Posted on 03/13/2017 7:44:43 AM PDT by dynoman
Trump has no idea really what he wants for the health care bill except that everyone is covered, will cost less, and your health care will be great.
Supporting Ryancare will be a big mistake. This issue is a loser unless they simply repeal and then let the rest play out IMHO.
I agree, repeal all of Obamacare.
It will crash and burn even if they change the name.
>>I disagree. I think the most important aspect of America is that we support individual liberties. I will not be forced to buy health insurance because its good for the country or for other taxpayers bottom line. <<
You’ll have to quote me where I said you should be forced to by health insurance. If I wrote that, I must have been in a booze-induced coma.
Ah, well, it is refreshing, to note that President Trump is NOT calling lying Ryan his friend...
>>Healthcare is not a right, it is a responsibility or a charity. No one is entitled to have their risks lifted from them because they have paid regularly.<<
Nowhere did I say healthcare is a right. However, I do think it’s reasonable to set up the law so that as long as you get insured, and remain insured, you can’t have your insurance taken from you. Under current law you can effectively be priced out of your insurance by a shrinking group (adverse selection). The law should encourage groups that are so large that adverse selection becomes a non-issue.j
We’ve been having a reasonable discussion up to now, but now you seem to be wanting to put words in my mouth. Time to drop out.
>>Are you saying that we will have no choice as to which pool we will go into, and that we all will have to go into some pool?<<
I’m saying that the law could be written so that insurance is fairly priced to everyone. That means that young people should pay much lower premiums than old people because they are far less likely to need healthcare.
The key to the pools is that they have to be large. Otherwise, as a few people get really sick, the healthy drop out of the pool and find insurance elsewhere because premiums become too onerous. But with essentially nationwide pools of, say, 20-29 year olds, that problem would be much less likely to occur. The premiums charged all in the group would reflect the risk of the entire group, just like car insurance and home insurance. Everybody pays about the same, and those who suffer losses collect, whereas those who don’t have paid for the comfort of knowing they won’t suffer a catastrophic loss that costs them dearly.
I am sorry that our conversation de-evolved. I feel we do not agree on certain points and will not agree better by speaking more on the topic. That doesn’t mean we might not agree better on another topic.
“However, I do think it’s reasonable to set up the law so that as long as you get insured, and remain insured, you can’t have your insurance taken from you.”
For me this statement says that the law is going to force your insurer or some other insurer to continue to insure you no matter what illness you develop life long at the same rate as a healthy person. That is what you have stated several times in our dialog. That is what I meant by a right to healthcare for purposes of this discussion, based on your statements.
In essence you have a right to healthcare insurance at a specific rate that you expect the Government to enforce on the insurance industry. I think that any contract is mutual and the insurance industry does not owe you coverage at the same rate as a healthy person your age if you terminate the relationship with the first company. They have a choice once the contract has ended. It is important to me that Government power over individuals & companies is limited since that is the cost of freedom. You would probably come down at a different point of the continuum. Not to offend just to clarify.
Also we differ on risk assessment and its place in the insurance industry. When a policy is offered it takes into account general health, weight, fitness, blood-work, smoking history, family history. Usually there is a physical involved so that the company can decide what rates to offer you for the various plans. If they do all that to arrive at the price its because the information is pertinent. It will be just as pertinent as you age.
If you wish to buy a whole life health insurance plan the company would need to factor in the probabilities of illnesses over your life expectancy and prorate the costs over your lifetime. Some companies might want to offer this kind of complex plan but the costs would be much higher.
Most young people get very inexpensive insurance. As they get older & renew they move into higher risk categories with higher rates. Once you have degenerative or malignant disease your cost to the company is bound to be higher and your rates will go up.
The pool idea is basically risk sharing which works for large companies and coops. It lowers the cost best when the largest portion of the pool is young & healthy. That is what Obamacare was trying to do, spread the costs of insuring the unhealthy around to enough young healthy people so they wouldn’t notice the burden.
It didn’t work because the young people didn’t want to risk share and add to their cost. That is the hidden fly in the ointment. It sounds great to get someone else to absorb the cost but they don’t like it.
Your plan to force insurance companies to absorb the costs of people who become chronically ill depends on them passing the costs to others. While they factor in a certain number of those lives into their rates it needs to be a controlled factor.
Staying with your original company your rates would go up gradually but the company could be prevented from dropping you by the terms of your policy or by state law. To keep policy costs down there could be a lifetime cap. Basically its not a thing in my mind done with laws but an agreement where you get what you pay for. More protection from downside risk, higher premiums from the get go. If the state makes demands which make it impossible for the companies to generate a profit they don’t write policies in that state.
If you were to join a coop then you would be among a group of like minded individuals who had agreed to risk share and then you would have the right to the same premium as anyone your age or whatever premium criterion the coop set up.
I was reacting to the fact that you want to set up the ground rules to coerce people into having to have life long health insurance or suffer significant consequences, two enrollment periods, penalties if you delay or need to drop out due to monetary constraints.
That is social engineering which I am allergic to when applied to myself. Thus I don’t like to see it applied to others. I like to set conditions so that people are rewarded for making good decisions, working hard, thinking ahead and that is a form of social engineering.
I see this insurance construct as a much less selfless form of social engineering since in general young people don’t need much health insurance, mainly catastrophic, often offered for a few $100 by colleges. So there is an aim of taking advantage of people rather than setting them up to succeed, of needing a base for a pyramid scheme that was a very basic and repellant aspect of Obamacare. The plan can be couched in noble terms but it comes down to coercion and loss of personal choice so that others can benefit, with the carrot dangled that others will carry you in later years.
“young people should pay much lower premiums than old people because they are far less likely to need healthcare”
If young people pay more than their age group requires, it’s not because they’re paying for old peoples’ problems, it’s because they’re paying ahead for when they become old.
>>If young people pay more than their age group requires, it’s not because they’re paying for old peoples’ problems, it’s because they’re paying ahead for when they become old.<<
That’s a nice thought if you can sell it. The problem is that you can’t sell it, you have to force it on the young, which is exactly what Obamacare attempted, and is one of the main reasons it’s failing.
There is a system like you describe, however. It’s the employer-provided group health insurance market. In it, young people are conned into taking a benefit that’s worth, say, $2,000 to them per year whereas an older person doing the same job (at the same salary even) is getting a health benefit worth, say, $12,000 to him.
The effect of that system is to lock older employees into their present employer because they can’t replace the benefit if they quit their jobs. It’s also the reason older people are less attractive hires when they’re out looking for a new job.
>>For me this statement says that the law is going to force your insurer or some other insurer to continue to insure you no matter what illness you develop life long at the same rate as a healthy person. That is what you have stated several times in our dialog. That is what I meant by a right to healthcare for purposes of this discussion, based on your statements.<<
That is what you mean as a right to healthcare, but it’s not what I mean by that term. A true right to healthcare leads directly to socialized or nationalized medicine, both concepts I feel certain neither of us support.
What I’m describing is what reasonable insurance terms should be, by law. You say a person should, effectively, lose their insurance if they become a serious health risk. What’s the difference then in saying that you should lose your life insurance if you get in a serious accident, one from which you’ve recovered, but which has seriously shortened your future life expectancy?
The obvious answer is that the contract specifies that you are insured until death. You would no doubt agree? My position is simply that for true health insurance to exist, those contracts should also be in effect until death, with adjustments made for increasing age since payouts obviously increase as one ages. Without that provision, you can’t insure yourself for life. It would be equivalent to term insurance.
Perhaps a middle ground would be to offer both life coverage and term coverage. Obviously term coverage would be cheaper. The problem is that term coverage in life insurance makes sense to many people because they need coverage early in life, but not later when their dependents are either dead or able to take care of themselves. Such is not the case with your personal health. You, apparently, prefer to set the market rules so that fate determines whether or not you can purchase insurance at the going rate for a 59 year old when you reach that age. That’s not the way I would structure the law, because it’s not a sufficient insurance policy then.
To be clear, I want an insurance marketplace where everyone can get, and maintain, their insurance if they desire to be insured. If they don’t want it, they suffer the consequences of that decision. And if they simply can’t afford insurance, then rather than having the government make direct payments for their care as now in Medicaid, Medicare, and the VA, simply have the government seek to maintain each individual’s premium payments when they’re unable to do so on their own.
This would lead, almost certainly, to everyone having high deductible policies covering catastrophic care. And that would lead to a serious reduction in healthcare costs, and a corresponding reduction in premiums (and thereby in costs to the government as well.)
Thank you. Under your optimal plan “This would lead, almost certainly, to everyone having high deductible policies covering catastrophic care. And that would lead to a serious reduction in healthcare costs, and a corresponding reduction in premiums”. Further “ the government seek to maintain each individual’s premium payments when they’re unable to do so on their own.”
Will you be bringing the same thought process to education, housing, food & clothing? Everyone to be maintained at the equivalent “high deductible level” & those who can pay do, those who can’t the Gv’t will maintain? I would hate to see the productivity in your ideal society, sounds a lot like the EU. A health insurance contract is as you have noted a term contract not a life contract. As I noted previously there are Heathcare Coop’s and some companies write whole life contracts. Most folks are not looking for them.
Everything else in life changes and we have no guarantees. Why is this one facet of life something you think all American’s should have cradle to grave even though in doing so you must give them the only illusion of care rather than the reality?
Furthermore the solution you propose robs Americans of $ they would prefer to spend elsewhere. Consider how this situation would effect the state of healthcare in America by distorting both the demand for services and the innovation which is only made possible by the ability of people to demand new better solutions & to pay for them.
A little time studying the state of healthcare in the UK would cement that connection between Gv’t controlled healthcare & quality of care. But no doubt we would all soldier on and accept whatever crumbs we could get from the insurance we were given. In the present state of America less than 35% have $1K in reserve, so if a catastrophe were to come along, the insurance you describe would do nothing to help because the family would lose everything just to pay the deductible.
Had it caught your notice that the actual healthcare expenses that most American’s are complaining about would not be covered. People still could not get to the doctor, get prescription meds etc unless they were able to satisfy the deductible. So while they satisfied the social planners need for everyone to have lifelong catastrophic insurance, whether they wanted to or not, many were left poorer and with very limited healthcare access. It also seeks to decrease medical costs for the Nation by eliminating access to Healthcare rather than cutting bureaucratic layers. It would leave regulatory & bureaucratic costs intact & undoubtedly add to them; it would stifle innovation in policy design and in tailoring coverage. Bravo.
I also note that when management of their affairs is left to the people they can chose HSA. In those vehicles they can save money, in flush times, by paying out of pocket, leaving & banked to pay medical expenses before their deductible is met in lean times, and at the end have a substantial nest egg for retirement.
I think we have both clearly outlined our viewpoints and can amicably remain in full disagreement on this issue.
Only problem is just like the pyramid scheme aka Social Security when they get old enough to need it the ground rules will have changed & its “so sorry but...”
“That’s a nice thought if you can sell it.”
You’re correct. I don’t buy it either. If old people who at that stage of their life are unlikely to contribute to our economy, in addition to that, suck away the money of the young, that’s not a good thing.
I think employer-provided insurance works partly because employed people are more healthy than chronically unemployed people. Then there’s the tax advantage of employers providing the insurance, which is a bad thing.
Here’s something to think about: Humira is avertised regularly on TV. A month’s supply costs about $4500 (sticker price). It’s for arthritis and I imagine needs to be taken ‘forever’. Not many individuals can afford that. Does that mean the rest of us will pay for their Humira? This is crazy stuff.
I think the part you’re missing in what I’m saying is that this approach could replace Medicaid. You write of all the people who can’t afford even the first dollar of care. They go to emergency rooms, or they’re already on Medicaid, or they just suffer.
I’m not a bleeding heart who can’t stand to see them suffer. If they’re too proud, or stupid, to fix what ails them via Medicaid or emergency room care, so be it.
I am, however, against setting the system up so that care is provided via emergency rooms (exceptionally wasteful, and ineffective to boot) and through Medicaid (truly socialized medicine, that.)
You seem to prefer no care at all if someone can’t afford it (I don’t really think that’s the case), or you’re just okay with people going to emergency rooms and you think Medicaid is just dandy. ( I really don’t think you believe that either.)
So that leaves me wondering if you actually believe we’re going to just go every man for himself at some time. If so, I doubt there’s a chance in hell of that happening. In the meantime, we have a definite chance to address real issues like emergency care and Medicaid.
We seem to be arguing both sides at the same time. I do not know where you got the idea I wanted no saftey net since I have been talking about State saftey nets throughout our dialog.
I think that charity care & paid care should be completely separate with veterans having access to both streams (via the VA & private doctors/hospitals when the VA can’t accommodate). We have not been talking about the charity arm for the most part since we have been talking about people who pay and what regular payment entitles them to.
On the charity arm I believe the States should set up a saftey net and people would need to apply to it for whatever reason, poverty, uninsurability (where there might be a premium & copay equivalent to standard policies), a short term issue similar to a COBRA or other emergencies. The States would be responsible for negotiating the best rates for their pool and there would be less choice as to types of plan but the plans would be for the most part low copay & deductible since the population is selected for inability to pay.
Since the State is paying there would be limited access to very expensive treatments, cosmetic treatments and some yearly caps, as we have seen when Oregon decided what they would cover & not cover. I expect it would be better care than the present system because of the decrease in waste & overhead.
I mean no disrespect to veterans by including them in the charity designation. I included them only because they are a category of 3rd party payment but earned, not as a charity.
>> I do not know where you got the idea I wanted no safety net since I have been talking about State safety nets throughout our dialog.<<
Yes, but the point I think you’ve been missing is that I have been doing that too. But when I do that you then ask if I want to subsidize food, clothing, etc., as well.
What I’ve been trying to say is that if the individual insurance market is set up properly, as this bill could accomplish in large part, then the role of the individual States could best be focused on seeing that people maintain their insurance (simply by making the payments for them in lieu of making direct payments to providers for their care.)
That would accomplish much, I think. First, people getting State aid would still be looking at a relatively high deductible, so they’d remain price conscious when selecting healthcare services. Second, the State could set up whatever system it wanted for addressing a person’s failure to pay their remaining medical bills, while bearing in mind the fact that paying all of someone’s bill turns off their “price-consciousness.)
Third, by setting up the system that way, private charitable organizations would have obvious targets for aiding people. If the States kept poor people insured via State action, then private charity could focus on helping people make their deductibles, especially in certain cases where the care is essential, like surgery following an accident, for example. One of the real problems today is that when a neighbor is in an accident, no one really knows how badly they’ve been injured financially. Do they have insurance? Are they already on assistance? Did the hospital forgive some charges? Etc.
This way, if a person was responsible enough to take out insurance, and the State has made certain that they’ve remained insured through tough times, only a few thousand dollars at a fundraiser would be sufficient to take care of their needs. Far, far, more people could be aided by private charity due to the setup of the system. And for those who aren’t aided, some charges will eventually be forgiven by the providers, and some will eventually be paid off by the individual. But the incidents of people running up a hundred thousand dollar hospital bill while uninsured could be reduced tremendously.
Anyway, that’s how I see it. I’m actually trying to reduce the government’s role, including very much the States’ role, in paying directly for care, but still have a system in place where people get the care they need and don’t go without it due to having no source of funds, or alternatively, stick the hospital with the bills.
“Only problem is just like the pyramid scheme”
Check out this FR post:
http://www.freerepublic.com/focus/f-news/3535298/posts
Are Collapsing Pensions “About To Bring Hell To America”?
Yes indeed, good parallel.
When the music stops who gets the chairs?
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