Perinova,
Individual and small group insurance is legislated at the State level, and laws/regulations vary from state to state. Depending on which state you live in, you may be satisfied or dissatisfied with the "system". Generally, health insurance premium rates have risen phenomenally since year 2000, and my research on this subject suggests that the recession in early 2000 resulted in large numbers of people moving to Medicaid which had a hugely negative impact on pricing in the private sector, because hospitals and providers have been forced to cost-shift to the private sector in order to make up for lost income, resulting in higher premiums for all private markets, large and small. Since then, there have been Medicaid and Medicare "cuts" as well as a large number of Baby Boomers moving to Medicare, which has also resulted in cost-shifting. Those problems combined with the "pay as you go" approach (which leads to problems when someone loses employment and hasn't finished treatment yet) vs. "pay per incident" approach that we have with other types of insurance and the rich benefits that have long sheltered people from the true cost of care have led to exhorbitant inflation over the years.
In an effort to "fix" the problem of unaffordability and unavailability of coverage, legislators have played with community rating and guaranteed issue of coverage, which always results in lack of competition in the marketplace, ultimately resulting in higher premiums and/or taxes for all.
IMHO, the best "fixes" would be:
a.) Continue exploring the possibilities of consumer-driven healthcare and teach people to use insurance as protection against bankruptcy instead of an entitlement that pays for routine, easily affordable services.
b.) Work towards disassociating health insurance from employment.
c.) Work towards better portability of coverage from State to State.
d.) Medicare / Medicaid reform...We need some consumer-driven options here, and people should pay for their subsidized coverage on a sliding scale instead of being cut-off at particular eligibility points.
I think all of these changes will ultimately have to come from a Federal level of legislation vs. a State level.
If I were to vote, I would select two of the choices. 1.) I am very satisfied with the quality of care that my family has received in general, and 2.) The incredible inflation has not been good for anyone, and there are solutions out there that we need to experiment with. As an agent, my experience so far with HSAs and HRAs has seemed to be beneficial to the marketplace and in my opinion, they have helped to make health insurance more affordable to many, many people. Whether or not people are satisfied with high-deductible plans over time will remain to be seen. Since the Great Depression, Americans have become "spoiled" with benefits that have paid nearly 100% for even minor, easily affordable, heatlhcare services. Learning to save to plan for higher deductibles will take some getting used to, but in the longrun, consumer-driven healthcare may be a very viable solution to the problem.
