I’m wading through all of these UHC threads, and I see a common theme - that insurance companies are vile pits of greed and dishonor, and they are almost fully to blame for the presumed healthcare mess. I’m on the “No UHC” side of things, but I certainly feel that the stranglehold of insurance companies needs to be broken, and that health insurance companies need to be taken to task.
So - if we could pass regulations on the insurance companies, would you still feel that UHC is necessary? Say we:
Open state lines to insurance competition
Set limits on pre-existing condition premiums
Force efficiency on the companies, thereby doing away with multiple doctor’s staff members and constant arguments with the company on what is covered
Mandate that each company has to offer at least one catastrophic plan, with no strings attached, other than paying premiums
Something else, strictly related to the behavior of insurance companies, that you can think of
What now? Would you still push for UHC, or would you be willing to wait and see how this effects the market?
**Please note - this is not necessarily the position I support, just an attempt to separate the issues for discussion purposes
Opening state lines isn’t a benefit. You’ll have all insurance companies move to the least restrictive state and then offer the worst policies for the lowest prices across the nation, thereby undercutting state regulation. For example, some states require that, if an insurance company offers drug coverage, they must also offer contraceptive coverage. This change would effectively negate that rule. You’ll end up with insurance companies that operate like credit card companies – move to South Dakota and offer what would be usurious rates in other states, but legal in South Dakota.
You can’t limit pre-existing premiums without everyone forced to sign up. Otherwise, everyone waits until they are sick and then goes and gets coverage. This type of adverse selection would drive up premiums overall, making the healthcare situation worse. Once you force everyone to sign up, then you have to offer subsidies to people who can’t afford it. Once you do that, you have the Senate bill, basically.
I’m not sure how you can force efficiencies on companies – they operate efficiently from the point of view of the shareholder. Just not necessarily from the point of view of the doctor or patient. Arguing over what’s covered is efficient from a profit-making perspective or else they wouldn’t do it.
Again, would the catastrophic plan cover people with pre-existing conditions? If so, see (2) above.
Can’t think of anything else off the top of my head that doesn’t either hamstring the companies to the point of extinction or move towards UHC.
I’m for the current reform bill, but think the current vilification of the Insurance companies is over the top and that they aren’t anywhere near the primary culprits in the US’s current healthcare problems. So I disagree with your premise.
Other then that,
will only work if you couple it with strong national regulations, otherwise every inusrance company is going to relocate to the state with the least strenuous regulations, and your plan to increase regulation on insurance companies will instead reduce regulation.
Is a pretty major part of the currently proposed plan, but it won’t work unless you couple it with a mandate, since if you force insurers to take people with pre-conditions, the incentive to buy insurance before you develop a condition is greatly reduced and the entire point of insurance is more or less thrown out the window. But then if you add in a universal mandate, you’ll need to subsidize the people that can’t afford to get insurance, and then you’ve basically recreated the current Reform proposal
And on preview, I’m basically recreating Ritter’s post, so I’ll just say I agree with him on points three and four
I mean, okay, say you own an insurance company, and I own an insurance company, and we both relocate to South Dakota or whatever along with ten other insurance companies owned by ten other guys. And all of us start offering policies at thus-and-such a price. And then what?
Won’t one or two of 'em decide to compete by offering a better deal? Wouldn’t you? Couldn’t the government readily play to its traditional strength of making sure they vigorously compete with each other in such a fashion if ever they start acting like the functional equivalent of a monopoly instead?
That sounds awesome! If anything, I like my credit-card coverage better than I like my health-insurance coverage.
(And that’s really saying something, since I’m among the 80+% who like their health-insurance coverage.)
Maybe, but see the OP here. The image of the Insurance companies as using monopolies to rake in huge profits isn’t based on reality, so their ability to squeeze profits to compete with each other is fairly minimal.
I’m agnostic on whether allowing competition across state lines is a good idea or not, but even if it is a good idea, I don’t think it will do much to actually lower premiums or solve any of the other problems the current effort at Health Reform is aimed at solving.
I just don’t see how anything you do to insurance companies will have an impact. “Insurance” is the wrong tool for the job.
Consider that for an insurance company to remain viable (profitable, not bankrupt) it has to charge the highest premiums the market will allow for, and minimize pay outs. The ability to make payouts also requires that they have more inactive customers than active ones.
In terms of health care, part 1 means poor and sick people (the ones that need health insurance) can’t afford it. Part 2 means someone currently needing treatment is denied, or someone that received treatment will go bankrupt. Part 3 requires that you have a massive pool of health people insured to pay for the sick people.
So think about it in terms of car insurance. When I first met my wife we used to have to drive her sister around. She had 3 or 4 car accidents so her parent’s insurance said either their rates would quadruple or they wouldn’t cover her. You can’t force auto insurance companies to carry high risk drunk drivers, without allowing them to increase the cost for all policy holders. If the cost gets too high, good drivers are eventually going to decide that it is more cost effective to save the premiums and pay on the chin when something happens. That’s how insurance works. Best Buy asked me the other day to buy a $20 coverage plan for a $30 item. Does that seem like a good idea to you? I did, however, by a $30 plan on a $3000 item.
What can any of your regulations accomplish when applied to that scenario? She costs the insurance company a fortune. Why should they be forced to carry her when they know she’s a liability. Why shouldn’t they charge her more as compensation?
Let’s be clear about something: If you require the insurance companies to carry high risk policies they’ll go bankrupt unless they can increase the premiums for healthy people. If the premiums go up, health people won’t buy them. If you require everyone to buy insurance, it is the same thing as a tax, it might as well be an income tax or payroll deduction.
So if the conclusion is 1) insurance companies have to carry sick people 2) everyone has to buy 3) premiums need to be capped or adjusted based on income; than you’ve got UHC.
I expect that most people with health insurance are relatively pleased with their coverage, until they need it most desperately. Then they find out that they’ve been paying premiums so that they get a chance to play Wheel of Coverage.
I ask again the question: if the insurance companies can make a modest but respectable profit without doing unspeakable things to our fellow citizens, then why don’t they? And if they can’t make a profit and behave respectably, then what good are they?
I believe they’re both making a profit and behaving respectably, since I can’t much fault consenting adults for doing as they please with those companies. As always, I believe the government has a useful role to play in making sure there’s truth in advertising for the products on the market, and in busting up monopolistic behavior, and in lowering barriers to competition across state lines – but I then believe consumers should have the final say.
If, as you say, the reason so many people express so much satisfaction with their coverage is based on mere ignorance, then that’s the valid target. If you believed that folks only think they’re getting a good deal at a particular restaurant, then how would you suggest we remedy that problem? Sure, publicize the real nutritional information, and crack down on false advertising, and send the occasional inspector to make sure everything’s above-board back in the kitchen – but at what point do we let people make their own decisions?
I agree completely. This whole debate seems to miss the point that we are supposed to be a free people. A company should be able to offer the products and services that it sees fit, and a person should be able to accept or refuse that offer as he sees fit. If an insurance company chooses not to offer a service to people based on preexisting conditions, that is their right. If enough people vote with their dollars not to do business with companies that have this policy, then those companies will go under.
Now, I understand that most people’s insurance is linked to their job, and they don’t have a lot of choice since they can either take the insurance that is offered, or not. Well, again, you are free not to work there.
The only “reform” I support is full transparency. The insurance companies should have to spell out, in plain language, what they cover and what they do not. And there should be MASSIVE penalties if they do not live up to what they promise to cover.
And, of course, companies should be allowed to compete across state lines. It is ridiculous that they can’t.
Such may work with most industries, but if it’s “you either go with us or you will go bankrupt/die,” is there really any actual mobility? I think that’s one of the reasons for the OP’s question in the first place. Heck, there’s a Doper here who had to move out of the country because no insurance company would touch him due to a preexisting condition. Mobility only takes you so far, especially when you have to depend on a LOT of others following your lead. And as I already said, it’s not something that can be taken lightly.
I don’t agree with the OP’s basic premise - that insurance companies are the problem with health-care in America. The problem is that health-care costs too much money here. Yes, if everyone magically had enough insurance so that care didn’t cost so much, then everyone would be happy because the thing we want would be paid for with magic…!
Until medical costs are brought under control somehow, and yes, that would mean the medical industry wouldn’t be able to continue making obscene profits anymore, then all the insurance in the world isn’t going to fix the problem. What the current plan seems to be is a promise to the medical industry that we will all pay whatever they ask if they will treat the 30 mil Americans currently without insurance. The AMA and big Pharm must be creaming their pants in anticipation of 30 million new blank checks.
Except it cuts payments for Medicare patients, who will probably end up being much larger utilizes of the medical system then the relatively healthy cohort of people that currently don’t have insurance and for whom the gov’t will write “blank checks” for. And the providers and pharmacutical companies will still have to deal with insurers in whoms interest it is not to “pay with a blank check”. So I don’t think its a particularly great deal for pharmacuticals or providers, though probably better then they could’ve gotten in other situations.
Before we even impose new regulations, actually enforcing anti-trust law would be a good start. Lack of adequate competition among insurance companies is a major driver of cost. A recent study (PDF) argues the following:
My emphasis. The article is not short and somewhat technical. If you want to get a sense, reading the conclusions (starting on p28) might suffice. If you have an appetite for econometrics, then definitely give the author’s model specification and data a look.
If you do this they’ll raise everyone’s rates, and/or just deny coverage after the fact. No improvements will come of it.
I think that there should be a legally mandated standard form/application system that all companies should be required to use, if that’s what you’re talking about. There’s no way to get around that the greatest inefficiency is the insurance companies desire to do everything possible to deny coverage, though.
Charging only one-tenth of your soul per month, right?
Insurance companies logically cannot be in the business of covering health care costs - the profit motive is at direct odds with the notion of paying for care when it is required. Insurance companies have already demonstrated that they recognize this by devoting themselves to taking money and refusing to pay it out. To avoid this, we have to remove the profit motive - or mandate that they can never refuse payment.
Hmm, how’s that for a reform - all coverage must be universal coverage. Of course, if we do that then the only thing that insurance companies can compete on would be price. Which means that the company that can do things most efficiently will “win”, pricing everyone out and becoming a monopoly, or perhaps a few companies will be able to find an equilibrium together.
Also note that you certianly can’t do all three of these:
allow people to sign up whenever
require companies to ignore pre-existing conditions
require companies to cover everything
-because otherwise the peoples will game the system and kill all the insurance companies. So, if we have 3, then 1 or 2 must go. If 1 goes, then you have private UHC. If 2 goes, then you have companies doing everything they can to purge their rolls of anyone who could possibly get sick and become unprofitable, including dumping you the moment you get old. This is probably bad. So, we should mandate enrollment, giving us private UHC.
Now, what’s wrong with private UHC? Well, it still has a profit motive, and the only way to raise profit is to raise rates for identical coverage - basically funnelling money from the customers to the company for no additional gain to society. Since this is a detriment to the populace, it makes sense to establish an insurance company without a profit motive. And now you have government UHC
It looks like even cranking the regulations to the limit, government UHC seems inevitably better than private health insurance can be. So yeah… insurance reform doesn’t cut it for me.
You can have pre-existing coverage if you make people wait 12 or even 18 or 24 months… and would not have to force people to buy it.
I’d have been happy to have insurance that excluded my pre-existing condition for 12 or even 24 months. But every company in the state said it was an auto-decline and that they would never insure me under any circumstances.
Do you know what irritates the SHIT out of me? The fact that “preexisting conditions” are lumped in as “high risk”
Just b/c someone has a chronic condition, it does NOT mean that we’re all medically fragile.
Heck, I have a rare syndrome but never see my PCP except for physcials.
Back when I saw my specialists I saw them more then I saw my PCP.