I won’t be surprised if/when the local news starts in on the same vein - the difficulty of finding a doctor and participating hospital - given our state has a whole one insurance company provider (same was true of the individual market before Obamacare, ftr) - and they cut 10 of the state’s 26 hospitals for the Obamacare policies.
I know several women who had chosen plans that didn’t cover pregnancy-related costs and now have significantly higher premiums because those plans are not available.
The fact is that pregnancy cost related insurance is very different than, say, insurance against breaking bones or getting a disease. We know quite well how to prevent pregnancy, and many people actively plan their pregnancies.
I’m not sure that I’d raise that to the level of horror story, but each of those people now has to pay more for medical coverage they don’t want or need.
That’s some of the free-riding that the individual mandate is designed to reduce. The year you decide to have a baby, you pick up a policy that costs something more (but presumably much less than the pregnancy costs). So you are having all of the other policy holders subsidize your costs.
Since I assume that government legislation preventing insurance companies from dropping plans they find unaffordable would be unacceptable, I remain curious how exactly these people think the corporations should have been impelled to continue offering plans they no longer find are in their best interest.
I would ask first of all why anyone should find it “unacceptable” to so regulate insurance companies; after all, they have chosen to be in a business on which human health and life is critically dependent. With those functions come concomitant responsibilities, and health insurers are indeed so regulated in every other industrialized country in the world, if indeed they are permitted to have any significant role at all.
But one doesn’t even have to argue that tight regulation is the only way to go. What if the insurers were free to do whatever they liked, but the government offered a non-profit public option with all the desired features like low rates and low deductibles which was viable over the long term because of the size and breadth of the subscriber base? The private insurers would have to compete or go into a different business, in the competitive spirit so vaunted by conservatives*. Perhaps the health insurers could just be in the business of offering gold-plated plans for the wealthy that covered a variety of non-critical amenities. Or perhaps they could eventually go into a different line of business altogether, like loansharking or extortion or some other form of more traditional racketeering.
I realize that true conservatives would argue that government should never enter into such a business venture. I would argue that private enterprise making life-or-death decisions and allowing someone to die because it’s too expensive to treat them is no longer a business venture and it isn’t a “business decision”, it’s murder. And while that certainly happens, more often people are just forced to deplete their life savings or sell their homes in order to pay medical expenses. And those are the real horror stories in American health care.
This exact scenario was one of the horror stories of the 1993-1994 reform in Washington state. The year after reform passed, the individual mandate was repealed.
At the time, I remember reading about the woman mentioned in this article.
I would think the reaction from anyone looking in on this from anywhere else in the developed world would be the same … it’s a process - rough and smoth, good and bad - but the US will one day reach a much better place than it was, and certainly better it was headed.
Not that have a clue what any of you are talking about.
The moral of any of these horror stories is that half-assed or otherwise incompetent regulation can sometimes be as bad as no regulation at all, not an argument against regulation per se. Prohibiting insurance companies from denying claims or refusing to issue a policy based on pre-existing conditions is essentially saying that they must not block access to medically necessary health care, which should be self-evidently an essential part of the social contract of any society that lays claim to being civilized. The horror stories that occurred when insurance companies were less regulated and were routinely denying claims or refusing policies seem to be quickly forgotten. The inconsistency comes into the picture if you also allow insurance enrollment to be optional, which is not a lot different than the absurdity of insisting that anyone must be able to buy auto insurance if they anticipate that they will likely have an accident or have already had one.
The whole basis of health insurance being different than all other forms of insurance is that everyone will need it sooner or later, guaranteed, and that when they do, it can be an essential matter of life and death that cannot in any moral conscience be denied – and that includes not just acute conditions, but conditions needing long-term care and care for the elderly. The only rational solution is a system of broad-based universal coverage, regardless of how one chooses to administer it. However the hallmark of public single-payer or its equivalent (some “single-payer” systems have many equivalent regulated insurers) is a community-based rather than risk-based premium system and universal enrollment.
To be clear, the ACA does provide for some community-based scenarios, but the individual mandate is weak to the point of non-existence. You either need to strictly enforce the mandate (which seems to be garnering a tremendous amount of opposition) or you need enact a different set of rules about making a choice once and for all.
I believe you are conflating health care and health insurance. If you repurpose your above statement of need for health care I would be with you.
I pick this nit because I believe that the fundamental flaw of the ACA is targeting insurance as the “Way to fix it” in the first place. The ACA is an industry-authored piece of crap that does nothing but enshrine greed-oriented business practice into law. Everyone’s rates go up to care for the outliers because instead of a direct payment system where a 20% profit margin can be eliminated (or, at the very least, redirected to the doctors) you now have to homogenize the payments across the populace in a mix-n-match, spot-covered way.
I have my opinion there wouldn’t have been anywhere near the reaction of the populous as it’s had to the ACA if we’d simply pushed nationalized the care or, at the very least, gone with a Canadian model. The major opposition to it is not only the disconnect of “affordable” between our politicians (e.g. $147/month plus deductible for a 27 year old making $25,000 and after rebates is “affordable”) and our populace but the amount of extra cost we all must undertake for a benefit to a relatively small number of people.
Yes, most people would agree that something had to be done. However, as you saw when this was pushed through Congress this solution wasn’t a popular one and a lot of the critical remarks about it that were bandied about at the debate stage were right (critical remarks and not partisan talking points. Those both pro and con where all over the map). And, now, costs are beginning to rise and with all of the changes the “why” isn’t apparent just yet.
Thus I close my long-winded nit pick: The population doesn’t need insurance. It needs health care. Not just health care, but actually affordable health care that’s not the most expensive in the world for no good reason.
I completely agree with your general sentiments, but you cannot separate health care from the way it is funded, so I don’t believe I’m really conflating the two things.
Even if you have a fully nationalized system of health care paid for by general taxation, you’ve made a conscious decision that this is how you want to fund it. In practice you might also have rules about fixed-rate or community-based supplemental premiums, and perhaps some element of private insurance for non-critical amenities like fully private hospital rooms, cosmetic dentistry, or whatever. In all cases, the way you fund it becomes intrinsic to how it’s administered, ranging from things as basic as whether health care providers are public or private or both, to the general availability and quality of health care, and – crucially – to how provider costs are controlled. You absolutely cannot separate the funding from the delivery. Any attempt to do so results in things like EMTALA (“free” mandatory emergency health care) which is an utter disaster that is neither free nor is it health care; it’s basically a very expensive way for the chronically ill uninsured to die.
I believe that cheaper insurance that doesn’t cover pregnancy should be available for women. What if she had a hysterectomy, for instance? BTW, insurance for young women was indeed more expensive than for men, not because of discrimination but because of pregnancy! Nobody says that men paying more for car or life insurance is discriminatory, do they?
Awesome. I have a list of 937 genetic disorders that I am not a carrier of. I would like insurance that doesn’t cover that- after all, I’ll never get them. And I ride the subway, so I don’t see any need to cover car accidents. And I’m cutting back on tropical travel, don’t want to pay for anyone else’s dengue or malaria.
Nicely said. I was going to make a more prosaic reply, so let me do it now to reinforce the point. No, nobody says that men paying more for car or life insurance is discriminatory, but some do say that the most efficient way to administer health insurance is a fixed-rate community-based system in conjunction with a cost-controlled provider system and universal enrollment. Given that such systems are by far the most efficient, the only real beneficiaries of risk rating are the individual insurance companies in a fragmented competitive system.
Wait, there were insurance plans out there that didn’t include catastrophic coverage? How is that even “insurance”? That sounds to me more like what I’d call “extortion”, and I don’t see why someone who’s now off an extortion plan should be upset by that fact.
I disagree and I think that the “funds = program” thought process about our government needs to die. We can as a country squeeze a huge amount of efficiency out of our bureaucracy - increasing service without necessarily increasing the costs of that service. What has materialized is “more money is better.” While this may hold true in a consumer good or service (and not even always then) it’s a horrible philosophy for government service.
Example? Health care. We pay double what the world does for average health care. An example on the other side? Welfare payments - primarily SNAP. It became hugely more efficient by dropping the old food stamp model and going to a benefits card, putting more of the funds directly into the hands of those that need them and eliminating unneeded overhead.
Because of this, I think we should sit our congressional corporate shills down and make them define exactly what is covered and then have the CBO tell them how much it’ll cost (with administrative overhead built in) and then find a way to fund it. Be it a voluntary competition with the private market insurers, a direct tax, or robbing Iraq of it’s lunch money, we should manage that need separately.
I have no disagreement with anything you said there, so I assume that your disagreement with me must be based on a misinterpretation of what I said. At no point did I say or imply that the solution to the health care problem was to throw money at it, whether taxpayers’ dollars or anybody else’s.
The biggest problem with US health care is that it’s the most wasteful and inefficient in the world, and that singular fact has everything to do with how it’s funded. Because how it’s funded is, for the most part, based on considering health care to be a market commodity like a washing machine, and to let Big Business have a go at it in the great spirit of Free Markets. Sadly, health care is nothing at all like a washing machine, health insurance nothing at all like car insurance, and that’s why the model utterly fails.
Wouldn’t it be wonderful – let your imagination run wild for a second – if an expert committee reporting to Congress was chartered with the task of examining the health care systems around the world (again, a concept that I maintain is indistinguishable from the funding model) and then recommending a rational non-partisan course of action from these learnings that would result in a health care system at least as efficient as in the rest of the industrialized world – one that Congress would either have to implement or have to justify why they won’t? Wouldn’t that be great?