Bob Laszewski has found the solution to the Bush health care program’s reliance on the non-functioning individual health insurance market. The plan needs a model that addresses the problems of medical underwriting, denial of coverage, age band underwriting, risk selection, access and availability, and it’s called “Part D”!
Feb
19
If you think about the individual health insurance market in America, the lack of any social beneficial mission definition to the healthcare system becomes obvious. You pay into the system when you are well, but when you get sick and need it, the subsequent yearly premiums that the companies can set in most states can force you out due to extremely high charges just when you need the care most? How can a social system be allowed to practice such ridiculous processes.
It can and does because the healthcare system in America has no defined social mision to do good for everyone, IMHO. That mission should be set first, and then regulations to make sure the entire system meets that mission should be put in place no matter whether it is a government run program or a market oriented program.
If I had to define the current mission statement for the American individual health insurance market, it would be first and foremost to make profit for insurance companies even at the expense of adequate longer term healthcare for those covered.
I have been paying for medical benefits for about 10 years. I have used medical benefits about 5 times. Could be less than that. None of which were expensive incidents. Where does all the money go that people like me put into the system?
“I have been paying for medical benefits for about 10 years.”
Uh, no. You have been paying for insurance. There is a difference between insurance and medical benefits.
“Where does all the money go that people like me put into the system?”
Most of it goes to pay the medical benefits for people who actually incurred expenses and are entitled to be paid. That is how insurance works. The idea is to finance the unexpected expenses of the few by asking the many to contribute. This is the same whether it is a private insurance scheme or a public program such as in Germany or France. The idea breaks down in the U.S. because we expect our insurance to pay for routine and affordable medical expenses, not simply the unexpected, large expenses. We are living out a tragedy of the commons and we will not escape so long as our expectations do not change.
By all means, if you don’t think that insurance is a good deal, don’t buy it.
True I could elect not to pay for insurance (medical benefits) but like you said the unexected expense may occur. I just believe that with all insurance if you do not use it you should see some kind of kick back. Thats all I am saying. Just my opinion, everyone has one.
“The idea breaks down in the U.S. because we expect our insurance to pay for routine and affordable medical expenses, not simply the unexpected, large expenses.”
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Maybe this is a contributing factor, but I believe the major cause of our breakdown is the death spiral of insurance pools so only the actually sick stay in decent coverage pools while the young and healthy opt out of such pools. IMO, Regulation related to a healthcare mission would tend to force everyone into huge (the best would be one) pools and also prevent individual ratings for charges with obvious guaranteed renewability.
Even without huge pools, place the guaranteed renewal, community ratings, and at least minimum mandatory policy possession (with subsidies for the poor) on all health insurance companies and then see what they can do to compete but with the mission of providing care when needed for all enrollees now and in the future front and foremost, instead of the current cherry-picking game to see how much they can keep instead of providing actual healthcare!
“only the actually sick stay in decent coverage pools while the young and healthy opt out ”
NG, that’s true of individual policies (roughly 10% of the working population) but is not true of group coverage – roughly 50% of the working population). This is because group plan sponsors pay a substantial part of the premium. The employees’ net contribution for group insurance is some fraction of the total premium, which attracts enrollment from young & healthy employees as well as older employees who have more chronic conditions. By contrast in the individual market, insurance companies screen who they will cover based on health status. This practice is controversial. If the government insured everyone, this screening would not be necessary (however younger people would lose their option not to participate – which would be controversial).