There is not much competition to Blue Cross of Mass. so the premiums are really high.

The Blues own Ted Kennedy and John Kerry. Remember when Kerry was running for President and kept saying, “I have Blue Cross.”

Got the blues, paying way to much for health insurance?

Bart, in Mighigan you are correct. By state law there are no exclusionary riders so these people (with small medical problems) are just declines. Guess what company gets these declines. If you guessed Blue Cross of Mighigan you would be correct.

Blue Cross of Mighigan was a big supporter of Senator Debbie Stabenow (D-MI) in her last election.

The proponents of yet another public plan claim that they are offering an option that would improve the current situation. The question, in view of the existing prices and plans, is why they think that?

Proponents of more public plans persist in pushing them while dismissing all other possible reforms. They fail to explain why another public plan is desirable. Lewin’s Colorado modeling suggests that there is little need for one. Finally, existing public plans make medical care difficult to access, have high costs, and are mired in financial mismanagement that, in the case of Medicare, has led to insolvency.

Judging from the results in Massachusetts, individual mandates would adopt requirements that would make many existing health insurance policies invalid for satisfying the mandate.

The maximum deductible allowed in Massachusetts, for example, is lower than about half of the policies purchased in the individual market according to the 2007 AHIP survey.

An individual mandate means that the government gets to define what health insurance is, and can force you to purchase whatever some committee determines that you need. Existing evidence suggests that the people who want to do that want different things than a large fraction of people who actually purchase their own health insurance. See my post on this at at http://www.john-goodman-blog.com/designing-health-insurance-evidence-from-massachusetts/

I’m not in favor of the individual mandate, at least not yet, but to me it’s much less onerous than some of the other proposals, such as an employer mandate.

“Well if they impose a tax on me for insurance when I have it through employer anyway to cover someone else that doesn’t, that is infringing on my freedom.”

But I’m paying taxes to make up for your tax-free employer-provided coverage. Doesn’t that infringe on my freedom?

For policies that guarantee renewal at class average rates, I would assume that underwriting costs continue until such time as the individual’s risk rises above class average.

Note that I wasn’t really advocating for the public option, I was only trying to establish the actual cost of such a proposal for comparison purposes.

But here’s a thought exercise: suppose everyone purchases individual coverage at birth, with guaranteed renewal at class-average rates, and maintains that coverage for life. Eventually some people will develop chronic conditions and their risks will become greater than class-average, but their premiums will only increase to class average. This will create a deficit in funding, so rates for low-risk individuals will have to rise as well. Wouldn’t the end result be the same as community rating (or modified community rating, depending on how “class average” is defined)?

For “oddball events” just look at the questions asked on an insurance application. “Have you had a BP reading above 140/90 in the last 10 years?” “Have you been treated for a prostate problem in the last 5 years?” These could be spurious events that have nothing to do with a long-term condition. For “relatively minor chronic condition”, try past diagnosis for asthma, depression, hypertension, etc. I say “relatively minor” because I am not talking about heart failure or “a head full of tumors”. Any single event or chronic condition may only result in a premium increase of 25-50 percent, but stack up two or three of them and you are uninsurable.

I’m all for individual high-deductible policies, with or without the HSA. I agree with you that anyone who can get one should consider doing so, and dismiss the employer tax break as false economy. But these are already available in most states, so I don’t see where any policy reform is required in this area.