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Old 08-13-2011, 03:34 PM   #21
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term;

(2) Breaking the link between employer and health insurance.
I agree with both, but this in particular was a real disappointment for me as well. Breaking this link would have many positive ramifications for the economy, business and employment.
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Old 08-13-2011, 04:27 PM   #22
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I agree with both, but this in particular was a real disappointment for me as well. Breaking this link would have many positive ramifications for the economy, business and employment.
Agreed, as I alluded to before, I can't count the number of times I've heard people say they could retire except for the health insurance conundrum, or bright and innovative people who say they'd love to leave their jobs and start up their own businesses except for the health insurance conundrum.

This is an economic drag that's hard to calculate, but it is very real. In the former case you reduce unemployment and turn someone from a net tax consumer into a net tax payer, and in the latter case you unlock a lot of growth potential that's stagnating in a corporate cubicle.
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Old 08-13-2011, 05:13 PM   #23
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What exactly is the reason you would prefer the Swiss model?
IMO, the biggest advantage of the Swiss system over what we might get under the ACA is the ACA's continued linkage between employers and health care. Luckily, the ACA will destroy employer provided health care in the US (it is much cheaper for employers to simply drop coverage,pay the fine, and let the employees buy their own insurance with a big government subsidy. The much larger need for subsidies as this process continues is a reason the estimates for the cost of the ACA are far too low). If we still have private insurers competing for business in the exchanges when the employer coverage ends, and if the government can restrain the urge to mandate all kinds of "free" care in the obligatory packages, then things might work out. It could also be a good model for Medicare--just open the exchanges to the Medicare age group and let oldsters use their government Medicare entitlement as a voucher to buy from whichever provider they'd like. That shouldn't be controversial.

I still think it's possible the vast majority of people could be induced to buy health insurance even without an individual mandate. Once the US puts in place a system that goes the extra mile to make individually-purchased health insurance more affordable, then folks without insurance will feel some increased pressure to get aboard.
-- Isn't a person with health insurance more creditworthy than someone without? Medical costs are a big reason for bankruptcies. So, those without insurance might have lower credit scores, pay more for loans, etc.
-- Isn't a prospective employee with health insurance more desirable than one without? Isn't it a sign of a responsible individual? No reason employers shouldn't look at this factor, and laws should specifically permit it. Because high health costs definitley make an individual more prone to have an acute need for money, failure to have insurance could be a factor in granting security clearances, in bonding, in obtaining and maintaining licenses and certificates issues by accrediting agencies for those who handle funds or valuable property, etc.
-- Child support arrangements should make it clear that divorced parents must cover their kids.
-- There should be big costs to individuals who lean on public payments to health care providers when they get sick. It's gotta be painful--garnishment of wages, seizure of assets by the government, etc. If the system is set up so people can get affordable insurance and they don't do it, then they really have no right to expect free care.
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Old 08-13-2011, 05:32 PM   #24
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If insurance companies are forced to take all applicants, without an individual mandate you will have a strong incentive to simply wait until you are sick to buy insurance.

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I still think it's possible the vast majority of people could be induced to buy health insurance even without an individual mandate. Once the US puts in place a system that goes the extra mile to make individually-purchased health insurance more affordable, then folks without insurance will feel some increased pressure to get aboard.
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Old 08-13-2011, 05:38 PM   #25
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If insurance companies are forced to take all applicants, without an individual mandate you will have a strong incentive to simply wait until you are sick to buy insurance.
I understand that. I'm providing some positive and negative inducements to get people to sign up for this insurance when the individual mandate is found to be unconstitutional. Let's say, after the government subsidy, health insurance were to cost you $2000 per year out of pocket. Would you buy it? Would you buy it if it would help your credit rating so it lowered your mortgage by $2000 per year? Would you buy it if having insurance made it more likely you could get and keep a job? Would you buy it if "free" treatment at an ER meant the government would take serious steps to get their money back for the care you received?
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Old 08-13-2011, 05:38 PM   #26
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Employer provided health care is already in the process of self-destructing. The push toward temp/part-time/consultant/contract/outsourced/etc jobs has resulted in a greater percentage of unisured every year.

I don't know that the ACA makes that any worse(or better, depending on your point of view), it just allows the people who are losing their group coverage to effectively buy coverage on the individual market (at least that is the intent)

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IMO, the biggest advantage of the Swiss system over what we might get under the ACA is the ACA's continued linkage between employers and health care. Luckily, the ACA will destroy employer provided health care in the US (it is much cheaper for employers to simply drop coverage,pay the fine, and let the employees buy their own insurance with a big government subsidy. The much larger need for subsidies as this process continues is a reason the estimates for the cost of the ACA are far too low).
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Old 08-13-2011, 05:38 PM   #27
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If insurance companies are forced to take all applicants, without an individual mandate you will have a strong incentive to simply wait until you are sick to buy insurance.
IMO, you simply can NOT eliminate underwriting without universal coverage.
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Old 08-13-2011, 05:46 PM   #28
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[the ACA] just allows the people who are losing their group coverage to effectively buy coverage on the individual market (at least that is the intent)
That's the intent, and I hope that's the result. We can't say it's doing anything of the sort yet.
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Old 08-13-2011, 05:47 PM   #29
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I for one was disappointed to see this set back to the health care mandate. Is there any AAA rated country (which we are apparently no longer) that does not have some kind of affordable health safety net for the entire populace?

I see this (universal health insurance) as something that improves the fabric of American society and brings us up a notch or two in terms of being a civilized example to the rest of the world.
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Old 08-13-2011, 05:53 PM   #30
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Maybe. I think we are going to see some inter-generational friction in the years ahead.

At a certain point, the youth of this country are probably going to object to constantly having massive transfers from their paychecks to the elderly.

Funny how no one ever suggests that car insurance should not be priced by age.


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That is a very good thing. Employer provided insurance generally does the same. And family plans involve a giant subsidy of large families by couples and those who have smaller families. No problem there either.
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Old 08-13-2011, 06:00 PM   #31
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Is there any AAA rated country (which we are apparently no longer)
There are three major rating agencies, two of them rate the US in their highest category.

The reason our bonds are losing their status is because our government spends much more than it takes in. How does even more government spending make our bonds a better credit risk?
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Old 08-13-2011, 06:17 PM   #32
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There are three major rating agencies, two of them rate the US in their highest category.

The reason our bonds are losing their status is because our government spends much more than it takes in. How does even more government spending make our bonds a better credit risk?
I think it is be cheaper to ensure a healthy, well cared for society. Just as a well-educated society is a catalyst for the good.

I am not in favor of a government agency to be in charge of all this. I believe some incentive to the insurance underwriters is more the answer. I have excellent health insurance supplied at no cost to me by my employer. I don't think anyone should be cut off from access to health care just because they are either too well off to qualify for Medicaid or don't have access to employer sponsored health care. I think everyone should pay something (other than the abjectly poor), but is should be affordable.
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Old 08-13-2011, 07:06 PM   #33
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As others have said, without a mandate and guaranteed-issue insurance, people will game the system.

I know this isn't "politically correct" to say, but if guaranteed-issue insurance (with appropriate subsidies) can be provided for all, why do we need a mandate. Simply refuse to treat those who refuse to purchase insurance, unless they can pay for the treatment themselves. If I decide not to buy insurance for my house, and it burns down, no one is going to help me out.
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Old 08-13-2011, 07:39 PM   #34
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Simply refuse to treat those who refuse to purchase insurance, unless they can pay for the treatment themselves.
A few hundred years ago, that would have worked. Times have changed, and now we don't think it's okay to let people die in misery because it was their own fault. Sorry if you don't care for our new, less judgmental, and gentler society.
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Old 08-13-2011, 07:59 PM   #35
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ERD -- I don't think many of us have said or implied that opposition to the AHCA is opposition to universal health care.
I assume this was my quote you were responding to:

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It's why I get frustrated when some people characterize the bill opponents as being against everything.
You may be correct. I don't know that 'many' make the characterization, I merely said 'some' do. And I'm frustrated by those that do, and that is where my frustration was aimed. It may just be a vocal minority (newspaper editorials/comments, other forums, etc).


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And family plans involve a giant subsidy of large families by couples and those who have smaller families. No problem there either.
Actually, I have a problem with it, even though I've benefited from it. I have a fractionally larger than average family. I can't think of any reason why our company health insurance charges the same for a family of 2 as a family of 10. If someone wants to have ten kids, I think they should be responsible for the costs. Why should a childless couple subsidize the health care for another family? I don't get it.

-ERD50
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Old 08-13-2011, 09:34 PM   #36
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Sorry if you don't care for our new, less judgmental, and gentler society.
Which is, in itself, a rather judgmental statement. Don'tcha think?
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Old 08-13-2011, 11:57 PM   #37
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Copy the Swiss system (vouchers for all, individual choice on how to use them), and start from there. Adjust as needed.

-ERD50
The Swiss system requires the purchase of private insurance by all. If in-country 90 days or more one must buy at least the Basic policy.

Of course they have a different constitution and body of law than we do.
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Old 08-14-2011, 07:25 AM   #38
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The Swiss system requires the purchase of private insurance by all. If in-country 90 days or more one must buy at least the Basic policy.

Of course they have a different constitution and body of law than we do.
Even if the SC rules against the mandate a voucher approach could pass muster because we would not need a mandate that individuals purchase anything. The tax base would have to be expanded substantially (capturing the current funds going to insurance from individuals and employers plus whatever is needed to cover the rest). This wouldn't necessarily mean more money but the funds would initially go to government only to be returned to everyone in the form of a flat voucher sufficient to cover a basic insurance policy. Individuals could choose the policy of their choice, no mandate needed since they couldn't use the voucher for anything else. Should they choose not to use the voucher, they would be on their own. They could potentially purchase HC with their own funds. If they entered a hospital they could be required to provide payment in cash or by enrolling in a basic insurance policy at that time. With no preexisting condition exceptions that should not be a problem. An alternative would be some sort of tax credit sufficient for a basic policy. Neither concept carries any likelihood of making it in today's society which is why I favor working from the current system.
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Old 08-14-2011, 09:22 PM   #39
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We're going to lose our Cobra insurance in about 8 months. I've been investigating coverage and was told that there are 5 states that cannot deny someone coverage or charge more on the basis of pre-existing conditions. So how does this work in New Jersey, for example, without a mandate? I realize premiums are higher in these states.
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Old 08-14-2011, 09:25 PM   #40
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I'd also like to add to the discussion that I think that one reason that employers are not hiring new people and are working fewer people harder is because of employer health care. I'm surprised that I never hear this as part of the debate about the economy. It could also make it more profitable to hire younger people, to outsource, to automate, etc.
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