Why does health insurance vary state to state

[mykidslovedogs]

Many of the people with current pre-existing conditions didn't have them when they first took out their insurance. They didn't vote for anything. They just were unlucky. They carried insurance for many years and then lost it due to a quirk in the system.

My wife has a policy with Assurant. She was originally with Mutual Of Omaha. When MOH exited the individual market, Fortis (now Assurant) looked over the risk pool she was in and cherry-picked the healthy people. They offered her a policy (not-guaranteed issue) at an attractive premium. Now I see exactly the same thing going on with Assurant that happened with MOH prior to them leaving the market. The 15-20% premium increases every 9 months. I don't know how you can be sure they won't exit the individual market. Oh BTW, I also had a $5000 deductible policy with MOH - had it for 10 years - never collected a dime (and I'm thankful for that). However, I was declared uninsurable and ended up with a guaranteed-issue policy from BCBS, at nearly double what I was paying MOH for approximately the same coverage. Thanks to HIPAA no waiting periods. But htese things just shouldn't happen, One buys insurance for a sense of security.

That is very unfortunate. What state do you live in? MOH left the market, IMO, because they were forced to by irresponsible legislators, Left of Center, who felt like they were doing "good" by forcing community rating and guaranteed issue on a couple of States where MOH had a great majority of their business. This legislation made it almost impossible for MOH to remain profitable in the individual business, thus they were driven out of the market .

The people who voted for this irresponsible leglislation left a lot of people alienated in the name of equality for the sake of a minority of uninsurable people who didn't buy health insurance, like you did, when they were healthy enough to qualify for it. Now, you are on the "other side", and your misfortune is blindsighting you, because legislation that you would be in favor of, legislation that would seem "fair" to you, will alienate another large quantity of people, by taking away choice and quality of care.

I realize that you think your rates are high now, but just imagine how much you (or people younger than you) will pay out in a universalized system. Were talking a minimum of a 40% increase in income taxes almost immediately. That will do for a while, until demand begins to exceed supply at an excessive rate..at which point, we will have to start paying premiums on top of taxes for our care, and last, but not least, 10-20 yrs down the road, we might as well forget being able to have an MRI or CT scan when we need one or surgery when we need or want it. Instead, we will be on a long waiting list.

 

[Rich_by_the_Bay]

In a previous post (look back) you said the portability was just between selective states and certain carriers, not universal.

I also think your last sentence shows complete insensitivity to the person who did think ahead and buy the right policy, then lost it through a quirk (e.g. his carrier left the individual insurance market and canceled his policy).

And that is commonplace. "Uninsurable" in a realistic sense means that you simply can't by insurance even on your own, from the carriers realistically available to you at that point in time. This is not a "very, very small percentage" in my experience, but actually rather common. That is why COBRA exists, among other reasons.

 

[bright eyed]

Take a look at what socializing the system did to Canada....people there are NOT happy with the system, and they are BEGGING legislators to legalize private health insurance. I posted a couple of links earlier in the thread. I simply prefer choice over lack of access to care. With that may come the sacrifice of a small percentage of people having less access than other people. To me, it makes more sense that only a few people are disadvantaged, than having EVERYONE be disadvantaged in the name of equality.

Um, i don't think most proposals you will see in the next decade will include the options people considered in the clinton era or universal canada type system. Americans are both uninformed and too wary of those two. Most politicians are now talking about using the private system to cover the uninsured.

It's just plain dumb to have a group of uninsured people - we all end up paying for it in the end. Some estimate americans pay 40% more than other ind'd countries

Aside from being a bit heartless, your assumption about the vast leap of sacrifice you imagine you would have to make seems disproportionate to the actual outcome of whatever plan may take hold. Most countries manage to take care of their populations without sacrificing so many and then paying more in the end...

I'd rather have less so everyone can have some (particularly preventative care) and I'd assume that rates wouldn't change vastly for everyone after the system readjusts from the current stupidity...

 

[mykidslovedogs]

Actually, to reply to the absurd example, there are laws against doctors colluding in such a manner as I understand it. But more importantly, the main reason is that carriers have a virtual stranglehold on many markets. The competing carriers dominate the system (and are employer-based), ratchet down prices and each demands the use of their own "preferred" labs, imaging centers, and other services; these can change often with upheaval in the paperwork and so on. Failure to "participate" by doctors is possible in selected circumstances but ruinous to new practitioners who have no established practice. They kite payments by delaying on technicalities and the paperwork requires added personnel in the office who do nothing but fight denied claims, many of which are hung up on trivial issues. It's a nightmare.

There are examples of doctors fighting particularly foul carriers (Aetna comes to mind years back), but as a sustained, organized global boycott it is no longer realistic. The market is too heavily under the chokehold of the carriers.

It would be like an autobody dent shop not accepting anything related to car insurance.

I realize the example was absurd. The point was, there are "capitalistic" reasons for doctors to contract with insurance carriers...Namely to build up a business when first starting out and also to guarantee payment. You see, without insurance companies, I believe doctors would struggle with collections even worse than they do now. (this is because most people think they are entitled to services without paying for them).

A single payor system might make it easier on existing doctors as far as collections, but it might be harder to build up a new practice, unless you are a very saavy business man/woman. And with the low pay you are guaranteed to get from the government, the cost of marketing a new practice might even be prohibitive, without having access to the insurance carrier's huge referral networks.

 

[mykidslovedogs]

Um, i don't think most proposals you will see in the next decade will include the options people considered in the clinton era or universal canada type system. Americans are both uninformed and too wary of those two. Most politicians are now talking about using the private system to cover the uninsured.

It's just plain dumb to have a group of uninsured people - we all end up paying for it in the end. Some estimate americans pay 40% more than other ind'd countries

Aside from being a bit heartless, your assumption about the vast leap of sacrifice you imagine you would have to make seems disproportionate to the actual outcome of whatever plan may take hold. Most countries manage to take care of their populations without sacrificing so many and then paying more in the end...

I'd rather have less so everyone can have some (particularly preventative care) and I'd assume that rates wouldn't change vastly for everyone after the system readjusts from the current stupidity...

Well, the main reason we have such a problem with preventive care in the USA today is BECAUSE there is too much demand as compared to supply created by the Federally funded Medicare and Medicaid systems. Doctors don't get paid enough by the gov't to become primary care physicians so they opt for specialist careers where they can make more money. How do you think it will be better in a universalized system?

I don't think it will be possible to utilize private insurance to insure everyone. That means mandates placed on private enterprise, which drives competition out of the marketplace. Even if we could make it work, there won't be very many choices. Most insurance companies will just drop out of the healthcare business, leaving just a couple to take care of everyone. Government mandates and private enterprise do not go well together.

If you are going to universalize care, it has to be from the gov't. The next question is, do we make it the same for everyone by disallowing private insurance altogether, or do we allow people to purchase supplemental plans? If we do allow supplemental coverage, that still means there will be inequality, which the Left does not tolerate very well. If we make private insurance illegal, then there will be people waiting on waiting lists for services eventually.

BTW - Did you know that Mass is thinking about canning their "new" system as they are now discovering that it is going to cost 2-3 times more than what they budgeted?

 

[Rich_by_the_Bay]

I think the "solutions" being advocate here are patronizing and insulting; in this bizarre argument, you should a) lock in to a private individual policy unrelated to your employment at age 22, b) forego or double-pay employer-sponsored health insurance by continuing to pay your personal insurance for 40 years even if you are part of a group policy, c) avoid getting sick so you don't get dropped or underwritten, and d) do all this through an insurance agent whose incentives are ambiguously aligned.

And be sure you don't move to the wrong state somewhere along the line. Oh - and be sure that you don't become uninsurable by the next time your plan may be dropped or re-built as a different product by your carrier - so don't get lymphoma or lupus or renal failure or have a stroke or melanoma.

This ain't politics (incessant quips notwithstanding) - we are talking about peoples' lives, and they are not all dumb losers who brought it on themselves.

 

[mykidslovedogs]

I think the "solutions" being advocate here are patronizing and insulting; in this bizarre argument, you should a) lock in to a private individual policy unrelated to your employment at age 22, b) forego or double-pay employer-sponsored health insurance by continuing to pay your personal insurance for 40 years even if you are part of a group policy, c) avoid getting sick so you don't get dropped or underwritten, and d) do all this through an insurance agent whose incentives are ambiguously aligned.

And be sure you don't move to the wrong state somewhere along the line. Oh - and be sure that you don't become uninsurable by the next time your plan may be dropped or re-built as a different product by your carrier - so don't get lymphoma or lupus or renal failure or have a stroke or melanoma.

This ain't politics (incessant quips notwithstanding) - we are talking about peoples' lives, and they are not all dumb losers who brought it on themselves.

Rich,

Don't worry. Once we go universal, we won't get employer sponsored benefits anymore. We'll simply pay out the ying yang in income taxes (probably more than what a private policy would have cost)....and you won't get "benefits" anymore, because they won't be necessary, so you won't have to worry about "double-paying" or "foregoing" benefits. You'll just pay twice as much in taxes for half as good of coverage than you would have paid for your own, personal policy.

BTW - Insurance carriers can't just drop you personally because you get sick or personally price you out of the market because of your personal claims. Like Mutual of Omaha, they can drop a whole line of coverage if they are forced out of business by irresponsibile legislation that bankrupts them, but they can't just drop someone because they get sick. And they can only raise your rates by the same percentage that they raise everyone else's rates...you can't be singled out for a rate increase. IMO if moving makes getting healthcare prohibitive for you, then don't move. For the large majority of people, moving will not be a problem.


And Rich, don't you think that being in your line of business, you would naturally think that more people are sick and "uninsurable" than what there really are? I mean, your job is to take care of sick people. I am willing to bet that the statistics are not as high as you think they are. I'll have to do more research. I'll bet the population of chronically ill people who don't currently have any coverage is a lot lower than you think it is.

 

[2B]

I'll bet the population of chronically ill people who don't currently have any coverage is a lot lower than you think it is.

Come to Texas and find out. We probably have the worst state insurance plan in the nation.

A major factor in my retirement will be getting affordable health insurance. It's too bad I lived until I was 50 and have half the problems most people my age have. I'll still be forced into the "high risk pool" where I'll pay $7K per year and have a $5K deductible per person.

Unless we find a way to keep people that have paid for insurance for most of their lives insured at a reasonable cost, we will have a continuing joke of what passes for health insurance.

 

[Martha]

And Rich, don't you think that being in your line of business, you would naturally think that more people are sick and "uninsurable" than what there really are? I mean, your job is to take care of sick people. I am willing to bet that the statistics are not as high as you think they are. I'll have to do more research. I'll bet the population of chronically ill people who don't currently have any coverage is a lot lower than you think it is.

This is a tough number to get your arms around. I have seen estimates as low as 2 to 5% of the population as having chronic conditions. This was, IIRC, from proposals from the current administration concerning HSAs. Other estimates are as high as 50% of the population. I suppose it depends on how you define chronic. For example, does it include high blood pressure? Roughly one in five people have high BP. One in 10 have depression

I have read that the percentage of people with chronic conditions that are unisured is actually lower than the percentage of uninsured in the general population. Part of the reason for this may be that the elderly are more likely to have chronic conditions and medicare is available to them. But even among the non-elderly, those with chronic conditions are more likely to be insured. This survey (somewhat dated and limited to certain chronic conditions only) reports 88% of the non-elderly chronically ill have insurance vs. 81% of the general population: http://www.markle.org/resources/facct/doclibFiles/documentFile_287.pdf

However, even if the chronically ill have insurance they cannot always afford the cost of medical care. For example, you might not be able to afford the drugs necessary to treat the chronic condition. Non-compliance with treatment programs is a big problem for the chronically ill and is in part likely due to cost. This is a big problem for many who have to take a number of medications to treat their illnesses. Medicare, until recently, didn't cover drugs. Drug co-pays can be high. Research regarding HSA and high deductibles show a reduction in compliance with drug treatment.

I have also read that the chronically ill are more likely to stay with a job they are having difficulting in doing or otherwise want to leave because of "job-lock", staying at a job just to keep the health insurance.

Anyway, it is a big and complicated question, not just turning on whether someone is insured or not.

 

[mykidslovedogs]

Come to Texas and find out. We probably have the worst state insurance plan in the nation.

A major factor in my retirement will be getting affordable health insurance. It's too bad I lived until I was 50 and have half the problems most people my age have. I'll still be forced into the "high risk pool" where I'll pay $7K per year and have a $5K deductible per person.

Unless we find a way to keep people that have paid for insurance for most of their lives insured at a reasonable cost, we will have a continuing joke of what passes for health insurance.

The biggest part of this problem here is that people HAVE NOT paid for their own insurance most of their lives....their employers paid for it FOR THEM, and now they are spoiled, so when they retire, they think that they should have insurance for a fraction of what it really costs because they have never had to pay for it on their own, and they really don't have a clue about the true cost!

Health insurance is expensive because health CARE is expensive. Maybe the gov't could try placing cost controls on our providers?....I mean, not just via Medicare and Medicaid, but perhaps the gov't should prohibit providers from shifting lost profits (due to low Medicaid and Medicare reimbursement) to the private sector as well.....That's what's going to happen eventually anyway (in a universalized system...There won't be a private sector to shift costs to). So why go through all of the trouble of becoming universalized? Let's just pass legislation prohibiting providers from cost-shifting! That will fix everything, right?

Try living in Canada....they don't even cover prescriptions on their universal plan. The goverment simply can't afford to subidize prescriptions anymore. Is that the kind of healthplan you want? At least with a high deductible plan, you have a cap on your out of pocket costs, including prescriptions. In Canada, you get to pay 40% higher taxes there than in the USA PLUS about $125.00 in monthly premiums and you still have to pay for all of your own prescriptions out of pocket.

 

[brewer12345]

Hey, MKLD:

I think we all value your suggestions on how to find coverage, technical aspects of policy provisions, etc. But on the subject of healthcare reform, how individuals are responsibble for getting cancer, why we should all just deal with a completely unfettered free healthcare market, etc., I suspect I am not alone in wishing you would just SHUT THE FCUK UP!






Oh yeah:

 

[mykidslovedogs]

I never said people are responsible for getting cancer or any other illness that they get. Granted, I do believe some lifestyle choices lead to illness that could be prevented. My opinion is that a universal system will ultimately lead to lower quality of care for a much higher cost, alienating a lot more people than the current system does. I never said there wasn't room for improvement. I just think many people are very misguided in their thoughts that universalizing will be the utopian fix for our troubles, and I prefer a system that works the best for the most amount of people vs. a system that fails more people than it helps.

The Canadian system is a good model for comparison, because many who are in favor of single-payor are also NOT in favor of two-tiered systems where there is any inkling of "inequality". The Canadian system tried to eliminate inequality, and look where they are today. The sickest individuals cannot get the care they need and many end up crossing the border looking for better, quicker care from the USA. Like it or not, we will end up in the same situation 10-20 yrs down the road. Universalization is inevitable. As soon as Clinton is elected (and she will be), changes will be made quickly. All I can say is that only time will tell. We won't know for 10 or 20 years what the consequences will be, but once it happens, it will too late to fix and even though the older people (people who are older right now) might never be affected, our children will have a mess on their hands.

 

[teejayevans]

The Canadian system is a good model for comparison, because many who are in favor of single-payor are also NOT in favor of two-tiered systems where there is any inkling of "inequality".

There always will be 2 tier systems like UK, etc. Currently we people leaving the US
for places like Thailand to get care because of the cost. There is no perfect solution,
but having some basic level of medical care seems necessary.

If I were president:
I would legalized assisted suicides, we talk about being humane to our pets because
they're in pain, but for humans, nope. It's just a way for the medical establishment to
suck the last dime from your pocket.

I would like to see a breakdown of where the money goes, ie how much for
insurance, etc. I really like to see how much mal-practice insurance is costing us?

Also I would eliminate advertising for prescription drugs, makes no sense to me.
Tom

 

[mykidslovedogs]

There always will be 2 tier systems like UK, etc. Currently we people leaving the US
for places like Thailand to get care because of the cost. There is no perfect solution,
but having some basic level of medical care seems necessary.

You are right....no perfect solution. People may leave to get care from Thailand because of cost, and that is fine, as long as Thailand can provide those services. We also see a lot of people leaving their countries for care in the USA because they don't have access to the technology that we do, and they are willing to pay for it! Once the USA system goes to the same as everyone else's people won't have those choices anymore...The whole world will be in the same boat....so if you want the best, forget it, because there won't be anyplace to go for the best, because that choice will be gone, even if you are willing to pay more for it.

Anyway, maybe in 10 or 20 years it won't matter because people won't have any concept of what they are missing out on! (unless of course, they look back into history and find that in the "old days" people never had to wait 10 or 20 weeks for high tech services.

 

[Peter]

Hey, MKLD:

I think we all value your suggestions on how to find coverage, technical aspects of policy provisions, etc. But on the subject of healthcare reform, how individuals are responsibble for getting cancer, why we should all just deal with a completely unfettered free healthcare market, etc., I suspect I am not alone in wishing you would just SHUT THE **** UP!

You are not alone .....

 

[bright eyed]

If you've been knee-deep in sh*t sometimes you forget you stink...and then try to convince others it's nice in there!

it ain't so bad...come on in!

 

[mykidslovedogs]

Wait times in Canada...A detailed analysis...

http://www.fraserinstitute.ca/admin/books/chapterfiles/wyt2006.pdf#

 

[brewer12345]

Wait times in Canada...A detailed analysis...

http://www.fraserinstitute.ca/admin/books/chapterfiles/wyt2006.pdf#

What about the price of tea in China, ***?

Edit: removed profanity.

 

[Rich_by_the_Bay]

The Fraser Institute
"Our vision is a free and prosperous world where individuals benefit
from greater choice, competitive markets, and personal responsibility.
Our mission is to measure, study, and communicate the impact of
competitive markets and government interventions on the welfare
of individuals."

 

[mykidslovedogs]

The Fraser Institute
"Our vision is a free and prosperous world where individuals benefit
from greater choice, competitive markets, and personal responsibility.
Our mission is to measure, study, and communicate the impact of
competitive markets and government interventions on the welfare
of individuals."

Make sure that you don't read the rest of the study. Sentence #1 tells all! There is nothing to be gained from learning about the actual data that was collected

 

[bright eyed]

http://en.wikipedia.org/wiki/Fraser_Institute

great source of unbiased info huh?

 

[mykidslovedogs]

http://en.wikipedia.org/wiki/Fraser_Institute

great source of unbiased info huh?

There is a lot of data that is included in the report that you can draw your own conclusions from. You don't have to accept Fraser Institutes conclusions, but at least look at the data. Oh...I forgot...that's too much to ask of this group.

 

[brewer12345]

There is a lot of data that is included in the report that you can draw your own conclusions from. You don't have to accept Fraser Institutes conclusions, but at least look at the data. Oh...I forgot...that's too much to ask of this group.

Nah, I'd rather watch Fox "News."

 

[Rich_by_the_Bay]

Make sure that you don't read the rest of the study. Sentence #1 tells all! There is nothing to be gained from learning about the actual data that was collected

Your escalating sarcasm doesn't enhance your credibility.

Nonetheless, the political or economic agenda of an information source is fair game and, indeed, an important component for a reader to be aware of in drawing conclusions. The content of such "studies" (or the decision about which studies to cite) may be biased by the slant of the sponsoring organization. This is why I try to rely on objective, often academic research from unbiased sourced if available. This is especially true on the web, where anyone can cast a google hook out there and turn up "support" for virtually any opinion, regardless of its validity.

Similarly, I also refuse to use pharmaceutical reps as my source of information about new drugs, probably wouldn't trust any political advocacy group's own data in drawing my conclusions (liberal or conservative), and wouldn't ask a BMW dealer what the best car brand is.

Perhaps it is not "this group" (as you condescendingly refer to it) which has a closed or doctrinaire attitude on the issues.

 

[brewer12345]

Your escalating sarcasm doesn't enhance your credibility.

Now c'mon, doc: you just don't want to see the "facts" here. :