I love people commenting on THCB, and 99% of the comments are very, very thoughtful. But I am a little dismayed that while only one person wants to comment on my long piece on the individual insurance market, one other on VC in health care (and that someone I wrote about clarifying a point she made) and none on my experience at the consumerism conference—28 people have something to say about a malpractice study I just point to!
People, malpractice is one percent of the dollars, and it’s about 17th on the list of major health care problems and issues we face in this country! It’s the abortion issue of health care—polarizing way way beyond it’s importance. <sigh>
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Blog comment can be motivated by a desire to open another facet of a post’s topic for discussion. That isn’t going to happen as much ( at first anyway ) with a thoughtful and comprehensive essay. You aren’t the only author to think comment frequency to be an effective gauge of reception : it isn’t proven.
Matt,
Don’t be sad – I read your blog nearly every day and enjoy the content. Unfortunately, most of your readers are probably very hard working individuals, and I for one don’t have the time to post.
Keep up the great work!
-Scott
I meant individual insurance in the last paragraph.
In 2004 only 24 million people inthe US were covered by private individual health insurance–about 12% of those having private health insurance. In the aggreagate it isn’t that important. The WSJ, wanting to free employers form having to deal with health insurance, wants everybody to buy indidvidual health insurance in a nationwide marketplace. They eschew community rating and guarantee issue–pointing to the much higher rates in states with community rating.
First, each state’s individual insurance rates are set based on provider contracts in their local area and local provider practice styles. You can’t buy New Hampshire individual health insurance and expect to be covered in New Jersey. The network doesn’t extend there except on a visitor basis.
Secondly, a community rated individual health policy rate is, by definition, going to be more expensive than the best available rate in a non-community rated state. Non-community rated individual rates are either filed with the state and the insurance company can refuse anyone. Here in Georgia, Kaiser Permenente reject 40% of individual applicants. BCBS of Georgia rejects only 10%, but imposes 2 to 4 years waits for benefits on any current conditions. Other states allow the premiums to be rated up to a maximum percentage based on health questions. Community rated premiums offer the advantage of providing access to insurance for all at an average rate for the age, sex, and location. Further community rated rates probably average close to non cummunity rated rates when all rates for people of all conditons are factored in.
In most states, indvidual insurance rates are increased quarterly compared to anuually in group rates, and second year increases are large since pre-ex conditons limitations will have lapsed in most cases.
Community rating and guarantee issue can lead to a death spiral for the coverage. Adverse selection occurs, leading to higher rates and more defections from the plan by the healthy. This has been the case in Maine. Taken to an extreme, rates keep rising till no one can afford them. Community rating and gurantee issue work well only in cases of madatory insurance.
Finally, indivdual insurance is not geared for the long term. Plan provisions are much more limiting and lifetime maximums are low.
Employers shifting their employees to group insurance is just not possible under current conditions. In most states, a significant portion would not be able to obtain coverage or be offered limited high cost coverage, possible in a high risk pool. Since rates are not averaged across age groups, most older workers in middle income jobs would find converage unaffordable regardless of subsidy. This would create a large pool of high risk uninsured workers.
I just wish that some would first learn the details of implementation before prescribing superficial answers to complex problems.
I have to agree with Peter. Unfortunately he paints what I think is a particularly accurate picture of the state of this country. Now I’m really depressed.
And as far as this blog, it doesn’t do much good preaching to the choir. I happen to agree with most of what you say. We need to get those on the other side of the issue to see the error of their ways.
Matt, the article was great, but every time I read one of these I get a headache and have to make an appointment to see my shrink!. The newest entity amongst medical providers to replace the IPA is called a “messenger organization”. Keep up the great stuff, read you all the time, and don’t be SAD.
Matthew- I strongly disagree about your analogy to abortion. Medical liability is a central concern to nearly every physician involved in the delivery of healthcare. The 1% number is terribly misleading.
It implies the dollars are spread evenly throughout the system. They are not.
Medical negliglence can ruin lives.
Meritless lawsuits ruin careers and have the result of exponentially limiting the access to care for others who might have benefited from seeing a physician who no longer takes ‘call’, who no longer will take care of complex conditions.
David Studdert’s study in the NEJM today saying that nearly 1/3 of the suits brought are meritless sounds about right.
PS. here is my take on the individual insurance market— end business tax deductibility for insurance, pass the Health Care Choice Act, pass SBHP to end the big insurer monopoly, and eliminate the crazy restrictions on patients and doctors for medicare preventing price competition, and do not go from 10,000 codes to 40,000 codes under medicare coding rules, do the opposite and go from 10,000 to 1,000, and tax credit care for those with very low income. Oh, and make Bridges to Excellence to model for P4P (carrots and sticks for both doctors and patients.
PPS. health courts would complement this nicely.
PPPS. VC is great. Less politcal intrusion would bring more to healthcare… remember the internet?
PPPPS. I’m sorry you are sad!
Matt, I did read your long piece on the individual market. Too many number relationships that needed analysis for me to make much of a comment on. I have chirped in on the comments now on that thread. I am quite disheartened and cynical (can’t you tell from my comments) about the future of healthcare and any hope for a solution prior to near catrastrophy. If you read the comments on the malpractice thread there are sidebar comments on the whole system and there is somewhat of a tie to all the problems we face. The poloarization we see comes from the political climate that has been created in this country where coming together and finding solutions has been abandoned for, it’s every person for themselves, I’ve got my lobbyist you get your own, and let’s find some hot button issue that divides Americans, usually with the right amount of subtle hate. The voter patterns that have developed in this country, too many people tuned out, have left two bases fighting each other with the goal being that we just need one more vote than them. I find this blog extremely interesting and I think the quality of commenters (excluding me, not a wonk) to be very good. But I wonder whose reading this outside of the bloggers. We can all discuss this forever but if the policy makers are not participating then what’s it all for. Some lobbyist will just pay off some politician in the end and screw the rest of us. Keep it up however, I would rather have this than not have it.