Even More Obamacare Follies

#3,651
#3,651
lawgator1 said:
The problem is that when you start indivdualizing the required coverage insurance product too much, you destroy the entire premise of shared risk. Where the correct line is, is debatable. But you can't have insurance for only those things for which you have highest risk, otherwise insurers cater only to the lowest risk, and no one covers people at risk.
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Some of it is policy, though, not just actuarial risk. Such as whether women should pay more than men.
 
#3,652
#3,652
Velo Vol said:
Some of it is policy, though, not just actuarial risk. Such as whether women should pay more than men.
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Right, but that can vary. Certainly a 25 year old woman has greater potential risk than a 25 year old man, because of pregnancy. Reverse that at 65 (not because of pregnancy, obv).
 
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#3,654
#3,654
lawgator1 said:
The problem is that when you start indivdualizing the required coverage insurance product too much, you destroy the entire premise of shared risk. Where the correct line is, is debatable. But you can't have insurance for only those things for which you have highest risk, otherwise insurers cater only to the lowest risk, and no one covers people at risk.
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So do you think it right that someone who has multiple DUIs pays the same as someone that doesn't have any? How about smoking? How about alchoholics/drug users? How about diabetes? At what point do you take responsibility and pay for things that are within your control? How about someone with children? Should they pay the same as someone that has none?
 
#3,655
#3,655
Smoking price discrimination is still there. Hardly any other lifestyle discounts were available before the ACA (at least they weren't for me).
 
#3,656
#3,656
SpaceCoastVol said:
So do you think it right that someone who has multiple DUIs pays the same as someone that doesn't have any? How about smoking? How about alchoholics/drug users? How about diabetes? At what point do you take responsibility and pay for things that are within your control? How about someone with children? Should they pay the same as someone that has none?
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Practically speaking, the list is endless, and I don't see how you can account for everything.

Eat too many potato chips
Smoke
Don't get servings of fruits and vegetables
Drive too fast
Drive too slow
Drive at all
Got too much sun as a teenager
Play baseball
Wear a helmet when playing baseball
Don't wear a helmet when playing baseball
Ride a motorcycle
Stay up past 11
Drinks too much coffee
Doesn't drink enough coffee
Walks down the street
Single
Married
Divorced
Tennessee fan
Gator basketball fan (this year)
Live in house never struck by lightning


The point of insurance is to spread risk. You are higher in some respects than others. Others are higher in other respects. You just can't try to carve that up. Makes no sense, otherwise.
 
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#3,657
#3,657
lawgator1 said:
The problem is that when you start indivdualizing the required coverage insurance product too much, you destroy the entire premise of shared risk. Where the correct line is, is debatable. But you can't have insurance for only those things for which you have highest risk, otherwise insurers cater only to the lowest risk, and no one covers people at risk.
Click to expand...

Making men pay for maternity coverage was War on Women crap.

The "essential benefits" mandated in ACA can certainly be streamlined without damaging risk pools.

When you separate a set of essential mandates at the "this is to keep you alive" level then you can use supplemental coverage and specialization to handle the risk pool.

Since insurers can compete for all citizens in Switzerland you have specialization in the supplemental market so that those who want to pay for fertilization coverage have some options to choose from but not all carriers over the coverage so you still have sufficient numbers in the pool.

Also, choice comes not just in what's covered but in choice of providers. Ask someone who is on Medicaid how much choice they have in provider - here's a hint; virtually none since it's generally a money loser for the provider.
 
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#3,658
#3,658
Velo Vol said:
I don't know if it is accurate, but I read a blog post that Swiss insurance policies don't price according to age--a 30 year-old pays as much as a 60 year-old. And if you look at the link above, you'll notice that basic plans are required to cover maternity care.

So I don't think the minimum required plans are as regulation-free as you suggested above.

But obviously, what should be covered is a somewhat subjective debate.
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Agreed. My point is that the "required" part should be pushed down to real essentials (always a debate) and let the choice occur:

1. In the provider you choose to provide the essentials (including price/deductible mix)

2. The manner in which you'd like to pay (ACA trashed HSAs which were working)

3. The additional coverages (both what is covered and provider choice).
 
#3,659
#3,659
lawgator1 said:
Practically speaking, the list is endless, and I don't see how you can account for everything.

Eat too many potato chips
Smoke
Don't get servings of fruits and vegetables
Drive too fast
Drive too slow
Drive at all
Got too much sun as a teenager
Play baseball
Wear a helmet when playing baseball
Don't wear a helmet when playing baseball
Ride a motorcycle
Stay up past 11
Drinks too much coffee
Doesn't drink enough coffee
Walks down the street
Single
Married
Divorced
Tennessee fan
Gator basketball fan (this year)
Live in house never struck by lightning


The point of insurance is to spread risk. You are higher in some respects than others. Others are higher in other respects. You just can't try to carve that up. Makes no sense, otherwise.
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This is nonsense. The old all or nothing approach....

True, the list of variables is endless. Practically speaking, one doesn't need to consider all of them...not even a majority of them.

Life insurance companies do this with great success. Car insurers do as well. Health insurers do the same to an extent when not under a group policy.

But to use this an an argument that men need maternity coverage or some other useless form of coverage is nonsense.
 
#3,660
#3,660
volinbham said:
Making men pay for maternity coverage was War on Women crap.

The "essential benefits" mandated in ACA can certainly be streamlined without damaging risk pools.

When you separate a set of essential mandates at the "this is to keep you alive" level then you can use supplemental coverage and specialization to handle the risk pool.

Since insurers can compete for all citizens in Switzerland you have specialization in the supplemental market so that those who want to pay for fertilization coverage have some options to choose from but not all carriers over the coverage so you still have sufficient numbers in the pool.

Also, choice comes not just in what's covered but in choice of providers. Ask someone who is on Medicaid how much choice they have in provider - here's a hint; virtually none since it's generally a money loser for the provider.
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I wonder if part of women's coverage for cancer, generally, includes pooled risk for prostate cancer.

Seriously, I don't know.
 
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#3,662
#3,662
VolsNSkinsFan said:
It would be great if your car insurance would subsidize my boat insurance
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I don't see how an insurance company could differentiate your rate from that of one who owns a yacht. I mean you both go out on the water. It seems impossible to me??
 
#3,663
#3,663
lawgator1 said:
I wonder if part of women's coverage for cancer, generally, includes pooled risk for prostate cancer.

Seriously, I don't know.
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Given the treatment prognosis for prostate cancer vs ovarian or even breast cancer I'd say to the extent they are pooled the men are still subsidizing.

Bottomline, to the extent we can drop the essential benefits to "essential" (medical necessity) we can lower HC costs.

By using supplementary plans people can add the level of choice (non-medical necessity and provider).

This has been proven to reduce utilization without reducing health outcomes.

To do so requires:

1. removal of state barriers to competition (talk about a risk pool killer)

2. changes to essential benefits

3. ideally shifting from an employer/provider model to a customer pays (employers could still "pay" for it through salary or bonus)

4. subsidizing the poor for essentials plan (including paying for it all).

5. strengthening HSA style programs

(This assumes the mandate stays)
 
#3,664
#3,664
volinbham said:
Given the treatment prognosis for prostate cancer vs ovarian or even breast cancer I'd say to the extent they are pooled the men are still subsidizing.

Bottomline, to the extent we can drop the essential benefits to "essential" (medical necessity) we can lower HC costs.

By using supplementary plans people can add the level of choice (non-medical necessity and provider).

This has been proven to reduce utilization without reducing health outcomes.

To do so requires:

1. removal of state barriers to competition (talk about a risk pool killer)

2. changes to essential benefits

3. ideally shifting from an employer/provider model to a customer pays (employers could still "pay" for it through salary or bonus)

4. subsidizing the poor for essentials plan (including paying for it all).

(This assumes the mandate stays)
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I used to think eliminating the state barrier thing was a good idea, but I've read quite a bit on that lately and it turns out its a horrible idea.

It is likened to the similar credit card measure, enacted some years back. Ever notice how all of your credit card offers come from just a handful of states? Nebraska, Delaware maybe.

Its because the state legislatures in those states have been bought and paid for by the credit card companies. They flock there, because they have enacted laws that allow them to charge exorbitant interest rates and fees -- rates and fees that do not pass muster in your own state.

Same would happen with insurance. They would take over a state government, have it effectively deregulate them, kill off all mandated benefits (even ones you would agree with), and gouge people. All by eliminating things and regulation your own state requires for the good of the citizenry.

Really, its a terrible idea.
 
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#3,666
#3,666
lawgator1 said:
I used to think eliminating the state barrier thing was a good idea, but I've read quite a bit on that lately and it turns out its a horrible idea.

It is likened to the similar credit card measure, enacted some years back. Ever notice how all of your credit card offers come from just a handful of states? Nebraska, Delaware maybe.

Its because the state legislatures in those states have been bought and paid for by the credit card companies. They flock there, because they have enacted laws that allow them to charge exorbitant interest rates and fees -- rates and fees that do not pass muster in your own state.

Same would happen with insurance. They would take over a state government, have it effectively deregulate them, kill off all mandated benefits (even ones you would agree with), and gouge people. All by eliminating things and regulation your own state requires for the good of the citizenry.

Really, its a terrible idea.
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Disagree.

In many states now you have near monopolies - BCBS owns about 75% of the market in Alabama. If consolidation is a problem then we have it in spades now in most states.

Also, single payer is the ultimate consolidation.
 
#3,667
#3,667
For the first time in 8 years my Premium did not increase. Out of pocket Maximum went up by 1k. Still for the coverage I get it's very hard to complain.

I'm on a CDHP so my ded is 3k. It's high but the company I work for provides a FSA for 2k that rolls over if I don't use it. So I only end up spending 1k out of pocket before insurance kicks in and that's after the discounts the insurance gets for in network. Very smart IMO. It's there if you need it and last year we did with the birth of my son and my wifes medical issues.

JMO, but if anyone's company offers it or starts offering a CDHP plan I would highly recommend you look into it.
 
#3,668
#3,668
volinbham said:
Disagree.

In many states now you have near monopolies - BCBS owns about 75% of the market in Alabama. If consolidation is a problem then we have it in spades now in most states.

Also, single payer is the ultimate consolidation.
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Yes, but the consolidated interests in a given state have to play by that state's rules. They forecast the loss, add in profit and administration, and there's the rate.

If you let them all converge in one state, quality of coverage goes down. In some cases waaaaay down. And costs go up, relative to benefits covered.

The only people who tout this are the insurers. And those they have paid.
 
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#3,669
#3,669
lawgator1 said:
Yes, but the consolidated interests in a given state have to play by that state's rules. They forecast the loss, add in profit and administration, and there's the rate.

If you let them all converge in one state, quality of coverage goes down. In some cases waaaaay down. And costs go up, relative to benefits covered.

The only people who tout this are the insurers. And those they have paid.
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link?
 
#3,671
#3,671
More ACA cost savings:

FDA approves first biosimilar product Zarxio

The Biologics Price Competition and Innovation Act of 2009 (BPCI Act) was passed as part of the Affordable Care Act that President Obama signed into law in March 2010. The BPCI Act created an abbreviated licensure pathway for biological products shown to be “biosimilar” to or “interchangeable” with an FDA-licensed biological product, called the “reference product.” This abbreviated licensure pathway under section 351(k) of the Public Health Service Act permits reliance on certain existing scientific knowledge about the safety and effectiveness of the reference product, and enables a biosimilar biological product to be licensed based on less than a full complement of product-specific preclinical and clinical data.
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Biologics are among the most expensive drugs on the market. Elsewhere, biosimilar drugs sell for 20-30% less than the originals. If more of these are approved in the U.S., it will mean billions in savings.
 
#3,672
#3,672
volinbham said:
1. removal of state barriers to competition (talk about a risk pool killer)
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If you are in favor of insurance competition, you better hope the government prevails in Burwell. At a symposium I was at today, a DC health care policy lawyer said he has heard that if the plaintiffs win, some insurance companies may entirely pull out of some federal exchange marketplace states. Death spiral for the insurance markets.
 
#3,673
#3,673
Velo Vol said:
If you are in favor of insurance competition, you better hope the government prevails in Burwell. At a symposium I was at today, a DC health care policy lawyer said he has heard that if the plaintiffs win, some insurance companies may entirely pull out of some federal exchange marketplace states. Death spiral for the insurance markets.
Click to expand...

Did he explain why?
 
#3,674
#3,674
lawgator1 said:
I used to think eliminating the state barrier thing was a good idea, but I've read quite a bit on that lately and it turns out its a horrible idea.

It is likened to the similar credit card measure, enacted some years back. Ever notice how all of your credit card offers come from just a handful of states? Nebraska, Delaware maybe.

Its because the state legislatures in those states have been bought and paid for by the credit card companies. They flock there, because they have enacted laws that allow them to charge exorbitant interest rates and fees -- rates and fees that do not pass muster in your own state.

Same would happen with insurance. They would take over a state government, have it effectively deregulate them, kill off all mandated benefits (even ones you would agree with), and gouge people. All by eliminating things and regulation your own state requires for the good of the citizenry.

Really, its a terrible idea.
Click to expand...

th
 
#3,675
#3,675
lawgator1 said:
Practically speaking, the list is endless, and I don't see how you can account for everything.

Eat too many potato chips
Smoke
Don't get servings of fruits and vegetables
Drive too fast
Drive too slow
Drive at all
Got too much sun as a teenager
Play baseball
Wear a helmet when playing baseball
Don't wear a helmet when playing baseball
Ride a motorcycle
Stay up past 11
Drinks too much coffee
Doesn't drink enough coffee
Walks down the street
Single
Married
Divorced
Tennessee fan
Gator basketball fan (this year)
Live in house never struck by lightning


The point of insurance is to spread risk. You are higher in some respects than others. Others are higher in other respects. You just can't try to carve that up. Makes no sense, otherwise.
Click to expand...

So again, why should someone who eats responsibly, gets regular exercise, doesn't smoke and all those things have to pay for lottery paying smoking drinking welfare recipients that do nothing but sit on their asses all day? It is another .gov hand out.
 
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