What's a health insurance exchange?

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Greenbeard, Jul 21, 2010.

  1. Greenbeard
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    Greenbeard Gold Member

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    The centerpiece of the insurance-related portion of the new reform law is the creation of state-level health insurance exchanges ("American Health Benefit Exchanges"). Sounds like a pretty importance concept but what is it, why have both Republican and Democratic reform bills called for their creation, and what are they supposed to do?

    GWU and Robert Woods Johnson are working together to create Health Reform GPS, a very well put together resource for navigating the implementation of reform. The other day they released a brief on health insurance exchanges that some of you may find helpful.

    I'm going to quote some of the background here but if you want more information about what they are, what they're going to be doing and what they're required under the new law to be doing, follow that link. Lots of information.

     
  2. Greenbeard
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    Greenbeard Gold Member

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    Some news on the exchanges yesterday. HHS is now requesting input from "states, consumer advocates, employers, insurers, and other interested stakeholders" on the rules and standards that exchanges will be subject to. They also announced the availability of grants to "give states resources to conduct the research and planning needed to build a better health insurance marketplace and determine how their Exchanges will be operated and governed." Implementation is moving forward.
     
  3. seofriend6
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    seofriend6 Rookie

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    This was a gr8 article indeed lot to learn..

    Emphasis was good.. nice to read.. Thanks for sharing..

    ..
     
  4. editec
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    editec Mr. Forgot-it-All

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    The most rational system for insurance in society is a universal system IF the point of the system is to provide the most coverage at the lowest cost to society overall.

    Of course since this collectivation of risk goes against the whole concept of capitalism, we cannot find the political will to make that sage decision.

    The more balkanized our insurance system the higher the costs (overall to society) it will be.
     
  5. AVG-JOE
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    AVG-JOE American Mutt Staff Member Gold Supporting Member

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    And the higher the profits for insurance companies...

    The best 'exchange' I've seen for auto insurance is the TV - why not let every insurance company try to sell their insurance to everyone in America? The biggest problem I see with the status quo is that 'capitalist' ideals have been removed from the picture - if health insurance were a market of competition, we'd see them advertise.

    If America doesn't have the political will to remove the middle man, create a truly public option and 'self insure', the least we can do for the consumer is make creating an insurance company easy and let them compete in any market they have the stones to try.

    It's not like 'insurance' is rocket science.... all you need to open an insurance company is a computer and a truck-load of cash.
     
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  6. Skull Pilot
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    Skull Pilot Platinum Member

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    Good point Joe but it's not just insurance that needs to be subjected to the full force of free market pressure but the health care industry as well.

    No one knows what anything costs when it comes to their health care. If we knew the menu and the prices, we could shop around and let competition between medical providers drive prices down.

    Another issue is insurance companies dictating what doctor one has to see. health insurance should cover you no matter what doctor you visit which would apply even more market pressure to the system.
     
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  7. editec
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    editec Mr. Forgot-it-All

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    The basic conept of insurance is to spread risk.

    Obviously the larger the pool the better it works.

    Private insurance is not more efficient than universal precisly because it creates more than one risk pool.

    Now that universal system doesn't need to be run by government to be more efficient.

    It merely needs to be universal.

    But any money spent on advertising or sales is money not spent on providing HC.

    so here's a collectivist/cpaitalist proposal...

    ONE for-profit, public utility insurance company.

    It guarantees a modest return on investment but the cost of insurance is set by the government, as are the prices paid to the private HC providers.

    And since its the ONLY game in town, this system has the ability to set payments for services rendered.

    Now who will be the loser in this system?

    Private insurance companies and the providers of HC who will not be able to make enormous amounts of money for their services.

    And who will byhe winners be?

    Everybody else.
     
    Last edited: Aug 17, 2010
  8. AVG-JOE
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    AVG-JOE American Mutt Staff Member Gold Supporting Member

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    Absolutely. But I'll take baby steps. After introduction of a truly competitive insurance market the spending decisions would need to be returned to the consumer soon or the smaller, leaner insurance companies won't survive getting started and the only change would be the Doctors Union running the cash cow instead of the Insurance Executives good-old-boys club.
     
  9. AVG-JOE
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    AVG-JOE American Mutt Staff Member Gold Supporting Member

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    Only if I get an equal voice with everyone else who uses it in selecting those who run it as the years go by..... kind of like the way we vote for boys and girls who run the public utilities that run Social Security, The Airports, National Security, Education, etc. but more efficiently if we can pull it off.
     
    Last edited: Aug 17, 2010
  10. auditor0007
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    auditor0007 Gold Member

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    I'll give this a "bravo". Health insurance is a huge mess because the insurance comapanies along with healthcare providers are the ones calling all the shots. I've said this over and over again. The true cost for healthcare is nowhere near what we are paying. Since I was forced to go without health insurance when I moved out of state, I have found that the true cost is drastically less for everything I need compared to what was being paid through insurance companies in the past.

    Examples?

    Ultrasound of my liver: before through insurance, $1200; currently out of pocket, $220.
    Phlebotomy: before through insurance, $400; currently out of pocket, $145.
    Basic set of lab tests; before through insurance, $550; currently out of pocket, under $200.

    These are just a few procedures that I need personally, but I am quite certain that this could be said of most medical procedures here in the US. If people had to pay out of pocket for most of this crap, they would find the lowest price, and they would understand how the combination of provider and insurance company is collusion at its worst.

    This is not to say that there is no need for insurance. Obviously, major illness or major surgery is not something most people can afford to pay out of pocket. However, knowing that the true costs of most procedures is only 25 to 50 percent of what we are actually paying should be a signal that there must be a better way. The real question is how do we find that way? How do we create true competition in healthcare, while still providing adequate protection against catastrophic expenses in the case of serious illness, and how do we allow coverage for everyone? I'm sorry, but I am not one who believes just because you can't afford it, you should be denied medical care. The bottom line is that if we were only paying the true cost of healthcare, then we could easily afford to subsidize those who cannot pay the full amount on their own.
     
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