Is Mitt right?

[dblack]

You already did that.

And?

The answer to "what I would do" depends on the question. I'm not even really sure what problem PPACA (guaranteed issue insurance combined with the individual mandate) is trying to solve.

In my view, there are two distinct problems with the health care market. And the problems require different, and in some ways conflicting, solutions.

First is the problem of runaway health care inflation. Health care prices have been increasing much faster than the rate of inflation for several generations now. There are many factors causing that, not the least of which is that most people who are insured are "over-insured". Their inherent lack of normal consumer motivations distorts the market and drives prices ever higher.

The second problem, which sounds closer to what you're concerned with, is what to do about health care for the poor. Which is a special case of what to do about the poor in general. As someone who values voluntary cooperation and freedom over dictatorial government, I prefer a voluntary approach toward community responsibility. But I also understand that's not very popular these days. People like the idea of passing laws that force someone else to do the dirty work for them.

Recognizing that political reality, I'd say we simply beef up Medicare. Government run safety nets, while not my first choice, aren't the worst solution. Certainly not as bad as the lunacy being promoted by PPACA.

EDIT: I'd also add that, while the first of these problems seems less urgent (certainly to sick people without insurance coverage) it's actually the more important of the two. Because as health care prices continue to climb, more and more of us can't afford it. To put it another way, if health care prices were to come down, less of us would be affected by the second problem. So reversing health care inflation is crucial, otherwise we won't be able to build a 'safety-net' large enough or strong enough.

 

[rightwinger]

So someone who had cancer as a child or someone who has heart disease and lost their job is just shit out of luck

I don't know why you'd presume that. Forcing insurance companies to act irrationally isn't the only way to care for people who fall through the cracks - or even a very good one.

The only answer is cradle to grave health insurance that you can carry your whole life.

The only answer? I bet even you could think of others if you tried.

We are forcing insurance companies to respond to the whole market, not just the part they can make the most money off of. Currently, insurance companies pick who they want to cover and the rest get dumped on the taxpayer. We are basically telling them......if you want access to the market, you have to serve the whole market
Our existing system of some people having access to employer provided insurance while others operate on the fringe does not work. People take jobs and remain in unwanted jobs because they need the insurance. Lose your job, lose your insurance. People need access to insurance they can carry for their whole life

 

[BDBoop]

And frankly, if it takes a presidential act to get said insurance companies to stop overcharging us simply for being female? I'm all for it.

 

[Moonglow]

So they are just screwed, is what you're saying.

sure, repubs want death panels operated by insurance companies, look at Arizona. But we are a christian nation.

 

[dblack]

Insurance companies are in business to make money, not to pay claims. Insurance companies are amoral; the GOP policy which puts insurance companies before individual human beings is immoral.

Fair to say. So why would we want amoral companies to be responsible for caring for the poor?

I wouldn't, therefore, I'm not a Republican.

Whatever. I'm not talking about left/right, Democrat/Republican crap - rather the irrationality of trying to push community safety net responsibilities on the insurance companies. I guess I'm not clear on what you're advocating here. Are you for guaranteed issue, or not?

 

[dblack]

We are forcing insurance companies to respond to the whole market, not just the part they can make the most money off of. Currently, insurance companies pick who they want to cover and the rest get dumped on the taxpayer. We are basically telling them......if you want access to the market, you have to serve the whole market

No offense, but that isn't rational. It's not the way insurance works. As many here have pointed out.

Our existing system of some people having access to employer provided insurance while others operate on the fringe does not work. People take jobs and remain in unwanted jobs because they need the insurance. Lose your job, lose your insurance. People need access to insurance they can carry for their whole life

Absolutely agree. We've screwed up royally by allowing the insurance industry to implant itself as the defacto 'provider' of health care. Insurance should be a stop-gap, a protection against catastrophic loss. Instead, we've bought into the idea that we can use it to finance our regular health care expenses. In that sense, it's just a shitty credit card with a really high interest rate.

 

[oldernwiser]

Requiring insurance companies to cover pre existing conditions means that most people just wouldn't get insurance at all until they were diagnosed. What is more persuasive is to be prohibited from covering pre existing conditions for someone who is just changing companies but has paid for insurance.

California has a state provision that covers those considered "uninsurable" due to pre existing conditions. The downside is, they can only be treated at the county hospital.

Most states already have a high risk pool set up to accommodate those who were rejected by private insurers. These folks pay MUCH higher rates, but, IMO, that's only fair.

Health insurance rates are set using a loss ratio applied to a specific group - benefits paid divided by premiums paid. As people with a MUCH higher risk are accepted in a specific group, the ratio approaches 100%. ACA would cap insurance providers to 80% before they ask for rate hikes - but how long do think it will take before the ACA plan starts to look really good financially?

As it is, the costs of medical services is expected to rise another 7+% next year, and will continue a 4 to 6% per year climb for the next decade at least. This is the benefits paid portion of the equation. Adding the requirement of pre-existing conditions (where the new subscriber WILL be using benefits) means a MUCH higher premium.

Do you know how many people we have in this country with preexisting conditions that insurance companies rejected? 1% 10% 50%???? And are you saying, we as Insurance payers now, are ALREADY experiencing higher costs for our insurance so to pay for those without insurance...? Are the hospitals charging more for procedures etc to the insurance companies when their negotiations are made right now to cover those with preexisting conditions, and also for those without insurance....

basically, aren't our prices now for health insurance much higher than they should be, to cover the hospital's expense for all of those patients the hospitals take in with pre existing conditions or no insurance to help pay the bill?

Wasn't health insurance increasing each year before the health care bill passed at around 7%-12% a year and what was the reason for these increases the decade BEFORE Obama care?

Just wondering...

Lot of questions, but let's see if I can get them all.

Do you know how many people we have in this country with preexisting conditions that insurance companies rejected?

This one depends on who you ask. California says that 87% of their population is insured, for example. They don't give this number in terms of who qualified for private insurance, high risk pool, or Medi-Cal. The point being is that there seems to be a way to be insured if you have the cash to do so, and there are state and federal government sponsored programs to cover some of the folks who don't.

And are you saying, we as Insurance payers now, are ALREADY experiencing higher costs for our insurance so to pay for those without insurance...? Are the hospitals charging more for procedures etc to the insurance companies when their negotiations are made right now to cover those with preexisting conditions, and also for those without insurance....

I'll answer these as block because they pretty much point to the same thing. We are indeed experiencing higher premiums in most states. These are due to a quite a few factors. 1st, understand that insurance is a pool of OUR OWN money. Over the last few years we've been losing the good jobs which would allow us to participate in employer group plans. In fact the jobs outlook has been bleak pretty much since 2001. Fewer contributors to the pool means less resources.

At the same time, medical costs themselves - from medical provider services to durable equipment to pharmacology - have been steadily rising at about 4-7% per year (also depending on who you ask).

But, people get sick or are injured whether they are insured or not. And they need treatment which they may not be able to afford. And, despite the horror stories you hear, public hospitals are mandated by every state to treat patients without regard to their ability to pay. Hospitals are businesses, and treating patients who don't pay isn't good for profits, so they amortise their losses by inflating the prices for the people who CAN pay. They also tend to have multiple rates depending on whether you are paying for services yourself, paying with insurance, or paying through Medicare or Medicaid - call your local hospital or family doctor and see this yourself.

And, on the subject of pricing negotiations between insurers and service providers, these values are based on "reasonable and customary" charges for particular services. They aren't necessarily the lowest price. Profits WILL be made by the providers.

basically, aren't our prices now for health insurance much higher than they should be, to cover the hospital's expense for all of those patients the hospitals take in with pre existing conditions or no insurance to help pay the bill?

Maybe... I know that North Carolina mandates a medical loss ratio of not less than 60%. State law also says that if the loss ratio exceeds 80%, the insurance company can raise the rate to bring the ratio back to 80%. In my state, $0.20 to $.40 of every dollar paid for premiums is never returned to us in the form of health care payments. Is that why our premiums are so high? I don't think so. IMO, premiums are high because the cost for services are the highest they've ever been - for a ton of reasons - and is expected to continue to be so for a long time to come.

 

[Si modo]

Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions

Read more: Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions - NY Daily News

Is Obama right?

Sources: Obama administration mulls pared-back health law if court strikes down mandate | Fox News

To forestall such a problem, the administration asked the court -- if it declares the mandate unconstitutional -- to also strike down certain consumer protections, including the requirement on insurers to cover people with pre-existing health problems.

 

[BDBoop]

Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions

Read more: Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions - NY Daily News

Is Obama right?

Sources: Obama administration mulls pared-back health law if court strikes down mandate | Fox News

To forestall such a problem, the administration asked the court -- if it declares the mandate unconstitutional -- to also strike down certain consumer protections, including the requirement on insurers to cover people with pre-existing health problems.

Oh, thank you! Because the next sentence explains why.

That would mitigate a damaging spike in premiums.

 

[Si modo]

Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions

Read more: Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions - NY Daily News

Is Obama right?

Sources: Obama administration mulls pared-back health law if court strikes down mandate | Fox News

Oh, thank you! Because the next sentence explains why.

That would mitigate a damaging spike in premiums.

So, you're in favor of not covering pre-existing conditions.

 

[oldernwiser]

Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions

Read more: Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions - NY Daily News

Is Obama right?

Sources: Obama administration mulls pared-back health law if court strikes down mandate | Fox News

To forestall such a problem, the administration asked the court -- if it declares the mandate unconstitutional -- to also strike down certain consumer protections, including the requirement on insurers to cover people with pre-existing health problems.

There are some provisions in the ACA which are very good for seniors, such as closing the prescription donut hole for Medicare recipients.

But, here's what I found most interesting:

Overturning the mandate would have harmful consequences for the private insurance market. Under the law, insurers would still have to accept all applicants regardless of health problems, and they would be limited in what they can charge older, sicker customers.

As a result, premiums for people who directly buy their own coverage would jump by 15 percent to 20 percent, the Congressional Budget Office estimates. Older, sicker people would flock to get health insurance but younger, healthier ones would hold back.

I believe that the CBO's estimate is low - or at least doesn't tell the whole story.

First, there's a very troubling provision in ACA which sets the medical loss ratio to a firm 80%, meaning that insurance companies can only keep 20% of the premiums collected for administrative costs. There's also a provision which mandates that insurance companies pay into a high risk pool - which also comes from our premiums. This will mean there's absolutely no cash to pay commissions to brokers/agents - which kills that sector of the insurance industry.

Next, consider what happens when seniors are able to buy into the health care pool at a diminished rate, and people with pre-existing conditions can't be turned away. As I stated in a post above, the medical loss ratio = Benefits Paid / Premiums Collected, which under ACA is a firm 80%. If the CBO is correct, then the addition of these 2 groups of people will mean that the insurance companies will raise rates 15-20% because the benefits they pay out till only jump 15-20%. However, this can only happen if the Premiums Collected portion of the formula is steady. As the prices rise, fewer people will be able to afford insurance. Also, there's a price point where the higher cost of insurance doesn't make sense to people who rarely use insurance benefits - resulting in even fewer subscribers. Premiums would then have to rise AGAIN to account for that reduction in subscribers. Essentially, at some point, insurance companies will begin to re-assess their own viability in the market because they can't collect enough funding to reasonably cover the care of their subscribers - and (illegal?) intrastate marketing will only go so far to hold that off. And that leaves EVERYONE out in the cold.

Obviously the pre-existing conditions clause will have to go. The reduced rates for seniors will have to go. Now think about the other great things ACA has to offer - closing the Medicare donut hole, for example. This was to be funded by the (imaginary?) increase in subscribers. Who will fund that now?

That pretty much leaves us with the issue of regulating the insurance companies themselves and allowing for rate-shopping in "foreign" markets. In 1945, SCOTUS declared insurance to be commerce (governed by the Sherman Act) unless Congress said otherwise. In 1946, Congress did, indeed, say otherwise when they passed the McCarron-Ferguson Act. Essentially, this placed the regulation of the insurance industry in the hands of the individual states. This law will need to be repealed in order for us to access intrastate markets - something that looks great in the short term, but allows monopolies (read that as price fixing and higher average rates) to develop as a natural course of action. ACA does not contain much for intrastate regulation language, which allows lower rate rural markets to become saturated with higher cost industrial markets.

Please don't get me wrong here - I'm all for health care reform. But the more I delve into how ACA works the less reform I actually see. Being the equal opportunity hater that I am, I also don't see anything all that promising coming to replace this legislation either.

 

[ItsjustmeIthink]

Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions

Read more: Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions - NY Daily News

Is Obama right?

Sources: Obama administration mulls pared-back health law if court strikes down mandate | Fox News

To forestall such a problem, the administration asked the court -- if it declares the mandate unconstitutional -- to also strike down certain consumer protections, including the requirement on insurers to cover people with pre-existing health problems.

If, in America, taking steps to prevent sickness was more popular than simply taking a pill after you've already gotten sick then insurance companies shouldn't have to pay for pre-existing conditions. However, we all know that isn't true and for companies to try and avoid having to pay for pre-existing condistion, its obvious that's just an attemp at extra profits.

I like my country, but all to often people prioritise money over human life.

 

[BDBoop]

Is Obama right?

Sources: Obama administration mulls pared-back health law if court strikes down mandate | Fox News

Oh, thank you! Because the next sentence explains why.

That would mitigate a damaging spike in premiums.

So, you're in favor of not covering pre-existing conditions.

I'm not in favor of damaging spikes in premiums, if the SCOTUS rules against the Act.

 

[oldernwiser]

Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions

Read more: Mitt Romney: Insurance companies should be allowed to deny coverage for pre-existing conditions - NY Daily News

Is Obama right?

Sources: Obama administration mulls pared-back health law if court strikes down mandate | Fox News

To forestall such a problem, the administration asked the court -- if it declares the mandate unconstitutional -- to also strike down certain consumer protections, including the requirement on insurers to cover people with pre-existing health problems.

If, in America, taking steps to prevent sickness was more popular than simply taking a pill after you've already gotten sick then insurance companies shouldn't have to pay for pre-existing conditions. However, we all know that isn't true and for companies to try and avoid having to pay for pre-existing condistion, its obvious that's just an attemp at extra profits.

I like my country, but all to often people prioritise money over human life.

Here's where you kind of come off the tracks a bit. Insurance companies would have no problem with taking on pre-existing conditions if we didn't mind paying more for our premiums - much more. It's not exactly the insurance companies who pay for care - they get their money from us. I, as well as others in our group, pay for your care.

If you would care to do some googling, check out your state's laws regarding how much "profit" insurance companies are allowed to make. It ain't much, and it has to be approved by your state's Department of Insurance.

 

[dblack]

Here's where you kind of come off the tracks a bit. Insurance companies would have no problem with taking on pre-existing conditions if we didn't mind paying more for our premiums - much more.

Sure, but that's hardly an 'if'. For many it's not even a question of "minding" - for many employers and individuals, higher premiums simply means they won't be able to afford it.

The bottom line is, we're trying to save a health insurance scheme that's not viable. The sooner we allow it to pass, and find better ways to finance our health care, the better. PPACA is just a last-gasp attempt to save the old paradigm.

 

[oldernwiser]

Here's where you kind of come off the tracks a bit. Insurance companies would have no problem with taking on pre-existing conditions if we didn't mind paying more for our premiums - much more.

Sure, but that's hardly an 'if'. For many it's not even a question of "minding" - for many employers and individuals, higher premiums simply means they won't be able to afford it.

The bottom line is, we're trying to save a health insurance scheme that's not viable. The sooner we allow it to pass, and find better ways to finance our health care, the better. PPACA is just a last-gasp attempt to save the old paradigm.

You're right - it's not a big "if" at all. The fact is that insurance companies know they're walking a tightrope - if they raise rates, people can't afford them. They do what they can by passing on more of the actual expenses to the subscribers, but eventually we'll be priced out of medical care completely.

ACA can ONLY be thought of as a stop-gap measure. In it's entirety, it will force new money into the system. But, IMO, the only way to make health care affordable to everyone is to find a way to reduce medical costs themselves. ACA does not do that.

 

[dblack]

... IMO, the only way to make health care affordable to everyone is to find a way to reduce medical costs themselves. ACA does not do that.

Exactly. Arguably, ACA amplifies the upward price pressure on health care by doubling down on failed approach to funding health care. We need less insurance, not more. We're suffering from the mass delusion that insurance can make our health care expenses 'go away', and it can't. Health insurance, like all insurance, only works as a hedge against unforeseen risk. As a means of financing regular health care expenses it's irrational and is the root of the problem.