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View Diary: HCR:  Where Do We Go Now, Sweet Child 'O Mine? (45 comments)

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  •  Lots of well done analysis. (3+ / 0-)
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    conchita, Pris from LA, kareylou

    Probably HCR as passed would be a bit more equitable if your ideas were brought to fruition.

    But the problem is the absurd presence of a for profit entity,health insurance,that provides absolutely no value. None.
    Healthcare dollars need to be spent on healthcare,not insurance.

    "George RR Martin is not your bitch" ~~ Neil Gaiman

    by tardis10 on Mon Jun 14, 2010 at 06:47:19 PM PDT

    •  Which they will be under current law. (1+ / 0-)
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      yella dawg

      Certainly a much greater portion of it as insurance agents, who receive 10-20% FY commissions in the individual insurance market), will be wiped out.  So will much of medical underwriting costs, which comprise a substantial percent of insurance costs.

      And to say that taking the profit out of health insurance will solve all our problems -- well, MN requires all insurers to be non-profit, and I haven't exactly seen premiums much cheaper in the Gopher State than in other states.

      Also, 60 percent of Americans in employer-based health insurance get their health insurance from an employer who self-insures.  And nobody exactly says that self-insurance lowers the cost of health insurance that much -- well, except that those who self-insure can escape premium taxes, minimum benefit packages, have flexibility on reserves, etc.

      3% of your premiums go to insurance company profits.  That's not exactly a huge percentage.  The number one factor of medical inflation is technology, and the number one reason health insurance is so expensive is provider compensation.  So let's go after the real culprit of rising premiums -- not the politically convenient culprit.

      •  Why no public option in your wish list (1+ / 0-)
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        conchita

        I notice you didn't have PO there. Do you have an objection to public option? Also- there is a promising provision dealing with the funding of at least one non-profit co-op for each state exchange. That is our last best hope.You don't have anything in your proposals for strengthening the co-ops neither. You are proposing making the mandate penalty much harsher. So you are forcing people to patronize for-profit health insurers.

        •  Yes, the individual mandate penalty ... (2+ / 0-)
          Recommended by:
          joedemocrat, yella dawg

          ... is much harsher.  But the community rating, the minimum benefits package, and the subsidies are much, much stronger.  So are the provisions to prevent anti-selection.  This is nothing for any liberal to sneeze about.

          As far as public programs, Medicaid is expanded to 150 percent FPL, and states are allowed to form single-payer programs.  The latter is a nice political decoy, but heck, why not throw in the public option as another politcal decoy?  It worked pretty well last time?

          Here's my question on the public option?  Let's say, for example, Massachusetts requires coverage of in vitro fertilization as it does now, would the public option be required to cover it as well since IVF clearly is not in the list of required services to become a QHBP?

          •  Public Option was polling very well (0+ / 0-)

            Last time it only failed purely because of the spinelessness of the senate & the White House. It was polling perfectly well.

            The thing about the mandate is- it was originally a grand bargain. AHIP gets the mandate, and we get the PO. But now we got shafted. They get the mandate, we get nothing. And under your proposal, the most unpopular element of HCR gets strengthened, and the popular element gets no play. I think it should be the other way around.

            In any event, have you considered some alternatives to the PO? For example- how about a long waiting period? I believe the current max waiting period of 90(?) days is too short. If you lengthen it to 6 to 12 months then people will be scared to go without insurance. Another alternative is this- make people pay the surtax, but in exchange offer them some kind of barebones type plan. They get to choose from a list of barebones plans offered by the insurers. That way they still get something for their surtax.

            •  Oops that last paragraph should read (0+ / 0-)

              "have you considered some alternatives to the mandate?"

              •  The public option was never ... (0+ / 0-)

                ... very strong to begin with simply because the Exchange was so weak.  Remember, the PO is a two-part deal:  First, the employer has to dump their employees onto the Exchange, and second, the people on the Exchange have to choose the public option.  If the Exchange itself becomes a dumping ground for employers who have more trouble getting health insurance, than the Exchange will be unpopular, and the public option won't matter.  By making employer participation in the Exchange voluntary, it is likely that employers who have more trouble getting health insurance will be the first to dump their employees onto the Exchange.  This will lead the plans on the Exchange to be pricer, and begin an insurance death spiral.  Whether there is or isn't a public option won't matter if the Exchange is weak.

                6 to 12 months is next to nothing for a healthy, 27-year-old bachelor.  And the elimination of age and smoker ratings is going to raise their premiums dramatically.  The pre-exclusion period and ineligibility for subsidies would have to be 5 years minimum if it were to replace level of effectiveness of the penalty that I have.

                I'm not into the barebones deal.  The sooner we get rid of that crap, the better.

      •  Pull the other one. (2+ / 0-)
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        conchita, kareylou

        Sorry,not buying. 3% to "profits" & how much to "expenses"?  Insurance companies in the U.S. have considerable administrative overhead, far greater than in nationalized, single-payer systems, such as Canada's. We both know this. We are wasting about .30 on the healthcare dollar. Ridiculous. In short,I don't want private health insurance companies to exist. I have lived way too long to not see this as the racket it is.

        Politically convenient scapegoat? No,if my view were "politically convenient" the US wouldn't be saddled with this.

        We can agree that there is waste on the provider and the patient side,but as long as insurance companies,businesses that exist solely to make a profit or employ non-providers,are part of the equation,the US Healthcare system will remain the unjust,morally bereft mess that it is.  

        "George RR Martin is not your bitch" ~~ Neil Gaiman

        by tardis10 on Mon Jun 14, 2010 at 07:50:53 PM PDT

        [ Parent ]

        •  Let's go to a government resource ... (1+ / 0-)
          Recommended by:
          yella dawg

          ... since government seems to be the only thing you trust:

          Per the Congressional Research Service:

          In addition, because benefit values are calculated as a percentage of allowed medical expenses, or "claims," they exclude the impact of administrative expenses, another factor that affects premiums. One analysis,10 prepared under contract by the Small Business Administration (SBA) Office of Advocacy, found that insurers’ administrative expenses for health insurance sponsored by small employers—"small group coverage"— amounted to 33%-37% of claims; for large companies’ self-insured plans,11 administrative expenses amounted to 5%-11% of claims. For small group coverage, the cost of commissions were found to make up 4%-11% of premiums, taxes and fees 2-3%, general expenses 10%-11%, and profits 4%-5% of premiums.

          •  Thank you for making my point. (0+ / 0-)

            Gee,those expenses sure add up.

            I understand you embrace the continuation of the health insurance model. Likely you think of yourself as pragmatic on this issue. Me,I think your views are dangerously short sighted and fiscally unsustainable. But your side has won this debate and I see you are trying to make some sort of lemonade here. I hope you succeed..

            Btw,there are all kinds of things I trust in the universe but,no,corporate entities aren't real high on my list.

            "George RR Martin is not your bitch" ~~ Neil Gaiman

            by tardis10 on Mon Jun 14, 2010 at 08:27:18 PM PDT

            [ Parent ]

            •  But you don't consider the higher... (1+ / 0-)
              Recommended by:
              jim bow

              incident of Fraud, Waste and Abuse in government plans...it all equals out...since there is higher overhead in private plans but less FW&A...

              Obama - Change I still believe in

              by dvogel001 on Tue Jun 15, 2010 at 01:54:35 AM PDT

              [ Parent ]

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