[ebuddy]

Originally Posted by besson3c 

How about the fact that health care is cheaper in every other country, by far?

Short list of their contributions to the advancement of medicine please?

[ebuddy]

Originally Posted by besson3c 

I have this theory that when you let the free market do its thing, what can/often happen is that the complexity of service increases astronomically. Exhibit a: health care billing/insurance, exhibit b: cell phone companies, exhibit c: the stock market/banking. Do you buy this?

Next time you're at the doctor, please ask them which paperwork is easier to compile and submit; that for the private insurer or that for Medicaid and Medicare. If your concern is bureaucracy and complexity, there is no worse place to be than attempting to establish a patient's needs to the government-sponsored plans. It's not even close. Period.

Cell phone companies? Thank the FCC and their taxation packages for your complication. The stock market? Thank the SEC. Banks? Thank the Federal Reserve System, the Comptroller of Currency, Office of Thrift Supervision, Federal Deposit Insurance Corporation, and the National Credit Union Association.

Whenever you think your complex bureaucracy can't get any worse, consider more government oversight and you'll quickly learn to be very happy with how things are right now. Everything the government does is exponentially more complex and more expensive than its private-enterprise counterpart. Everything. Again, not even close. And this is no more evident than in the health care industry.

[besson3c]

Originally Posted by ebuddy 

Short list of their contributions to the advancement of medicine please?

Let's not do that. I don't want to get into a weird tit for tat, trying to take into account the populations of the countries, the depth of their contributions, when a thing was invented and whether this should be counted, etc.

It also distracts from the point I was making. I'm not saying that the approach of government negotiation would work in America right now if transplanted, I think I've made that clear, but again, the point is that government *can* help reduce costs in negotiating lower prices via the same power that comes in pooling groups of people together that you were describing takes place with large employers.

[besson3c]

Originally Posted by ebuddy 

Next time you're at the doctor, please ask them which paperwork is easier to compile and submit; that for the private insurer or that for Medicaid and Medicare. If your concern is bureaucracy and complexity, there is no worse place to be than attempting to establish a patient's needs to the government-sponsored plans. It's not even close. Period.

Is comparing it to Canadian Medicare fair game?

Cell phone companies? Thank the FCC and their taxation packages for your complication. The stock market? Thank the SEC. Banks? Thank the Federal Reserve System, the Comptroller of Currency, Office of Thrift Supervision, Federal Deposit Insurance Corporation, and the National Credit Union Association.

Whenever you think your complex bureaucracy can't get any worse, consider more government oversight and you'll quickly learn to be very happy with how things are right now. Everything the government does is exponentially more complex and more expensive than its private-enterprise counterpart. Everything. Again, not even close. And this is no more evident than in the health care industry.

I agree, but with the reality of what exists today in this country, not in some sort of universal, fundamental rule. This needs to be vastly improved.

[ebuddy]

Originally Posted by besson3c 

Let's not do that. I don't want to get into a weird tit for tat, trying to take into account the populations of the countries, the depth of their contributions, when a thing was invented and whether this should be counted, etc.

Does that mean we can quit with the bumper stickers and one-liners that overlook copious amounts of critical information? Otherwise, I did exactly to you what you did to others. If you don't like that, check yourself. What you will find when you break out the data is that health care expenditures are directly proportional to GDP by country and yes, the US patient funds a great deal of the R & D benefitting other countries. Why? Because we're at the top of the GDP food chain and folks into the whole wealth distribution thing should be cheering.

It also distracts from the point I was making. I'm not saying that the approach of government negotiation would work in America right now if transplanted, I think I've made that clear, but again, the point is that government *can* help reduce costs in negotiating lower prices via the same power that comes in pooling groups of people together that you were describing takes place with large employers.

So... you clearly aren't saying it and then you *sort of* clearly are. Okay, I'll just deal with the *can* piece by saying; so *can* the health care consumer. I'd rather we exhaust that option first because from what I see in just about every industry you could cite, is a bloating of bureaucracy and expenditures under government management. Some of this could be attributed to the fact that you could fit several Canadian Health Care Systems in a handful of US cities, but I'd also submit that a great deal of it is in waste and compliance with a ridiculous regulatory environment. A good place for comparison in the regulatory environments would be the Canadian and US banking systems. The Canadian banking system is a giant cigar-chomping anarchist compared to the US system.

[ebuddy]

Originally Posted by besson3c 

Is comparing it to Canadian Medicare fair game?

Was it unfair to compare Medicare with Private Insurance in the US?

I agree, but with the reality of what exists today in this country, not in some sort of universal, fundamental rule. This needs to be vastly improved.

And I agree with this. Seeing as nearly half of the status-quo health care industry had been government-managed prior to the ACA and is only getting worse on all counts after the ACA, we should give the free market and you and I a chance to make this work. I trust us more than they and have provided some great ideas for a starting point. Let's do this. The government-panacea delivery of health care has proven a failed model in dire need of vast improvement.

[besson3c]

Originally Posted by ebuddy 

And I agree with this. Seeing as nearly half of the status-quo health care industry had been government-managed prior to the ACA and is only getting worse on all counts after the ACA, we should give the free market and you and I a chance to make this work. I trust us more than they and have provided some great ideas for a starting point. Let's do this. The government-panacea delivery of health care has proven a failed model in dire need of vast improvement.

Why don't conservatives lead the charge on putting their collective energy into getting both Democrats and Conservatives to allow insurance providers to compete across state lines? I get that they want to repeal Obamacare, but they can be working on new legislation to put this ball into motion this simultaneously, because Obamacare or no, this seems genuinely useful in any private insurance-based system - particularly tackling the regulatory framework.

I think Democrats should be working on this too, but this seems like a better opportunity for conservatives in reshaping their image going into an election, and delivering something that is in the wheelhouse of conservatives to boot.

[ebuddy]

Originally Posted by besson3c 

Why don't conservatives lead the charge on putting their collective energy into getting both Democrats and Conservatives to allow insurance providers to compete across state lines? I get that they want to repeal Obamacare, but they can be working on new legislation to put this ball into motion this simultaneously, because Obamacare or no, this seems genuinely useful in any private insurance-based system - particularly tackling the regulatory framework.

In 2009, Republicans offered the ‘‘Common Sense Health Care Reform and Affordability Act’’ as an Amendment to HR3962 and one of about 38 other Republican proposals that couldn't gain traction among the majority Democrats, struck down along party-lines. Perhaps they'll resurrect it or some form of it in a less obstructive environment.

Per Kaiser Health News; The bill's general approach expands state-based high-risk insurance pools for Americans with pre-existing health problems, permits trade associations to organize to purchase group insurance, imposes caps on medical liability lawsuits and allows health insurance companies to sell policies across state lines. In the PDF, you'll also find provisions that bolster HSA's and compatible, catastrophic plans.

I cringed when I heard Obama's speech announcing the 7.1 million "enrollees" and once again trotting out the line that Republicans haven't offered a single alternative. Our partisan atmosphere in Washington has become shameless.

I think Democrats should be working on this too, but this seems like a better opportunity for conservatives in reshaping their image going into an election, and delivering something that is in the wheelhouse of conservatives to boot.

Good point. I don't know if I was talking to you at the time, but I had long been suggesting that the American public does not have the stomach for "repeal" and the Republicans had better more effectively express what they are for, than what they're against. They're starting to come around to this attitude and you can hear "replace" in their vernacular more regularly. In this current political climate unfortunately, Democrats simply need to lose the Senate because at present, they're just too dug in politically. If they maintain a majority of the Senate while Obama is in office, they will remain in lock-step and nothing will get through them, but if they lose the Senate there will be more pressure for Democrats to work with the majority Republicans.

[OAW]

ebuddy,

I started to put this in my reply to you in the other thread but since the topic was the recent SCOTUS decision regarding campaign financing I didn't want to derail it. I figured it was more appropriate to put it here instead. A couple of issues I hope we can substantively address ...

1. You mention "Insurance Commissioners" ... as if the existence of the ACA is why we have 50 of them. Even though we both know the system of insurance regulation at the state level has been in place for decades. Or as Biden would say ... "literally decades". My point though is, you and others on the right keep saying that private insurance companies should be able to sell across state lines. I and others on the center and/or left keep saying that's a great idea ... but it's not us that's the hold up on that. So I'm going to try to pin you down on your actual position and hopefully you'll give me a straight answer. In my view what appears to be agreement on both sides of the political spectrum on this issue falls down over the issue of regulation. IOW, who does the regulating? At what level of government does the regulatory regime exist? Now forgive me if I'm being presumptuous but you've never struck me as the "libertarian fringe" type so I won't waste time positing the "No regulation at all." option. Especially in an industry as notoriously shady as the insurance business. Much like record labels and cable companies, the insurance industry is a necessary evil at best. So it would seem that leaves these options for selling insurance across state lines:

A. National Insurance Market - Regulation moves to the Federal Level

B. National Insurance Market - Regulation stays at the State Level - Determined by the Customer's location

C. National Insurance Market - Regulation stays at the State Level - Determined by the Insurance Company's location

Now IMO, Option A makes the most sense. I just fundamentally don't see the point of making a company deal with 50 different government bureaucracies for something as mundane as insurance. It's just wasteful, costly, and inefficient. I mean ... isn't one regulatory agency to deal with enough? That's like having the equivalent of the EPA for all 50 states.

Now given the often knee-jerk negative reaction many conservatives have regarding anything with the word "national" or "federal" in it ... it is my understanding that you guys oppose Option A prima facie. So if one had to choose between Options B and C it seems that most Dems would favor B because of the stronger consumer protections that approach affords. Whereas most GOP would favor C because of the friendly business climate that approach affords. That was the "positive" way to put it. The more "negative" take on it is ...

Most Dems oppose Option C because it would encourage a "race to the bottom" where insurance companies set up shop in the most lax states and circumvent the greater consumer protections afforded in more tightly regulated states. And most GOP oppose Option B because it would essentially re-create the status quo and force companies to have to take on the financial burden of complying with a plethora of regulatory regimes.

So my question is what option do you favor? And why?

2. The second issue relates to the individual mandate. Don't worry I have no interest in further debating its origins. What I want to discuss is that in relation to the ban on denying coverage for people with pre-existing conditions because that seems to be a position that conservatives are supporting these days. Of course, that wasn't always the case. I certainly recall all the "If you already have a pre-existing condition then that's not insurance." arguments. But apparently the "Tough sh*t. Sucks to be you!" attitude that comes across in such sentiments didn't go over so well with the public at large so now the talking points coming from the right are seemingly more receptive to the idea. In any event, my point is that the individual mandate exists to cover the costs of requiring insurance companies to accept customers with pre-existing conditions. So my question to you is ...

Absent the individual mandate, by what mechanism would you cover the cost of banning insurance company denials due to pre-existing conditions?

You mention "high risk pools", but please explain how any insurance pool comprised solely of the sick, people with chronic conditions, and/or the elderly could ever be even remotely affordable for the average consumer?

For millions of Americans with a pre-existing medical condition, health insurance can be an unattainable goal. In the absence of laws requiring insurers to provide individual coverage to people with pre-existing conditions, many of these people joined the ranks of the uninsured. These uninsurable individuals have sought coverage, but have been unable to purchase it because they have been rejected or because they have been offered coverage only at unaffordable, high premium rates. Because of their often complex or costly health conditions, uninsurable individuals are the segment of the larger uninsured population that most needs health insurance coverage.

In response to the problems of uninsurable individuals, 35 states set up high-risk health insurance pools over a 25 year span, from 1976 to 2009. Across these 35 states, the national enrollment was 226,615 by December 31, 2011. This compared to 200,047 as of December 2007. This is about 1.9 percent of the individual market enrollment, but is up to 25 percent of the individual market documented to be subject to denials or "adverse underwriting" restrictions due to pre-existing medical conditions.

High Risk Pools for Health Coverage | Coverage for the Uninsurable



IOW, this is saying that up to 25% of the orange slice is subject to denials or other restrictions due to pre-existing conditions, but the high-risk pools designed to accommodate them only covers 1.9% of that slice. Which is a teeny tiny sliver of the smallest slice on the chart. I'm listening, but it just doesn't seem realistic that this issue can be addressed by expanding high-risk pools alone.

OAW

[BadKosh]

"These uninsurable individuals have sought coverage, but have been unable to purchase it because they have been rejected or because they ***** have been offered coverage only at unaffordable, high premium rates *****."

And this is what the current OwebamaKare is doing to a much larger group of people now. Face it, the ACA was poorly conceived and is based on fictional stereotypes and situations, much like all the other liberal 'solutions' like gun control etc.

[ebuddy]

Originally Posted by OAW 

ebuddy,

I started to put this in my reply to you in the other thread but since the topic was the recent SCOTUS decision regarding campaign financing I didn't want to derail it. I figured it was more appropriate to put it here instead. A couple of issues I hope we can substantively address ...

1. You mention "Insurance Commissioners" ... as if the existence of the ACA is why we have 50 of them. Even though we both know the system of insurance regulation at the state level has been in place for decades. Or as Biden would say ... "literally decades". My point though is, you and others on the right keep saying that private insurance companies should be able to sell across state lines. I and others on the center and/or left keep saying that's a great idea ... but it's not us that's the hold up on that. So I'm going to try to pin you down on your actual position and hopefully you'll give me a straight answer. In my view what appears to be agreement on both sides of the political spectrum on this issue falls down over the issue of regulation. IOW, who does the regulating? At what level of government does the regulatory regime exist? Now forgive me if I'm being presumptuous but you've never struck me as the "libertarian fringe" type so I won't waste time positing the "No regulation at all." option. Especially in an industry as notoriously shady as the insurance business. Much like record labels and cable companies, the insurance industry is a necessary evil at best. So it would seem that leaves these options for selling insurance across state lines:

A. National Insurance Market - Regulation moves to the Federal Level

B. National Insurance Market - Regulation stays at the State Level - Determined by the Customer's location

C. National Insurance Market - Regulation stays at the State Level - Determined by the Insurance Company's location

edited to include;
D. National Insurance Market - Regulation is administered under Charter States - States compete for Charter Status and Insurers compete for Charter States.

Now IMO, Option A makes the most sense. I just fundamentally don't see the point of making a company deal with 50 different government bureaucracies for something as mundane as insurance. It's just wasteful, costly, and inefficient. I mean ... isn't one regulatory agency to deal with enough? That's like having the equivalent of the EPA for all 50 states.

Now given the often knee-jerk negative reaction many conservatives have regarding anything with the word "national" or "federal" in it ... it is my understanding that you guys oppose Option A prima facie. So if one had to choose between Options B and C it seems that most Dems would favor B because of the stronger consumer protections that approach affords. Whereas most GOP would favor C because of the friendly business climate that approach affords. That was the "positive" way to put it. The more "negative" take on it is ...

Most Dems oppose Option C because it would encourage a "race to the bottom" where insurance companies set up shop in the most lax states and circumvent the greater consumer protections afforded in more tightly regulated states. And most GOP oppose Option B because it would essentially re-create the status quo and force companies to have to take on the financial burden of complying with a plethora of regulatory regimes.

So my question is what option do you favor? And why?

I favor option D because I believe that option affords the best of both worlds and while this will certainly not eliminate regulation, it will consolidate regulation; the inherent benefits including reduction and simplification for consumers, insurers, and legislators.

It should be noted that the race to the bottom phenomena is interpreted two different ways;

1. Democrats appear to be more concerned with the piece of paper and its Issuer's claim of access to care - Insurance.
2. Republicans are more focused on access to care - doctors, hospitals, and providers.

Health Insurers have three primary components by which they can compete in the marketplace; the premium, the benefits, and the network of doctors and providers. The ACA has made "benefits" its primary focus and then "premiums" and as such deem the race to the bottom to be an Insurance company problem of setting up shop in more lucrative markets. The ACA also mandates "Community Rating" which means the only leverage left for an insurance company to compete in the marketplace is in their network of doctors and providers using what little freedoms afforded them to make this work. Because the individual mandate is essentially a promise that it would bring in the necessary number of healthy people, Insurers were allowed a great deal of freedom in setting their Community Rated premiums and in choosing their own networks. Sick people shop on health care availability, healthy people shop on price.

This is resulting in another race to the bottom, but worse -- among providers and we're already seeing this with BCBS in Rhode Island, in California as noted by the Los Angeles Times, BCBS of Texas, and as noted by the New York Times; from California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans. What is happening is that Insurers are essentially compensating doctors on average, only 10% more than the compensation paid by Medicaid and like Medicaid, its single largest challenge has been maintaining providers as demonstrated by Massachusetts. Worse, studies are showing that your access to care is no better under Medicaid (which is being expanded 10-fold) than it is for the uninsured with a wait time for a doctor's appointment in Boston for example, now on average two months; the worst in the country. That's not a coincidence OAW. So as you can see, there is another race to the bottom and it's much worse.

2. The second issue relates to the individual mandate. Don't worry I have no interest in further debating its origins. What I want to discuss is that in relation to the ban on denying coverage for people with pre-existing conditions because that seems to be a position that conservatives are supporting these days. Of course, that wasn't always the case. I certainly recall all the "If you already have a pre-existing condition then that's not insurance." arguments. But apparently the "Tough sh*t. Sucks to be you!" attitude that comes across in such sentiments didn't go over so well with the public at large so now the talking points coming from the right are seemingly more receptive to the idea. In any event, my point is that the individual mandate exists to cover the costs of requiring insurance companies to accept customers with pre-existing conditions. So my question to you is ...

Absent the individual mandate, by what mechanism would you cover the cost of banning insurance company denials due to pre-existing conditions?

The same mechanism used for Group Plans. Remember, your narrative relies solely on the minority, individual market. These are essentially the only people who'd ever face the prospect of a higher premium or declined coverage due to a preexisting condition. Even so, the overwhelming majority of insureds, even in the individual market @ 6 in 7, are being covered for preexisting conditions.

Your narrative also requires carefully-worded hyperbole that does not acknowledge any real number and I will be pointing that out as we continue along below.

You mention "high risk pools", but please explain how any insurance pool comprised solely of the sick, people with chronic conditions, and/or the elderly could ever be even remotely affordable for the average consumer?

I don't recall mentioning "high risk pools", I was focused on pooling risk nationally, overall. This can be done by occupation-type, this can be done through high-risk pools certainly by focusing on coverages needed while eliminating what's not needed in order to tailor plans unique to their care requirements, no longer possible now that medical underwriting has been all, but entirely eliminated.

IOW, this is saying that up to 25% of the orange slice is subject to denials or other restrictions due to pre-existing conditions, but the high-risk pools designed to accommodate them only covers 1.9% of that slice. Which is a teeny tiny sliver of the smallest slice on the chart. I'm listening, but it just doesn't seem realistic that this issue can be addressed by expanding high-risk pools alone.

OAW

Above in bold and underlined is the carefully-worded hyperbole I was telling you about. Why not focus on the actual number of those declined for a preexisting condition or those facing higher premiums and restrictions due to their preexisting conditions, OAW?

Answer: because that number is astoundingly small, OAW. Why? Because the overwhelming majority of insureds are covered under group plans either through their government or private employers through a pooled-risk methodology. To the tune of more than 98% of them.

To your question; by what mechanism would you cover the cost of banning insurance company denials due to pre-existing conditions?

• The ban was a government-solution looking for a problem to begin with by using hyperbole and ignoring reality.
• The mechanism for covering preexisting conditions would be the same mechanism used to cover the more than 98% of insureds who had preexisting coverage prior to a law requiring it.
• The law requires a piece of paper claiming coverage for conditions, it does not provide care. In fact, as established earlier, the ACA has worsened access to care across the board.

[OAW]

^^^^

I appreciate the constructive feedback my friend. I'm on my iphone so I'll make this quick since we STILL don't hand a decent mobile site.

1. I'm intrigued by your Option D suggestion. But you really didn't explain the whole "charter state" thing. Please elaborate.

2. It is my understanding that the individual mandate is designed to make the individual market more like the employer sponsored group policy market. Thereby enabling the coverage of those with pre-existing conditions. Am I missing something?

OAW

[ebuddy]

Originally Posted by OAW 

^^^^

I appreciate the constructive feedback my friend. I'm on my iphone so I'll make this quick since we STILL don't hand a decent mobile site.

1. I'm intrigued by your Option D suggestion. But you really didn't explain the whole "charter state" thing. Please elaborate.

It follows the same basic principle as Corporate Chartering in which an insurer would be chartered in a primary state that would administer the regulation and grant the Insurer a license to sell in any state that met the minimum Federal guidelines administered by that charter state. The idea is that Charter States are selected in a jurisdictional fashion that provide a single license enabling insurers to sell nationally as long as the minimums are satisfied. Here's a link to an abstract of the study around this proposal and within it is a link to download the entire proposal.

2. It is my understanding that the individual mandate is designed to make the individual market more like the employer sponsored group policy market. Thereby enabling the coverage of those with pre-existing conditions. Am I missing something?

OAW

Yes and no. The first problem with the individual mandate is that it's wildly unpopular, particularly for those upon which the mandate applies as evidenced by the waivers now available for declining the coverage combined with the delay of the mandate itself. The individual mandate was necessary to collect money from the young, healthy, and wealthy, but what we're seeing is that the option of purchasing coverage for previously uninsured is only appealing to those who qualify for heavily-subsidized plans or already have a medical condition they're seeking to cover. Once the "7.1 million covered" is exposed for the charade it is, we will find out that the model is not monetarily sustainable and all will be facing more premium increases, increased deductibles, and narrowed provider options to offset the higher costs incurred by the Insurers. Group plans are administered through a contract between a company of guaranteed insureds and premiums paid as deducted automatically from pay, but remains win-win (carrot) for both insurer and insured. The "group" could also take measures to improve the underwriting of their risk for lower rates, now not possible under the Community Rating requirements. The individual mandate is administered through a promise to the Insurer of a specific demographic (low-risk, high reward) consumer being required by law (stick) to get themselves coverage, but this model is not win-win and the necessary demographic still does not see the need to the degree necessary to make the math work en masse. Worse, the back-end system that administers payment is still not completed and we do not know how many of those who've "enrolled" have paid their premium -- necessary for actual coverage.

[OAW]

Originally Posted by ebuddy 

It follows the same basic principle as Corporate Chartering in which an insurer would be chartered in a primary state that would administer the regulation and grant the Insurer a license to sell in any state that met the minimum Federal guidelines administered by that charter state. The idea is that Charter States are selected in a jurisdictional fashion that provide a single license enabling insurers to sell nationally as long as the minimums are satisfied. Here's a link to an abstract of the study around this proposal and within it is a link to download the entire proposal.

I took a look at the abstract and skimmed the actual proposal in the linked PDF. It's intriguing for sure. In a nutshell the guys is advocating a hybrid approach that would allow a nationwide market with a single point of regulation a the state level ... but all states would have to regulate with minimum standards set by the federal government. It addresses the downsides of the current state by state approach while also preserving the potential benefits of regulatory jurisdictional competition. I can support this. In fact, I can see no reason why the ACA couldn't easily be tweaked to enable a nationwide insurance competition in this fashion.

OAW

[Snow-i]

Originally Posted by OAW 

I took a look at the abstract and skimmed the actual proposal in the linked PDF. It's intriguing for sure. In a nutshell the guys is advocating a hybrid approach that would allow a nationwide market with a single point of regulation a the state level ... but all states would have to regulate with minimum standards set by the federal government. It addresses the downsides of the current state by state approach while also preserving the potential benefits of regulatory jurisdictional competition. I can support this. In fact, I can see no reason why the ACA couldn't easily be tweaked to enable a nationwide insurance competition in this fashion.

OAW

When we've said "increase the competition" in the industry, this is what we meant. I really like ebuddy's use of "carrot" and "stick". He explained things much better than I could.

[besson3c]

Originally Posted by Snow-i 

When we've said "increase the competition" in the industry, this is what we meant. I really like ebuddy's use of "carrot" and "stick". He explained things much better than I could.

This is what you meant? When did you propose some sort of way of handling regulation to allow cross-state insurance competition?

[Snow-i]

Originally Posted by besson3c 

This is what you meant? When did you propose some sort of way of handling regulation to allow cross-state insurance competition?

Did you ever read any of my posts past the first sentence? We've had this problem before besson, and we've covered this topic.

[ebuddy]

It'd be nice at some point if we could get buy-in on the notion of a more pressing need to regulate the Government. I mean, you might be getting over-billed by your insurance company or some other business and we need to keep that in check, but when do we put it in its proper perspective? It's not like they've straight lost money they took from you by force. And when's the last time you saw someone who had, sport an orange jumpsuit?