My doctors office can barely keep up with the local and state regulations, codes,etc. Can you imagine if the father had a policy in one state, the mother had a policy from another, and the kids had a policy from another state? Then multiply that mess times EVERY family. My doctor's office wouldn't be able to handle that nightmare with all the healthcare policy intricacies. There would be tons of mistakes happening all the time. Especially having to keep up with the policy changes from year to year and state to state. It would be a mess. And i'd laugh to my republican friends for their Obamacare "fix".
9
There will never be capitalistic competition in health insurance industry unless and until the insurance companies reveal the cost and quality of their enrolled patients preventive, medical, surgical and palliative care.
All else is smoke and mirrors. The McCarron Ferguson Act protects the health insurance industry from antitrust and the ERISA laws protect the health insurance industry from malpractice for rationing access, diagnostics, treatments, surgery and palliative care for profit.
What a joke. And cross state registration is supposed to cure this scam?
All else is smoke and mirrors. The McCarron Ferguson Act protects the health insurance industry from antitrust and the ERISA laws protect the health insurance industry from malpractice for rationing access, diagnostics, treatments, surgery and palliative care for profit.
What a joke. And cross state registration is supposed to cure this scam?
13
My denomination, the Lutheran Church--Missouri Synod, administers its health plan for its pastors and teachers, etc., across state lines. Maybe you want to see how that works.
4
Ms Sanger-Katz is absolutely correct in that it sounds a lot easier then it really is. It would definitely have to be determined under whose state law the company would operate, that of the insured or that of the home office not to mention the red tape involved in disclosure would try the patience of a nun. The time which it would take to implement makes the Affordable Care Act look like mailing a post card by comparison.
Like most GOP proposals such as the flat tax (fair tax or whatever the term du jour) it sounds good to an uninformed person but cannot withstand scrutiny for actually benefiting the majority of citizens.
Like most GOP proposals such as the flat tax (fair tax or whatever the term du jour) it sounds good to an uninformed person but cannot withstand scrutiny for actually benefiting the majority of citizens.
15
"It also involves setting up favorable contracts with doctors and hospitals so that customers will be able to get access to health care. Establishing those networks of health care providers can be hard for new market entrants."
Federal law could allow network piggybacking.
Utah's New Entrant Insurer could piggyback on say the NY Blue Cross networks paying the providers the largest in-state insurer rate in the last twelve months for a provider plus a random federal tax of say 2% to 5% per provider. The random federal tax rate would be generated for each provider with a taxpayer ID by the IRS.
The average 3.5% tax would be charged to make things fair for NY's Blue Cross networks for their expensive network building and price negotiating efforts.
Federal law could allow network piggybacking.
Utah's New Entrant Insurer could piggyback on say the NY Blue Cross networks paying the providers the largest in-state insurer rate in the last twelve months for a provider plus a random federal tax of say 2% to 5% per provider. The random federal tax rate would be generated for each provider with a taxpayer ID by the IRS.
The average 3.5% tax would be charged to make things fair for NY's Blue Cross networks for their expensive network building and price negotiating efforts.
2
Ah, yes. Yet another conservative/Republican proposal to bring the "discipline" of the workings of the free market to bear on the delivery of medical care. Great in theory; totally unworkable and unfeasible in practice. Again.
But why allow competition only across state borders? Why not across national borders? I'd love to be able to get access to Canada's single-payer system.
But why allow competition only across state borders? Why not across national borders? I'd love to be able to get access to Canada's single-payer system.
20
What could be done is to separate out outpatient drug coverage.
Drug plans could be run nationwide.
I just want hospitalization and surgery coverage, the type I grew up with.
I'm 56 years old and no insurance company has ever paid one cent for an outpatient drug for me.
I don't think any government should mandate any scope of coverage.
Why should a government be prohibited from regulating abortion but allowed to make health insurance so expensive I can't afford to buy hospitalization coverage?
I might have been born a female and had an ectopic pregnancy while poor.
On my ~$3,800/year income I don't qualify for subsidies. Since I live in Florida, Medicaid isn't an option either.
Drug plans could be run nationwide.
I just want hospitalization and surgery coverage, the type I grew up with.
I'm 56 years old and no insurance company has ever paid one cent for an outpatient drug for me.
I don't think any government should mandate any scope of coverage.
Why should a government be prohibited from regulating abortion but allowed to make health insurance so expensive I can't afford to buy hospitalization coverage?
I might have been born a female and had an ectopic pregnancy while poor.
On my ~$3,800/year income I don't qualify for subsidies. Since I live in Florida, Medicaid isn't an option either.
6
"Insurers have been muted in their enthusiasm for G.O.P. across-state-lines plans."
Of course they have. They like the status quo. Companies don't want to compete, they like when they have monopolies. If it's good for the consumer, it's typically bad for the producer. You're not selling this idea that standardized federal health insurance regulations, and therefore, national health plans, are bad.
Of course they have. They like the status quo. Companies don't want to compete, they like when they have monopolies. If it's good for the consumer, it's typically bad for the producer. You're not selling this idea that standardized federal health insurance regulations, and therefore, national health plans, are bad.
6
@Pfo
PA
In your simplistic eagerness to condemn insurers it appears to have escaped your notice that the PROVIDERS of healthcare within states are by and large ALSO oligopolies. Their principal effective counterweight when it comes to what they charge consumers for a product (for which the demand is inelastic) are the insurers.
PA
In your simplistic eagerness to condemn insurers it appears to have escaped your notice that the PROVIDERS of healthcare within states are by and large ALSO oligopolies. Their principal effective counterweight when it comes to what they charge consumers for a product (for which the demand is inelastic) are the insurers.
4
You are aware that ACA gives the Health Insurance Industry exactly the monopoly you're taling about, arent you?
What we have today, with ACA, is that monopoly.
You're dang right the Health Insurance Industry doesnt want the GOP to upset the status quo.
What we have today, with ACA, is that monopoly.
You're dang right the Health Insurance Industry doesnt want the GOP to upset the status quo.
4
@short end
sorosville
Er...the ACA has made absolutely no difference to the relative oligopolistic position of insurers. ACA has added about 11 million to insurers rolls when they were already covering around 200 million people. The roughly 35 health insurers were oligopolies before the ACA and they're still oligopolies. It's certainly given them a bit more volume which they like of course but hasn't changed the fundamentals one bit. Nor do I ever remember Republicans complaining about insurers being oligopolies. Or are you suggesting the Republican party now has plans to destroy the health insurance industry on the grounds that it's monopolistic. No I thought not. You people are so funny.
sorosville
Er...the ACA has made absolutely no difference to the relative oligopolistic position of insurers. ACA has added about 11 million to insurers rolls when they were already covering around 200 million people. The roughly 35 health insurers were oligopolies before the ACA and they're still oligopolies. It's certainly given them a bit more volume which they like of course but hasn't changed the fundamentals one bit. Nor do I ever remember Republicans complaining about insurers being oligopolies. Or are you suggesting the Republican party now has plans to destroy the health insurance industry on the grounds that it's monopolistic. No I thought not. You people are so funny.
7
If you think starting and running a health insurance company is so easy, ask the co-ops founded under ACA. Only 1 is making money. the others are losing it hand over fist, even with capital provided by taxpayers. This isn't cheap. This isn't easy. If it were, we wouldn't be talking about it.
4
First Republicans attack Obamacare for the insurers offering policies that restrict the provider network within a single State, something that began at least a half century ago - Blue Shield did not pay doctors who were not part of the Blue Shield provider coop and Blue Cross did not pay hospitals that were not part of the Blue Cross provider coop.
The only thing Obamacare did is make it clear that switch insurers has a cost for individuals which was one reason workers stayed at a single employer for decades and joined with coworkers to demand their employers not change insurers.
But now they propose everyone being able to buy insurance from Idaho based on it being cheaper, when its cheaper because it has a provider network limited to the lowest priced doctors and hospitals in Idaho. So, to get your treatment for cancer as a NYC resident, you simply pay for the plane fare to the West coast and then on to Idaho to see doctors and hospitals in Idaho.
Do Republicans think they would not be attacked for a cost saving plan that takes away access to doctors and hospitals is worse ways than Obamacare?
The only thing Obamacare did is make it clear that switch insurers has a cost for individuals which was one reason workers stayed at a single employer for decades and joined with coworkers to demand their employers not change insurers.
But now they propose everyone being able to buy insurance from Idaho based on it being cheaper, when its cheaper because it has a provider network limited to the lowest priced doctors and hospitals in Idaho. So, to get your treatment for cancer as a NYC resident, you simply pay for the plane fare to the West coast and then on to Idaho to see doctors and hospitals in Idaho.
Do Republicans think they would not be attacked for a cost saving plan that takes away access to doctors and hospitals is worse ways than Obamacare?
2
Lets make it really simple: Effective immediately ALL people born since 1995 will be automatically enrolled in Medicare. Automatic National Insurance company. Thus giving the Medical Insurance companies incentive to open up in all fifty states
5
Larry Hoffman
Middle Village
Leaving aside the impracticality of destroying the health insurance industry, did you understand a word of Sanger-Katz's explanation of why insurers can't operate in all 50 states.
Middle Village
Leaving aside the impracticality of destroying the health insurance industry, did you understand a word of Sanger-Katz's explanation of why insurers can't operate in all 50 states.
Wrong. Medicare operates in all 50 states, doesn't it?
I like Larry's proposal, but making it "immediate" also makes it impossible for Congress to pass. I'd like the Medicare age first to be lowered to 62, the youngest age that people can get Social Security. That would encourage people to retire who want to retire early, but can't afford the health care (and it would open up jobs for younger people). Then, I'd lower it further to include people in their mid-50s. This group has more health problems and a hard time finding employment. Younger people could still get their insurance through the private market, but the Medicare age level could gradually be lowered after that until everyone was covered.
Doing it this way would wind down the "health insurance industry" slowly so the economy wouldn't be affected. (And it deserves to be "destroyed." It doesn't provide health care or provide the money for health care. It just stands in between the doctors and the patients, skimming off its cut from each transaction.
I like Larry's proposal, but making it "immediate" also makes it impossible for Congress to pass. I'd like the Medicare age first to be lowered to 62, the youngest age that people can get Social Security. That would encourage people to retire who want to retire early, but can't afford the health care (and it would open up jobs for younger people). Then, I'd lower it further to include people in their mid-50s. This group has more health problems and a hard time finding employment. Younger people could still get their insurance through the private market, but the Medicare age level could gradually be lowered after that until everyone was covered.
Doing it this way would wind down the "health insurance industry" slowly so the economy wouldn't be affected. (And it deserves to be "destroyed." It doesn't provide health care or provide the money for health care. It just stands in between the doctors and the patients, skimming off its cut from each transaction.
3
Frankly, I do not understand why networks of providers are necessary. Why not simply allow people to go to their chosen providers, and not require the insurance company to have a contract with them?
1
Insurance is, and always has been, a business. Health care is, and always has been, a necessity. Some people have always recognized that health care needs must be met for everyone, even those who can't pay - a quick example would be Doctors Without Borders. However, I don't believe I've ever heard of a group called "Health Insurance Without Borders" - perhaps because, contrary to what those with the power in the US seem to think, health insurance is not and should not have to be a necessity. Single payer...........
9
Disagreed with the concept that health care is a right to the point where the needs must be met for everyone, no matter their ability to pay.
1
One of the network issues that hasn't been noted is that historically, for reasonable plan design, local health access is a different animal that out-of-area emergency access.
The GOP-led discussion assumes that the only reason for health insurance is a trip to the ER, whereas the PPACA understands that long-term health maintenance and preventative care is what will drive down the cost curve in the long term. PPACA plans allow for out-of-network ER visits, but key to the preventative/maintenance component is having strong and cost-effective contracts with local providers.
Unless of course we want a single-payer system (which would be the logical alternative!) But even with that, because of state-based medical and hospital credentialing, there would still be a state-based network component to access.
The GOP-led discussion assumes that the only reason for health insurance is a trip to the ER, whereas the PPACA understands that long-term health maintenance and preventative care is what will drive down the cost curve in the long term. PPACA plans allow for out-of-network ER visits, but key to the preventative/maintenance component is having strong and cost-effective contracts with local providers.
Unless of course we want a single-payer system (which would be the logical alternative!) But even with that, because of state-based medical and hospital credentialing, there would still be a state-based network component to access.
2
Why are the contracts necessary between the provider and the insurance company in order for people to receive strong preventative care? The entire concept of network providers is artificial and needless structure we have built into our health care system over a system where people go to their providers, get the bill, and the people submit the claim to their insurers.
1
The solution to the problem is to get rid of networks. It makes absolutely 0 economic sense that a physician will charge one price to an in-network insured patient, a different price to a patient with a different insurance carrier, and charge 10x the amount charged to either insured patient to the patient who has no insurance and is instead paying cash. If anything, the cash patient should be the cheapest as a huge part of the cost of medicine is all of the administrative hassles involved with billing and collecting from insurers. Managed care networks are a scam by the organizers and health insurers, add no value to society, and serve no purpose other than driving up costs and enriching insurance administrators. We would all (well except for insurance executives) be much better off if physicians billed for their time hourly like the vast majority of professionals and didn't have to hide their various rates to play the insurance network games.
12
Agreed. It is discriminatory to charge different prices to different classes of patient, and we could remove significant cost from the process by moving claims handling away from the provider to the patient.
1
It is time for politicians to let this nonsense talking point go. It is well and truly debunked.
To wit:
1. Several states have already removed ALL legal barriers to "foreign" carriers from other states coming in. Georgia is a great example of this, a large and lucrative health insurance market. They removed all restrictions three years ago, not a single carrier has brought in a single product from another state. Not one.
2. MOST of the cost of health insurance is medical claims costs. By law, a health carrier MUST spend 85% of all money collected in premiums on healthcare for their largest customers. The 15% left over typically has 3-5% taxes in it, meaning real overhead is maybe 10%. How much of that are you really going to save in inefficiency gains just because your product came from another state? 1%? 2%? Not worth doing.
3. If starting products in a new state was so easy, all the Co-Op plans, with their non-profit models and Community-based board of directors would be flourishing. They are not, 3 down and more to go at this time.
It's nonsense. It's bogus, yet the Repubs stick to it like a long lost friend. Almost as offensive as when a politician loses an argument and insists his course of action is the "right thing to do". Then you know they are well and truly lost.
WR
To wit:
1. Several states have already removed ALL legal barriers to "foreign" carriers from other states coming in. Georgia is a great example of this, a large and lucrative health insurance market. They removed all restrictions three years ago, not a single carrier has brought in a single product from another state. Not one.
2. MOST of the cost of health insurance is medical claims costs. By law, a health carrier MUST spend 85% of all money collected in premiums on healthcare for their largest customers. The 15% left over typically has 3-5% taxes in it, meaning real overhead is maybe 10%. How much of that are you really going to save in inefficiency gains just because your product came from another state? 1%? 2%? Not worth doing.
3. If starting products in a new state was so easy, all the Co-Op plans, with their non-profit models and Community-based board of directors would be flourishing. They are not, 3 down and more to go at this time.
It's nonsense. It's bogus, yet the Repubs stick to it like a long lost friend. Almost as offensive as when a politician loses an argument and insists his course of action is the "right thing to do". Then you know they are well and truly lost.
WR
8
I live in Minnesota, which has pretty strict insurance regulations. I used to live in Oregon, where the regulations are looser, and when I first went free-lance, I checked into options for health insurance there.
Some of the plans I was offered were incredibly cheap. The trouble was that they excluded everything I had ever had (including broken bones, because I broke my arm at age 11) and allergies (I have allergies, but what if I developed anaphylactic shock in response to a new allergen?) and cancer (because of two *negative* biopsies).
I finally rejected all of them in favor of Kaiser-Permanente.
But all the private insurance companies are full of Catch-22s and new ways to provide less service for more money.
It was with great relief that I went on Medicare earlier this year.
Some of the plans I was offered were incredibly cheap. The trouble was that they excluded everything I had ever had (including broken bones, because I broke my arm at age 11) and allergies (I have allergies, but what if I developed anaphylactic shock in response to a new allergen?) and cancer (because of two *negative* biopsies).
I finally rejected all of them in favor of Kaiser-Permanente.
But all the private insurance companies are full of Catch-22s and new ways to provide less service for more money.
It was with great relief that I went on Medicare earlier this year.
7
Lol, there is no capitalism in the health insurance market due to the McCarron Ferguson act which exempts health insurance companies from all Federal Regulations including collusion. In addition, ERISA enables these same companies to ration access, preventive care, diagnostics, treatments and palliative care for profit without any risk. Cash gifts to all elected officials have ensured government subsidies for these insurance companies via Medicare Advantage, Medicaid and AHA plans enable these same companies to safely remain profitable by removing a minimum of 30% of each health care dollar for their executives, bureaucrats, bondholders, shareholders and patron politicians. What a scam..
Oh and enabling nationwide sales of plans will solve this crooked dilemma which kills millions of Americans yearly.
In my next life I want to return as a health insurance executive in America.
Oh and enabling nationwide sales of plans will solve this crooked dilemma which kills millions of Americans yearly.
In my next life I want to return as a health insurance executive in America.
12
More nonsense. McF does not allow for the creation of monopolies in any sense, not even close. It simply allows the Blue plans to operate separate subsidiaries that don't encroach on one another in separate states. It does not deter competition, and certainly has not slowed down United, Humana, Cigna, Aetna, Kaiser, etc from going into those same markets and competing.
In addition, Carriers are required BY LAW to keep overhead at 15% or less for their largest clients. If they violate that rule, they must issue rebates until the number is back to 15%.
Get your facts straight, it's not that hard.
WR
In addition, Carriers are required BY LAW to keep overhead at 15% or less for their largest clients. If they violate that rule, they must issue rebates until the number is back to 15%.
Get your facts straight, it's not that hard.
WR
1
The only products manufactured and produced by doctors with their patients are outcomes. Insurance companies ration access, diagnostics, treatments, preventive care and palliative care for profit. Insurance companies don't compete capitalistically based on the quality or price of their patients outcomes.
Interstate registration will not force these companies to compete capitalistically based on the quality or price of their products (outcomes). Wouldn't you like to know which insurance companies patients in age and disease matched controls live longer or have better rates of morbidity and mortality or are less sick? Wouldn't it be nice to know which insurance companies patients have better outcomes for a better price.
That is capitalistic competition and will bring prices down, and reveal that the insurance industry rations for profit.
Interstate registration will not force these companies to compete capitalistically based on the quality or price of their products (outcomes). Wouldn't you like to know which insurance companies patients in age and disease matched controls live longer or have better rates of morbidity and mortality or are less sick? Wouldn't it be nice to know which insurance companies patients have better outcomes for a better price.
That is capitalistic competition and will bring prices down, and reveal that the insurance industry rations for profit.
2
Below is a copy of a message sent to chris coons and tom carper of delaware earlier today.
I am writing in hopes that you will work to appeal the affordable care act as being unconstitutional in that it creates adverse and disparate impact on two protected classes, the disabled and those who reach retirement age. Both receive Medicare and either SSDI or SSA benefits as the source of income.
I pay $195 in premiums for Medicare from my SSDI benefits, resulting in a net deposit of $1943 monthly, so I am spending about 10% of my check in premiums. I am not eligibile for any premium or prescription assistance due to my high income even though part of my benefits are taxable. I am subject to the doughnut hole, which is not a feature of any marketplace plan.
In July my husband suffered two strokes and our out of pocket medical costs are about $1300 monthly. A large part of this is due to a $1450 copay for provigil, because of the doughnut hole. IN May the manufacturer reached a $1.2 billion dollar price fixing settlement with the FTC but all of that money went to big coompanies and there has been no impact on retail prices.
I am writing in hopes that you will work to appeal the affordable care act as being unconstitutional in that it creates adverse and disparate impact on two protected classes, the disabled and those who reach retirement age. Both receive Medicare and either SSDI or SSA benefits as the source of income.
I pay $195 in premiums for Medicare from my SSDI benefits, resulting in a net deposit of $1943 monthly, so I am spending about 10% of my check in premiums. I am not eligibile for any premium or prescription assistance due to my high income even though part of my benefits are taxable. I am subject to the doughnut hole, which is not a feature of any marketplace plan.
In July my husband suffered two strokes and our out of pocket medical costs are about $1300 monthly. A large part of this is due to a $1450 copay for provigil, because of the doughnut hole. IN May the manufacturer reached a $1.2 billion dollar price fixing settlement with the FTC but all of that money went to big coompanies and there has been no impact on retail prices.
1
Well... You should probably send a copy of that letter to GWB and ask him to repeal the Medical Prescription Act. That is what is actually causing your problem. Nothing you wrote seems to be related to the ACA at all.
5
The funny thing is that most Republicans identify themselves as Federalists, yet advocate a plan to essentially eliminate the state by state regulation that our Federalist system mandates.
I will gladly give the Republicans their national health care insurance as long as the regulation is Federal- not the lowest common denominator state they can find.
I will gladly give the Republicans their national health care insurance as long as the regulation is Federal- not the lowest common denominator state they can find.
3
It doesn't eliminate the federalist system in that states are still free to make their own mandates for insurance companies, but it protects the freedoms of the people to not be bound by the provisions of a given state.
1
"Allowing Insurance Companies to sell their products across state lines" is a straw-man argument - they already can, but choose not to sell their product in certain states because it wouldn't be as profitable, i.e. they would be required to cover things that they don't want to by certain states. Who could cover really big things like expensive tests and treatments, using the most sophisticated devices ? Answer: The Federal Gov't. So then, everyone, able-bodied or not, should automatically be considered a member of the armed forces so that they may receive universal healthcare. We don't seem to have a problem funding the military.
5
You clowns expect me to believe that in spite of the world's ability to provide complex insurances across international, cultural and ideological lines; we are unable to develop health insurance across state lines in America. In the words of the immortal Billy Phelan: "Where do these bed bugs come from?"
1
@bsc111
Olympia Wa
Only a clown would believe that an insurance product sold in Germany or the UK, by say AIG, doesn't have to conform to the local regulatory regime and market conditions, and vice versa. Do you think the Martin Act for example (which is a New York state law) doesn't apply to European financial institutions like BNP who hold licenses to operate in NYC.
Olympia Wa
Only a clown would believe that an insurance product sold in Germany or the UK, by say AIG, doesn't have to conform to the local regulatory regime and market conditions, and vice versa. Do you think the Martin Act for example (which is a New York state law) doesn't apply to European financial institutions like BNP who hold licenses to operate in NYC.
5
Imagine--GOP candidates agitating against something (artificial state line restrictions on healthcare) that do not even exist in the ACA.
Oh, my (gasp!)-it is like they haven't even read the law!!!!
Oh, my (gasp!)-it is like they haven't even read the law!!!!
3
We are certain Nancy Pelosi didn't ! LOL !
1
Thank you, NYT, for doing some actual political reporting and looking into whether a policy proposal has worked or not, instead of commenting on the candidate's hair.
4
Well, that's why a national healthcare, i.e. Medicare for all is the best for everyone.
5
Medicare operates THROUGH private insurers. It's private insurers that process the claims. It's not federal employees. That's why the overhead for Medicare looks so low - they cost shift the admin onto the private sector. Medicare for all is about access, not cost or administration.
Disagreed. That takes the problem and expands it to the opposite extreme.
1
Reading this, I don't see the harm in passing such legislation...only that insurance companies might not readily use or benefit from the change. Why not pass the legislation and see what happens? Opening up the markets might give folks in a state that doesn't offer chiropractic or infertility benefits access to them or those who don't want them access to a cheaper plan that excludes them. Choice and affordability are the goals, aren't they?
1
Just look up "self-insured" companies and you'll see that only 30% of companies fall into that category.
The writer inadvertantly makes the argument for insurance competition by ably describing the cronyism between the big insurers and state legislatures. Thank you!
The writer inadvertantly makes the argument for insurance competition by ably describing the cronyism between the big insurers and state legislatures. Thank you!
@Earl
Chappaqua, NY
Self insured is a bit of a misnomer because even when corporations self insure (I ran one such) the program is often run for them by a major insurer. And there's no shortage of cronyism (a somewhat all embracing but vague pejorative much beloved by the naive) between big health networks and state legislatures. In fact much of the world functions on the basis of what you'd call cronyism.
Chappaqua, NY
Self insured is a bit of a misnomer because even when corporations self insure (I ran one such) the program is often run for them by a major insurer. And there's no shortage of cronyism (a somewhat all embracing but vague pejorative much beloved by the naive) between big health networks and state legislatures. In fact much of the world functions on the basis of what you'd call cronyism.
1
This should be an easy call for the G.O.P. candidates.
It's called "States' Rights"
If a State has laws about the offering of insurance, why should the Federal Government invalidate them? Do principles stand for nothing in this new G.O.P. ??
It's called "States' Rights"
If a State has laws about the offering of insurance, why should the Federal Government invalidate them? Do principles stand for nothing in this new G.O.P. ??
1
The federal law does not invalidate the state laws about the offering of insurance. However, it eliminates the state's power to bind individuals to those preferences.
1
Health care discounts are not ethical. They are used to keep the sticker price high for the uninsured and creates the illusion that an insurance company is doing something good. The health insurers are evil to the extent they harm the uninsured. Health care discounts should be prohibited and prices should be posted so people can shop around. It is a far better way of using market competition to control health care costs.
7
@Eugene Patrick Devany
Massapequa Park,
They're no more unethical than auto or hotel discounts.
Massapequa Park,
They're no more unethical than auto or hotel discounts.
John, I think even you know the difference between inflating the cost of vital health care (dangerous policy) and pricing consumer items according to business whim. We don't allow the sale of blood or organs or baby parts for good reasons - all of which fall under the heading of public ethics. Stop playing devil's advocate.
1
@Eugene Patrick Devany
Massapequa Park, NY
Pricing consumer items according to business whim? You clearly don't begin to understand anything about economics or business. Building discounts into a pricing structure is routine business practice whether it's providing autos, airflights, spectacles, plastic surgery, new teeth, colonoscopies or new babies . The provision of healthcare in this country is a for profit business (a huge one) like any other but you seem to be the only person in the country who is unaware of it.
Massapequa Park, NY
Pricing consumer items according to business whim? You clearly don't begin to understand anything about economics or business. Building discounts into a pricing structure is routine business practice whether it's providing autos, airflights, spectacles, plastic surgery, new teeth, colonoscopies or new babies . The provision of healthcare in this country is a for profit business (a huge one) like any other but you seem to be the only person in the country who is unaware of it.
This article, and its ensuing discussion, are at heart another searing indictment of this hotch potch of 50 fiefdoms we are stuck with in the 21st Century. Imagine for a moment, if you can, a single-payer national system with uniform national regulations. Boggles the mind, doesn't it? Other countries with saner governmental arrangements do this. But this governmental kluge the "Founding Fathers" stuck us with will never permit it. This country is indeed a camel, defined as "a horse designed by a committee".
6
Such a concept to force everybody onto a single model of insurance, rather than the current force of a person onto the model in one's respective state is to take the problem and move it to the opposite extreme than allowing individuals the ability to pick the policy one wants, even if it sold in another state.
The article touches on the real reason selling across state lines has appeal, but then buries it with other possibly correct, but confusing info.
Avoiding state mandated benefits is the driving force. Insurers would still be financially regulated and licensed by the state in which they sell, they would have to have networks in the state in which they sell and they would need some level of customer service in the state in which they sell. What is avoided is the string of mandated benefits like chiro, in vitro and hair transplants that special interests can lobby into state law.
That is the sole source of "savings." Of course ACA with its own set of mandates and pricing restrictions dilutes any such reform. Even if one state repealed all its mandates and that plan design could be sold USA wide the lowered cost would be impacted by the ACA mandates. Probably not much to be gained in the end.
Avoiding state mandated benefits is the driving force. Insurers would still be financially regulated and licensed by the state in which they sell, they would have to have networks in the state in which they sell and they would need some level of customer service in the state in which they sell. What is avoided is the string of mandated benefits like chiro, in vitro and hair transplants that special interests can lobby into state law.
That is the sole source of "savings." Of course ACA with its own set of mandates and pricing restrictions dilutes any such reform. Even if one state repealed all its mandates and that plan design could be sold USA wide the lowered cost would be impacted by the ACA mandates. Probably not much to be gained in the end.
1
@Underwriterguy
Scottsdale, AZ
As with most things in life (and in nothing is this more true than healthcare) the devil is in what you call the "Confusing" details. The article explains in some depth why the alleged benefits of selling insurance across state lines are largely illusory like so much else with the Republican's so called solutions to expanding the availability of healthcare. And if you think states are just going to give up control of the quality of products sold in their states without a huge fight you are truly naïve. I thought states rights were a central Republican belief btw. The real problem for you of course is that the confusing details (which are indeed correct and fairly well known to anyone with knowledge of how the healthcare industry functions) blow a large hole in your belief system.
Scottsdale, AZ
As with most things in life (and in nothing is this more true than healthcare) the devil is in what you call the "Confusing" details. The article explains in some depth why the alleged benefits of selling insurance across state lines are largely illusory like so much else with the Republican's so called solutions to expanding the availability of healthcare. And if you think states are just going to give up control of the quality of products sold in their states without a huge fight you are truly naïve. I thought states rights were a central Republican belief btw. The real problem for you of course is that the confusing details (which are indeed correct and fairly well known to anyone with knowledge of how the healthcare industry functions) blow a large hole in your belief system.
5
Hartford, huh? Work in the industry, do you? Aside from the political comments you seem to agree with me that there is not much to be gained by selling across state lines. My handle gives a hint at what I did for a living.
1
@Underwriterguy
Actually I don't live in Hartford but never mind. However, I've signed off on the purchase of a lot of health insurance in my time and have listened to a lot of presentations from insurance execs some of whom may have come from Hartford. Au fond, as is widely acknowledged and well explained by this piece which wasn't in the least confusing, the obstacles to selling insurance across state lines are not principally regulatory (although they are not to be totally dismissed either...the mores of CT are somewhat different than MS ) but to do with the financial and administrative relationships between insurers and providers. In short the benefits of selling across state lines are, as you say, just another one of those Republicans myths like the tort reform. And I'd add you can't disregard politics. This is all about political ideology in the case of the Republicans and has nothing to with the reality of how the system functions which is a bit Rube Goldberg but that's what pathway dependency does for you.
Actually I don't live in Hartford but never mind. However, I've signed off on the purchase of a lot of health insurance in my time and have listened to a lot of presentations from insurance execs some of whom may have come from Hartford. Au fond, as is widely acknowledged and well explained by this piece which wasn't in the least confusing, the obstacles to selling insurance across state lines are not principally regulatory (although they are not to be totally dismissed either...the mores of CT are somewhat different than MS ) but to do with the financial and administrative relationships between insurers and providers. In short the benefits of selling across state lines are, as you say, just another one of those Republicans myths like the tort reform. And I'd add you can't disregard politics. This is all about political ideology in the case of the Republicans and has nothing to with the reality of how the system functions which is a bit Rube Goldberg but that's what pathway dependency does for you.
1
The article misses so many points. First, it is a nightmare for an individual who is relocating from one state to another to have to change all insurance policies (including health care, auto, liability, homeowners, multiple small business policies). As a small business owner, I had to change 14 insurance policies when I moved from California to New York. It is a real barrier to following business or personal opportunities across state lines. Second, individual health care policies do not even cover you out of your home state. If I live in NJ and work in NYC I can't see a doctor during my lunch hour because I have to have a doctor in NJ. I have to take time off to schedule an appointment in the NJ. Why does health care insurance have to be up there at the top of my considerations of whether to move or work in a particular state?
2
Ummm, no. This article isn't saying that there wouldn't be advantages to national or regional health care plans. It's saying that there are many non-regulatory, market barriers to setting up such plans, and that moves that have been made to facilitate regional plans haven't actually seen takers.
3
@ mary
Well during my business career in the US (I also spent some time overseas if you want to talk about nightmares) I've moved five times in this country. Your description of nightmares in the US is ludicrous, it's just part of life's administrative routine, and you also exaggerate the number of insurance carriers you have to change. In fact exaggeration of your personal hardships seems to something of a feature of your approach to life. Since when was health insurance the main determinant of moving to another state? Instead of focusing on personal sufferings why don't you address the point being made here which is that there are considerable barriers other than regulation to selling health insurance across state lines the benefits of which are therefore, largely illusory despite what Republican politicians may tell you.
Well during my business career in the US (I also spent some time overseas if you want to talk about nightmares) I've moved five times in this country. Your description of nightmares in the US is ludicrous, it's just part of life's administrative routine, and you also exaggerate the number of insurance carriers you have to change. In fact exaggeration of your personal hardships seems to something of a feature of your approach to life. Since when was health insurance the main determinant of moving to another state? Instead of focusing on personal sufferings why don't you address the point being made here which is that there are considerable barriers other than regulation to selling health insurance across state lines the benefits of which are therefore, largely illusory despite what Republican politicians may tell you.
3
"If I live in NJ and work in NYC I can't see a doctor during my lunch hour because I have to have a doctor in NJ."
That may be your insurer's policy but it's not universal. In the Washington metro area (D.C., Va, Md) many (most?) plans include doctors that are nearby but across the boundary.
That may be your insurer's policy but it's not universal. In the Washington metro area (D.C., Va, Md) many (most?) plans include doctors that are nearby but across the boundary.
With so many heath care companies mergers occurring, it would appear that network problems operating across state lines would be reduced.
Why do I suspect that the reason Merrill Matthews is having so much trouble explaining the flaws in interstate health insurance to his fellow Republicans is that *they don't really care whether it would work?*
On reflection, maybe it DOES work. Maybe it's already doing precisely what it's supposed to do: allowing those Republicans to claim they have a plan.
On reflection, maybe it DOES work. Maybe it's already doing precisely what it's supposed to do: allowing those Republicans to claim they have a plan.
19
So Obamacare passed because "we have to do something; the status quo doesn't work."
But don't sell across state lines. That's just crazy talk.
But don't sell across state lines. That's just crazy talk.
1
National health insurance for all with just one network in the nation is what we need.
10
Trump for Pres 2016
President Obama and legislators mistakenly would not permit "government's unfair low cost advantages" to be used to compete against private insurers and providers when the 2000 page Obamacare legislation was passed
Using the VA's high quality low cost advantages to provide all government funded care will make it possible for everyone in the US who needs or just plain would rather have free healthcare to have it no insurance to purchase, no copay's, no restrictions for preexisting conditions or any other reasons just ask at any free government hospital and everything will be provided for free period.
Repealing and Replacing ObamaCare will slash a $trillion annually from the $3.8trillion that was spent by patients, businesses, local, states, the federal government's and taxpayers last year.
All healthcare costs and involvements will be eliminated for businesses, local and all states government's.
Sales taxes collected from 50 million tourists and everyone shopping in the US could pay for for the free healthcare option without the crippling overhead costs we are forced to pay today for insurance, medications, healthcare and copays.
$500 billion of Treasury and Federal Reserve funding, like that used to bail out the banks and Wall Street, could be used to purchase about 30% of the existing public and private healthcare facilities in the US from willing sellers to quickly form the new free government single payor healthcare option for patients to use nationwide in 2016.
Using the VA's high quality low cost advantages to provide all government funded care will make it possible for everyone in the US who needs or just plain would rather have free healthcare to have it no insurance to purchase, no copay's, no restrictions for preexisting conditions or any other reasons just ask at any free government hospital and everything will be provided for free period.
Repealing and Replacing ObamaCare will slash a $trillion annually from the $3.8trillion that was spent by patients, businesses, local, states, the federal government's and taxpayers last year.
All healthcare costs and involvements will be eliminated for businesses, local and all states government's.
Sales taxes collected from 50 million tourists and everyone shopping in the US could pay for for the free healthcare option without the crippling overhead costs we are forced to pay today for insurance, medications, healthcare and copays.
$500 billion of Treasury and Federal Reserve funding, like that used to bail out the banks and Wall Street, could be used to purchase about 30% of the existing public and private healthcare facilities in the US from willing sellers to quickly form the new free government single payor healthcare option for patients to use nationwide in 2016.
3
So you're going to repeal and replace Obamacare with a single payer plan? In what universe?
2
The VA? Really? That's your model of the "future" of healthcare?
No thanks. I'll stick with my messy, fractured expensive Blue Cross where I actually get to see docs this century and get my prescriptions filled with no waiting.
WR
No thanks. I'll stick with my messy, fractured expensive Blue Cross where I actually get to see docs this century and get my prescriptions filled with no waiting.
WR
No. No. No. A more competitive marketplace is not what is needed by an ever expansive, ever more intrusive government. What is needed are higher premiums so the demand for single payer replacement of private insurance companies reaches a major crescendo. Once the government takes over the entire health care industry then everyone can have free medical care, and health care providers can also be free to bill the Government whatever they determine to be fair prices for their goods and services.
See, the future looks bright.
See, the future looks bright.
Insurance is just as it says, and if all other insurance can sell across state lines why not health insurance? for instance my car insurance company is based out of Texas but I live in Kentucky and that is the same with my home insurance. if I decide I don't like my insurance coverage with the one in Texas I can change it to one in any state I choose my coverage is the same. it is insurance.
That's, right and United Healthcare is based out of Minnesota, and Aetna Connecticut. Anthem Indianapolis. They do write across state lines, but each state has different laws.
2
It is not necessary for insurance companies to "establish favorable contracts with doctors and hosopitals," any more than it is necessary for car insurers to establish contracts with body shops. The insurance companies can publish how much they will pay for a given service, and the consumer can then decide what premium is justified by the coverage. In other words, transparency, something which does not currently exist.
3
I wish the trope that the private Medicare Advantage plans are "wildly popular" would be killed and buried. The advantage is almost entirely the insurers'. Medicare Advantage programs have many higher out of pocket expenses, and that if patients have many appointments, their copays quickly add up to many more $$$ than traditional Medicare reimbursement. The only scenario in which the advantage plans come out less expensive are for those with no known health problems who use benefits only for preventive screening.
As to this latest GOP "idea", it wouldn't receive a passing grade in a sixth grade health class. Willful ignorance while refusing to represent the electorate is criminal.
As to this latest GOP "idea", it wouldn't receive a passing grade in a sixth grade health class. Willful ignorance while refusing to represent the electorate is criminal.
18
Thank you, ask. I had a Medicare Advantage plan that I found was cheaping out on their alleged obligations and sticking me with the difference, which was quite substantial. The company, UHC, is now out of life, as are every other "Advantage" that contacts me beginning in September of each year.
3
aek...I have a sister who's a home health nurse, and she says her company recommends that patients use Traditional" Medicare instead of Medicare Advantage (handled fully by the insurance co.) because Advantage denies too often what the doctors recommend their patients require/need...
3
I find it Ironic that the people who scream states rights, want to strip the rights of states here. Years ago most Insurance laws only applied to Group insurance contracts issued in that state. Carriers avoided this by issuing contracts in other states, states with few or limited laws, To compensate for that so that there would be uniformity in the state, so doctors and patients wouldn't have to guess if a procedure is covered. The legislature changed the way they wrote laws, to cover people who were insured in a state.
Most of the pricing quoted on mandates is out of date and misapplied, many cost pennies but are categorized as less than 1%. Critics of these mandates often count them as 1% when claiming how much they add to the price.
Writing across states lines doesn't save money it redistributes it against the people who need it the most.
Most of the pricing quoted on mandates is out of date and misapplied, many cost pennies but are categorized as less than 1%. Critics of these mandates often count them as 1% when claiming how much they add to the price.
Writing across states lines doesn't save money it redistributes it against the people who need it the most.
14
Let's promote an across-state-lines plan; but also combine it with a public option -- ie Medicare for all.
Phase 1: ACA
Phase 2: public option
Phase 3: ????
Phase 4: (societal) Profits!!!
Phase 1: ACA
Phase 2: public option
Phase 3: ????
Phase 4: (societal) Profits!!!
4
This article inadvertantly illustrates the problem with Obamacare. The left has continually equated healthcare with insurance. Insurance is a piece of paper that allows Democrat friends in the insurance company to rob billions of dollars of healthcare money. Health care is not an insurance policy but is the actual treatment of patients. Democrats continue to play this shell game to the detriment of the nation.
1
No health insurance, no treatment you can afford. How is that a shell game?
4
You're right that healthcare has mistakenly been equated with insurance for nearly the entire 20th and 21st centuries, but it's not like that is entirely Democrats' fault. The Republicans buy into this too. Everyone has. That's why we have the healthcare mess we have.
3
The Heliocentric Theory of Health Care Reform
Before Copernicus and Kepler, people generally believed the sun and the planets revolved around the earth, but as we got more data it became increasing hard to reconcile this basic idea with the observed facts. People thought up the Ptolemaic system in which the heavenly bodies didn't just revolve around the earth, but they revolved in small circles called epicycles as they went around the earth. That eventually turned out not to be sufficient, so they hypothesized epicycles within the epicycles. The last iteration of the Ptolemaic system was an incredible complicated mess that was almost beautiful in it's complexity.
That's what we are doing today with health care reform. We wanted a "uniquely American solution." We wanted to keep the private insurance industry. We wanted the sun to go around the earth.
So we talk about mandates, exchanges, reference pricing, death spirals, etc. The problem of adverse selection is an example. We need some more epicycles. We wound up with a bill with thousands of pages whose result is unknown. HR676 (improved Medicare for All) had 70 pages.
If Kepler were alive, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."
Before Copernicus and Kepler, people generally believed the sun and the planets revolved around the earth, but as we got more data it became increasing hard to reconcile this basic idea with the observed facts. People thought up the Ptolemaic system in which the heavenly bodies didn't just revolve around the earth, but they revolved in small circles called epicycles as they went around the earth. That eventually turned out not to be sufficient, so they hypothesized epicycles within the epicycles. The last iteration of the Ptolemaic system was an incredible complicated mess that was almost beautiful in it's complexity.
That's what we are doing today with health care reform. We wanted a "uniquely American solution." We wanted to keep the private insurance industry. We wanted the sun to go around the earth.
So we talk about mandates, exchanges, reference pricing, death spirals, etc. The problem of adverse selection is an example. We need some more epicycles. We wound up with a bill with thousands of pages whose result is unknown. HR676 (improved Medicare for All) had 70 pages.
If Kepler were alive, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."
76
Probably Right, but for 'American Exception" Also all those lost Campaign Contributions for Politicians--esp. Republicans.
1
When insurers lower reimbursements in a network, they attract more of the least experienced medical service providers. When insurers seek out fewer regulations, the consumer suffers. Were Congress simply to say that an insurer must provide uniform reimbursement for the same services within a metropolitan or other large geographic area, this network idea that limits patient choice would evaporate. Either through competition or collusion, the insurers would offer the same rates and the artificial barrier to access to physicians that networking caused would disappear.
3
"His campaign wouldn’t confirm the company’s insurance arrangement, but nearly every large American company is what’s called self-insured. That means it is not subject to state insurance regulation." Unless I'm misinterpreting what the author said here, i don't think this is the case. Every large company I ever worked for offered health insurance through various HMO and or Blue Cross type plans. While these might be subsidized by the company, this isn't a "self insurance" plan. I'm guessing that self-insured corporate health plans are much less common than the author intimates.
I've been insured by an employer-provided Blue Cross plan, and it was nonetheless 'self-insurance.' That is because the employer contracts with Blue Cross (or the like) to *administer* the plan, while the costs of the medical care thus provided are covered by the company, not the insurance company. The plan does not need to comply with many state regulations, because then it is part of 'company benefits' rather than genuine insurance. This is very, very common. Also rather inconvenient, when the insurance company does something the employee doesn't like and which is not consistent with state regulation: call the state insurance commissioner's office and they will tell you they can do nothing. Been there, done that.
33
You are wrong.
Very large companies merely hire insurers to administer their plans.
They are self-insured because with a large workforce they have a sufficient pool of enrollees to do it.
Very large companies merely hire insurers to administer their plans.
They are self-insured because with a large workforce they have a sufficient pool of enrollees to do it.
12
Company self insurance plans are the norm. They are all managed by health companies with names you recognize. At my employer we are self insured with plans managed by CIGNA and Kaiser.
A previous employer, much bigger, was also self insured. They were managed by Blue Cross Blue Shield. You would not likely know how you plan is funded unless you work in HR or are a union rep.
A large company may be able to budget a smaller amount, say 5% of revenues towards health care this way vs. paying say 10% for a straight health care plan.
This is why when Apple CEO Tim Cook commented that two employees with huge medical expenses cost the company so much money. They are paying directly and did expect that large of an expense that year.
A previous employer, much bigger, was also self insured. They were managed by Blue Cross Blue Shield. You would not likely know how you plan is funded unless you work in HR or are a union rep.
A large company may be able to budget a smaller amount, say 5% of revenues towards health care this way vs. paying say 10% for a straight health care plan.
This is why when Apple CEO Tim Cook commented that two employees with huge medical expenses cost the company so much money. They are paying directly and did expect that large of an expense that year.
Why not remove the state regulations and see what happens? If the issue really is building networks, we won't likely see much change, but there's no harm. And who knows? Maybe the network problem is easy to overcome.
What about State's Rights? The Republicans will then call this another usurpation of State's Rights by the Federal Government.
4
You can be sure that if Republicans are in support of the idea it is because they think insurers can make more profit from it. Then they attempt to sell the idea to the gullible public with a misleading rationale. That is their standard modus operandi: hoodwink the rubes.
33
So Trump continues his campaign of talking out of his mouth and a lot of hot air hits the airwaves? What else is new? He was like this well before he starting running for President. Why do you think he does not speak in public in his home city? Because everyone here knows he is full of it. So he goes to Podunk and spouts his inanities and Red State fools love it.
5
Why not ONE national market / risk pool with 315 million people, a.k.a. single payer? Get rid of the complexity we have today: the federally regulated ERISA plans; Taft-Hartley Plans; state regulated small group; Obamacare individual plans; the 50 or more flavors of Medicaid; Medicare (Parts A through D); Medicare Advantage; Medi-gap; Tri-Care; VA.
I'm a conservative, but also a practical person who likes efficiency and simplicity. The current Byzantine system is complicated and wasteful, adding hundreds billions in costs to our healthcare.
I'm a conservative, but also a practical person who likes efficiency and simplicity. The current Byzantine system is complicated and wasteful, adding hundreds billions in costs to our healthcare.
74
It is a few years ago since my dad sold health insurance policies. The current proposals for 'cross state' purchases were being suggested then - in the late 60's and early 70's. His response was always, if the policy is cheaper in another state, you need to read the benefits, 'You get what you pay for'. Because regulations are different from state to state, you can't be sure you will get the same benefits as the policy you may already have within your own state. It is an old trick of politicians who have not studied the insurance business or how companies in different states develop their coverage. It is a 'Buyer Beware' situation and don't trust the politician.
35
Insurance rates are lower in Colorado at least in part because Colorado has the lowest rate of obesity in the nation. In Utah, a state made up largely of religious Mormons, religious Mormons do not smoke cigarettes.
Much of health care costs is a result of tobacco use, obesity and lack of exercise, and alcohol and drug abuse.
By implementing the WHOs MPOWER anti-tobacco program as NY State and City have done helps to reduce tobacco use. Raising the cost of tobacco through taxes creates over half the effect of getting people to quit smoking and helps to ensures teens never start. Raising taxes on sugar-added beverages such as Coke is what CDC and other public health experts recommend for reducing obesity.
What the Republican *should* legislate is to reduce deductibles to a maximum of $1000 while ensuring that rate increases are held to no more than 5%. What point is there to having laws that state people must be insured when premium rates or deductibles are outrageously high?
Much of health care costs is a result of tobacco use, obesity and lack of exercise, and alcohol and drug abuse.
By implementing the WHOs MPOWER anti-tobacco program as NY State and City have done helps to reduce tobacco use. Raising the cost of tobacco through taxes creates over half the effect of getting people to quit smoking and helps to ensures teens never start. Raising taxes on sugar-added beverages such as Coke is what CDC and other public health experts recommend for reducing obesity.
What the Republican *should* legislate is to reduce deductibles to a maximum of $1000 while ensuring that rate increases are held to no more than 5%. What point is there to having laws that state people must be insured when premium rates or deductibles are outrageously high?
7
Kudos! An article talking about facts and issues. How refreshing and too infrequent!
Insurers shopping for the state with the most lax regulations and/or least effective enforcement is a real problem. Of course, this could be mitigated by good federal regs and enforcement, but that would be anathema to Republicans.
Insurers shopping for the state with the most lax regulations and/or least effective enforcement is a real problem. Of course, this could be mitigated by good federal regs and enforcement, but that would be anathema to Republicans.
25
The insurance companies love the state-supplied red tape that provides them plausible deniability regarding market entry and helps them segment the national market into neat little profit centers for their business. I have paid for my own family health insurance for decades. I see no evidence of the big companies competing head to head in my market. I see a major insurance firm, a Blue, and maybe a much smaller company.
If the market were truely national I think that large companies like Amazon, Google, et Al, could figure out the provider network pieces without much trouble. The current big boys like United, Aetna, Cigna would have to adapt if they wanted to stay in business. As it turns out, United and Aetna are acquiring their competitors so they can secure a larger part of the government healthcare business. Is that going to help the competetive landscape?
I have paid for my own family coverage for decades. Prices rose slowly in the past and have ballooned thanks to the ACA. So much for affordability. Until we allow companies to compete nationally, health insurance will become increasingly expensive
If the market were truely national I think that large companies like Amazon, Google, et Al, could figure out the provider network pieces without much trouble. The current big boys like United, Aetna, Cigna would have to adapt if they wanted to stay in business. As it turns out, United and Aetna are acquiring their competitors so they can secure a larger part of the government healthcare business. Is that going to help the competetive landscape?
I have paid for my own family coverage for decades. Prices rose slowly in the past and have ballooned thanks to the ACA. So much for affordability. Until we allow companies to compete nationally, health insurance will become increasingly expensive
1
And that explains why interest rates on credit cards are so low. They can compete nationally.
1
J, your statement that "Prices rose slowly in the past and have ballooned thanks to the ACA" are not supported by any research/facts---prices rose tremendously before & have slowed down since the ACA...however, as to whether it's because of the ACA or the downturn in the economy has not been fleshed out.
3
The idea that selling policies across state lines would somehow make a dent in the population of uninsured is the worst Republican fantasy since Supply Side. Prof Krugman pointed out that the real problem is the market does not provide incentives to provide better service at a better price, the situation in which competition can improve service but competition between Insurance companies as to who can get healthy people to pay premiums and avoid having sick customers who need pay outs. The answer is to abolish for profit health insurance. A better case can be made for outsourcing the defense or policing of our nation than for pour system of foisting health care for the population off on the private, for profit sector. Allowing states to sell barely existent policies for cheap will not help. Especially when the discount insurer will reneg on their policies the minute they are asked to pay.
24
Another issue that would be resolved by single payer. Even people on Medicare are not immune from this idiocy, at least those of us who buy Medigap policies. Private companies have no business delivering public goods.
45
One question I have about going national with health insurance is what happens when insurance companies merge (as would have to occur) and we're down to three or four gigantic insurance companies that control health insurance across the entire nation? Can you imagine the equivalent of corporate cable giants Verizon, Comcast, Time Warner, and RCN as our only choices for health insurance? Give me taxpayer funded universal healthcare any day. The sooner the better. I am thankful that I am close to the age where I will be eligible for Medicare and not in my twenties having to deal with what is to come if Republicans take the White House and Congress in 2016.
44
Moreover, there would be buyouts.
I wonder if my health insurance contract might be picked up just as my home mortgage is picked up, by a different provider, and I have no choice in the matter, unless I move to a different network.
I wonder if my health insurance contract might be picked up just as my home mortgage is picked up, by a different provider, and I have no choice in the matter, unless I move to a different network.
7
I would be more afraid if we were at the mercy of 3 or 4 giant Hospital systems, who could then charge whatever they wanted for care. At least when I buy an insurance policy, that company has incentives to pay docs and hospitals less, not more.
And since their overhead is now federally limited to 15% on their largest customers, they are at the same "true" overhead that Medicare has, according to the GAO, where they note the "official" overhead is 4.5%, and the "unofficial" overhead (lost to fraud, waste, and abuse) brings the number to about 13%.
WR
And since their overhead is now federally limited to 15% on their largest customers, they are at the same "true" overhead that Medicare has, according to the GAO, where they note the "official" overhead is 4.5%, and the "unofficial" overhead (lost to fraud, waste, and abuse) brings the number to about 13%.
WR
The near-idiocy of this debate -- as I see it -- is that we
don't really need insurance companies to get very good health
care. The insurers run on very high administrative and sales-
commission costs, and provide nothing resembling the sort
of market we're accustomed to in, say, consumer auto insurance.
Health insurers never really compete on price -- not if you read
the fine print -- and they are merging like rabbits as their profit
margins keep getting fatter -- another cost on the consumer's back.
No health insurer has a superior underwriting discipline, unlike
the case in many other lines of insurance. The consumer sees monopoly pricing and monopoly profits that are pure transfers from users of health
care to the drug companies and health insurers.
When Obama left writing the legislation to Congress, he effectively
handed lobbyists for health insurers and drug companies a form
of carte blanche to write the perfect bill for themselves.
The simple, rational solution is to expand Medicare to include
everyone, period. No phony debates or arguments about how the
insurance process should run. And just listen to the monopolists squeal.
Just look at your billing. Look at your price -- including the price
implied in the deductible. Look at the plan you had 2-3-4 years ago.
50% price increases, or else plans nowhere available any more,
are now the norm.
Debating how to make our health insurance process improve is Lewis Caroll-
worthy. Let's kill this bandersnatch.
don't really need insurance companies to get very good health
care. The insurers run on very high administrative and sales-
commission costs, and provide nothing resembling the sort
of market we're accustomed to in, say, consumer auto insurance.
Health insurers never really compete on price -- not if you read
the fine print -- and they are merging like rabbits as their profit
margins keep getting fatter -- another cost on the consumer's back.
No health insurer has a superior underwriting discipline, unlike
the case in many other lines of insurance. The consumer sees monopoly pricing and monopoly profits that are pure transfers from users of health
care to the drug companies and health insurers.
When Obama left writing the legislation to Congress, he effectively
handed lobbyists for health insurers and drug companies a form
of carte blanche to write the perfect bill for themselves.
The simple, rational solution is to expand Medicare to include
everyone, period. No phony debates or arguments about how the
insurance process should run. And just listen to the monopolists squeal.
Just look at your billing. Look at your price -- including the price
implied in the deductible. Look at the plan you had 2-3-4 years ago.
50% price increases, or else plans nowhere available any more,
are now the norm.
Debating how to make our health insurance process improve is Lewis Caroll-
worthy. Let's kill this bandersnatch.
40
My family lives in New York State where insurance regulators do their jobs, while I live in poorly regulated Louisiana.
I would not welcome my family members getting their health insurance under Louisiana's poorly regulated insurance industry.
A year ago, for example, there was a bizarre and unnecessary decision by Louisiana health insurers to refuse federal assistance for insurance for AIDS patients. Louisiana's health commissioner Jim Donelon did nothing.
I would not welcome my family members getting their health insurance under Louisiana's poorly regulated insurance industry.
A year ago, for example, there was a bizarre and unnecessary decision by Louisiana health insurers to refuse federal assistance for insurance for AIDS patients. Louisiana's health commissioner Jim Donelon did nothing.
43
I lived in Louisiana years ago. A few of the insurance commissioners then ended up in prison. For some reason that position just attracted corrupt politicians.
17
Why do politicians have to create more problems than we need. Lets just tax everyone for healthcare and allow every citizen to access it. Yes some might call it socialism (God forbid), but I call it practical and a no-brainer. Will politicians ever come around? Probably not as long as the medical industry continues to buy them off.
Why do politicians have to create more problems than we need. Lets just tax everyone for healthcare and allow every citizen to access it. Yes some might call it socialism (God forbid), but I call it practical and a no-brainer. Will politicians ever come around? Probably not as long as the medical industry continues to buy them off.
87
Been tried already. See "Vermont 2015".
People said "don't tax me". Businesses said "Don't tax me!".
So far, the general public does not buy it.
WR
People said "don't tax me". Businesses said "Don't tax me!".
So far, the general public does not buy it.
WR
This is an important point about a Republican proposal that I have not seen anywhere else. the article reports that it is not really profitable for health insurers to set up separate policies in multiple states, and even if one could buy policies from another state, provider networks would be narrow. It seems to me this type of policy proposal is typical of Republicans, they propose "solutions" that are not real, when the surface is scratched.
1
This is an important point about a Republican proposal that I have not seen anywhere else. the article reports that it is not really profitable for health insurers to set up separate policies in multiple states, and even if one could buy policies from another state, provider networks would be narrow. It seems to me this type of policy proposal is typical of Republicans, they propose "solutions" that are not real, when the surface is scratched.
63
just as long as they sound plausible to uneducated ears
14
Forget the insurance for just one minute.
Hospitals are charging up to $100 for a single Tylenol.An X-Ray is now up to $1500.Do any of you see a problem?
Hospitals are charging up to $100 for a single Tylenol.An X-Ray is now up to $1500.Do any of you see a problem?
1
Yes. Too many people repeat the same old talking points without really knowing what they're talking about.
Forget the insurance for just one minute.
Hospitals are charging up to $100 for a single Tylenol.An X-Ray is now up to $1500.Do any of you see a problem?
Hospitals are charging up to $100 for a single Tylenol.An X-Ray is now up to $1500.Do any of you see a problem?
16
Yes. Too many people repeat the same old talking points without really knowing what they're talking about.
11
Is this what is billed or what you pay?
You can't forget insurance.
You can't forget insurance.
4
Yes the problem is Obama-care.
There are only so many of us here who pay for anything. We are the middle class and upper middle class (not the 1%) but the 15% of the nation who are taxed left right and center from the feds, states, local communities....and now from insurers and cable operators and cell phone providers. We are being asked to underwrite and fund all the people who pay nothing.
Recently our primary care physician relayed that she is seeing patients who are requiring tests and referrals after decades of ignoring their health and abusing their bodies. Thanks to Obama care there is no test or procedure they will not get courtesy of you and I. And that was our doctor's take on it...
There are only so many of us here who pay for anything. We are the middle class and upper middle class (not the 1%) but the 15% of the nation who are taxed left right and center from the feds, states, local communities....and now from insurers and cable operators and cell phone providers. We are being asked to underwrite and fund all the people who pay nothing.
Recently our primary care physician relayed that she is seeing patients who are requiring tests and referrals after decades of ignoring their health and abusing their bodies. Thanks to Obama care there is no test or procedure they will not get courtesy of you and I. And that was our doctor's take on it...
1
The ultimate in state's rights. Let one state control another state's rights.
The ultimate in state's rights. Let one state control another state's rights.
7