Can Public Option Work?

[Maple]

Housing is both manufacturing and retail and the mortuary business was so corporately corrupt in the 80's and 90's that it remains the most paperwork intensive industry in the country, worse than medicine to hear some tell.

People should be free to purchase as much house or as nice a casket as their means will allow, but what do you want from your insurance company other than fair premiums and the bills paid on time?

I stand by my thesis that 'Insurance' is different, it is just a bureaucracy and we don't need to pay individuals millions to run the damn thing. They are not worth what they charge and they should be fired.

Insurance profits were 4% last year....less than most service industries
Furthermore, they employed millions.
Finally, such is capitalism....it works you know.

Housing is NOT any more manufacturing than insurance. Once the owner has a built structure, what he offers the consumers is a service...you pay him X amount of dollars, he gives you a roof over your head. Not only a service, but no less essential to life as insurance. And before you say "there are many that survive without a roof over their head", lets make it an equal playing field....there are probably more that survive without health insurance.

The real question that has yet to be answered and is a basic business question I have...

Insuracne premiums go up dramatically every year. However, their profits dont.

What needs to be analyzed AND fixed is "what is causing such increases in costs to insure?".....becuase it is not profits that are driving the rates...it is operating costs.

Now many, myself included believe frivilous law suits are a main reason.

But put that aside for a minute....

If insurance companies that are skilled at maximizing profits can not control the costs to operate...what makes ANY OF US think that governemtn can?

Imagine what will happen to costs, and to taxes, when insurance is run by the least efficient business model known to mankind with no concern for a bottom-line....

You are so right, the feds could not run a neighborhood lemonade stand without bankrupting it.

This debate is over, Obama care and Cap and Trade are burned, dead and buried. Pelosi stated she would bring it to a vote today, then it was postponed to tomorrow, then postponed to Sunday, now sometime next week. It's quite obvious that after the humiliating democratic loses in Virginia and New Jersey, the horrific jobs report today, that she is losing votes by the dozens. They are sneaking out the back door on her and Obama care. Cap and trade is dead on arrival in the senate.

" First they ignore you, then they laugh at you, then they fight you, then you win." Mahatama Gandi

First they ignore you= the tea partiers.
Then they laugh at you= the tea partiers.
Then they fight you= the tea partiers
Then you win= the tea partiers and landslide elections in Virginia and New Jersey.

 

[ThePickledPunk]

Insurance profits were 4% last year....less than most service industries
Furthermore, they employed millions.
Finally, such is capitalism....it works you know.

Housing is NOT any more manufacturing than insurance. Once the owner has a built structure, what he offers the consumers is a service...you pay him X amount of dollars, he gives you a roof over your head. Not only a service, but no less essential to life as insurance. And before you say "there are many that survive without a roof over their head", lets make it an equal playing field....there are probably more that survive without health insurance.

The real question that has yet to be answered and is a basic business question I have...

Insuracne premiums go up dramatically every year. However, their profits dont.

What needs to be analyzed AND fixed is "what is causing such increases in costs to insure?".....becuase it is not profits that are driving the rates...it is operating costs.

Now many, myself included believe frivilous law suits are a main reason.

But put that aside for a minute....

If insurance companies that are skilled at maximizing profits can not control the costs to operate...what makes ANY OF US think that governemtn can?

Imagine what will happen to costs, and to taxes, when insurance is run by the least efficient business model known to mankind with no concern for a bottom-line....

You are so right, the feds could not run a neighborhood lemonade stand without bankrupting it.

This debate is over, Obama care and Cap and Trade are burned, dead and buried. Pelosi stated she would bring it to a vote today, then it was postponed to tomorrow, then postponed to Sunday, now sometime next week. It's quite obvious that after the humiliating democratic loses in Virginia and New Jersey, the horrific jobs report today, that she is losing votes by the dozens. They are sneaking out the back door on her and Obama care. Cap and trade is dead on arrival in the senate.

" First they ignore you, then they laugh at you, then they fight you, then you win." Mahatama Gandi

First they ignore you= the tea partiers.
Then they laugh at you= the tea partiers.
Then they fight you= the tea partiers
Then you win= the tea partiers and landslide elections in Virginia and New Jersey.

Actually- they could run it forever, as long as the tax base was viable.

 

[toomuchtime_]

The only thing I can think of is regulation that CAPS prices...and that is so repulsive to so many....

but it is the better alternative to a windfall tax of any kind imo....

A windfall Tax, discourages making a profit....that is not so good....imo.

HOWEVER, a reasonable, with EMPHASIS ON REASONABLE cap on procedures and products for every procedure and everyone, including medicare recipients, at LEAST gives the company a chance to modify their budget to come in profitably...

A cap on prices is like a cap on ones budget in the free market...where the corporation tells you that you only have X amount of money to achieve X amount in your sales goal....and you sit there and say WTF? they want me to have a 20% increase in sales over last year with 20% less in inventory to accomplish this?????????? They've GOT to be kidding????

THEN, the rubber hits the road, and you figure every way possible to cut corners while not cutting sales, to come in to that figure..."When the going gets tough, the tough get going" is a model that can not be discounted, in my humble opinion.

So putting a cap on what insurance companies are charged for your procedures done by doctors and and hospitals and labs, is like what i explained above.....IT FORCES EFFICIENCIES....it forces these various portions of the health care businesses to give themselves another look, on becoming more productive or more efficient in order to still be profitable with the limited money or...caps.

having only medicare prices caps, defeats the purpose, because businesses then calculate their losses from the medicare caps in to the prices of those with regular insurance or those without Medicare....it even forces doctors to stop taking in medicare patients etc.....

HOWEVER, if the caps were on the entire field, and not just for medicare patients, then there would be NO ONE for the health care industry to pass these prices on to, and if this were the case, then I can assure you they would have to become more efficient, and they would become more efficient and they would change their business model to accommodate such...they WILL NOT let their companies/corporations fall.... "when the going gets tough, the tough WILL GET GOING"...trust me on this....they will not just throw in their hands and fold.

care

Setting lower reimbursements for health care services will lower overall health care/insurance costs, but what price is too low a price for a given service if we do not want to sacrifice quality or how much quality are we willing to sacrifice to lower costs? At what point will peak efficiency be reached and doctors begin to see so many patients to keep their incomes up that they can't do their best work? Hospitals cut back on capital improvements so that there are fewer hospital beds and operating rooms and MRI's, etc. and people have to wait too long for tests and procedures? At what point will medical device manufacturers stop trying to improve their pace makers or joint replacements, etc. because the rate of return on research is too low to attract enough capital to pay for the research?

I don't know how low reimbursements can go before we begin to sacrifice too much quality, or even if too much is the same for everyone, and I doubt you know or that anyone in the WH or Congress or even in the health care industry knows. It is because no one knows at what point peak efficiency is reached that planned economies are always less efficient than free market economies, and in the case of controlling health care/insurance costs, why free market competition is more likely to lead us to sustainable reimbursements at peak efficiency than are government mandates.

The problem is not that the free market in health insurance has failed us, it is that archaic federal and state laws have made a truly free market in health care/insurance impossible. We can reached peak efficiency, meaning the best price-quality combination, in three easy steps at hardly any cost to taxpayers.

1. Have Congress pass a law allowing insurance companies to sell national health insurance policies, so that when you shop for a policy you will have hundreds or thousands to choose from instead of just the few choices you now have.

2. Amend ERISA so that companies must allow employees to choose between the company plan and a voucher that can be used to buy an individual policy.

3. Require all health insurance policies to use the same format at the Exchange and present all information in easy to understand language, and supply easy to use software so that a shopper can easily sort through the hundreds or thousands of choices for the benefits he/she wants at the price he/she wants to pay.

These three steps will create intense competition that will allow the most efficient insurers and providers to drive down costs to the lowest sustainable levels and allow consumers with different priorities to find the policies that best suit their individual needs instead of being told what they are allowed to buy by some politicians.

 

[Cold Fusion38]

Coverage is denied where people have lied on their applications. Newsflash: the scumbags are often the insureds, not the insurers.

total backwards out your ass bullshit. It's the people who are TRUTHFULL about their pre-exsisting conditions who have them denied as pre-exsisting and therefor DENIED! Quit you bullshit outright LIES.

I would ask for some kind of proof but that would assume that you can a) read and b) understand properly what you've read. You haven't demonstrated any ability for either.
And btw does your mom know you talk like that?

You just spout out blatant fucking LIES and act like they are TRUE because you WANT them to be. Why would an applicant LIE about pre-exsisting conditions if they would not be DENIED coverage for those conditions. So you have tried to place the BLAME for denial of pre-existing conditions on the VICTIM rather than where it belongs with the ins co.

 

[saveliberty]

Hoyer: House vote may be pushed back - Health care reform- msnbc.com

"House passage of the 10-year, $1.2 trillion legislation that extends health coverage to tens of millions of uninsured Americans and puts tough new restrictions on insurance companies would be a breakthrough for Obama's agenda."

I thought Obama was going to veto anything above $900b.?

 

[The Rabbi]

The only thing I can think of is regulation that CAPS prices...and that is so repulsive to so many....

but it is the better alternative to a windfall tax of any kind imo....

A windfall Tax, discourages making a profit....that is not so good....imo.

HOWEVER, a reasonable, with EMPHASIS ON REASONABLE cap on procedures and products for every procedure and everyone, including medicare recipients, at LEAST gives the company a chance to modify their budget to come in profitably...

Let's analyze that a second.
What is "reasonable"?? If government caps the price at a rate above the market rate (and there is a market rate for everything), then the cap will be ineffective, actually counter-productive since companies will raise prices to the limit.
If it caps it below the market rate then you will create fewer providers and more buyers. This creates a shortage, which will come out as rationing. Whether it will be gov't rationing (you get a coupon to see the cardiologist once a year) or market rationing (there is one cardiologist in town and his next appointment is 6 months from now) is irrelevant.
But it is the absolute certain result of gov't fiat pricing.

 

[ThePickledPunk]

total backwards out your ass bullshit. It's the people who are TRUTHFULL about their pre-exsisting conditions who have them denied as pre-exsisting and therefor DENIED! Quit you bullshit outright LIES.

I would ask for some kind of proof but that would assume that you can a) read and b) understand properly what you've read. You haven't demonstrated any ability for either.
And btw does your mom know you talk like that?

You just spout out blatant fucking LIES and act like they are TRUE because you WANT them to be. Why would an applicant LIE about pre-exsisting conditions if they would not be DENIED coverage for those conditions. So you have tried to place the BLAME for denial of pre-existing conditions on the VICTIM rather than where it belongs with the ins co.

You ever hear a lefty open her mouth without cryin about victim status?

 

[Care4all]

The only thing I can think of is regulation that CAPS prices...and that is so repulsive to so many....

but it is the better alternative to a windfall tax of any kind imo....

A windfall Tax, discourages making a profit....that is not so good....imo.

HOWEVER, a reasonable, with EMPHASIS ON REASONABLE cap on procedures and products for every procedure and everyone, including medicare recipients, at LEAST gives the company a chance to modify their budget to come in profitably...

A cap on prices is like a cap on ones budget in the free market...where the corporation tells you that you only have X amount of money to achieve X amount in your sales goal....and you sit there and say WTF? they want me to have a 20% increase in sales over last year with 20% less in inventory to accomplish this?????????? They've GOT to be kidding????

THEN, the rubber hits the road, and you figure every way possible to cut corners while not cutting sales, to come in to that figure..."When the going gets tough, the tough get going" is a model that can not be discounted, in my humble opinion.

So putting a cap on what insurance companies are charged for your procedures done by doctors and and hospitals and labs, is like what i explained above.....IT FORCES EFFICIENCIES....it forces these various portions of the health care businesses to give themselves another look, on becoming more productive or more efficient in order to still be profitable with the limited money or...caps.

having only medicare prices caps, defeats the purpose, because businesses then calculate their losses from the medicare caps in to the prices of those with regular insurance or those without Medicare....it even forces doctors to stop taking in medicare patients etc.....

HOWEVER, if the caps were on the entire field, and not just for medicare patients, then there would be NO ONE for the health care industry to pass these prices on to, and if this were the case, then I can assure you they would have to become more efficient, and they would become more efficient and they would change their business model to accommodate such...they WILL NOT let their companies/corporations fall.... "when the going gets tough, the tough WILL GET GOING"...trust me on this....they will not just throw in their hands and fold.

care

Setting lower reimbursements for health care services will lower overall health care/insurance costs, but what price is too low a price for a given service if we do not want to sacrifice quality or how much quality are we willing to sacrifice to lower costs? At what point will peak efficiency be reached and doctors begin to see so many patients to keep their incomes up that they can't do their best work? Hospitals cut back on capital improvements so that there are fewer hospital beds and operating rooms and MRI's, etc. and people have to wait too long for tests and procedures? At what point will medical device manufacturers stop trying to improve their pace makers or joint replacements, etc. because the rate of return on research is too low to attract enough capital to pay for the research?

ideally, lower costs mean more sales, more people to prorate their costs for things like....mri's/catscans/xray/chemical analysis/ machines, or kidney dialysis machines, and to prorate any research and development costs over more people.

and yes, you are right that it can be tricky knowing when to say WHEN, when it comes to deciding on the caps....

there are many tools that can be used to calculate it, it won't be done haphazardly, it can be done with enough information available to not blow up the system imo.

I don't know how low reimbursements can go before we begin to sacrifice too much quality, or even if too much is the same for everyone, and I doubt you know or that anyone in the WH or Congress or even in the health care industry knows. It is because no one knows at what point peak efficiency is reached that planned economies are always less efficient than free market economies, and in the case of controlling health care/insurance costs, why free market competition is more likely to lead us to sustainable reimbursements at peak efficiency than are government mandates.

the problem with your solution of the free market taking care of it on its own, is ideally correct....IF THERE WAS NO GVT INVOLVEMENT.... however, there IS A HECK OF A LOT of gvt involvement that can not be stopped or frankly, WILL NOT CHANGE, like Medicare, medicaid, disability, 100% tax write offs for employers purchasing it, funding of medical schools and medical degrees, and pharma research and development, and medical research and development, paying the healthcare of millions of government workers and their families, paying the health care bill of all of our military and some veterans, of all of congress and post office workers etc...

AND UNLESS the government allows the free market to be free of their involvement including what i mentioned above which is ALL government meddling in the market, then what you say you want to happen, let the free market work....WON'T EVER HAPPEN, it will not happen....

The problem is not that the free market in health insurance has failed us, it is that archaic federal and state laws have made a truly free market in health care/insurance impossible. We can reached peak efficiency, meaning the best price-quality combination, in three easy steps at hardly any cost to taxpayers.

1. Have Congress pass a law allowing insurance companies to sell national health insurance policies, so that when you shop for a policy you will have hundreds or thousands to choose from instead of just the few choices you now have.

2. Amend ERISA so that companies must allow employees to choose between the company plan and a voucher that can be used to buy an individual policy.

3. Require all health insurance policies to use the same format at the Exchange and present all information in easy to understand language, and supply easy to use software so that a shopper can easily sort through the hundreds or thousands of choices for the benefits he/she wants at the price he/she wants to pay.

These three steps will create intense competition that will allow the most efficient insurers and providers to drive down costs to the lowest sustainable levels and allow consumers with different priorities to find the policies that best suit their individual needs instead of being told what they are allowed to buy by some politicians.

some of those measures are in this reform bill already, your number 3 is part of the bill.

on #2, individual policies are 2-3 times more expensive than ANY group policy, a voucher to buy an individual policy is of no help at all when they are sooooooo expensive in the first place....

there should be someway to pool all those looking for individual coverage in to one group for more reasonable group coverage....

and on number #1 i agree but it is easier said than done... and does this infringe on States rights?

 

[toomuchtime_]

The only thing I can think of is regulation that CAPS prices...and that is so repulsive to so many....

but it is the better alternative to a windfall tax of any kind imo....

A windfall Tax, discourages making a profit....that is not so good....imo.

HOWEVER, a reasonable, with EMPHASIS ON REASONABLE cap on procedures and products for every procedure and everyone, including medicare recipients, at LEAST gives the company a chance to modify their budget to come in profitably...

A cap on prices is like a cap on ones budget in the free market...where the corporation tells you that you only have X amount of money to achieve X amount in your sales goal....and you sit there and say WTF? they want me to have a 20% increase in sales over last year with 20% less in inventory to accomplish this?????????? They've GOT to be kidding????

THEN, the rubber hits the road, and you figure every way possible to cut corners while not cutting sales, to come in to that figure..."When the going gets tough, the tough get going" is a model that can not be discounted, in my humble opinion.

So putting a cap on what insurance companies are charged for your procedures done by doctors and and hospitals and labs, is like what i explained above.....IT FORCES EFFICIENCIES....it forces these various portions of the health care businesses to give themselves another look, on becoming more productive or more efficient in order to still be profitable with the limited money or...caps.

having only medicare prices caps, defeats the purpose, because businesses then calculate their losses from the medicare caps in to the prices of those with regular insurance or those without Medicare....it even forces doctors to stop taking in medicare patients etc.....

HOWEVER, if the caps were on the entire field, and not just for medicare patients, then there would be NO ONE for the health care industry to pass these prices on to, and if this were the case, then I can assure you they would have to become more efficient, and they would become more efficient and they would change their business model to accommodate such...they WILL NOT let their companies/corporations fall.... "when the going gets tough, the tough WILL GET GOING"...trust me on this....they will not just throw in their hands and fold.

care

Setting lower reimbursements for health care services will lower overall health care/insurance costs, but what price is too low a price for a given service if we do not want to sacrifice quality or how much quality are we willing to sacrifice to lower costs? At what point will peak efficiency be reached and doctors begin to see so many patients to keep their incomes up that they can't do their best work? Hospitals cut back on capital improvements so that there are fewer hospital beds and operating rooms and MRI's, etc. and people have to wait too long for tests and procedures? At what point will medical device manufacturers stop trying to improve their pace makers or joint replacements, etc. because the rate of return on research is too low to attract enough capital to pay for the research?

ideally, lower costs mean more sales, more people to prorate their costs for things like....mri's/catscans/xray/chemical analysis/ machines, or kidney dialysis machines, and to prorate any research and development costs over more people.

and yes, you are right that it can be tricky knowing when to say WHEN, when it comes to deciding on the caps....

there are many tools that can be used to calculate it, it won't be done haphazardly, it can be done with enough information available to not blow up the system imo.

I don't know how low reimbursements can go before we begin to sacrifice too much quality, or even if too much is the same for everyone, and I doubt you know or that anyone in the WH or Congress or even in the health care industry knows. It is because no one knows at what point peak efficiency is reached that planned economies are always less efficient than free market economies, and in the case of controlling health care/insurance costs, why free market competition is more likely to lead us to sustainable reimbursements at peak efficiency than are government mandates.

the problem with your solution of the free market taking care of it on its own, is ideally correct....IF THERE WAS NO GVT INVOLVEMENT.... however, there IS A HECK OF A LOT of gvt involvement that can not be stopped or frankly, WILL NOT CHANGE, like Medicare, medicaid, disability, 100% tax write offs for employers purchasing it, funding of medical schools and medical degrees, and pharma research and development, and medical research and development, paying the healthcare of millions of government workers and their families, paying the health care bill of all of our military and some veterans, of all of congress and post office workers etc...

AND UNLESS the government allows the free market to be free of their involvement including what i mentioned above which is ALL government meddling in the market, then what you say you want to happen, let the free market work....WON'T EVER HAPPEN, it will not happen....

The problem is not that the free market in health insurance has failed us, it is that archaic federal and state laws have made a truly free market in health care/insurance impossible. We can reached peak efficiency, meaning the best price-quality combination, in three easy steps at hardly any cost to taxpayers.

1. Have Congress pass a law allowing insurance companies to sell national health insurance policies, so that when you shop for a policy you will have hundreds or thousands to choose from instead of just the few choices you now have.

2. Amend ERISA so that companies must allow employees to choose between the company plan and a voucher that can be used to buy an individual policy.

3. Require all health insurance policies to use the same format at the Exchange and present all information in easy to understand language, and supply easy to use software so that a shopper can easily sort through the hundreds or thousands of choices for the benefits he/she wants at the price he/she wants to pay.

These three steps will create intense competition that will allow the most efficient insurers and providers to drive down costs to the lowest sustainable levels and allow consumers with different priorities to find the policies that best suit their individual needs instead of being told what they are allowed to buy by some politicians.

some of those measures are in this reform bill already, your number 3 is part of the bill.

on #2, individual policies are 2-3 times more expensive than ANY group policy, a voucher to buy an individual policy is of no help at all when they are sooooooo expensive in the first place....

there should be someway to pool all those looking for individual coverage in to one group for more reasonable group coverage....

and on number #1 i agree but it is easier said than done... and does this infringe on States rights?

Your assumption that the government would be able to calculate how low reimbursements can go before they are too low is clearly mistaken. That's why the Sustainable Reimbursement formula Congress passed into law in 1998, which should have lowered reimbursements to physicians from Medicare by about 3% to 4% every year, has been overridden by Congress in every year but one since then and will be overridden again this year. Congress didn't know what the correct formula was for deciding how much doctors should be paid back in 1998, and after thinking about it for 11 more years, Congress clearly still doesn't know.

Individual policies are not 2 to 3 times more expensive than group policies. The companies, on average pay about 70% of the cost of a group policy so it seems individual policies are 2 to 3 times more expensive, but if the company had to give you a voucher for the same amount it pays for the company plan you would be able to find an individual policy for about the same price as the company's plan. So if the average family policy cost about $13,000, the company would pay $9,100 and the worker would pay $3,900. What I am suggesting is that the company be required to offer the worker a choice of paying $3,900 for the company plan or receiving a voucher for $9,100 to buy an individual policy, so he/she would still only pay the difference between the full cost of the policy, still approximately $13,000, and the $9,100 voucher you would receive.

The only reason group policies are cheaper than individual policies is that the administrative cost of servicing a group policy, including sales commissions, is less that the administrative costs of servicing many individual policies, but administrative cost is one area where efficiencies can almost always be achieved if necessary, so if employers were required to offer vouchers instead of forcing employees into the company plan, more efficient insurance companies would find ways to cut their costs, perhaps by eliminating sales commissions and selling directly to the consumer or by reducing reimbursements to some providers, and offer individual health insurance policies for less than the company plan would cost or with greater benefits than the company plan offered.

In order to keep too many workers from defecting from the company plan, the insurance company that had that contract would have to find ways to lower its costs or offer more benefits, and this competition between the insurer that had the company plan contract and the hundreds of insurers who were trying to lure workers away from the company plan would not only put downward pressure on administrative costs but it would also put downward pressure on providers, and this downward pressure would continue until reimbursements got so low that quality could not longer be maintained if they went any lower.

A federal law that defined national health insurance policies would be a matter of inter state commerce, which clearly falls under the jurisdiction of the federal government, not the states, which are prohibited by the Constitution from passing laws that limit or inhibit commerce between states. The only reason the states have the authority to regulate insurance companies to the extent they do now is the anti trust exemption Congress passed years ago and that the Dems are determined to overturn now.

 

[Care4all]

Setting lower reimbursements for health care services will lower overall health care/insurance costs, but what price is too low a price for a given service if we do not want to sacrifice quality or how much quality are we willing to sacrifice to lower costs? At what point will peak efficiency be reached and doctors begin to see so many patients to keep their incomes up that they can't do their best work? Hospitals cut back on capital improvements so that there are fewer hospital beds and operating rooms and MRI's, etc. and people have to wait too long for tests and procedures? At what point will medical device manufacturers stop trying to improve their pace makers or joint replacements, etc. because the rate of return on research is too low to attract enough capital to pay for the research?

ideally, lower costs mean more sales, more people to prorate their costs for things like....mri's/catscans/xray/chemical analysis/ machines, or kidney dialysis machines, and to prorate any research and development costs over more people.

and yes, you are right that it can be tricky knowing when to say WHEN, when it comes to deciding on the caps....

there are many tools that can be used to calculate it, it won't be done haphazardly, it can be done with enough information available to not blow up the system imo.

I don't know how low reimbursements can go before we begin to sacrifice too much quality, or even if too much is the same for everyone, and I doubt you know or that anyone in the WH or Congress or even in the health care industry knows. It is because no one knows at what point peak efficiency is reached that planned economies are always less efficient than free market economies, and in the case of controlling health care/insurance costs, why free market competition is more likely to lead us to sustainable reimbursements at peak efficiency than are government mandates.

the problem with your solution of the free market taking care of it on its own, is ideally correct....IF THERE WAS NO GVT INVOLVEMENT.... however, there IS A HECK OF A LOT of gvt involvement that can not be stopped or frankly, WILL NOT CHANGE, like Medicare, medicaid, disability, 100% tax write offs for employers purchasing it, funding of medical schools and medical degrees, and pharma research and development, and medical research and development, paying the healthcare of millions of government workers and their families, paying the health care bill of all of our military and some veterans, of all of congress and post office workers etc...

AND UNLESS the government allows the free market to be free of their involvement including what i mentioned above which is ALL government meddling in the market, then what you say you want to happen, let the free market work....WON'T EVER HAPPEN, it will not happen....

The problem is not that the free market in health insurance has failed us, it is that archaic federal and state laws have made a truly free market in health care/insurance impossible. We can reached peak efficiency, meaning the best price-quality combination, in three easy steps at hardly any cost to taxpayers.

1. Have Congress pass a law allowing insurance companies to sell national health insurance policies, so that when you shop for a policy you will have hundreds or thousands to choose from instead of just the few choices you now have.

2. Amend ERISA so that companies must allow employees to choose between the company plan and a voucher that can be used to buy an individual policy.

3. Require all health insurance policies to use the same format at the Exchange and present all information in easy to understand language, and supply easy to use software so that a shopper can easily sort through the hundreds or thousands of choices for the benefits he/she wants at the price he/she wants to pay.

These three steps will create intense competition that will allow the most efficient insurers and providers to drive down costs to the lowest sustainable levels and allow consumers with different priorities to find the policies that best suit their individual needs instead of being told what they are allowed to buy by some politicians.

some of those measures are in this reform bill already, your number 3 is part of the bill.

on #2, individual policies are 2-3 times more expensive than ANY group policy, a voucher to buy an individual policy is of no help at all when they are sooooooo expensive in the first place....

there should be someway to pool all those looking for individual coverage in to one group for more reasonable group coverage....

and on number #1 i agree but it is easier said than done... and does this infringe on States rights?

Your assumption that the government would be able to calculate how low reimbursements can go before they are too low is clearly mistaken. That's why the Sustainable Reimbursement formula Congress passed into law in 1998, which should have lowered reimbursements to physicians from Medicare by about 3% to 4% every year, has been overridden by Congress in every year but one since then and will be overridden again this year. Congress didn't know what the correct formula was for deciding how much doctors should be paid back in 1998, and after thinking about it for 11 more years, Congress clearly still doesn't know.

Toomuchtime, it can be done, with fairly good accuracy...and we can learn from mistakes and get better at it. This is what insurance companies do, in order to negotiate their own prices with different hospitals and doctors.... Insurance companies do NOT PAY the ASKING price, just as medicare does not.

In a way this is all just typical "retail"....the vendor lists a higher price so they can really sell a hell of a lot of it when they "say" it is discounted or marked down....

(When i worked for Dillard's, if our competition advertised a sale price on an item 2 times, the 3rd time of their markdown price or sale price happened we had a policy that we had to permanently reprice our same product at their sale price, as its newly established regular price....)

But these hospitals and doctors and labs etc, keep the higher price as their established retail price and never reestablish it at the discounted price they actually sell it for to the majority of their customers...I believe the reason they do not, is because there is some sort of Tax Write off in it for them?

Back to your point, i think our gvt has done a pretty good job with medicare caps and pricing, and although there have been some problems, nothing that could not be addressed. And yes, Insurance companies go through the same type situations when they try to negotiate their prices with hospitals....and they work deals with these hospitals that they can only be charged a certain amount for each procedure JUST LIKE medicare does.

Individual policies are not 2 to 3 times more expensive than group policies. The companies, on average pay about 70% of the cost of a group policy so it seems individual policies are 2 to 3 times more expensive, but if the company had to give you a voucher for the same amount it pays for the company plan you would be able to find an individual policy for about the same price as the company's plan. So if the average family policy cost about $13,000, the company would pay $9,100 and the worker would pay $3,900. What I am suggesting is that the company be required to offer the worker a choice of paying $3,900 for the company plan or receiving a voucher for $9,100 to buy an individual policy, so he/she would still only pay the difference between the full cost of the policy, still approximately $13,000, and the $9,100 voucher you would receive.

I begged to differ with you on this because i have just gone through the experience of trying to find individual insurance. I have personally priced individual health care policies here for matthew and I, and it was $25,000 a year for the two of us....Matthew could be retired with me right now if it wasn't for what health care would cost us yearly so he is working only for the health care coverage. On his company's group plan for the 2 of us, it is about $10,000 a year....so if they paid 60-70% of that, the voucher would be $6-7k towards a $25,000 dollar a year policy...NOT MUCH HELP, when we would have to come up with the other $18,000 - $19,000....Group insurance is much much cheaper than individual insurance...there is a huge bulk discount in the price of the policies negotiated.



The only reason group policies are cheaper than individual policies is that the administrative cost of servicing a group policy, including sales commissions, is less that the administrative costs of servicing many individual policies, but administrative cost is one area where efficiencies can almost always be achieved if necessary, so if employers were required to offer vouchers instead of forcing employees into the company plan, more efficient insurance companies would find ways to cut their costs, perhaps by eliminating sales commissions and selling directly to the consumer or by reducing reimbursements to some providers, and offer individual health insurance policies for less than the company plan would cost or with greater benefits than the company plan offered.

There's a little more to it than just paperwork in the negotiation process...these insurance companies are basically guaranteeing these hospitals and doctors that are "IN NETWORK" a certain amount of customers, their GROUP.

Otherwise, I agree with you and you've got some pretty good cost savings ideas of your own that should be passed along to these guys... There is huge savings that can be had in this area of streamlining paperwork. and most of it is on the Hospital's billing side imo.

In order to keep too many workers from defecting from the company plan, the insurance company that had that contract would have to find ways to lower its costs or offer more benefits, and this competition between the insurer that had the company plan contract and the hundreds of insurers who were trying to lure workers away from the company plan would not only put downward pressure on administrative costs but it would also put downward pressure on providers, and this downward pressure would continue until reimbursements got so low that quality could not longer be maintained if they went any lower.

Over all, the concept and idea of what you described about with vouchers and company group plans is really good, and I like it. But it will only work if individual policies were more reasonable that what they are now...and maybe they would be, if these other insurance companies know that they have a GOOD SHOT at getting a whole bunch more customers!

But this still doesn;t help as much as we all would like with our health care insurance prices...because they just really reflect what the doctors and hospitals and labs are charging.... if we wanted to really affect the price of the actual health care, it would be us, as customers, influencing the price of health care one on one with the hospitals and doctors that we buy it from....the middle man, would be no where to be found.

A federal law that defined national health insurance policies would be a matter of inter state commerce, which clearly falls under the jurisdiction of the federal government, not the states, which are prohibited by the Constitution from passing laws that limit or inhibit commerce between states. The only reason the states have the authority to regulate insurance companies to the extent they do now is the anti trust exemption Congress passed years ago and that the Dems are determined to overturn now.

So if the anti trust exemption is removed, then this could happen constitutionally? then GREAT, this should be done.... however, as said, if we really look at the big picture, insurance companies are only one part of the problem with higher health care costs.

 

[AVG-JOE]

I noticed you did not respond to:

Housing...a need for all....NOT manufacturing
Mortuary services....not manufacturing but a need for all

There are others as well......and ALL are expensive....and ALL result in the 4% profit for those industries...so why not them as well?

Housing is both manufacturing and retail and the mortuary business was so corporately corrupt in the 80's and 90's that it remains the most paperwork intensive industry in the country, worse than medicine to hear some tell.

People should be free to purchase as much house or as nice a casket as their means will allow, but what do you want from your insurance company other than fair premiums and the bills paid on time?

I stand by my thesis that 'Insurance' is different, it is just a bureaucracy and we don't need to pay individuals millions to run the damn thing. They are not worth what they charge and they should be fired.

Insurance profits were 4% last year....less than most service industries
Furthermore, they employed millions.
Finally, such is capitalism....it works you know.

Housing is NOT any more manufacturing than insurance. Once the owner has a built structure, what he offers the consumers is a service...you pay him X amount of dollars, he gives you a roof over your head. Not only a service, but no less essential to life as insurance. And before you say "there are many that survive without a roof over their head", lets make it an equal playing field....there are probably more that survive without health insurance.

The real question that has yet to be answered and is a basic business question I have...

Insuracne premiums go up dramatically every year. However, their profits dont.

What needs to be analyzed AND fixed is "what is causing such increases in costs to insure?".....becuase it is not profits that are driving the rates...it is operating costs.

Now many, myself included believe frivilous law suits are a main reason.

But put that aside for a minute....

If insurance companies that are skilled at maximizing profits can not control the costs to operate...what makes ANY OF US think that governemtn can?

I'll bet you $1 (US funds) that your 4% figure does not include the 'profits' handed out to executives in the form of bonuses. 7 figures is a lot for a bureaucrat.

Are they worth it?

In my humble opinion, we pay the bureaucrats we know as Insurance Executives too money to do their jobs. I believe we can find willing and able people who will do them for a lot less. The easiest path to reasonable prices for the job of Insurance Executive is a public option patterned after Social Security, where you must pay into the system to get more than the most basic of coverage and let people choose their own level of personal risk.

 

[Annie]

Something honest from a 'pro-reform healthcare', it's lies, but lies that are justified. Won't be able to be undone, that's the beauty of it, regardless of outcome. The freshness of truth! Well as good as it gets from someone fine with lies:

Some Vaguely Heretical Thoughts on Health-Care Reform: Rational Irrationality : The New Yorker

NOVEMBER 4, 2009
SOME VAGUELY HERETICAL THOUGHTS ON HEALTH-CARE REFORM

With the publication of H.R. 3962, the House Democrats’ mammoth, 1,990-page proposal to restructure the health-care system (the outlines of which can be found in this detailed summary), decision time is fast approaching in the big reform debate. Paul Krugman, in his usual forthright style, says, “History is about to be made—and everyone has to decide which side they’re on.” Democrats and progressives can line up behind the reform legislation that House Speaker Nancy Pelosi put forward last week, or they can help to kill reform for another generation by aligning with hard-line conservatives.....

..Let’s remind ourselves of the basics. There are two big (and linked) problems with the current health-care system. It excludes 46.3 million Americans, according to the Census Bureau, and it is inordinately expensive. The proposed reform purports to tackle both of these problems; in fact, it only addresses the first one in any systematic manner. The future cost savings that the Administration and its congressional allies are promising to deliver are based on wishful thinking and sleight of hand. Over time, the reform, as proposed, would almost certainly add substantially to the budget deficit, thereby worsening the long-term fiscal crisis that the country faces. Financing this measure alone wouldn’t break the U.S. Treasury. Other elements of the fiscal picture, such as the looming increases in interest payments on the national debt and an explosive growth in Medicare spending as the baby boomers retire—are far larger. But the numbers involved in health-care reform are still significant—perhaps one per cent of annual G.D.P.

The Pelosi bill, in particular, wouldn’t do much, if anything, to address the overall escalation in health-care costs, much of which is rooted in the nature of insurance, where individuals consume costly health services, and different people—the other members of their risk pool—pay for them. This is the “moral hazard” problem that the economist Kenneth Arrow identified as long ago as 1963...

It gets worse, or 'better' depending on your perspective...

 

[Chris]

I would ask for some kind of proof but that would assume that you can a) read and b) understand properly what you've read. You haven't demonstrated any ability for either.
And btw does your mom know you talk like that?

You just spout out blatant fucking LIES and act like they are TRUE because you WANT them to be. Why would an applicant LIE about pre-exsisting conditions if they would not be DENIED coverage for those conditions. So you have tried to place the BLAME for denial of pre-existing conditions on the VICTIM rather than where it belongs with the ins co.

You ever hear a lefty open her mouth without cryin about victim status?

Horseshit.

Watch Glenn Beck sometime.

"THEY don't surround us."

"WE surround THEM."

 

[Care4all]

Housing is both manufacturing and retail and the mortuary business was so corporately corrupt in the 80's and 90's that it remains the most paperwork intensive industry in the country, worse than medicine to hear some tell.

People should be free to purchase as much house or as nice a casket as their means will allow, but what do you want from your insurance company other than fair premiums and the bills paid on time?

I stand by my thesis that 'Insurance' is different, it is just a bureaucracy and we don't need to pay individuals millions to run the damn thing. They are not worth what they charge and they should be fired.

Insurance profits were 4% last year....less than most service industries
Furthermore, they employed millions.
Finally, such is capitalism....it works you know.

Housing is NOT any more manufacturing than insurance. Once the owner has a built structure, what he offers the consumers is a service...you pay him X amount of dollars, he gives you a roof over your head. Not only a service, but no less essential to life as insurance. And before you say "there are many that survive without a roof over their head", lets make it an equal playing field....there are probably more that survive without health insurance.

The real question that has yet to be answered and is a basic business question I have...

Insuracne premiums go up dramatically every year. However, their profits dont.

What needs to be analyzed AND fixed is "what is causing such increases in costs to insure?".....becuase it is not profits that are driving the rates...it is operating costs.

Now many, myself included believe frivilous law suits are a main reason.

But put that aside for a minute....

If insurance companies that are skilled at maximizing profits can not control the costs to operate...what makes ANY OF US think that governemtn can?

I'll bet you $1 (US funds) that your 4% figure does not include the 'profits' handed out to executives in the form of bonuses. 7 figures is a lot for a bureaucrat.

Are they worth it?

In my humble opinion, we pay the bureaucrats we know as Insurance Executives too money to do their jobs. I believe we can find willing and able people who will do them for a lot less. The easiest path to reasonable prices for the job of Insurance Executive is a public option patterned after Social Security, where you must pay into the system to get more than the most basic of coverage and let people choose their own level of personal risk.

you are correct Ajoe,

those high salaries and bonuses and stock options given and luxurious sales meetings and cars to drive or limo services are PAID before that profit figure comes in to play.

 

[Chris]

Insurance profits were 4% last year....less than most service industries
Furthermore, they employed millions.
Finally, such is capitalism....it works you know.

Housing is NOT any more manufacturing than insurance. Once the owner has a built structure, what he offers the consumers is a service...you pay him X amount of dollars, he gives you a roof over your head. Not only a service, but no less essential to life as insurance. And before you say "there are many that survive without a roof over their head", lets make it an equal playing field....there are probably more that survive without health insurance.

The real question that has yet to be answered and is a basic business question I have...

Insuracne premiums go up dramatically every year. However, their profits dont.

What needs to be analyzed AND fixed is "what is causing such increases in costs to insure?".....becuase it is not profits that are driving the rates...it is operating costs.

Now many, myself included believe frivilous law suits are a main reason.

But put that aside for a minute....

If insurance companies that are skilled at maximizing profits can not control the costs to operate...what makes ANY OF US think that governemtn can?

I'll bet you $1 (US funds) that your 4% figure does not include the 'profits' handed out to executives in the form of bonuses. 7 figures is a lot for a bureaucrat.

Are they worth it?

In my humble opinion, we pay the bureaucrats we know as Insurance Executives too money to do their jobs. I believe we can find willing and able people who will do them for a lot less. The easiest path to reasonable prices for the job of Insurance Executive is a public option patterned after Social Security, where you must pay into the system to get more than the most basic of coverage and let people choose their own level of personal risk.

you are correct Ajoe,

those high salaries and bonuses and stock options given and luxurious sales meetings and cars to drive or limo services are PAID before that profit figure comes in to play.

And the $3.4 BILLION DOLLARS that the healthcare lobbyists paid to Congress over the last decade came from where?

 

[toomuchtime_]

some of those measures are in this reform bill already, your number 3 is part of the bill.

on #2, individual policies are 2-3 times more expensive than ANY group policy, a voucher to buy an individual policy is of no help at all when they are sooooooo expensive in the first place....

there should be someway to pool all those looking for individual coverage in to one group for more reasonable group coverage....

and on number #1 i agree but it is easier said than done... and does this infringe on States rights?

Your assumption that the government would be able to calculate how low reimbursements can go before they are too low is clearly mistaken. That's why the Sustainable Reimbursement formula Congress passed into law in 1998, which should have lowered reimbursements to physicians from Medicare by about 3% to 4% every year, has been overridden by Congress in every year but one since then and will be overridden again this year. Congress didn't know what the correct formula was for deciding how much doctors should be paid back in 1998, and after thinking about it for 11 more years, Congress clearly still doesn't know.

Toomuchtime, it can be done, with fairly good accuracy...and we can learn from mistakes and get better at it. This is what insurance companies do, in order to negotiate their own prices with different hospitals and doctors.... Insurance companies do NOT PAY the ASKING price, just as medicare does not.

In a way this is all just typical "retail"....the vendor lists a higher price so they can really sell a hell of a lot of it when they "say" it is discounted or marked down....

(When i worked for Dillard's, if our competition advertised a sale price on an item 2 times, the 3rd time of their markdown price or sale price happened we had a policy that we had to permanently reprice our same product at their sale price, as its newly established regular price....)

But these hospitals and doctors and labs etc, keep the higher price as their established retail price and never reestablish it at the discounted price they actually sell it for to the majority of their customers...I believe the reason they do not, is because there is some sort of Tax Write off in it for them?

Back to your point, i think our gvt has done a pretty good job with medicare caps and pricing, and although there have been some problems, nothing that could not be addressed. And yes, Insurance companies go through the same type situations when they try to negotiate their prices with hospitals....and they work deals with these hospitals that they can only be charged a certain amount for each procedure JUST LIKE medicare does.

Individual policies are not 2 to 3 times more expensive than group policies. The companies, on average pay about 70% of the cost of a group policy so it seems individual policies are 2 to 3 times more expensive, but if the company had to give you a voucher for the same amount it pays for the company plan you would be able to find an individual policy for about the same price as the company's plan. So if the average family policy cost about $13,000, the company would pay $9,100 and the worker would pay $3,900. What I am suggesting is that the company be required to offer the worker a choice of paying $3,900 for the company plan or receiving a voucher for $9,100 to buy an individual policy, so he/she would still only pay the difference between the full cost of the policy, still approximately $13,000, and the $9,100 voucher you would receive.

I begged to differ with you on this because i have just gone through the experience of trying to find individual insurance. I have personally priced individual health care policies here for matthew and I, and it was $25,000 a year for the two of us....Matthew could be retired with me right now if it wasn't for what health care would cost us yearly so he is working only for the health care coverage. On his company's group plan for the 2 of us, it is about $10,000 a year....so if they paid 60-70% of that, the voucher would be $6-7k towards a $25,000 dollar a year policy...NOT MUCH HELP, when we would have to come up with the other $18,000 - $19,000....Group insurance is much much cheaper than individual insurance...there is a huge bulk discount in the price of the policies negotiated.



The only reason group policies are cheaper than individual policies is that the administrative cost of servicing a group policy, including sales commissions, is less that the administrative costs of servicing many individual policies, but administrative cost is one area where efficiencies can almost always be achieved if necessary, so if employers were required to offer vouchers instead of forcing employees into the company plan, more efficient insurance companies would find ways to cut their costs, perhaps by eliminating sales commissions and selling directly to the consumer or by reducing reimbursements to some providers, and offer individual health insurance policies for less than the company plan would cost or with greater benefits than the company plan offered.

There's a little more to it than just paperwork in the negotiation process...these insurance companies are basically guaranteeing these hospitals and doctors that are "IN NETWORK" a certain amount of customers, their GROUP.

Otherwise, I agree with you and you've got some pretty good cost savings ideas of your own that should be passed along to these guys... There is huge savings that can be had in this area of streamlining paperwork. and most of it is on the Hospital's billing side imo.

In order to keep too many workers from defecting from the company plan, the insurance company that had that contract would have to find ways to lower its costs or offer more benefits, and this competition between the insurer that had the company plan contract and the hundreds of insurers who were trying to lure workers away from the company plan would not only put downward pressure on administrative costs but it would also put downward pressure on providers, and this downward pressure would continue until reimbursements got so low that quality could not longer be maintained if they went any lower.

Over all, the concept and idea of what you described about with vouchers and company group plans is really good, and I like it. But it will only work if individual policies were more reasonable that what they are now...and maybe they would be, if these other insurance companies know that they have a GOOD SHOT at getting a whole bunch more customers!

But this still doesn;t help as much as we all would like with our health care insurance prices...because they just really reflect what the doctors and hospitals and labs are charging.... if we wanted to really affect the price of the actual health care, it would be us, as customers, influencing the price of health care one on one with the hospitals and doctors that we buy it from....the middle man, would be no where to be found.

A federal law that defined national health insurance policies would be a matter of inter state commerce, which clearly falls under the jurisdiction of the federal government, not the states, which are prohibited by the Constitution from passing laws that limit or inhibit commerce between states. The only reason the states have the authority to regulate insurance companies to the extent they do now is the anti trust exemption Congress passed years ago and that the Dems are determined to overturn now.

So if the anti trust exemption is removed, then this could happen constitutionally? then GREAT, this should be done.... however, as said, if we really look at the big picture, insurance companies are only one part of the problem with higher health care costs.

I think you're confused about the insurance premiums. If you're paying $10,000 for the company plan and the company is paying 60% of the cost of the policy then the company is paying $15,000. $15,000 is 60% of $25,000, which is what you say an individual policy would cost you. If the company had to offer you a voucher equal to what it pays towards your insurance, the voucher would be for $15,000, the company's current contribution for your health insurance, and you would still have to pay $10,000 for health insurance, but you would be able to choose the policy and insurance company you wanted not just the one your husband's employer wanted you to have.

Now if everyone had the option of choosing the voucher and every health insurer in the country could sell you a policy, you would have $15,000 of the company's money to spend and some of these companies that you currently can't choose are probably more efficient than the ones that are now available to you, so after applying the $15,000 voucher you might only have to pay an additional $9,000 or $8,000 or perhaps some more efficient insurance company would offer you additional benefits you would like to but don't want to pay extra for. Highly competitive markets not only drive prices down, but they also cause companies to find more creative ways of attracting customers.

You are mistaken about how Medicare reimbursement rates are set. Medicare does not negotiate with providers the way private insurers do. Medicare rates are set by law, either by new acts of Congress or by formulas that were established by past legislation. That's why it takes an act of Congress to change the rates. Obviously, when Congress established the Sustainable Growth Rate formula in 1998, it did not even consult with providers, let alone negotiate with them. If it had, it would not have been necessary to pass legislation every year but one since to prevent the formula from taking effect. There are no tools to determine before hand how low rates can go before quality of care is effected. If there were, Medicare would use them to set its rates and establish its formulas and Congress would not have to pass special legislation each year to try to correct its past mistakes.

It is a myth that health insurers offer some sort of volume discount to groups. There are only two factors that determine premiums, claims experience and administrative costs. If the underwriting is the same for groups and individuals, the claims experience should be the same, so the only difference in the insurance company's costs are the administrative costs, which are higher for individual policies than they are per capita for group policies. Most of the administrative costs are involved in underwriting and sales, but if the proposed reforms go through, insurers will have to accept everyone, so very little underwriting will be necessary, and if the individual policies are sold directly by the company, either through the Exchange or on the internet or even by phone, the sales costs will be very low and very close to the per capita administrative costs for group plans.

Doctors who accept HMO's do not get paid one rate for patients that have group policies and another rate for patients that have individual policies. Their agreements with the insurance company cover all patients with the same kind of coverage, group or individual.

 

[Care4all]

Toomuch, just reading your post...and to answer your first part....no, the 10k, is the amount of the policy, emplyees would pay about 4 grand a year for it....maybe it is 12k max this year but last year it was about 10k for that policy plan....the company pays 60%. this is an out of state headquartered corporation, not certain if they get better rates because they have thousands of employees nationwide vs the individual anthem, blue cross/blue shield plan that i priced within our state. we have only 2 insurance companies in the state that supply 88% of the insurance policies....no competition, a duopoly here in maine...


haven't read the rest of your post yet....

 

[Care4all]

Your assumption that the government would be able to calculate how low reimbursements can go before they are too low is clearly mistaken. That's why the Sustainable Reimbursement formula Congress passed into law in 1998, which should have lowered reimbursements to physicians from Medicare by about 3% to 4% every year, has been overridden by Congress in every year but one since then and will be overridden again this year. Congress didn't know what the correct formula was for deciding how much doctors should be paid back in 1998, and after thinking about it for 11 more years, Congress clearly still doesn't know.

Toomuchtime, it can be done, with fairly good accuracy...and we can learn from mistakes and get better at it. This is what insurance companies do, in order to negotiate their own prices with different hospitals and doctors.... Insurance companies do NOT PAY the ASKING price, just as medicare does not.

In a way this is all just typical "retail"....the vendor lists a higher price so they can really sell a hell of a lot of it when they "say" it is discounted or marked down....

(When i worked for Dillard's, if our competition advertised a sale price on an item 2 times, the 3rd time of their markdown price or sale price happened we had a policy that we had to permanently reprice our same product at their sale price, as its newly established regular price....)

But these hospitals and doctors and labs etc, keep the higher price as their established retail price and never reestablish it at the discounted price they actually sell it for to the majority of their customers...I believe the reason they do not, is because there is some sort of Tax Write off in it for them?

Back to your point, i think our gvt has done a pretty good job with medicare caps and pricing, and although there have been some problems, nothing that could not be addressed. And yes, Insurance companies go through the same type situations when they try to negotiate their prices with hospitals....and they work deals with these hospitals that they can only be charged a certain amount for each procedure JUST LIKE medicare does.

Individual policies are not 2 to 3 times more expensive than group policies. The companies, on average pay about 70% of the cost of a group policy so it seems individual policies are 2 to 3 times more expensive, but if the company had to give you a voucher for the same amount it pays for the company plan you would be able to find an individual policy for about the same price as the company's plan. So if the average family policy cost about $13,000, the company would pay $9,100 and the worker would pay $3,900. What I am suggesting is that the company be required to offer the worker a choice of paying $3,900 for the company plan or receiving a voucher for $9,100 to buy an individual policy, so he/she would still only pay the difference between the full cost of the policy, still approximately $13,000, and the $9,100 voucher you would receive.

I begged to differ with you on this because i have just gone through the experience of trying to find individual insurance. I have personally priced individual health care policies here for matthew and I, and it was $25,000 a year for the two of us....Matthew could be retired with me right now if it wasn't for what health care would cost us yearly so he is working only for the health care coverage. On his company's group plan for the 2 of us, it is about $10,000 a year....so if they paid 60-70% of that, the voucher would be $6-7k towards a $25,000 dollar a year policy...NOT MUCH HELP, when we would have to come up with the other $18,000 - $19,000....Group insurance is much much cheaper than individual insurance...there is a huge bulk discount in the price of the policies negotiated.



The only reason group policies are cheaper than individual policies is that the administrative cost of servicing a group policy, including sales commissions, is less that the administrative costs of servicing many individual policies, but administrative cost is one area where efficiencies can almost always be achieved if necessary, so if employers were required to offer vouchers instead of forcing employees into the company plan, more efficient insurance companies would find ways to cut their costs, perhaps by eliminating sales commissions and selling directly to the consumer or by reducing reimbursements to some providers, and offer individual health insurance policies for less than the company plan would cost or with greater benefits than the company plan offered.

There's a little more to it than just paperwork in the negotiation process...these insurance companies are basically guaranteeing these hospitals and doctors that are "IN NETWORK" a certain amount of customers, their GROUP.

Otherwise, I agree with you and you've got some pretty good cost savings ideas of your own that should be passed along to these guys... There is huge savings that can be had in this area of streamlining paperwork. and most of it is on the Hospital's billing side imo.

In order to keep too many workers from defecting from the company plan, the insurance company that had that contract would have to find ways to lower its costs or offer more benefits, and this competition between the insurer that had the company plan contract and the hundreds of insurers who were trying to lure workers away from the company plan would not only put downward pressure on administrative costs but it would also put downward pressure on providers, and this downward pressure would continue until reimbursements got so low that quality could not longer be maintained if they went any lower.

Over all, the concept and idea of what you described about with vouchers and company group plans is really good, and I like it. But it will only work if individual policies were more reasonable that what they are now...and maybe they would be, if these other insurance companies know that they have a GOOD SHOT at getting a whole bunch more customers!

But this still doesn;t help as much as we all would like with our health care insurance prices...because they just really reflect what the doctors and hospitals and labs are charging.... if we wanted to really affect the price of the actual health care, it would be us, as customers, influencing the price of health care one on one with the hospitals and doctors that we buy it from....the middle man, would be no where to be found.

A federal law that defined national health insurance policies would be a matter of inter state commerce, which clearly falls under the jurisdiction of the federal government, not the states, which are prohibited by the Constitution from passing laws that limit or inhibit commerce between states. The only reason the states have the authority to regulate insurance companies to the extent they do now is the anti trust exemption Congress passed years ago and that the Dems are determined to overturn now.

So if the anti trust exemption is removed, then this could happen constitutionally? then GREAT, this should be done.... however, as said, if we really look at the big picture, insurance companies are only one part of the problem with higher health care costs.

I think you're confused about the insurance premiums. If you're paying $10,000 for the company plan and the company is paying 60% of the cost of the policy then the company is paying $15,000. $15,000 is 60% of $25,000, which is what you say an individual policy would cost you. If the company had to offer you a voucher equal to what it pays towards your insurance, the voucher would be for $15,000, the company's current contribution for your health insurance, and you would still have to pay $10,000 for health insurance, but you would be able to choose the policy and insurance company you wanted not just the one your husband's employer wanted you to have.

Now if everyone had the option of choosing the voucher and every health insurer in the country could sell you a policy, you would have $15,000 of the company's money to spend and some of these companies that you currently can't choose are probably more efficient than the ones that are now available to you, so after applying the $15,000 voucher you might only have to pay an additional $9,000 or $8,000 or perhaps some more efficient insurance company would offer you additional benefits you would like to but don't want to pay extra for. Highly competitive markets not only drive prices down, but they also cause companies to find more creative ways of attracting customers.

You are mistaken about how Medicare reimbursement rates are set. Medicare does not negotiate with providers the way private insurers do. Medicare rates are set by law, either by new acts of Congress or by formulas that were established by past legislation. That's why it takes an act of Congress to change the rates. Obviously, when Congress established the Sustainable Growth Rate formula in 1998, it did not even consult with providers, let alone negotiate with them. If it had, it would not have been necessary to pass legislation every year but one since to prevent the formula from taking effect. There are no tools to determine before hand how low rates can go before quality of care is effected. If there were, Medicare would use them to set its rates and establish its formulas and Congress would not have to pass special legislation each year to try to correct its past mistakes.

It is a myth that health insurers offer some sort of volume discount to groups. There are only two factors that determine premiums, claims experience and administrative costs. If the underwriting is the same for groups and individuals, the claims experience should be the same, so the only difference in the insurance company's costs are the administrative costs, which are higher for individual policies than they are per capita for group policies. Most of the administrative costs are involved in underwriting and sales, but if the proposed reforms go through, insurers will have to accept everyone, so very little underwriting will be necessary, and if the individual policies are sold directly by the company, either through the Exchange or on the internet or even by phone, the sales costs will be very low and very close to the per capita administrative costs for group plans.

Doctors who accept HMO's do not get paid one rate for patients that have group policies and another rate for patients that have individual policies. Their agreements with the insurance company cover all patients with the same kind of coverage, group or individual.

tmt

it is not a myth...

Group Health Insurance
The majority of people under the age of 65 have medical insurance through their employers' group insurance. According to the National Coalition on Health Care, in 2005, over 80 percent of employees were eligible for employer-group insurance and 83 percent of those who were offered, opted for these types of plans. This is usually because employers and other organizations can get better rates because they have a large number of people to cover. The insurance company sees it as good risk because they'll probably end up paying out very little for many people in the group, while collecting premiums from everyone. Normally, this translates into premiums that are much lower than those found in individual health insurance plans and are the same price for everyone in the group regardless of their health.

HowStuffWorks "Group Insurance vs. Individual Insurance"

 

[toomuchtime_]

So if the anti trust exemption is removed, then this could happen constitutionally? then GREAT, this should be done.... however, as said, if we really look at the big picture, insurance companies are only one part of the problem with higher health care costs.

I think you're confused about the insurance premiums. If you're paying $10,000 for the company plan and the company is paying 60% of the cost of the policy then the company is paying $15,000. $15,000 is 60% of $25,000, which is what you say an individual policy would cost you. If the company had to offer you a voucher equal to what it pays towards your insurance, the voucher would be for $15,000, the company's current contribution for your health insurance, and you would still have to pay $10,000 for health insurance, but you would be able to choose the policy and insurance company you wanted not just the one your husband's employer wanted you to have.

Now if everyone had the option of choosing the voucher and every health insurer in the country could sell you a policy, you would have $15,000 of the company's money to spend and some of these companies that you currently can't choose are probably more efficient than the ones that are now available to you, so after applying the $15,000 voucher you might only have to pay an additional $9,000 or $8,000 or perhaps some more efficient insurance company would offer you additional benefits you would like to but don't want to pay extra for. Highly competitive markets not only drive prices down, but they also cause companies to find more creative ways of attracting customers.

You are mistaken about how Medicare reimbursement rates are set. Medicare does not negotiate with providers the way private insurers do. Medicare rates are set by law, either by new acts of Congress or by formulas that were established by past legislation. That's why it takes an act of Congress to change the rates. Obviously, when Congress established the Sustainable Growth Rate formula in 1998, it did not even consult with providers, let alone negotiate with them. If it had, it would not have been necessary to pass legislation every year but one since to prevent the formula from taking effect. There are no tools to determine before hand how low rates can go before quality of care is effected. If there were, Medicare would use them to set its rates and establish its formulas and Congress would not have to pass special legislation each year to try to correct its past mistakes.

It is a myth that health insurers offer some sort of volume discount to groups. There are only two factors that determine premiums, claims experience and administrative costs. If the underwriting is the same for groups and individuals, the claims experience should be the same, so the only difference in the insurance company's costs are the administrative costs, which are higher for individual policies than they are per capita for group policies. Most of the administrative costs are involved in underwriting and sales, but if the proposed reforms go through, insurers will have to accept everyone, so very little underwriting will be necessary, and if the individual policies are sold directly by the company, either through the Exchange or on the internet or even by phone, the sales costs will be very low and very close to the per capita administrative costs for group plans.

Doctors who accept HMO's do not get paid one rate for patients that have group policies and another rate for patients that have individual policies. Their agreements with the insurance company cover all patients with the same kind of coverage, group or individual.

tmt

it is not a myth...

Group Health Insurance
The majority of people under the age of 65 have medical insurance through their employers' group insurance. According to the National Coalition on Health Care, in 2005, over 80 percent of employees were eligible for employer-group insurance and 83 percent of those who were offered, opted for these types of plans. This is usually because employers and other organizations can get better rates because they have a large number of people to cover. The insurance company sees it as good risk because they'll probably end up paying out very little for many people in the group, while collecting premiums from everyone. Normally, this translates into premiums that are much lower than those found in individual health insurance plans and are the same price for everyone in the group regardless of their health.

HowStuffWorks "Group Insurance vs. Individual Insurance"

If you think about it, this makes no sense. Why would the insurance company expect to pay out less to 1,000 people who participate in a group plan to to 1,000 people who bought individual policies? How much the insurance company expects to pay out in claims is determined by the risk profile of the group from the company or the group of individual policy holders. If the risk profiles are the same, the company will expect the claims experience to be the same and will have the same costs. The only difference in the company's costs will come from the fact that it will cost more per capita to sell and service 1,000 individual policies than to sell and service one group plan.

Employers want you to believe that group insurance is cheaper because it allows them to hold on to employees. Insurance companies want you to believe that group policies are cheaper because once they sell the contract to the employer, they have a monopoly on sales to the employees, and unions want you to believe it because it makes the membership feel more dependent on the leadership, but from your own example you posted earlier, if you are paying $10,000 and your company is paying 60% of the cost of the policy, then the total cost of the group policy is $25,000, exactly the same as an individual policy would cost you. Clearly, it's a myth.

 

[toomuchtime_]

Toomuch, just reading your post...and to answer your first part....no, the 10k, is the amount of the policy, emplyees would pay about 4 grand a year for it....maybe it is 12k max this year but last year it was about 10k for that policy plan....the company pays 60%. this is an out of state headquartered corporation, not certain if they get better rates because they have thousands of employees nationwide vs the individual anthem, blue cross/blue shield plan that i priced within our state. we have only 2 insurance companies in the state that supply 88% of the insurance policies....no competition, a duopoly here in maine...


haven't read the rest of your post yet....

There is simply no way the insurance company's per capita costs for 1,000 individual policies can be 2 1/2 higher than the per capita costs for 1,000 people in a group if the coverage is the same. Either you've made a mistake or Maine's insurance industry is vastly different from the rest of the country's.