Negotiating With Pre-Existing Conditions

The NY Times opens the latest round of coverage of the health care debate with one for the "no kidding" file:

WASHINGTON — The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage.

Groan - Hilary and Obama waltzed around this topic endlessly at debate after debate.  Hillary's view was that she would require everyone to have coverage (see the Massachusetts plan) but she coyly (more votes for "disingenuously"?) refused to specify the "or else" that she would inflict upon non-compliers.

Obama promoted an alternative fantasy - his subsidy plan would make health care so appealing that the working poor would buy subsidized insuarance rather than simply wait until they were seriously ill and then avail themselves of their new ability to buy insurance (presumably still subsidized) regardless of pre-existing conditions.  It is not yet clear to me whether Obama really thinks people are that stupid or simply figured this packaging was more politically expedient.

A bit from the current Times story:

The new policy statements [from the insurance associations] are silent on two important issues: how to enforce an individual mandate and how to regulate insurance prices, or premiums.

While insurers would be required to sell insurance to any applicant, nothing would guarantee that consumers could afford it. Rate regulation promises to be a highly contentious issue, since it pits the financial interests of insurers against those of consumers.

...

“Insurance works best when everyone is in the pool,” Ms. Fox said. “You need healthy people in the insurance pool to help pay for sicker individuals who are much more motivated to buy coverage.”

Insurers did not say how the government should enforce an individual mandate: whether through fines, tax penalties or other means. Politicians have also been reluctant to specify details of enforcement, which could prove highly unpopular.

Comments

[bad]

...whether Obama really thinks people are that stupid or simply figured this packaging was more politically expedient.

yes

[Buford Gooch]

Yeah, we'll insure any of you, if you promise that we get to insure all of you (at prices unnamed). That's the ticket.

[Pofarmer]

Well, if we didn't have a health care crisis, we will soon. The govt needs to BUTT OUT.

[bad]

Rush said yesterday he forsaw some monster healthcare bill coming down in Ted Kennedy's name that no one would have the guts to vote against.

[George S]

All these nationalized, universal, affordable, whatever-you-call-it government health care plans are completely unviable unless one pre-condition is firmly established: make it a serious crime to engage in private health care transactions.

If you could pay under the table, then what's the point of all being covered - you still do not get accesss to the best of the system because the "rich" are meeting the doctors in the parking lot and arranging their health care. The have-nots will see no change; they were bought with the promise and they have to stay bought.

[bgates]

It is not yet clear to me whether Obama really thinks people are that stupid
In light of the election results, it would be hard to gainsay that conclusion.

[Appalled]

George S:

Canada is the only national health I know of where private insurance/doctirs is banned. Most other places, national health serves as a floor plan (much like Medicare), where those who want more coverage or different doctors can buy it. Some of those systems (Japan) work OK. Others (England) don't work as well.

[vinman]

We hear constantly about how America sucks the resources out of the rest of the world.

America has 3% of the oil, yet consumes 60% of all oil.

America has 5% of the world's population, yet consumes 50% of all durable goods.

Why not find some unsuspecting, growing economic tiger (India? China?) to fund our wild health insurance fantasies?

[DrJ]

Canada is the only national health I know of where private insurance/doctirs is banned.

Really? This must be new. I interviewed for a VP position with a Canadian company about 10 years ago. One of the benefits was private healthcare insurance. They were surprised at my surprise that this was necessary.

(No, I did not get the position, as their strategic direction changed.)

[JM Hanes]

Great headline, TM!

[Jor]

I don't want to break it to the wingnuts over here -- but health care in America is already basically govt run. Medicare sets the reimbursement rates for everything, and private insurers, generally take medicare's rates and multiply it by a fudge factor.

Part of the problem with the cost of health care (besides access) -- is that the system Medicare has in place has the incentives grossly messed up (see last weeks New England Journal). Somehow, "the market", has yet to fix this.

All I will say is health care is a gigantic cluster-fuck. The market hasn't worked and the govt reimbursement system is causing shit loads of problems. Healthcare needs some type of major reform -- what that reform is, I got nothing.

[clarice]

I think if you're sick, it's a good idea to go to India for health care. And it'll be a better idea the longer these dopes are in charge.
(Did you see that Reid--obviously at O's urging--is offering to make Hill the Senate health czar if she doesn't get-or take--the S of S position which she may or may not have been offered by a president-elect (with his fingers crossed behind his back).

[George S]

I'm not talking about the world, just here in the States. Our health care system is the best in the world because it is driven by capitalism. Universal government coverage cannot work here with private insurance with all else remaining equal.

Look at what happened to the housing market when all those people got money they didn't earn to go out into the market and join those of us who could afford houses. The prices got bid up as the houses became competitive and caused a world-wide economic disaster when the free market finally found this appalling.

What do you think will happen when people who previously could not afford top quality health care now go looking for services they previously couldn't afford? The same thing - the destruction of the system.

Apples and Oranges: Canada, Japan and England do not have the same level of quality care we have here - so what benefit does private insurance have? No one escapes our system to go over there.

[Appalled]

Jor:

The hell of the healthcare market is that the consumers of the service are not usually the purchasers -- creating a number of perverse incentives. And, if you created a system where the consumer were the true purchaser, many of those consumers would not be able to buy insurance because they are essentially uninsurable.\

Clarice:

India for healthcare? My brother the infectious disease doctor claims that it is the birthplace for almost all the infectious diseases he deals with. Whatever the healthcare system, I'm not sure I want to subject my disease weakened system to all those bugs.

[jb]

A fundamental problem is that Health insurance is not like traditional insurance at all. It is more of a spread the cost system. Often the true cost is hidden because it is paid for by a third party, usually an employer. More traditional insurance would be insurance against a catastrophic loss, like an auto accident or a fire. Most drivers have auto insurance and hope to never use it. Most health care consumers expect to use their insurance every year.

The only universal type of health insurance that might work would be limited to covering true health catastrophes. The things that no one can afford to save up for like cancer treatment or surgeries other than for cosmetic reasons. Cost could be contained because the coverage would be limited to treatment that no one expects to have or wants to have on a yearly basis. Or it could simply be a large deductible health care plan where the initial cost up to 10K would be born by the consumer.

You could create tax incentives that would allow people to create health savings accounts to use for most every day health care costs up to 10K and on top of that have universal care only for true catastrophic health problems or simply yearly treatment in excess of 10K.

The problem is everyone wants everything covered and covered for "free." Anyone who argues for a limit on care or for requiring people to foot the bill initially is demagogued as unfeeling and downright evil. The truth is that any system that allows health care consumers to chose their care without regard to cost is doomed to inefficiency and skyrocketing costs.

[clarice]

Bingo! Absolutely correct jb.

Another problem is that giveaway legislators love to demand insurers cover one thing or another not normally included--sort of the procedure or illness of the day--this year I believe it is mental illness, something ill defined with unclear treatment parameters.

No matter that catastrophic insurance should be for catastrphic illnesses Congress would in a minute start defining catastrphic the way late term abortionists defined "to save the mother's health".

[clarice]

***catastrophic***

[Jane]

You are just jealous that we have mandatory podiatry coverage in MA.

Thank you deval.

[clarice]

Guess the podiatrists collected on their contributions, no?

[cathyf]

No one escapes our system to go over there.

Strictly speaking, not true. If you want an adhesiolysis that works, you go to Germany...

[clarice]

"My brother the infectious disease doctor claims that it is the birthplace for almost all the infectious diseases he deals with"

Could be, but for first quality health care and patient treatment at an affordable price, go to India.

Many Brits do and more Americans are doing it.
Private hospitals are well staffed by US trained doctors, they are spotless and well run with excellent patient care.

[Lea]

The market hasn't worked and the govt reimbursement system is causing shit loads of problems

So the government is meddling and it's not free market, but the free market doesn't work?

The main problem that needs to be fixed is for the people who can't get coverage because of pre-existing conditions, but if you force insurers to cover everyone who has a pre-existing condition, then everyone will just wait until something is wrong and then run out and get insurance. That wouldn't work.

[JM Hanes]

jb:

That's what stands the whole "national conversation" on its head, because financing regular healthcare is an entirely different business than providing odds-based insurance. When we're looking at a majority of people over age 40 on permanent medication of some sort, for example, or when we include servicing those with preexisting conditions, we're tossing the actuarial models which make insurance an economically viable proposition right out the window.

Maintaining the fiction that what's at issue is universal access to insurance, means running universal healthcare through a byzantine maze of mandated employee benefits and regulating the insurance industry into a non-profit delivery agent for massive, ex-officio, medical entitlements. The regulatory overhead alone will make a single-payer system look like a cheap, uncomplicated alternative. There are just too many slippery slopes here to count, from requiring businesses across the board to foot the entitlement bill (which won't even cover everyone in need) to federal intrusion at every level of the marketplace and individual decision making -- in the name of anything else that could conceivably be cast as a putative greater good.

If there's an issue more in need of straight talk and less likely to get it, I don't know what it is. If there's any initiative crying out for politically salable opposition talking points, let alone a credible opposition package, and apparently less likely to see any of same, I don't know what that is either. What I see is folks on the right grumbling loudly amongst themselves (including yours truly) about free market principles, and bickering over who the real RINOs are, as they sink beneath the oncoming wave. Mitt Romney should get a medal for being the only guy with enough guts to float a kind word for big pharma on public stage.

[Barney Frank]

The hell of the healthcare market is that the consumers of the service are not usually the purchasers -- creating a number of perverse incentives.

Very true. Even company provided health insurance functions as a form of socialized medicine, as it seldom has a substantial deductible and is seldom seen as payment in lieu of cash by employees; its just a benefit and entitlement that appears from the ether. And as Jor pointed out medicare is setting the rates of compensation. As in all socialized systems prices are being squeezed which is leading to rationing of services and doctors.

And, if you created a system where the consumer were the true purchaser, many of those consumers would not be able to buy insurance because they are essentially uninsurable.

Very untrue. When the consumer is the true purchaser and pays the real costs they buy it when they are young and healthy and hold onto it in case of catastrophic illness. The perverse incentives Appalled referred to disappear when the user pays premiums reflecting true costs.
Universal HSAs with high deductible plans would solve the non medicare problem in short order.
The irresponsible and foolish should be provided minimal care just as they are provided minimal provisions in the rest of their lives by society.
The responsible, but just plain unlucky require more charity.

[Captain Hate]

Could be, but for first quality health care and patient treatment at an affordable price, go to India.

When I was traveling to India last year, after a layover in Amsterdam I sat beside a person who was traveling from there to secure the services of doctors from India that would provide their expertise at a reasonable cost.

[Appalled]

Barney:

For the system to work as you intend (without adverse selection), you need some government intervention. For example, individuals would need to be forced into health insurance at a young age. Also, insurance companies would have to be, in some way, prevented from using individual rating. Othersise, there will be people who will not be abe to get health insurance, because the cost of it will be made too high for them. (And, boy the political wars that would be fought if some classifications, like for smoking, drinking, or obesity, were established to better weight risks...)

Sounds like we are getting close to the Romney system up in Mass, which is not exactly the free market, is it?

[Jane]

Sounds like we are getting close to the Romney system up in Mass, which is not exactly the free market, is it?

A lot less so since Deval Patrick got his hands on it.

[Pofarmer]

That's the problem with govt. Any time somebody can get in and tinker with it, there's the possiblity the end product won't be anything you'd recognize.

[Barney Frank]

Appalled,

Well California has a pretty robust free market in auto insurance and it is mandated that all drivers have to be insured and insurance companies use individual ratings.

In the transition there would have to be allowances made for pre existing conditions, but after a time when those allowances were gone people would do whatever they had to to make sure they didn't drop their insurance once a condition came along. Believe me I speak from experience. With my wife racking up a few hundred thousand in claims the last three years the first bill that gets paid is the health insurance.
Of course none of this should be handled at the Federal level partly because the Feds are even worse than the states at running things and partly because it was never given this power by the Constitution (which I realize is of no concern to anyone anymore).

[Appalled]

Barney:

Car insurance and health insurance are such different animals. One important difference is that there is consensus that if you drive a pricey car, or have some speeding tickets, or have had a claim before (because you caused a wreck), you should pay more for your insurance. There is no consensus (nor any attempt to form one) that, if you are overweight, you should pay more for insurance, or that if you have had cancer, and therefore need to go to the doctor more frequently, you should pay more for your insurance.

I am real open to ideas that open the medical environment to the free market. But I have yet to see one that also ensures decent health care to a universal group.

[Appalled]

Barney:

Actually, since insurance is clearly interstate commerce, the Feds have plenty of ability to regulate under the constitution. The remainder of the ability comes under the tax code, since medical benefits are excluded from income, and are deductable by an employer. And the tax code also has consitutional support

Legislatively, Congress has handed over regulation of insurance to the states. That's really not been fortunate: State mandates on medical policies run up the cost of those olicies, and have been passed willy nilly over the years under the silly belief by state legislatures that all these manadted benefits don't cost anything.

[kim]

Appalled, the only way possible will be to re-involve the patients and the doctors in making honest market and medical decisions. The best way to do that is through free and ready access of information. But that is hardly detailed directions from here to there.
========================================

[JM Hanes]

I'd have spent a lot more time catching up on my mail instead of posting here this morning, if Instapundit had put up a link to this story sooner: How Tom Daschle Might Kill Conservatism.

[centralcal]

Well, JMH, thanks (I guess) for that sobering link. Pretty scary.

[clarice]

Don't be so sure Daschle's going thru--conflicts are showing up by the minute.

[Pofarmer]

From the Daschle link we get this drivel.

a near-landslide presidential election victory

You can't beleive ONE WORD these peole say.

[centralcal]

Well- glad to hear that Clarice about Daschle. Got any specific links?

[centralcal]

Po: Is a peole kinda sorta like an aole?

[JM Hanes]

"You can't beleive ONE WORD these peole say"

Well, Pofarmer, the election certainly wasn't nearly as close as I hoped it would be. The electoral vote was a pretty big blowout for Obama, not just in terms of in the vote that counts, but also in successfully breaking up the reliably solid south and walking away with virtually all of the battleground states. It doesn't get much better than that.

[clarice]

No--But I read a story today about his work for the Mayo Clinic and others that was being used to question whether he could avoid those conflicts.

[Pofarmer]

but also in successfully breaking up the reliably solid south and

And look where they one them. I'm increasingly worried that we're simply doomed. Our Urban centers have just become to fuckin stupid. I think I'll move to Texas.

Texans are not whining about the elections.

Ok, Folks. Texas has given you complainers plenty of time to get used to the election results. After listening to all the whiners after the election, some folks from Real Texas have decided that we might just take matters into our own hands.

First, a little history lesson. It's our independent nature to point out the people who enjoy the Texas Lifestyle have the right to secede and form our own country (it was in the agreement that annexed Texas as a state), whenever the people of Texas choose to do so. Some other states also have this right. The difference is, Texas has actually pulled that trigger before.

Yes, Texas was an Independent Republic before it became a state and can secede. Nothing inherently prohibits that from taking place.

Let's get this straight. John McCain, a real American hero, carried Texas by over a million votes. Texans can still smell the fires of the Twin Towers . We would also honor President Bush. George Bush simply did what any Real Texan would do and that is to go try his best to annihilate anyone who was responsible for attacking us. We don't fault him for that. We applaud that sort of behavior. It's Texas politics, Texas style.

We're ready to secede.

Don't get me wrong. We like ya'll — We just don't want to be like ya'll.
#1: Barak Obama becomes President of the United States (all the other 49 states).
#2: Ross Perot becomes the next President of the Republic of Texas and invites John McCain to be an honorary Texan. We honor our heroes in Texas and honor their service. McCain is welcome here and he can be Secretary of the Texas Navy. Native Texan George Foreman will be Secretary of Defense. After that is all said and done, we wish Mr. Obama well. We really do.

#3. We expect one of Perot's first acts as President of the Republic will be to tear down the border wall and erect a 10' wall around Austin to keep the "Austin Weird" folks in and away from the rest of us. If they will just pipe their Texas music out over the wall, it will keep the rest of us happy. (Just kidding my Austin relatives on that one.)

#4. Willie will be Secretary of Agriculture and music. Wonder what he will grow?

So what does Texas have to do to survive as a Republic? Here's a few things to be aware of. Texas is the 11th largest economy on the planet. We are bigger than Spain and right behind Great Britain. We are also bigger than Russia . We are an economic force to be reckoned with. We have a constitutional amendment to balance our budget….and we do it (are you listening California?). We also have a multi-billion dollar budget surplus this year. We are so big, we have our own power grid. Yes, that's true.

What else?

NASA is in Houston . (we will control the space industry).
We refine over 85% of the gasoline in the United States.
Defense Industry? We have over 65% of it. The term "Don't mess with Texas," will take on a whole new meaning.
Oil - we can supply all the oil the Republic of Texas will need for the next 300 years. Obama states? Sorry about that.
As David Werst said, "We like ya'll, we just don't want to be like ya'll." You can buy oil (pronounced like ya'll) from us instead of terrorist countries that hate you. We will love you for paying so much to us instead of Saudi Arabia, Venezuela, Kuwait and others.

You don't want to 'drill baby drill' or put up with those nasty oil wells? Well, we do and we know how to do it without polluting the land, air, and sea. BTW-We have our own ports and shipping lanes. We're also not
"waiting on our FEMA check" to rebuild Galveston . We are doing it right now as we speak.

Natural Gas - Again we have all we need and again, it's just too bad about you blue Obama states who don't want drilling. We've been driving around with those big tanks in the backs of our pickups for years now. We'll switch over to compressed natural gas. Obama will figure a way to keep ya'll warm….according to your need. Or, you could use ocean waves, or make friends with Hugo Chavez or what's his name in Iran .

Computer Industry - we currently lead the nation in producing computer chips and communications: Small places like Texas Instruments, Dell, EDS, Raytheon, Motorola, Intel, Austin Technology Centers, etc., etc. The list goes on and on.

Health Centers - We have the largest research centers for cancer research, the best burn centers and the top trauma units in the world, and other large health centers.

We have enough colleges to keep us going: UT, Texas A&M, Texas Tech, Texas State University, Rice, SMU, TCU, University of Houston, Baylor, UNT, Texas Women's University, etc. Ivy grows better in the south anyway. By the way, we play some pretty good football and baseball at those schools.

We have a ready supply of workers (just open the border when we need some more). But, we won't have an illegal immigration problem. Former Texas Governor candidate Kinky Friedman solved that. He proposed we pay 5 Mexican generals a million a year to control illegal immigration-folks coming from Mexico to Texas illegally. For every illegal that slips through, we deduct $10,000. Wonder how many will get across the border into Texas? We won't need a Border Patrol.

We like tourism. Come stay a while. Enjoy a Cowboys game or go to Six Flags over Texas ….then go home. We don't need any more Californians or New Yorkers coming here and messing things up. Or, they could live in Austin where we can keep an eye on 'em.

We have control of the paper industry, plastics, insurance, etc. In case of a foreign invasion, we have the Texas National Guard and the Texas Air National Guard. We don't have an army but since everybody down here is heavily armed and has at least six rifles and a pile of ammo, we can raise an army in 6 hours if we need it. That's the Texas way. When the tower sniper started shooting in Austin a few years back, citizens piled out of their cars and pickups and started returning fire within 2 minutes. Our citizens are licensed to carry handguns on their person.

We have a saying down here: "If you mess with the bull, you're gonna get the horn." And an even more remarkable finding from the past….

Average Murder per 100,000 residents in counties won by Bush: 0.1 of one percent.

Average Murder per 100,000 residents in counties won by Gore: 13.2.

In Texas, even some of our school teachers carry guns. We won't surrender our kids to nuts and terrorists without a fight. Don't even think about messing with us.

If you want the sticker, click on it…
If the situation really gets bad, we can always call the Texas DPS and ask them to send over a couple of Texas Rangers.
We are totally self sufficient in beef, poultry, hogs and vegetable produce and everybody down here knows how to cook them so that they taste good. Don't need any food.
Arts? Bob Wills is still the king, but we also like different types of music, Country….and….Western. We even have our own beer. Lone Star, The National Beer of Texas . This just names a few of the items that will keep the Republic of Texas in good shape. There isn't a thing out there that we need and don't have. Just keep on reading David Werst's Real Texas Blog for more details on how to be a Real Texan.
Now to the rest of the United States under President Obama:
Since you won't have the refineries to get gas for your cars, We'll sell you gas too. We'll call the gas company Texasco or something like that. Happy to do it.
You won't have any TV as the space center in Houston will cut off your communications or ask you to pay for the signal. It will be Texas Direct TV. Hank Jr. will move here and be in charge of programming
Did you know we don't even have an income tax?
We have all we need here in God's country and like I've already said, if we don't have it, we don't need it. We will have cheap, plentiful energy. The new Texas Secretary of Energy, T. Boone Pickens will be putting up thousands of wind generators all over the west Texas plains and since everybody else thinks Texas is full of hot air, we might as well take advantage of it.
Good luck. Ya'll are gonna need it.

Signed, The People of Real Texas

[JM Hanes]

I can't remember whether I said thank God for Texas out loud on these boards, but I sure said it to myself every time I looked over the electoral college map in the final days of the campaign!

The rest of us will be sharing the fate of Republicans in California, if we don't figure out how to take our respective states' cities back. "All politics is local" has never been truer than it is right now for Republican causes.

[AdrianS]

SIGN THE PETITION TO FORCE BARACK HUSSEIN OBAMA TO PRESENT HIS QUALIFICATIONS.

PETITION FOR PUBLIC RELEASE OF
BARACK HUSSEIN OBAMA'S BIRTH CERTIFICATE

To: Electoral College, Congress of the United States, Federal Elections Commission, U.S. Supreme Court, President of the United States, other controlling legal authorities

Whereas, by requirement of the United States Constitution, Article 2, Section 1, no one can be sworn into office as president of the United States without being a natural born citizen;

Whereas, there is sufficient controversy within the citizenry of the United States as to whether presidential election winner Barack Obama was actually born in Hawaii as he claims;

Whereas, Barack Obama has refused repeated calls to release publicly his entire Hawaiian birth certificate, which would include the actual hospital that performed the delivery;

Whereas, lawsuits filed in several states seeking only proof of the basic minimal standard of eligibility have been rebuffed;

Whereas, Hawaii at the time of Obama's birth allowed births that took place in foreign countries to be registered in Hawaii;

Whereas, concerns that our government is not taking this constitutional question seriously will result in diminished confidence in our system of free and fair elections;

SIGN HERE:
http://www.worldnetdaily.com/index.php?fa=PAGE.view&pageId=81550

The above article appears on WorldNetDaily.

[sophy]

I do not know how to use the knight online gold ; my friend tells me how to use.