the basic assumption is the competition is always good. in the case of health care, insurance companies provide overhead and act as gatekeepers. this can be valuable in preventing unnecessary use, but it is not clear whether this function degrades when only one company does it. the bottom line for health care is the individual doctor, therapist, lab technician not the insurance administrator.
the few people who will get the money do not care. That for many Thrump supporters, they will have cut their own lives short if this becomes law.
7
Why have private insurers at all?
They wastefully restrict access to health care on all levels, acting as redundant, greedy middlemen.
The issue should be health _care_, not health _insurance_.
They wastefully restrict access to health care on all levels, acting as redundant, greedy middlemen.
The issue should be health _care_, not health _insurance_.
12
Essentially, this article is a really good example of why single payer health insurance & health care is the only reasonable and viable solution...
10
Health insurers don't have to be on site. They operate remotely. This is a ridiculous argument! And a terrific argument for single payer, one risk pool across a state -- or nation.
10
Capitalism depends on "competition"; once you have monopoly, you are post-capitalist. The monopoly has dictatorial control over your choices and prices.
So, we wish to pretend we have a "free market" health insurance system. But that has not really been true for a long time. Most of us have had no choice. Most of us are also ill equipped to shop around for medical care, since we don't have medical expertise. (What sort of blood test would I ask for? There are countless ones.)
Obamacare, when first rolled out, offered almost 40 plans in my area. Half a dozen companies with many choices with combinations of premiums, co-pays, low or high deductibles...I was very pleased with this. As a small business person, I wished to improve my monthly cashflow--so I could choose a lower monthly payment and a higher deductible.
I no longer believe that healthcare and the free market are compatible--it's just the wrong business model. The notion of "shopping" when you are ill is just absurd. If Obamacare could not work (and of course, the GOP did everything to undermine it, especially in my state), then it's time to get real. we need Medicare for all. Make it part of citizenship.
So, we wish to pretend we have a "free market" health insurance system. But that has not really been true for a long time. Most of us have had no choice. Most of us are also ill equipped to shop around for medical care, since we don't have medical expertise. (What sort of blood test would I ask for? There are countless ones.)
Obamacare, when first rolled out, offered almost 40 plans in my area. Half a dozen companies with many choices with combinations of premiums, co-pays, low or high deductibles...I was very pleased with this. As a small business person, I wished to improve my monthly cashflow--so I could choose a lower monthly payment and a higher deductible.
I no longer believe that healthcare and the free market are compatible--it's just the wrong business model. The notion of "shopping" when you are ill is just absurd. If Obamacare could not work (and of course, the GOP did everything to undermine it, especially in my state), then it's time to get real. we need Medicare for all. Make it part of citizenship.
13
As a Canadian whose father became politically active when we as a nation developed our Universal Health Care Accessibility, I am reminded of some of his analogies regarding the lack of a system for those who could not afford insurance. One of note is how he had a credit bureau chasing him for hospital and doctor bills for my oldest brother's appendix operation. He worked 3 jobs to pay that off and celebrated the fairness and equality of our National Healthcare when it came to be.
The inherent problem I see with the US system is the delisting of medical services in Medicare or through insurers. There should be universality of available medial coverage in all 50 states. And the most disgusting reality of the Republican bills is that the proposed monetary savings would be then "given" to the wealthy in the form of tax reductions - money representing such a low percentage of that persons wealth - yet in real dollars would offer such needed programs and care.
The US needs to step back from the idea of "free market capitalism" when it applies to health of the nations citizens. A poor person, or working poor should not have to choose between health care for themselves and their children and putting nutritious food ( leads to a healthier populace ) on the table.
The inherent problem I see with the US system is the delisting of medical services in Medicare or through insurers. There should be universality of available medial coverage in all 50 states. And the most disgusting reality of the Republican bills is that the proposed monetary savings would be then "given" to the wealthy in the form of tax reductions - money representing such a low percentage of that persons wealth - yet in real dollars would offer such needed programs and care.
The US needs to step back from the idea of "free market capitalism" when it applies to health of the nations citizens. A poor person, or working poor should not have to choose between health care for themselves and their children and putting nutritious food ( leads to a healthier populace ) on the table.
19
so, change the rules.
here in NM, if an insure want to operate in the state, they have to cover the whole state.
here in NM, if an insure want to operate in the state, they have to cover the whole state.
10
Many studies have shown that people in rural areas are less healthy than people in cities and suburbs. The opioid crisis is worse in rural areas.
The median age is higher in rural areas. Couple that with higher costs due to little competition and you have patients who are more expensive than in more populous areas.
I'm sure insurance companies are avoiding rural areas because they are less profitable. Why anyone thinks a market-based healthcare system can work is a mystery to me.
The median age is higher in rural areas. Couple that with higher costs due to little competition and you have patients who are more expensive than in more populous areas.
I'm sure insurance companies are avoiding rural areas because they are less profitable. Why anyone thinks a market-based healthcare system can work is a mystery to me.
9
Here's an idea: How about no health insurers in rural areas? Why don't we just expand Medicare to make it easier on the patients and the healthcare providers?
As a healthcare advocate, I see first hand how our health insurance system impedes patients' access to affordable care and provider networks. Insurers bury providers in limitless tons of claims paperwork, causing avoidable inefficiencies.
No insurer in rural South Dakota? Put those Americans into the Medicare system and have the government insure them. It will keep the one or two private insurers from price gouging the policy holders, and will give patients better access to a the largest healthcare network in our country -- Medicare.
As a healthcare advocate, I see first hand how our health insurance system impedes patients' access to affordable care and provider networks. Insurers bury providers in limitless tons of claims paperwork, causing avoidable inefficiencies.
No insurer in rural South Dakota? Put those Americans into the Medicare system and have the government insure them. It will keep the one or two private insurers from price gouging the policy holders, and will give patients better access to a the largest healthcare network in our country -- Medicare.
10
Government entities could address underserved communities with subsidized primary and secondary health care facilities. The use of such facilities should be based on ability to pay + subsidies. Eliminate all the waste, fraud and abuse associated with insurance. Insurance companies have, after all, decided to pull out of these communities.
1
we as a nation need to understand that there are areas and citizens that for a variety of reasons require more attention and assistance(regardless of party affiliation or the lack of it).
certainly rural areas require a federal plan of assistance for their viability;health care is one of them.
certainly rural areas require a federal plan of assistance for their viability;health care is one of them.
3
Until America stops expecting the majority of people to get insurance through their employer nothing will change. Individuals don't have the clout to negotiate decent prices on insurance.
This health care bill is terrible. Putting more costs onto the states is a non starter. States are not allowed to run deficits and many are already struggling.
Rural areas don't have enough supermarkets or banks, how can they be expected to support an insurance market. Sadly, voters are not well enough informed to see that the GOP does not have their interest at heart.
This health care bill is terrible. Putting more costs onto the states is a non starter. States are not allowed to run deficits and many are already struggling.
Rural areas don't have enough supermarkets or banks, how can they be expected to support an insurance market. Sadly, voters are not well enough informed to see that the GOP does not have their interest at heart.
9
The authors of this article conveniently overlook the fact that the Obamacare insurance market place is an on line market place, not a brick and mortar marketplace. As a result, so long as customers are able to get on line, the market should be as large as the area covered by internet service in that state.
And health care is not delivered entirely by a local hospital in rural areas. Yes, simple cases may be treated at the local hospital, but in rural areas, that small local hospital is affiliated with a larger, central hospital, and anything serious involves transportation of the patient to that larger facility.
The premise of a competitive market is that there be competition. Since the early 1900s, states have rate regulated monopolies to afford them an opportunity to earn a just and reasonable return on their business. However, in return, those monopolies had an obligation to provide service to all members of the public who sought the service. A one insurer Obamacare market place does not meet that criteria.
And health care is not delivered entirely by a local hospital in rural areas. Yes, simple cases may be treated at the local hospital, but in rural areas, that small local hospital is affiliated with a larger, central hospital, and anything serious involves transportation of the patient to that larger facility.
The premise of a competitive market is that there be competition. Since the early 1900s, states have rate regulated monopolies to afford them an opportunity to earn a just and reasonable return on their business. However, in return, those monopolies had an obligation to provide service to all members of the public who sought the service. A one insurer Obamacare market place does not meet that criteria.
3
There is a lot about your comment that I would like to have you question. The idea that health care is not local and should be easier to sell in rural places does not take into account a lot of what happens. The internet helps, but it does not solve structural differences between rural and urban health services.
There are less doctors out there, less places that they work out of. They see less patient in a day, so they either ask for more money per patient, take less take home pay, or both. This makes it hard for providers to get doctors to work in these areas. More travel is required, and say an MRI tech might travel a wide swath of are working out of several regional locations. The costs ARE different in the city versus in a rural area.
There are less doctors out there, less places that they work out of. They see less patient in a day, so they either ask for more money per patient, take less take home pay, or both. This makes it hard for providers to get doctors to work in these areas. More travel is required, and say an MRI tech might travel a wide swath of are working out of several regional locations. The costs ARE different in the city versus in a rural area.
3
So - once again - insurance pools of folks with pre-existing conditions that pay modest premiums and consume huge dollars of health care while young and healthy folks roll the dice and buy no insurance equals huge costs not offset by modest inflows for insurance companies.
Hence the insurers leave the market - because they are free markets - macroeconomics 101 - independent of dems or republicans having the reins.
Hence the insurers leave the market - because they are free markets - macroeconomics 101 - independent of dems or republicans having the reins.
5
I have been in Pain Mgmt since a 2005 Spinal surgery from an on the job injury three years before. My doctor does the drive 90 miles North to a rural Mtn town once a week. That still does not meet the need of rural folks. When I meet people who routinely drive 1 1/2 to 2 hrs from the North down to Atlanta, I ask them why they don't go to the rural office. The responses are we like coming down once a month. Then we do other shopping and we go out to eat. Others claim, I don't go over there ever. Or it takes just as long to go across the mountain roads then to just get on I-75 and come south.
I am also coming from as far as 3 hrs into Alabama.
I on the other hand have lived around the corner from where the doctor lives. On my first visit to him he said to me you live just around the corner from me.
I am also coming from as far as 3 hrs into Alabama.
I on the other hand have lived around the corner from where the doctor lives. On my first visit to him he said to me you live just around the corner from me.
1
Actually all they need is one insurer. We have Medicare. Single payer, and costs thousands less per equivalent patient than the big Private For Profit Insurers. If Private For Profit Insurers cannot beat Government bureaucracy, then the Private For Profit Insurers should shut down. For an example how it is done right, look at Australia which even addresses drug prices. Our son lives there and it works!
7
Not true. If we had a national market with all subscriber rating, then anyone, anywhere could purchase various types of coverage. The state by state regulatory system for health insurers is totally broken. Reasonable reimbursement of providers would solve most of of the network issues. As it is almost all providers are quite used to fee schedules from various private insurers as well as Medicare and Medicaid. Would every problem in American health care be solved? No, every problem is never solved, but his alone would go a long way to solving much of the problems outlined here.
You just described Medicare! The only solution that will bail out the rural areas is Medicare for all. Standard Medicare is already used by the 65 plus population in Rural America. As of 2015 the cost for Medicare , the average cost with 65 plus population was $9,900year. Adding a buy in to Medicare with the ACA credits for those under 65, will do the trick. Plus it will bring the costs down in the private markets.
7
I'm always thrilled to see in depth reporting on rural America, and I'm a loyal subscriber -- but I'm fairly certain this headline is incorrect. I'd be curious to know what data determined the use of the word "most," or what defines "rural" in this sentence: "Most rural areas have only one grocery store and school..."
I live and work in a small Ozarks town, certainly "rural" by any parameters I'm aware of, yet we have four grocery stores, and multiple schools (public and private).
Aside from accuracy, I want to encourage our nation's best reporters to be careful not to promote stereotypes about rural America and how limited or desolate life is here.
Carry on doing the good work of the free press.
I live and work in a small Ozarks town, certainly "rural" by any parameters I'm aware of, yet we have four grocery stores, and multiple schools (public and private).
Aside from accuracy, I want to encourage our nation's best reporters to be careful not to promote stereotypes about rural America and how limited or desolate life is here.
Carry on doing the good work of the free press.
7
To these authors, the idea of driving 20 miles to a grocery store is unimaginable. Here in southern Vermont, it is a 20 mile drive to a large full service grocery store, and people shop accordingly. But within that 20 miles, there are three supermarkets, and if you expand the radius to 30 miles, there are at least six. And if you need a half gallon of milk to tide you over between weekly shopping trips, the convenience store is three miles away.
6
I'd be more than happy to show you some areas in many states where there is only a Piggly-Wiggly store or a locally owned market that's more like a general store, no pharmacy without a long road trip and a hospital two or more counties away.
4
The bottom line is that as long as we consider health care a supply/demand capitalistic endeavor, we will pay through the nose for health care. Just think, how much can a supplier charge for the ONE drug available to treat your cancer? What would you pay?
We have separated supply and demand by a near monopolistic gate keeper that is mandated by fiscal laws to put its own profit ahead of other considerations.
Just consider: we could theoretically lower health care costs across the board by going to Medicare for all and lowering overhead from 20 % to near 2 %.
Every other industrial country has found that some sort of single payer universal health care system is fairer, cheaper and provides better outcomes.
(We pay the costs of the uninsured one way or another: our every premium, bill, deductible contains a surcharge for unreimbursed costs for the treatment of last resort--and the most expensive option-- the emergency room).
The ACA is the best version of a system forced to include private insurance companies as our gate keepers to health care. The idea that the GOP would consider a far poorer plan for us--out of spite for a name change and out of greed for donors, not citizens, is incomprehensible--until now.
We have separated supply and demand by a near monopolistic gate keeper that is mandated by fiscal laws to put its own profit ahead of other considerations.
Just consider: we could theoretically lower health care costs across the board by going to Medicare for all and lowering overhead from 20 % to near 2 %.
Every other industrial country has found that some sort of single payer universal health care system is fairer, cheaper and provides better outcomes.
(We pay the costs of the uninsured one way or another: our every premium, bill, deductible contains a surcharge for unreimbursed costs for the treatment of last resort--and the most expensive option-- the emergency room).
The ACA is the best version of a system forced to include private insurance companies as our gate keepers to health care. The idea that the GOP would consider a far poorer plan for us--out of spite for a name change and out of greed for donors, not citizens, is incomprehensible--until now.
5
The most popular comments here all suggest that single payer (Medicare from cradle to grave) is the best way to provide cost-effective health insurance.
As a physician practicing for over 35 years I can reassure everyone that insurance companies are in the business of making a profit by denying care and harassing physicians and their staff.
We have the most expensive healthcare compared to 11 countries that have government funded healthcare and we rank last in quality, outcomes and access.
The reason for this catastrophe is the corruption of our government by insurance and drug companies. We need to elect representatives that represent constituents, not corporations.
Teddy Roosevelt (happened to be a Republican) was the first President who advocated for single payer, but the AMA at that time was against it. We need to elect people with the same mind set as Teddy Roosevelt.
No insurance company can compete with the efficiency and fairness of Medicare. We also need to incentivize physicians by rewarding them for quality, not quantity.
We need not only "socialized" medicine but free college tuition to public universities to educate our children to have the opportunity of rewarding careers and have the knowledge to make the best decisions in the voting booths.
As a physician practicing for over 35 years I can reassure everyone that insurance companies are in the business of making a profit by denying care and harassing physicians and their staff.
We have the most expensive healthcare compared to 11 countries that have government funded healthcare and we rank last in quality, outcomes and access.
The reason for this catastrophe is the corruption of our government by insurance and drug companies. We need to elect representatives that represent constituents, not corporations.
Teddy Roosevelt (happened to be a Republican) was the first President who advocated for single payer, but the AMA at that time was against it. We need to elect people with the same mind set as Teddy Roosevelt.
No insurance company can compete with the efficiency and fairness of Medicare. We also need to incentivize physicians by rewarding them for quality, not quantity.
We need not only "socialized" medicine but free college tuition to public universities to educate our children to have the opportunity of rewarding careers and have the knowledge to make the best decisions in the voting booths.
36
A larger and surprising pattern is emerging in the various policy areas of the Trump Administration, who owes their 2016 election to lopsized majorities in small towns, rural areas and states.
In almost every area, from health care to infrastructure to immigration and tax reform, from environment and climate change to energy, low density areas are the big losers in the Trump agenda.
The best approach for rural health care access would be expanding low cost public insurance rather than high cost for-profit fee for service. The best approach to infrastructure for rural America would look more like Eisenhower's Interstate project and less like shady Trump tax subsidized real estate deals, which will favor metros with money.
Wind and solar power are a potential boon for much of rural America, Kansas alone has enough wind generation potential to power 50% of America, if only the transmission grid existed.
And the recent NYT US climate change map shows the future negative impact to tbe very areas that are the GOP base.
Trump's first budget was a model plan for rural destruction.
In almost every area, from health care to infrastructure to immigration and tax reform, from environment and climate change to energy, low density areas are the big losers in the Trump agenda.
The best approach for rural health care access would be expanding low cost public insurance rather than high cost for-profit fee for service. The best approach to infrastructure for rural America would look more like Eisenhower's Interstate project and less like shady Trump tax subsidized real estate deals, which will favor metros with money.
Wind and solar power are a potential boon for much of rural America, Kansas alone has enough wind generation potential to power 50% of America, if only the transmission grid existed.
And the recent NYT US climate change map shows the future negative impact to tbe very areas that are the GOP base.
Trump's first budget was a model plan for rural destruction.
9
What I don't get is why these sparsely populated area can't be put together as if it were one area or, for example, put them in the Las Vegas pool, thus spreading the financial risk.
9
The analogy of a rural area having only one grocery and only one insurer is bogus.
Firstly, insurers don't have to have storefronts in each village like grocery stores would. They operate by mail and phone and computer.
I live in North Carolina and recently had to negotiate with USAA in Texas because of an accident caused by their insured person. So what if they're in Texas? My own auto insurance, Metropolitan, is or was headquartered in New York City. Again, so what?
What's happening in the healthcare market is that insurers are cherry-picking populations they want to insure. They want to insure only those who are employed and healthy and live in areas with many hospitals they can pit against each other, so the insurer can make a larger profit.
When they talk about losses, they are only talking about losses in the little segments of their business that they don't want -- these rural populations for instance. They're not talking about losses in their overall business, because if they were, they wouldn't be allowed or able to function in the insurance business. This is because they need to have large amounts of assets to pay claims. If they don't have those assets, the regulators won't allow them to do business.
What would solve the problem is not to divide the insurance market into sub-classes. Consider the market as all the people in an entire state. Either an insurer wants to do business there -- in every city, town, and dirt road -- or they don't.
Firstly, insurers don't have to have storefronts in each village like grocery stores would. They operate by mail and phone and computer.
I live in North Carolina and recently had to negotiate with USAA in Texas because of an accident caused by their insured person. So what if they're in Texas? My own auto insurance, Metropolitan, is or was headquartered in New York City. Again, so what?
What's happening in the healthcare market is that insurers are cherry-picking populations they want to insure. They want to insure only those who are employed and healthy and live in areas with many hospitals they can pit against each other, so the insurer can make a larger profit.
When they talk about losses, they are only talking about losses in the little segments of their business that they don't want -- these rural populations for instance. They're not talking about losses in their overall business, because if they were, they wouldn't be allowed or able to function in the insurance business. This is because they need to have large amounts of assets to pay claims. If they don't have those assets, the regulators won't allow them to do business.
What would solve the problem is not to divide the insurance market into sub-classes. Consider the market as all the people in an entire state. Either an insurer wants to do business there -- in every city, town, and dirt road -- or they don't.
10
Several commenters are missing the point about rural health care. It isn't about the insurers, its about the providers. When a higher percentage of the population is older, less healthy, lower income and less dense, with less employer insurance, its harder to cover the costs of modern health care, with expensive equipment, facilities and highly paid specialists.
Medicaid and Medicare keep these providers afloat, not private insurers.
Medicaid and Medicare keep these providers afloat, not private insurers.
8
Ergo: the logic of Medicare for all.
6
The government insurance programs don't have to be the only supporters of rural healthcare. Insurers should pick up the costs as well. It relates to the notion of "the cost of doing business." Sorry, but insurers shouldn't be able to just skim the cream off the top and let the rest of society deal with what lies beneath.
1
This information about the cause and effect on rural areas is so important. Can we provide this information to rural voters through any news outlet other than the NY Times? The sad fact is that a greater percentage of rural voters don't read, and those that do read aren't likely to read the NY Times. Yet, this is information they need to know and understand before going to the voting booth.
6
chandlerny:
Your comment impugns rural residents by asserting "that a greater percentage of rural [than urban] voters don't read". This is not compatible with my experience.
With the advent of the Internet, many rural voters do, in fact, read the New York Times.
Your comment impugns rural residents by asserting "that a greater percentage of rural [than urban] voters don't read". This is not compatible with my experience.
With the advent of the Internet, many rural voters do, in fact, read the New York Times.
3
When I was in the Navy 45 years ago lots of sailors had a subscription to their local newspaper which was mailed. Some of those papers were weeklies. There was also a library service available to us,
Yes, rural people do read.
Yes, rural people do read.
2
So true. I always read newspapers, but did not read the NYT until it went online. As many of my fellow Nebraskans are the same.
1
Interesting. There are rural areas up in the mountains in Switzerland, too, but everyone there has a large selection of health insurers to choose from. Are we better organized - or does our government actually want to provide health care for all of its citizens and demand that insurers cover everyone?
(Many other European countries, such as Sweden or Finland, have wide areas of forest with few inhabitants. They also have universal coverage.)
(Many other European countries, such as Sweden or Finland, have wide areas of forest with few inhabitants. They also have universal coverage.)
21
A big problem with private insurance is their fiction of "the group."
A company may have literally millions of customers in a state, and yet they pretend that each county or each employer is a "group," or worse yet, that all of the individuals on the individual market are "groups" unto themselves.
The fact is that my insurance premiums never went into a drawer to be used for me and me alone. Nor do the insurance premiums paid by Acme Widgets for its employees go into the exclusive Acme Widgets drawer.
I understand that insurance is handled on the state level in this country. Why, then, can the states not mandate that insurance companies treat the entire state and everyone in it as a single group, instead of price gouging a fifty-person company with one MS sufferer or abandoning a county because there are not enough customers to satisfy the shareholders?
Or how about doing away with private health insurance altogether and treating all 350 million of us as a single group with a single insurer?
A company may have literally millions of customers in a state, and yet they pretend that each county or each employer is a "group," or worse yet, that all of the individuals on the individual market are "groups" unto themselves.
The fact is that my insurance premiums never went into a drawer to be used for me and me alone. Nor do the insurance premiums paid by Acme Widgets for its employees go into the exclusive Acme Widgets drawer.
I understand that insurance is handled on the state level in this country. Why, then, can the states not mandate that insurance companies treat the entire state and everyone in it as a single group, instead of price gouging a fifty-person company with one MS sufferer or abandoning a county because there are not enough customers to satisfy the shareholders?
Or how about doing away with private health insurance altogether and treating all 350 million of us as a single group with a single insurer?
32
Yes! One year, when my individual policy premium went up 23%, the insurer's letter explained that a few expensive members were responsible. I called to ask how many were in my group. I was shocked at how small it was. If I recall correctly, it was only four figures. THIS is the problem -- the insurers' dividing us up into tiny risk pools. (In the eight years BEFORE the ACA, my premiums tripled; in the three years I was on the Exchange, my tax subsidy kept my premiums virtually flat -- what a relief! But best of all? Reaching Medicare.)
2
Because an insurance company is first responsible to its shareholders for maximizing profit--to do otherwise is to act against their fiduciary responsibility.
Their mandate is to charge the highest premiums the market will bear and provide the least treatment they can get away with. Think of it as gerrymandering the groups for profit.
Their mandate is to charge the highest premiums the market will bear and provide the least treatment they can get away with. Think of it as gerrymandering the groups for profit.
4
The government recognizes the economic differences in some rural areas by forgiving student loans for medical professionals who elect to practice in "under-served areas." If there are no insurers willing to do business in a sparsely populated area, provide similar recognition of economic differences by funding insurers to support services in these areas.
2
If you have no insurance, you pay all your own money. The wealth transfer to the billionaire owners of big pharma will happen faster and the GOP can finally get rid of the middle class...
2
It's actually worse than that. Many doctors refuse to see anyone who does not have health insurance. One rationale I heard: "You wouldn't have the money to follow through on my diagnosis." So, a couple of physicians I interviewed rationalized, why bother to see a doctor? Why should I bother to treat you for cancer? For anything serious?
And this is the horror of being uninsured/uninsurable in America as a non-wealthy person (defined by physicians et al as "money is an issue") before Obamacare, and without Medicaid. I figured the only way to survive emotionally was to think of myself of living in the 19th century. Or being "non-rich" in any Third World country. If you think you can avoid this fate under GOP-uncare by eating well and exercising (the "just don't get a medical condition"), please remember that accidents can happen to everyone, at every age.
And this is the horror of being uninsured/uninsurable in America as a non-wealthy person (defined by physicians et al as "money is an issue") before Obamacare, and without Medicaid. I figured the only way to survive emotionally was to think of myself of living in the 19th century. Or being "non-rich" in any Third World country. If you think you can avoid this fate under GOP-uncare by eating well and exercising (the "just don't get a medical condition"), please remember that accidents can happen to everyone, at every age.
5
Instead of allowing the negative message from republican politicians to fill the media, the NYTimes must correct their distortions by writing more articles about how the ACA has been working.
NYTimes should say and repeat the message that there is no reason to repeal the ACA, and that if anything must be done, it's to only improve the ACA. However, The TImes currently repeats (too often) the "lie" that it's failing/failed. This is not the truth. The alternate (and true) story must be repeated over and over, to those in the nation who don't understand the issues underpinning healthcare reform. This has become a purely political game, driven by republicans and haters of our first Black President. The ACA is very close to Romney's plan enacted in Massachusetts (where it works), yet republicans won't admit that.
We need to correct misconceptions being repeated 1000 times. Because as we all know, a lie told 1000 times (if not countered) becomes a "truth".
The only way to counter a 1000 lies is with 1000 truths!
NYTimes should say and repeat the message that there is no reason to repeal the ACA, and that if anything must be done, it's to only improve the ACA. However, The TImes currently repeats (too often) the "lie" that it's failing/failed. This is not the truth. The alternate (and true) story must be repeated over and over, to those in the nation who don't understand the issues underpinning healthcare reform. This has become a purely political game, driven by republicans and haters of our first Black President. The ACA is very close to Romney's plan enacted in Massachusetts (where it works), yet republicans won't admit that.
We need to correct misconceptions being repeated 1000 times. Because as we all know, a lie told 1000 times (if not countered) becomes a "truth".
The only way to counter a 1000 lies is with 1000 truths!
10
Conservatives do not handle complexity well, when you drill down into the details of healthcare it is complex and pretty much each component you change may very well have an effect elsewhere whether intended or not, all this being said Trump is probably the last man on the planet you would in charge of Healthcare.
5
Just guarantee minimum access to at least one health insurer for everyone, even if the insurer is regulated by a state with the most lax regulations. That will allow the insurer to achieve the greatest profitability at minimum cost. I'm sure that plan could be spun to get GOP votes by showing a thin veneer of healthcare in rural areas. And then, when people are reported dying from totally preventable or treatable diseases, dismiss the deaths as Fake News.
Sound crazy? Just look at what the Trump administration is already denying.
Sound crazy? Just look at what the Trump administration is already denying.
1
Republicans always purport the faulty belief that the invisible hand of the free market will all magically lead us to a utopian la la land where everyone is happy. Since the problems afflicting rural communities with regards to health care choices existed before and after the Affordable Care Act, the free market seems to think rural areas in the U.S. deserve no more than the limited and expensive options they have before them now. I wonder if the GOP will be OK with that or will they come to their senses, not because they are 'compassionate conservatives' or any other nonsense like that, but because not doing so may cost them votes?
5
Is there, and if not, why not, a linking together of scattered rural communities to form an insurance marketplace? Bare counties unite?!
2
One can always drive to the next grocery store with better prices, and bring stuff home to shelf and refrigerator and have it handy. Doesn't work that way for health insurance--the analogy is faulty.
2
I think the point being made was that most people in rural areas don't have the choice with regards to grocery options you seem to be assuming they have.
1
Surely there are empty US places with no commerce, but most people can fill grocery carts with stuff and take it all home to last for quite awhile, making the travel worth it. There is no analogous option for health insurance. Either it's available where you are, or you're out of luck--I don't think traveling across a no-insurance line works at all, does it? Rs are sabotaging ACA to minimize the availability of health care plans by destabilizing insurance payments to companies doing quite well. Groceries operate on very thin margins, an entirely different business that is willing to plunk down a store for a modest profit.
1
Bloody ironic that this problem affects almost exclusively Trump supporters. Be that as it may as the the article points out this is a preexisting problem, monopoly power where there is only one hospital. As with all monopolies the government can regulate prices charged for services as a utility or, if that won't keep medical facilities there, open and run their own facilities. You can't expect insurance companies to magically negotiate their way around the problem. They could even offer more subsidies for services rendered in isolated facilities because of the increased cost of doing business there. This perhaps could or should be part of Obamacare.
2
What an arrogant, insensitive and irrelevant comparison.Let them eat cake!
The lack of providers has nothing to do with low density. It has everything to do with a poorly conceived plan that is an abject failure.
The lack of providers has nothing to do with low density. It has everything to do with a poorly conceived plan that is an abject failure.
2
No it does not, the same problem existed before Obamacare, insurance companies probably simply paid more for services there and maybe charged more for premiums. Build that into Obamacare for isolated facilities.
3
In all these incessant analyses of our health care debacle, I've seen no mention of these whining insurance companies' bottom lines. They're publically traded stocks mostly. Are they paying dividends? How are the stock prices trending? Most importantly, are they making billion dollar profits, or actually losing money?
I suspect most of these companies whining about how they have to pull out of certain markets are profitable, since we're not reading articles about them teetering on insolvency, considering mergers to increase efficiency, CEOs getting canned because Wall Street is dissatisfied. These same insurance companies whining about their projections are reimbursing hospitals twenty dollars for a couple of Tylenols, hundreds of dollars for an IV infusion of sterile salt water where the costs of the materials doesn't reach ten dollars, a thousand dollars for a hospital room where you don't get your own private nurse, an emergency room bill for a few grand for the doctor to put in ten stitches in fifteen minutes or tell you the ankle isn't broken, just a bad sprain . . .
These middlemen insurance companies are nothing but parasites feeding at the trough of our wealth care system. The entire system is rotten to the core, as corrupt as anything that goes on in the worst African kleptocracy or communist bureaucracy. The % of GDP we spend on health care with worse results than countries that spend less is all the proof a rational person should need. We're Number One!
I suspect most of these companies whining about how they have to pull out of certain markets are profitable, since we're not reading articles about them teetering on insolvency, considering mergers to increase efficiency, CEOs getting canned because Wall Street is dissatisfied. These same insurance companies whining about their projections are reimbursing hospitals twenty dollars for a couple of Tylenols, hundreds of dollars for an IV infusion of sterile salt water where the costs of the materials doesn't reach ten dollars, a thousand dollars for a hospital room where you don't get your own private nurse, an emergency room bill for a few grand for the doctor to put in ten stitches in fifteen minutes or tell you the ankle isn't broken, just a bad sprain . . .
These middlemen insurance companies are nothing but parasites feeding at the trough of our wealth care system. The entire system is rotten to the core, as corrupt as anything that goes on in the worst African kleptocracy or communist bureaucracy. The % of GDP we spend on health care with worse results than countries that spend less is all the proof a rational person should need. We're Number One!
24
Insurance companies are mandated to put their profits above other considerations as for-profit entities. Charity only matters in the sense of good advertising/optics--which plays to the bottom line once again, enticing more customers.
The highest premiums the market will bear, as little treatment as they can get away with--this is our gatekeeper between our health needs and the providers.
The ACA at least did away with the various ways such as age, caps, and preexisting conditions that insurance companies used to sort the market to find those who would not require much health care while paying their premiums.
(Their ideal customer is the man who pays insurance all his life, avoids checkups, and drops dead of a heart attack just as his age starts to place him at risk for chronic or lifestyle illnesses--all profit for the insurance company.)
Single payer universal coverage would remove this greedy middleman and enlarge the risk pool. But, the point of both House and Senate bills was not optimum health care--it was stealing money from the neediest to give to the already rich.
The highest premiums the market will bear, as little treatment as they can get away with--this is our gatekeeper between our health needs and the providers.
The ACA at least did away with the various ways such as age, caps, and preexisting conditions that insurance companies used to sort the market to find those who would not require much health care while paying their premiums.
(Their ideal customer is the man who pays insurance all his life, avoids checkups, and drops dead of a heart attack just as his age starts to place him at risk for chronic or lifestyle illnesses--all profit for the insurance company.)
Single payer universal coverage would remove this greedy middleman and enlarge the risk pool. But, the point of both House and Senate bills was not optimum health care--it was stealing money from the neediest to give to the already rich.
1
The answer to GOP concerns about an apparent lack of competition in rural areas with only one or no insuarnce carriers is quite simple - open up all residents in these areas to have access to Medicare coverages at rates the US government currently pays now.
Here in NC, we have 95 counties out a 100 that have coverage offering from only 1 carrier - BCBS. And BCBS-NC states on their website the 2018 ACA premiums will increase by 23% due entirely to the uncertainty provided by the GOP Congress as to whether or not the ACA cost-sharing subsidies will be paid. BCBS-NC goes on to say if that uncertainity did not exist, they would be requesting a 9% increase. Go figure out where the problem is.
Here in NC, we have 95 counties out a 100 that have coverage offering from only 1 carrier - BCBS. And BCBS-NC states on their website the 2018 ACA premiums will increase by 23% due entirely to the uncertainty provided by the GOP Congress as to whether or not the ACA cost-sharing subsidies will be paid. BCBS-NC goes on to say if that uncertainity did not exist, they would be requesting a 9% increase. Go figure out where the problem is.
10
And a 9% increase is still obscene.
3
And to remedy this, all the legislature has to do is tell BCBS that they will be removed as the insurer for the state employees health plan (the largest employer in the state) unless they are willing to provide coverage under AHA at reasonable prices, the state health plan will look for another carrier. But the NC legislature will never do that.
1
And isn't this why we need a health care system with at least a public option, if not single payer health care system?
17
I live in a rural area and I want the equivalent of Amazon Prime for Healthcare. There is one Grocery store in our area; several liquor stores; 2 pharmacies and several eateries. There are several doctors or different types, but we have 4 different delivery options for Amazon Prime: USPS, UPS, FEDEX, and sometimes DHL. So why isn't there the equivalent of a Amazon Prime Healthcare company that will embrace the business model to service rural areas.
I bet if you bundled many rural areas into a healthcare service sector, there would be a lot less of zero counties with service and maybe there might even be many with two or more... hmm food for thought!
I bet if you bundled many rural areas into a healthcare service sector, there would be a lot less of zero counties with service and maybe there might even be many with two or more... hmm food for thought!
5
PD writes: "So why isn't there the equivalent of a Amazon Prime Healthcare company that will embrace the business model to service rural areas."
Health insurers must work on a state basis rather than a national or international basis.
Health insurers must work on a state basis rather than a national or international basis.
4
@PD:
By suggesting your "solution" (ie, copy Amazon Prime), you do not understand the problem of healthcare delivery. It can't be "FedEx'ed" to your door.
The truth is, you live in an area/state where few American doctors want to live or work. Even few Americans live there. Rural areas are akin to "Zimbabwe", in that the population is low and nothing that a typical doctor wants are available there. This is why you have only "several doctors or [sic] different types". If someone in your town needed a pediatric oncologist, they would probably have to go 80+ miles just for a visit.
Your solution, of using "Amazon Prime" is unrealistic. Amazon Prime is a convenience system for delivering packaged goods. If you want a convenient way of delivering healthcare, then that pediatric oncologist must drive/be driven to your town or nearby. That just won't happen. The time taken to "transport" that doctor to your area will be wasted time -- s/he's sitting in a vehicle for ~2 hours, when they could be treating others. It's unrealistic. Not to mention, they don't examine and treat people with bare hands; they need special equipment that isn't in your area. Your area doesn't even have multiple hospitals.
The solution is that if you chose to live in "Zimbabwe", you need to realize that America won't "FedEx" itself at your whim, to keep you healthy. Because if we did, the costs would be greater than the current costs.
Tele-medicine can help, but won't solve the problem.
By suggesting your "solution" (ie, copy Amazon Prime), you do not understand the problem of healthcare delivery. It can't be "FedEx'ed" to your door.
The truth is, you live in an area/state where few American doctors want to live or work. Even few Americans live there. Rural areas are akin to "Zimbabwe", in that the population is low and nothing that a typical doctor wants are available there. This is why you have only "several doctors or [sic] different types". If someone in your town needed a pediatric oncologist, they would probably have to go 80+ miles just for a visit.
Your solution, of using "Amazon Prime" is unrealistic. Amazon Prime is a convenience system for delivering packaged goods. If you want a convenient way of delivering healthcare, then that pediatric oncologist must drive/be driven to your town or nearby. That just won't happen. The time taken to "transport" that doctor to your area will be wasted time -- s/he's sitting in a vehicle for ~2 hours, when they could be treating others. It's unrealistic. Not to mention, they don't examine and treat people with bare hands; they need special equipment that isn't in your area. Your area doesn't even have multiple hospitals.
The solution is that if you chose to live in "Zimbabwe", you need to realize that America won't "FedEx" itself at your whim, to keep you healthy. Because if we did, the costs would be greater than the current costs.
Tele-medicine can help, but won't solve the problem.
7
This is way America needs universal access single payor health care rather than what we have. The ACA did not solve this problem. The insurance companies aren't interested because there isn't enough of a profit for them in these areas. Keeping the insurance companies happy is not working for the patients or the physicians. For profit health care is an oxymoron. The profit will always come first with health insurance companies, pharmaceutical companies, hospital chains, labs, etc. Whether Americans want to admit it or not, health care is something that should not be left to the free market. The free market will not do the right thing when the choice is between the bottom line and our health.
23
True. How much will you pay for the one cancer drug that might save you? In a for-profit scenario--pharma should be researching your finances to see how much they can charge. You are not competing with anyone but yourself.
And this is why we need a single payer option, folks. Only 1 private insurer offering plans in your area? No private insurers offering plans? No problem! Medicare/Medicaid for everyone.
20
Private for-profit insurance companies are the bane of our existence. They should not be allowed to meddle in determining life and death. Being sanctioned by our government to do so is the real atrocity.
Congress makes the rules. Some of its members are completely beholden to the insurance industry. They are not doing their job, looking out for the General Welfare of we the people. Some members are owners or stakeholders of health care providers. Can you imagine that? Someone who makes laws about your health care has a vested interest in seeing their stock goes up when insurance companies make a greater profit by denying you health care. That should be a crime, but it's not. It's been legalized by your Representatives. Republicans in Congress preach incessantly about "Freedom" and "Liberty", which means leaving you to fend for yourself in negotiating with insurance behemoths. It's a battle of David versus Goliath on a daily basis.
Who in their right mind would set up a system where the less services I provide you the greater benefit it is to my profit margin? Congress, that's who. And it's time the people called them out on this farce. Government-run, health care, like Social Security, Medicare and Medicaid works if it not purposely sabotaged by Republican members of Congress. The ACA is not melting down, Americans are denied universal health care because Republicans want to give the rich even bigger tax cuts. America, do something about it.
DD
Manhattan
Congress makes the rules. Some of its members are completely beholden to the insurance industry. They are not doing their job, looking out for the General Welfare of we the people. Some members are owners or stakeholders of health care providers. Can you imagine that? Someone who makes laws about your health care has a vested interest in seeing their stock goes up when insurance companies make a greater profit by denying you health care. That should be a crime, but it's not. It's been legalized by your Representatives. Republicans in Congress preach incessantly about "Freedom" and "Liberty", which means leaving you to fend for yourself in negotiating with insurance behemoths. It's a battle of David versus Goliath on a daily basis.
Who in their right mind would set up a system where the less services I provide you the greater benefit it is to my profit margin? Congress, that's who. And it's time the people called them out on this farce. Government-run, health care, like Social Security, Medicare and Medicaid works if it not purposely sabotaged by Republican members of Congress. The ACA is not melting down, Americans are denied universal health care because Republicans want to give the rich even bigger tax cuts. America, do something about it.
DD
Manhattan
44
Just how do you claim Republicans are sabotaging Medicare and Medicaid? We just had 8 years of a Democrat President. I fully disagree with you that the ACA is "not" melting down. People who pay for their own health insurance have seen premiums up 100% due to Obamacare; phony "insurance" Bronze and Silver plans have such high deductibles ($3-12,000) that they are not really insurance, except for catastrophic events. The government pays doctors pitifully low reimbursement for Medicare and Medicaid patients...often below overhead. Universal health care in the USA? I give you the government run, single payer, VA.
And Democrats fully controlled the House,Senate, and Presidency in 2010. Democrats did not create single payer then.
And Obama lied about not losing you doctor or your insurance plan, and about decreasing premiums by $2,500.
And Democrats fully controlled the House,Senate, and Presidency in 2010. Democrats did not create single payer then.
And Obama lied about not losing you doctor or your insurance plan, and about decreasing premiums by $2,500.
2
Dear KS:
After attempting to get through your poorly written post, my first thought was to disregard it. I had you down as one of the may ignoramuses who gets their news from FOX " news".
But then, this being the Fourth of July weekend, I thought why not address an perhaps educate a fellow American with some facts. As you know, among all First World nations, we have the worse health care system. Forget the nonsense about the best medical care anywhere. That is only for us well-to-do types in places like Manhattan. Here, if you have the money, you can get the best care in the world. But that care, relegated to but a few, is not for most Americans.
As a lifelong bleeding heart liberal, what me and my fellow brethren say is: this is not fair. We believe in universal health care for all, from cradle to grave coverage. Not only is it doable, it is being done in all First World nations except ours. If you think it can't then, you are wrong, and being deluded by whomever and wherever you gather your news. Any politician who tells you it can't be done is lying.
As for the VA, the same applies. It is being mismanaged on purpose. All veterans should have lifetime universal care, period. They can, if citizens like yourself would get your heads out of the sand with Stinking Thinking. Travel to other countries if you are a non-believer. I have lived in them and I know firsthand how it works. If you can't afford that, read a book by T. R. Reid on the subject. And think.
DD
Manhattan
After attempting to get through your poorly written post, my first thought was to disregard it. I had you down as one of the may ignoramuses who gets their news from FOX " news".
But then, this being the Fourth of July weekend, I thought why not address an perhaps educate a fellow American with some facts. As you know, among all First World nations, we have the worse health care system. Forget the nonsense about the best medical care anywhere. That is only for us well-to-do types in places like Manhattan. Here, if you have the money, you can get the best care in the world. But that care, relegated to but a few, is not for most Americans.
As a lifelong bleeding heart liberal, what me and my fellow brethren say is: this is not fair. We believe in universal health care for all, from cradle to grave coverage. Not only is it doable, it is being done in all First World nations except ours. If you think it can't then, you are wrong, and being deluded by whomever and wherever you gather your news. Any politician who tells you it can't be done is lying.
As for the VA, the same applies. It is being mismanaged on purpose. All veterans should have lifetime universal care, period. They can, if citizens like yourself would get your heads out of the sand with Stinking Thinking. Travel to other countries if you are a non-believer. I have lived in them and I know firsthand how it works. If you can't afford that, read a book by T. R. Reid on the subject. And think.
DD
Manhattan
5
Dear DD
In typical liberal fashion, you begin by insulting me. I'm perfectly happy with my post. What are your credentials that allow you to criticize me? What, specifically, do you consider poorly written?
Haven't watched FOX for ages. I have many sources, and even read the NYT (527 for Dems). I am even in DC from time to time.
We may have one of the worst health care "systems," but we do not have the worst care. Care is excellent in many US hospitals. We have such excellent drs that people come here from many countries for the superb care. And you don't need money to be treated in the best university hospitals in America.
Who is going to pay for your health care for all? Govt's failure to pay is noted above.
Cradle to grave? NHS=coverage in England. But people who don't want to wait for care may elect to go to private drs. Canada? A two year wait for hip replacement. An Ontario judge opined, in 2006, that the Canadian system does not guarantee care...it only guarantees a place in line.
Politicians telling me? I am fairly conversant with the issues. I was in Tom Price's confirmation hearing.
Who is mismanaging the VA on purpose? And why? With no service disability, I get no VA care.
I have been to other countries and visited hospitals...even on rounds at Queen Square a half century ago.
As for TR Reid, I am familiar with his book, have heard him on a panel, have spoken to him in person. I strongly disagree with his positions. And, in person, he told me the VA was just fine.
In typical liberal fashion, you begin by insulting me. I'm perfectly happy with my post. What are your credentials that allow you to criticize me? What, specifically, do you consider poorly written?
Haven't watched FOX for ages. I have many sources, and even read the NYT (527 for Dems). I am even in DC from time to time.
We may have one of the worst health care "systems," but we do not have the worst care. Care is excellent in many US hospitals. We have such excellent drs that people come here from many countries for the superb care. And you don't need money to be treated in the best university hospitals in America.
Who is going to pay for your health care for all? Govt's failure to pay is noted above.
Cradle to grave? NHS=coverage in England. But people who don't want to wait for care may elect to go to private drs. Canada? A two year wait for hip replacement. An Ontario judge opined, in 2006, that the Canadian system does not guarantee care...it only guarantees a place in line.
Politicians telling me? I am fairly conversant with the issues. I was in Tom Price's confirmation hearing.
Who is mismanaging the VA on purpose? And why? With no service disability, I get no VA care.
I have been to other countries and visited hospitals...even on rounds at Queen Square a half century ago.
As for TR Reid, I am familiar with his book, have heard him on a panel, have spoken to him in person. I strongly disagree with his positions. And, in person, he told me the VA was just fine.
1
This article makes a compelling case for Medicare-for-all, or at least a public option, in rural markets. But once rural areas are infected with the single payer virus, the infestation might spread rapidly to more densely populated areas. That would be very bad for the health insurance industry. I predict the industry will fight tooth and nail to prevent that outcome, with the help of their friends in Congress.
34
Single-payer for rural and urban areas. Improved Medicare for All. There are now 113 House Democrats signed on to https://www.congress.gov/bill/115th-congress/house-bill/676
We have to replace quite a few Representatives and a few Senators and demand that the co-signers get really serious, but we can do it.
We have to replace quite a few Representatives and a few Senators and demand that the co-signers get really serious, but we can do it.
18
Let's take the "one grocery store" example and apply it to everything.
Your automobile options are limited to only one make and model. Oh, and the gov't will set the price on it.
You can eat only one kind of food the rest of your life.
You can wear only one brown uniform the rest of your life.
Oh wait. We have the internet, invented by Al Gore. No matter where one lives, even in rural areas, one can access pretty much anything, including a variety of health insurance options.
Don't tell me everyone in rural areas buys car and home coverage through only one property insurer.
What's so bad about competition?
Your automobile options are limited to only one make and model. Oh, and the gov't will set the price on it.
You can eat only one kind of food the rest of your life.
You can wear only one brown uniform the rest of your life.
Oh wait. We have the internet, invented by Al Gore. No matter where one lives, even in rural areas, one can access pretty much anything, including a variety of health insurance options.
Don't tell me everyone in rural areas buys car and home coverage through only one property insurer.
What's so bad about competition?
3
Competition is not bad per se. The free market mantra is that competition will lead to the best quality products for the lowest possible price. And sometimes, it works. In health care, it hasn't. There are many countries with single-payer systems that offer health care of comparable quality at lower cost.
9
You completely missed the point of the article. Basically, the challenge is that there isn't competition not because of govt but because of the marketplace. This article laments this lack of competition.
A free market offer services for the appropriate marketplace. A small town of with only 1000 residents can't support a Costco, but it can support a smaller grocery.
A free market offer services for the appropriate marketplace. A small town of with only 1000 residents can't support a Costco, but it can support a smaller grocery.
11
I used to live and work in a rural area. Competition works great in areas when multiple vendors are competing for your business. That is simply not the case in rural areas. Not all goods and services can be purchased with the internet. Unless you grow your own food, you are stuck with the local grocery store. Most folks are not going to drive hundreds of miles to get a better price on a car. For health care, you are stuck with the local providers for all but non-urgent, elective care. If you are purchasing health insurance, your options are limited to those offered in your area.
Did you even read the article?
Did you even read the article?
8
Why allow the insurers to pick and choose which counties they cover? If they want to sell insurance in a state, make it required that they cover the whole state.
Alternatively, if there are no insurers in a county make Medicare an option, with an appropriate premium.
Alternatively, if there are no insurers in a county make Medicare an option, with an appropriate premium.
27
Couldn't states institute that rule without Federal intervention?
Not enough insurance companies in your county for the free market to work its magic for you? Only one in your county, so somewhat constrained for "choice"? Now you're looking at none in 2018? Oh, woe is us. Whatever shall we do?? I have a simple solution for you and the entire US: HOW ABOUT NO INSURANCE COMPANIES. That's right, GET THEM OUT OF HERE, ALL OF THEM. Right now; this instance; good riddance. In this corrupt system's place, MEDICARE FOR ALL. Problem solved. Class can be dismissed early. (This, of course, presumes you were honestly in search of a solution to begin with.)
79
Once you blow through all the pixie dust of people having the right to decide to pay more for less, or have nothing at all, single payer is the answer. Build healthcare around illness, not profits. The young and healthy pay for the old and sick and poor so that when they become old and sick and poor there will be something there for them. That's the gamble with the best odds of the greatest good for the greatest number (Jeremy Bentham). Trying to help the rich stay rich is something else.
37
If "single payer is the only answer" -- and only 3 nations on earth have single payer -- explain how all countries in Europe manage? They have UNIVERSAL COVERAGE...but not single payer. In fact, each nation has somewhat different ways of dealing with health care, and the cost varies dramatically from country to country.
Senate GOP working hard so we have the best health plan ever! Ocare in a death spiral! Poor people just stop being poor! or move! Sad!
2
The unwillingness to serve rural areas just makes a stronger case for Medicare for all. Most Americans live in cities but those who live in rural areas shouldn't be treated as second class citizens just because they are the minority. Other countries provide better healthcare that costs half as much as ours because they spread the burden equally throughout their entire country. People in rural areas receive the same level of care as city dwellers.
22
It all sounds like the old days when AT&T wouldn't provide rural phone service until the govt made it a prerequisite to providing service where it was profitable. The same could be done here, with the very big stick that the govt would take over the entire program everywhere if there was no compliance.
35
The Republicans found that they could effectively sabotage the ACA by putting certain payments in doubt and failing to enforce penalties on those who choose not purchase insurance. Insurance relies on the ability to accurately forecast the future and the right wing has made the medical insurance market unpredictable. Republicans both created and complain about the problems created.
The right wing also ignores the obvious fact that the healthcare industry is not a classical capitalist market. First, when you are sick or injured, care is essential and comparison shopping time is limited. When you are not sick, healthcare can be ignored. Second, we may not have single payer but we have a very limited number of payers that dominate the market. In other words, the US medical system is more monopoly than free market. The result is a market failure that delivers high prices and poor results. Neither the ACA nor whatever the right dreams up will change this essential fact.
The right wing also ignores the obvious fact that the healthcare industry is not a classical capitalist market. First, when you are sick or injured, care is essential and comparison shopping time is limited. When you are not sick, healthcare can be ignored. Second, we may not have single payer but we have a very limited number of payers that dominate the market. In other words, the US medical system is more monopoly than free market. The result is a market failure that delivers high prices and poor results. Neither the ACA nor whatever the right dreams up will change this essential fact.
17
It was a huge, but a predictable mistake, to allow the vast majority of medical services companies to merge into just a handful. We see this in other US industries as well.
2
And yet, what is done to prevent this? Or even slow it down? Amazon-Whole Foods, anyone???
The problem exists only because no "public option" is available. A public option would have effectively guaranteed the availability of at least one insurance plan regardless of where you lived.
Why was the public option not an option in Obamacare?
You can thank former Democratc Senator Joe Lieberman. Because of the insurance companies headquartered in Connecticut, Lieberman refused to sign on. Without Lieberman's vote, Obamacare would not have passed.
There was good reason for calling him "Traitor Joe."
Why was the public option not an option in Obamacare?
You can thank former Democratc Senator Joe Lieberman. Because of the insurance companies headquartered in Connecticut, Lieberman refused to sign on. Without Lieberman's vote, Obamacare would not have passed.
There was good reason for calling him "Traitor Joe."
69
Looks like a perfect lab for a public option with state wide rating for costs.
They don't have anything to lose.
They don't have anything to lose.
9
I know an easy way to cut insurance costs; cap doctors's pay to a mere $350,000 per year, which sure sounds like a lot to me. Surely they don't need or even want to live in big mansions while their patients are suffering; they may not realize that they are earning so much money off the backs of the working poor. And also, hospital administrators do not need to earn more than $250,000; if $50,000 is enough for the average guy and gal, than 5x should be enough for them. And lastly, force drug companies to charge people without prescription drug insurance the same price they charge insurance companies for their medicines. This "Friends and Family" rate could be given to the general public. And once a patent expires, ban the original maker from charging more than the "generic" price. Those drug people don't need 7-figure salaries any more than I need a 6-figure salary. If I can live well on $70,000, so can they.
5
Amen. Big Amen. On the MD salaries and the administrators salaries. For sure. Feeling same about pharma CEOs - $250K is plenty - but consider sales people who are on commission? Move to salary? $125,000 should be fine. They're not selling luxury goods to multi-millionaires, no matter how much they sell, but necessary drugs and devices for the well-being and survival of the ill and for the common good of society. Time to infuse positive mission and ethics back into work and, even, capitalism. It can be done.
1
I agree that cost controls are essential, there is no objective reasons why costs in USA should be 50-100% higher than in Canada and West Europe. However, it is a much more complex issue than "the easy way" you have mentioned. Many of the best (if not most most moral) minds of this nation produce tricks to increase their profits from American health care needs.
Only "single payer" system, if not sabotaged by Congress, can control the cost. Keep in mind that this is a big "if".
Only "single payer" system, if not sabotaged by Congress, can control the cost. Keep in mind that this is a big "if".
@NMAAHC what shall we cap YOUR salary at? Surely you can live on less than $70,000. You don't need more than one coat, one pair of shoes, two shirts and two pairs of pants. How many lives have you saved lately, anyway?
1
The authors have missed the point. The Republicans have touted weak competition and limited choice as their excuse for the collapse of the ACA for the ENTIRE country--not just rural areas. Here in suburban New Jersey my husband and I pay $16,000 for a plan with a $5,000 family deductible, meaning we must hit $21,000 out of pocket expenses before we receive any reimbursement. (We work for ourselves and are not eligible for Obamacare subsidies. That said, it doesn't mean that $21,000 per year is an easy, acceptable amount for us). Under Obamacare, we must purchase health insurance in NJ only. If we could buy a policy from Texas where premiums are cheaper, it is quite possible that Horizon BCBSNJ would be forced to be competitive. Under the circumstances, we really have no healthcare, albeit catastrophic, and are paying for those on subsidies and Medicaid who probably see doctors more that we did. THAT too is part of the Republican argument.
8
I am on Medicare. Now I live in FL, but for a long time we lived and worked in NJ. My wife had insurance as an employer in NJ that cost $684 per month with national coverage. Now she has retired too. The best we can do in FL is a Blue Cross plan costing $1400 or so per month, with an out-of-pocket $3000. It too covers the country, not just Florida or parts thereof (some are county plans). We can manage, but it's a lot of after tax $.
1
I don't get it. Why $21,000 before you get reimbursement. Don't you get reimbursement after the $5000 deductible is satisfied?
How would a health insurance policy from Texas help you in NJ? As other's have stated, our private health insurance model relies on insurance companies negotiating rates with "in-network" hospitals, doctors, and providers. You Texas policy would only give you access to the network that they negotiated which almost certainly is within the state of Texas.
Moreover, your policies are regulated by your state insurance commission (aka "local control"). The Texas policy would have to pass their review.
This is consistent with other common insurance policies. Life, auto, homeowners are all controlled at the state level and need to be approved by the respective commission. Just because State Farm sells in NJ and TX, doesn't mean you're "buying across state lines." You can't buy an auto policy from TX when you live in NJ.
Moreover, your policies are regulated by your state insurance commission (aka "local control"). The Texas policy would have to pass their review.
This is consistent with other common insurance policies. Life, auto, homeowners are all controlled at the state level and need to be approved by the respective commission. Just because State Farm sells in NJ and TX, doesn't mean you're "buying across state lines." You can't buy an auto policy from TX when you live in NJ.
6
"There’s Only One Grocery Store in Most Rural Areas."
Which one sells Cheerios?
Which one sells Cheerios?
2
Just checked, there's three Walmart supercenters in the whole state of Kansas.
5
Lucky them...
1
Why can't we have national insurance, rather than state? Seems ridiculous to have state by state insurers. Can't something be done about this?
13
Insurance companies are regulated by the states. Different rules apply per state and even per county. Insurance carriers have to set up a network of doctors and hospitals that will accept their payments and they negotiate with these at the county level.
The real answer to the inequities is a single-payer, national system - like medicare.
The real answer to the inequities is a single-payer, national system - like medicare.
14
"Why can't we have national insurance, rather than state?"
Because States' Rights, I suppose. The "something that can be done about this" is a national single-payer system that completely eliminates the for-profit health insurance industry. But, remember who shot Bulworth when he dared advocate for such a thing.
Because States' Rights, I suppose. The "something that can be done about this" is a national single-payer system that completely eliminates the for-profit health insurance industry. But, remember who shot Bulworth when he dared advocate for such a thing.
2
This is precisely why we needed the public option, the government is the insurer of last resort.
13
Congress subsidies rural electric, internet, telephone and many other services going to rural areas - not counting 80-years of farm subsidies (all live off the urban taxpayers). But under Obamacare the GOP is cutting healthcare fuinding to insurance companies and it impacts rural areas most - its the GOP's self-fulfilling death spiral. Subsidize health care to rural areas and the insurance companies will return. The uncertainly and threat to withdraw more money into Obama care by the GOP is the source of most problems. Medicad has worked in America's rural areas, But GOP threats to cut Medicad and Obama care are destroying any reason for private insurers to stay there.
18
It's time to stop defending Obamacare when it is not working for the people who foot the bill for running this great country. These are the people to work for their healthcare benefits, pay out of their pockets for care and pay heavy taxes to fund healthcare for many that do not work. There are millions of these people. and as long as the system doesn't work for them it will not survive.
6
The author's comparison between grocery stores and health insurers just doesn't hold up. I lived in rural areas of Arizona for years. We always had access to more than one grocery store - and I mean actual, well stocked grocery stores, not Kmart. We shopped the sales. The stores competed with each other.
I never had to drive more than 30 minutes to have a choice of grocery stores. I don't think the author understands that a 30 minutes drive for groceries is not in any way the same as having to drive 3 HOURS in order to get health care.
OF COURSE there should multiple health insurers. There shouldn't be a monopoly anywhere. As long as they remain for-profit, they should have competiiton.
I never had to drive more than 30 minutes to have a choice of grocery stores. I don't think the author understands that a 30 minutes drive for groceries is not in any way the same as having to drive 3 HOURS in order to get health care.
OF COURSE there should multiple health insurers. There shouldn't be a monopoly anywhere. As long as they remain for-profit, they should have competiiton.
6
People who live in rural counties already are covered by Medicare, VA health care and some nation-wide health care programs administered by the Interior Dept. covering reservations and tribes. State programs like Medicaid cover individuals living in rural areas as well. These programs, especially Medicare find a cost-effective way to provide access to what health care exists locally and to the urban health care centers rural residents must go to for serious issues.
Not all aspects of health care can be profit centers. Keeping open sufficient emergency or birthing centers in rural areas will never be money-making enterprises. Expecting a robust market for individual insurance in sparsely populated rural areas is a ridiculous notion. Forcing all health care to be at the whim of "market forces" is an artificial construct which makes no sense in reality. This obsolete ideology will not create a strong, secure country with healthy communities.
Not all aspects of health care can be profit centers. Keeping open sufficient emergency or birthing centers in rural areas will never be money-making enterprises. Expecting a robust market for individual insurance in sparsely populated rural areas is a ridiculous notion. Forcing all health care to be at the whim of "market forces" is an artificial construct which makes no sense in reality. This obsolete ideology will not create a strong, secure country with healthy communities.
9
As I understand it, and I'm probably wrong, insurers must stay within State lines. This really alters the economic dynamic. But if you'd follow the single payer Medicare model, you'd get economies of scale, diluting the small % of sick in a larger pool of healthy.
10
One insurer indeed would be enough for everybody: expand Medicare! Single Payer Now!
91
Agreed mdieri..or a system similar to it. The rest of the civilized world has figured it out. It is amazing we are still debating this issue and living in literally the middle ages with it.
7
By expanding Medicaid or Medicare this widens the door open for more fraud.
One can look at market forces, insurance and geography from a different angle. It is economically unattractive for insurers to offer plans in rural areas, so they make the choice not to. That fact makes it at least one reason why it may be economically unattractive to live in a rural area - and in this country residents have the freedom to choose to live in denser communities with more health care options.
Of course, one could see us all as a single community - getting health care coverage from a single payer.
Of course, one could see us all as a single community - getting health care coverage from a single payer.
50
Many residents of rural US areas have the option of foraging, hunting, and fishing for food; essentially free sources of nutrition.
You are advocating rural folks moving to the cities. Biggest problem with that is who is going to grow your crops, your vegetables, your cattle and animals for your plate?
Rural America is dying on its own, continued increase in cost of health insurance, or its total absence will force more people to sell out, and the country's food cost will go up and products may not even be available.
Why not go to universal health care which will take the excess monopoly profit out of the system, and should include government and non profit dominance of the markets. Why is the Republican party continuing to kill Americans to make wealthy middle east dictators more profit as health care insurance and provider investors? It is as if the GOP is now a partner to terrorists!
Rural America is dying on its own, continued increase in cost of health insurance, or its total absence will force more people to sell out, and the country's food cost will go up and products may not even be available.
Why not go to universal health care which will take the excess monopoly profit out of the system, and should include government and non profit dominance of the markets. Why is the Republican party continuing to kill Americans to make wealthy middle east dictators more profit as health care insurance and provider investors? It is as if the GOP is now a partner to terrorists!
I keep wondering if the "Public Option" might have been a solution to this problem. I think we came very close to having the option to buy Medicare in addition to the Insurance Company options on each exchange.
It seems to me that this would have, had it been included, ensured at least one option in every geography AND ensured competition and lower costs.
Very sorry that the Dems did not include this. A common argument back then was that it was a "back door" to Medicare for all.
It seems to me that this would have, had it been included, ensured at least one option in every geography AND ensured competition and lower costs.
Very sorry that the Dems did not include this. A common argument back then was that it was a "back door" to Medicare for all.
10
The problems with rural health care are three fold (I know, I live in rural flyover country). First, the number of competing providers has dwindled significantly. Usually the one or two providers are corporations that gobbled up clinics and private practices. Second, insurance is regulated at the state level and always has been. They are the gatekeepers and excluders of insurance companies. The entire state should be a risk pool and the regulators should not allow cherry picking by insurance companies. Third, just like the federal employee coverage, an insurance provider (e.g. Blue Cross) sets a price for all employees nationwide and each blue cross unit within each state accepts that price so the rural federal employee pays the same price as the urban resident. It is a way to greatly widen the pool and prevents the slice and dice we see from individual states and insurance companies. If some such method of cross border pricing was available to the general public, it would solve the problem.
7
Nope, even in the Blues, the same price is not paid by a company for the premiums across multiple states. They reimburse each other for actual costs within their areas. Then the "home" plan takes those costs and develops the rates billed to employers. Worked for 10 years in a Blues plan in the accounting department that billed and paid and reconciled payments for groups that had "national" coverage between multiple Blues plans. Even within a state, a company could pay different rates at plants located in different counties or that had different types of workers.
2
I saw South Dakota Senator Mike Rounds on Brian Williams show the night before last. He claimed that prior to Obamacare, South Dakota with a population of around 850,000 had around 13 companies offering group insurance and around 13 companies offering individual insurance and now, after Obamacare, they were down to two. So what he was saying and what this column says are diametrically opposed. What is the truth?
Rounds was a very smooth talker and said a number of things that, as far as I could tell, misrepresented how Obamacare works, so I wouldn't be at all surprised if he was in some way distorting the insurance situation in South Dakota prior to the ACA. Does anyone know more about this?
Rounds was a very smooth talker and said a number of things that, as far as I could tell, misrepresented how Obamacare works, so I wouldn't be at all surprised if he was in some way distorting the insurance situation in South Dakota prior to the ACA. Does anyone know more about this?
9
Can't answer specifically about South Dakota, but there used to be a lot of policies individuals could buy. Most of them were inadequate. When we were first married (a long time ago), my wife had one of these policies. She had an emergency operation and was in intensive care for about a week. 6 days in, I got a call from the hospital's accounting department informing me that here policy had hit it's maximum payout (I think it was $10,000) and I had to make arrangements for the balance or they would sue to garnish my wages. Took me about 4 years to pay off the balance.
So when politicians talk about all the choices in the past, many of them were bad choices.
So when politicians talk about all the choices in the past, many of them were bad choices.
21
JJ: what your wife had is often called "mini-med" and it has a very low cap for coverage -- but please don't assume that because she bought that policy without reading it, that EVERYONE prior to the ACA had "mini-med" or inadequate plans. That is simply NOT TRUE.
1
What's beyond me is how a "business", that's so desperately in need for big and balanced risk pools, could be regionally fragmented down to the county level.
Only nation-wide coverage will be sustainable in the long term. Not necessarily a single-payer system would be needed. Doing away with this fragmentation alone would already help with getting costs down by more negotiation leverage and more balanced pools.
Maybe if health care law required all insurers to offer nation-wide plans, the "market" might possibly sort out some of its worst problems on its own.
Only nation-wide coverage will be sustainable in the long term. Not necessarily a single-payer system would be needed. Doing away with this fragmentation alone would already help with getting costs down by more negotiation leverage and more balanced pools.
Maybe if health care law required all insurers to offer nation-wide plans, the "market" might possibly sort out some of its worst problems on its own.
10
The problem is the way most insurance plans work these days. They are based on "in-network" providers, which means there is a list of health care providers who they contract with to charge a certain amount for treatments, etc. If you use a provider who is "out-of-network," either the insurance company won't pay the bill or will only pay a part of it. For an insurance company to offer a nationwide plan, they would need to organize and negotiate with providers all over the country. As this column points out, where there is only one hospital and a limited number of physicians, the insurance companies have little leverage over prices. In all likelihood, they would balk at a nationwide plan for both practical and economic reasons. We really need to take a serious look at our entire health care system and figure out how to make it work best for all of us rather than primarily for the benefit of executives and investors. Some people say that the country is too large for us to have the kind of systems they have in other industrialized countries, but Canada, I believe, actually has the provinces administer their health care.
19
Here we see the miracle of the market at work, in combination with, dare I say it, a blind spot in the vision of the founding fathers.
Compare Australia, where the Federal parliament has power to make laws about insurance under a constitution which makes any Federal law override contrary state laws. So in Australia it has been relatively easy to establish a universal health care system, although a user-pays and privately insured system exists alongside it. Australia also has a universal pharmaceutical benefit scheme that makes approved medicines available at very modest prices, subsidised by the community as a whole.
It is certainly easier to become very rich as a medical practitioner or health insurance executive in the US than in Australia. But this benefit is one which we, as a community, are largely prepared to forego.
Query whether the commerce clause would permit Congress to regulate the private health insurance market to a degree that affordable insurance is made available to all: I really don't know, but am aware of the legal shenanigans brought in the wake of the ACA. Alternatively, I would have thought that each state, which as I understand controls its own insurance licensing, could regulate coverage and, shudder, pricing.
Compare Australia, where the Federal parliament has power to make laws about insurance under a constitution which makes any Federal law override contrary state laws. So in Australia it has been relatively easy to establish a universal health care system, although a user-pays and privately insured system exists alongside it. Australia also has a universal pharmaceutical benefit scheme that makes approved medicines available at very modest prices, subsidised by the community as a whole.
It is certainly easier to become very rich as a medical practitioner or health insurance executive in the US than in Australia. But this benefit is one which we, as a community, are largely prepared to forego.
Query whether the commerce clause would permit Congress to regulate the private health insurance market to a degree that affordable insurance is made available to all: I really don't know, but am aware of the legal shenanigans brought in the wake of the ACA. Alternatively, I would have thought that each state, which as I understand controls its own insurance licensing, could regulate coverage and, shudder, pricing.
2
Not really. The Blues plans were originally set up to be non profit mutual plans that worked together across state lines to process claims for each other. The problem started when many of them went to "for profit" plans. Anthem started out as a Blues mutual company, then in the 1990's went to profit.
2
It's easy to expand coverage. The federal government can require that the commercial companies that insure federal employees must be on the exchanges. They already have the networks of providers set up. Or, the states could require the insurers who cover state employees be on the exchanges. That might be only Blue Cross & Blue Shield, and that's OK. It just takes some political will....
6
Obamacare was never perfect but it was a start. Before it there were high risk pools where a single person might be charged $10,000/year for coverage, there was no guarantee of coverage for children 18-26, and no guarantee of coverage for pre-existing conditions. Wasn't that fun, GOP? Whatever system we develop, we must force drug companies to charge a fair price for their merchandise and streamline costs so that a CT scan in one place is not $3000 more expensive than another. Hospitals need to focus on patient care rather than glitzy billboards extolling their virtues. And we the people need to take responsibility for our own health to the extent that we can.
9
Wouldn't the way to do that be to expand Medicare coverage to everyone? People could pay premiums based on a sliding scale of income. Medicare already has the best cost controls in the market, and agreements with providers everywhere. Most people on Medicare are actually serviced by a plan, administered by one of the large insurance companies already.
Companies and individuals could still choose other plans, where available, but everyone would at least have the guarantee of of good medical care, wherever they were. Plus the influx of younger, healthier people into the Medicare system would reduce the per-head costs of that system.
Companies and individuals could still choose other plans, where available, but everyone would at least have the guarantee of of good medical care, wherever they were. Plus the influx of younger, healthier people into the Medicare system would reduce the per-head costs of that system.
16
People already do take responsibility for their own health as best they can. Problem is, not everyone has an average IQ--millions and millions of people have a low average or borderline IQ (I'm not counting people with MR, who generally have others helping them make healthy eating and activity decisions).
Not everyone has the leisure time to be active (try standing on your aching feet all day at work, then a long commute home, feeding your family, and... a nice 5-mile run through a dangerous neighborhood? A gym membership you can't afford? Exercises you can't do with a toddler crawling over you?
Many people overeat when severely stressed. We already know shaming doesn't help and most diets fail. Much of their stress is caused by factors beyond their control (fear of job loss & homelessness, coping with a loved one's medical bills).
People who are already ill have an even steeper route to attaining good health on their own, and non-millionaires often have more factors working against them than assisting them.
I worry about the notion that ill health is a personal failure and can thus be fixed by reminding people it's their own dang fault... rather than finding ways to assist them in an often overwhelming struggle.
Not everyone has the leisure time to be active (try standing on your aching feet all day at work, then a long commute home, feeding your family, and... a nice 5-mile run through a dangerous neighborhood? A gym membership you can't afford? Exercises you can't do with a toddler crawling over you?
Many people overeat when severely stressed. We already know shaming doesn't help and most diets fail. Much of their stress is caused by factors beyond their control (fear of job loss & homelessness, coping with a loved one's medical bills).
People who are already ill have an even steeper route to attaining good health on their own, and non-millionaires often have more factors working against them than assisting them.
I worry about the notion that ill health is a personal failure and can thus be fixed by reminding people it's their own dang fault... rather than finding ways to assist them in an often overwhelming struggle.
32
Rural health care used to be less expensive than urban care. That was when medicine was an altruistic profession rather than a for-profit business. There are many more surprises to come. We already see women dying with greater frequency in the modern Texas for profit health care. Get ready America, you are next.
5
You know, Canada has vast areas with low population density. All Canadians have health care. Why does this article not explore options beyond private insurance? What we need from the NYT is a series on how we might transition to a national health service, what it might cost, and how long it might take.
One thing seems clear. If we go to a national service, we need to make sure much of the money that employers pay to insure their employees goes into the system, either through higher wages/taxes or directly from business to service. Perhaps starting with the latter and moving toward the former.
One thing seems clear. If we go to a national service, we need to make sure much of the money that employers pay to insure their employees goes into the system, either through higher wages/taxes or directly from business to service. Perhaps starting with the latter and moving toward the former.
105
Even countries that are far less rich than Canada manage to provide decent healthcare to remote communities. Not long ago I was on a remote island in Greece when a flotilla of speedboats in V-formation pulled into the harbor, seven or eight of them I think. It turns out that they were specialist doctors who travel from island to island to treat patients, which is apparently more efficient than doing things the other way around. If a poor, chaos-prone country like Greece can do something like this, surely America could too. And I'll bet the doctors were having the time of their lives while they were at it.
1
Richard Janssen: Greek doctors can do this, because they earn a fraction of what wealthy American doctors earn. When you earn $400K a year, your time is unbelievably valuable, so that patients MUST come to you -- rather than you go to them.
I'd love to see this system reformed -- but please tell me how we convince American doctors to work for European wages and cut their income by half or more?
I'd love to see this system reformed -- but please tell me how we convince American doctors to work for European wages and cut their income by half or more?
1
CC: Good to hear from you. Slashing the cost of higher education would obviously help, as would a different approach to malpractice litigation. But as to how to convince doctors in the US to adopt a more altruistic, idealistic ethos, beats me. Despite what you rather disparagingly call their "European wages", doctors I know in Germany lead comfortable enough lives, though they generally lack the exalted status of their US peers. I think it's fair to say that few of them are in it for the money.
1
I buy individual health insurance, and just got a letter from my insurer, saying they were getting out of the individual health insurance market, and I should look elsewhere. I wonder how many letters like that went out this year? I wonder how much I will have to pay next year? Already I'm paying twice as much for medication than I did last year, under a different policy. The pharmacist apologized when I saw my first bill. Plus, spending time trying, each year, to figure out what health insurance to buy. Oh, for a single payer system! I lived under one once, in England, and it was so easy. You could work on your health, rather than your health insurance.
91
Why can't we design a system both useful and user friendly?
1
This is nothing new and can be solved in the simple old fashioned way. If you want to provide home or life or auto insurance, you must also provide health insurance. Providers of more lucrative types of insurance will use those insurance profits to shore up health insurance losses. Not lucrative for political back door profits, though.
6