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POLICY: Health insurance 101

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Head over to Managed Care Matters for Joe Paduda’s just excellent health care 101 (or should it be 001) rendition of why universal coverage and community rating require each other, and are both essential for health care reform to work.

And of course remember that this is true both for multi-payer and single payer solutions.

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kurt jarcikJUDYgjuddGeorge JaspertDon Osborn Recent comment authors
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kurt jarcik
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Easystm.com will give Coverage of short term health insurance as early as the next day… just a few simple medical questions to answer. Best of all, you can choose to receive your policy electronically!
http://www.easystm.com

kurt jarcik
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Easystm.com will give Coverage of short term health insurance as early as the next day… just a few simple medical questions to answer. Best of all, you can choose to receive your policy electronically!
http://www.easystm.com

JUDY
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JUDY

Do anyone know of a New York State mandate regarding no copay for any schedule well care visit? If so please advise link so I can forward to my child’s doctor.
Thanks!

gjudd
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gjudd

Just months before he died, I had the opportunity to ask Milton Friedman if he thought there might be any way health risk might be effectively securitized via some variant of the “cap & trade” model devised to deal with industrial pollutants. (background on cap & trade here: http://en.wikipedia.org/wiki/Emissions_trading ) That is, create a mechanism to establish a more fluid market for the ‘trading’ of health risk. He thought for several moments, and replied: “I’m pretty sure I do not understand the question.” : – ) health risk already is securitized on a small scale for health system receivables, but… Read more »

George Jaspert
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This site has a hybrid proposal for the uninsured: Creates 50 new state workforces of Universal Health Care Workers, at lower labor rates to provide direct health care to the uninsured vs. insuring them with health care policies. This would separate them from the current system which must raise rates to cover the 42 million who are uninsured. This policy does not or using Canadian style health care for everyone. Utilizes non for profit retired, college and foreign workers. The new UHC workers would not need medical policies themselves. It also issue a New Universal State (Part B Policies) so… Read more »

Don Osborn
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The answer is to promote individual plans, and end the group sponsored plans. Allow families to shop for and purchase direct policies on a pre-tax basis. This will bring back free the market forces. Minimal regulation is all that will be required from the States.
Don Osborn
http://mtnhealthinsurance.com

DaveS
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Coverage under a health insurance plan provided by your spouse can be tricky if you also have coverage provided under your company as well. Another alternative for folks looking for affordable health care is to look for a new job that might offer great health benefits. Many people choose to not worry about medical insurance, because they or their family are not sick today; that is a big mistake. Find out exactly what is covered in your plan to be sure it meets all of your family’s needs. A health insurance plan that is considered affordable by most people would… Read more »

Skeptic
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Skeptic

Mr. Fembup: I agree with you 100%—reform of the insurance market by itself will not necessarily provide relief for high health care costs. The U.S. has fundamental problems with the way it finances health care as well as the way it delivers health care and when debating health care reform we should always distinguish between those two problems. On the other hand, certain aspects of financing systems (e.g., provider payment mechanisms) do have a profound impact (for better or worse) on delivery systems. My biggest fear about most single payer proposals is that while they could provide an effective remedy… Read more »

John Fembup
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John Fembup

It’s fine to seek the best & fairest way to allocate health care costs via insurance premiums. Let’s be sure at the same time to keep in mind that even the optimal manner of setting premiums won’t reduce health care costs by a nickel. Rising insurance premiums are caused by rising health care costs – the cost of health care is the deeper problem. This is why I think meaningful relief from the problem of high health care costs – or high insurance premiums – won’t be found thru any agreement on community rating, whether CR “works” or not. Meaningful… Read more »

Skeptic
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Skeptic

Mr. Paduda, thanks very much for your feedback. But at the risk of repeating myself, I must respectfully disagree with you—even in a market where there is universal coverage, community rating is problematic. The following quote explains the nub of the problem (you can substitute “individual mandate” or “employer mandate” for “managed competition” and the essential meaning of the quote does not change): “It is sometimes said that community rating is essential to managed competition because it forces insurers to stop competing on the basis on how well they select risk. Just the opposite is true. Community rating greatly intensifies… Read more »

John Fembup
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John Fembup

“Actually, it will ONLY work with universal coverage – therefore comparisons to NY and other states that have partial community rating are not germane.”
You must be referring to some kind of community rating I’m not familiar with. The kind of community rating I have encountered e.g., in New York, certainly dos work in the absence of universal or even statewide coverage, and the NY small-group market is a perfectly germane example.

Joseph Paduda
Guest

Skeptic – kudos for your considered and thoughtful comments. That said, I still must disagree with your observations re community rating will not work. Actually, it will ONLY work with universal coverage – therefore comparisons to NY and other states that have partial community rating are not germane. You note that insurers will attempt to “increase profits by avoiding individuals expected to generate high health care costs.” That’s true. But community rating and elimination of medical underwriting will eliminate insurers’ ability to do just that. Insurers CAN’T avoid risks they don’t want by underwriting or policy limits or benefit design.… Read more »

Skeptic
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Skeptic

re: The recent posts by B. Carol, J. Fembup, and JD: Response to Barry Carol: your compromise approach (i.e., one rating tier for under age 40 and one for age 40-64) is an interesting idea. I might find it acceptable if it could be combined with generous tax credits linked to income so that it doesn’t cause a massive shift of wealth from the young to the old that I described in my previous posts. However, I fear that in the context of the current voluntary insurance market (i.e., no individual or employer mandate) that exists in virtually all states… Read more »

Tom Quigley
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Why not use the tax laws that are currently available and take advantage of them versus crying over spilled milk. There is no health crisis people need to wake up especially the agents who sell health insurance.

Barry Carol
Guest
Barry Carol

I think it might be easier to achieve universal coverage if the insurance package as proposed by Senator Wyden were broken into two pieces with only the first piece mandatory as follows: Part A (mandatory) – $5,000 per person deductible and then 100% of covered services after that. Part B (optional) – 20% co-pay for the first $5,000 of charges ($1,000 OOP). If the package as proposed by Wyden would cost $357 per month (national average) for single coverage, insurers might be able to sell the catastrophic piece with a $5K deductible for $250 per month or less. The Part… Read more »