The Health Insurers have already won

[Martha]

Quote:

Originally Posted by Gotadimple OK, I'll play. By portability, you mean that you take your insurance coverage with you? That means you get to pay the same premium even if you are no longer provide services to your old employer? And if they change coverage, you get what you get? Even if they chose to drop coverage? How about NO employer provided insurance coverage at all? People have to buy their own, they can buy through their employer or directly from a carrier, or through a club or association (the 'group' plan). If they buy from their employer, they don't get to exempt the premium cost from income tax on their salary. Those who itemize may be able to deduct the cost of premiums. Oh, did I mention that without the upfront income tax exemption the cost would be a lot higher, because employers can't deduct the cost of insurance when they file their taxes. You wouldn't always get the employers contribution to the premium you get today. Today, most carriers require an employer to contribute 50% or more of the monthly premium before they will issue a group plan. For comparison: try COBRA. Yikes! Rita

Yeah, there is the cost problem, with many not being able to afford COBRA. Big companies and government get a better insurance deal because of bargaining power so their policies can at a reasonable cost. But smaller business policies are much more expensive. Frankly, I saved money going from COBRA to a risk pool, which is a higher cost plan than average.

Some employers self insure with stop loss policies. That doesn't port well

****, it is complicated. Again, it is because we don't have a health care system.

Some ideas on piece by piece fixes:

If you made underwriting illegal, the problem is adverse selection unless you require all to have insurance. So cost goes up. Requiring all to have insurance leads to all sorts of other issues, like cost barriers, that congress is having a hard time sorting through. In the long run I think everyone needs to be required to be insured to make the health care sector work. As they work on that I suggest immediately provide that:

(1)If you are insured and have been for at least a certain period of time (maybe a year), whether or not it is a group plan, you should be able to get into another plan without a preexisting condition waiting period and no underwriting. This may help address the adverse selection issue as people cannot just wait until they are sick to buy insurance. This would be an expansion of current HIPAA rules. THis is a twist on the portability suggestion that doesn't quite work.

(2) Create a subsidized federal risk pool for those who are uninsured currently and cannot be insured due to underwriting. After a year or two or three, move them to category number one. There may have to be a preexisting condition waiting period to avoid adverse selection.

(3) Regulate insurance company profits and admin costs that can be passed on to customers. Treat them like a utility. This would be harder. The alternative, price regulation, may be even more difficult.

(4) It gets harder when talking about what to do with people who can't afford insurance. Maybe while we work on reform we have a temporary recession increase in medicaid funding (states are being killed on this) and broaden who are eligible for medicaid. Right now states are narrowing who are eligible because of shortage of funds. Maybe, like earned income credit, also have a cash money credit for lower income people who can only buy insurance with a bit of extra money.

This is just thinking off the top of my head while watching HGTV, so don't bite my head off for the weaknesses.
-

[FIRE'd@51]

Quote:

Originally Posted by Martha (1)If you are insured and have been for at least a certain period of time (maybe a year), whether or not it is a group plan, you should be able to get into another plan without a preexisting condition waiting period and no underwriting. This may help address the adverse selection issue as people cannot just wait until they are sick to buy insurance. This would be an expansion of current HIPAA rules. THis is a twist on the portability suggestion that doesn't quite work.

This is a good idea, and to work properly it needs to be coupled with very large (and stable) risk pools, the fewer the better. One of the problems, especially in the individual insurance market, is that the insurance companies actually create adverse selection by constantly coming out with new (and usually cheaper) policies which require underwriting. Those who can pass underwriting switch to the new policies, which have a new risk pool, thereby leaving their old (and now sicker) risk pool behind. Those who can't switch face higher than average premium increases due to the fact that they are now in a more unhealthy risk pool. This game repeats itself, and leaves a bunch of unhealthy risk pools in its wake. In the extreme, this can result in the insurance company eventually deciding to cancel all the policies that were originally issued for a given risk pool, leaving those folks without insurance, thereby forcing them into a state risk pool (or its equivalent).

[Martha]

Quote:

Originally Posted by Rustic23 Why not take one issue, say portability and solve that. Nothing else just that. Structure a bill that allows portability. It should not have to be 1000 pages, should not have any other type of reform, just solve portability. Vote on it sign it and then ask what is the next thing that needs to be solved. Lets say it is cut cost through streamlining of medical records. Once more one bill on only one issue.

I have thought that this should be the dems strategy. Not necessarily the portability issue, but attacking it bit by bit as agreement is reached.

[ziggy29]

Quote:

Originally Posted by Martha I have thought that this should be the dems strategy.

Probably so. The simple truth is that most people are satisfied with their current health coverage, but the big fear is in losing it and then getting sick. Or getting sick to the point where you'd be screwed if you lost your current insurance, making job loss a double-whammy (there's that ornery link to employment again).

If we did nothing this year but create a way to guarantee portability without creating higher costs through adverse selection, that would be a huge first step. And real portability would also go a long way to weaken the link to employer, because someone could leave their job and keep their current plan (or transfer to another plan with no underwriting).

[Rustic23]

Martha,
I just picked portability as first. The point is just pick one and only one. Then write as simple a bill as possible. Something everyone can understand. However, I will confess I have little faith that politicians of either party are capable of doing this, and I have even less faith that the voters will do anything to correct this.

[Martha]

Yeah, I understand.

[samclem]

The "one problem at a time" approach sounds like a good way to incrementally lick all the problems, but I wonder what it would produce. If it is a building-block approach, the first problem you pick (and the solution we decide upon for it) would, deliberately or not, set us on a course that could make the other problems even more difficult to solve, or introduce entirely new ones.

Big change all at once is very scary and politically very hard. I think this President has lost his chance--squandered his capital and goodwill on other projects-of-the-week. It's too bad we can't set up 50 experiments in the 50 states--let's see what works for the US. That would let us gain confidence gradually when we see the results of a particular approach. Unfortunately, state-by-state programs don't work, as the sick people would move to the states that provide them the most advantages, and businesses vote with their feet.

I think, unfortunately, it's going to take a crisis to get a solution to this problem. We don't have a crisis now--we have a long-term chronic problem that affects (primarily) those with the least societal influence. A problem among that population could fester for decades (more) without resolution. Here's my Malthusian prognostication: I think we'll have a crisis when our dysfunctional system (which disconnects the cost of services from the recipients, etc) finally causes sufficient price escalation in medical care that it impacts our economy in general. When these costs (and other factors already in place--including a huge US national debt) make the US noncompetitive and we have a surplus of workers looking for jobs, employers will finally decide that they can dump the by now way-too-expensive medical insurance plans and still keep their employees (and even stay in business). Then we'll have a marketplace for individual policies, and a huge number of people falling through the cracks and into an impossibly stressed government safety net. With the economy in a slump ("no new taxes!") and faced with renewed public pressure and an exhausted credit line, Uncle Sam does what he often does in these situations--passes an unfunded mandate. In this case, it is a mandate for everyone to be covered by some minimal, standard individual health insurance plan available from numerous private sources. Underwriting is prohibited in these approved health insurance policies/plans (making them available and affordable to those with previously existing conditions, but increasing the cost for all others somewhat). The needy get vouchers. Voila! This is how we get to where we ought to be anyway (portability, universal coverage, a choice of insurers and delivery means, all the advantages a free market brings to almost every other area of our economy--reduced costs, innovation, etc) but in the most painful way possible.

[Rustic23]

Solving the first problem, could cause problems for the solution to the others, however, it also seems that the same problem exist if you try to solve everything at once. It seems infinitely more difficult to solve all problems at once.

[Martha]

SamClem, I agree. bit when you got such a mess it might be the only way to deal with it politically, even if it isn't sensible. I want the whole sector fixed but I am worried that it won't occur. My incremental changes aren't that different from where you think we will end up.

I don't know that I agree that the President squandered his political capital. Many of the projects of the week bailouts occurred before he was in office, which tarnished the legislative bodies. Our public is impatient. No matter who was president if you have a deep recession you can't expect government to turn it around in six months or a year. Plus, we can never run a counter experiment to see how things would be without bailouts.

I am not impressed with our country right now. I dislike the lack of empathy. I dislike that health care for the poor is being cut by just about every state, including Minnesota. I dislike the rhetoric coming out of the legislature. I dislike the press coverage, which just seems to thrive on excitement. I dislike that people think having a 1000 page plan is bad just because it is a 1000 pages. I used to have clients who wanted to have short agreements as if somehow that made life simpler. Well, I easily could convince them otherwise but the series of "what ifs" that an agreement should address.

Well, it still might happen. But given people don't seem to be expressing much empathy for those without, eventually may be further out than I hoped. The issue may be how close to a crisis we are.

[Notmuchlonger]

At least this time I am thankful we have a 2 party system. Its nice to see some give and take. Trying to railroad an absurd system would not be good for us in the long haul

[samclem]

Quote:

Originally Posted by Martha I don't know that I agree that the President squandered his political capital. Many of the projects of the week bailouts occurred before he was in office, which tarnished the legislative bodies. Our public is impatient. No matter who was president if you have a deep recession you can't expect government to turn it around in six months or a year. Plus, we can never run a counter experiment to see how things would be without bailouts.

Yes, the responsibility for the rapidly-increasing public resistance to big government programs rests with the previous and current legislature as well as President Obama (and Bush). It's just that the toll is so much more evident on President Obama. We're used to being disgusted with Congress, but there were such high hopes among those who voted for Obama. And his popularity has definitely suffered more as the public wariness grows and he adopts a more defensive, less inclusive and optimistic, approach to his communications with the public. It all happened so quickly.

[ERD50]

Martha, I agree with much of what you say regarding the issues (but not all of it). However, I do want to express to you that this line you keep trotting out is actually a bit offensive:

Quote:

Originally Posted by Martha But given people don't seem to be expressing much empathy for those without, eventually may be further out than I hoped.

Saying it should be set up as "pay as you go" , or that Congress should read and understand what they are signing is not about not showing empathy. Just the opposite. It is showing empathy, because I want a system which is sustainable. One that falls apart will not help those in the future. I am trying to show concern for both present and future citizens.

I think the vast majority here have expressed that they want reforms. It is the implementation of those reforms that they are concerned about. They want it done right. You seem to be painting anyone against these current proposals as a bit heartless, and I think that is just a bit too convenient, and unfair.

Sorry if that was expressed too bluntly, but I've ignored those comments enough times that the pressure built a little. So please consider how those words sound to some of us.

OK, I got that out of my system carry on.


-ERD50

[REWahoo]

Quote:

Originally Posted by ERD50 However, I do want to express to you that this line you keep trotting out is actually a bit offensive:

Take a glance in the mirror.

If those of us who bothered to read your repeated diatribes expressed offense each time you repeated the same point we'd all be tearing our hair out by now.

Quote:

Sorry if that was expressed too bluntly, but I've ignored those comments enough times that the pressure built a little. So please consider how those words sound to some of us.

Yep, some quality mirror time is definitely in order.

[FIRE'd@51]

REWahoo,

With all due respect (and I do very much respect you), I have to disagree with you here.

IMO, ERD50 is one of the major contributors in terms of content to this forum. I don't always agree with him, but I have found him to be respectful of others' opinions. I would not classify his posts as "diatribes", but rather as non-emotional and based upon intellectual honesty. Count me as someone who is interested in hearing what he has to say about most any topic.

I'm not taking sides against Martha here (she is quite capable of defending herself) - just that I think you have been overly harsh on ERD50.

[Martha]

Quote:

Originally Posted by ERD50 Martha, I agree with much of what you say regarding the issues (but not all of it). However, I do want to express to you that this line you keep trotting out is actually a bit offensive: Saying it should be set up as "pay as you go" , or that Congress should read and understand what they are signing is not about not showing empathy. Just the opposite. It is showing empathy, because I want a system which is sustainable. One that falls apart will not help those in the future. I am trying to show concern for both present and future citizens. I think the vast majority here have expressed that they want reforms. It is the implementation of those reforms that they are concerned about. They want it done right. You seem to be painting anyone against these current proposals as a bit heartless, and I think that is just a bit too convenient, and unfair. Sorry if that was expressed too bluntly, but I've ignored those comments enough times that the pressure built a little. So please consider how those words sound to some of us. OK, I got that out of my system carry on. -ERD50

We all get testy, me included. I am tired of this debate on the forum and we all repeat ourselves too often. I get especially testing when posters bring up unsupported claims, like those made in the past day or two about Medicaid. Frankly, I think that you and I should bow out of the discussion here unless we have specific facts to offer.


You are taking my quote about empathy entirely out of its context.I have been clear on saying that I have problems with the current proposals. I would do reform differently. I never said that you cannot criticize current proposals and still be empathetic. And I wasn't talking at all about pay as you go as I have a rather complicated view of the concept. (For example, states in a bad economy are forced to cut medicaid but that is when it is the most needed, sometimes the feds have to step in during recessions and spend more than what is coming in.) I have talked a fair amount about the cost issue, the likely need to raise taxes, the definite need to manage costs, and I am one of the few here who talks about specific suggestions on cost containment and problems in quantifying cost savings. I don't just whine about the need for reform nor do I just whine about how much reform will cost.

I stand by what I said in the post you snipped the quote out of but I will try to be clearer: I was riffing off of SamClem's comment that the crisis primarily is a crisis of the disadvantaged which could fester for decades. It already has festered far too long. If as a country we really value health care for all we would find a way to do it. If we don't it does not reflect well on our country. That is what I think. Others may differ in what they think.

[Nords]

Quote:

Originally Posted by FIRE'd@51 IMO, ERD50 is one of the major contributors in terms of content to this forum. I don't always agree with him, but I have found him to be respectful of others' opinions. I would not classify his posts as "diatribes", but rather as non-emotional and based upon intellectual honesty. Count me as someone who is interested in hearing what he has to say about most any topic. I'm not taking sides against Martha here (she is quite capable of defending herself) - just that I think you have been overly harsh on ERD50.

I think that ERD50 is exhibiting classic noodge behavior in the most Yiddish sense of the word.
Nudge Definition | Definition of Nudge at Dictionary.com

Whether that's involuntary or deliberate is difficult to discern.

But E-R.org members have already voted with the "Ignore Poster" feature. I'm in favor of releasing the "Top Ten" list in that category.

[ERD50]

Quote:

Originally Posted by REWahoo Take a glance in the mirror. If those of us who bothered to read your repeated diatribes expressed offense each time you repeated the same point we'd all be tearing our hair out by now.

I fully understand that I am often "pushing" the issue in a lot of cases with my posts. It is because I am sometimes trying to dig a little deeper and get a real answer. Some of the recent topics that I pushed on have been discussed every few months, and never go anywhere. Despite the fact that some people may have gotten tired of it, I am actually satisfied that I learned a little more than I did previously. People can skip those posts, or use the ignore function if that is their thing. I am who I am.

What I was commenting on in this case, was not the repetition, but the sum of those which I perceived as a "dishonest debate", putting supporters and non-supporters into a good guy / bad guy role.

Quote:

Originally Posted by FIRE'd@51 I would not classify his posts as "diatribes", but rather as non-emotional and based upon intellectual honesty.

Thanks FIRE'd@51 - that is my intention. I'm glad that someone can see that for what it is meant to be and appreciate it (or not for that matter).

Quote:

Originally Posted by Martha You are taking my quote about empathy entirely out of its context.

Ok, but... oh well, we are probably all too tired of this to go further to understand the context. Sorry if I misunderstood. My intent does stand, relative to my perceived context (as noted above).

Back to Health care, or Franken, or any other topic that will probably lead to health care anyway

Regards - ERD50

[Rustic23]

Martha,
I think you misunderstand those of us that dislike 1000 page plans. The problem with 1000 page plans are the political pay-off that is found in the footnote of page 588 or 396. Maybe just one line, that gives a big donor that tax break the rest of us don't get. When the bills become so big that the majority of the folks voting on them can not read them or understand them, that, IMHO is bad government.

[Martha]

I see your point, it is a question of trust. But the problem is that it may very well take a 1000 pages.

[Rustic23]

You got it, Trust, and based on the eight years of Republican rule, and the less than one year of Democratic rule, I have no more trust for the Congress of the United States. While there may be some good people up there, I firmly believe they have the own self interest in mind and not the good of the people of this country.