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Old 03-08-2009, 05:02 PM   #241
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Much of the paperwork could be standardized. Businesses do this all the time. I don't look to see who manufactured my Thumb/Flash drive before I stick it in the USB port - it's standardized. Yes, ins cos will try to differentiate themselves in some ways, but I would think the majority of costs could fit some standard procedures. I'll bet the Pareto principle applies, 20% of the procedures are responsible for 80% of the cost.

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Old 03-08-2009, 05:08 PM   #242
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Maybe I'm being over simplistic here, but I fail to see a problem. Everyone gets a voucher, they are in the system. Period. The vouchers are paid out of the general taxes, which is no different from most programs.



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I thought that the idea was you would go and buy your own plan, no underwriting, and if you are poor you get a voucher. (sorry, I haven't back tracked to read all that was said before). There are people who won't buy a plan and they get sick or hurt anyway. Young people for example can feel invulnerable. That is why you have pre-existing condition waiting periods if you are uninsured. Otherwise, who would buy insurance. You need some way to force them into the system. This has been a problem with MA.
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Old 03-08-2009, 05:16 PM   #243
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There's nothing sacred about the construct I've laid out there (and I'm sure there's not an original thought in it), but for it to work there needs to be no underwriting (not just excluding folks from coverage, but also no price differentiation based on health factors). If Prudential sells the "A" plan in Vermont, anyone who lives in Vermont can buy the "A" plan at the stated price. If better deals are available through employers, clubs, etc then there would be a significant opportunity to get de facto underwriting--since those who are employable are, as a whole, healthier than those who are not. You could form a club of 10K runners that requires all members to complete one 10K event per quarter, and then buy insurance as a group, thereby "cherry picking" and forcing higher rates on the public pool.
Isn't that the problem though? More and more pools are created to cherry pick the healthy and all that is left in the "public" pool are the unhealthy, making it very very expensive. Look at state risk pools. Most people can't afford them. And they are already subsidized.
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Old 03-08-2009, 05:28 PM   #244
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Illegal immigrants are not covered. That can become a serious problem for public health if they have contagious diseases.
I'm sure the issue of whether to cover illegals or not is a significant stumbling block for us in making a decision on what to do. It's a huge number and growing constantly. Opinions are all across the board.

If we don't cover them, they will use emergency rooms for basic care anyway as they do now.

If we do cover them, their numbers would add significantly to the bill and the coverage would be another reason for millions more to come.

Tough questions.

I believe Canada takes a much tougher stand on illegals than we do so it may not be as much of an issue.
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Old 03-08-2009, 05:32 PM   #245
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all that is left in the "public" pool are the unhealthy, making it very very expensive. Look at state risk pools. Most people can't afford them. And they are already subsidized.
But the costs of the unhealthy will be included in any universal system we come up with, no? Adding young and healthy folks to the risk pools would not make them less expensive. It would make them more expensive. The costs of the unhealthly would still be there plus you are adding the costs of the young and healthy folks.

I think you making be thinking in terms of "per person." But the bill we have to pay as a country is the aggregate bill for everyone.
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Old 03-08-2009, 05:32 PM   #246
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I believe Canada takes a much tougher stand on illegals than we do so it may not be as much of an issue.
It's estimated that there are somewhere between 35,000 and 100,000 illegal immigrants in Canada. Most Canadians would like to see illegal immigrants deported. However, the Auditor General last year criticized the Federal Government for losing track of 40,000 of them.
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Old 03-08-2009, 05:45 PM   #247
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Yeah, but look at those damn camera and phone chargers. Everyone is different.
Good News: All Cell Phones to Have Same Charging Port by 2012

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Old 03-08-2009, 05:46 PM   #248
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But the costs of the unhealthy will be included in any universal system we come up with, no?

Well, it depends on the extent you want to have the unhealthy pay for their own care. With risk pools, the unhealthy pay a lot and many can't afford it. I was responding to SamClem who suggested that group buying could be allowed to reduce the cost of the group. The problem is then how much will people who are not in a group going to have to pay?

If you have a voucher or subsidy system based on how much you can afford, what will the cut offs be? For example, if you are retired on a pension, that likely would be be the income that is looked at. But if you are retired on a million in assets, but no pension, would you get a subsidy or would you have to spend down your million? Most people are not overly sympathetic to millionaires. And who would review each person's finances to see what kind of subsidy they would get?

If you are going to have insurance companies in the mix with the ability of people to form groups you will have an adverse selection problem for people who do not fit in a group. If you allow for group formation you will need to have price regulation. Look at the guaranteed issue states, the prices are outrageous because of adverse selection.
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Old 03-08-2009, 05:48 PM   #249
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Old 03-08-2009, 05:49 PM   #250
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I thought that the idea was you would go and buy your own plan, no underwriting, and if you are poor you get a voucher. (sorry, I haven't back tracked to read all that was said before). There are people who won't buy a plan and they get sick or hurt anyway. Young people for example can feel invulnerable. That is why you have pre-existing condition waiting periods if you are uninsured. Otherwise, who would buy insurance. You need some way to force them into the system. This has been a problem with MA.
Well, I'm sure there will be many proposals. I believe in the KISS principle. Just give *everyone* a voucher. Done. Everyone is in.

Why bother trying to figure out who can pay and who can't? The ones that can pay will pay - through their taxes. Cuts the administration of that aspect of it down near zero.

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Old 03-08-2009, 05:53 PM   #251
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There are people who won't buy a plan and they get sick or hurt anyway. Young people for example can feel invulnerable. That is why you have pre-existing condition waiting periods if you are uninsured. Otherwise, who would buy insurance. You need some way to force them into the system. This has been a problem with MA.
My understanding about the Massachusetts plan is that there IS a mandate to be insured, but that (a) the enforcement is weak and (b) the penalties aren't severe enough to encourage fuller compliance from the younger and healthier.
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Old 03-08-2009, 05:54 PM   #252
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Well, I'm sure there will be many proposals. I believe in the KISS principle. Just give *everyone* a voucher. Done. Everyone is in.

Why bother trying to figure out who can pay and who can't? The ones that can pay will pay - through their taxes. Cuts the administration of that aspect of it down near zero.

-ERD50

That is fine. Everyone gets a voucher. But what do you get for your voucher? If it is a decent healthcare plan, that is fine. If there are deductibles and copays, which is fine, probably even good, there has to be a way to subsidize the poor.

What I was trying to get my arms around was SamClem's comment above about allowing people to form groups to get cheaper care, which was a red flag to me because of the cherry picking and adverse selection issue.
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Old 03-08-2009, 05:55 PM   #253
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My understanding about the Massachusetts plan is that there IS a mandate to be insured, but that (a) the enforcement is weak and (b) the penalties aren't severe enough to encourage fuller compliance from the younger and healthier.
Correct.
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Old 03-08-2009, 06:09 PM   #254
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What I was trying to get my arms around was SamClem's comment above about allowing people to form groups to get cheaper care, which was a red flag to me because of the cherry picking and adverse selection issue.
I'm looking for his post, I *think* you may be reading that into it.

edit - here they are:

Socialized Medicine

Socialized Medicine

I think he spoke about allowing some people (maybe if you prove you can afford to pay up to the deductible) to take a high deductible plan. Maybe you could get a rebate? Or maybe you trade off deductibles for private rooms, etc.
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That is fine. Everyone gets a voucher. But what do you get for your voucher? If it is a decent healthcare plan, that is fine. If there are deductibles and copays, which is fine, probably even good, there has to be a way to subsidize the poor.
The voucher should cover "basic" care, plus preventive care based on some reasonable basis that it is cost effective or provides a better quality of life. The poor and the millionaire alike would get the same voucher. The millionaire would have more options available, he could pay for concierge service, for example.

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Old 03-08-2009, 06:54 PM   #255
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The factors you cite are certainly pushing in the direction of higher costs, but I am troubled by your last sentence. It seems wrong to me to imply that a good reason to oppose providing health care to those who currently don't have it is to prevent the rest of us from having to pay more for our own health care. We are all in this country together.
You misunderstood my post. The last paragraph wasn't intended to be an argument for or against government supplied insurance. I was merely expressing my opinion that the price of health care will continue to go skyward for the next few years no matter what the government does and adding more people who are currently uninsured will only compound the problem.
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Old 03-08-2009, 07:41 PM   #256
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You misunderstood my post. The last paragraph wasn't intended to be an argument for or against government supplied insurance. I was merely expressing my opinion that the price of health care will continue to go skyward for the next few years no matter what the government does and adding more people who are currently uninsured will only compound the problem.

Got it. In this format, it is sometimes hard to differentiate between simple observation and a normative statement.
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Old 03-08-2009, 07:52 PM   #257
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I'm looking for his post, I *think* you may be reading that into it.
I was simply responding to this post: Socialized Medicine


I am ok with a voucher plan where everyone gets a voucher which will buy a health insurance plan provided any deductibles and copays are addressed for the very poor. However, I see no point of having insurance companies in the mix as they don't seem to offer any value and just another layer of cost but I probably will have to live with them. I also don't see how the post I linked to above is consistent with that concept. But no matter. We aren't designing the plan.
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Old 03-08-2009, 08:35 PM   #258
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If you have a voucher or subsidy system based on how much you can afford, what will the cut offs be? For example, if you are retired on a pension, that likely would be be the income that is looked at. But if you are retired on a million in assets, but no pension, would you get a subsidy or would you have to spend down your million? Most people are not overly sympathetic to millionaires. And who would review each person's finances to see what kind of subsidy they would get?

.
Sadly, if we wind up with a universal system totally funded by taxes and free to all, the same issues will arise. The new system will require new or higher taxes to pay the bills. Who will pay? What will the cut offs be? Will the new or increased taxes be based only on income or will they include something like a property tax which will go after people's assets? Who will review people's assets to determine their fair share of the increased or new taxes to fund the new system?

No matter how you do it, there will have to be decisions made on who pays how much to take care of the funding. Just saying the new system will be free to all and we'll just pay for it with taxes doesn't at all answer the question of who will pay how much.
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Old 03-08-2009, 09:06 PM   #259
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No matter how you do it, there will have to be decisions made on who pays how much to take care of the funding. Just saying the new system will be free to all and we'll just pay for it with taxes doesn't at all answer the question of who will pay how much.
Exactly. That is why I prefer to give a voucher to everyone, pauper and millionaire alike. It is an equation that needs to be balanced, so do it the simplest way possible. Put the "means test" on one side of the equation (the payment of taxes), not *both* sides (the payment of taxes *and* the distribution of vouchers). To do both sides adds complexity, which always results in additional inequalities, unintended consequences, loopholes, and added administration costs. None of which goes to helping people get better health care, which should be the goal. The KISS plan.

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However, I see no point of having insurance companies in the mix as they don't seem to offer any value and just another layer of cost but I probably will have to live with them.
I understand your point, and I'm struggling with it too. It would appear that the ins cos are just an added layer, sucking up costs. The only reason to consider them is if the competition helps control costs over and above their profits. That is a net benefit to consumers, even though the ins cos did rake some off the top. A real world voucher example:

The recent Digital TV conversions. The govt provided $40 vouchers for the converter boxes. They set guidelines, any "voucher qualified" box had to meet some minimum standards. At that point, the free market took over. I researched on-line, found boxes with the added features I wanted, did some comparison shopping to get the best price, and I'm pretty happy with the result. Only $5-$15 out of pocket per box.

Now, lets eliminate the middle-man (ins cos or the TV Box cos). Hmmm, so the govt would manufacture the converter boxes and offer them for sale direct to the public? How does that spur competition? How does that give the consumer choice? Who do I complain to if I don't like the one and only box offered? No, I prefer the voucher system. Imperfect as it is, and even with the added middleman raking a profit, I think it served me better than only having the govt brand of cheese.

edit/add - here you go: http://en.wikipedia.org/wiki/Comparison_of_CECB_units

Dozens of companies competing for my voucher. And public information helping me decide which one best suits my needs. I like that!


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I also don't see how the post I linked to above is consistent with that concept. But no matter. We aren't designing the plan.

I was simply responding to this post: Socialized Medicine
Sorry, maybe I'm the one misunderstanding here, but I think samclam just threw the special groups out there as examples of the problem. I think he is saying he would not support picking out one group over another for favored rates, as that throws a wrench into the whole system. Exceptions would be paying for added service, or trading higher deductibales for something.

But you are right, we are not designing the system. All I really hope for out of these exchanges is to get a better understanding of the problems, potential solutions, and hopefully talk intelligently when people ask me about this subject. In some small way, that might help us and others figure out what plans we want to tell our govt reps we support. Tilting at windmills I guess, but I'm not dead yet, so I will.

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Old 03-08-2009, 09:15 PM   #260
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I was responding to SamClem who suggested that group buying could be allowed to reduce the cost of the group. The problem is then how much will people who are not in a group going to have to pay?
Martha,
Sorry, I apparently did not communicate well. I was proposing that no group plans/buying be permitted. Instead, there would be approx five standardized plans and the price for each of them is the same for anyone who applies. No special deals. The post you read (http://www.early-retirement.org/foru...&postcount=214 ) was my response to lets-retire's comment about group pricing. I agree with you--group pricing will promote adverse selection and is not a good thing.
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