I'm not actually sure yet who we will send the checks too and I did not say we send the checks to the feds. I said the only choice we will truly have is who we will send the check to. Meaning I can choose United Healthcare to send my check to or I can choose Aetna, but they will be regulated in such a way that they are all forced to offer the exact same policies for the exact same price and those policies will be limited so much that I as a consumer really won't have a choice at all... except as I said, which company do I want to make my check out to.
I fully expect that before this is all said and done payment will be made through nothing other than... you guessed it... payroll tax deductions.
Immie
i actually thought that you paid the exchange or the govt, then picked fixed plans.
instead there are plans that fit in categories like basic, premium, and premium plus, then they can deviate a lil bit within each with their deductibles and the premiums will be what they'll have to make competitive.
if they make the specs too stringent, the providers will probably collude, i say.
If they do collude, I am sure they will have to include several key members of Congress in the collusion and provide incentives to those members to allow them to adjust their price schedule.
Immie
if they lobbied the bill, i wouldnt see why they wont lobby the steering committee to nevermind the pricing coincidences. if there's lots of providers, that wont work. if there's enough opportunity for them to wriggle a diversified plan, collusion would be a non-issue. thats how it is now, though: apples and grapes and pomegranates. i like the idea of 80% standardization, allowing the plans to vary just enough to allow some consumer choice and room for competition.
this is also a bit simplified. they cant drop or deny coverage to anyone (?), but they can put people in different risk groups and charge accordingly (?). as long as they dont know i play rugby, a healthy guy like myself wont be bunched in with a 50y/o smoker on dialysis.
i would suspect that low risks will have disproportionately more competitively priced packages (and little/no collusion effect), and higher risks will have to just be pleased that they are getting offers at all - probably dealing with pricing fixed across the board.
what precedent could a commissioner hold a provider to with regard to covering my 50y/o or higher risk guy? these folks are often not covered because of their conditions today. presents a collusion free-for-all.
exchanges have been tried before. not all mandated that providers must have a plan in all categories for all risk groups. the problem with the failed exchanges, i understand, was that providers would poach the low risks and leave the high-risk folks without options or with soaring costs since remaining providers couldnt use lower risks to hedge.
i actually thought that you paid the exchange or the govt, then picked fixed plans.
there's still an exchange trust fund. i dont know what that is.
i think the public option leveraged pricing from the medicare system into the exchanges to deflate the collusion issue and add a revenue stream against the insolvency of social security/medicare. sounds nice from a consumer/citizen standpoint, but if the government competed with me directly in their own bid process i'd be pissed.
i didnt think that would make it in the bill, and i doubt that there will be anything like that in the future because of the bad taste with biz interests/lobbies.
