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Old 01-09-2010, 08:18 PM   #21
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This issue IS about the regulations in place forcing bad business onto the books and the government then giving Anthem a big "eff you".
By "bad business" do you mean "insuring sick people"?
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Old 01-09-2010, 09:34 PM   #22
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Just one more reason to favor a single payer system.
Are those the only choices? "Unconstitutional" and "bad"? I'm optimistic we can do better.
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Old 01-10-2010, 11:37 AM   #23
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Are those the only choices? "Unconstitutional" and "bad"? I'm optimistic we can do better.

As far as I can tell, those are the choices.

I'm certainly open to listen to alternatives, but every one I've heard so far comes with its own set of unworkable problems.

And is the current solution with its complex regulation of private companies, who will be working tirelessly to circumvent those regulations, individual mandates and complicated subsidy formulas really a better alternative to a single payer system. I don't see how.
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Old 01-10-2010, 12:34 PM   #24
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By "bad business" do you mean "insuring sick people"?
I'd say the bad business is "insuring sick people while allowing adverse selection." And as long as being insured is optional, they'd be right.

Many of the insurers are on record saying they'd support reforms eliminating pre-existing condition exclusions and underwriting IF it came with a universal coverage mandate that eliminates adverse selection.
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Old 01-10-2010, 12:42 PM   #25
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I'd say the bad business is "insuring sick people while allowing adverse selection." And as long as being insured is optional, they'd be right.
I'd take it a step further.

If your goal is to maximize profits, then insuring sick people is bad business . . . period. And that is a problem that will not change under any regulatory scheme.
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Old 01-10-2010, 12:48 PM   #26
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I'd take it a step further.

If your goal is to maximize profits, then insuring sick people is bad business . . . period.
Not if doing so becomes a requirement to remain in business. Because then, the profit for refusing to do so is *zero* as the regulators put you out of business for doing so.

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And that is a problem that will not change under any regulatory scheme.
See above.
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Old 01-10-2010, 12:48 PM   #27
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I don't know why we can't pass a law to make Allstate insure burning houses. I could save a lot on my insurance.
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Old 01-10-2010, 01:02 PM   #28
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Not if doing so becomes a requirement to remain in business.
Requiring a profit seeking enterprise to engage in money losing business is like trying to prevent water from going down hill. The regulation has to be air tight or people will find a way around it or through it or over it. I'm not sure such a regulatory construct exists.
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Old 01-10-2010, 01:15 PM   #29
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Requiring a profit seeking enterprise to engage in money losing business is like trying to prevent water from going down hill. The regulation has to be air tight or people will find a way around it or through it or over it. I'm not sure such a regulatory construct exists.
I could be wrong, but it feels like you're intentionally evading my point because it doesn't necessarily lead to the conclusion that government-run single payer is the only possible option.

Group insurance offered through employer groups already *does* insure unhealthy people without underwriting (and without pre-existing condition exclusions if the insured qualifies under HIPAA), and yet it's profitable. How could that be if what you say is correct?
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Old 01-10-2010, 03:21 PM   #30
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I could be wrong, but it feels like you're intentionally evading my point because it doesn't necessarily lead to the conclusion that government-run single payer is the only possible option.

Group insurance offered through employer groups already *does* insure unhealthy people without underwriting (and without pre-existing condition exclusions if the insured qualifies under HIPAA), and yet it's profitable. How could that be if what you say is correct?

They underwrite the group though and price it so it is profitable. It works if your group has enough healthy people, otherwise the group is probably priced out of the market too. That's a big reason why many small businesses can't offer health insurance. The pool isn't big enough.

And once they insure the group, the insurance company doesn't have the option of cleaving off individuals it doesn't like. It is a take it or leave it thing. But that isn't true with individual policies. The individual is the "group". And once the "group" becomes unprofitable, you can expect the insurance company to walk.

The truth is that there isn't a free market solution for a problem that requires profit seeking companies to suffer losses. It just doesn't work.
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Old 01-11-2010, 12:04 AM   #31
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Why do they stay in Maine if they can't make money there?
Anthem does make money in Maine. They just didn't make any from individual policies in 2009. They made money in previous years from individual policies.
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Old 01-11-2010, 12:12 AM   #32
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Anthem does make money in Maine. They just didn't make any from individual policies in 2009. They made money in previous years from individual policies.
They won't be there for long if the state keeps this up....

YrsToGo - Kaiser Permanente and many of the Blue Cross/Blue Shield companies are non-profit. Guess what? Their premiums are still expensive. If you stripped away every cent of profit, the premiums would still be expensive. If people were all required to buy policies that have no up-front benefits except preventative care, the premiums would be much less expensive. That idea isn't popular because it's the smart thing to do, and we all know the government doesn't do smart things.
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Old 01-11-2010, 01:59 AM   #33
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I don't know what you mean by "no up-front benefits except preventive care." Do you mean the policy won't cover illnesses/accidents?
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Old 01-11-2010, 02:17 AM   #34
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I don't know what you mean by "no up-front benefits except preventive care." Do you mean the policy won't cover illnesses/accidents?
I mean no co-pays for office visits/diagnostics/prescriptions/ER visits/etc. Everything goes towards deductible like they do on a high deductible HSA plan. If people really knew what things cost, they would not utilize so many services. I can't tell you how many people I talk to that had a group plan and are taking Lipitor/Crestor/Advair/Flonase/Prevacid/etc....prescriptions that would normally cost $100-300 per month if you had to pay for them. All of those people are paying $20-30 for each month's supply and would more than likely switch to a generic alternative if they had to pay the full cost. Multiply that by a few million people.
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Old 01-11-2010, 02:44 AM   #35
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OK, thanks for the explanation.

Many insurers require a much higher copay for non-generics, which generally makes a lot of sense. Some even remove them from their formulary. For example, Lipitor is not on my insurer's formulary anymore and it won't cover it at all.

The issue with having preventive care go to deductible is that there is a tradeoff. Sometimes it is most cost effective to get preventive care and chronic care. There is some evidence that high deductibles and no-copay plans discourage people from seeking necessary care and care for chronic conditions, leading to higher cost in the end. But it can discourage unnecessary goods/services.

I do favor low copay for generics and for costs to go up from there. I even think that it makes sense to remove some drugs from the insurer's forumulary. Other drugs should have to be justified. Though there are irritations with these rules. Some drugs never seem to get a generic. Insulin for example, it is all branded.
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Old 01-11-2010, 05:56 AM   #36
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Instead of completely removing the name brand from the formulary, I think it would be better for the insurance companies to place a clause in their policy stating generics are preferred. Mine has that, and the only time a name brand can be used is when the doctor writes "no substitute" on the prescription. They could go one step farther in requiring proof that a generic works differently than a name brand. That way people can't go in and constantly request a name brand when the generic will work just fine. Many people who have seizures develop problems when going from a generic to a name brand or the other way around. If a person is taking the name brand drug and is having good control switching to the generic often times will result in seizures. The same can happen going from a generic to a name brand, so it isn't anything bad about the generic. They just work differently.
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Old 01-11-2010, 08:48 AM   #37
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Instead of completely removing the name brand from the formulary, I think it would be better for the insurance companies to place a clause in their policy stating generics are preferred. Mine has that, and the only time a name brand can be used is when the doctor writes "no substitute" on the prescription. They could go one step farther in requiring proof that a generic works differently than a name brand. That way people can't go in and constantly request a name brand when the generic will work just fine.
My insurance does work that way. Unless there is a medically necessary reason for a name brand (such as a known allergic reaction to inert ingredients in the generic), ours is a "step formulary" which generally requires the use of generics when a drug is first prescribed. If that doesn't work, then the MD can specifically prescribe the name brand. Anyone who wants a name brand otherwise would have to pay the difference between the generic and the name brand out of pocket.
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Old 01-11-2010, 09:12 AM   #38
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They won't be there for long if the state keeps this up....
Maybe Maine will be a testbed. Anthem pulls out and there are no private insurers in Maine, and none can be induced to come in based on the prior actions of the ME legislature. So the legislature institutes a Maine govt run single payer plan for everyone. Everyone gets what they apparently want, and the country gets to see how things go.
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Old 01-11-2010, 09:42 AM   #39
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Maybe Maine will be a testbed. Anthem pulls out and there are no private insurers in Maine, and none can be induced to come in based on the prior actions of the ME legislature. So the legislature institutes a Maine govt run single payer plan for everyone. Everyone gets what they apparently want, and the country gets to see how things go.
They can't have a single payer system if there is no money to pay for anything. The state "public option" is already bankrupt and hasn't taken on a new applicant in about two years because of budget constraints.
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Old 01-11-2010, 11:15 AM   #40
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Actually something similar did happen in 1999 in the state of Washington. Due to legislative mandates affecting the individual health insurance market, the majority of health insurers stopped selling to individuals.

Read this for a better understanding of what happened.

Universal Health Insurance in Washington State: A Grim Prognosis For All of Us
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