5 freedoms you'd lose in health care reform

[FuzzyLumpkins]

Health Reforms hidden victims

Young people and seniors would pay a high price for ObamaCare.


http://online.wsj.com/article/SB1000...720472842.html

1) REad the article thats not what it says.
2) The issue with 2:1 is in the house plan which i agree sucks.

[ElNono]

These are excepts from the article "5 freedoms you'll lose in health care reform" they are in quotations or bold:

"The bills in both houses require that Americans purchase insurance through "qualified" plans offered by health-care "exchanges" that would be set up in each state. The rub is that the plans can't really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer. "

"Obama platform would mandate extremely full, expensive, and highly subsidized coverage -- including a lot of benefits people would never pay for with their own money -- but deliver it through a highly restrictive, HMO-style plan that will determine what care and tests you can and can't have."


We don't want full maximum coverage. What if we want what we already have? Why should the government choose what we need and don't need. Most people want choice and to be able to fit a plan according to their needs. Do they know our health more than we do? Mandating full coverage, makes it more expensive to keep my private insurance because the insurer is competing with the highly subsidized government mandated plan. Government Subsidies make it impossible to compete.

Who are we? You and the insurance companies?
Plus, from the sole basis that we still don't know the full extent of the minimum required coverages, you're basically complaining of hypotheticals. My understanding is that it won't be maximum coverage, but a set of minimums required. Once the minimum required covered procedures/treatments information is released, then we can attend to your incessant ing.

"The Senate bill would require coverage for prescription drugs,mental-health benefits, and substance-abuse services."

"The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses."

I would not have a choice to decline substance and mental health coverage. Yet, it's requiring all of us to pay for that. Also, young healthy people shouldn't be forced to have maximum insurance.

This is no different than your run of the mill group coverage plan. You are offered a package and then you're either happy and take it, or if you're not happy then you decline it in it's entirety. There are things covered there that you pay for and you probably won't use.
If you don't like any plan, you're always free to pay the penalty of not carrying a plan (which is cheaper than paying for a plan) and then pay out of pocket for just want you want.

"Hundreds of companies now offer Health Savings Accounts to about 5 million employees. Those workers deposit tax-free money in the accounts and get a matching contribution from their employer. They can use the funds to buy a high-deductible plan -- say for major medical costs over $12,000. Preventive care is reimbursed, but patients pay all other routine doctor visits and tests with their own money from the HSA account. As a result, HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care."

We use HSA together with our insurance, and it's a good combination. It certainly makes us more cost conscious. It seems this plan may be eliminated.

Nothing more cost conscious than running a $20K bill when your insurance company gave you the middle finger.

"The employees who got their coverage before the law goes into effect can keep their plans, but once again, there's a catch. If the plan changes in any way -- by altering co-pays, deductibles, or even switching coverage for this or that drug -- the employee must drop out and shop through the exchange. Since these plans generally change their policies every year, it's likely that millions of employees will lose their plans in 12 months."

It's just as I thought. If I don't like my current private plan, and want to change it, I would be forced into the exchange which only has the mandated maximized health care coverage plans to pick from. So, this exchange will not allow us to pick a similar private plan.

Rather, we would be forced into the exchange where the minimum coverage is mandated by the government and is different from my original private plan.

Again, you can't claim it's maximized simply because we still don't know what that baseline coverage is. And you always have the choice not to have a plan and pay out of pocket.

[ElNono]

Sine the government will mandate the minimum coverage allowed, like substance abuse or mental disorder coverages, all insurers in the exchange would have to carry that minimum policy. So, yes, everybody will have at least the government version policy -they have too.

So, if you don't carry any of the coverages that are mandated by the government, and you leave your private plan for whatever reason, you will be forced into the exchange. So, whether you like it or not, you will have to carry the minimum mandated government coverage plus whatever else you would like to add.

The bill in its current stage is mandating the mental and substance abuse coverage. No one knows yet how much more or less will be mandated until the final version is adopted.

So what you're against is a minimum mandated coverage... that's a different story. Don't go saying your only choice is the public option, because that's simply not accurate at all.

[Spursmania]

So what you're against is a minimum mandated coverage... that's a different story. Don't go saying your only choice is the public option, because that's simply not accurate at all.

No, what you're saying is not accurate. People will no longer have the choice of choosing their own coverage and their own plan. You're misleading by assuming people don't think it's a change because they have to carry a minimum. That in and of itself already is a different policy set by bureaucrats in Congress.

I am against the government mandating my insurance options, period. That is what this plan does. It takes away our choice to choose what type of coverage we want, to say otherwise is misleading. When the government forces you to buy a certain policy how can that be choice?

[Spursmania]

Who are we? You and the insurance companies?
Plus, from the sole basis that we still don't know the full extent of the minimum required coverages, you're basically complaining of hypotheticals. My understanding is that it won't be maximum coverage, but a set of minimums required. Once the minimum required covered procedures/treatments information is released, then we can attend to your incessant ing.

"We" is every American who may not want government mandated minimum coverage. The analysis is based on the most current version out there. By your logic, however, any arguments you make or your "incessant ing" as you like to refer to it would also be based on complete hypotheticals and hogwash since nothing has indeed passed.

If your understanding is different on the Max coverage-then please refer me to your information.

This is no different than your run of the mill group coverage plan. You are offered a package and then you're either happy and take it, or if you're not happy then you decline it in it's entirety. There are things covered there that you pay for and you probably won't use.
If you don't like any plan, you're always free to pay the penalty of not carrying a plan (which is cheaper than paying for a plan) and then pay out of pocket for just want you want.

What? Of course, this is different. The government will be mandating a required minimum even though we may never need substance or mental disorder coverage, etc... So, Americans are forced to pay for items they don't want in their coverage. How is that cost efficient? Americans don't like paying extra for things they don't use or need.

Free to pay the penalty? This is different, as well. We will be forced to carry insurance the government wants us to carry or be forced to pay a penalty. Neither of which many people find appealing. This is not free choice.

Nothing more cost conscious than running a $20K bill when your insurance company gave you the middle finger.

It's clear you don't know how the HSA's work.

Again, you can't claim it's maximized simply because we still don't know what that baseline coverage is. And you always have the choice not to have a plan and pay out of pocket.

Again, you can't claim I'm wrong either, because this analysis is based on the current version. So, based on your logic, you too would have no business refuting this analysis since you have no idea what will pass.

Everybody, knows this Bill may not be the final version, but parts of it might very well be. You think forcing Americans to pay a penalty for declining insurance is a choice?

No one knows the final version yet. However, it's useful to analyze what the bill would require us to do in it's current form.

[ElNono]

"We" is every American who may not want government mandated minimum coverage. The analysis is based on the most current version out there. By your logic, however, any arguments you make or your "incessant ing" as you like to refer to it would also be based on complete hypotheticals and hogwash since nothing has indeed passed.

I'm not ing about it, you are.

If your understanding is different on the Max coverage-then please refer me to your information.

I've seen them called 'essential benefits', but again, they're yet to be determined. Here is an article I pointed to in another thread.

What? Of course, this is different. The government will be mandating a required minimum even though we may never need substance or mental disorder coverage, etc... So, Americans are forced to pay for items they don't want in their coverage. How is that cost efficient? Americans don't like paying extra for things they don't use or need.

Your current employee provided insurance plan might cover cancer treatment that you might never end up using. You're still paying for it. Now I'll ask you the same questions that you're asking me: How is that cost efficient? Americans don't like paying extra for things they don't use or need. (But they do anyways).

Free to pay the penalty? This is different, as well. We will be forced to carry insurance the government wants us to carry or be forced to pay a penalty. Neither of which many people find appealing. This is not free choice.

Do you have a choice not to pay taxes on your income? How about your car insurance? In this case, you essentially DO have an option.

It's clear you don't know how the HSA's work.

I do, but it's not the point. HSA might work for people of certain income and age, but overall make it more expensive for everyone else. It basically goes against the social redistributive idea of insurance. Furthermore, they're subject to market risk, just like any other investment, making the entire proposition a risky gamble. And I'm not even going into the bait and switch of selling reduced priced premiums with high deductibles to people that can ill afford to fund the HSA account.
If you're looking to reduce cost in healthcare, HSA is one of the very first things that need to go.

Again, you can't claim I'm wrong either, because this analysis is based on the current version. So, based on your logic, you too would have no business refuting this analysis since you have no idea what will pass.

Everybody, knows this Bill may not be the final version, but parts of it might very well be. You think forcing Americans to pay a penalty for declining insurance is a choice?

No one knows the final version yet. However, it's useful to analyze what the bill would require us to do in it's current form.

I don't have a choice not to have car insurance if I want to drive. At least this gives me a choice if I'm willing to pay for the penalty. So yeah, it is a choice after all. You might not like it, but that's a different story altogether.

[Spursmania]

Sorry, but none of your replies are convincing nor does it controvert the fact that our choices will be limited and will come from the government. Our private plans will never be the same and eventually we will all be on government plans. You can buy basic stripped down packages now which you won't be able to do once the government is involved.

We should be focusing on national tort reform. Doctors order extra tests to cover their ass and practice defensive medicine because if they don't there's always blood hungry attorneys who will abuse the legal system. As a result, Doctors are required to pay several thousands of dollars in medical malpractice insurance. These costs spill over to patient's fees. We all suffer because of this huge national problem. This reform doesn't even begin to address that. Why?

Obama is a lawyer and most members of Congress are lawyers. The Trial Lawyer's asscoiation feeds millions of dollars into congress' members to avoid any type of reform. They are all one big happy family. Meanwhile, we are all left with a problem, Congress isn't even bothering to address tort reform. It's really an insult to the whole idea of reform when it's not even considered. We should concentrate on kicking insurance companies' asses and tort reform first before we start overhauling the whole industry.

[101A]

It seems this lady doesn't understand how insurance works. The entire principle of insurance is that you pool risk and spread the cost around. All insurance companies do it. If someone pays $2000 a year for full coverage on their BMW M5 and you wreck it costing $40k to replace it then is that person going to be ever paying for the benefits he received?

You don't know a whole lot about insurance.

If you are MUCH MORE LIKELY to wreck your M5, then the insurance company will charge you a great deal more. If they KNOW you are going to wreck your M5, and total it, they will charge you replacement cost, plus administrative fees, plus reserve funding, commissions and taxes.

An underwriter's job is to KNOW what normal expenses are going to be, and then charge for the risk the insurance company is taking for things beyond "normal". They add premium loads to that to cover administrative costs.

An older person should pay more because they have: 1. Higher Normal, everyday costs (maintenance drugs, more doctors visits, etc.),; 2. Higher risk - MUCH more likely to get a seriously expensive disease; 3. Higher administrative costs because the insurance company is going to be spending a great deal more resources on them, than the 22 year old, who may, or may not have a single claim all year.

Yes, insurance exists to spread the cost around, but that is mainly related to the risk piece; the unknowable; the rest is known.

Which brings us to WHY healthcare WAS so cheap and has been rising SO fast.

As with most other issues in this country, it's the baby boomers fault. In the 70's, the bulge was with young, healthy types; lots of them paying premium, with relatively few elderly; and nobody gave much of a crap about the elderly - the market and focus was on the boomers. As they've aged; so has the cost of healthcare risen; and NOBODY thought for the boomers to be putting money away to cover their future healthcare costs; so that burden falls on all of us. Wouldn't want to duly stress the boomers, would we? Pile on top of that the rush to develop new drugs to sell to the boomers (nobody heard of VIAGRA until a 'boomer couln't get it up), and you have a perfect storm of increasing prices.

And the kicker?

There's no solution.

The Boomers ARE getting older, and sicker - the cost is going to continue to go up, unless we decide to NOT spend a great deal of money on them when they get catastrophically ill.............the only real solution.

Frankly, I think Obama gets this, but he just can't say it.

[ElNono]

Sorry, but none of your replies are convincing nor does it controvert the fact that our choices will be limited and will come from the government. Our private plans will never be the same and eventually we will all be on government plans. You can buy basic stripped down packages now which you won't be able to do once the government is involved.

On the same note, what you want is utopian. It doesn't exist. That's why you can't come up with a proposition. You want:
1) Lower premiums
2) Higher quality of care
3) Lower care costs
4) Minimum or no government intervention

There's simply no incentive for insurers or pharmas to lower any costs. Actually, the opposite is true. Even the cost whining on this plan is a red herring, because 5 years from now, with the status quo, we will be on the hook for $1 trillion to fund medicare and medicaid alone, and you bet it's gonna come from taxes. Furthermore, we will keep on reducing access to care, as premiums keep on growing a disproportionate amount compared to salaries.

Now, this might not be the best plan your money can buy, and we can debate that to eternity, but it's an attempt to move in another direction. Something that's long overdue.

We should be focusing on national tort reform. Doctors order extra tests to cover their ass and practice defensive medicine because if they don't there's always blood hungry attorneys who will abuse the legal system. As a result, Doctors are required to pay several thousands of dollars in medical malpractice insurance. These costs spill over to patient's fees. We all suffer because of this huge national problem. This reform doesn't even begin to address that. Why?

I agree this is something that should have been included, but I also can't fault the entire plan for not containing a provision to deal with that topic. Like I said in another post, there's just so many battles you can fight at one time. Plus it's not like you can't do tort reform on a separate bill.

Obama is a lawyer and most members of Congress are lawyers. The Trial Lawyer's asscoiation feeds millions of dollars into congress' members to avoid any type of reform. They are all one big happy family. Meanwhile, we are all left with a problem, Congress isn't even bothering to address tort reform. It's really an insult to the whole idea of reform when it's not even considered. We should concentrate on kicking insurance companies' asses and tort reform first before we start overhauling the whole industry.

You need to make a point that the entire plan is inviable if tort reform is not included. I haven't seen that yet.

[ElNono]

Which brings us to WHY healthcare WAS so cheap and has been rising SO fast.

I don't necessarily disagree with your view, but I don't think it really encompasses the entire spectrum. The better question to me is: Why does premiums and profits keep going up when some of these companies actually insure LESS people?

[Wild Cobra]

Anyone care for CBO numbers?

I find them generally to be way off on expected costs. The costs are generally way higher than they estimate. Anyway:

CBO preliminary analysis of H.R. 3200 7/17/09

Text of HR 3200

[101A]

I don't necessarily disagree with your view, but I don't think it really encompasses the entire spectrum. The better question to me is: Why does premiums and profits keep going up when some of these companies actually insure LESS people?

Depends on the company.

Insurance companies often run in cycles; we talk about it as either the marketers or the accountants running things. When the salespeople are dominant; they write a lot of paper; drive up revenue - but it's not good for profit; which leads to the accountants taking over, and tightening up underwriting guidelines (charging more when people get sick, etc.); which increases profit, and often sends those less attractive cases to another company which is looking to add policy-holders, and with more loose underwriting criteria. People, and groups, move from carrier to carrier all the time.

Profit could also go up becuse bonuses went down, they stopped buying or building new offices; anything - and the company is trying to build cash. Profit is simply what is left over after ALL expenses are covered - including salaries, bonuses AND dividends. It's kind of funny, but in my own business, "profit" is not a good indicator of how we are doing. The company made more profit in the past fiscal year, but I made less money. Our profit went up considerably, simply because we stopped depreciating an expensive software package we bought 5 years ago; had nothing to do with cash on hand - but it appears as if something significant happened. I assume the same kinds of things apply to large companies; but on a much different scale.

[101A]

There's simply no incentive for insurers or pharmas to lower any costs.

Why do you lump insurers with pharamceuticals?

Pharmaceuticals are providers, like doctors and hospitals and drug stores; insurance carriers are payors.

[Wild Cobra]

In a thread on 10/17/08, I stated the following after the first bailout:

Watch the future. My senator Gordon Smith (R) in a blue state will lose this November now. I'm sure this hurts him enough with conservatives that he will be replaced by the more liberal democrat running against him!

Merkley won the 2008 election 49% to 46%. Smith won the 2002 election 56% to 40%! He was on the wrong side of two issues that pissed off his base. Amnesty for illegals, and the bailout.

Remind your republicans that this will likely happen to them if they vote for HR 3200. Doesn't hurt to tell your democrats that also.

[Bender]

Our profit went up considerably, simply because we stopped depreciating an expensive software package we bought 5 years ago; had nothing to do with cash on hand - but it appears as if something significant happened. I assume the same kinds of things apply to large companies; but on a much different scale.

true. That's why a Cash Flow statement is a truer indicator of how a company is doing, rather than a P&L statement. CF statements remove such "non-cash" items such as depreciation & amortization.

[ElNono]

Depends on the company.

Insurance companies often run in cycles; we talk about it as either the marketers or the accountants running things. When the salespeople are dominant; they write a lot of paper; drive up revenue - but it's not good for profit; which leads to the accountants taking over, and tightening up underwriting guidelines (charging more when people get sick, etc.); which increases profit, and often sends those less attractive cases to another company which is looking to add policy-holders, and with more loose underwriting criteria. People, and groups, move from carrier to carrier all the time.

Sure they do. Until they can't find coverage they can afford anymore. Then you get more and more people uninsured and underinsured. Regardless of profits, premiums keep on growing at a pace that salaries can't match.

Profit could also go up becuse bonuses went down, they stopped buying or building new offices; anything - and the company is trying to build cash. Profit is simply what is left over after ALL expenses are covered - including salaries, bonuses AND dividends. It's kind of funny, but in my own business, "profit" is not a good indicator of how we are doing. The company made more profit in the past fiscal year, but I made less money. Our profit went up considerably, simply because we stopped depreciating an expensive software package we bought 5 years ago; had nothing to do with cash on hand - but it appears as if something significant happened. I assume the same kinds of things apply to large companies; but on a much different scale.

There's so much you can attribute to external or one-time factors. This is not a one time occurrence, but a trend that has been happening over the course of years. At the end of the day, the bread and butter of these companies are low-risk people. There's simply no incentive for them to charge less or take on more risky users. Sooner or later the only people they need to respond to are stockholders.

[ElNono]

Why do you lump insurers with pharamceuticals?

Pharmaceuticals are providers, like doctors and hospitals and drug stores; insurance carriers are payors.

They both contribute, in different ways, to the cost of care, which is what I was answering to.

[101A]

There's so much you can attribute to external or one-time factors. This is not a one time occurrence, but a trend that has been happening over the course of years. At the end of the day, the bread and butter of these companies are low-risk people. There's simply no incentive for them to charge less or take on more risky users. Sooner or later the only people they need to respond to are stockholders.

You are aware that in the state of Texas, NO insurance company doing business here can decline an employer group of at least 2 coverage?

You are aware that they cannot load their rates more than 67% over "book", or normal rates?

So you see, if insurance companies do business in Texas, they DO NOT just get the healthy? They get the sick; in droves.

[ElNono]

You are aware that in the state of Texas, NO insurance company doing business here can decline an employer group of at least 2 coverage?

Not in all cases. As you're well aware, that only applies if at least 75% of them are eligible (with the rounding favoring the company). That's for the small employer case. Actually, in your 2 employer case (say husband and wife), the law requires 100% participation, or the insurer can simply decline.

You are aware that they cannot load their rates more than 67% over "book", or normal rates?

Only for businesses classified under 'Small employer'. Why do you think these protections were put in place?

So you see, if insurance companies do business in Texas, they DO NOT just get the healthy? They get the sick; in droves.

There's 300,000 more uninsured just from the period 1995 to 2001. (source)
I wish they had more recent numbers, and specially underinsured numbers.
This is a system that's simply not viable on the long term.

I'm also wondering, do you believe we would have less costs and more insured if all these state and federal regulations were not in place?

[101A]

I'm also wondering, do you believe we would have less costs and more insured if all these state and federal regulations were not in place?

Generally regulations raise the cost of insurance, but not the cost of healthcare.

Ultimately, our healthcare is expensive because people get very sick, and it costs a lot of money to try to save their lives. No matter how you choose to pay for it, that is a truism.

I don't understand why people ascribe rules for health care that are different than for everything else. If your house burns down, it costs the same to build it again, regardless of how much premium you paid to insure it, or even if it was not insured at all.

That's not to say that in individual cases, the cost of healthcare is different depending on who's paying; but it macro, on a nationwide level; there are going to be X number of claims, and those claims are going to cost Y number of dollars. The majority of those claims dollars are going to be spent on very sick people either dying, or coming damn close to it; cancer/heart disease/dialysis/premature births.

Anecdote: My company's health plan spends about $12,000 per month - coerage for 25 employees; several spouses, and some children. $144,000 per year, for ALL of their healthcare. An employee in 2004 got Pancreatic cancer; was sick for 6 weeks, and died. Cost for that single episode? $620,000. Nearly six years of coverage for 25 families spent in 6 weeks on a single individual. The case is not unique.

Now, unless we limit what doctors are paid, or hospitals can charge OR don't pay for some of those "heroic" treatments; the costs are there - they are going to be incurred. The question is: What is the most effective, efficient way to pay for it? Obviously, we can eliminate paper work and inefficiencies in the system; and save dollars. But, remember, paperwork and inefficincies = clerical jobs for many Americans. Reducing those $$$$ reduces jobs.

How about this; We put Uncle Sam in a position to do the most good; while not being able to do the most damage (day to day operation and control of people's healthcare). Make the fed the ultimate stop-loss; they pay claims on individuals over $100,000 - to $250,000 (and index it to healthcare inflation biannually); private en ies cover everything up to that point - with subsidies for people who cannot afford that lower coverage. The payor's file claims with the govt. for claims over the stop/loss - the govt. reimburses the claim; but doesn't have to get involved directly with the processing - although, obviously, they must have an ability to audit. Pass a regulation, not controlling prices; but making pricing by providers transparent (doctors/hospitals/labs); they must post their charges publicly; and must charge everyone the same price - whatever that might be (I cringe at this suggestion; but for reasons that are more complex than I want to explain - there are a lot of shenanigans that go on in contractual pricing that should be stopped).

[Spursmania]

I'm all for healthy debates guys. It's nice to hear different perspectives without the insults.

[ElNono]

(I skipped over the parts I mostly agree with)

That's not to say that in individual cases, the cost of healthcare is different depending on who's paying; but it macro, on a nationwide level; there are going to be X number of claims, and those claims are going to cost Y number of dollars. The majority of those claims dollars are going to be spent on very sick people either dying, or coming damn close to it; cancer/heart disease/dialysis/premature births.

Anecdote: My company's health plan spends about $12,000 per month - coerage for 25 employees; several spouses, and some children. $144,000 per year, for ALL of their healthcare. An employee in 2004 got Pancreatic cancer; was sick for 6 weeks, and died. Cost for that single episode? $620,000. Nearly six years of coverage for 25 families spent in 6 weeks on a single individual. The case is not unique.

Now, unless we limit what doctors are paid, or hospitals can charge OR don't pay for some of those "heroic" treatments; the costs are there - they are going to be incurred.

I think it's really, really hard to really tell what are the actual costs under the current system. The doctor will bill one thing (is that the actual cost?), then insurance will pay another thing (is that the actual cost?), if you offer to pay out of pocket, you might get quoted a different amount (is that the actual cost?) and lastly, if you compare how much the same procedure costs somewhere else, adjusted for differing standards of living, liability, etc you get yet another sum (is that the actual cost?).

For the most part, I think costs are inflated. I think the doctor charges 'X' to the insurance, because he already knows that the insurance, if it approves it, will only pay 'X/4'.
Then there's other legitimate factors, such as overuse. We've argued extensively about the CYA angle which encompasses tort reform. Then there's physician owned hospitals, and their abuse of testing.

So, I really think we need a whole lot more of transparency when it comes to really determining where this 1/6 of our entire economy is being spent on.

At the end of the day, you can't really reduce this to a 'baby boomers only' or 'we have more sick now' issue. Other countries have their own generations of elders to care for, and they do it with relatively the same outcome for a fraction of what costs us. Furthermore, their systems have sustainability, something our current system does not have. So there's something we're not doing quite right. The thing is to identify what exactly that is.

How about this; We put Uncle Sam in a position to do the most good; while not being able to do the most damage (day to day operation and control of people's healthcare). Make the fed the ultimate stop-loss; they pay claims on individuals over $100,000 - to $250,000 (and index it to healthcare inflation biannually); private en ies cover everything up to that point - with subsidies for people who cannot afford that lower coverage. The payor's file claims with the govt. for claims over the stop/loss - the govt. reimburses the claim; but doesn't have to get involved directly with the processing - although, obviously, they must have an ability to audit. Pass a regulation, not controlling prices; but making pricing by providers transparent (doctors/hospitals/labs); they must post their charges publicly; and must charge everyone the same price - whatever that might be (I cringe at this suggestion; but for reasons that are more complex than I want to explain - there are a lot of shenanigans that go on in contractual pricing that should be stopped).

It's not an unreasonable proposition. However, I think you automatically assume that by removing risk, insurance companies will pass the savings directly to the consumers, and I don't see it anywhere near as clear cut.
I would add a rule to restrict companies from having over 50% of market concentration in a single area, as a way of fomenting actual compe ion. As far as pricing being public and transparent, I agree (see my comment above), but I'm also skeptical it's enough. Whoever dictates those prices are going to end up being a new big lobbying group, just like pharma, fighting against any kind of check and balances to determine the methodology of their price scale. I'm sorry if I sound somewhat pessimistic, but I trust corporations to regulate themselves as much as I trust government to control it's own spending... that is, not much at all.

Thanks for taking the time to put together a proposition. You've succeeded where others have failed!

[FuzzyLumpkins]

You don't know a whole lot about insurance.

If you are MUCH MORE LIKELY to wreck your M5, then the insurance company will charge you a great deal more. If they KNOW you are going to wreck your M5, and total it, they will charge you replacement cost, plus administrative fees, plus reserve funding, commissions and taxes.

An underwriter's job is to KNOW what normal expenses are going to be, and then charge for the risk the insurance company is taking for things beyond "normal". They add premium loads to that to cover administrative costs.

An older person should pay more because they have: 1. Higher Normal, everyday costs (maintenance drugs, more doctors visits, etc.),; 2. Higher risk - MUCH more likely to get a seriously expensive disease; 3. Higher administrative costs because the insurance company is going to be spending a great deal more resources on them, than the 22 year old, who may, or may not have a single claim all year.

Yes, insurance exists to spread the cost around, but that is mainly related to the risk piece; the unknowable; the rest is known.

Which brings us to WHY healthcare WAS so cheap and has been rising SO fast.

As with most other issues in this country, it's the baby boomers fault. In the 70's, the bulge was with young, healthy types; lots of them paying premium, with relatively few elderly; and nobody gave much of a crap about the elderly - the market and focus was on the boomers. As they've aged; so has the cost of healthcare risen; and NOBODY thought for the boomers to be putting money away to cover their future healthcare costs; so that burden falls on all of us. Wouldn't want to duly stress the boomers, would we? Pile on top of that the rush to develop new drugs to sell to the boomers (nobody heard of VIAGRA until a 'boomer couln't get it up), and you have a perfect storm of increasing prices.

And the kicker?

There's no solution.

The Boomers ARE getting older, and sicker - the cost is going to continue to go up, unless we decide to NOT spend a great deal of money on them when they get catastrophically ill.............the only real solution.

Frankly, I think Obama gets this, but he just can't say it.

Dude I sold it for 4 years so blow me.

The entire idea was that there would be payouts that the people involved would never be able to repay. I am aware for how risk rating works.

Oh and BTW a 16 year old male driving a brand new M5 with full coverage would cost about 2.5 times as much as a 36 year old married female. Thats about as extreme of a risk rating difference as you can get. Thats not 5x as much.

At the end of the day though using current medical insurance price structures as an attempt to show what is wrong in the state plan is pretty dumb. I know that the very worst for property and casualty its not 5 times as much. What AETNA et al has been doing for years now is pricing things so that people are excluded.

We are not privy to the actuarial data so the point at the end of the day as to what a good ratio is is moot anyway.

And I am sorry I am not down with the whole 'lets just let the older generation suffer hurt and die' idea even though they are the reason why were in this pickle today.

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There is obviously population(medical treatment) bump as boomers (an innocent result of Hitler's war) hit retirement. But then there is also a bump in the govt income from the population bump from the boomer's children.

To say that boomers are THE reason for the health care fiasco is nothing but the wrongies shifting the blame away from corrupt, predatory ins utions they love to absolve and protect onto the individuals.

Most people of ALL ages simply do not have any clue how to take care of their health. No exercise and overeating industrial food-like dead substances are two main reasons that all ages have diabetes or pre-diabetes, CVD or showing signs of it in teen years, etc, etc. So it's just not boomers who are sick.

BigPharma is simply a criminal exercise. "pop-a-pill" is hypnotically ingrained into every American as the only solution to everything that ills ya.

Then there is BigPharma's pervasive, sinister $60B/year marketing that convinces healthy people that there is something somewhere wrong with them (you're missing out on The American Dream of perfection and perfectibility), and convinces sick people they are really much sicker than they are.

Fee-for-service causes doctors and hospitals to go for volume of treatments and flipping through patients to run up their volume services, separate from results. Treatment often causes more disease and dysfunction, but that's OK, that means more treatment.

And as if performing unnecessary services wasn't enough, there is the widespread fraud of (over)charging (Medicare/Medicaid) for services not performed. Something like $2.5b+/year in CA alone.

But let's forget about all that. THE problem is boomers. GMAFB

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We are not privy to the actuarial data so the point at the end of the day as to what a good ratio is is moot anyway.

Speak for yourself.