OK, with all the rancor and sneering going on, that leaves me wondering: are there any changes, any at all, that can be made to the health care or insurance system that everyone can agree on? Sure, I realize many pundits say that the current one is the “best in the world,” but even they don’t say it’s perfect.
I’m especially interested in the opinions of conservatives/libertarians since many liberal ideas have gotten a lot of media attention considering who’s behind the currently debated bill, and again, many on their side say the current one is the best.
So, anyone want to float changes they think would be mostly agreed on?
There are dozens of ideas that have very wide support, such as increased monitoring of Medicare fraud, which saves far more money than it costs. But here’s two I’ve never heard mentioned anywhere:
(1) Recission Window: All rescission of health insurance contracts must be made within 6 months of signing the contract. Health insurance companies are not allowed to investigate whether you crossed all your t’s and dotted all your i’s only after you get sick and they’ve taken years of your premiums.
(2) Targeted Tort Reform: The kind of lawsuit that supposedly causes defensive medicine is a claim that a doctor failed to diagnose some condition. There is no need to amend tort rules for when a doctor cuts off the wrong leg, or gives you the wrong medicine – even the reform advocates don’t think those kinds of torts are driving health care costs in any significant way. So just amend the rules regarding claims that a doctor failed to find some condition. That way, there’s a lower incentive to do unnecessary tests. Additionally, this is a kind of malpractice people can defend themselves against (by getting a second opinion), unlike the kind where the doctor removes the wrong arm. I think both mandatory arbitration and a cap on the award would be appropriate.
I can certainly agree that the rules under which a policy can be canceled should be tightened, though honestly I don’t know what they are at present.
Also, there ought to be as broad as possible an interpretation of what constitutes a ‘family’ that can be convered under a policy; ‘domestic partners’ certainly, perhaps children of any age.
I don’t think an insurer should be ableto refuse coverage to someone because a DNA profile shows that the person is more likely to get some condition in the future.
No; too many people oppose any reform at all. Too many Republicans oppose anything that might possibly work with a Democrat as President. Too many Democrats are in the pocket of the insurance industry. Too many libertarian types think that the sick should just be left to die.
some mechanism, separate from everyday HCI, that allows people to buy catastrophic insurance at a very low rate. It’s not right when someone does everything right and then they get hit with a medical condition that causes them to lose their home and go bankrupt.
I don’t think there is wide agreement on States Lines, unless there are very strong federal regulations that go with it.
If we allowed across state lines insurance the first thing insurance companies would do would move their corporate headquarters to the state with the lowest regulations. You’d have to have the strong federal minimum standards or it would end up much worse for the consumer.
I was thinking that the company would have to comply with state regulations. If you are an insurance company in WI and want to sell insurance in CA, you’d have to comply with all CA laws. If you find it to troublesome, you don’t do it.
I heard someone on NPR pose an interesting proposition, one that I cannot, myself, really evaluate. It was to the effect that this HCR will result in a public option, and Obama knows that it will, without having to go to the effort to pass one.
The reasoning? The health insurance industry is built on the rules as they are, where they can run rampant and grab every dollar they can get their hands on. These rules, even as watered down as they are, means that they cannot expect the same sort of bountiful returns, they will be reduced to a modest but sustainable business model. And they will bail, they will not accept such reduced circumstances, because they lost a metric buttload of money in the recent catastrophe, and if they can’t have current rules in place, they will be forced out of business. Then, the public option becomes the only possibility.
I don’t know. I’d love to know, but I don’t. Is Obama that fucking smart? He’s smarter than me, and I’ve managed to forgive him for that, but still…
If this bill results in a significant number of people not being able to get insurance because insurance companies go out of business, the more logical step I seeing being taken is to rescind the bill (or cut it back significantly) rather than going for the public option.
Both houses are expected to lose a few seats to Republicans in Nov, so this is pretty much it for the Dems. Pass whatever you can now, and hope for the best.
Speech like this is delusional if not outright lunacy. Of course most libertarians and republicans both agree that reform is a necessary. The reasons for and the methods to obtain are where they differ.
Firstly, all forms of health insurance should be taxed equally. All exemptions granted to employer-sponsored health insurance should be matched with tax deductions for non-employer-sponsored health insurance.
Another idea that I had: working with advisors from the industry, create reasonable standard templates for a few forms of health insurance, identified by specific, protected titles, and publish a layman’s guide to these specific contracts, making both freely available for use by industry. Since the layman can have a greater understanding of Standard Health Insurance Contract A than any individualised alternative, they will prefer to choose the former over the latter. This means there’s an incentive for insurers to take advantage of the new standard, since they’ll get more clients than the terms alone would suggest.
Oh, please. The Republicans quite clearly would oppose anything Obama wants, just because he’s Obama. Nor do I see any evidence that they see anything about health care that needs to be reformed, except getting rid of it for the more libertarian types. As for the libertarians themselves, they hate the concept of the government doing anything whatsoever to help or protect people. They don’t even want the FDA to exist; they are perfectly happy with letting the almighty free market sort everything out, no matter how many people die.
Pretending that these people are decent, well meaning human beings won’t make it so.
Someone who leans Libertarian, but with a practical bent.
I’d suggest the parameters that are already in effect in my state:
No exclusions for pre-existing conditions. However, just like with the current health care bill, you may have to wait up to 90 days after purchasing insurance to have the pre-existing condition covered. [In my state some insurance companies make you wait anywhere from 30 to 90 days for pre-existing conditions; some have no wait period.]
No lifetime caps.
No rescissions or cancellations except in the case of fraud (identity theft, intentionally lying about pre-existing conditions and treatments).
Community rating. Everyone pays the same amount for the same level of coverage. The current health care bill allows older folks to be charged 3 times the premium of younger folks, for example. In principle, I’m okay with charging higher risk groups a higher premiums. However, if you’re only penalizing a few high risk groups and not penalizing others, it’s rather arbitrary.
Establish minimum coverage requirements; allow people to purchase coverage above and beyond minimum standards without tax penalty. [I know of no one who has coverage for cosmetic procedures, for example.]
No one is compelled to buy health insurance.
High deductible and catastrophic policies are allowed.
The state also runs an insurance fund for lower income people who don’t qualify for Medicaid. Of course, the state doesn’t abide by its own minimum mandates for those who offer and buy private insurance.
For example, the state requires that private and employee-sponsored insurance cover chiropractors. However, their own plans for lower income folks do not offer that coverage (surprise!). Nor does it cover ambulance services (which private insurers must).
Anyhow, does all this make health insurance affordable? That depends on your definition of “affordable”. For individuals it’s really pretty affordable. For families, the scaled-down state plan can cost up to $918 per month with a prescription program. But there are several levels you can choose from.
Beyond that:
Keep the current rules that allow FSA/HSA holders to buy OTC drugs with their own FSA/HSA funds. The current bill would eliminate this provision so that no one can use their funds to buy NSAIDS, OTC eyedrops, Claritin, etc.
Keep the deduction for health care expenses at 7.5% of AGI. The current bill raises it to 10%, except for those age 65 or older. If you have a bad year healthwise, this can make a difference in your disposable income.
At least some states tax all health care, from insurance to services. In my state, that tax hovers around 10%, which also drives up the cost of health care. Really? – if the goal is to make health care affordable then why are you adding 10% to the costs right off the bat, except that it’s an easy money grab.
Some sort of tort reform should be included. I suspect that most folks just look at awards or the cost of malpractice insurance and figure that those are the total costs of malpractice. There are additional burdens that I had never considered until I came to know an ob/gyn nurse.
For example, the principals involved in any suit are often deposed multiple times. This means that the provider must pay the person who is being deposed AND pay someone else to cover their duties at work. The process can go on over the course of months, which is probably one of the reasons why most providers settle out of court, regardless of culpability or lack thereof.
Either way, it can be a cost driver. Overall, it may not be a huge driver, but it’s probably larger than most people claim when you factor in stuff like this.
Encourage providers to publish fees for services. If the provider is going to send out for tests, inform the patient which tests are being performed and a rough estimate of the cost [assuming the patient is capable of informed consent].
If the tests are not critical, allow the patient to opt out. Ask me how I know about unnecessary tests and their surprising costs, plus taxes.
That isn’t actually the case. Even if a company were to go where the regulations were weakest, they would sell what people want to buy and are willing to pay for. The people at the lowest end would buy the least, but if it didn’t give them something they considered worth the cost, they wouldn’t bother buying, and it would avail the company nothing to have offered it. At higher price levels, they wouldn’t buy from that company if they felt there were too many strings attached. Only if every company offered trash would the consumer suffer, but then all it would take is one company offering better to suck up all the market share from the skinflint companies.
