Health care game changer?

[Gravis Marketing]

It is not possible to have a regulation that simultaneously makes consumers, insurance agencies, and health care providers *all* better-off. 

Yet this comes close. If there's a market inefficiency or a prisoner's dilemma that is cured with a regulation, it's possible for everyone to be better off.

[Torie]

What are the market inefficiencies, other than those perhaps caused by government regulation, to wit, one cannot shop for plans outside one's own state?

[Senator Sbane]

Employers wouldn't be allowed to charge more for an adult child than those under the age of 18,

Isn't this a subsidy, to wit not being "allowed to" charge market rates?  I will take a look at your link. The assumption that with government involvement, "administrative costs" will just magically disappear or at least be slashed, is one that I question of course.

So kids of all ages are being subsidized right now? Because the plan is not being changed, just the eligibility.

Also in Switzerland, where insurance companies are private (not sure if non-profit), administrative costs are about 5% of total costs. For individual plans here, it runs above 20%. You are deluded if you somehow think we have the best health care system, even after excluding those dirty uninsureds.

[Torie]

The scope changed, but not the price. That suggests a subsidy. This administrative cost issue does deserve study of course. I do know that the billing system through insurance companies is expensive and time consuming, and needs to be revamped. In fact the way medical services are delivered needs to be revamped, using HMO's and having telephone consults, and everything getting computerized, and so forth.

If you can find where I ever wrote that the US has the best health care system in the world, putting aside the uninsureds or otherwise, I will give you one of  my properties. I am confident that I didn't, because I think our current system sucks. Cheers.

[Gravis Marketing]

What are the market inefficiencies, other than those perhaps caused by government regulation, to wit, one cannot shop for plans outside one's own state?

If you can shop for plans outside your state, all insurance companies will relocate to the state (South Dakota, Delaware, take your pick) that offers it the least regulation and croniest enforcers, and decline to offer policies adhering to higher standards, and that will be all that's in the market. We can rule that out.

The market is inefficient because:
1. Customers are woefully underinformed about what procedures to get and what they should cost, and it's not realistic for them to become experts
2. People often need health care at times where it's an emergency and they can't comparison shop or do their homework
3. The tax provisions which tie insurance to compensation mean that many companies have oligopsonistic power which hurts everyone outside of them
4. Similarly, with health care as a form of compensation, individuals don't have incentive to know or care what things cost
5. People value life and health in bizarre ways that break market analysis
6. Yes, government regulation
7. Adverse selection
8. Moral hazard

[Torie]

What are the market inefficiencies, other than those perhaps caused by government regulation, to wit, one cannot shop for plans outside one's own state?

If you can shop for plans outside your state, all insurance companies will relocate to the state (South Dakota, Delaware, take your pick) that offers it the least regulation and croniest enforcers, and decline to offer policies adhering to higher standards, and that will be all that's in the market. We can rule that out.

The market is inefficient because:
1. Customers are woefully underinformed about what procedures to get and what they should cost, and it's not realistic for them to become experts
2. People often need health care at times where it's an emergency and they can't comparison shop or do their homework
3. The tax provisions which tie insurance to compensation mean that many companies have oligopsonistic power which hurts everyone outside of them
4. Similarly, with health care as a form of compensation, individuals don't have incentive to know or care what things cost
5. People value life and health in bizarre ways that break market analysis
6. Yes, government regulation
7. Adverse selection
8. Moral hazard

Well yes, you need national standards. That goes without saying, if you are going to subsidize premiums up to a certain level of coverage. So you say, well we have found vendors on a competitive bid basis or whatever (probably most of them HMO's, so if someone wants a PPO, they will have to pay the additional cost because it won't be subsidized), who will charge a premium not to exceed X for this level of coverage, which we will subsidize on a means tested basis (well everyone would get a tax credit if they have insurance, but folks of means will be paying more taxes to offset the credit), so now go out there and shop nationwide for the best deal you can get, and hey, if you can get it cheaper, from a company that is sound, and performs well, with the given level of coverage, you get to keep the savings.

Price transparency and performance results, all on line, would mitigate a lot of the lack of information issue. Health care needs to be severed from the employer, and insureds need an incentive because they will be paying out of pocket, to comparison shop. I did not mean to suggest that the current system does not have market inefficiencies, but rather that they are not so much inherent to the product, but more due to dumb rather than smart government intervention or tax policies or the like, or the way we handle the care of lack thereof of the impecunious, and/or feckless.

This should not be about ideology. It should be about pragmatism. Ideology in this realm really, really sucks. I hate it!

[Senator Sbane]

The scope changed, but not the price. That suggests a subsidy. This administrative cost issue does deserve study of course. I do know that the billing system through insurance companies is expensive and time consuming, and needs to be revamped. In fact the way medical services are delivered needs to be revamped, using HMO's and having telephone consults, and everything getting computerized, and so forth.

If you can find where I ever wrote that the US has the best health care system in the world, putting aside the uninsureds or otherwise, I will give you one of  my properties. I am confident that I didn't, because I think our current system sucks. Cheers.

Ugh, you must pay for healthcare yearly when getting it through your employer. If your kid stays on your plan longer, you pay more for longer and so does the employer. Again you refuse to answer my question, but do you think the employer paying for a kid who is under the age of 18 a subsidy or part of compensation?

And you think the current private insurance system sucks leaving aside Medicare and Medicaid? That's news to me. I always though you had a love affair with insurance companies. And I don't think they are evil or anything but the way our system is set up imposes these extra costs on them. In our system the healthy might just not purchase insurance if not provided by their employer, which is why insurance companies are paranoid about making sure they know exactly what every applicants health history is. In a group, the paranoia subsides a bit. And if we ensured that the entire population had to join the market, the paranoia would subside further. Hmm, I wonder which bill did that.

As for reducing costs we need to go to a system where payments are made based on outcomes and not services provided. Easier said than done though. And I'm glad to see Romney talking about it. Though if a Democrat came out and proposed it (let's not forget the individual mandate was a republican idea) suddenly all republicans would be against it.

[Torie]

do you think the employer paying for a kid who is under the age of 18 a subsidy or part of compensation?

Part of it is a government subsidy because the "compensation" is not taxed (while the poor individual has to use after tax dollars), but otherwise presumably yes, it is a part of compensation. And then suddenly for the same price insurance companies have to keep covering the rug rats until age 26 rather than 18 or 21 or whatever. That suggest a subsidy, because if that rule did not screw them, why wouldn't they just do that on their own? So since all insurance companies have to do this, they recover their additional costs through raising premiums on others.

Anyway, those are my factual assumptions and reasoning. I hope I answered your f'ing question! 

[Senator Sbane]

do you think the employer paying for a kid who is under the age of 18 a subsidy or part of compensation?

Part of it is a government subsidy because the "compensation" is not taxed (while the poor individual has to use after tax dollars), but otherwise presumably yes, it is a part of compensation. And then suddenly for the same price insurance companies have to keep covering the rug rats until age 26 rather than 18 or 21 or whatever. That suggest a subsidy, because if that rule did not screw them, why wouldn't they just do that on their own? So since all insurance companies have to do this, they recover their additional costs through raising premiums on others.

Anyway, those are my factual assumptions and reasoning. I hope I answered your f'ing question! 

Fair point on the tax incentives, something that needs to be changed of course.

The people getting screwed here are the employers providing insurance, not the insurance companies. They have to pay for a part of their premiums for about 5-6 years longer than they would otherwise. They will likely take this out of compensation for the employees or raise premiums for the family plan. I couldn't find much complaining about this on the Internet so I don't know exactly who is so pissed off about this. Seems like you are alone here.

As for the insurance companies, I am sure they love this arrangement. More customers for them who otherwise would likely not purchase health insurance unless they needed access to health care.

And my overall point here is that parts of Obamacare are good. Not just the letting adult children stay on plans but the creation of exchanges and letting people form groups to lower costs as well as the individual mandate which is also a good idea. Changes should be made to it but the whole thing should not be discarded. Republicans only want to do that for political reasons so they can get credit for health care reform when in fact they were too timid to start when they were in power.

[Torie]

We start anew, and if some parts of Obamacare are the best way to go, then sure. For example, how to deal with the uninsured sicks, and how folks can move from insurance company to insurance company after they get sick, is a hideously complex problem potentially. Obamacare might have some mechanisms that might prove useful.

As to the 26 years old thing, it seems that next to nobody understands the complex cross subsidy issues, except myself and that lawyer Clement who argued that Obamacare was un-Constitutional before SCOTUS, with that being its Achilles Heel legally. So your internet anecdote does not surprise me at all. Obamacare makes zero logical sense here for the reasons that I outlined, but then much of what we end up doing doesn't.

[Senator Sbane]

You are certainly wrong about insurance companies being forced to cover more people for the same money. Completely wrong.

What did Clement say btw? I am interested in reading or hearing that. Which day of the oral arguments was that?

[Torie]

You are certainly wrong about insurance companies being forced to cover more people for the same money. Completely wrong.

What did Clement say btw? I am interested in reading or hearing that. Which day of the oral arguments was that?

I still don't understand why I am wrong, but whatever. I am just obtuse I guess. But I explained my reasoning.  In fact I think that was one thing that was mention by Anthem in one of their rate increase letters - the mandatory to age 26 thing. I guess it could be researched.

I have to run now, but I will discuss Clement later. I think I have some posts up about it, which you might do a search for. Once you have cross subsidies, you can't have a clear limiting principle to the degree of the erosion of what remains of the limits of the reach of the commerce clause is the gist of it. Without the cross subsidies, I think you can as to the mandate, even though the solicitor general was too incompetent to explain that, and Clement clearly was not going to help him. Clement was ready to pounce on the cross subsidy aspect of the mandate, like a cat near a big fat wounded bird limping along on the ground. That left poor Ruth Bader Ginsburg muttering well, social security has a cross subsidy too, and yes it does. But guess what?  SS is a tax!  Game, set and match.

[Senator Sbane]

Oh I remember that, but that was not dealing with keeping adult children on their parent's insurance, but rather cross subsidies from the young who purchased their plans to the old.

Also it looks like if you have an individually purchased family plan, insurers would be required to keep on your kids until the age of 26. Of course you would still be paying the premium for the family plan so I don't see what the problem is. If covered by your employers, you and the employer would be paying the premiums on a shared basis.

This is what is confusing you I think....this is what the department of labor says.

Q7: Will young adults have to pay more for coverage or accept a different benefit package?

Any qualified individual must be offered all of the benefit packages available to children who did not lose coverage because of loss of dependent status. The qualified young adult cannot be required to pay more for coverage than similarly situated individuals who did not lose coverage due to the loss of dependent status.

https://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html

[Torie]

Oh I remember that, but that was not dealing with keeping adult children on their parent's insurance, but rather cross subsidies from the young who purchased their plans to the old.

Also it looks like if you have an individually purchased family plan, insurers would be required to keep on your kids until the age of 26. Of course you would still be paying the premium for the family plan so I don't see what the problem is. If covered by your employers, you and the employer would be paying the premiums on a shared basis.

This is what is confusing you I think....this is what the department of labor says.

Q7: Will young adults have to pay more for coverage or accept a different benefit package?

Any qualified individual must be offered all of the benefit packages available to children who did not lose coverage because of loss of dependent status. The qualified young adult cannot be required to pay more for coverage than similarly situated individuals who did not lose coverage due to the loss of dependent status.

https://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html

I am not sure what the bolded part means exactly, or its intent. This will just have to be researched as to whether insurance companies are losing money on these 18 to 26 year olds.

[Senator Sbane]

Oh I remember that, but that was not dealing with keeping adult children on their parent's insurance, but rather cross subsidies from the young who purchased their plans to the old.

Also it looks like if you have an individually purchased family plan, insurers would be required to keep on your kids until the age of 26. Of course you would still be paying the premium for the family plan so I don't see what the problem is. If covered by your employers, you and the employer would be paying the premiums on a shared basis.

This is what is confusing you I think....this is what the department of labor says.

Q7: Will young adults have to pay more for coverage or accept a different benefit package?

Any qualified individual must be offered all of the benefit packages available to children who did not lose coverage because of loss of dependent status. The qualified young adult cannot be required to pay more for coverage than similarly situated individuals who did not lose coverage due to the loss of dependent status.

https://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html

I am not sure what the bolded part means exactly, or its intent. This will just have to be researched as to whether insurance companies are losing money on these 18 to 26 year olds.

I think it means others who are dependent on health insurance from another persons employment such as spouses and children under the age of 18.

[True Federalist]

Oh I remember that, but that was not dealing with keeping adult children on their parent's insurance, but rather cross subsidies from the young who purchased their plans to the old.

Also it looks like if you have an individually purchased family plan, insurers would be required to keep on your kids until the age of 26. Of course you would still be paying the premium for the family plan so I don't see what the problem is. If covered by your employers, you and the employer would be paying the premiums on a shared basis.

This is what is confusing you I think....this is what the department of labor says.

Q7: Will young adults have to pay more for coverage or accept a different benefit package?

Any qualified individual must be offered all of the benefit packages available to children who did not lose coverage because of loss of dependent status. The qualified young adult cannot be required to pay more for coverage than similarly situated individuals who did not lose coverage due to the loss of dependent status.

https://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html

I am not sure what the bolded part means exactly, or its intent. This will just have to be researched as to whether insurance companies are losing money on these 18 to 26 year olds.

I think it means others who are dependent on health insurance from another persons employment such as spouses and children under the age of 18.

What it means is that the people who were kicked off their parent's plan because they were too old but are now eligible to be covered cannot be charged the higher rate that some plans charge if the parent chooses to drop coverage of their dependents, but then seeks to resume coverage.

[Senator Sbane]

Oh I remember that, but that was not dealing with keeping adult children on their parent's insurance, but rather cross subsidies from the young who purchased their plans to the old.

Also it looks like if you have an individually purchased family plan, insurers would be required to keep on your kids until the age of 26. Of course you would still be paying the premium for the family plan so I don't see what the problem is. If covered by your employers, you and the employer would be paying the premiums on a shared basis.

This is what is confusing you I think....this is what the department of labor says.

Q7: Will young adults have to pay more for coverage or accept a different benefit package?

Any qualified individual must be offered all of the benefit packages available to children who did not lose coverage because of loss of dependent status. The qualified young adult cannot be required to pay more for coverage than similarly situated individuals who did not lose coverage due to the loss of dependent status.

https://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html

I am not sure what the bolded part means exactly, or its intent. This will just have to be researched as to whether insurance companies are losing money on these 18 to 26 year olds.

I think it means others who are dependent on health insurance from another persons employment such as spouses and children under the age of 18.

What it means is that the people who were kicked off their parent's plan because they were too old but are now eligible to be covered cannot be charged the higher rate that some plans charge if the parent chooses to drop coverage of their dependents, but then seeks to resume coverage.

Ah, thanks for that. So does the requirement to cover kids up to 26 years of age a burden on insurance companies as opposed to those paying the premiums, whether it's just the parent in an individual plan or the employer and the parent in an employer provided plan?

[greenforest32]

A drop in the bucket compared to some real game changers:

http://www.huffingtonpost.com/dean-baker/do-liberals-have-to-be-lo_b_940798.html

There has also been a massive strengthening of patent and copyright laws in this period. As a result of patent protection, we pay almost $300 billion a year for prescription drugs that would sell for about $30 billion a year in a free market. The difference of $270 billion is more than 5 times as large as the amount at stake with the Bush tax cuts.

http://www.deanbaker.net/images/stories/documents/End-of-Loser-Liberalism.pdf

pg. 138-139
Most people will pay almost any price to protect their life or the life of a loved
one. Giving the drug companies‟ monopoly control over potentially life-saving
drugs  is  like  allowing  firefighters  to  negotiate  their  pay  package  with  the
homeowner when the house is on fire. Needless to say, firefighters would be
very well paid under these circumstances, and drug companies raise enormous
revenue under the patent system.

Of  course,  the  research  and  testing  necessary  to  bring  a  drug  to
market has enormous costs. But this expenditure has already been made when
the drug comes on the market. The key goal of progressive policy should be to
separate  the  payment  for the  research  from  the  payment  for  the  drug. 

If the payment for the research is made independent of the payment for the drug,
then all drugs can be sold in a free market without patent monopolies, just as
generic drugs are sold today. The two main alternatives for financing research
apart from the patent system  are  a  prize  system and direct public  funding. 
Both would involve an expansion of public  funding  for biomedical research.

Currently,  the federal government spends  $30  billion  a  year on biomedical
research through the National Institutes  of  Health. For an additional  $30  billion
to $80 billion  it could  replace the research currently funded through the patent
system. Even taking the higher figure, the government would soon recoup this
cost through savings  on  drug  expenses  in  Medicare,  Medicaid,  and  other
public  health programs.

Once a cost is off the government budget, it's automatically cheaper and more efficient right?

[Purch]

Yes Torie, keeping those who are in internships or graduate school on health plans where their costs are lower due to employer contributions is a good thing. Employer contributions into health care for everybody is necessary for the system to stay solvent. Whether you do that with payroll taxes followed up by subsidization of care or through schemes like keeping people on their parents plans till 26 is your choice. I prefer the former since it helps out everyone and not just those whose parents have insurance, bu the Republicans haven't proposed that have they? And speaking of which, have the Republicans proposed a plan that will ensure most of the uninsured get insured?

I assume it's something similar to Dems not proposing a budget in years because Paul Ryan's and other repubs budget was too far to the right.

I mean why propose a health care bill when Obamacare was as far left as it can go with the complete socialization of healthcare?


One of two things needs to happen in these senerious

1. Either the other party proposes a plan as far left or right as the original plans and they work something towards the middle. Which would involve both parties actually having real plans for both healthcare and the budget.

or

2. Congress continues to be as dysfunctional as it already is.

[Χahar]

Obamacare was as far left as it can go with the complete socialization of healthcare

Is this a joke?

[Torie]

Obamacare was as far left as it can go with the complete socialization of healthcare

Is this a joke?

It probably should be infractable to use the word "socialism" or "socialization." These days they are just contentless expletives, and should be inksable.

[Purch]

I mean feel free to explain to me where I'm wrong. I'm not saying Obamacare is a bad thing in fact I do agree with how it adresed the healthcare issue in our country.

By socialization I mean mandating everyone to buy healthcare so because everyone is puting money in so then you can distribute the HC to the whole country.

And let me explain I don't belive socialism is a dirty word I just associate it with the extremeist on the far left because I've seen a lot of similarities between the socialist party specificlly in france and far left democrats.

Democrats I don't associate with socialism, however extreme democrats who wants to repubuild this country by applying a hundread taxes, rasing corprate taxes and taxing the rich so they can spend more do seem to cross that border in my opinion.

Just like I have a tendency to associae people on the far right as extreme neo-con capitalist who don't truly understand why certain things that support the middle class and the poor sholdn't be cut before the military budget.

Again I'd be happy to be corrected as I'm only 18 and gained and intrest in politics within the last 7 months.

[anvi]

If you can find where I ever wrote that the US has the best health care system in the world, putting aside the uninsureds or otherwise, I will give you one of  my properties. I am confident that I didn't, because I think our current system sucks. Cheers.

Well geez, Torie, if you are going to put a property on the table, that's enough to bring me out of my self-imposed dungeon.

Almost every other industrialized country on earth has basically solved the problems of providing both universal access to heath care and controlling health care costs. -anvikshiki

Ya, they did it, through more Draconian rationing in large part (and I agree that rationing is essential in any system), and pursuant to the US subsidizing most drug research via the mechanism that US consumers pay far more for prescription drugs than the rest of the planet because other rich nations with single payer systems are monopsony buyers.
...
Addendum: One other thought occurs to me. My impression is that US MD's still make considerably more on average than MD's in other rich nations. If that ends, over time, will the quality of MD's in the US decline?  That may be a necessary evil, but the point is that there is no free lunch here, that will expand medical services without substantially increasing costs, or degrading the quality of same. There just isn't that much fat in the system, and very little fat in the private insurance mechanism. Heck effecting rationing in a more Draconian fashion will entail substantial administrative costs, as a triage system is created, and continually evaluated, and enforced.

And:

You don't think it is fair to suggest, that say vis a vis, Britain, 80% (or some such percentage) of the medical services consumers in the US get more rapid access, (assuming there is any access at all in some instances in single payer systems and the like), to expensive medical procedures? You have not read that in the UK, you often have to wait months to get an MRI, while for example, just last week, I got one in 2 days (of which my insurance company will pay the bulk of the $1,400 cost)?  That is one of the prime reasons, if not the prime reason, that medical care in the US is so much more expensive. We just get more...

Of course, I am compelled to be fair about the qualification you made immediately after the above comments.

...and for that reason primarily, the system is collapsing from a fiscal standpoint. Granted, about 20% are royally screwed in the US as to even minimally adequate  medical care, and that is neither sensible, moral, or sustainable, either.

This qualification is enough to prevent me from winning the bet for either myself or on sbane's behalf.  But, s*%t, you put a free property on the table...you can't blame a guy for trying. 

Would you settle for buying me a drink, Steve?

[Torie]

It would be a pleasure to buy you a drink anvi.  And btw, just because the US health care system has some plus points vis a vis Britain, or did, or whatever, does not mean it is anywhere near getting out of the land of suckdom. I have been ranting about how silly and dysfunctional it is since about the time you kissed your first girl.

[Progressive Realist]

Health care should be affordable and universal.