Catastrophic Medical Insurance

[Supposn]

Catastrophic Medical Insurance:


Excerpted from Congressman Paul Ryan’s web site. He forwarded a transcript concerning his positions of regarding USA’s healthcare policies; Racine [, WIS] Journal News, Mark Schaaf, July 7, 20217.
“Republicans have proposed the federal and state governments subsidize the cost of care for people in the individual market with catastrophic illnesses, Ryan said. He believes that will make it easier to insure people in those high-risk pools at a more affordable price”.


Paul Ryan’s economic positions but federal funding of catastrophic medical costs for the catastrophys’ duration of times and extents of their costs is a concept that both sides of the political ailse could agree upon. Our federal government should accept fiscal responsibility for catastrophic medical condition regardless if patients were or were not previously insured. That federal responsibility should continue until the catastrophic financial condition no longer exists.


Respectfully, Supposn

 

[emilynghiem]

Catastrophic Medical Insurance:


Excerpted from Congressman Paul Ryan’s web site. He forwarded a transcript concerning his positions of regarding USA’s healthcare policies; Racine [, WIS] Journal News, Mark Schaaf, July 7, 20217.
“Republicans have proposed the federal and state governments subsidize the cost of care for people in the individual market with catastrophic illnesses, Ryan said. He believes that will make it easier to insure people in those high-risk pools at a more affordable price”.


Paul Ryan’s economic positions but federal funding of catastrophic medical costs for the catastrophys’ duration of times and extents of their costs is a concept that both sides of the political ailse could agree upon. Our federal government should accept fiscal responsibility for catastrophic medical condition regardless if patients were or were not previously insured. That federal responsibility should continue until the catastrophic financial condition no longer exists.


Respectfully, Supposn

Ted Cruz proposed that insurance companies be free to offer any number or range of plans.
SO LONG AS THEY INCLUDE ONE option that is like the Obamacare level.
And the Republicans in his own base struck that down.

I have a suggestion: why not let all parties propose plans
and let taxpayers CHOOSE on our tax forms which plan to fund?

Then the best plans would get the most support
and BE PAID FOR BY THAT BASE TO SERVE THAT BASE.

Wouldn't that solve the problem?

Mike Lee said what the bill needs is an option to OPT OUT.

Sen. Mike Lee lays out what GOP healthcare bill needs to get his vote

Sen. Lee Comments on Delayed Healthcare Vote

What I'm saying is taxpayers should be required to OPT IN and PAY FOR whatever platform matches their BELIEFS, and work with their affiliated group or company of their choice to democratically determine the terms and "rules of exemptions" NOT THE GOVT -- Because the exemptions are basically "regulating on the basis of BELIEF or religion." (not just if you BELIEVE in limited govt or you BELIEVE in single payer health care being federal duty of govt, but if you look at the current federal exemptions, you have to be a PAID MEMBER of QUALIFYING RELIGIOUS organizations in order not to be under the mandates at all -- THAT'S regulating taxes on the basis of someone's BELIEFS and RELIGIOUS faith-based affiliation and PAYMENT to such a group!)

These terms of paying for health care and public charity should belong to the PEOPLE
and the States if they represent the people, but not federal govt UNLESS A CONSTITUTIONAL AMENDMENT
IS P ASSED BY THE STATES FIRST GIVING THEM THAT POWER OVER INDIVIDUAL HEALTH CARE DECISIONS
AND FREE CHOICE/CIVIL LIBERTIES TO BEGIN WITH.)

Either revert the responsibility to the STATE level, or if people can't agree by state,
give people the choice to opt in or out of plans through their PARTY of choice.

And list these on their tax forms:
I want to pay and be covered for health care under:
* my state plan
* my party plan - State
* my party plan - Federal
* my party plan - local or other
* federal plan A (original Obamacare) as revised by supporters who opt into this plan
* federal plan B (revised Trump plan) as revised by supporters who pay for this plan
* federal plan C (other option to be revised by voters and supporters choosing this plan)

Each plan/track is then funded and voted on/revised by the voters/supporters
who opt into and vote for THAT plan....

 

[dblack]

A law with an opt-out provision makes no sense.

 

[Supposn]

Ted Cruz proposed that insurance companies be free to offer any number or range of plans.
SO LONG AS THEY INCLUDE ONE option that is like the Obamacare level.
And the Republicans in his own base struck that down.

I have a suggestion: why not let all parties propose plans
and let taxpayers CHOOSE on our tax forms which plan to fund?

Then the best plans would get the most support
and BE PAID FOR BY THAT BASE TO SERVE THAT BASE.

Wouldn't that solve the problem? ...

Emilynghiem, the Affordable Care Act’s purpose is to increase the aggregate possibility or probability of USA citizens and legal residents finding some affordable and adequate medical expense insurance. Cruz’s proposal would exacerbate our problems.

Currently ACA acceptable insurance plans must meet ACA’s minimal adequacy requirements. The requirements may differentiate for gender or other patients’ statuses, but the insurer may not differentiate their pricing due to those statuses. (I believe that some less than market value differentiations may be permitted for age).

Due to those prohibited pricing practices, ACA approved insurance is a far greater bargain for some individuals and are somewhat overpriced for some others.
Permit those pricing practices, we’re back to the same situations that requires a federal policy of mandated medical insurance.

If the tax upon those that choose not to be adequately insured is eliminated, that increases the costs and thus the prices of adequate insurance sold by ACA qualified insurers; that severely reduces if not effectively eliminating the Affordable Care Act.

If the pricing prohibitions are eliminated or Ted Cruz’s proposal is adopted, many more millions of USA citizens will not be adequately insured unless they can qualify for the extremely low maximum income caps of Medicaid participants. Medicaid is entirely funded by federal and state taxpayers.

Respectfully, Supposn

 

[debbiedowner]

A law with an opt-out provision makes no sense.

You're right, but when have they ever made sense?

 

[debbiedowner]

You also cannot tailor make a plan for each individual. Can you imagine each person picking and choosing what they want to be covered or not?

I can see sitting down with a woman and her saying I want my right boob covered because I had a scare a few years back. How about your left, well is that extra, yep, no I never had a problem with that one.

 

[dblack]

You also cannot tailor make a plan for each individual. Can you imagine each person picking and choosing what they want to be covered or not?

Sure. Why not?

 

[debbiedowner]

You also cannot tailor make a plan for each individual. Can you imagine each person picking and choosing what they want to be covered or not?

Sure. Why not?

How would an actuary determine the risk for one particular person? In my scenario of the boob right vs left, that left boob she doesn't want to be covered probably has a good chance of developing breast cancer if she had it in the right.

 

[dblack]

How would an actuary determine the risk for one particular person?

By estimating their odds of getting sick based on their health records, lifestyle etc.... how else would they do it?

 

[task0778]

Well we're gonna have to do something cuz Medicare and Medicaid are not sustainable as they are now. There's no easy or cheap answer here, so the best option I can see is a federal catastrophic illness/accident insurance program that is paid for by a consumption tax. The states can augment that with their own insurance programs and insurance could be purchased across state lines. If you've got a pre-existing condition that falls under the federal program then you're covered by that, otherwise you better find yourself insurance that is affordable.

 

[debbiedowner]

How would an actuary determine the risk for one particular person?

By estimating their odds of getting sick based on their health records, lifestyle etc.... how else would they do it?

Then you're talking about underwriting that isn't in the bill because they still say anyone can get insured regardless of health. You involve underwriting then people will get turned down or charged more money for certain pre x conditions.

 

[dblack]

How would an actuary determine the risk for one particular person?

By estimating their odds of getting sick based on their health records, lifestyle etc.... how else would they do it?

Then you're talking about underwriting that isn't in the bill because they still say anyone can get insured regardless of health. You involve underwriting then people will get turned down or charged more money for certain pre x conditions.

What you're talking about (what ACA tries to "mandate") isn't insurance.

 

[Supposn]

You also cannot tailor make a[n insurance] plan for each individual. Can you imagine each person picking and choosing what they want to be covered or not?

Sure. Why not?

DBlack, many products are sold as packages of individual gods and/or services. Due to economies of scale or other factors or concepts, sellers are able to offer some goods and/or service products at more attractive prices, if they package the items into standard item groups.

DebbieDowner's post correctly implied its unlikely that an insurance company could offer any meaningful price savings for insuring ONLY the right breast; in fact that might require special handling that may be of GREATER expense to the insurance company and would INCREASE the cost to the purchaser.

The insurance broker on the other hand, (and I'm assuming the broker has two hands), may be pleased to handle both of the lady's breasts.

Two handed insurance brokers came to mind when I thought of president Truman wanting to hire only one handed economists that wouldn't be telling him “but on the other hand”.
Respectfully, Supposn

 

[dblack]

WTF?

 

[MadChemist]

Catastrophic Medical Insurance:


Excerpted from Congressman Paul Ryan’s web site. He forwarded a transcript concerning his positions of regarding USA’s healthcare policies; Racine [, WIS] Journal News, Mark Schaaf, July 7, 20217.
“Republicans have proposed the federal and state governments subsidize the cost of care for people in the individual market with catastrophic illnesses, Ryan said. He believes that will make it easier to insure people in those high-risk pools at a more affordable price”.


Paul Ryan’s economic positions but federal funding of catastrophic medical costs for the catastrophys’ duration of times and extents of their costs is a concept that both sides of the political ailse could agree upon. Our federal government should accept fiscal responsibility for catastrophic medical condition regardless if patients were or were not previously insured. That federal responsibility should continue until the catastrophic financial condition no longer exists.


Respectfully, Supposn

"Paul Ryan’s economic positions but federal funding of catastrophic medical costs for the catastrophys’ duration of times and extents of their costs is a concept that both sides of the political ailse could agree upon."

Could you be more clear on what you are proposing here. An example would be useful.

"Our federal government should accept fiscal responsibility for catastrophic medical condition regardless if patients were or were not previously insured."

Why should the federal government accept fiscal responsibility ? What is the basis for that comment ?

Do you have any figures that indicate what that liability might be ?

"That federal responsibility should continue until the catastrophic financial condition no longer exists."

Who makes that call ?

 

[MadChemist]

You also cannot tailor make a[n insurance] plan for each individual. Can you imagine each person picking and choosing what they want to be covered or not?

Sure. Why not?

DBlack, many products are sold as packages of individual gods and/or services. Due to economies of scale or other factors or concepts, sellers are able to offer some goods and/or service products at more attractive prices, if they package the items into standard item groups.

DebbieDowner's post correctly implied its unlikely that an insurance company could offer any meaningful price savings for insuring ONLY the right breast; in fact that might require special handling that may be of GREATER expense to the insurance company and would INCREASE the cost to the purchaser.

The insurance broker on the other hand, (and I'm assuming the broker has two hands), may be pleased to handle both of the lady's breasts.

Two handed insurance brokers came to mind when I thought of president Truman wanting to hire only one handed economists that wouldn't be telling him “but on the other hand”.
Respectfully, Supposn

Supposn,

The example that DebbieDowner puts forth is an Appeal To The Extreme.

What is for certain is that Obamacare requires 10 Essential Health Benefits:

Affordable Care Act's 10 Essential Health Benefits

The level of those benefits can vary...but they must be present at some level.

It is clear that companies do offer categories of insurance (car insurance can be tailored within certain categories) with different levels of benefit which can, again be tailored.

The removal of basic catastrophic insurance from the menu is an example of a reduction in the kind of flexibility people enjoyed before.

My point being that:

1. You can offered insurance tailored to a degree.
2. Obamacare is not good in that regard.

Now, how that relates to you original post is not clear to me. I am still interested to see what you are proposing.

I agree that people with extreme conditions must be addressed outside the normal insurance model. However, I am not convinced turning it over to the Federal Government is the correct way to take care of it.

Looking for a better argument as to what that would be the case.

 

[Supposn]

A possible proposal for catastrophic medical insurance?

The “moment” a patient's annual medical costs attain or exceed the catastrophic amount, their status should be that of a catastrophic-patient.

Catastrophic patient's status continues for no less than a year after that “moment” and until the patient's annual medical costs no longer exceed a third of the catastrophic-amount.
The federal government will pay or reimburse half of the payments for medical providers' medical costs during the year prior to their acquiring catastrophic-patient status, and their entire medical costs while they retain catastrophic-patient status.

After a patient is no longer a catastrophic patient, their catastrophic-amount throughout the remainder of their lives is effectively half of the generally legal catastrophic-amount.
After a patient is no longer a catastrophic patient, and if the patient had been at the “moment” medically insured, the medical insurer is obliged to re-accept the patient as a client with no disfavoring penalties.

Definitions:
Catastrophic- amount: It's suggested an individual's accrued medical expenses of $15,000 within a year's duration be considered as catastrophic annual medical costs. That amount's subject to annual cost-of-living adjustment. But that initial amount now, in the year 2017 is suggested as a start for congressional debate.

Medical costs: reasonable medical expenditures on behalf of the patient. Medical costs are subject to review similar to that done within Medicare.

Patient: the individual beneficiary of medical costs.

Year's duration: 365 days, (i.e. an annual duration).
Respectfully, Supposn

 

[dblack]

A possible proposal for catastrophic medical insurance?

The “moment” a patient's annual medical costs attain or exceed the catastrophic amount, their status should be that of a catastrophic-patient.

Catastrophic patient's status continues for no less than a year after that “moment” and until the patient's annual medical costs no longer exceed a third of the catastrophic-amount.
The federal government will pay or reimburse half of the payments for medical providers' medical costs during the year prior to their acquiring catastrophic-patient status, and their entire medical costs while they retain catastrophic-patient status.

After a patient is no longer a catastrophic patient, their catastrophic-amount throughout the remainder of their lives is effectively half of the generally legal catastrophic-amount.
After a patient is no longer a catastrophic patient, and if the patient had been at the “moment” medically insured, the medical insurer is obliged to re-accept the patient as a client with no disfavoring penalties.

Definitions:
Catastrophic- amount: It's suggested an individual's accrued medical expenses of $15,000 within a year's duration be considered as catastrophic annual medical costs. That amount's subject to annual cost-of-living adjustment. But that initial amount now, in the year 2017 is suggested as a start for congressional debate.

Medical costs: reasonable medical expenditures on behalf of the patient. Medical costs are subject to review similar to that done within Medicare.

Patient: the individual beneficiary of medical costs.

Year's duration: 365 days, (i.e. an annual duration).
Respectfully, Supposn

In effect, we already have this. We have solid safety net programs for people who are driven to bankruptcy by health care bills. The shift in thinking promoted by "reformers" is that government needs to step in before then; that health care bills should never drive one to bankruptcy in the first place. But they never really say why.

Why should an unfortunate investment drive someone to bankruptcy, but not health care costs? Why should we let the loss of a job, or a divorce, drive someone to bankruptcy, but not health care bills? Why should a freak accident drive someone to bankruptcy, but not health care costs?

 

[Supposn]

In effect, we already have this, [i.e. catastrophic medical insurance]. We have solid safety net programs for people who are driven to bankruptcy by health care bills. The shift in thinking promoted by "reformers" is that government needs to step in before then; that health care bills should never drive one to bankruptcy in the first place. But they never really say why.

Why should an unfortunate investment drive someone to bankruptcy, but not health care costs? Why should we let the loss of a job, or a divorce, drive someone to bankruptcy, but not health care bills? Why should a freak accident drive someone to bankruptcy, but not health care costs?

DBlack, for the same reasons that contracts generally have clauses absolving participants of blame for what's described as “acts of G-D”, and those “acts” substantially increase medical insurers' costs?

[Insurance contracts usually do cover “acts of G-d” but they're generally offered at lesser prices when the contract excludes some specifically catastrophic “acts G-d”. Additionally, prices upon most insured items are based in part upon the value of the item being insured. Medical insurance prices based upon monetary valuation of the patient would be contrary to our social practices and/or less feasible].

(1) Whatever generally increases medical insurers' costs, does so for both government and non-government medical insurers, and are directly or indirectly past on as increased costs and/or prices to all those eventually paying for medical insurance.
(2) Thus, further motivating the younger and/or healthier to refrain from purchasing medical insurance.
(3) Thus, reducing the remaining insured population to be less young and/or less healthy.
(4) Thus, further increasing medical insurers' costs and leading back to (1).

Respectfully, Supposn

 

[dblack]

In effect, we already have this, [i.e. catastrophic medical insurance]. We have solid safety net programs for people who are driven to bankruptcy by health care bills. The shift in thinking promoted by "reformers" is that government needs to step in before then; that health care bills should never drive one to bankruptcy in the first place. But they never really say why.

Why should an unfortunate investment drive someone to bankruptcy, but not health care costs? Why should we let the loss of a job, or a divorce, drive someone to bankruptcy, but not health care bills? Why should a freak accident drive someone to bankruptcy, but not health care costs?

DBlack, for the same reasons that contracts generally have clauses absolving participants of blame for what's described as “acts of G-D”, and those “acts” substantially increase medical insurers' costs?

Not really sure what that has to do with anything. I'm asking how we got it in our heads that health care shouldn't cost money.

The common claim revealing this attitude is usually expressed as "No one should face bankruptcy because of health care bills". Do you agree with that statement?