No, I don’t think this will improve our fiscal standing. If companies sense that this program is being pulled from them, then they will just increase their premiums even more. About 85% of the exchange population is already subsidized. So, the impact of this is likely to be higher government subsidies, i.e., it will likely end up costing the government more if they follow through with stopping this risk adjustment program.
The self-destructive stupidity of the American voter is simply beyond belief. It’s simply insane. Our country is fucked, and these morons asked for it.
I hope that every single time someone gets told their insurance won’t cover their healthcare, someone is there to remind the dumbfucks that they voted for this.
Actually what should sicken you is the fact that MANY people think they should be able to live their lives as they wish and then have SOMEONE ELSE pay for their long term troubles due to their choices. (granted, not always!)
Actually no it doesn’t, some people in a society will make harmful choices, some of that circumstantial and with health issues, lots of randomness. It’s part of being in a society.
But what does make me ‘sick’ is seeing how fucked up and greedy American heath-care is and how deceptive it is stating how great it is. Go outside the US (my example is France, Spain, Portugal, all which I have some personal experience with) and pay out of pocket for medical care and it is often cheaper then what the US system charges to someone with insurance. And don’t get me started on the prescriptions. We are getting ripped off, hosed and left to die, and it’s not the doctors that are making the money. The US system as I see it is a lie that needs to be told and believed to keep the system going. Now that really makes me ‘sick’.
The idea that it’s only “other people” who make bad choices is laughable- we all make good and bad choices. I might have to provide a social safety net for someone who might have made poor choices, but I also benefit from other people who made better choices than I did. And other people may have covered me when I might have made a bad choice. It’s just part of being in a functioning society.
And it’s not just choices. I have prostate cancer. Almost all men who live long enough will get it. Luckily it’s usually a slow growing cancer that can often be left untreated if it waits until your 70 to start. If you’re one of the “lucky” ones like me, it hits you in your 50s. If you’re one of the real lucky ones, the operation and radiation won’t get it all, and it will metastasize.
What causes it? We don’t know.
One recent study said, vitamin E might make it worse. You remember vitamin E, that stuff we were all supposed to take to keep us healthy. It turns out I only ever took it for a short time, so that’s probably not it.
I very much doubt that you could point to the “bad choices” I made, because my doctor can’t.
Fortunately there is a medicine I take which help keeps it in check, and it only costs $9000+ a month. In Canada it costs about $4000 and a bit less in Mexico. It costs 2300 pounds in the UK, and the manufacturer has agreed to rebate the cost after the 11 months of treatment. (I’m currently on my 7th and with a 3-5 year prognosis will go way past 11 months). I wonder why we here in the US can’t get such deals? Could it be that Medicare is not allowed to do such negotiations something that would help set prices here?
Let me ask you a question. Do you think healthy people should pay more for health insurance, so that sick people can pay less?
That’s essentially risk-pooling right there. If that is not allowed, then insurance as a concept goes away. You have to have people within any group subsidizing others, whether you’re talking about government-provided insurance or private health insurance.
It’s not that healthy people pay more so sick people pay less. It’s that with universal care, everyone is covered from birth so you don’t know who the healthy and sick ones are. That way if you have a genetic defect, you’re covered. If you have childhood leukemia, you’re covered. If you suffer a traumatic injury playing football as a kid, you’re covered. …
Yes. Healthy people will generally be paying less, in total, since they will access health insurance less often. So I’d rather pay $25 instead of $15 for my once annual checkup, so that a child with asthma can pay $5 to get routine and urgent care more often to keep their asthma better controlled. It’s much better than the same child ending up in the ER with a life threatening asthma attack. Cheaper too.
Yes, it’s essentially the idea of a Rawlsian veil of ignorance. The principle is that you commit to contribute to the insurance pool before you are born, before you know anything about your future lifetime healthcare needs. In practice, this means that a public universal healthcare system funded out of obligatory general taxation is part of the social contract of living in any civilized country (except the U.S.).
This is not correct.
“Insurance as a concept” applies when the risks being pooled are unknown upfront. Insurance doesn’t work if higher risks are charged the same rates as lower risks. That’s why non health insurance has different rates for higher risk people and situations. Attempts to regulate these in the specific case of health insurance to either lessen or eliminate risk-based rating are changing health insurance from being true insurance to being a form of social program.
That’s not to take a position on whether this is right or wrong in the case of health insurance. Just to point out that it’s incorrect to describe the form of “risk-pooling” being pushed in the case of health insurance as “insurance as a concept” when the exact opposite is the case.
Medicare and Social Security are insurance programs that don’t charge based on risk, and function just fine. The funding issues with those programs are based on demographics, not risk.
I would say Medicare and SS are social programs and not true insurance.
And you’re not a true Scotsman.
No this is not correct. I know of no company run (private) group health insurance which requires a medical exam or charges different rates for the same coverage. And as far as I know it was not regulated to be this way. It was a private i.e., industry-customer choice
By and large, private defined benefit retirement plans do not look at health risks either. Private life annuities that you can purchase after retirement with IRAs etc. also do not consider anything other than age in setting your payments. I won’t say there are no plans that are different, but these are the norms.
I would say Social Security retirement and health care under ACA are very close to what that the private sector provides here. If you don’t want to call these things insurance by your definition, I don’t suppose we can stop you, but it is certainly within common usage to call them such.
No, I don’t think healthy people should pay more. I think that those who cannot afford it be able to afford it. But telling a for profit organization that THEY shall eat crow and help others isn’t what this needs to be.
I don’t have much of a dog in the single payer/Obamacare/private insurance fight. I simply don’t care one way or the other but trying to get private insurance to be the bad guy because they make a profit is plain stupid. (And why? Because you can’t get single payer or some other miraculous cost reduction plan passed)
Get those plans pushed out to the public, show who pays what and why. SELL IT
Homeowner’s coverage is true insurance … and some Florida residents with gable roofs pay A LOT more for coverage than those with hip roofs … and this is an objective fact …
How do we divide up the medical risk pool? … should stamp collectors pay less than free climbers? … what objective facts do we use? … BMI comes to mind …
ETA: For Florida homeowners, we have to make this decision before the hurricane strikes … for medical insurance we must decide before anyone gets sick …
This is not correct. (I don’t know how much your “I know of no company …” and “As far as I know …” are worth. How much knowledge and experience do you have in this area?)
Most group insurance is provided and sponsored by employers, and to the extent allowed by law they absolutely charge differently based on demographic risk and health risk scores. What some people may find confusing in this respect is that the employer then charges uniform employee contributions without reflecting these factors, but that’s an employer business decision which has nothing to do with insurance.
Individual coverage would very much rate differently by age, gender, smoking status to the extent allowed, not to mention prior conditions.
I’m not as familiar with these types of plans as I am with health insurance, so I’m reluctant to make any definitive claims here.
But I would point out that WRT retirement plans/annuities, the risk is the other way around, so to speak. Meaning, the insurer loses money if the person lives too long, and profits if the person lives shorter. So a high risk person is a very healthy person, and vice versa. The only way to price by factors other than age and gender would be to give people lower rates if they can prove that they have various health conditions and a shorter expected live span, which is not so feasible and lends itself to gaming.
I agree that they’re within the common usage of those terms. But we’re getting into the nitty gritty here, and at that point you can’t fall back on the common usage, which often obscures technical differences of great importance.
The context here is the claim that if you don’t allow for cross-subsidization between high cost people and low cost people, that you would be rejecting a fundamental concept of insurance. Meanwhile, the exact opposite is true - risk underwriting is the fundamental concept of insurance that applies here. In that specific context, pointing to SS retirement and Medicare as examples of insurance which exists without risk underwriting is invalid, because these are run more as (mandatory) social programs and for that very reason don’t operate using ordinary insurance principles.