Virgiana lawsuit vs. Healthcare bill clears first hurdle!!

[Greenbeard]

I think I made my position pretty clear, if it be a man or a woman that wishes to purchase health insurance for themselves and their family they should have affordable options available to them. Medical history, while I do not think anyone should be denied medical converage based on medical history, I do feel that once the factors that actually ahave an effect on the high cost of medical care are aactually addressed there will be little change in the high cost of providing health insurance to those with pre-existing conditions.

There's a lot in what you've said there and entire pages of thread could be chewed up talking about this. But the key seems to be the focus on the "high cost of medical care"--here we have to make sure we distinguish between the price of health insurance (or even the direct price of care a provider would charge) and the cost of providing that care.

Many times people focus very much on the price of insurance and so they design solutions based entirely on the premise that health insurance should be de-regulated at the state level. But those "solutions" don't correspond to "if it be a man or a woman that wishes to purchase health insurance for themselves and their family they should have affordable options available to them," in part because the savings some hope to achieve that way are achieved by shedding risk or denying benefits to some. That strategy has nothing to do with addressing the cost of care itself (this is in fact one of the primary places that the reform law differs from those approaches).

Personally, I believe that it would take little effort to provide a catastrophic health insurance program , much like life insurance for everyone at a low cost through Medicare.

It sounds like you're advocating a Medicare-for-all sort of system with sufficiently high deductibles and cost-sharing. I'm intrigued, all though you'd have to work out some of the equity issues on the cost-sharing front.

My position is that if the incentives are there then this silly notion of mandates will not be needed and young people as well as older Americans will sign up for a regular payroll deduction for a catastrophic policy at the very least.

Even with catastrophic coverage plans (however you would define that), you'll still have to deal with issues of adverse selection issues if people can opt in without having paid much or anything in through the (voluntary?) payroll deductions you mention.

 

[Oddball]

Many times people focus very much on the price of insurance and so they design solutions based entirely on the premise that health insurance should be de-regulated at the state level. But those "solutions" don't correspond to "if it be a man or a woman that wishes to purchase health insurance for themselves and their family they should have affordable options available to them," in part because the savings some hope to achieve that way are achieved by shedding risk or denying benefits to some. That strategy has nothing to do with addressing the cost of care itself (this is in fact one of the primary places that the reform law differs from those approaches).

That premise presumes that people have some kind of right to an insurance risk pool.

Since when is that the case?

 

[Navy1960]

I think I made my position pretty clear, if it be a man or a woman that wishes to purchase health insurance for themselves and their family they should have affordable options available to them. Medical history, while I do not think anyone should be denied medical converage based on medical history, I do feel that once the factors that actually ahave an effect on the high cost of medical care are aactually addressed there will be little change in the high cost of providing health insurance to those with pre-existing conditions.

There's a lot in what you've said there and entire pages of thread could be chewed up talking about this. But the key seems to be the focus on the "high cost of medical care"--here we have to make sure we distinguish between the price of health insurance (or even the direct price of care a provider would charge) and the cost of providing that care.

Many times people focus very much on the price of insurance and so they design solutions based entirely on the premise that health insurance should be de-regulated at the state level. But those "solutions" don't correspond to "if it be a man or a woman that wishes to purchase health insurance for themselves and their family they should have affordable options available to them," in part because the savings some hope to achieve that way are achieved by shedding risk or denying benefits to some. That strategy has nothing to do with addressing the cost of care itself (this is in fact one of the primary places that the reform law differs from those approaches).

Personally, I believe that it would take little effort to provide a catastrophic health insurance program , much like life insurance for everyone at a low cost through Medicare.

It sounds like you're advocating a Medicare-for-all sort of system with sufficiently high deductibles and cost-sharing. I'm intrigued, all though you'd have to work out some of the equity issues on the cost-sharing front.

My position is that if the incentives are there then this silly notion of mandates will not be needed and young people as well as older Americans will sign up for a regular payroll deduction for a catastrophic policy at the very least.

Even with catastrophic coverage plans (however you would define that), you'll still have to deal with issues of adverse selection issues if people can opt in without having paid much or anything in through the (voluntary?) payroll deductions you mention.

Think about it a moment, there has been much debate over this so called public option, one which I find rather stunning because we already have a public option that is age limited called Medicare and the support structure in place to support it. So it makes little sense to create a new one. I am advocating Medicare until you are age qualified for full coverage as a catastophic insurace program, much like a life insurance policy would cover someone, or a long term disability policy would. Plus, in a system where someone would volunteer through payroll deductions or even direct pay, they can even be given the option of purchasing full coverage if they so desire. From a funding standpoint it has the added bonus of shoring up Medicare and keeping the program solvent. As for defining what is catastrophic coverage , I define it as coverage such as in patient hospital care, etc. things such as regular Doctors visits and continuing care can be addressed through the purchse of plans in the marketplace. I don't see a system of mandates working very well especially from an enforcement standpoint. Lets say you have 200 million in the system and 100 million not in the system are you going to expend the billions of dollars needed to enforce the law on those that choose not to particpiate ? It seems to be a self defeating law IMHO ...

 

[Tech_Esq]

I think I made my position pretty clear, if it be a man or a woman that wishes to purchase health insurance for themselves and their family they should have affordable options available to them. Medical history, while I do not think anyone should be denied medical converage based on medical history, I do feel that once the factors that actually ahave an effect on the high cost of medical care are aactually addressed there will be little change in the high cost of providing health insurance to those with pre-existing conditions.

There's a lot in what you've said there and entire pages of thread could be chewed up talking about this. But the key seems to be the focus on the "high cost of medical care"--here we have to make sure we distinguish between the price of health insurance (or even the direct price of care a provider would charge) and the cost of providing that care.

Many times people focus very much on the price of insurance and so they design solutions based entirely on the premise that health insurance should be de-regulated at the state level. But those "solutions" don't correspond to "if it be a man or a woman that wishes to purchase health insurance for themselves and their family they should have affordable options available to them," in part because the savings some hope to achieve that way are achieved by shedding risk or denying benefits to some. That strategy has nothing to do with addressing the cost of care itself (this is in fact one of the primary places that the reform law differs from those approaches).



It sounds like you're advocating a Medicare-for-all sort of system with sufficiently high deductibles and cost-sharing. I'm intrigued, all though you'd have to work out some of the equity issues on the cost-sharing front.

My position is that if the incentives are there then this silly notion of mandates will not be needed and young people as well as older Americans will sign up for a regular payroll deduction for a catastrophic policy at the very least.

Even with catastrophic coverage plans (however you would define that), you'll still have to deal with issues of adverse selection issues if people can opt in without having paid much or anything in through the (voluntary?) payroll deductions you mention.

Think about it a moment, there has been much debate over this so called public option, one which I find rather stunning because we already have a public option that is age limited called Medicare and the support structure in place to support it. So it makes little sense to create a new one. I am advocating Medicare until you are age qualified for full coverage as a catastophic insurace program, much like a life insurance policy would cover someone, or a long term disability policy would. Plus, in a system where someone would volunteer through payroll deductions or even direct pay, they can even be given the option of purchasing full coverage if they so desire. From a funding standpoint it has the added bonus of shoring up Medicare and keeping the program solvent. As for defining what is catastrophic coverage , I define it as coverage such as in patient hospital care, etc. things such as regular Doctors visits and continuing care can be addressed through the purchse of plans in the marketplace. I don't see a system of mandates working very well especially from an enforcement standpoint. Lets say you have 200 million in the system and 100 million not in the system are you going to expend the billions of dollars needed to enforce the law on those that choose not to particpiate ? It seems to be a self defeating law IMHO ...

Well, I don't see the "support structure" that supports it when there is a 38 Trillion dollar unfunded mandate for obligations made by, but not paid for, the medicare system.

The basic facts are simple and dramatic:

* Medicare has an unfunded liability of almost $38 trillion;
* Medicare's hospital insurance trust fund will become insolvent in 2017;
* Congress has ignored funding warnings; and
* American households will inherit hundreds of thousands of dollars worth of debt.

Time to Get Serious (Again) About Medicare Reform | The Heritage Foundation

Asking Medicare to support the rest of the health care of the nation would be like diverting I-95 over a 150 year old wooden bridge that nobody had been over in 40 years. The result are apparent, patent and predictable.

 

[Navy1960]

Tech, my feeings are not based on a system thats Free nor unfunded, Medicare is just the vehicle that IMHO could serve as an insurance organization by which people could PURCAHSE which is the keyword, low cost catastrophic coverage through payroll deductions or direct pay. While Im sure there would be several bumps in the road along the way, eventually if mamanged correctly, I don't see that part as an unfunded mandate.

 

[Tech_Esq]

Tech, my feeings are not based on a system thats Free nor unfunded, Medicare is just the vehicle that IMHO could serve as an insurance organization by which people could PURCAHSE which is the keyword, low cost catastrophic coverage through payroll deductions or direct pay. While Im sure there would be several bumps in the road along the way, eventually if mamanged correctly, I don't see that part as an unfunded mandate.

I understand your desire to provide a catastrophic type policy for reasonable prices. I agree with the goal. I understand that Medicare is an existing system that provides medical insurance that seems like it might be an available tool. (Why reinvent the wheel? Right?)

What I'm pointing out is that Medicare as a program is a powder keg that is about to explode. Now, if you figured out how to remedy all that ails the existing program and then wanted to add something on to it, we would have a different discussion (I would still be opposed, but for philosophical reasons, not economic/financial reasons.

I think the better position for the government is one of creating marketplace by designing the rules by which a nationwide market for health insurance exists and setting up a "pay to play" system for health insurance companies. The funds would partially offset payments to low income people who cannot afford to purchase insurance. That fund would be matched by the Feds and possibly the states. Coverage could be had across state lines and HSAs would be mandatory.

Until the "third-party" payer is taken out of the health care system, we will not have any price reform. When people start using "consumer-like" shopping habits for medical care, then we will see some movement on prices. HSAs are instrumental in that behavior.

 

[Greenbeard]

Think about it a moment, there has been much debate over this so called public option, one which I find rather stunning because we already have a public option that is age limited called Medicare and the support structure in place to support it. So it makes little sense to create a new one. I am advocating Medicare until you are age qualified for full coverage as a catastophic insurace program, much like a life insurance policy would cover someone, or a long term disability policy would. Plus, in a system where someone would volunteer through payroll deductions or even direct pay, they can even be given the option of purchasing full coverage if they so desire.

Something sort of like that was entertained during the health care debate: by the leadership, a limited version (opening a Medicare buy-in option only to people aged 55-64) and by the more radical legislators, a full "open Medicare to anyone who wants to buy in." Neither went very far.

The public option proposal existed in a number of forms but in its purest (and original) form, it piggybacked on Medicare. It used the same DRG prospective payment system (with provider reimbursements bumped up by 5%) as Medicare and started off with the same provider network, though Medicare providers could opt out of the public issue if they chose to. So, yes, it would make some sense to take the ostensibly simpler route of just modifying Medicare.

I don't see a system of mandates working very well especially from an enforcement standpoint. Lets say you have 200 million in the system and 100 million not in the system are you going to expend the billions of dollars needed to enforce the law on those that choose not to particpiate ? It seems to be a self defeating law IMHO ...

The mandate exists because if 1) anyone can buy an insurance plan when they want it, and 2) the ability of the insurer to charge discriminatory rates based on medical history is curtailed you run into a problem: adverse selection. People can choose to not buy coverage until they get sick (at which point they can buy it without fear of exclusion or discriminatory rates), leaving insurance pools disproportionately filled with people who are drawing benefits, i.e. are less healthy. That's a problem that medical underwriting currently exists to address. But if medical underwriting is to be scaled back because the logic of it is exclusionary (i.e. based on people not being able to buy a plan when they want to), then it has to be replaced with something. That's where the individual mandate comes in.

If you had a publicly financed system, you wouldn't need to mandate anything, you'd just finance it out of tax revenue and if a citizen wants to use the services they do. But since we're taking a stab at largely private near-universal coverage we need to have some mechanism in place to prevent adverse selection from destroying insurance markets.