Comments on: How To Beat Obamacare

By: liv&win

liv&win — Sat, 23 May 2009 17:05:01 +0000

Spartacus: Yes, I would mandate the secondary insurance coverage. And because you are taking billions of primary care transactions out of the picture, the cost of the coverage would be reduced in both administration and pure insurance costs.

The purchasing decision on the insurance is chiefly financial for the individual: do you want prescription drug coverage for generics only, formulary only, or full coverage. do you want level 1, 2, 3, 4, 5 or 6 specialist coverage. do you want 100-10000 deductible for facility care? It is so straight forward that you can even build your policy starting with how much you can afford to pay. You want to pay $150 a month? You can afford level 2 specialist coverage, formulary rx and a $5000 facility deductible.

I have to say that I envision this replacing all current plans and programs currently being used. I am philosophically opposed to any legislation that does not apply to everyone. I think where laws are concerned, every citizen should be equal.

By: liv&win

liv&win — Sat, 23 May 2009 16:48:40 +0000

sinz54: your not exactly correct about eliminating pre-exisiting condition limitations. We did away with them in the small group market 10 years ago in CA. there was no mandate and we even limited rate increases to 10% above the standard risk rate which are filed and approved by the DOI. Insurance companies want the mandate, but it is not necessary. I can explain later.

"You yourself said that many Americans, particularly younger Americans, don't even bother to purchase coverage because they think they'll be healthy forever. " Actually what I said was that 25% of the uninsured are young 18-25 year olds. 40 million uninsured, 25% is 10 million. 10 million out of 150 million insured is not "MANY" it is just the opposite, is it "very few".

Spartacus: what I propose for cost control in the secondary care area I discussed is complicated. At the core is transparency, freedom of choice, quality measurements and competition. It looks like this: you see your primary dr and you are told you need to see a specalist. Right there you get to see the availability and quality of all the specialists in the health care district. The specialist with the highest quality rating will probably not have an appt for 45 days. the specialist with the lowest quality rating might have an open appointment next friday. The patient gets to choose.

Competition for quality outcomes and the reward is compensation. The lowest quality doctors get 100% of medicare reimbursement. The highest get 200% of medicare and then there are 4 levels in between (1.0, 1.2, 1.4, 1.6, 1.8 and 200%). Your selection of insurance plan includes a choice on what quality level the plan will reimburse. So if you choose a plan that reimburses at 100% of medicare and you see a doctor that has earned through quality care 200% of medicare, that difference between the charges and the reimbursement would be the copay/deductible/out of pocket cost or whatever you want to term it.

By: sinz54

sinz54 — Sat, 23 May 2009 11:16:05 +0000

danbmil99: I would certainly like to see some elements in health care reform that incentivize wellness. With auto insurance, you get a discount on your premium for being a "safe driver." And your premiums are calculated based on your risk--your age, the neighborhood you live in, the amount of driving you do, etc.

Something like that could be carried over to health insurance premiums. Discounts for not being overweight or underweight; discounts for not smoking (we already have that discount with life insurance), discounts for not using illicit drugs, etc.

But health insurance isn't like auto insurance in one big respect: Most folks junk their autos at some point and buy other ones. Whereas with your body, you are forced to keep getting medical care (and filing health insurance claims), as long as you can live. It's like maintaining a 70 year old antique car. It's going to be expensive.

By: sinz54

sinz54 — Sat, 23 May 2009 11:10:08 +0000

Spartacus: Obama wants to eliminate Medicare Advantage entirely, if he can. Its budget was cut in Obama’s first budget.

By: danbmil99

danbmil99 — Sat, 23 May 2009 05:17:57 +0000

This whole issue is such a train wreck about to happen. Everyone knows the end game: health care becomes a nationalized, big-government service. There is no middle ground, except boutique services for the uber-rich.

Once you give up on the idea of insurance being an indemnity against risk, you're pushed into the role of taking from the healthy to give to the sick. As others have said, insurance is now a misnomer: it's collective payment that is averaged out among the group. That's why it works in companies -- you have a group, and it's unlikely their aggregate health costs will be much different than the average.

This is indeed going to be massive redistribution of wealth -- there's no getting around it. Everyone has to contribute or the pool is skewed. It's a new tax for a new entitlement.

By:

Fri, 22 May 2009 23:14:04 +0000

Sinz: I know you're in favor of mandate, but universal care, by itself, is not going to reduce costs enough. You'll will have some savings due to preventative care, but almost certainly not enough to prevent economic disaster.

Any public plan that is intended to operate alongside private plans would naturally have to charge premiums. The difference is that the public plan, in theory, would be much cheaper mainly b/c of purchasing power.

As for Medicare, it does charge premiums. And, many private insurers participate in that market through the Medicare Advantage program.

By:

Fri, 22 May 2009 23:06:41 +0000

liv&win: Your plan sounds like a huge improvement over the status quo, but how do you control costs for services that aren't covered under the primary coverage?

Also, I think you need to have some minimum national standards for secondary policies. I think it's fine to have multiple options, but there's no evidence that the consumer will read or understand the differences btwn all the options.

I think you'd also have to mandate secondary policies, although they would probably be much cheaper since a lot of care would be covered by the primary policy.

By: danbmil99

danbmil99 — Fri, 22 May 2009 21:56:06 +0000

"The fact is, Republicans have a real opportunity to derail Democrats efforts, and the model is their 2007 defeat of immigration reform."

Wow, that's a positive agenda! What other goodies do you have in your GOP bag of tricks?

Don't bother with a realistic, workable alternative. You didn't bother with that on immigration. Instead, you accepted a status-quo where 10 million plus non-citizens are sort of tolerated but have no civil rights. Kind of like Apartheid. Yes, they broke the law. The problem is, we let them -- practically begged them to. But I digress. The new agenda is to make sure 50 million people continue to use emergency rooms as their first line of defense against medical problems. How's that working for you?

I've got a fancy new nickname for the GOP: The Derailleur.

By: sinz54

sinz54 — Fri, 22 May 2009 21:48:33 +0000

liv&win: The private insurers won't sit still for eliminating pre-existing condition exceptions, if the pool of policyholders isn't expanded. And if they oppose health care reform like they did in 1993, that could sink it.

You yourself said that many Americans, particularly younger Americans, don't even bother to purchase coverage because they think they'll be healthy forever. The result is that Americans will delay purchasing coverage till AFTER they're diagnosed with a serious illness. Then the insurer will be forced to cover them (now that the pre-existing clause is dropped). If the insurer can't make up in premiums what it will be paying out in claims, it will go bankrupt.

We faced that problem in Massachusetts. It's a straightforward Grand Bargain: The insurers drop the pre-existing clause, in exchange for a universal coverage mandate which forces young, healthy policyholders into the pool. And that's what the private insurers have told Congress for any national reform as well.

By: sinz54

sinz54 — Fri, 22 May 2009 21:42:30 +0000

Spartacus: I have always been in favor of a mandate to force everyone to purchase health insurance. That forces young, healthy policyholders into the pool, as we did here in Massachusetts where I live.

Secondly, Senator Schumer, in YOUR party, is well aware that a public plan that appears to be "free" (zero premiums and zero co-pays) would cause employers to drop private group coverage, and cause many Americans with individual policies to switch to the public plan. And he's working a compromise (see below).

I'm currently paying $465 a month in premiums to Blue Cross. Do you think I wouldn't be strongly tempted to switch to a public plan with zero premiums and save myself $5,000 a year??? Who the heck would give up the opportunity to have "free" health care???

To fix that, Senator Schumer's proposed compromise involves a public plan that charges premiums and co-pays, just like the private plans do. That way it can never drive the private insurers out of business by being "free."

You mentioned Medicare. Medicare crushed 95% of the pre-1965 private insurance market for seniors, because of Medicare's zero premiums. There may be an "option" to choose private insurance, but a retiree isn't going to spend thousands of dollars on private insurance if Medicare is "free"--unless Medicare's cost caps have caused his favorite doctors to stop accepting Medicare reimbursements. That's been happening more and more. At least 25% of American doctors now refuse to accept Medicare reimbursements, because the caps are too low.

So if you think that a public plan can't drive the private plans out of business, I suggest you tell that to Senator Schumer. He's in YOUR party, after all.