sell insurance in both New Jersey and New York but only have to deal with the regulators in one of those states. I have a strong incentive to pick the regulatory regime that is most profitable for me. This is not a theoretical problem: the example of South Dakota’s credit card industry, e.g., is quite well known. “Minimum regulatory standards” is only part of the issue, because enforcement of those standards is also a function of state regulators.
Some states are rather notorious for a cozy relationship between state regulators and the industry they are supposed to be regulating. Even where regulators aren’t overly cozy, there are still perverse incentives. For example, if I am the elected insurance commissioner in Kansas, what’s my motivation to care what happens to customers in New York? They didn’t elect me, and they won’t re-elect me no matter how good a job I do for them. The company that I regulate that provides their coverage, however, is a potential source of campaign contributions for me.
Like much that the R’s do, their plan is a horrible plan, designed to benefit wealthy folks and to stick it to everyone else. They do it because they have been doing it before and it got them elected. Why? Because the American Public, by and large, is a bunch of fools who focus on single issues that seem, at the moment, to be of overriding import to them. The sex of the candidate, the race, the willingness to allow women to choose to have an abortion, the desire to spend tax money of horrible things like education, roads, job training and so forth instead of building walls and more aircraft carriers, 10 for every one anyone else has.
We have the only country in the world where conservatives are able to block nationalized health care. Why? Because they are only Christians from 10 until noon every Sunday. Otherwise, they are greedy money-grubbing snakes.
As a conservative Republican, I will admit that I agree that the healthcare plan currently put out by House Republicans and being cheerlead by Republicans is a terrible plan that won’t reduce the cost of insurance and stop premium increases, mainly due to how many taxes it keeps after it being implemented, hell it even keeps the Cadillac tax indefinitely.
Sen. Rand Paul’s ObamaCare Repeal & Replace plan is much more better; I just saw it on his website.
It’s terrible - removing mandates for enrollment will leave it underfunded, which is a sure recipe for disaster. Also, I though Republicans hated deficits? How is that justified?
Removal of essential health benefits requirement? How do you justify removing essential benefits?
Removal of medical loss ratio requirements? That means it would be legal for a healthcare company to spent 80% of it’s money on salaries and advertising and only 20% on actual care, whereas the current requirement is 80% on actual care with no more than 20% for everything else. How do you justify that reversal?
HSA are bullshit for anyone with a chronic condition - they will NEVER be able to acquire any savings! With someone who is afflicted from birth they will never have a chance to get ahead. It also leaves young people who become ill through no fault of their own (which is most ill young people) out in the cold. This ONLY works for people who enjoy BOTH a long period of health in their early adult years AND have the income to put this money aside. The poor and the chronically sick are shit on with HSA’s.
(I will note that allowing HSA’s without a high-deductible policy requirement, and allowing their use for things like prescription drugs and paying for premiums could be a very good thing)
The problems with selling policies across state lines have already been addressed in this thread.
Rand Paul’s proposal have a few good ideas but it still favors the wealthy and shits on the poor and sick. It sucks. It’s more of the same bullshit.
Something I’ve pointed out before and will continue to point out, even though it is seldom acknowledged.
Many of the “plans people loved” weren’t cheap catastrophic plans.
Pre-Obamacare, some insurers sold small “bridge policies” to cover the deductible on a real insurance policy. The plans were inexpensive, often well under $100 a month. And they covered a lot of routine services,doctor visits , eyeglasses, prescription drugs… with low or no copays and no deductible. The only catch was the annual maximum benefit which was usually around $2000.
Now these plans were not intended as primary insurance. In fact, they had big “This Plan Is Not Insurance” warnings on them. But some people got the bright idea to offer them up to low income employees of companies like McDonalds and Walmart as insurance.
And the employees LOVED them and understandably so. Here was this insurance plan that paid for every bit of routine care and it cost under $100 a month. And the large majority of those policy holders, most of them young,never experienced a significant medical event that would expose the fatal flaw of those policies.
So Obama wasn’t really as big of a liar as he was made out to be. These plans, along with a lot of “Health Care Savings Club and Discount Card” health plans never met the legal definition of an insurance policy. But telling people they can’t keep their insurance because it wasn’t really insurance sounds weasely, even if it’s 100% true.
And Obama didn’t personally write the ACA, nor christen it Obamacare. Nevertheless his administration made it a priority, and he put his clout into passing it. There is precedent here, set by republicans. If the bill isn’t good enough for Trump to put his name on it, I’d recommend he stop supporting it so vigorously.